UMIND NOFO 72012125RFA00002 .pdf

Issue Date: November 22, 2024

Deadline for Questions: December 16, 2024

Closing Date: January 15, 2025

Closing Time: 3:00 p.m. local Kyiv time

Subject: Notice of Funding Opportunity No. 72012125RFA00002/ Initial Announcement

Program Title: Ukraine Mental Health Initiative for National Development Activity

Federal Assistance 98.001 Listing Number:

Greetings, The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from qualified entities to implement the Ukraine Mental Health Initiative for National Development (U-MIND) activity. Eligibility for this award is not restricted.

USAID intends to make an award to the applicant(s) who best meets the objectives of this funding opportunity based on the merit review criteria described in this Notice of Funding Opportunity (NOFO), subject to a risk assessment. Eligible parties interested in submitting a concept paper are encouraged to read this NOFO thoroughly to understand the type of program sought, concept paper submission requirements, and selection process.

This funding opportunity will utilize a multi-tiered review process under USAID Automated Directive System (ADS) Chapter 303, Section 303.3.6.1.c. The evaluation will occur in the following phases:

1. Phase 1: Applicants will submit an initial concept paper pursuant to Section D of this NOFO. Based on USAID’s evaluation and in accordance with the merit review criteria set forth herein, the applicant(s) whose initial concept paper best meets the objectives of this funding opportunity will be requested to submit a full application.

2. Phase 2: The Merit Review Committee will transmit a second-level solicitation to the selected applicant(s), as noted above. Upon receipt of the full application(s), the Merit

U-MIND NOFO No. 72012125RFA00002

Review Committee will conduct a review thereof, using more specific merit review criteria.

Additional details regarding the review process are provided in Section D of this NOFO.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section B of this NOFO. This funding opportunity is posted on www.grants.gov and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this NOFO and to ensure that it has been downloaded from the internet in its entirety. USAID bears no responsibility for data errors resulting from transmission or conversion process. If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the Grants.gov Support Center at 1-800-518-4726 or via email at support@grants.gov for technical assistance or if you need assistive technology and are unable to access any material on this site.

Unless an exception in 2 CFR 25.110 applies, applicants must comply with 2 CFR 25 requirements to obtain a Unique Entity Identifier (UEI) and register in the System for Award Management (SAM.gov), as applicable. See Section E, Submission Requirements and Deadlines, for more information. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early.

Please send any questions to the point(s) of contact identified in Section A.4. The deadline for questions is shown above. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

Issuance of this NOFO does not constitute an award commitment on the part of the Government nor does it commit the Government to pay for any costs incurred in preparation or submission of comments/suggestions or a concept paper. Concept papers are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.

Thank you for your interest in USAID/Ukraine programming.

Sincerely, /s/ Jessica R. Faber Agreement Officer http://www.grants.gov mailto:support@grants.gov

TABLE OF CONTENTS

Section A – Basic Information

Section B – Eligibility

Section C – Program Description

Section D – Application Content and Format

Section E – Submission Requirements and Deadlines

Section F – Application Review Information

Section G – Award Notices

Section H – Post-Award Requirements and Administration

Section I – Other Information

Annex 1 - Summary Budget Template

Annex 2 - Standard Provisions

Annex 3 - Abbreviations and Acronyms

SECTION A: BASIC INFORMATION

1. Executive Summary

The United States Agency for International Development (USAID) Ukraine’s Office of Health (OH) proposes a cooperative agreement award entitled “Ukraine Mental Health Initiative for National Development” (U-MIND). The primary goal of the Ukraine Mental Health Initiative for National Development (U-MIND) activity is to establish a comprehensive, evidence-informed, inclusive mental health system that addresses immediate, medium and long term needs, contributes to the wellbeing of all Ukrainians and enhances their ability to participate in Ukraine’s economic recovery. By promoting mental wellness among Ukrainians, U-MIND seeks to enhance resilience, social cohesion, and economic productivity, thus fostering sustainable economic development and growth in Ukraine. The Activity will respond to immediate and long-term systems strengthening. Implementation should focus on effectiveness, accessibility, scalability, adaptiveness, and cultural fit, in order to respond to the rapidly evolving mental health landscape.

2. Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one Cooperative Agreement pursuant to this NOFO.

Subject to funding availability and at the discretion of the Agency, USAID intends to provide up to $50,000,000 in total USAID funding over a five-year period.

3. Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five years. The estimated start date will be on or around March 31, 2025.

4. Agency Point of Contact

The Agreement Officer is:

Jessica R. Faber USAID/Ukraine kyivrcohealth@usaid.gov

For information on this NOFO, direct all correspondence to kyivrcohealth@usaid.gov. All contact information provided herein is for informational purposes only. The NOFO itself and any subsequent amendments can be found at www.grants.gov, and all concept papers must be submitted according to the instructions contained in this NOFO.

