Side event: Promoting mental health, well-being and resilience in families and communities in the COVID-19 crisis through evidence-based drug use prevention, treatment and mental health initiatives

Organized by Japan with the support of France, Indonesia, and Jordan, and the UNODC Prevention, Treatment and Rehabilitation Section, and the World Health Organization

Japan: It’s my pleasure to welcome you today highlighting evidence on drug prevention and mental health initiatives, which we hope will provide comfort and support to our US family and communities who struggle to cope with the challenges presented by the COVID 19 pandemic. Leading role in promoting effective, comprehensive, and best drug abuse prevention and treatment initiative with respect for appropriate and human life perspective throughout the COVID-19 pandemic. We’ve worked to find a particular prevention, treatment and rehabilitation section at the UNODC for their expertise and support the hard work and dedication has not gone unnoticed. The increasing rate of mental health problems and the rising level of drug use. In this regard, Japan has been praised to oppose the development and dissemination of such programmes, including family united and harmony of finance as a family-based innovation programme for children and families affected by drug use and drug use disorders. We hope that best understand from the realm of crisis will have a lasting, positive result on all of our societies. We hope to continue finding a new way to connect and to support each other, as we’re doing here today. We look forward to hearing more about the lessons from our distinguished panel. Thank you very much.

Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: good evening to our distinguished guests and to participants. Let me introduce myself. It is my great honour today to motivate this side event that will showcase best practices from all around the world on promoting the mental health, well being and resilience of families and communities during the pandemic through the prevention, treatment and Mental Health Initiative as we have heard from Mr Yamato. My name is Giovanna Campello. I am the chief of the prevention, treatment and rehabilitation section here at UNODC. And as I mentioned, this event was sponsored by Japan together with France, Indonesia. We have speakers from the United States and from Indonesia and Jordan civil society as well so we have a packed session for you. I now give the floor to Andres Finguerut, the chief of the drug prevention and health branch here at UNODC to share some words of wisdom and inspiration on this issue of which we have been working together quite a long time, and the floor is yours.

Mr. Andres Finguerut, Chief, Drug Prevention and Health Branch, UNODC: Thank you. I think the wisdom would come from the other participants at these events, who are the people who operate in the field and who implement the programmes. So, my intention is really to first of all to welcome you all on behalf of UNODC and to thank in particular, the Government of Japan for the organisation of the event and the support to our work, but also as already mentioned the armies of friends join in Indonesia. Indonesia, our colleagues, who, and also to mention some of our distinguished speakers. We are very grateful to all of you for sharing your knowledge and experience with us. This is an important event. As already mentioned, we will be highlighting the challenges, and also the good practices in drug use prevention, treatment, and recovery, particularly this time of pandemic. There is special, challenging circumstances, the pandemic has affected all our lives. These effects have not only impacted on individuals well being but also, and in particular, the recreation, safety and security of family and community environments are all seen by impacts can be more serious for people in difficult circumstances. In particular, in low and middle income countries. The people and families affected by drug use are among the most profoundly impacted by the pandemic. Available research indicates significantly higher COVID-19 morbidity and mortality rates amongst people with the drug use disorders. In addition, the affected populations, often face other life challenging situations including health comorbidities and depression, anxiety, trauma, of course HIV or hepatitis, as well as to worsen the situation stigmatisation and discrimination. And we should not forget that during the pandemic, we also have seen an increased risk of drug overdose incidents, as well as drug overdose death, family difficulties such as conflicts, physical and psychological abuse and violence have also been on the rise. Another negative coping behaviours, families in particularly challenging circumstances, such as those in refugees and displaced populations or in post conflict situations or other settings have experienced a heavier load in the pandemic. To address these challenges UNODC has developed science and family based strategies prevention and treatment initiatives, which have been piloted and scaled up with strong support for member states. Programmes include family United primary prevention and treatment programme for drug treatment of adolescents and families, which have benefit from continued support from the people and the Government of Japan. The strong focus programmes developed with the support of the Bureau of International Narcotics Law Enforcement Affairs of the United States government further implemented with contribution from Japan, Sweden and France has proven effective in preventing drug use, and violence particularly amongst children and youth. The programme is recognised in many interagency initiatives such as inspired as technical package of key strategies to end violence against children developed in partnership by WHO, UNICEF, United States, Centres for Disease Control and Prevention of the World Bank. Also the UNODC Listen First campaign has played an important role in building resilient children healthy and supportive environments. We are going to be co-working to strengthen these. In order to do so, we count on continuing strong and active support for all our partners, including those present here today. We have experienced other pandemics in the past. Despite the high cost, particularly human lives, humanity has overcome in the constantly connected world of today, our collective wisdom creativity, innovation, and above all, close international cooperation with the key in overcoming the challenges we face in building by better resilient united and thriving societies. We look forward to working together with you and sharing the tools we have developed at UNODC with your support in order to jointly address emerging challenges faced by families and communities, including the challenges posed by drug use disorders. Our common objective being to strengthen support for public health, and improve the wellbeing, safety and security of our communities. Thank you all for your attention and I look forward to the presentations, and the exchanges today.

Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: Thank you so much Andres for your opening kind words and as indeed as you mentioned, the core of this event is not only introducing some of our tools that we have put at the disposal of the world, but above all to hear from the countries that have been implementing some amazing practices for the resilience of families and communities and it is exactly in the Spirit, that it’s my great honour to give the floor to Dr Amrita Devi, the director for strengthening community based rehabilitation institutions in national narcotics board of Indonesia. Dr. Devi, you have the floor, and we’re looking forward to hear your experience.

Dr. Amrita Devi, Director for Strengthening Community-Based rehabilitation Institutions, the National Narcotics Board of Indonesia: Good evening from Indonesia and warm afternoon to fellow friends in Vienna. We would like to thank the moderator yourself, The Government of Japan for organising this event, fellow speakers and participants of this event. I will provide an overview of Indonesia’s initiatives in delivering drug Demand Reduction Services, amidst the COVID pandemic, and my fellow friend from Indonesia Krishna will follow on words with the more technical sides of his presentation. Over the past decade, there have been a reduction in the drug problems in Indonesia. However, we are faced with challenges such as we have limitations, services and accessible in remote areas, stigma, and the identification of 83 new psychoactive substances with only 74 of them being regulated. In view of the situation, abides with a balanced approach of demand and supply reduction, including the minimization of adverse effects to harm reduction approaches. And these strategies are actually in the pursuit to achieve a drug free Indonesia we are embarking on a new programme called Indonesia free from drugs. To support what was mentioned earlier we see here, rehabilitation centres, basically located in major cities, and of course with an archipelago of around 17,000 Islands, the existing centres, do not cater to the diverse needs of treatment that is readily needed for those using and abusing drugs. we can see that the locations of the treatment centres in big cities and in areas where it is accessible only by certain means on transportations, in which Indonesia with the 17,000 Islands. We have since the past year embarked on community based initiative. This approach is extremely important as an effort to bridge the gap in increasing access to treatment, an initiative, which this year is to be implemented nationwide by members of the community. And we have volunteers in the field called the recovery agent who is conducting the intervention. We call this programme as community based intervention. This is actually low terrestrial programme in which those conducting the activities are members of the community themselves. So it’s an initiative of the people for the people and by the people, and indeed CBI or we call community based intervention plays a pivotal role in generating cities responsive towards drug abuse. So, ladies and gentlemen, our highest appreciation to the Government of Japan and also UNODC for the timely initiative and enhancing family participation through family initiative. It started out in Indonesia as a pilot project couple of years ago in few sites and subsequent to the positive result. It is now an integrated part of the community based intervention. We see here the positioning of family united and treatment family initiative is actually a part of the biggest big picture. So, we have community based initiatives as part of a community, drug free community area, and we have embarked also on developing cities who are responsive to drugs, we call COVID City responses to drugs. So we see there’s a synergy here between how the very important role of treating that family intervention, and family united is responsive to drugs and the awareness, community and mobilising the potentials and within community in the pursuit to together, be responsive. In regards to drug abuse. It has been over one year since the COVID pandemic struck the world, Indonesia is on a massive and intensive vaccination programme to date. Nevertheless, safety measures and equipping all personnel with personal protection equipment, developing guidelines, ensuring health protocols are being implemented, regular rapid antigen tests and PCR is part of tracing screening and confirmation are conducted regularly, including treatment based on who guidelines. All helpers at the provincial and district level, have been vaccinated and close coordination with relevant stakeholders have been established in regards to measures against COVID and in delivering safe in delivering safe services to the community and these are highlights of the activities that we conduct during the pandemic. We have to come up with new innovations in delivering services and utilising it through e-consult and webinars. and in order to optimise what we have started, the future plans would be to develop standards in delivering community based interventions, more interesting programmes to increase community participation on the importance of family resilience against the impact of drug abuse, especially towards maintaining mental and health condition.  Of equal importance is to develop periodic evaluation tools and a more comprehensive involvement of family, with the diverse socio cultural available in Indonesia.

