Deliberation upon integrating Mental

health into primary Healthcare systems

with special emphasis on Marginalized
populations
 Letter from the Executive Board

Dear Delegates!

We are very pleased to welcome you to the simulation of the WHO at Meru
International School MUN 2023. It will be an honour to serve on your
Executive Board for the duration of the conference. This Background Guide is
designed to give you an insight into the case at hand. Please refer to it carefully.
Remember, a thorough understanding of the problem is the first step to solving
it.

However, remember that this Background Guide is in no way exhaustive and is

only meant to provide you with enough background information to
establish a platform for beginning the research. Delegates are highly
recommended to do a good amount of research beyond what is covered in the
Guide. The guide cannot be used as proof during the committee proceedings
under any circumstances.

Finally, we would like to wish you luck in your preparation. In case you have
any questions, procedural or otherwise, please feel free to direct them to any
member of the Executive Board and we will get back to you as soon as possible.
Please do not hesitate to contact us with any queries or concerns. We expect all
delegates to be well-versed with the various nuances of the agenda and geared
up for an intense debate, deliberations, and great fun.

We are looking forward to meeting you at the conference!

Regards,

Eswar Chava Sai Preethi Polu

Chairperson Vice-Chairperson
 Points to Remember
A few aspects that delegates should keep in mind while preparing:

1. Procedure: The purpose of putting in procedural rules in any committee

is to ensure a more organized and efficient debate. The committee will
follow the UNA-USA Rules of Procedure. Although the Executive
Board shall be fairly strict with the Rules of Procedure, the discussion of
the agenda will be the main priority. So, delegates are advised not to
restrict their statements due to hesitation regarding the procedure.

2. Foreign Policy: Following the foreign policy of one’s country is the

most important aspect of a Model UN Conference. This is what
essentially differentiates a Model UN from other debating formats. To
violate one’s foreign policy without adequate reason is one of the worst
mistakes a delegate can make.

3. Role of the Executive Board: The Executive Board is appointed to

facilitate debate. The committee shall decide the direction and flow of
the debate. The delegates are the ones who constitute the committee and
hence must be uninhibited while presenting their opinions/stance on any
issue. However, the Executive Board may put forward questions and/or
ask for clarifications at all points in time to further debate and test
participants.

4. Nature of Source/Evidence: This Background Guide is meant solely

for research purposes and must not be cited as evidence to substantiate
statements made during the conference. Evidence or proof for
substantiating statements made during the formal debate is acceptable
from the following sources:

i) United Nations: Documents and findings by the United Nations

or any related UN body are held as credible proof to support a
claim or argument. Multilateral Organizations: Documents from
international organizations like OIC, NAFTA, SAARC, BRICS,
EU, ASEAN, the International Criminal Court, etc. may also be
presented as credible sources of information.
 ii) Government Reports: These reports can be used in a similar
way as the State Operated News Agencies reports and can, in all
circumstances, be denied by another country.

iii) News Sources:

a. Reuters: Any Reuters article that clearly makes mention of

the fact or is in contradiction of the fact being stated by a
delegate in the council.

b. State operated News Agencies: These reports can be used

in the support of or against the State that owns the News
Agency. These reports, if credible or substantial enough,
can be used in support of or against any country as such
but in that situation, may be denied by any other country
in the council. Some examples are – RIA Novosti (Russian
Federation), Xinhua News Agency (People’s Republic of
China), etc.

***Please Note: Reports from NGOs working with UNESCO, UNICEF, and
other UN bodies will be accepted. Under no circumstances will sources like
Wikipedia, or newspapers like the Guardian, Times of India, etc. be accepted.
However, notwithstanding the criteria for acceptance of sources and evidence,
delegates are still free to quote/cite from any source as they deem fit as a part
of their statements.
 What is a Position Paper?

A position paper is a brief overview of a country’s stance on the topics being

discussed by a particular committee. There is a specific format that the position paper
must follow, it should include a description of your positions your country holds on
the issues on the agenda, relevant actions that your country has taken, and potential
solutions that your country would support.

Each delegate should be writing a position paper for the committee’s agenda. Each
position paper should not exceed three pages, and must fit into a single document per
delegate.

For the World Health Organization, position papers are not mandatory but highly
recommended as they would be marked upon, and will make an impact for a delegate
to be winning an award.

The format for a position paper:

Committee: WHO

Country/Allotment:

Agenda:

1. Topic Background

2. Past International Actions

3. Country Policy

4. Possible Solutions

5. Sources

Font: Times New Roman

Size: 12
Line spacing: 1.5

Maximum limit on words: 700

Please ensure that you justify the text (Use Ctrl + J in Word or just Google how to
justify text in Word)

Remember, you shall be marked on the position paper so please avoid using
plagiarized content.

