Bridging factors within Ukraine's mental health system during wartime: a qualitative study of stakeholders'...

The full-scale Russian invasion of Ukraine in February 2022 dramatically increased mental health needs while simultaneously disrupting service delivery systems. This study examines bridging factors-elements that connect the outer system and inner organizational context-within Ukraine's evolving mental health system during an emergency context.

We conducted semi-structured interviews with 18 mental health stakeholders from diverse professional backgrounds and organizational types across Ukraine between March and October 2023. Using deductive and inductive qualitative analysis approaches, we identified and categorized bridging factors according to established typology.

Using previously described categories of bridging factors, we identified and classified bridging factors described by stakeholders: coordination structures, regulatory and guidance and funding frameworks (formal arrangements), information exchange and synthesis, referral networks, knowledge transfer (process-oriented bridging factors), and collaborations, recruitment, and individual boundary spanners (relational ties). The interviewees perceived these factors as functioning with varying degrees of formalization, effectiveness, and sustainability in facilitating resource flow, knowledge exchange, and mental health service delivery. Although some bridging factors were deliberately planned (e.g., coordination mechanisms), others remained underdeveloped (e.g., referral systems). Notably, individuals who crossed the institutional boundaries played a critical bridging role by leveraging multiple affiliations to connect actors within mental health system.

In the described conflict-affected setting, bridging factors served as essential adaptation mechanisms, creating connections between fragmented system components while simultaneously supporting emergency response functions and transformation toward an evidence-based community-oriented mental health system. The strategic development of these bridging mechanisms, particularly through formalizing effective relational networks, strengthening local coordination capacity, and optimizing resource pathways, can enhance system integration when structural reform resources are constrained.