Ms. Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: Now I would like to give the floor to the civil society representative and specifically, Mr. Wahyu Khresna, Counsellor at Karisma in Indonesia. You have the floor.

Mr. Wahyu Khresna, Counsellor, Karisma Indonesia: Good evening, ladies and gentlemen. Thank you very much for the opportunity that Karisma had to present our treatment intervention in Indonesia. So, in 2019 Karisma, our staff had the privilege to get the data intervention from the UNODC international narcotic board. Karisma are chosen as one of the civil society organisations under family intervention. Before pandemic, we have seven clients that are divided by age, so there is a 16 years old, 17 years old, 18 years old and 21 years old. So in gender we have five male and two female, and the family was involved in the study with parents, siblings and their spouse. Before the pandemic we’re doing it for the adolescent client but during pandemic we’re doing adult clients between 19 and 38 years old. We’re doing the activity as the client needed. We have the support from the UNODC but during the pandemic, we don’t have any support and then we try to what we try to do it independently and plan. So, the process of Karisma is family involvement by looking at perspective of family members. Besides that, we also doing the family assessment by looking at the interaction in the family which is often quite different. So, it is necessary to do the positive reframing technique to the family using positive relational reframing technique to encourage behaviour change and stimulate family and client expectation in independent primary interventions. The termination is the process of evaluating what changes have been done. Family are more open to discuss the problem with the teenager, and then family feel that they need help in helping them.

Ms. Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: Thank you Mr. Khreshna for sharing with us the good experiences of Indonesia and starting to develop a family therapy for adolescents in spite of and during the pandemic. And now, from Indonesia to Jordan from civil society to academia, it’s my great pleasure to introduce Dr Youssef cada. He is a professor of epidemiology at Georgia University of Science and Technology, and telling her experience of a new app. Please Dr. Heather, the floor is yours.

Dr. Yousef Khader, Professor of Epidemiology, Jordan University of Science and Technology: Good morning and good afternoon to all participants and presenting this work. We’d like to present our work on the children immunisation app called Sima, and especially for this updated version of the app, where we have integrated parenting skilled materials by UNODC. The SIMA project was implemented in one of the largest refugee camps in Jordan, called Zachary camp. It has an area of five kilometres with over 90,000 residents. The camp is located in the northern part of Jordan, very close to the southern border of Syria, to give you a perspective, the size of the city of Vienna is 83 times bigger than the Zachary camp, but the population density of Zachary camp is five times bigger than the population density of Vienna. The camp has a basic infrastructure and as you see here, all households are made out of containers, and there is installed system for water, sewer, and electricity, whether it is hybrid between solar panels and government electricity. Networks has 10 primary health care clinics, providing primary care services, and vaccination centres. We built semen, to combine the digitalization of the vaccination records for the pills, so they get reminders for the appointment for their children and we added also health information on vaccination provided by unison. The initial seed funding for this project was from Grand Challenges Canada. In 2018, we had around 500 children in the app. We learned about so many interesting elements and the support of children and their parents, the utility of the technology did empower women to advocate for the rights of their children. Also that’s become more engaged in health checkups for their children. Due to COVID 19 pandemic there has been a strict lockdown in Jordan, that covered the whole country, including the camp. So this has affected the mental health situation inside the camp. At the same time, due to strict measures for personal safety, it was not easy to visit the camp to help the parents. Therefore, we felt there is a need to use digital health again. We found the parenting skills of the UNODC to be useful and helpful. So we have approached UNODC to ask to integrate the parenting skills, materials, and the theme. We did relaunching for the app with parenting skill materials. In January, 2021, and February 2021 We started rolling children out two vaccination clinics in Jordan. So, an idea came from local volunteers inside the camp to do household visit every Saturday, and they can keep physical distance, and they wear masks, so we could not say no to such idea, especially when it’s coming from the locals. This was a strong sense of ownership for the app, and the materials. Therefore, we are doing enrollment Monday to Thursday in the clinics. Friday is a holiday in Jordan, and Saturday was the date for the two volunteers to do household visits. By the end of March 2021, we managed to enrol 1100, children, parents were informed about the content of the app, including that parenting skills. Overall the parents were so happy to receive these materials, and they found them helpful to support them, especially during the lockdowns. Thank you very much.

Ms. Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: Thank you for not only finding ingenious ways of disseminating some of our materials but also sharing experiences. Back to our member states, it is my great honour to introduce to you Mr. Tom Hill, the Senior Policy Advisor in the Office of the Director at the White House Office of National Drug Control Policy in the United States of America. Mr Hill, the floor is yours.

