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‘Psychological first aid’: Training mental-health first-responders in the Ukraine refugee crisis

Ukrainian refugees walking next to a bus

At the Siret border in Romania, new arrivals from Ukraine board buses to take them to the nearby city of Suceava and onwards to their final destinations. Photo: Lucy Beck/CARE

At the Siret border in Romania, new arrivals from Ukraine board buses to take them to the nearby city of Suceava and onwards to their final destinations. Photo: Lucy Beck/CARE

Florian Koleci, a psychiatrist with training in cognitive behavioral therapy and art therapy, is among 500 psychiatrists, social workers, and healthcare workers on the Romania-Ukraine border and in transit hubs who recently received emergency psychosocial support and trauma-counseling training.

Portrait of Florian Koleci
Dr. Florian Koleci in his office with a client's dog. Photo courtesy of Florian Koleci.

The training, a partnership between CARE, the Headington Institute, and the Federation of Child Protection NGOs (FONPC), will be paid forward as Florian and others like them train other frontline workers and provide counseling to many undergoing one of the most stressful events in their lives.

Florian’s organization the Estuar Foundation is one of the biggest foundations working with adults with mental-health issues in Romania. Here, he shares the applicability of his experience and training to the current refugee crisis.

A new arrival from Ukraine tarries a moment at the Siret border, studying her phone and contemplating the future. Photo: Lucy Beck/CARE

Global experience in a specific topic

“I have been working with Estuar for over 20 years and I have a lot of experience in the field of mental health. I run a number of programs including psychoeducation, a parents’ school, and one-on-one counseling with people with severe mental health problems. I am also a trainer – of our staff, companies, and other organizations on the topics of mental health.

”During the COVID-19 pandemic we opened a counselling program – both online and over the phone – for doctors and nurses working on the frontlines of the COVID response in hospitals, looking at topics like communications with patients and how to deal with burnout.

“I heard about the Headington training on Facebook and was also contacted by FONPC. It was really interesting and useful to get the perspective of people with so much global experience in this specific topic of psychological first aid. It really helped broaden my knowledge and develop new skills. With Estuar we are planning to open day centers for Ukrainians arriving specifically with mental health issues.

Photo: Lucy Beck/CARE

The space to think things through

“I myself volunteered and worked with Ukrainians arriving at the central train station in Bucharest and at the airport. The biggest barrier was language to actually be able to communicate and express issues. Most people I spoke to were dealing with the kind of issues you would expect when leaving home and leaving everything behind – many were practical issues like challenges of travelling onwards or how to stay and work in Romania. Mainly I try to listen and give them the space to think these things through.

“I think one of the main issues for those arriving is levels of distress. Many were also worried about the cultural differences and whether values would align, especially for those staying with private hosts, and worried about their privacy and the security of their possessions. The need for space is really important to people in this situation.

Small acts of kindness also have a big impact for people when they are arriving.

“For example, volunteers at the border are giving out hot soup and drinks to mothers with young children when they arrive, this is so important when you are arriving in a new place, and unknown country and situation, without speaking the language and with so many emotions.

“Also, for those coming with pre-existing mental health issues there will be a real issue with continuing access to therapy, or for those with more serious mental health problems the continuity of medication. This might not be the most important thing in the first days, but it is important to consider for the longer term. In Estuar we have a principle – ‘try to work with the healthy part of the person and help them to grow this healthy part.’

Woman pushing small child in stroller through border checkpoint
Ukrainian refugees pass through the Ukraine-Romania border at Issacea. Photo: Valentina Mirza/CARE

Protecting children at all costs

“One thing that really impressed me, and will stay in my mind from working with these refugees, was the effort of mothers to shield their children from their own grief and worry. I saw one mother, who, in front of her children, was smiling and trying to be happy. Then she went off to talk on the phone and she broke down in tears. But when she came back she would be composed again. She made such an effort to keep the pressure to herself and not to transfer it to her child.

“In Romania we are not used to emergencies like the current one, so it is really helpful to learn from people who work in these situations a lot. Even if we learnt it in our studies, this is the first time we are seeing it happen in real life. What I liked a lot about the training was the way the trainers dealt with questions. I saw in practice how they handle questions and concerns themselves.

“One thing I learned that was such a basic thing but so useful, was to take a tennis ball with me.

It is something small, but you can use it for a lot of therapeutic purposes and it can change the perspective.

“I would like to use the training to teach these skills to others – other organizations and specialists – but also medical staff and volunteers working with Ukrainian refugees. The interventions of a doctor of a nurse are not just medical acts, but also psychological acts, and they are really some of the frontline providers of this first emergency psychological aid.

“It is also really important to provide this training to translators working with the refugees. If they do not understand the intention of your questions they can sometimes not translate the question properly, and in therapy and counseling the language you use is so important. If they know the basic principles, then the way that they ask the question is more secure and less harmful.”

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