UNODC helps mental health workers of Kazakhstan to stay safe during COVID – 19 pandemic

Pandemics and health emergencies like the current COVID-10 outbreak, can cost many lives and pose additional risks to the global economy and overall security and stability. Ensuring continued access to health care during a pandemic, including services for people who use drugs and treatment of drug use disorders, are key not only to protect the health of populations, but also key to security and stability.

Drug use disorders are frequently accompanied by somatic conditions such as HIV/AIDS, hepatitis B and/or C and tuberculosis, lung or cardiovascular disease, stroke, cancer and injuries and traumas among others. Moreover, people with drug use disorders, especially those who inject drugs, may have a compromised immune system. Finally, stigma and discrimination linked to drug use and drug use disorders often result in limited access to basic resources such as housing, employment, health care and social support. For all these reasons, it may be more difficult for people who use drugs and with drug use disorders to protect themselves and they may be particularly at risk of developing COVID-19.

These days Almaty-based Republican Mental Health Centre, one of UNODC’s primary national counterparts in Kazakhstan, and its Pavlodar-based affiliation are at the coronavirus frontline providing emergency medical help to people with the mental health problems and drug use disorders – the most dysfunctional in the epidemiological sense population. Their health conditions most of the time are aggravated with the proneness to vagrancy, failure to comply with quarantine measures, and numerous contacts with people.

On the wake of the pandemic in Kazakhstan in August this year and following the urgent request from the Republican Mental Health Centre, United Nations Office on Drugs and Crime (UNODC) Programme office in the Republic of Kazakhstan, purchased personal protection equipment and bactericidal equipment for the “dirty zone” for the total amount of  12 000 US dollars. Two global UNODC programmes – “UNODC-WHO joint programme on drug dependence treatment and care” and “HIV/AIDS prevention, treatment, care and support for people who use drugs and people in prison settings” – have provided funding for this timely initiative. 

”In order to ensure the safety of medical workers who are at the coronavirus frontline now, proving emergency medical help to people with the mental health problems and drug use disorders, and to prevent the spread of COVID-19 in clinical departments, we organized separate, isolation units in the “dirty zone”  where newly arrived patients are waiting for the results of their COVID-19 tests”, said Mr. Nikolay Negay, head of the Republican Mental Health Centre. 

“We do not stop treatment of people in dirty zones thus reusable anti-plague suits, medical goggles, gloves and masks, shoe covers, and bactericidal irradiators-re-circulators will serve as a good protection to our medical workers”, he highlighted.

As elsewhere, in Kazakhstan the situation has become more complicated with regard to access to harm reduction and drug treatment programmes, and it has become more difficult for people who use drugs to receive health-retention services as the healthcare system is more focused on combating COVID-19. Although respondents of the UNODC ROCA produced report “Brief overview of COVID-19 impact on drug use situation as well as on the operations of the drug treatment services and harm reduction programmes in Central Asia”  report reduced overdose cases, it should be predicted that in the shortest term, the use of synthetic drugs, poor quality substances, and mixed substances may lead to serious consequences for the somatic and mental health of PWUD. Consequently, the demand for healthcare services may increase significantly among this population group in Kazakhstan.

Countries reported widespread disruption of many kinds of critical mental health services:

Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%).

67% saw disruptions to counseling and psychotherapy; 65% to critical harm reduction services; and 45% to opioid agonist maintenance treatment for opioid dependence.

More than a third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.

30% reported disruptions to access for medications for mental, neurological and substance use disorders.

Around three-quarters reported at least partial disruptions to school and workplace mental health services (78% and 75% respectively).

“The Impact of COVID – 19 on mental, neurological and substance use services: result of a rapid assessment”, WHO, 2020

The support was provided within the framework of Sub-programme 3 - “Drug prevention, treatment and reintegration and HIV prevention” of the UNODC Programme for Central Asia 2015-2020 and UNODC Global Project GLOK32 “UNODC-WHO Joint Programme on drug dependence treatment and care”.

