Journal Article Ahead of print
PubMed: 42949753 DOI: 10.1001/jamapsychiatry.2026.3438
The Unbroken Integrative Psycho-Trauma Care Model: Health System Implementation in Wartime Ukraine.
JAMA Psychiatry
Authors: Oleh Berezyuk, Dori Rubinstein, Or Duek, Shelley Amen, Oleg Samchuk, Ulyana Krynytska-Berezyuk, Oleksandr Filts, Mariana Svirchuk, Hnat Herych, Laritta Paolini, Beatrice Patsalides Hofmann, Marina Bluvshtein, Askar Umarbekov, Noah S Philip, Ilan Harpaz-Rotem
Affiliations
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
- First Territorial Medical Union of Lviv, Lviv, Ukraine.
- UNBROKEN University, Lviv, Ukraine.
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine. UNBROKEN University, Lviv, Ukraine.
- First Territorial Medical Union of Lviv, Lviv, Ukraine. UNBROKEN University, Lviv, Ukraine.
- Centre Primo Levi, Paris, France.
- Adler University, Chicago, Illinois.
- Canadian Red Cross, Ottawa, Ontario, Canada.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island.
- Department of Psychology, Yale University, New Haven, Connecticut.
Abstract
IMPORTANCE
The ongoing war in Ukraine has generated an unprecedented burden of psychological trauma, frequently compounded by posttraumatic stress disorder, traumatic brain injury, severe physical injury, and the psychiatric consequences of captivity among former prisoners of war. In large military conflicts, civilian hospital systems are essential for delivering trauma-informed mental health care at scale while managing patients with complex, overlapping medical and psychiatric conditions under active conflict, with limited implementation guidance.
OBSERVATIONS
This Special Communication describes the implementation and clinical workflow of the Unbroken Integrative Psycho-Trauma Care Model, a multidisciplinary health system approach embedded in the Lviv First Medical Union in Western Ukraine to organize trauma-informed mental health care within a wartime civilian hospital. From February 24, 2022, through December 31, 2025, the Lviv First Medical Union treated more than 15 000 individuals for war-related injuries and cared for more than 400 former prisoners of war. During this period, 7538 unique individuals received psychiatric care through the Unbroken Model, including 4165 who received trauma-focused psychotherapy. The model was implemented through proactive psychiatric rounds across medical and surgical departments, structured triage into 4 clinical pathways, stabilization-first care sequencing, and longitudinal case management integrated with neurological, surgical, and rehabilitation services. This organization of care enabled early identification of trauma-related distress, continuity between medical and psychiatric treatment, and adaptive delivery of trauma-focused psychotherapies within a high-volume conflict setting.
CONCLUSIONS AND RELEVANCE
The Unbroken Model demonstrates how trauma-informed mental health care can be delivered at scale within a civilian hospital during active conflict. Its primary innovation lies in the organization of care delivery, integrating proactive outreach, triage-driven pathways, multidisciplinary coordination, and stabilization-first sequencing into a unified, scalable framework. This approach may be applicable to conflict-affected and postconflict health systems worldwide.
MeSH
Triage, Mental Disorders, Stress, Physiological, Psychotherapy, Prisoners Of War, Conflict, Psychological, Prisoners, Stress Disorders, Traumatic, Wounds And Injuries, Mental Health