SEMID-EU’s Findings on Migration, Homelessness and Drug Use in Amsterdam

On the 9th of November, a meeting organised by two SEMID-EU project partners, C-EHRN and Mainline, took place in Villa Buitenlust, Amsterdam with relevant local actors in the field of migration, homelessness and drug use. This gathering sought to address the multifaceted challenges encountered by migrants who use drugs and experience homelessness throughout Europe, with a specific focus on Amsterdam. The event aimed to share the findings and materials of the SEMID-EU project and prompt discussion on the situation in Amsterdam.

SEMID-EU is a project specifically designed to fill gaps in knowledge and practice on drug use in migrant populations. By gaining a better understanding of the needs of migrants who use drugs in Europe, it aims to improve policies and responses that affect these groups to increase their access to high-quality healthcare, drug treatment, harm reduction and (re)integration services. The focus of SEMID-EU has been on marginalised migrants, for whom institutional, structural, social and personal barriers stand in the way of the fulfilment of their basic human rights.

The key results at an Amsterdam level underlined the importance of collaboration between relevant stakeholders to support services for migrants who use drugs. In Amsterdam, homelessness is a big problem intra-European and Spanish-speaking migrants who use drugs are dealing with. Research conducted in SEMID-EU reveals the significant advantages individuals experience through drug consumption rooms, shelters and support services aimed at fulfilling their fundamental needs. However, the capacity of these services is sometimes too limited. For example, the occasional shelter does help but does not tackle the uncertainty and stress of homelessness. Without a safe and stable environment to sleep, long-term substance dependency aid (when requested) is impossible. Migrants who use drugs struggle to access (social) housing, employment, and healthcare services, and the need for insurance to access healthcare that depends on formal residence is an especially big issue.

Among the group of Maghreb Arabic-speaking refugees, there is a reported lack of support services available to help with procedures of migration, laws, drugs and drug dependency services, financial support and mental health services. However, the most prominent support services needed are mental health services, necessary to cope with the trauma that originated in their countries of origin and at refugee camps and are too often not offered.

Low-threshold (harm reduction) services serve as crucial connections for migrants who use drugs, acting as a gateway to other essential healthcare and support services. Nevertheless, these services need greater support from funding bodies due to their frequent capacity constraints. Within the discussion, there was a clear emphasis on the necessity for national cohesion in the Netherlands to adopt human-rights-centred responses to homelessness, ensuring adequate housing solutions for individuals in need.

Plenty of resources that can support the expansion of availability and quality of services for migrants who use drugs are going to be made available soon on both Mainline’s and Correlation’s websites. Of these, the following are already available:

SEMID-EU is coordinated by Mainline, an organisation based in Amsterdam whose mission is to improve the health and social position of people who use drugs, without primarily aiming to reduce drug use and out of respect for the freedom of choice and possibilities of the individual.

Other partners involved in the SEMID-EU project are Ghent University, ISGlobal – Barcelona Institute of Global Health, Positive Voice, Fixpunkt e.V., Gaïa Paris and C-EHRN.

Position Paper | People Who Use Drugs and Mental Health

This World Mental Health Day, in a significant stride towards prioritising the mental health of individuals who use drugs, the Civil Society Forum on Drugs (CSFD) has sent its position paper to the EU Spanish Presidency, the Horizontal Working Party on Drugs, and the European Commission. The paper, titled “People Who Use Drugs and Mental Health“, emphasises the urgent need to address the often neglected intersection of mental health and substance use within the European context.

The paper addresses the complexity of the relationship between mental health conditions and substance use. Mental health conditions are influenced by social determinants such as inequality, discrimination, violence, and homelessness, factors which disproportionately affect people who use drugs. Furthermore, specific subpopulations, including women, young people, ethnic minorities, and indigenous groups, face unique challenges in accessing appropriate services for their mental health and substance use needs. These disparities highlight the pressing need for a comprehensive and inclusive approach to addressing these issues from a person-centred, holistic perspective. The paper also calls for specific terminology reform, promoting the use of the term ‘comorbidity’ to describe the existence of both mental health conditions and substance use.

The paper concludes with a number of recommendations related to this issue, urging for a comprehensive review of current shortcomings in accessibility, inclusivity and sustainability of care. The CSFD welcomes the introduction of this topic within the political agenda, as these issues have historically been disregarded and warrant urgent consideration. The CSFD’s position paper serves as a call to action, urging policymakers, healthcare providers, and society at large to recognize and address the critical issues surrounding mental health and substance use. By adopting these recommendations and working together, we can strive for a more inclusive and compassionate approach to mental health care for all, particularly those who use drugs and face complex challenges.

