world health organization - limun · 2016. 1. 30. · points a resolution should address 9 further...

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LONDON INTERNATIONAL MODEL UNITED NATIONS 2016 .

World Health Organization London International Model United Nations 17th Session | 2016

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Table of Contents

Topic A: The question of antibiotic resistance

Scope of the Problem 3

Definition of Key Terms 5

Discussion of the Problem 5

Points a Resolution Should Address 9

Further Reading 9

Key Resolutions and UN Documents 10

Sources 11

Topic B: Mental health action plan (2013-20): Promoting care and treatment

Introduction 13

Statement of the Problem 15

Key Projects 17

Discussion of the Problem 18

Points a Resolution Must Answer 25

Further Reading 26

Sources 27

Conference Information 28

Position Papers 29

Contact Details 30

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Topic A: The question of antibiotic resistance

Introduction

Antibiotics have been in use since the 1940s to treat patients who have

bacterial infections.1 For the past 70 years, these drugs have effectively

reduced illness and death from infections by targeting bacteria. However,

these drugs have been used very widely for a long period of time such that the

bacteria they target have adapted, making the drugs less effective.1

“Antibiotic resistance occurs when an antibiotic has lost its ability to effectively

control or kill bacterial growth; in other words, the bacteria are “resistant” and

continue to multiply in the presence of therapeutic levels of an antibiotic.”2

Antibiotic resistance is a natural phenomenon. Bacteria that are resistant to a

specific antibiotic have a higher chance of survival in the presence of that

antibiotic, compared to other susceptible bacteria which are more likely to be

killed or inhibited by the antibiotic.2 Thus the resistant bacteria are more likely

to grow and multiply. Though antibiotic resistance occurs naturally, the level of

antibiotic resistance is exacerbated by the abuse and overuse of antibiotics.

For example, in some countries and through online markets, there are some

antibiotics which can be acquired without a doctor’s prescription.2 Antibiotics

are often taken when they are not needed or to treat viral infections for which

they are ineffective. Though some bacteria are naturally resistant to certain

antibiotics, they may also become resistant through a genetic mutation or by

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acquiring resistance from another bacterium. Resistant bacteria can pass

this trait to their offspring and to other kinds of bacteria.3

Bacteria that acquire resistance may be capable of resisting one or more type

of antibiotics. They can become resistant to several types of antibiotics due to

their ability to collect multiple resistance traits.2 Antibiotic resistant bacterial

infections raise the levels of disease and death, as well as extending the

duration of time people stay in hospitals.4 Additionally, only few new antibiotics

are being developed.4 Thus, it will become more difficult to treat infections as

bacterial resistance develops. Drastic change should be undertaken in the

way antibiotics are prescribed and used. Without behavioural change,

antibiotic resistance will only increase as a threat, even if new drugs are

developed.5

In many countries, using an antibiotic is easier than resorting to other solutions.

It is also cheap, and highly desired because of its reputation for being effective

at treating illnesses. This misconception arises because antibiotics are indeed

highly effective as a treatment, but only as a treatment of bacterial infections.

Different antibiotics are specific to different kinds of bacterial infections, and

should not be used to treat other illnesses such as viral infections. Unfortunately,

however, many people are unaware of this, or simply do not care, simply

seeking the cheapest and easiest form of medication.

Scope of the Problem

Antibiotic resistance is a global problem, especially with the ease and

frequency with which people travel. The accomplishments of modern

medicine are at risk as a result of antibiotic resistance. Without effective

antibiotics for the prevention and treatment of bacterial infections, the risk of

several medical treatments such as organ transplantations, chemotherapy

and surgeries increases.5

“Each year in the United States, at least 2 million people become infected with

bacteria that are resistant to antibiotics and at least 23,000 people die each

year as a direct result of these infections.”1 And “in the European Union alone,

drug-resistant bacteria are estimated to cause 25,000 deaths and cost more

than US$1.5 billion every year in healthcare expenses and productivity losses.”5

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Definition of Key Terms

Antibiotic Resistance – According to the WHO, it is the resistance to antibiotics