In order to maintain a fair and transparent funding opportunity, USAID maintains strict guidelines regarding those individuals within USAID that may be contacted regarding concept mailto:kyivrcohealth@usaid.gov http://www.grants.gov papers or questions about the opportunity. Applicants may only contact USAID via the email address provided in this NOFO. Failure to comply with the USAID points of contact guidance mandated herein may result in disqualification.

5. Acquisition and Assistance Ombudsman

The A&A Ombudsman helps ensure equitable treatment of all parties who participate in USAID’s acquisition and assistance process. The A&A Ombudsman serves as a resource for all organizations who are doing or wish to do business with USAID. Please visit this page for additional information:

https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman.

The A&A Ombudsman may be contacted via: Ombudsman@usaid.gov

6. Authorized Geographic Code

The geographic code for the procurement of commodities and services under this program is 935 (any area or country including the cooperating country, but excluding foreign policy restricted countries). Except as may be specifically approved in advance by the Agreement Officer, all commodities and services that will be reimbursed by USAID under this award must be from the authorized geographic code specified in this NOFO, and must meet the source and nationality requirements set forth in 22 CFR 228.

[END OF SECTION A]

https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman

SECTION B: ELIGIBILITY

1. Eligible Applicants

Eligibility for this NOFO is not restricted, except that individuals and government entities are ineligible.

Faith-based organizations are eligible to apply for federal financial assistance on the same basis as any other organization and are subject to the protections and requirements of Federal law. Additionally, USAID welcomes concept papers from organizations that have not previously received financial assistance from USAID.

Interested and eligible applicant organizations may submit no more than one concept paper under this NOFO.

Applicants must have established financial management, monitoring and evaluation processes, internal control systems, and policies and procedures that comply with established U.S. Government standards, laws and regulations. In order for an award to be made the AO must make a positive risk assessment pursuant to ADS 303.3.9. This means that the applicant must possess or have the ability to obtain the necessary management and technical competence to plan and carry out the assistance program to be funded. The applicant must agree to practice mutually agreed-upon methods of accountability for funds and other assets provided or funded by USAID.

In the absence of a positive risk assessment, an award cannot ordinarily be made. However, in rare cases, an award can be made with “Specific Conditions” (e.g., additional non-standard award requirements designed to mitigate the risk presented to USAID of making an award to an NGO for which a positive risk assessment cannot be made), but only where it appears likely that the applicant can correct the deficiency in a reasonable period.

2. Cost Sharing

Cost Sharing is not required for this activity.

3. Exclusive Commitments

USAID/Ukraine discourages any applicant from requiring exclusive commitments by local organizations to participate as part of the consortium or sub award. Local organizations participating in a consortium may elect to participate in another consortium under a different application.

[END OF SECTION B]

SECTION C: PROGRAM DESCRIPTION

USAID/Ukraine plans to provide up to $50 million, subject to availability of funding, over a five-year period to support U-MIND. This is a new activity. This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting award will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section H.

1. U-MIND GOALS AND OBJECTIVES

The primary goal of the Ukraine Mental Health Initiative for National Development (U-MIND) activity is to establish a comprehensive, evidence-informed, inclusive mental health system that addresses immediate, medium and long term needs, contributes to the wellbeing of all Ukrainians and enhances their ability to participate in Ukraine’s economic recovery. By promoting mental wellness among Ukrainians, U-MIND seeks to enhance resilience, social cohesion, and economic productivity, thus fostering sustainable economic development and growth in Ukraine. The Activity will respond to immediate and long-term systems strengthening. Implementation should focus on effectiveness, accessibility, scalability, adaptiveness, and cultural fit, in order to respond to the rapidly evolving mental health landscape.

This Activity has four main objectives: The successful Applicant will work to achieve this activity’s goal by focusing on four objectives:

● Objective 1: Increase availability of and access to quality mental health care services for all Ukrainians

● Objective 2: Enhance the competencies and professionalization of the mental health workforce to deliver high-quality services

● Objective 3: Improve the enabling environment via strengthened policies, strategies and regulatory frameworks related to mental health services and workforce

● Objective 4: Contribute to the evidence base regarding effective mental health interventions and implementation approaches in Ukraine.

2. PROGRAM DESCRIPTION

Mental health in Ukraine. Amid Russia’s full-scale invasion, the Ukrainian people are facing pressing mental health needs. A January 2024 survey found that 77 percent of Ukrainians reported stress or severe nervousness recently. Another study found that 44 to 48 percent1 reported moderate to severe anxiety and 32 to 39 percent reported PTSD symptoms, with Internally Displaced Persons (IDPs) reporting worse outcomes than those who had not been

1 Gradus. (March 2024). Mental health and attitudes of Ukrainians towards psychological assistance.

https://gradus.app/en/open-reports/mental-health-and-attitudes-ukrainians-towards-psychological-assistance-during-war/ displaced. An audit of mental health needs conducted in 2022 projected that 40 to 50 percent2 3 of Ukraine’s population (up to 18 million people) will need psychological support of varying intensity, including internally displaced persons (IDPs), veterans, first responders, health workers, unemployed, children, survivors of captivity, and survivors of conflict-related sexual violence. The World Health Organization estimates that 22 percent of individuals impacted by conflict experience a mental health disorder (depression, anxiety, trauma-disorders, bipolar disorder, schizophrenia). For Ukraine, that is equivalent to approximately 9.6 million people. Rates are4 5 anticipated to be higher among military veteran populations, further complicated by high rates of traumatic brain injuries.