Report on Access to Mental Health Care for People Who Use Drugs in Central and Eastern Europe and Central Asia

The Eurasian Harm Reduction Association and a team of researchers conducted an exploratory study in Central and Eastern Europe and Central Asia (CEECA) to assess the availability of mental health care services for people who use drugs and published the findings in the report titled LINKING DOTS: Assessment of opportunities for optimal access to MENTAL HEALTH CARE services for people who use drugs in the CEECA region.

They focused on Czechia, Estonia, Moldova, and Poland, collecting data through in-depth research, literature analysis, and interviews with health service providers, harm reduction service staff, and patients/clients. The study revealed that despite relatively developed mental health facilities and treatment facilities for people who use psychoactive substances in these countries, significant obstacles persist in providing mental health services to people who use drugs.

The researchers recommend using these findings to improve harm reduction and healthcare programs, address systematic barriers, and promote cooperation among agencies to enhance access to mental health care. The study aims to advocate for the integration of harm reduction and mental health support systems to provide better care and support for individuals in need.

Improving access to care at the intersection of mental health and drug use

At the meeting of the Horizontal Working Party on Drugs on the 11th of July, Iga Jeziorska, Correlation’s research officer spoke about the position of people who use drugs in a mental health context on behalf of the Civil Society Forum on Drugs, bringing some recommendations on improving their access to care.

When it comes to access to care, people who experience the co-occurrence of psychiatric disorder and substance use disorder are faced with various barriers on different levels. The prioritisation of specialised, large mental health institutions, the limited amount of alternative, community-based care possibilities and insufficient funding for mental health services are some examples of systemic barriers.

Meanwhile, there is a lack of mental health professionals and the gaps in mental health education result in a lack of comprehensive understanding among practitioners. These are staff-related barriers, which also include the stigma that people who use drugs face when reaching out for care. At the same time, innovations in care services can not keep up with the changing drug markets and drug use patterns.

Besides the above, the low accessibility of the services also challenges access to care. On the one hand, there is a lack of knowledge on available mental health support, while on the other hand the costs and insurance policies, waiting times and necessary documents, and the lack of mental health support in low-threshold services also prevent many when it comes to trying to access care.

To counter these barriers, it is key to ensure the availability of mental health care services for people who use drugs outside the context of drug dependence treatment as well. Community-based service options, such as the integration of mental health care into community-based harm reduction services, would also increase the number of accessible services. Besides, the scaling-up of reintegration services could ensure the continuum of care.

The integration of mental health care and substance use services, and the availability of these at a primary health care level should also be a goal. Training and the establishment of multidisciplinary teams able to address a range of problems could support the promotion of person-centred approaches that can incorporate biological, psychological, and social factors and the complex interactions of these.

Investment in research and innovation in the field is of crucial importance, while continuous monitoring and evaluation of the effectiveness of interventions is also needed. Additionally, awareness-raising campaigns could help reduce stigma and improve health literacy.

Reflections from the Youth4Health Forum

On the 25th to 27th October, the Youth Forum took place in Tirana. Stefan Pejic, our youth officer from ReGeneration, attended the forum and wrote a report about his experience.

Youth4Health – Health and Well-being Forum for Youth

More and more we hear the words like “youth”, “inclusion”, “participation” being thrown left and right, but when it comes to meaningful participation and youth inclusion, where do we really stand? How can we put an end to youth tokenism? Are we on our way to actually making and holding space for meaningful youth engagement and leadership?

This year from 25th until 27th of October in sunny Tirana, Albania, the first health and well-being forum for youth was organized by World Health Organization, in partnership with the Albanian Ministry of Health and Social Protection, the Office of the Albanian Minister of State for Youth and Children, the Municipality of Tirana and the United Nations Population Fund (UNFPA).

The aim of the forum was to ensure that young people partner with governments and WHO to co-design policies and frameworks impacting youth health and well-being. According to WHO, around 500 young people from 30 countries participated in the forum along with almost 200 other delegates representing government, UN and civil society partners – what a time to be alive.

Covering topics from mental and public health, youth engagement, communication, (mis)information; to disability, sexual and reproductive health and rights, making heathcare inclusive, just to name a few. All forum panel sessions will be available from 18th November here.

For me, it was really nice to exit my harm reduction bubble for a bit, and to hear other (young) people’ opinions, views and challenges, but to also rethink our own approach to the topics mentioned during the forum. 

To be honest, going to the forum – I wasn’t expecting much. I was sure this was going to be just another “you wanted youth, here’s youth” type of event, and the first day felt a lot like that with all these officials taking a stand, and talking about how youth engagement is important. Almost none of them were young. What a shocker. Talking with my peers, we were all confused and had a lot of questions, mostly about why we’re there and how our presence would contribute to the aims of the forum.