that occurs in common bacteria that cause infections.8

Antimicrobial resistance – According to the WHO, this refers to broader

categories of drug resistance that treats infections caused by other microbes

as well as antibiotics, such as parasites (for example, malaria), viruses (for

example, HIV) and fungi (for example, Candida).8

Multidrug Resistance (MDR) – Antimicrobial resistance presented by certain

microorganisms to various antimicrobial drugs. The most dangerous MDR is

known to be the MDR bacteria that are resistant to multiple antibiotics.9

Extensively Drug Resistant (XDR) – Often used to describe a specific degree of

Tuberculosis, Extensively Drug Resistant Tuberculosis (XDR-TB) is a type of TB due

to anti-TB drug resistance. The misuse of first line anti-TB drugs such as isoniazid

and rifampicin, leads to the use of second line anti-TB drugs including

amikacin, kanamycin and capreomycin. Inadequate management of

second line drugs leads to extensive drug resistance.9

Discussion of the Problem

Public health issue

If someone becomes infected with antibiotic resistant bacteria, these resistant

bacteria can spread to other people. When antibiotics are no longer

successful in treating bacterial infections, the result is longer or more

complicated illnesses, more frequent and longer visits to healthcare

practitioners, the use of stronger and more expensive drugs, and higher rates

of fatalities. Antibiotic resistance also impacts the economy as it leads to more

sick leaves, and more funds must be set aside for research and development

of new drugs.6 The resistance is accelerated by the misuse and overuse of

antibiotics, as well as poor infection prevention and control.5

Public Perspective and Awareness

The general public has some responsibility in keeping antibiotic resistance at

bay. They can prevent infections by regularly washing hands, maintaining

hygiene when dealing with food, and ensuring they are up-to-date with their

vaccinations. Antibiotics should only be used when they are prescribed, and

the full prescriptions should be followed.5 The full course of the drug should be

completed, even if the patient is feeling better. Using left-over antibiotics

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and/or taking antibiotics prescribed for others are bad practice and

should be avoided.5 6

Furthermore, in most countries patients have the right to choose their

treatment. However, this is sometimes abused by patients who incorrectly

believe that antibiotics are the best course of actions due to the public

mentality of antibiotics being a successful treatment for everything, as

discussed earlier. This means that physicians are placed in awkward positions

by their patient only to end up feeling obliged to prescribe antibiotics to a

patient who is not in need of them.

Protecting the food supply

Antibiotic resistance is also an issue with animals raised for meat-consumption

which are treated with antibiotics. The antibiotics will kill most harmful bacteria;

however, misuse of antibiotic treatments can lead to antibiotic resistance. This

misuse is often in the form of exposing the bacteria to low doses of an antibiotic

over a long period of time. The resistant bacteria are then passed to humans

who handle or eat contaminated meat or produce.3

Government policies

Nations and governments also have the responsibility of tackling the issue of

antibiotic resistance. This can be achieved through national action plans,

surveillance of bacterial infections, and improving infection control and

prevention schemes. It is also the role of governments to regulate and promote

the correct use of medicines. By moreover rewarding developments in the field

of antibiotic treatments, governments can encourage further research about

antibiotic resistance and the development of new drugs.5

In many countries, especially developing ones, giving antibiotics is simply the

easiest thing, as there is limited research into alternative solutions, and

antibiotics are cheaper to import than other drugs. China and India, for

example, are important sources of inexpensive medicines, including

antibiotics.14

The greater responsibility of governments, however, is in their health systems,

and how they work. There are different policies governing the sale of

medications, especially when it comes to antibiotics. Different countries have

varying laws about which medicines can be sold over the counter, and which

need a prescription.

In a survey conducted by the WHO in Europe, it was found that:

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“In 19 countries, people can legally buy some antibiotics over the

counter;

In many countries, the general public can still buy antibiotics over the

counter, without a diagnosis or prescription, and use them at will;

In 5 countries, people can buy antibiotics on the Internet without a

prescription; and

In 12 countries, people can buy antibiotics from other sources than a

pharmacy, such as the black market or veterinary clinics.”13

Providing countries with better and more diverse access to healthcare

Due to lack of research and funding, it may be argued that there is no better

current alternative solution to using antibiotics, especially in developing

countries. In addition, antibiotics are cheaper and easier to provide than some

other drugs. Many countries are unable to provide funding for research about

antibiotic resistance or for the development of new medications.

In order to address antibiotic resistance, WHO needs to first address how these

countries can get better and more diverse access to healthcare. The

committee needs to look into how more people and countries can be

provided with a wide range of cheaper medications, and how training can be

provided to healthcare practitioners and government policy makers. Some

other things to consider are sanitation and vaccinations to decrease the

spread of infectious diseases.

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WHO response

“Tackling antibiotic resistance is a high priority for WHO. A global action plan

on antimicrobial resistance, including antibiotic resistance, was endorsed at

the World Health Assembly in May 2015. The global action plan aims to ensure

that the prevention and treatment of infectious diseases with safe and

effective medicines continues.”

The global action plan has 5 strategic objectives, which are supplemented by

member states’ national action plans. These are: to improve awareness and

understanding of antimicrobial resistance, to strengthen surveillance and

research, to reduce the incidence of infection, to optimize the use of

antimicrobial medicines, and to ensure sustainable investment in countering

antimicrobial resistance.5 Furthermore, not only the national action plans, but

also establishing integrated global programme for antibiotic resistance

between different sectors of the economy was recommended by the WHO.

Country priorities

The problem of antibiotic resistance is widespread among high, middle and

low-income countries. Both economic and health consequences of

antimicrobial resistance are burdening countries regardless of their level of

development. Although it is understood that significant amounts of investment

have already been made in tackling the problem, more investment is needed.

Especially financial and technical help to low and middle income countries will

be an important factor.

Technical assistance that can be provided to developing countries by

developed countries includes: control and spread of new antibiotics, diagnosis

methods of disease requiring antibiotics, preservation of existing antibiotics

and promoting the use of appropriate antibiotics.

As the Global Action Plan on Antibiotics takes into account countries at various

stages of economic development, all high, middle and low-income countries

should follow the plan and report to their governments, which will then be

passed on to the Sixty-ninth World Health Assembly. Furthermore the discussion

between UN bodies and governments should be done in order to identify the

optimum method of investment for efficient implementation of assistance

provided by developed countries.15

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Points a resolution should address

Is the WHO strategy effective enough to tackle the issue of antibiotic

resistance?

How can this strategy be adapted at a regional and global level?

How can public awareness of the issue be raised and public mentality

on the matter changed?

How can we ensure that the public is following the instructions provided

by their healthcare practitioners and by the labelling (if any) on

antibiotics?

How can we ensure that the agricultural sector is following tight

guidelines (if any) on the administration of antibiotics?

How can better and more diverse healthcare reach wider regions of the

world?

Is it the responsibility of the healthcare industry to tackle antibiotic

resistance or should the role be taken on by policy makers and

government officials? Who will provide the funds for any such schemes

of research and development of new antibiotics?

How can a balance between careful antibiotic use and economic gain

be achieved?

How can the WHO more effectively tackle outbreaks of resistant

bacterial infections?

Further reading

Antibiotic/Antimicrobial Resistance – Centers for Disease Control and Prevention

http://www.cdc.gov/drugresistance/protecting_patients.html

This link is useful in describing in more detail the measures that should be taken by

healthcare workers to prevent antibiotic resistance.

Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations – The

review on antimicrobial resistance, Chaired by Jim O’Neil, December 2014

http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-

%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nation

s_1.pdf

Focus should be on “The economic cost of drug-resistant infections” (page 6) and

“Future Work – already we see cause for optimism” (page 14).

