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WHO Regional Office for Europe workshop Addressing the mental health needs of refugees arriving from Ukraine in Poland and other receiving countries Proposed dates: 20–21 October 2022 Workshop format and topic This event, to be held in Warsaw, Poland, under the aegis of the WHO Regional Office for Europe Mental Health Coalition, will be a one-and-a-half day thematic subregional event focusing on the mental health needs of refugees and third-country nationals arriving from Ukraine in neighbouring countries and strengthening country capacities. The programme will consist of interactive sessions in a workshop style and require in-person participation. There will be an emphasis on sharing lessons learned and country experiences from the current responses in Poland and other receiving countries. The working language will be English. Background Millions of people who have been forcibly displaced since the onset of the war in Ukraine are experiencing enormous stress and uncertainty. Over 7 million refugees have fled to neighbouring countries and beyond. Millions more are displaced within the country's borders Among those crossing the border, the latest estimates are that approximately 1.35 million registered refugees are currently seeking temporary protection in Poland (1). Receiving countries are reporting a need for tailored mental health and psychosocial support services for refugees and third-country nationals as they arrive from Ukraine. The mental health and psychosocial well-being of these individuals – largely women and children – has been, in many cases, profoundly affected by their experiences of a wide range of traumatic and life- threatening events (2). Experiencing armed conflicts, war, displacement and family separation, and witnessing atrocities and other life-threatening events, can have immense and often long-lasting negative consequences for mental health. 1 Detail and context Mental health and psychosocial support Providing mental health and psychosocial support (MHPSS) requires actions that address all phases of migration. In the acute phase, most people will experience significant distress, such as feelings of anxiety, sadness, despair and hopelessness; difficulty sleeping; fatigue; and irritability. These are natural reactions and will for most people improve over time. As the conflict is prolonged, the risk of developing post-traumatic stress disorder increases. Further problems can arise during safe passage or in humanitarian settings, such as relapse of pre- existing conditions (including psychotic and mood disorders or alcohol and substance use); anxiety or stress about basic needs being met; and the undermining of community support structures, which can prevent traditional ways of coping from being used. 1 Before the crisis, Ukraine had a higher prevalence of major depressive disorders compared with the rest of eastern Europe (3.4% compared with 2.9%), and the prevalence of alcohol use disorders was much higher (6.0% compared with 1.5% globally). The national health system was committed to addressing this urgent need and, through the Special Initiative for Mental Health, WHO has been supporting integration of mental health into primary care through training and the launch of community mental health teams (3). However, under the current circumstances, people's mental health and psychosocial well-being are severely affected by exposure to life-threatening events; displacement; interrupted family and social connections; loss of homes and livelihoods; lack of access to health, education and social services; and fear and anxiety about the future of those who remain in conflict areas. This has generated a massive need for effective mental health and psychosocial support services for those arriving in all neighbouring countries (4). In June 2022 it was estimated that 42 million people were experiencing enormous stress and uncertainty, with many witnessing violence and millions forcibly displaced. Over 16 000 people with moderate to severe mental health conditions faced shortages of essential medicines (4). Poland, as the country receiving the largest group of people fleeing from Ukraine, has successfully established targeted interventions to meet the needs of people seeking refuge since March 2022. In cooperation with United Nations agencies, 27 803 people were counselled through nine Blue Dot Hubs (including two in Warsaw and two in Krakow) that assist with queries concerning access to health and medical services, transport, financial support, protection, social services, child protection services and MHPSS. Additionally, the country is offering those with an assigned national identification number (PESEL) access to free psychological support arranged by the municipalities and funded by the state (5). 1 New resource for WHO spokespeople and communications officers: Mental Health and Psychosocial Support (MHPSS) response in Ukraine and neighbouring countries, internal TPs and information for spokespeople. 2 WHO's response The WHO Regional Office for Europe is supporting countries to address the immediate health needs. Experts were deployed within days of the war to Ukraine and the surrounding countries to begin the complex process of coordinating mental health and psychosocial support, such as informing arriving refugees with pre-existing mental health conditions of where to get help – whether it be psychotropic medication or counselling. Further, WHO is making MHPSS resources available, supporting MHPSS coordination and providing surge support of MHPSS experts. WHO is closely collaborating with other United Nations agencies in neighbouring countries, to inter alia deploy trained psychosocial mobile teams that are linguistically and culturally capable of serving vulnerable refugees. WHO is supporting the provision of psychological first aid, individual psychosocial counselling, group sessions and social counselling, as well as community engagement activities (6). Specific examples include the support of an integrated service centre in Bucharest (Romania) providing awareness-raising activities on mental health services; the development of a geo-mapping exercise of MHPSS services in Czechia; and awareness campaigns around this year's World Refugee Day on 20 June to draw attention to the importance of making mental health and psychological services available to refugees. Workshop purpose and thematic areas The purpose of the meeting is to strengthen country capacities to address mental health needs of refugees arriving from Ukraine in neighbouring countries. It will give room to determine best practice examples, shared challenges and opportunities as well as points for action within the following thematic areas: Thematic area 1. Evidence on mental health needs and current responses  Present best-practice examples and lessons learned from Poland (share latest evidence gathered by the MHPSS Technical Working Group).  