Amedeea Enache, ESTUAR Foundation: "It's a big challenge to stay safe because the risk of being abused as a refugee is everywhere."

Business Review recently interviewed Amedeea Enache, the Executive Director of the ESTUAR Foundation, discussing the vital psychological support provided to Ukrainian citizens. Despite the ongoing conflict and the challenging lives of refugee citizens straddling Romania and Ukraine, it’s crucial to note that this topic remains of utmost importance, even if it may not always capture the same level of attention it once did.

Since May 2022, the ESTUAR Foundation has co-chaired the Mental Health and Psycho-Social Support (MHPSS) Group for Ukrainian refugees in Romania with the World Health Organization and the Ministry of Health. The group aims to enhance coordination for MHPSS emergency responses and quality interventions through capacity-building activities.

Can you provide an overview of your organization’s mission and the specific services it offers to individuals in need of psychological support?

Estuar Foundation was established in 1993 by the Penumbra Foundation in Scotland and the Romanian League for Mental Health with the mission to provide social and alternative options to adults with mental health problems for their inclusion in the Romanian community. In 30 years, Estuar was able to respond to the changing needs of its beneficiaries, adults with mental health problems, by identifying the necessary resources to enable them to do so. Since 2013 it has been recognized by the Romanian state as having public utility status. Estuar works in public-private partnerships with local public institutions from social assistance field, education, employment but also at European level. It has been working “at grass roots” and is open to everything that means social innovation, multidisciplinary partnerships, and involvement of beneficiaries. It is the first organization in Romania to offer sheltered housing to adults with mental health problems, a community-based alternative to admission to psychiatric hospitals. It is the only organization in Romania to provide this service on a permanent basis in the three sheltered housing facilities in Bucharest, since 1994. In our community services we provide social (psychosocial, employment facilities) and educational services (prevention & awareness) to raise the degree of our beneficiaries in their recovery.

What motivated your organization to focus on providing psychological support, and how do you see it making a difference in the lives of those you serve?

We started in 1993 when in Romania the only service in mental health was the psychiatry hospital. It was the dream of several young and enthusiastic psychiatrists to make a difference in the lives of their patients by adding a complementary service with a strong psycho-social component. In 1993 there was no legislation, no knowledge … .no anything but the experience taken from Scotland (Penumbra Association who supported us to understand mental health and grow up). We have some beneficiaries still with us from the early years. We’ve been together on launching books, playing theater, going outside the hospital, running marathons, even weddings and funerals.

In the past 30 years of activity, what are some of the biggest challenges your organization faces in providing psychological support, and what strategies do you employ to overcome these challenges?

I would say lack of funding, lack of governmental support, lack of national or regional strategies and networking in mental health. It is a field where there are mainly medical services…with few and non consistent projects and not programs. In Estuar we stay committed to our cause and continuously fundraise and work in partnership to maintain our services alive. Sometimes we even innovate- and every couple of years we open a new service (see the Clubhouse service we opened after a Finish model and we transferred later on to a public authority) or we create educational tools to support our experts or beneficiaries.

Could you share some insights into the unique challenges and mental health issues that individuals and communities face when dealing with displacement, such as Ukrainian refugees?

We started to work for refugees in Ukraine in March 2022 and we still do in partnership with UNHCR. I would say that the Ukrainian refugees need to be accepted and included in local communities. They need employment and educational support for their children, they need to be supported to learn Romanian and English languages to have better jobs and they need predictability from Romanian authorities. Without predictability they are at huge risks to be in need of mental health services. And a big challenge is to stay safe because the risk of being abused as a refugee is everywhere.

Read also: Art therapy for Ukrainian refugees from Romania enters UNIQLO competition

How do you ensure the accessibility and inclusivity of your services for individuals from diverse backgrounds, including refugees who may have limited resources or face language barriers?

We provide MHPSS (Mental Health Social Support Services) without any restriction to any adult who is facing a temporary or permanent mental health problem. Our services are not limited in time, are available for free and we offer the services with the support of Ukrainian or Russian language translators. It was something new for us to work mediated by translators but after more than a year we got used to adapting the services and including the translator in our teams.