The deadline for the submission is until 29th June 2023, 11:59 PM IST.

No submission post the deadline shall be accepted.

The submission is to be sent to both ugs18087_eee.eswar@cbit.org.in and

polusaipreethi@gmail.com

With the subject being Position paper_your country_WHO

 Committee and Mandate

The World Health Organization, also known as the WHO, is a specialized agency of
the United Nations and is devoted to universal healthcare across the globe. WHO was
established on April 7, 1948 with 61 countries having signed its constitution in 1946.
It has been formed under the terms of Article 57 of the United Nations Charter for the
purpose of co-operation among countries around the world for the promotion and
protection of the health of all Peoples.

Currently, it is headquartered in Geneva, Switzerland and operates through offices in

over 150 countries. In regards to its workload, the WHO monitors the world health
situation and related trends. It produces the annual World Health Report to support
international efforts to coordinate research by optimizing collaboration and
information exchange. WHO works alongside governments and other partners to
strive for the best attainable health for all people. It also sets and promotes health
norms and standards to be implemented by countries around the world. The council
has its own decision-making body known as the World Health Assembly (WHA)
which is attended by delegations from all WHO Member States and determines the
policies of the organization. The budget on which the WHO operates is mainly
supplied by its member states and partly by voluntary contributions that span two
years.

The council has provided health and humanitarian assistance to countries that are
experiencing war and humanitarian crises. WHO has coordinated international
responses to help countries at war maintain access to healthcare services during
conflicts. The organization bases its work on humanitarian principles and medical
ethics. In its 51st World Health Assembly, it has recognized its role as a bridge for
peace of the Health for All in the 21st Century Strategies, affirming that the role of
health workers is essential to peace building. However, as conflicts and challenges are
becoming more dynamic over the years, the task to guarantee healthcare services in
conflict areas will be more challenging than ever. Thus, cooperation from all countries
and related actors should greatly support WHO in completing its mission.
Its functions include:
1. Acting as the directing and coordinating authority on international health work;
2. Establishing and maintaining effective collaboration with the United Nations,
specialized agencies, governmental health administrations, professional groups
and such other organizations as may be deemed appropriate;
3. Assisting Governments, upon request, in strengthening health services;
4. Furnishing appropriate technical assistance and, in emergencies, necessary aid
upon the request or acceptance of Governments;
5. Providing or assisting in providing, upon the request of the United Nations,
health services and facilities to special groups, such as the peoples of trust
territories;
6. Establishing and maintaining such administrative and technical services as may
be required, including epidemiological and statistical services;
7. Stimulating and advancing work to eradicate epidemic, endemic, and other
diseases;
8. Promoting, in co-operation with other specialized agencies where necessary,
the prevention of accidental injuries;
9. Promoting, in co-operation with other specialized agencies where necessary,
the improvement of nutrition, housing, sanitation, recreation, economic or
working conditions and other aspects of environmental hygiene;
10. Promoting co-operation among scientific and professional groups which
contribute to the advancement of health;
11. Proposing conventions, agreements, and regulations, and make
recommendations with respect to international health matters and performing
such duties as may be assigned thereby to the Organization and are consistent
with its objective;
12. Promoting maternal and child health and welfare and to foster the ability to live
harmoniously in a changing total environment;
13. Fostering activities in the field of mental health, especially those affecting the
harmony of human relations;
14. Promoting and conducting research in the field of health;
15. Promote improved standards of teaching and training in the health, medical and
related professions;
16. Study and reporting on, in co-operation with other specialized agencies where
necessary, administrative, and social techniques affecting public health and
medical care from preventive and curative points of view, including hospital
services and social security;
17. Providing information, counsel, and assistance in the field of health;
 18. Assisting in developing an informed public opinion among all peoples on
matters of health;
19. Establishing and revising as necessary international nomenclatures of diseases,
of causes of death and of public health practices;
20. Standardizing diagnostic procedures as necessary;
21. Developing, establishing, and promoting international standards with respect to
food, biological, pharmaceutical, and similar products;
22. Generally taking all necessary action to attain the objective of the organization.

What is World Health Assembly (WHA)?