Ukraine’s mental health system is struggling to scale up quality mental health treatment to meet demands. It bears the legacy of Soviet-era approaches and past human rights abuses. Although6 7

Ukraine took steps towards system reforms prior to the war, the mental health system remains highly centralized. The current system relies on inpatient psychiatric hospitals with limited8 community-level access points (such as community mental health providers, mental health services within the primary healthcare system, or outpatient care centers within secondary care centers/general hospitals) and an extremely weak referral system between levels of care. There is an over-emphasis on long-term hospitalization–nearly 90 percent of the government’s budget for mental health is spent on inpatient care. A continuum of care, including community-based9 and outpatient services, was virtually non-existent before the war and is still very nascent.10

Recent efforts are spurring change–reform to the Public Medical Guarantee system (where certain primary care level providers can be reimbursed for some mental health services) is spurring unprecedented growth of primary healthcare providers’ completion of WHO’s mhGAP training. Another major shift is the expansion of community mental health teams–multidisciplinary mobile teams who treat severe to moderate disorders at the community level. However, an overall mismatch in the mental health care workforce persists–Ukraine has a relatively high number of psychiatrists per capita but very few non-medical mental health providers (social workers, psychologists, counselors, psychotherapists, etc). There is no system of licensure other than for psychiatrists working at public hospitals. Furthermore, both the medical and non-medical mental health workforce tend to be concentrated in urban areas.

Public perceptions include viewing psychiatric care as low-quality or ineffective; with the majority seeing psychiatric hospitals as prison-like. High levels of stigma include concerns about

10 University of Washington Global Mental Health (July 2020).

9 World Bank Group. (2017).

8 World Bank Group ( 2017). Mental health in transition.

7 University of Washington Global Mental Health (July 2020). Ukraine WHO Special Initiative on Mental Health Situation Assessment.

6 World Bank Group. (2017). Mental Health in Transition: Assessment and guidance for strengthening integration of mental health into primary health care and community-based service platforms in Ukraine. World Bank

5 World Health Organization Regional Office for Europe. (2023). Leveraging health financing to strengthen mental health services in Ukraine.

4 Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. The Lancet, 394(10194), 240-248.

3 Audit conducted by BarrierFree and CIVITTA NGOs, with the financial support of USAID Public Health System Recovery & Resilience activity.

2 Lushchak, O., Velykodna, M., Bolman, S., Strilbytska, O., Berezovskyi, V., & Storey, K. B. (2024). Prevalence of stress, anxiety, and symptoms of post-traumatic stress disorder among Ukrainians after the first year of Russian invasion: a nationwide cross-sectional study. The Lancet Regional Health–Europe, 36.

https://cdn.who.int/media/docs/default-source/mental-health/who-special-initiative-country-report---ukraine---2020.pdf?sfvrsn=ad137e9_4 https://documents1.worldbank.org/curated/en/310711509516280173/pdf/120767-WP-Revised-WBGUkraineMentalHealthFINALwebvpdfnov.pdf https://iris.who.int/bitstream/handle/10665/374725/WHO-EURO-2023-8927-48699-72383-eng.pdf?sequence=1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30934-1/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30934-1/fulltext https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00192-8/fulltext#:~:text=The%20first%20survey%20report%20provided,anxiety%2C%20and%2047%25%20depression.

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00192-8/fulltext#:~:text=The%20first%20survey%20report%20provided,anxiety%2C%20and%2047%25%20depression.

being excluded from employment opportunities if labeled as a mentally ill person. There is also11 a market of private mental health practice, but the data on the private providers is limited.

Economic impact of mental health. There is a complex relationship between an individual’s mental health and economic wellbeing. Globally, common mental health disorders are associated with direct and indirect costs, including lost productivity and labor force participation;

with depression and anxiety alone costing an estimated US $1 trillion per year. Ramifications of12 mental health conditions include increased physical health costs (chronic mental health disorders are linked with cardiovascular disease, stroke, type II diabetes, and some cancers), decreased productivity and labor participation (primarily through absenteeism and presenteeism), and increased social costs (family members investing time and financial resources for care, children negatively impacted on multiple levels, including socially and educationally, by parents’ poor mental health).13