What types of programs or projects does your NGO run specifically to support Ukrainian refugees, and what impact have these initiatives had so far?

We started with a Training Program. In a year, we developed 56 training sessions with 1615 participants (Social & Mental Health Specialists). Training Crisis Intervention program was initiated at the beginning of the humanitarian crises, as a part of the refugee crisis response when the will to support people was higher than the capacity of specialists and volunteers to act in a professional environment. The program was designed for specialists (psychologists, support workers etc.) & social field volunteers. All sessions were organized online via ZOOM.

Then of course we had the mental health services, with focus on psychiatric support for those who experienced trauma from war and displacement. Estuar Foundation psychotherapists and specialists conducted individual psychological support sessions in either English, or with a translator’s support. Participants were supported to make better decisions for their future or to manage personal situations (relationships with children, especially teenagers etc.) or to overcome pressure related to accommodation in Bucharest and connections with other refugees. The “How to talk about war with children” psychological support group gathered participants from Bucharest location and was led by a psychiatrist trained in working with children. From one session to another there were mainly the same participants. They learn how to manage conflict situations with children, how to approach difficult topics such as war and death and how to customize their approaches and discourses according to different ages. And I would like to mention our Protection from Sexual Abuse and Exploitation program, with focus on both refugees and staff who started to work in a new climate of vulnerability.

Are there any success stories or specific cases that stand out in terms of the impact of your psychological support services on refugees or other beneficiaries?

The psychological support program has a profound impact on the lives of war refugees. War and conflict can cause significant trauma and stress, leading to a range of mental health issues, including depression, anxiety, post-traumatic stress disorder (PTSD), and feelings of hopelessness and helplessness. Psychological support can help refugees process and cope with these experiences and begin to rebuild their lives. During the lifetime of the program, Ukrainian refugees’ mental health status was improved. We provided refugees a safe and supportive environment, so they began to process and overcome their traumatic experiences. We provided them coping strategies: project experts- psychologists helped refugees to develop coping strategies to deal with the stress and trauma of their experiences. We promoted resilience, providing refugees with the tools and support they need to overcome their challenges. Project specialists restored a sense of control for refugees: war can strip refugees of their sense of control over their lives, leaving them feeling helpless and powerless.

The MHPSS program supported refugees to regain a sense of control, enabling them to make decisions and plans.Overall, psychological support which was offered played a critical role in helping war refugees overcome the trauma of their experiences and begin to rebuild their lives. Besides statistical numbers, we end this project with the satisfaction that over people arriving in a crisis situation from Ukraine received in a very complicated time, emotional support, MHPSS support, specialized psychological support, and necessary social support to assure a smooth integration of refugees in Romania or support during their short stay. The program also had a high impact on the specialists and volunteers’ community because it offered a platform to train, gain specific knowledge and share methods & approaches. A strong group of specialists was built.

In terms of providing psychological support, what are some culturally sensitive approaches or strategies that your organization employs to effectively assist Ukrainian refugees who may have unique cultural or language needs?

At the beginning we noticed a reluctance for the Ukrainian refugees in asking for mental health support. Somehow they had the attitude that the Romanian individuals used to have twenty years ago. The attitude of not showing vulnerability and not discussing any mental health necessity. After a year and a half, people are more open to speak about and to accept support in mental health.

In light of the evolving situation for Ukrainian refugees, how does your organization adapt and respond to changing needs and circumstances?

At Estuar, we stick with our mission to support anybody who is within the mental health area of needs. We moved from state centers to communities, from groups of people to individuals. We expect anybody who need support in our Community Center in Bucharest.

Lastly, what message or advice do you have for individuals or communities looking to address the mental health needs of vulnerable populations, particularly in the context of refugee crises?

I think mental health needs of vulnerable populations should be addressed only by professional institutions or organizations, with trained experts. So I would suggest they work strategically to build partnerships with organizations with proven experience in mental health and in working with vulnerable populations.

The ESTUAR Foundation continues its psychological support for Ukrainian refugees in partnership with UNHCR until the end of 2023. Support is available to organizations across Romania and services include in-person support at the foundation’s center in Bucharest and Romexpo, therapeutic interventions in refugee centers, and online therapy. Organizations seeking assistance can email office@estuar.org.

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