The Regional Mission to Central Asia of the United Nations Office on Drugs and Crime (UNODC) is organizing a regional online training for national assessors experts on the use of UNODC/WHO-designed insights

The five-day regional online training on the skills of UNODC/WHO assessment experts on quality drug treatment has begun on 12 October 2020. The aim of the training is to strengthen institutional support to ensure the successful implementation of the UNODC/WHO drug treatment services in Central Asia and to promote a scientific approach to the quality of drug treatment and drug care services.

Following the launch of the International Standards for the Treatment of Drug Disorders, WHO/UN/UN resolution 59/4 by the Commission on Drugs (which calls for the development and dissemination of international standards for the treatment of drug-related disorders) and urges UNODC to support a systematic process of national adaptation and the adoption of national quality standards for accreditation of services under national law), the need for new globally applicable tools based on a coherent distribution strategy has been proposed to ensure a qualified and effective response to drug-related disorders around the world.

The development of such standards for the quality of drug treatment services is necessary to be able to evaluate best practices based on scientific and ethical principles. Quality standards also help to ensure that quality standards and opportunities for drug addicts are maintained by the health system for anyone with any other chronic disease.

A regional online refresher course for national assessor experts and other national experts involved in the development of national quality standards will focus on the following actions related to the continued implementation of quality standards in Central Asia:

  • Presentation of achievements in Central Asia based on the results of pilot initiatives;
  • Update on WHO/UNODC International Standards 2020 and a new set of service quality control tools from UNODC/WHO and Consensus Standards.
  • Discussion of quality control standards with an emphasis on what is currently lacking in Central Asia.
  • Focus on how to evaluate and plan improvements.
  • Identify the changes needed in each country after pilot projects and the next steps to adopt international quality standards and develop national quality standards

Ms. Ashita Mittal, UNODC Regional Representative for Central Asia, stressed that "these standards must be globally applicable and consistent with the International Standards for the Treatment of Disorders Caused by UNODC and WHO, as well as to support politicians, health service managers and practitioners to enhance their capacity to provide quality services for drug treatment and care for drug addicts." She also took the opportunity to thank national partners for their commitment to implementing UNODC quality standards and tools by establishing working groups to adapt and test UNODC quality standards and tools for drug treatment services in 2019.

This training is part of UNODC's GLOBAL GLOJ71 Project "Treatment of Drug Addiction and Its Health Effects: Treatnet II"

UNODC Regional Office for Central Asia Organizes Online Regional Training for Assessors on UNODC-WHO Quality Assurance Mechanisms/Tools for Drug Use Disorder Treatment

Five-day online regional refresher training for assessors on UNODC-WHO quality assurance (QA) tools for drug dependency treatment launched on 12 October 2020. The purpose of the training is to consolidate the institutional support to ensure the successful implementation of the UNODC-WHO QA mechanism of drug treatment services in Central Asia and promote the scientific understanding of quality drug use disorder treatment and care services.

For the five days, the participants from Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan will have a unique opportunity to discuss important issues related to the development and institutionalization of a drug treatment services QA mechanism to improve the quality of drug use disorder treatment in Central Asia.

Following the launch of UNODC-WHO International Standards of Treatment of drug use disorders and the approval of resolution 59/4 by the Commission on Narcotic Drugs (which calls for the development and dissemination of International Standards for Treatment of Drug Use Disorders and urges UNODC to support a systematic process of national adaptation and the adoption of national QA standards for the accreditation of services in accordance with national legislation), the need for new globally applicable tools based on an agreed dissemination strategy was proposed in order to ensure a qualified and effective response to drug use disorders around the world.

The development of such quality standards on drug use disorder treatment services is necessary in order to evaluate good practices informed by science and ethical principles. The quality standards also help to guarantee the same quality standards and opportunities for drug-dependent people that are provided by the health system for any other chronic disease.

The online regional refresher training for the national expert assessors and other experts involved in the development of national QA standards will focus on following actions related to continuing introducing QA standards in Central Asian countries:

  • Reflections on the achievements in Central Asia based on the findings of pilot initiatives
  • Updates on ‘International Standards’ WHO-UNODC 2020 and new UNODC-WHO Services QA Toolkit and the Consensus Standards.
  • Run-through on QA Standards areas with a focus on what is currently missing in Central Asia.
  • Focus on assessment methods and improvement planning.
  • Identifying changes required in each country following the pilots and next steps in adopting the International QA Standards and developing National QA Standards.