The WHO has three component parts:

1. World Health Assembly ((WHA)

2. Executive Board

3. Secretariat The WHA is the body that:

a. Determines the policies of the Organization;

b. Names the Members entitled to designate a person to serve on the

Board;

c. Appoints the Director-General;

d. Reviews and approves reports and activities of the Board and of the
Director-general and to instruct the Board in regard to matters upon
which action, study, investigation or report may be considered
desirable;

e. Establishes such committees as may be considered necessary for the

work of the Organization;

f. Supervises the financial policies of the Organization and to review

and approve the budget;

g. Instructs the Board and the Director-General to bring to the attention

of Members and of international organizations, governmental or
 nongovernmental, any matter regarding health which the Health
Assembly may consider appropriate;

h. Invites any organization, international or national, governmental, or

nongovernmental, which has responsibilities related to those of the
Organization, to appoint representatives to participate, without right
of vote, in its meetings or in those of the committees and conferences
convened under its authority, on conditions prescribed by the Health
Assembly; but in the case of national organizations, invitations shall
be issued only with the consent of the Government concerned;

i. Considers recommendations bearing on health made by the General

Assembly, the Economic and Social Council, the Security Council or
Trusteeship Council of the United Nations, and to report to them on
the steps taken by the Organization to give effect to such
recommendations;

j. Reports to the Economic and Social Council in accordance with any

agreement between the Organization and the United Nations;

k. Promotes and conducts research in the field of health by the

personnel of the Organization, by the establishment of its own
institutions or by co-operation with official or non-official
institutions of any Member with the consent of its government;

l. Establishes such other institutions as it may consider desirable;

m. Takes any other appropriate action to further the objective of the

organization. The WHA has the authority to adopt conventions or
agreements with respect to any matter within the competence of the
Organization.

A two-thirds vote of the WHA shall be required for the adoption of such conventions
or agreements, which shall come into force for each Member when accepted by it in
accordance with its constitutional processes. Each Member of WHO has undertaken
that it will, within eighteen months after the adoption by the WHA of a convention or
agreement, act relative to the acceptance of such convention or agreement. Each
Member shall notify the Director-General of the action taken, and if it does not accept
such convention or agreement within the time limit, it will furnish a statement of the
reasons for 7 non-acceptances. In case of acceptance, each Member agrees to make an
annual report to the Director-General in accordance with Chapter XIV.
The WHA has the authority to adopt regulations concerning:

a. sanitary and quarantine requirements and other procedures designed to

prevent the international spread of disease;

b. nomenclatures with respect to diseases, causes of death and public

health practices;

c. standards with respect to diagnostic procedures for international use;

d. standards with respect to the safety, purity and potency of biological,

pharmaceutical and similar products moving in international commerce;

e. advertising and labelling of biological, pharmaceutical And similar

products moving in international commerce.

Resolutions in WHA Resolutions are the formal documents through which the WHA
takes binding decisions. The resolution can pass only if a two-third majority of the
WHA votes for it. The syntax and structure of the resolution shall be explained on the
second day of the conference.

** We will be thoroughly explaining the Draft Resolutions and the documentation part as a
whole in the committee.
 Introduction
Health is now widely acknowledged as having both a physical and mental health
dimension. Indeed, as far back as 1948, WHO's constitution recognized health as ‘a
state of complete physical, mental and social well-being, and not merely the absence
of disease or infirmity’. Despite this, many primary healthcare systems in countries
around the world focus on physical care, failing to provide mental healthcare to their
populations.

Article I of the Declaration of Alma-Ata reaffirms that health is “a state of

complete physical, mental and social well-being, and not merely the absence of
disease or infirmity.” This multidimensional approach to health needs to be
strengthened, especially through a lifelong approach to promoting mental resilience as
part of primary health care. Given that it often goes unnoticed, ensuring mental and
psychological well-being is a core part of leaving no-one behind on the journey to
universal health care.

Mental disorders are extremely prevalent in all countries and are responsible for
immense suffering, poor quality of life, increased mortality and staggering economic
and social costs. As such they cannot continue to be ignored. Today, from the day of
the adoption of the Alma Ata Declaration, as the world prepares to re-affirm primary
healthcare as essential healthcare, universally accessible to individuals, an important
opportunity presents itself to change this state of affairs. Indeed, a fundamental shift
needs to occur in healthcare paradigm, from one of human rights violations and poor
health outcomes associated with care delivered through psychiatric institutions, to one
which respects human rights and promotes good health outcomes and recovery
through the delivery of mental healthcare in the primary health-care system.

What is Primary Healthcare systems?

“Primary Healthcare (PHC) is a whole-of-society approach to health that aims at
ensuring the highest possible level of health and well-being and their equitable
distribution by focusing on people’s needs and as early as possible along the
continuum from health promotion and disease prevention to treatment, rehabilitation
and palliative care, and as close as feasible to people’s everyday environment.” as
defined by WHO and UNICEF.