Morning brought new opportunities, and we started our day by exploring the standards for youth engagement in the Region and how these translate into practice when providing opportunities for young people to engage in discourse on health and well-being issues and decision making. Nice save!

Interactive sessions on youth engagement, improvement of health of youth in the Region, gender and health, risk communication, although very short, were really fun, and I liked the hands-on approach, I just hope it will be translated into practice.

Were our questions from the first day answered? Yes and no. 

Our inputs from all the workshop sessions were summed in this statement 

What are the next steps?

To cite Dr Hans Henri P. Kluge, WHO Regional Director for Europe:

“WHO/Europe is determined that we will help create the space that young persons need to be included in helping shape the decisions, the policies, the laws, that shape their lives and impact their health and well-being.

In creating Youth4Health, we are working with young persons to build a genuine network. 

We will be asking all our 53 Member States across Europe and central Asia to endorse it at our next Regional Committee in 2023 – WHO/Europe’s highest decision-making body, including of all ministers of health.

By governments endorsing Youth4Health, it paves the way for stronger, sustainable youth representation at the policy- and decision-making table.

Over the next year, leading up to the Regional Committee, we will work with the Youth4Health network to identify regional opportunities for youth representation – including on mental health, digital health and health emergencies.”

Even though I hoped for greater involvement of youth at a youth forum, more time for Q&A, and some tools we can actually use, it seems that this forum was a big step towards a more meaningful role of youth in decision making processes, so going forward, I will keep a close eye on WHO and Youth4Health Network in hopes that it will actually contribute to our better position, and not be just another tokenistic event. 

Thank you to Stefan for representing C-EHRN at the event, and for offering his unique insight into youth involvement.

New report – The Death Penalty for Drug Offences: Global Overview 2021

Harm Reduction International has monitored the use of the death penalty for drug offences worldwide since its first ground-breaking publication on this issue in 2007. This report, their eleventh on the subject, continues their work of providing regular updates on legislative, policy and practical developments related to the use of capital punishment for drug offences, a practice which is a clear violation of international law.

The Death Penalty for Drug Offences: Global Overview 2021 found that:

Read the report

C-EHRN Podcast Series #4: Mental Health, a humbug or an alarming topic?

The COVID-19 pandemic has profoundly affected mental health. Prior to the pandemic, marginalised communities already experienced a disproportionate risk of mental health conditions, along with consistently poorer mental health outcomes. It is commonly acknowledged that mental health should become an essential part of any pandemic response, particularly for marginalised communities in general and people who use drugs. However, that is yet not the case.

We talked to Jakub Gren of the Institute of Psychiatry and Neurology in Warsaw, Ben Collins and Nia Dunbar of ReShape/International HIV Partnerships, and Eliza Kurcevic of Eurasian Harm Reduction Association (EHRA). Following the session, NPS and Mental Health: humbug or an alarming situation? at the 5th European Harm Reduction Conference 2021 in Prague, our guests discussed the vulnerable communities’ main barriers in accessing mental health care and support. In addition, they told us what works and what does not.

What do you think?

Listen to the podcast and share your thoughts with us!

#HRAtWork #CEHRN #HarmReduction

World Mental Health Day

Every year on 10th October, World Mental Health Day is celebrated to raise awareness and draw attention to this highly impactful condition. For the last 29 years, World Health Organisation has been setting the campaign focus of the Day, which is this year “Mental health care for all: let’s make it a reality.”

While affecting the mental state of many people vigorously, the COVID-19 pandemic has shown clearly how unequal the health systems function in many countries. The inequalities due to race and ethnicity, sexual orientation and gender identity, and the lack of respect for human rights, came to the surface in 2020.

According to statistics, between 75% to 95% of people with mental disorders in low- and middle-income countries cannot access mental health services at all, and access in high-income countries is not much better either. Moreover, the numbers get even lower for vulnerable, marginalised communities, including people who use drugs, due to stigmatisation, discrimination, and human rights abuses.

Within the general context of the EU Health Policy Platform, the European Commission launched this year’s EU Health Award on two topics, one of which is Mental health. They claim to reward community-based initiatives alleviating the mental health impact of COVID-19.

This year, the Platform aims to gather good practices from cities and local authorities, NGOs, other non-profit organisations, and educational institutions.

Check out the Award page for more information and apply with your work.
Please remember to also support the Mental Health Day 2021 campaign by joining their live conversations with experts and influencers while sharing your initiatives online with the hashtag #WorldMentalHealthDay.

Further information on World Mental Health Day: