Ukraine, at 603 700 km2, has the second largest landmass in Europe. It has a population of about 47.4 million. Ukraine is a lower-middle-income country with a gross national income per capita of US$1260 (World Bank, 2002).
The health and well-being of the Ukrainian population, as in other former Soviet countries, are generally very poor. Life expectancy at birth is 69.7 years (64.4 years for men and 75.3 years for women). Overwhelmingly the most important reason for this is the combination of poverty, poor diet and living conditions, and lifestyle factors such as tobacco and alcohol use. Cardiovascular disease and trauma (accidents and poisonings) are the two most common causes of death, followed by cancer (UNDP & UNICEF, 2002).
Healthcare expenditure amounts to 3.5% of gross domestic product. In-patient care accounts for two-thirds of total healthcare expenditure. The number of physicians per 100 000 is 229; hospital bed provision is 903.2 per 100 000 (1998 figure), much in line with the average of 812.0 per 100 000 across Europe.
During the past 10–15 years government programmes have sought to strengthen primary healthcare on the basis of family medical practice, to develop a system of health insurance, and to create the conditions for private medical practice. A key feature of the current situation in Ukraine is the low level of remuneration for doctors and other healthcare staff (International Labour Office, 2001).
Mental health services
In-patient psychiatric care is delivered in 89 psychiatric hospitals. Of a total of 44 812 psychiatric beds, only 1468 are in general hospitals. There are also 6535 beds in 40 in-patient drug misuse facilities. The main features of the network of mental health services are their centralised structure, their focus on patients with a psychosis and their relative separation from other medical services.
Mental health legislation
The Law on Mental Healthcare was adopted by the Ukrainian Parliament in February 2000. It defines the legal and organisational principles for the provision of psychiatric care to citizens. The Law also defines forms of mental healthcare and the legal basis for psychiatric assessment, as well as for out-patient and in-patient treatment. For the first time, the Law set up a system for the provision of involuntary psychiatric care.