PHC is rooted in a commitment to social justice, equity, solidarity and

participation. It is based on the recognition that the enjoyment of the highest
attainable standard of health is one of the fundamental rights of every human being
without distinction.

For universal health coverage (UHC) to be truly universal, a shift is needed from
health systems designed around diseases and institutions towards health systems
designed for people, with people. PHC addresses the broader determinants of health
and focuses on the comprehensive and interrelated aspects of physical, mental, and
social health and wellbeing. It provides whole-person care for health needs throughout
the lifespan, not just for a set of specific diseases. Primary health care ensures people
receive quality comprehensive care - ranging from promotion and prevention to
treatment, rehabilitation, and palliative care - as close as feasible to people’s everyday
environment.

Why is Primary Healthcare important?

PHC is the most inclusive, equitable, cost-effective, and efficient approach to enhance
people’s physical and mental health, as well as social well-being. Evidence of
wide-ranging impact of investment in PHC continues to grow around the world,
particularly in times of crisis such as the COVID-19 pandemic.

PHC provides the 'programmatic engine' for Universal Healthcare, the health-related
SDGs and health security. This commitment has been codified and reiterated in the
Declaration of Astana, the accompanying World Health Assembly Resolution 72/2,
the 2019 Global Monitoring Report on UHC, and the United Nations General
Assembly high-level meeting on UHC.

PHC is also critical to make health systems more resilient to situations of crisis, more
proactive in detecting early signs of epidemics and more prepared to act early in
response to surges in demand for services. Although the evidence is still evolving
there is widespread recognition that PHC is the “front door” of the health system and
provides the foundation for the strengthening of the essential public health functions
to confront public health crises such as COVID-19.

What is Mental health?

Mental health is a state of mental well-being that enables people to cope with the
stresses of life, realize their abilities, learn well and work well, and contribute to their
community. It is an integral component of health and well-being that underpins our
individual and collective abilities to make decisions, build relationships and shape the
world we live in. Mental health is a basic human right. And it is crucial to personal,
community and socio-economic development.

Mental health is more than the absence of mental disorders. It exists on a complex
continuum, which is experienced differently from one person to the next, with varying
degrees of difficulty and distress and potentially very different social and clinical
outcomes. Mental health conditions include mental disorders and psychosocial
disabilities as well as other mental states associated with significant distress,
impairment in functioning, or risk of self-harm. People with mental health conditions
are more likely to experience lower levels of mental well-being, but this is not always
or necessarily the case.

Importance of Primary Mental Health Care Services

Several effective, evidence-based interventions exist which empower people with
mental and behavioral health difficulties and ensure more positive, long-term general
and mental health outcomes and wellbeing. A life course approach, addressing the
needs of children as well as adults, is required for early identification of mental and
behavioral health disorders. Huge cost savings can be made in the medical and
pharmaceutical realm, if appropriate planning is undertaken for the provision of early
psychosocial and behavioral health interventions for patients with common mental
disorders and comorbid chronic disease, at the primary care level.

Integrated mental health care enables the “right treatment, at the right time, in the right
place” by the appropriately trained provider, and prevents the stigma, discrimination,
marginalization and fragmentation of care still associated with referral (and
dislocation) to secondary and tertiary mental health treatment facilities. Such
interventions within primary care settings address barriers to treatment and closes
gaps in care by making services more accessible to the general population.
Furthermore, tremendous benefits have been identified as a result of mental health
promotion and early intervention within the primary care setting, addressing various
behavioral health needs and preventing more serious mental illness.

Why is mental health required in Primary Healthcare systems?

Mental health or psychological well-being is an integral part of an individual’s
capacity to lead a fulfilling life, including the ability to form and maintain
relationships, to study, work or pursue leisure interests, and to make day-to-day
decisions about education, employment, housing, or other choices. Good mental
health is put at risk by a range of factors including biological characteristics, social or
economic circumstances and the broader environment in which individuals find
themselves. Exposure to these risk factors or stressors can lead to a range of mental
health problems, especially among more vulnerable population groups.

A particular concern for global public health and development is that mental health
problems during childhood and adolescent period are on the rise, emerging as
prominent causes of morbidity and mortality. Globally, depression is a leading cause
of illness and disability among adolescents, and suicide is a leading cause of death in
15–19-year-olds.

Across all age groups, schizophrenia, depression, epilepsy, dementia, alcohol

dependence and other mental, neurological and substance use (MNS) disorders
constitute 13% of the global burden of diseases and account for one in every ten years
of lost health globally (10.4% of disability-adjusted life years). Alarmingly this
burden has risen by 41% in the last 20 years and it is most commonly due to physical
health conditions which are unrecognized and untreated.

Mental disorders are among the leading causes of disability worldwide. The treatment
gap refers to the difference in the proportion of people who have a disorder and those
individuals who receive care. This gap for people with mental disorders exceeds 50%
in all countries in the world and reaches nearly 90% in low-income countries. Mental
disorders constitute a significant proportion of morbidity seen in primary care. The
WHO international study of psychological problems in general health care, which was
carried out in 15 primary care sites across the world, revealed that primary care
physicians identified 23.4% of attendees as being a ‘case’ with a psychological
disorder (while a research instrument identified 33%). However, a significant
proportion of cases then were, and still are today, untreated due to a combination of
factors including the somatic presentation of symptoms, low levels of detection by
primary care providers and low availability of psychosocial and pharmacological
technologies.

Findings from the WHO World Mental Health Survey showed that only one in five
people in countries with high income and one in 27 in countries with low/lower
middle income received at least minimally adequate treatment for major depressive
disorder. The integration of mental health care into primary care has been advocated
by WHO since an expert committee report on the ‘Organization of mental health
services in developing countries’ was published in 1975. Twenty years later, a large
international WHO study on ‘Mental Illness in general health care’ demonstrated the
significance (and treatability) of psychological disorders in primary care across
cultures and resource settings.
Types of Marginalized populations
Persons with disabilities, youth, women, lesbian, gay, bisexual, transgender and
intersex people, members of minority groups, indigenous people, internally displaced
persons, and non-national, including refugees, asylum seekers and migrant workers
are just a few examples of marginalized populations. The list of marginalized groups
‘most at risk’ is long and the challenges they face worldwide in exercising, or seeking
to exercise, their assembly and association rights are enormous.

Individuals from minoritized ethnic communities are generally less likely to use
mental healthcare services than the majority white population. Some of the reasons for
disparities in mental health utilization by marginalized ethnic groups include provider
discrimination, lack of adequate health insurance, high costs, limited access to quality
care, stigma, mistrust of the healthcare system, and limited awareness about mental
illnesses.

Studies have shown that systemic racism often means that people of color and those
belonging to other marginalized ethnic groups do not receive the mental health
support they need. Providing mental health care for these groups represents a
particular challenge, and evidence on good practice is required. Various studies show a
higher prevalence of psychiatric disorders in marginalized groups than in the
age-matched general population. Providing mental health care for people from these
groups represents a particular challenge.

Additionally, marginalized groups can face significant administrative and financial

obstacles in accessing health services and be neglected in the distribution of health
resources. Services providing mental health care can struggle to reach people with
mental disorders in these groups and engage them in care. Compounding these various
difficulties, there is limited systematic research evidence to guide service provision for
these groups.

Definition of certain Marginalized groups

· The definition of long-term unemployed was based on the EUROSTAT definition:
a person of the national working age, who has been out of employment for twelve
months or longer.

· The definition of homelessness encompassed two categories: rooflessness

(sleeping rough or in emergency accommodation) and houselessness (sleeping in
hostels or other temporary accommodation).
· Asylum seekers and refugees were defined in relation to the 1951 UN
Convention Relating to the Status of Refugees. An asylum seeker was defined as a
person who is seeking international protection by applying for refugee status as
defined by the 1951 UN Convention, but whose claim has not yet been decided by
the relevant authorities.

· A refugee was defined as a person who has been granted such a status. Irregular
migrants were defined as those who are not in possession of a legal residency
permit in the host country, which includes failed asylum seekers.

· Travelling communities were defined as any communities that are committed to

a nomadic or travelling lifestyle and/or see travelling as an important part of their
cultural identity. This definition also included those who are settled but face
marginalization because of associations with travelling lifestyle traditions.

Further Emphasis
Gender:
Gender inequality has a profound effect on mental health worldwide. Some of the
psychological effects of gender inequality include higher levels of stress, anxiety,
depression, and post-traumatic stress disorder (PTSD) in women and people of
marginalized genders.

Gender inequality manifests itself in many ways. People can experience mental health
conditions as a direct result of gender-based discrimination or violence, for example.
They can also develop conditions indirectly as a result of exposure to socioeconomic
inequality, chronic stress, and harmful messages in the media. It also refers to the
differences between genders in terms of status, power, wealth, health, and
employment. When these differences are avoidable and unfair, it is known as gender
inequity.

According to a 2020 article, women with mental health conditions outnumber men by
as much as two or threefold, depending on the condition.

In comparison to men, women are:

● twice as likely to have generalized anxiety disorder

● twice as likely to have panic disorder

 ● approximately twice as likely to develop depression during their lifetime

● 4–10 times more likely to have an eating disorder

● more than twice as likely to develop PTSD

● more likely to attempt suicide, though men are 3.63 times more likely to die
by suicide

Men are equally likely to face mental health issues due to the complex factors that
influence their well-being. Societal norms often pressure men to adhere to traditional
expectations of masculinity, discouraging them from seeking help and expressing
emotions openly. This can lead to feelings of isolation, stress, and anxiety.
Additionally, societal stigma surrounding mental health further hinders men from
seeking support. It is crucial to challenge these norms, promote mental health
awareness, and create safe spaces for men to address their mental health concerns. By
fostering understanding and encouraging help-seeking behaviors, we can work
towards breaking the barriers that prevent men from accessing the support they need.

While it is true that many factors play a role in mental illness, including biological
differences between sexes, women are overrepresented in these statistics, as well as in
statistics for chronic physical illnesses. Studies have shown a link between
experiencing discrimination and mental health symptoms. Sexism also exposes people
to many of the risk factors of mental health conditions, including chronic stress,
negative self-image, and trauma.

Traumatic events can affect people differently. If the symptoms persist for long
periods after a traumatic event, people may meet the criteria for PTSD. Women are
also more likely to experience childhood neglect, intimate partner abuse, the sudden
loss of a loved one, and harmful practices such as female genital mutilation (FGM).
Childhood abuse is also strongly linked to depression.

LGBTQ+:
LGBTQ+ health refers to the physical, mental, and emotional wellbeing of lesbian,
gay, bisexual, transgender, queer, and intersex (LGBTQI+) people. LGBTQI+ people
represent a subset of individuals among the broader category of sexual and gender
diverse individuals. Sexual orientation, gender identity and expression (SOGIE) is
diverse and spans cultures across the world.
Individuals experience common and unique barriers to the enjoyment of the highest
attainable standard of health based on SOGIE. They are less likely to access health
services and engage with healthcare workers due to stigma and discrimination and
bear a disproportionate burden of adverse physical and mental health outcomes. As a
community, they are more likely to experience human rights violations including
violence, torture, criminalization, involuntary medical procedures, and discrimination.
In addition, they face denial of care, discriminatory attitudes, and inappropriate
pathologizing in healthcare settings.

Another reason for the disparity is minority stress: the negative impact of living with a
stigmatized identity. Despite advances in human rights for LGBTQ people, societal
disapproval and stigma remain prevalent. This contributes to various forms of
marginalization, including harassment, bullying, discrimination, microaggressions,
and family rejection. These negative experiences can subsequently contribute to
proximal minority stress, which are psychological reactions like self-stigma, rejection
sensitivity, and concealment of sexual orientation, all of which can interfere with the
formation and maintenance of stable, satisfying relationships.

Religion:
Although the impact of discrimination on mental health has been increasingly
discussed, the effect of religious discrimination has not been examined systematically.
The prevalence of perceived religious discrimination and its association with common
mental disorders is often forgotten. Religion has been an important source of
resiliency for many racial and ethnic minority populations. Religion has undoubtedly
been an important source of resiliency for many racial and ethnic minority
populations, and its narrative of perseverance and faith has proven to be a sustaining
force for these populations in the face of hardships and inequality.

Religiosity is a multidimensional concept that encapsulates a range of attitudes,

beliefs, and behaviors. Although religion is associated with a wide range of mental
health benefits, some aspects of religious involvement are harmful to mental health
and well-being. Religious doubt, religious extremism, are often stressors as well.
What a certain religion might or might not accept can also lead to negative mental
health, which is often seen in LGBTQI+ community.
Persons with Disabilities:
A recent study found that adults with disabilities report experiencing more mental
distress than those without disabilities. In 2018, an estimated 17.4 million (32.9%)
adults with disabilities experienced frequent mental distress, defined as 14 or more
reported mentally unhealthy days in the past 30 days. Frequent mental distress is
associated with poor health behaviors, increased use of health services, mental
disorders, chronic disease, and limitations in daily life. During the COVID-19
pandemic, isolation, disconnect, disrupted routines, and diminished health services
have greatly impacted the lives and mental well-being of people with disabilities.