The causal relationship between mental and economic wellbeing is multi-directional or “intertwined.” Lower economic status and unemployment are linked to poorer mental health14 outcomes. Various explanations include greater risk factors (social exclusion) and lower15 protective factors (such as education). Scaled-up treatment for common mental disorders has a16 positive impact on economic productivity gains. Research shows a significant and strong pathway between addressing mental health issues and increased productivity, reduced job absenteeism, and lower healthcare costs compared to those associated with untreated mental health conditions. Globally, the return on investment (ROI) is nearly triple the economic benefits for17 18 every dollar spent on treating anxiety and mental health (2.3-3.0 to 1). The value is even19 greater for middle income countries, with an ROI of 5.4-5.7 in economic benefits for every $1 spent on treatment.20

Common mental health disorders were already taking an economic toll in Ukraine even before the full-scale Russian invasion in 2022. Mental, neurological and substance use disorders were the second-leading cause of disability in Ukraine, after cardiovascular diseases, with associated loss of economic productivity and need for increased care. Ukraine had the highest disability21 burden due to depression in the entire region. Exposure to multiple Adverse Childhood22

Experiences (ACEs–such as exposure to violence, household mental illness or substance abuse, 22 Ibid.

21 World Bank Group. (2017). Mental Health in Transition.

20 Ibid.

19 Arias, D., Saxena, S., & Verguet, S. (2022). Quantifying the global burden of mental disorders and their economic value. EClinicalMedicine, 54.

18 Lund, C., Orkin, K., Witte, M., Davies, T., Haushofer, J., Bass, J., & Patel, V. (2024). Effects of mental health interventions on labor market outcomes in low- and middle-income countries.. National Bureau of Economic Research.

17 Alonso, J., Petukhova, M., Vilagut, G., Chatterji, S., Heeringa, S., Üstün, T. B., ... & Kessler, R. C. (2011). Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Molecular psychiatry, 16(12), 1234-1246.

16 Knapp & Wong (2020).

15 Ridley, M., Rao, G., Schilbach, F., & Patel, V. (2020). Poverty, depression, and anxiety: Causal evidence and mechanisms. Science (New York, N.Y.), 370(6522), 14 Knapp, M., & Wong, G. (2020). Economics and mental health: the current scenario. World psychiatry : official journal of the World Psychiatric Association (WPA), 19(1), 3–14.

13Ibid.

12 Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety:

a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.

11 Quirke, E., Klymchuk, V., Suvalo, O., Bakolis, I., & Thornicroft, G. (2021). Mental health stigma in Ukraine: cross-sectional survey. Global mental health (Cambridge, England), 8, e11.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00405-9/fulltext https://www.nber.org/papers/w32423 https://www.nber.org/papers/w32423 https://pubmed.ncbi.nlm.nih.gov/20938433/ https://pubmed.ncbi.nlm.nih.gov/20938433/ https://www.science.org/doi/10.1126/science.aay0214 https://doi.org/10.1002/wps.20692 https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30024-4/fulltext https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30024-4/fulltext https://doi.org/10.1017/gmh.2021.9 https://doi.org/10.1017/gmh.2021.9 education disruption) is generally acknowledged to have lifelong, negative impacts with serious cost implications. ACEs in Ukraine (using 2019 data) were estimated to cost the country an estimated US$9.3 billion annually, or six percent of the GDP. PTSD is known to negatively23 impact labor force participation and productivity (due to increased absenteeism and presenteeism). About 25 percent of Ukrainian veterans from Russia’s 2014 invasion had PTSD,24 with impacts on family and social functioning (interpersonal difficulties, increased alcohol/substance use, employment concerns, health complaints). Indeed, 28 percent of25 veterans who were employed before their military service were subsequently unemployed following an average of 18 months of service in the Anti-Terrorist Operation of 2014 (Russian’s 2014 invasion). While published peer reviewed research is limited since the beginning of the26 full-scale war, it is safe to assume that the increasing rate of mental health disorders related to the war is likewise driving up economic costs. Ukraine’s overall workforce pool is already strained, and so a decrease of worker availability and/or productivity due to mental health concerns would have serious implications for the country’s recovery. In the private sector, some Ukrainian businesses are recognizing the needs and benefits of supporting the mental health needs of their workers and are exploring ways to partner with the mental health sector or provide MHPSS services.27

ACTIVITY DESCRIPTION

Problem Statement. Ukraine’s current mental health system is unable to meet treatment needs on the scale needed to prevent further deleterious economic impacts. With nearly three years28 of war, the mental health system has been completely strained due to soaring needs and increased demands.29

Ukraine's mental health system faces numerous issues that impede its ability to provide comprehensive, holistic, integrated, and effective (evidence-informed) mental health support to its population. There are three main challenges:

● Lack of access and availability of care through holistic, community-based services.

● Absence of professionalization and workforce capacity within the mental health sector.

● Weak systems, regulations, policies and relevant legislation to create an enabling environment for mental health service provision.

