Table 3 Themes identified by physicians and psychologists

Physicians

 Perspectives on training

  Positive viewpoint

[I feel] positively [about training]. What surprises me is that someone doesn't want to know something.

  Interest in time-limited treatments

I support short-term psychological counseling. It would be interesting to take a training course that helps you to manage the behavior of patients. The number of doctors interested in psychology is increasing. It would be interesting for doctors to listen and get such experience.

 Identifying barriers

  Lack of referrals due to negative beliefs and stigma about mental health care

[There are] insufficient qualifications of psychologists. [There is] inconsistency of psychologists with the requirements for the treatment and diagnostic process.

  Resistance from patients

The only barrier is that patients are often offended. They accepted it as an interference in their private life. The question is how to get it across to the patient tactfully. The patient comes to a cosmetic surgeon and is redirected to a psychologist; he [the patient] perceives it painfully.

  Inadequate number of psychologists and limited time to see patients

[Psychologists are] short on time for the patient. There are many patients, but the psychologist is only one.

  Logistical challenges: financing and lack of office space

For employees, training has to be free. If training is during working time, then it must be decided at the highest [administrative] level.

 Identifying facilitators

  Recognition of the importance of mental health care and different specialist competencies

…there are competencies of a dentist and competencies of a psychotherapist.

  Support from medical staff and clinic administration

The administration is ready to pay if it increases the hospital's income. If you [providers] do not have to pay—it is positive.

Psychologists

 Perspectives on training

  Need for training in evidence-based approaches

There are huge needs: in particular, the need for modern, evidence-based methods of psychotherapy. Our methods are copied from the West, without certification, and are outdated.

Everything is outdated; everything needs to be changed to modern, evidence-based [practice]. I hear about a good effect from colleagues who practice cognitive behavioral therapy. I am lacking this knowledge.

  Interest in time-limited, targeted treatments

[We need to] learn what to do when you cannot prescribe antidepressants and how to help a person with specific concerns. If it works, is effective, reduces symptoms, then I will be surprised. I would like to see this method in practice, and learn it.

I have wanted [something like this approach] for a long time. I have an active desire for psychological structured counseling (rather than empty long hours of conversations about anything).

 Identifying barriers

  Difficulty engaging patients in treatment

There is a great need to destigmatize the whole field of psychiatry in Ukraine. Social advertising is necessary, about [why] you need to work on mental health. We need information that it is normal to practice and be engaged in mental health care. Sometimes, it can be difficult to establish trust with patients, especially one who has a trauma [history]. If they suspect something, they will leave and never trust.

  Unclear role of psychologists in clinic setting

But in our country, a psychologist is not equivalent to a psychiatrist. He is like a nurse, in contrast to the West, where a psychiatrist cannot make a diagnosis without a psychologist. Therefore, two-thirds of doctors do not understand the sense of the work of psychologists. They think that the psychologist is some kind of misunderstanding.

  Role of psychologists is not valued

But there is some caste that is present. Even a medical psychologist—this is a person with less responsibility. We are an auxiliary part… a caste system is present in which the psychologist is inferior to the doctor. A medical psychologist has no career growth, but also no responsibility in comparison with doctors.

  Concerns about time-limited interventions

Sometimes, short-term forms of treatment help. They work symptomatically. More often it doesn't help, because it's not only about removing symptoms.

  Logistical challenges (interruptions, lack of office space)

In our hospital, there is no idea that you cannot go [in when] therapy is happening. Doctors themselves break these rules. Some of them are doctors from the old system who do not understand what psychotherapy is.

  Ambivalent support from clinic administration

We have people who are more progressive than others, for example, our chief medical officer. But most people are suspicious of new methods. They believe that the Soviet methods work well, although there is no evidence of this. There are some administrations that are ambivalent: on the one hand, they understand the power of new methods, but on the other hand, they do not want to have unnecessary hassle, unnecessary checks of documents, etc.

 Identifying facilitators

  Desire to improve patient outcomes

It is very motivating that I will be able to better help my patients, with whom I empathize. I want them to get better in any way.

  Support for mental health providers on some treatment teams

Of course, people on the street (as I know) are not very serious about psychotherapy, [at least] most of them. But we do not have that in our work team. Everyone helps each other and understands the complexity of this area.

  Opportunities to engage stakeholders

It would be a good idea to hold a conference first, to provide general informational support: what kind of methods, its results… And then conduct a seminar and supervision support.

  Possible support from clinic administration

As far as we have heard, they are positive about this possibility, and they are ready to help. This is about [the general] hospital; for individual departments, it is unknown, although it is unlikely that anyone will put a spoke in the wheel.