Present evidence on the mental health needs of refugees arriving from Ukraine and share latest epidemiological data (such as Statistics Poland's pilot data collection).  Determine challenges in addressing the mental health needs of refugees arriving from Ukraine in the current emergency situation. Thematic area 2. Strengthening the MHPSS response and country capacities 3   Discuss key steps for the MHPSS response including well-functioning coordination mechanisms and connecting relevant MHPSS response actors, understanding mental health needs and sharing available resources.  Discuss successful approaches and strategies in addressing mental health needs of arriving refugees, strengthening the MHPSS response and building capacity, establishing and scaling up MHPSS in the current context of the emergency, integrating MHPSS services in programming and continuing support for refugees with pre-existing mental health conditions.  Make MHPSS resources available to Member States and disseminate a wide range of country resources from WHO and other stakeholders.  Share lessons learned from other contexts, approaches and programmatic advice from neighbouring countries addressing similar issues. Participants Approximately 20–30 participants are envisaged to take part in the workshop. The workshop will be designed for representatives from Member States that neighbour Ukraine and Member States hosting the largest numbers of refugees arriving from Ukraine. In addition, other relevant stakeholders will be invited:  three or four mental health and migration experts from civil society and international organizations, including close partners such as the European Union, IOM and UNHCR; and  representatives of WHO country offices working on and coordinating mental health responses, potentially one MHPSS worker working in the direct response. 4 Proposed workshop structure Day 1  9–10 am Setting the scene: presentation of latest evidence and testimony from MHPSS workers o 10 am–12 pm Strengthening capacities: group work on country responses, challenges, needs and solutions with groups of five (each group consisting of country representatives, one migration and one mental health expert)  12–1 pm Lunch break  1–-2 pm Presentation of group work results  2–4.30 pm Country presentations: effective interventions and strategies and sharing of experiences and lessons learned (20 minutes per country plus 10 minutes Q&A) Day 2  9–11:30 am Country presentations, continued  11:30 am–12 pm Looking forward: concrete actions to strengthen MHPSS responses and capacities (closing plenary)  12 pm Networking lunch 5 Key messages  People's mental health and psychosocial well-being are severely affected by exposure to life-threatening events; displacement; interrupted family and social connections; loss of homes and livelihoods; lack of access to health, education and social services; and fear and anxiety about the futures of those who remain in conflict areas. This generates a massive need for effective mental health and psychosocial support services for these people as they arrive in all neighbouring countries.  The needs of people with pre-existing mental health conditions should be considered as they are at risk of relapse or deterioration, given the added stressors and often limited access to their prescribed psychotropic medications. Those who are in psychiatric hospitals or other institutions are particularly vulnerable.  Children are doubly impacted: they are not only exposed to life-threatening situations and disrupted routines but are also vulnerable to the suffering of caregivers. Highly distressing experiences influence children's psychological well- being, often resulting in significant behavioural and emotional problems.  MHPSS is an umbrella term for mental health and psychosocial interventions that includes any support that people receive to protect and promote their well-being and prevent and treat mental health conditions. MHPSS also includes support for people with mental health conditions. It is important that people taking medication for mental health conditions can continue with their treatment. A MHPSS response helps to facilitate that as far as it is possible.2 MHPSS in neighbouring countries  A resource kit, Mental Health and Psychosocial Support: Humanitarian Response in Ukraine and Neighbouring Countries, has been created by the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings. The resources are available in English, Hungarian, Latvian, Lithuanian, Polish, Romanian, Russian, Slovakian and Ukrainian (7). This resource kit contains key evidence-informed tools developed to coordinate, communicate and deliver MHPSS in humanitarian crises. These tools can be used by everyone involved in the humanitarian response.  The resource kit should be promoted as widely as possible. 2 New resource for WHO spokespeople and communications officers: Mental Health and Psychosocial Support (MHPSS) response in Ukraine and neighbouring countries, internal TPs and information for spokespeople. 6   Community engagement is essential in the development and implementation of all MHPSS strategies.  There is no one-size-fits-all solution to MHPSS, which is why local communities must be involved from the beginning to tailor the activities to the local context.  