A holistic approach is essential to address these challenges, with consideration of how specific interventions will interact with each other and will explicitly fill critical gaps to ensure integration into the larger system that the GoU is currently building.

29 30% of displaced Ukrainians had sought some form of psychological support since 2022. International Federation of Red Cross and Red Crescent Societies. (April 2024). A sense of ‘futurelessness’: new data shows severity of mental health challenges for people from Ukraine.

28 Seleznova, V., Pinchuk, I., Feldman, I., Virchenko, V., Wang, B., & Skokauskas, N. (2023). The battle for mental well-being in Ukraine: mental health crisis and economic aspects of mental health services in wartime. International journal of mental health systems, 17(1), 28.

27 Focus group discussion with private sector stakeholders and USAID. US Embassy in Kyiv, April 19, 2024.

26 World Bank Group (May 2017). Socio-economic impacts of internal displacement and veteran return: Summary report. World Bank.

25 Omolovska, I., Botswick, M., Grant, L et al. (2023). Scars on their souls: PTSD and veterans of Ukraine. Globsec.

24 Alonso et al (2011).

23 Hughes, K., Ford, K., Bellis, M. A., Glendinning, F., Harrison, E., & Passmore, J. (2021). Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis. The Lancet Public Health, 6(11), e848-e857.

https://www.ifrc.org/press-release/sense-futurelessness-new-data-shows-severity-mental-health-challenges-people-ukraine#:~:text=30%25%20of%20displaced%20Ukrainians%20had,demand%20for%20mental%20health%20services.

https://doi.org/10.1186/s13033-023-00598-3 https://documents1.worldbank.org/curated/en/571011497962214803/pdf/116489-REVISED-Updated-Report-Socioeconomic-Impacts-Internal-Displacement-Veteran-Ret.pdf https://www.globsec.org/sites/default/files/2023-09/GLOBSEC_PTSD%20Report.pdf https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00232-2/fulltext https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00232-2/fulltext

Ultimately, a robust Ukrainian mental health system will foster a healthier population and a healthier workforce to fuel the nation’s economic recovery. Pre-2022, it was estimated that every $1 invested in scaled-up treatment of common mental disorders in Ukraine (depression, anxiety, PTSD, etc) would result in $2 in restored productivity and added economic value. When the30 benefits of improved physical health are also included, the ROI improves to $4 for every $1 invested in treatment of common mental disorders in Ukraine.31

Theory of Change. This Activity is expected to work on testing the following theory of change: IF Ukraine builds a holistic mental health ecosystem that is accessible and available to Ukrainians in need of mental health and psychosocial support; and IFmental health is destigmatized and use of services is accepted across Ukrainian society; and IF the mental health workforce–from non-specialist to specialist providers–increases competencies and skills to provide high-quality, culturally-reflective, and evidence-informed services to diverse populations; and IF the policy and regulatory framework supports sustainable MHPSS mechanisms at all levels of care and across public, private, and civil society spheres, THEN the impact of mental health conditions at the individual, household, community and societal levels will be mitigated, enabling greater citizen engagement in social and economic recovery.

This Activity has the potential to influence the future of Ukraine’s mental health systems through a timely and strategic intervention. The successful Applicant is expected to partner with GOU in supporting the establishment of a comprehensive and inclusive mental health ecosystem, building on the emerging strengths of Ukraine’s current system and ongoing reforms. This will increase the availability and accessibility of high quality services, reducing stigma so that Ukrainians seek services from well-trained, competent providers. An enhanced, transparent regulatory framework can increase public confidence in the mental health system and also foster ongoing monitoring, evaluation and learning regarding mental health outcomes. This collaborative effort will facilitate the restoration of mental and psychological well-being among citizens so they can actively participate in society and the workforce, contributing to the economic revitalization of the nation.

Priorities. U-MIND will operate in a highly dynamic environment that will require adaptability in program planning and implementation to address Ukraine’s changing context and needs. The activity shall balance response to short-term needs with long-term systems strengthening.

U-MIND will be national in scope and be implemented at both national and sub-national (oblast, rayon, and community) levels. The Implementing Partner will collaborate with stakeholders to determine the geographic targeting throughout the life of the Activity. Applicants should consider the GOU’s evolving priorities and needs related to implementation of mental health reform and provision of MHPSS services, availability of state funding, and willingness of regions to support and contribute to lasting change in the MHPSS sector. As U-MIND’s overarching goal is to contribute to the economic recovery of Ukraine through improved mental health and wellbeing, Applicants are encouraged to propose approaches that link to citizens’ improved engagement and/or productivity in the economy or education system.

31 Ibid.

30 World Bank Group, (2017). Mental health in transition.

The unprecedented focus and international investment in MHPSS in Ukraine creates great opportunities and challenges for coordination and collaboration. U-MIND will contribute to productive coordination by working with national and sub-national levels of the GOU, including but not limited to the NMHCC, MOH, MoSP, MoVA, etc, as well as coordination with the Mental Health and Psychosocial Support Technical Working Group. U-MIND will coordinate with USAID to best leverage evolving USG investments in Ukraine and optimize available resources where appropriate. This includes MHPSS, health and other sectors, including humanitarian assistance, economic strengthening, workforce development, veterans reintegration, and more. U-MIND32 will coordinate with other donors and stakeholders as well, to meet evolving needs. While this Activity invites innovation, the successful applicant is expected to build upon and integrate evidence-based approaches and implementation best practices into existing systems rather than creating new, isolated approaches and systems that may not be integrated or sustained after the life of the project.

RESULTS FRAMEWORK

U-MIND’s overarching goal is to establish a comprehensive, evidence-informed, inclusive mental health system that addresses immediate, medium and long term needs, contributes to the wellbeing of all Ukrainians and enhances their ability to participate in Ukraine’s economic recovery. The successful Applicant will work to achieve this activity’s goal by focusing on four objectives:

● Objective 1: Increase availability of and access to quality mental health care services for all Ukrainians

● Objective 2: Enhance the competencies and professionalization of the mental health workforce to deliver high-quality services

● Objective 3: Improve the enabling environment via strengthened policies, strategies and regulatory frameworks related to mental health services and workforce

● Objective 4: Contribute to the evidence base regarding effective mental health interventions and implementation approaches in Ukraine.

Objective 1: Increase availability of and access to quality, community-level mental health care services for all Ukrainians

For this objective, Applicants shall propose approaches that support the scale-up of evidence-informed, community- and outpatient-level MHPSS services in Ukraine. The aim is to transition from urgent assistance to sustainable systems of care integrated with the GoU’s overall MHPSS approach. This includes contributing to the expansion of a stepped care system involving multiple sectors (health, social services, veterans affairs, etc.)

Applicants should address facilitators and barriers to acceptability, availability and accessibility of community-level care. Stigma reduction remains an essential component. Stigma reduction will

32 Please note that USAID is not able to work directly with the Ministry of Defense. Veterans are defined as those fully discharged from military service, who are receiving services from public health facilities.

build on existing initiatives, including the First Lady’s “How Are U?” campaign. Stigma reduction efforts will target groups typically less likely to utilize services (such as men, veterans, rural residents, etc). U-MIND encourages partnership with societal resources Ukrainians typically rely on for support (such as faith leaders, primary health care providers, peer networks, youth leaders, etc). Applicants are encouraged to promote community-level access within a stepped care approach, increasing evidence-informed, culturally appropriate MHPSS services delivered by non-specialist and/or non-medical providers. The Applicant is encouraged to consider approaches with task-shifting from specialist to non-specialist care, as appropriate.

Non-specialist care at the community level encouraged by U-MIND may include focused person-to-person and brief psychological interventions (for example, delivered by trained and supervised lay workers, peers, community health workers, etc) and/or primary-care level interventions and referrals. Targeted, appropriate use of specialist care at the community level encouraged by U-MIND may include counseling and psychotherapy for populations requiring more intensive care (for example, delivered by social workers, psychologists, psychotherapists, etc).

Within community-level approaches, Applicants are encouraged to consider: telehealth and/or innovative use of other digital solutions, particularly for hard-to-reach communities in frontline areas; evidence-informed, integrated interventions to address harmful alcohol/substance use;

effective case management and referral systems; cross-sectoral linkages (such as social services, resilience centers, employment programs, veterans services, physical rehabilitation, educational institutions, etc); and engagement of MHPSS service users, persons with lived experience, families, and communities in all stages of service delivery. Innovative collaborations with private sector stakeholders are especially encouraged to understand labor force wellbeing needs, decrease stigma, increase access to MHPSS services in the workplace and/or in the community, and enhance productivity.

When considering priority populations for Objective 1, Applicants are encouraged to consider groups who have been most impacted by the war, including those in frontline communities.

USAID expects Applicants to propose evidence-based analyses that guide priority population identification aligned with their proposed technical application. Special consideration should be given to subpopulations who require MHPSS services to maximize their participation in employment or other productive activities.

Measurable impact should be achieved at various levels (individual, family, community, organizational, etc). Illustrative outcomes may include, but are not limited to:

● Changed knowledge and attitudes regarding mental health and use of mental health services

● Barriers to care addressed/reduced (cost, geographic availability, inclusive access points, etc)

● Increased utilization of evidence-informed MHPSS services in community-based settings

● Use of healthy coping skills increased and severity of mental health symptoms reduced

● Improved daily functioning, including improved outcomes related to employment, economic wellbeing and/or education.

● Relevant standardized operating procedures developed and utilized, in line with Ukrainian and international standards.

● Effective referral pathways established, utilized, and reviewed/updated by multiple stakeholders.

Objective 2: Enhance the competencies and professionalization of the mental health workforce to deliver high-quality services

A skilled, competent, and multidisciplinary mental health workforce is essential for delivery of quality MHPSS services within a stepped care system. Workforce strengthening must balance the needs for immediate service delivery as well as longer-term systems strengthening. U-MIND will support the planning, expansion, and training of a multidisciplinary mental health workforce.

This includes increasing skills of the existing mental health workforce, rapidly expanding the number of new providers, and improving education and training systems for the next generation of providers.

U-MIND’s training and continuing education for existing providers will prioritize development of core competencies and use of evidence-informed approaches across sectors, as appropriate.

Structured approaches for supportive and clinical supervision and competency based assessment are essential for both specialist and non-specialist providers. Humanitarian assistance workers or others experienced in providing MHPSS care or related services should be offered pathways to transition into the long-term MHPSS sector. Innovative bridging opportunities are encouraged to maximize Ukraine’s existing human capital. Applicants should consider strategies to prevent and address burnout and vicarious trauma among the workforce.

For development of new providers, Applicants are encouraged to focus on cadres needed for community-level MHPSS interventions (such as non-specialist and/or non-medical providers), with an emphasis on task-shifting. Training for existing and new specialist service providers, whether through continuing education or formal education institutions, will be informed by international standards. This may require review, revision and standardization of certain formal education programs at the university or graduate levels, including incorporation of practicums, multi-disciplinary clinical training, and clinical supervision.

Standard qualifications and regulations for specialized cadres (such social workers, psychologists, etc) are needed in Ukraine; currently, certification/licensure of professions is weak or non-existent. U-MIND will collaborate with various GOU stakeholders (NMHCC, MoH, MoSP and others) as well as other key stakeholders in development of standards for training and education, certification/licensure, and ongoing practice (see also Objective 3). U-MIND will also collaborate with and strengthen professional associations to support workforce development, including through advocacy, standardization and promotion of ethical practice among their respective members. Sustaining the multisectoral mental health workforce will also include interventions to address burnout and vicarious trauma through prevention, recognition, and care, using strengths-based approaches.

U-MIND applicants should propose a focused workforce strengthening approach that maximizes limited project resources. This includes building upon and coordinating with existing and emerging workforce development efforts in cooperation with government and international stakeholders. Illustrative outcomes may include, but are not limited to:

● Increased number of multidisciplinary MHPSS providers utilizing evidence-informed interventions appropriate to their level of competency.

● Organizations utilizing structured supervision (clinical and supportive) and competency assessment systems.

● Mental health workforce cadres defined and standardized.

● Professional associations strengthened and engaged in workforce development and oversight.

● Mental health workforce accesses evidence-informed support for prevention and care of burnout and vicarious trauma.

Objective 3: Improve the enabling environment via strengthened policies, strategies and regulatory frameworks related to mental health services and workforce

U-MIND will support ongoing GOU developments in policy, legislation, and regulations related to mental health. This will support a robust, resilient policy framework that aligns with EU accession standards while remaining flexible to meet the evolving needs of its population.

Applicants should propose strategies to support rollout of national-level reforms down to the local level, such as the development of regional and local mental health action plans. This may include capacity building of selected ministries or GOU bodies to implement mental health reforms and coordinate and oversee ongoing service delivery. Approaches may include establishing and/or improving systems for data collection and data for decision-making, development of standard operating procedures, intra- and inter-ministerial coordination, regional collaboration and learning, and more. Development and/or strengthening of mechanisms for service users, community members and civil society to inform and shape policy are encouraged.

U-MIND will support development of legislation, policy and regulatory requirements related to certification and/or licensure of key cadres of mental health specialists (see Objective 2).

Supporting consistent, transparent credentialing and licensing will help safeguard the public and align Ukraine with international and EU practices. U-MIND will support development of sustainable financing systems for community-based MHPSS services.

Recognizing that the NMHCC’s Target Model 2.0 calls for the involvement of most ministries in mental health, Applicants are encouraged to choose enabling-environment issues that clearly link to Objective 1 and 2 interventions. Illustrative outcomes may include, but are not limited to:

● Increased GOU coordination, planning and oversight of MHPSS service provision at local, regional and national levels.

● Increased partnership and shared decision-making with service users, marginalized groups, civil society organizations, and other stakeholders.

● Systematic data collection utilized for decision-making on MHPSS strategies and resource allocation, including at local level.

● Policy and regulations established to professionalize and standardize specialist MH cadres

● Sustainable financing for community MHPSS services established, revised and/or expanded.

● Humanitarian coordination transitioned to sustainable, system-level partnerships and linkages across sectors.

Objective 4: Contribute to the evidence base regarding effective mental health interventions and implementation approaches in Ukraine.