Indigenous people:
It is estimated there are 5000 to 6000 distinct groups of indigenous peoples living in
more than 70 countries. Their numbers total about 250 million persons, or four to five
percent of the world's population. This population is far from homogeneous. While it
may be true that indigenous peoples share a close attachment to their land, commonly
lack statehood, are subject to economic and political marginalization, and are the
objects of cultural and ethnic discrimination, they exhibit wide diversity in lifestyles,
cultures, social organization, histories, and political realities. Depression, substance
abuse, and suicide represent the areas of greatest need with regard to the mental health
of indigenous peoples.

Indigenous populations face different barriers and are less likely than majority
populations to receive professional help for mental health.

● Historical and intergenerational trauma – the psychological effects of forced

relocation, assimilation, and other traumas inflicted on Indigenous peoples
have long-lasting effects and can be passed from generation to generation.

● Racism, bias and discrimination, which can harm both physical and mental
health.

● Geographic challenges, including isolation from services for those in very

rural areas and isolation from family, culture and community for those
living in urban areas
Refugees:
Migrants and refugees often face various problems and stressors which can take place
at various stages of the migration process:

1) Pre-migration: lack of livelihoods and opportunities for education and

development, exposure to armed conflict, violence, poverty and/or persecution.

2) Migration travel and transit: exposure to challenging and life-threatening

conditions including violence and detention and lack of access to services to
cover their basic needs.

3) Post-migration: barriers to accessing health care and other services to meet

their basic needs as well as poor living conditions, separation from family
members and support networks, possible uncertainty regarding work permits
and legal status (asylum application), and in some cases immigration detention.

4) Integration and settlement: poor living or working conditions, unemployment,

assimilation difficulties, challenges to cultural, religious, and gender identities,
challenges with obtaining entitlements, changing policies in host countries,
racism and exclusion, tension between host population and migrants and
refugees, social isolation and possible deportation.

All the above-mentioned stressors can increase the risk of developing mental health
conditions. For example, unemployment, poor socioeconomic conditions, and lack of
social integration among migrants and refugees are risk factors for mental health
conditions such as depression.

Factors that negatively impact the mental health and well-being of migrant and
refugee children include socioeconomic deprivation, discrimination, racism, low
family cohesion, and frequent school changes. Children who have been separated
from migrating parents are at heightened risk of developing depression, anxiety,
suicidal ideation, conduct disorder, and substance use problems.

On the other hand, the impact of stressors can be buffered by protective factors such
as access to employment and services, social support, proficiency in the language of
the host country, and family reunification. Among resettled refugee children,
protective factors include better socioeconomic status, access to education, a
perceived sense of safety, contacts with family, living and socializing alongside other
people of the same ethnic origin, a stable and cohesive family structure and good
parental mental health.
What are the modes through which an individual’s mental health gets
affected?
Individual psychological and biological factors such as emotional skills, substance use
and genetics can make people more vulnerable to mental health problems. Exposure to
unfavorable social, economic, geopolitical, and environmental circumstances –
including poverty, violence, inequality, and environmental deprivation – also increases
people’s risk of experiencing mental health conditions.

Mental health risks and protective factors can be found in society at different scales.
Local threats heighten risk for individuals, families, and communities. Global threats
heighten risk for whole populations and include economic downturns, disease
outbreaks, humanitarian emergencies and forced displacement and the growing
climate crisis.

Mental health and the pandemic

While the pandemic is primarily a physical health crisis, it has also had widespread
impact on people's mental health, inducing, among other things, considerable levels of
fear, worry, and concern. The growing burden on mental health has been referred to by
some as the 'second' or 'silent' pandemic.

While negative mental health consequences affect all ages, young people, in
particular, have been found to be at high risk of developing poor mental health.
Specific groups have been particularly hard hit, including health and care workers,
people with pre-existing mental health problems, and women. The pandemic has also
appeared to increase inequalities in mental health, both within the population and
between social groups.
 CASE STUDY
Primary care for mental health for disadvantaged communities in
London, The United Kingdom

In Waltham Forest Primary Care Trusts (PCT), in the UK, two practices were
contracted to provide an integrated primary care service to vulnerable groups such as
asylum seekers, refugees, and homeless people. In particular, the service sought to
reach people not normally in contact with health services and people from minority
ethnic groups. This service offered a four-step approach to deliver holistic integrated
services in primary care.

I) During step I, general practices provided written and verbal information to

patients about mental disorders as well as how to access more specialized
mental health care services, housing, employment, and social services. Further
assistance, guidance and support was provided by an individual, usually a
mental health service user, who had the specific responsibility of promoting
self-help and social inclusion among patients.

II) During step II, the primary care practices undertook mental health and
psychosocial assessments of their patients, sometimes using standardized
screening and assessment instruments. Depending on the complexity of the
problem, patients were either managed in the practice or were referred to
appropriate secondary-level and community-based services within the PCT.
Psychological therapies, including cognitive-behavioral therapy, were provided
within the general practice by a counselor or referred to more specialized
services if needed.

III) In relation to step III, patients were referred to organizations or institutions that
could assist them with economic and social problems.

IV) Step IV relates to people who previously had been acutely ill, but were now
stable. These patients received holistic mental and physical health care within
the primary care setting, while at the same time reducing the load on secondary
level services. In addition, the practice had established linkages with
community mental health teams, hospitals, acute psychiatric services, local
pharmacies, social care advisers, legal services, the voluntary sector, service
user groups, and community groups.
This project demonstrated that, with appropriate support, disenfranchised population
groups can be managed within primary care. Since its establishment, the majority of
the program’s patients with a mental disorder were treated in primary care. The
number of patients with a severe mental disorder recorded on patient registers had
increased, with the suggestion of increased active management of these patients by the
general practitioners.

WHO Recommendations
Clearly the provision of effective mental healthcare at primary healthcare level is
highly dependent on the pre-existence of a well-functioning primary care system.
Sufficient resources (financial and human) are also a pre-requisite for effective mental
health treatment at this level of care.

Some of the recommendations are:

· Policies, Plans

· Laws and provisions

· Human resource development and further training

· Constant supervision and support wherever required

 Conclusion

This agenda calls for urgent attention and collective action by all the countries. It has
become evident that the integration of mental health into primary healthcare systems
is a critical step towards addressing the needs of marginalized populations and
ensuring their overall well-being.

The discussions and deliberations that are to be held within the committee must shed
light on the multifaceted nature of mental health issues and the unique challenges
faced by marginalized communities. It is imperative that recognition of the disparities
in access to mental healthcare services and work towards bridging the gap to achieve
equitable and more inclusive systems. The committee is expected to explore
innovative strategies, evidence-based interventions, and collaborative approaches to
effectively integrate mental health into primary healthcare. It is crucial to address the
social determinants of mental health and develop comprehensive policies that
prioritize prevention, early intervention, and holistic care for marginalized
populations.

Furthermore, the committee is encouraged to consider the importance of

destigmatizing mental health, raising awareness, and promoting community-based
initiatives that empower individuals and promote mental well-being. It must also be
emphasized that the significance of cross-sectoral collaboration, involving
governments, healthcare professionals, civil society organizations, and other
stakeholders, is required to foster an integrated and sustainable approach to mental
healthcare.

In conclusion, the integration of mental health into primary healthcare systems with a
special emphasis on marginalized populations requires a holistic and inclusive
approach. The solutions that are to be discussed should strive to address the unique
needs and challenges faced by marginalized communities, ensuring that mental health
services are accessible, affordable, and of high quality. By working together, we can
make significant progress in improving mental health outcomes and creating a more
inclusive and equitable healthcare system for all.

Our committee's recommendations should contribute to positive change, ensuring that

everyone receives the mental health support that they deserve and a future where
mental healthcare is accessible, inclusive, and responsive to the needs of all
individuals.
 Questions a Resolution must Answer (QARMA)

1. What is the need for the integration of Mental health into Primary healthcare
systems?

2. What steps can the WHO take ensure that the marginalized communities get the
proper and equal treatment in their respective countries?

3. How can we bring more attention in getting mental health care more accessible for
everyone despite their financial status?

4. What are the important things which would account for the mental well-being of
every individual?

5. What are some of the key objectives that integrated mental and behavioral health
care can provide?

6. How was the COVID-19 pandemic responsible in the increase of Mental health
related issues?

7. What are some of the existing measures taken by the international community
through treaties, resolutions, and laws to keep this issue in check?

8. How can we achieve this in third world countries that do not have enough
resources to maintain even primary healthcare systems?

9. What trends can be followed to modernize the process through which individuals’
mental health is given attention?
 Relevant resources for further reading

WHO Constitution

Alma- Ata Declaration of 1978 on Primary Health care

https://cdn.who.int/media/docs/default-source/documents/almaata-declaration-en.pdf?
sfvrsn=7b3c2167_2

https://pubmed.ncbi.nlm.nih.gov/28922319/

https://www.medicalnewstoday.com/articles/why-mental-healthcare-is-less-accessible-
tomarginalized-communities

https://www.reuters.com/article/us-health-crisis-mental-who-idUSKCN0XA1M7

https://www.aafp.org/pubs/fpm/issues/2021/0500/p3.html

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001443

https://www.europarl.europa.eu/RegData/etudes/BRIE/2021/696164/EPRS_BRI(2021
)696164_EN.pdf