The effectiveness of any MHPSS intervention is limited if people's basic protection needs are not ensured – providing access to safety, security and services that meet essential physical needs (e.g. food, water and first aid) must be done first.  Provision of these services can support mental health and psychosocial needs by involving community networks and strengthening local social supports. References 1. Operational data portal: Ukraine refugee situation [online database]. Geneva: United Nations High Commissioner for Refugees; 2022 (https://data.unhcr.org/en/situations/ukraine, accessed 7 September 2022). 2. Ukraine situation flash update #27. Geneva: United Nations High Commissioner for Refugees 2022 (https://data.unhcr.org/en/documents/details/95150, accessed 1 September 2022). 3. Ukraine WHO special initiative for mental health situational assessment. Geneva: World Health Organization; 2020 (https://cdn.who.int/media/docs/default-source/mental- health/who-special-initiative-country-report---ukraine---2020.pdf?sfvrsn=ad137e9_4, accessed 1 September 2022). 4. War in Ukraine: situation report from WHO Ukraine Country Office. Issue No. 10, 15 June 2022. Copenhagen: WHO Regional Office for Europe; 2022 (httcx, accessed 1 September 2022). 5. Poland: MHPSS Technical Working Group meeting minutes, July 2022. Geneva: United Nations High Commissioner for Refugees; 2022 (https://data.unhcr.org/en/documents/details/94747, accessed 1 September 2022). 6. IOM regional Ukraine response, situation report 21, 10 June 2022. Geneva: International Organization for Migration; 2022 (https://www.iom.int/sitreps/iom-regional-ukraine- response-situation-report-21-10-june-2022, accessed 1 September 2022). 7. Mental health and psychosocial support, humanitarian response in Ukraine and neighbouring countries. Geneva: Inter-Agency Standing Committee; 2022 (https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and- psychosocial-support-emergency-settings/mental-health-and-psychosocial-support- humanitarian-response-ukraine-and-neighbouring-countries, accessed 1 September 2022).) 7 Date: 19 September 2022 WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ Ms Elen Ohov Adviser REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L’EUROPE European Union Affairs and International Co- REGIONALBÜRO FÜR EUROPA operation Department ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО Ministry of Social Affairs Head office: Suur-Ameerika 1 UN City, Marmorvej 51, Tallinn 10122 DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Estonia Email: [email protected] Website: http://www.euro.who.int Dear Ms Ohov, Invitation to WHO/Europe workshop: Addressing the mental health needs of refugees arriving from Ukraine in Poland and other receiving countries It is with great pleasure that I invite a representative from the Ministry to the WHO/Europe workshop on addressing the mental health needs of refugees arriving from Ukraine, which is to take place on 20- 21 October 2022 in Warsaw, Poland. The meeting, co-hosted by the Ministry of Health of Poland, will bring together representatives of Ministries of Health and public health institutes, representatives of civil society and the refugee and migrant community, international organizations as well as representatives from WHO African and Eastern Mediterranean regions. The aim of the workshop is to strengthen country capacities to address mental health needs of refugees arriving from Ukraine in neighbouring countries. I hope that this meeting will provide an opportunity to determine together good practices, and potential solutions, strategies and interventions to be used in countries. The workshop will be held over one-and-half days using interactive sessions with in-person participation. The event is tailored to senior staff at management levels and heads of departments working in the field of mental health and/or involved directly in the refugee response. For more details, I enclose a draft concept note for the event. The working language will be English. I look forward to your nomination of a representative of the Ministry of Health or a partner government institution responsible for the mental health response in your country by email to [email protected]. Please note that the cost of one participant from your country would be covered by WHO/Europe. Sincerely yours, Gundo Weiler Director Country Support, Emergency Preparedness and Response Attached: Concept Note UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: http://www.euro.who.int Denmark Copy for information to: Ms Triin Uusberg, Head, European Union Affairs and International Co-operation Department, Ministry of Social Affairs Suur-Ameerika 1, Tallinn 10129, Estonia H.E. Ms Katrin Saarsalu-Layachi, Ambassador Extraordinary and Plenipotentiary, Permanent Representative, Permanent Mission of the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin du Petit-Saconnex 28A Genève CH-1209, Switzerland H.E. Mr William Mart Laanemäe, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of Estonia, Frederiksgade 19, 4th floor, Copenhagen K 1265, Denmark Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 8, Tallinn 10617, Estonia –2– Saatja: MELKI, Simona <[email protected]> Saadetud: 20.09.2022 19:03 Adressaat: Elen Ohov <[email protected]> Koopia: Triin Uusberg <[email protected]>; SM Info <[email protected]>; Ms K. Saarsalu-Layachi <[email protected]>; <[email protected]>; <[email protected]>; <[email protected]>; <[email protected]>; KÖHLER, Kristina <[email protected]> Teema: Letter of invitation from Dr Gundo Aurel Weiler, Director, Division for Country Support, Emergency Preparedness and Response, WHO Regional Office for Europe Dear Ms Ohov, On behalf of Dr Gundo Aurel Weiler, Director, Division for Country Support, Emergency Preparedness and Response, WHO Regional Office for Europe, please find a letter of invitation and concept note to a workshop on addressing the mental health needs of refugees arriving from Ukraine in Poland and other receiving countries. Sincerely yours, Ms Simona Melki Country Implementation Support for Impact Unit Division of Country Support, Emergency Preparedness and Response (CSE) World Health Organization ¦¢Regional Office for Europe UN City - Marmorvej 51 - 2100 Copenhagen ¨ª, Denmark Phone: ¦¢