Ms. Ashita Mittal, UNODC Regional Representative for Central Asia, highlighted “that these standards need to be globally applicable and aligned with the UNODC-WHO International Standards for Treatment of Drug Use Disorders and serve the purpose of supporting policymakers, treatment services managers and practitioners to improve their capacity to deliver quality drug use disorder treatment and care services”. She also used this opportunity to thank the national counterparts for their commitment to introduce UNODC QA standards and tools by supporting the establishment of Working Groups on adaptation and piloting of the 2019 version of the UNODC QA standards and tools for drug treatment services.

This training is organized within the framework of UNODC global project GLOJ71 “Treating drug dependence and its health consequences: Treatnet II”.

Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes

We invite you to register for this free webinar-based training course on Motivational Interviewing (MI). The three week long series is presented by Igor Koutsenok, MD, MS, Professor of Psychiatry at the University of California San Diego, Department of Psychiatry.

Igor Koutsenok ISSUP Motivational Interviewing

Motivational Interviewing is an essential, client-centered, counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. We are absolutely thrilled to bring you this skills-building opportunity presented by a recognized expert in the field of MI.

The course consists of four sessions to be held during June 2020 (see course descriptions and session dates below).

We highly encourage registration for all sessions.

Course Description

This is a training in evidence-based clinical methods of motivational interviewing (MI). After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building therapeutic relationships in clients’ outcomes. Integration of MI with other treatment modalities will be considered.     

Course Objectives

The goal is to provide knowledge and practical skill training for various practitioners on effective ways to enhance motivation of patients with substance use disorders that require significant behavioral changes to initiate and sustain positive and healthy behavioral choices. Skill building, and experiential training will be emphasized throughout the course by exercises to develop a therapeutic alliance with patients, assess patient needs, level of engagement in treatment process, structure treatment sessions, select appropriate interventions, and assist patient in maintaining motivation for a sustainable behavioral change.

Participants will learn the basic and advanced skills in motivational interviewing and strategies for engaging patients in collaborative relationship in treatment process and assist them in achieving sustainable positive behavioral changes. The course will:

  1. Help participants to acquire a systemic perspective of motivational interviewing and other motivational enhancement strategies;
  2. Build necessary clinical skills and attitudes to implement new strategies in working with ambivalent patients.

Learning Outcomes

Upon completion of the course, every participant will be able to:

  1. Describe all the aspects of the spirit of MI
  2. Explain the differences between MI and other counselling strategies
  3. Demonstrate the ability to respond to clients with reflective listening statements
  4. Identify change talk within client speech
  5. Generate open questions designed to elicit change talk
  6. Generate MI-consistent responses to client resistant statements
  7. Differentiate commitment language from other forms of change talk
  8. Provide and empathetic summary statements collecting change talk

Course Content, Dates & Registration

Session 1: Thursday June 4th 2020

Motivational Interviewing: Basic Understanding

After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.  

Learning outcomes:

  • Introduction: Motivation and behavioral change in addiction medicine
  • Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
  • Spirit of MI
  • Expressing empathy
  • Roadblocks to communication
  • Four Processes in MI

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar Recording 

Slide Deck

Session 2: Thursday June 11th 2020

Fundamental Skills in MI - OARS

This session will focus on Fundamental Skills in MI (OARS), providing practical exercises to help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Participants will learn strategies for engaging patients in a collaborative relationship in the treatment process and assist them in achieving sustainable positive behavioral changes. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.    

Learning outcomes:

  • Open and closed ended questions
  • Affirmations
  • Summaries
  • Rowing with OARS

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar recording

Session 3: Thursday June 18th 2020

Fundamental Skills in MI Continued

This third session will continue to focus on MI fundamentals, with a focus on more advanced skills and the integration of MI with other strategies and treatment modalities. Research evidence will be reviewed for the efficacy of MI and for the importance of building therapeutic relationship in clients’ outcomes.       

Learning outcomes:

  • Recognition and responding to change talk and sustain talk
  • Forming reflections
  • Levels of reflections
  • Recognizing readiness
  • Initial and intermediate planning
  • Integration with other skills and strategies

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar recording 

Session 4: Friday June 19th 2020

The fourth and final session will continue to build on MI Fundamentals covered in Session 3, increasing your knowledge of advanced MI skills.

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar recording 

We look forward to you joining us for these virtual sessions! Please contact info [at] issup [dot] net if you have any questions.

About Professor Koutsenok

Dr. Igor Koutsenok is а Professor of Psychiatry at the University of California San Diego, Director of the Center for Addiction Research, Training and Application, Director of the SAMHSA PEPFAR International Addiction Technology Transfer Center-Ukraine, and a co-director of the SAMHSA PEPFAR South East Asia Addiction Technology Transfer Center. He is also a Vice-President of the International Consortium of Universities on Drug Demand Reduction.

In 1983 he graduated as a medical doctor from the National Medical University in Kiev, (Ukraine). In 1986, he completed his psychiatry residency training and received degree as psychiatrist from the Medical University in Sofia (Bulgaria). In 1993-1996 he received a degree in addiction psychiatry at the University of London, Department of Addictive Behavior and Psychological Medicine at St. Georges Hospital Medical School. In 1996, he was recruited by the University of California San Diego, School of Medicine, Department of Psychiatry and since then he serves as faculty member of the Department. In 2013-2016 he served as Chief of Prevention, Treatment, and Rehabilitation at the United Nations Office on Drugs and Crime, United Nations Office in Vienna.

Over the last 25 years Dr. Koutsenok led the design and implementation of multiple training and technical assistance programs for mental health and addiction treatment practitioners, primary health care and social work practitioners, criminal justice professionals in the United States and around the world. He is also directing the UCSD Summer Clinical Institute - the second longest running Summer Institute in the United States (over 40 years). Dr. Koutsenok is also a member of the International Motivational Interviewing Network of Trainers (MINT). 

For many years, Dr. Koutsenok taught general and addiction psychiatry to medical students, psychiatry residents, psychology trainees, social workers, criminal justice professionals, and policy makers around the world. He is a recipient of numerous national and international awards. He has authored and co-authored over 50 scientific publications, one monograph, and contributed to 4 book. Dr. Koutsenok has been invited as a presenter and trainer to hundreds of conferences and workshops in the USA and more than 40 countries around the world. He is a proud father of three.

WEBINAR: Cary Hopkins Eyles sur l’auto-soin authentique pour les professionnels de la toxicomanie

Ce webinaire se concentre sur la question de l’auto-soin des professionnels de la toxicomanie et a été livré par le directeur adjoint de l’ICUDDDR, Cary Hopkins Eyles.

Beaucoup d’entre nous sont attirés par le travail dans le domaine des troubles liés à la consommation de substances en raison de notre histoire, de notre famille et de nos traits personnels, comme la compassion et l’empathie. Bien que ceux-ci puissent être de grands atouts, ils peuvent également nous nuire personnellement.

Dans ce webinaire, Cary explique comment identifier les traits sains et malsains, comment nous pouvons prendre soin de nous-mêmes, et à quoi ressemble l’auto-soin authentique.

Cary travaille dans le domaine des troubles liés à la consommation de substances depuis 18 ans. Elle est passionnée par l’aide aux professionnels dans ce domaine pour prendre soin d’eux-mêmes afin qu’ils puissent prospérer et aider ceux qui sont dans le besoin. Cary a travaillé dans le domaine des soins directs à but non lucratif aux États-Unis, a dirigé des programmes de traitement en établissement, en consultation externe et en justice pénale et a formé et encadré d’autres professionnels de la consommation d’alcool et d’autres drogues. Elle est maintenant directrice adjointe du Consortium international des universités pour la réduction de la demande de médicaments (ICUDDR) et soutient l’élaboration de programmes d’études sur la toxicomanie dans le monde entier. Elle est formatrice mondiale dans le programme de traitement universel (UTC).

Enregistré le 13 mars 2020

Cary Hopkins Eyles