Mr. Tom Hill, Senior Policy Advisor, Office of the Director, White House Office of National Drug Control Policy, U.S.A: Thank you for the kind introduction and thank you to Japan for hosting this important and exciting discussion. One thing I’d like you to know about me is that I’m a person in long term recovery from a substance use disorder, and for me that means that I haven’t used alcohol or drugs for almost 29 years. So it’s an honour to join today distinguished panellists from UNODC, Indonesia, Jordan, France, and the World Health Organisation. The COVID-19 pandemic has created unprecedented challenges for all kinds of people in all nations. People with substance use disorders have been particularly vulnerable to the disruption created by COVID. Social isolation has been difficult for everyone, but it does pose specific challenges for people with substance use disorders, including things like unaccompanied drug use that can increase the risk of fatal overdose, reduced access to treatment, harm reduction and recovery support services, and for people in recovery, isolation, and the risk of returning to drug use. In the United States, we have witnessed a rapid and unparalleled increase in the rate of fatal overdoses during the pandemic. It is estimated that over 88,000 people died of overdose in the United States during the 12 month period ending in August 2020 And that’s a 27% increase from the previous 12 month period. In the United States, peer support workers have been instrumental in helping people with substance use disorders safely navigate life during the pandemic, either as peer support workers or people with lived experience, either as people in recovery, or as allies or family members. They work in a variety of settings include recovery community organisations, treatment agencies, hospital emergency departments, harm reduction organisations, correctional and re-entry settings and healthcare organisations in response to COVID-19. We have seen a rapid transition of substance use disorder treatment, and other health care services, moving to telehealth platforms, and a concurrent shift of peer recovery support services, and mutual aid to online platforms. These virtual services and supports are poised to expand access to treatment, and recovery support services after the pandemic. Also, in response to the pandemic, the US also relaxed or waived certain regulations around the use of telehealth services procedures for prescribing buprenorphine, and the administration and transport of methadone all for the treatment of opioid use disorder. We are now reviewing the impact of these changes to determine what should remain in place after the pandemic. The Biden Harris administration statement of drug policy priorities was released through OFCCP earlier this month, and included expanding access to recovery support services. In the context of that recovery priority, we are especially excited to have worked with experts across the globe to expand universal treatment curriculum, to include recovery peers, and recovery allies, and include that curriculum. This new course is designed to train peer workers from around the world, and is currently under review by UNODC and international experts. We anticipate that the curriculum will be publicly available on the International Society of substance use professionals. The curriculum recognises that recovery from substance use disorder is a process of change, and supports efforts to promote long term person centred and person directed approaches to care and support. The United States is also supporting the global centre for credentialing and certification to develop a certification for peer support workers, which should be available by the end of 2021. Certification will permit consistency of standards and will help support peer support workers play a more consistent and proactive role in developing systems and providing services. These courses will join the suite of training materials on evidence-based practices and prevention, treatment and recovery support services that the United States has been very proud to support. We look forward to our continued collaboration with all of you to expand access to tools, in support of long-term recovery. It was a pleasure providing this brief overview and thank you for it.

Ms. Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC Thank you. It is now my pleasure and honour to introduce to you the representative of a member states that has been steadfast in the support of evidence based drug prevention and treatment throughout the years. Laura d’Arrigo is a diplomatic adviser at the interministerial nation for combating drugs and addictive behaviour in France.

Ms. Laura d’Arrigo, Diplomatic adviser, Interministerial Mission for Combating Drugs and Addictive Behaviours, France: It’s a real pleasure to attend this important event for France and to focus on prevention. So the COVID-19 pandemic has profoundly affected our lives and is a source of stress and anxiety among the youngest in particular, so promoting wellbeing and mental health is crucial to prevent risky behaviours. France is pursuing its policy of preventing addictive behaviours, with a twofold objective. The aim is to both delay the age of first experimentation, and to prevent experimentation from turning into addiction. So this policy has considerably evolved over the past three years. The new dynamic is based on developing life skills, whose effectiveness is scientifically proven. These skills include intellectual autonomy, self-esteem, critical thinking, self-confidence, trusting others, empathy and the ability to resist peer pressure. Life skills contribute to the individual’s wellbeing and resilience. This is especially true in the context of difficult and unexpected situations, such as the current health crisis. Scientific evidence shows that developing life skill is an effective way to prevent mental health problems. In fact, these skills enable to adopt an appropriate and positive behaviour with others. So let me just give you two examples of what we are currently promoting in France, mainly thanks to a dedicated investment of the National Fund against addiction. So first we promote life skills in school. We are, for example, deploying the unplugged programme on which you are certainly experts, and the objective is to integrate the program’s achievement into the national practices and to promote a common culture of life skills, and independent evaluation of this programme that we carried out in France recently. After eight months, it led to more than 50% reduction in tobacco, alcohol and cannabis consumption. So life skill development improve school performances as well and classroom atmosphere. So the number of beneficiaries of this programme increases every year in France. The aim is to progressively increase life skills programmes from kindergarten to university. So the second example I’d like to share with you is that developing scientific knowledge is also key. The greatest number of people should have access to science, since it also contributes to reducing risk taking. This is the reason why we also promote scientific mediation initiative, and we have a small initiative that is getting some further attention, which is ‘play to debate on addictions’. So young people from 13 to 25 acquire knowledge, critical thinking, and the ability to interact within a team. So a digital scientific media on addictions provide the scientific knowledge. As a result, young people become better aware of the dangers associated with rights and are better equipped to protect themselves. So France is also committed to promoting life skills internationally. We initiated this initiative in 2016 together with UNODC, WHO, the Ministry of Health and Social Affairs of Sweden, so the main aim is to insist on the role of the adults, not just as the one who deliver messages but also the ones who are available to listen. We insist on the importance that they make time for children and adolescents, on the importance of listening to them, not only on their fears and their difficulties, but also on their successes and dreams on the importance of being there for them is the very first step to help them grow healthy and safe. In the context of the pandemic, the relations between people are changed, and many young people are compelled to spend much more time at home, and are therefore partly deprived of social life. In these particular contexts, listening within the family is even more important. Thank you very much for your attention.

Ms. Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: It’s my great pleasure to introduce to you Dr. Alexander Butchart. He is from WHO and he is the head from the Violence Prevention Unit. He’s the leader of the Violence Prevention Alliance, which is a huge alliance of partners involved in violence prevention.

Dr. Alexander Butchart, Violence Prevention Unit Head, WHO: Thanks very much, and thank you very much to the organisers and to all the participants. WHO is at this event today because we are strongly supportive of a family oriented approach to prevention and to care. I’m going to focus on the prevention side of things, I’m going to focus upon parenting programmes, because for many years now, WHO has invested in the development of evidence based parent and caregiver support programmes that are aimed at addressing parents and infants, children and adolescents, both adolescent, parents, and parents of adolescents. Why? These interventions have got a rapidly growing evidence base which includes much new evidence from many low and middle income countries that they can prevent substance use, smoking disorders, improve sexual health, educational outcomes, reduce further involvement in sexual assault and violence, and so forth, not only during the time of childhood but also as children grow up and become adolescents and young adults. So, among the products that we had in place prior to the COVID 19 pandemic was a suite of free parenting programmes called the parenting for lifelong health programmes. They share many of the evidence based characteristics of similar programmes, developed by UNODC and other partners such as PEPFAR, and in fact, are strongly supported by those latter agencies too. So when COVID hit, very early in the pandemic we worked together with UNODC, CDC, PEPFAR, UNICEF, etc to convert what we have learned from the parenting for lifelong health programmes into a set of parenting leaflets. We heard about similar leaflets from UNODC and other sources for religious leaders, for radio talk show hosts etc. These were aimed at ordinary people as parents, as children, as friends of parents and children, as social workers unable, because of COVID lockdown, to do work in the normal personal way. These resources took off like wildfire. As we speak, we have been translated into something like 120 different languages can reach I think 150 million people in pretty much all the countries in the world. You can find them really easily in Google, simply by typing, COVID, 19, parenting, and you’ll find multiple sites with these tips. Now, in the course of doing this, we have learned that in person methods of providing parent and caregiver support are not the only way to go because, like in the USA, we had to rapidly learn how we could deliver these through digital and online methods through teleparenting support, and through other means. Where we stand now with this is that we, together with many partners- UNODC included are trying to convert this knowledge of what these parenting tip sheets have done. We don’t have a clear idea of the impact on behaviour. We know that parents felt that they were useful. We know that parents wanted them, we know there was a demand from governments and CSL for these tools so that they could feel that they were doing something appropriate, and there’s some suggestion from very subjective outcome evaluation studies that parents felt they did a better job. But we don’t have hardcore evidence about this. What we do have, however, is an emerging set of evidence, mainly from the USA, about app based hybrid programmes which combine apps with some in person interaction and are showing quite good evidence of effectiveness in enhancing positive parenting programmes and so forth. Thank you.

Ms. Giovanna Campello, Chief, Prevention, Treatment and Rehabilitation Section (PTRS), UNODC: Thank you all for your participation and looking forward to be in contact and cooperating more.

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