U-MIND will generate evidence that informs MHPSS services in Ukraine and guides ongoing investments in MHPSS. U-MIND will prioritize participatory research as well as applied research on the implementation of evidence-informed interventions. Research may focus on Ukraine’s unique mental health challenges, including needs of veterans and their families, interventions’ impact on economic participation and productivity, needs of survivors of captivity, etc. Other evidence may be related to costing (actual and forecasted), with the aim of equipping regional and local governments to make planning and budgeting decisions regarding MHPSS. Participation of persons with lived experience, MHPSS service users, and other local stakeholders is encouraged. Research dissemination will include regional, national and international strategies.

Examples of illustrative outcomes may include, but are not limited to, one or more of the following:

● Evidence products exploring the intersection of mental health and productivity;

intervention impact on economic participation and workforce retention.

● Evidence on implementation barriers and enablers to inform local, regional and national decision making.

● Research on uptake of MHPSS services among priority populations and the effectiveness of evidence-based interventions.

● Costing models for MHPSS services to inform resource allocation.

● Evidence products demonstrating return on investment, intervention impact on symptoms and economic productivity.

● Research on mental health workforce burnout and implementation effectiveness on burnout prevention and care strategies.

RELATIONSHIP TO USG STRATEGIES

Since February 2022, the United States Government (USG) has prioritized integrating mental health into its efforts to support the Ukrainian population and communities. This commitment extends across various governmental agencies to ensure that mental health and psychological support align with the overall mission strategy. Notably, the USG's largest combined mental health programming effort worldwide is currently underway in Ukraine. This effort contributes to the US goal of helping Ukraine win the peace.

The U-MIND activity will advance the overall goal of USAID Ukraine’s Country Development Cooperation Strategy 2019-2026, by contributing to an independent, democratic, prosperous, and healthy Ukraine united around core European values. Additionally, the activity is aligned with and will contribute to broader USAID and USG strategies.

USG Strategy Alignment

USAID/Ukraine Country Development Cooperation Strategy (CDCS)

● DO 1: Corruption Reduced in Target Sectors: IR 1.1 Increased health system transparency

● DO 2: Impact of Russia’s Aggression Mitigated: IR 2.1 Conditions Improved for Reintegration (by improving access to health services including mental health services for veterans and war-affected populations)

● DO 4: Inclusive, Sustainable, Market-Driven Economic Growth: IR 4.1 Strengthened SME competitiveness (by investing in human capital via mental health services)

US Embassy Ukraine’s Integrated Country Strategy (ICS)

● Win the Peace, Mission Objective 2.3: Ukraine implements international best practices and continues decentralization while rebuilding social, physical, and critical infrastructure.

US Department of State’s EUR/ACE Ukraine Assistance Strategy

● Objective 1: Enable Ukraine to win the war against Russia’s aggression: Assistance Objective 1.3 Enable the GOU to provide services to and govern its people

● Objective 2: Support Ukraine in its recovery from the war, and its Euro-Atlantic integration: Assistance Objective 2.3 Support macroeconomic stability and restoration of key government services

USAID’s E&E Bureau Strategic Framework (Engagement in Ukraine’s Recovery & Reconstruction)

● #1: Immediate Economic Recovery and Sustainable, EU-Oriented Rebound

● #4: Improved Health Services advancing the dignity and wellbeing of every Ukrainian

By prioritizing mental health alongside other critical areas, USAID contributes to Ukraine's overall resilience and capacity to function as a self-reliant partner. This integrated approach not only addresses immediate challenges but also strengthens Ukraine's ability to navigate complex threats and emerge as a stable, prosperous nation aligned with European values and interests.

Addressing mental health needs will reduce the disability burden and improve productivity and labor force participation over time. Decentralizing mental health care away from psychiatric33 hospitals to high-quality community-based care can ultimately reduce human rights violations, increase transparency within the health system, and foster cost-effectiveness through improved outcomes for service users and their families. Finally, U-MIND aligns with the principles and34

34Knapp, M., Beecham, J., McDaid, D., Matosevic, T., & Smith, M. (2011). The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience. Health & social care in the community, 19(2), 113-125.

33 Chisholm et al, 2016.

programming priorities of the USAID Mental Health Position Paper and accompanying evidence briefs.35

RELATIONSHIP TO GOVERNMENT OF UKRAINE STRATEGIES

The Ukrainian government had begun its commitment to mental health reform prior to the fullscale invasion; since February 2022, it has rapidly pursued changes necessary to create a person-centered, comprehensive mental health ecosystem.

In 2017, the Cabinet of Ministers ratified the “Concept on Development of Mental Health Care up to 2030,” which set out the initial path to transition away from Soviet-era care. It promoted a shift towards community-based services away from institutionalized psychiatric care, health workforce strengthening, and human rights. Mental health remained a lower priority, however, until the full-scale invasion. First Lady Olena Zelenska’s Initiative on Mental Health, launched in April 2022, demonstrates high political will to improve and de-stigmatize mental health care in Ukraine, allowing all citizens in need to access mental health support services. This Initiative garnered support from multiple donors and international organizations who understand that investments in strengthening and expanding mental health services and making them accessible for the people of Ukraine is essential for the country’s future.