WHO Global Strategy for Containment of Antimicrobial Resistance – World Health

Organisation WHO/CDS/DRS/2001.2

http://www.who.int/drugresistance/WHO_Global_Strategy_English.pdf

Focus should be on Part B, “Appropriate antimicrobial use and emerging resistance:

issues and interventions” (page 19 onwards) with extra focus on Chapter 8 which

discusses the international aspects of containing microbial resistance. Part C (page

http://www.cdc.gov/drugresistance/protecting_patients.html

http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf



http://www.who.int/drugresistance/WHO_Global_Strategy_English.pdf

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61 and onwards) is also critical as it points out important features on the

implementation of the WHO strategy.

Global Action Plan on Antimicrobial Resistance – World Health Organisation

http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1

This document is one of the core documents for the topic, as it provides wide ranges

of topics starting from the introduction to drug resistance, the progress of the topic,

challenges we face and strategies to overcome these challenges.

Antimicrobial prescribing and Stewardship competences, Public Health England

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/25

3094/ARHAIprescrcompetencies__2_.pdf

Focus points should be on: Infection prevention and control (page 7), antimicrobial

resistance and antimicrobials (page 7) and monitoring and learning (page 10).

National Strategy for Combating Antibiotic-Resistant Bacteria – The White House

Washington

https://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf

Focus points should be on “Goal 5 – Improve International Collaboration and

Capacities for Antibiotic Resistance Prevention, Surveillance, Control and Antibiotic

Research and Development” (page 20), and “Table 2 & 3 – Goals and Objectives for

Combating Antibiotic Resistant Bacteria and National Targets for Combating

Antibiotic Resistant Bacteria” (pages 29 – 33).

Key resolutions and UN documents

13 June 2015

C2015/28: Status Report

“Status Report on Antimicrobial Resistance”

http://www.fao.org/3/a-mm736e.pdf

26 May 2015

WHA68.7: Resolution

68th World Health Assembly – Global action plan on antimicrobial resistance

http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R7-en.pdf

18 May 2015

A68/3: 68th World Health Assembly, Agenda item 3

“Address by Margaret Chan, Director-General to the Sixty-eighth World Health

Assembly”

http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_3-en.pdf

27 March 2015

A68/20 68th World Health Assembly, Provisional agenda item 15.1

“Antimicrobial Resistance – Draft global action plan on microbial resistance”


20 March 2015

A68/19: 68th World Health Assembly, Provisional agenda item 15.1

“Antimicrobial resistance-summary report on progress made implementing resolution

WHA67.25 on antimicrobial resistance”


https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253094/ARHAIprescrcompetencies__2_.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253094/ARHAIprescrcompetencies__2_.pdf

https://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf

http://www.fao.org/3/a-mm736e.pdf



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26 June 2015

Outcome Statement: The Hague Ministerial Meeting

“Joining Forces for Future Health”

http://www.who.int/drugresistance/events/Outcome_Statement_haguemeeting_20

14_english.pdf?ua=1

24 May 2014

WHA67.25: Resolution

67th World Health Assembly- Antimicrobial resistance


24 January 2014

EB134.R13: WHO Resolution

134th Session–Combating antimicrobial Resistance including antibiotic resistance

http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_R13-en.pdf

Sources

1. Cdc.gov. Antibiotic / Antimicrobial Resistance | CDC [Internet]. 2015 [cited 3

December 2015]. Available from: http://www.cdc.gov/drugresistance/

2. Tufts.edu. Alliance for the Prudent Use of Antibiotics [Internet]. 2015 [cited 3

December 2015]. Available from:

http://www.tufts.edu/med/apua/about_issue/about_antibioticres.shtml

3. cdc.org. Antibiotic Resistance and Food Safety [Internet]. 2015 [cited 3

December 2015]. Available from: http://www.cdc.gov/narms/faq.html

4. Nhs.uk. Antibiotic awareness - The NHS in England - NHS Choices [Internet].

2015 [cited 3 December 2015]. Available from:

http://www.nhs.uk/NHSEngland/ARC/Pages/AboutARC.aspx

5. World Health Organization. Antibiotic resistance [Internet]. 2015 [cited 3

December 2015]. Available from:

http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/

6. fda.gov. Combating Antibiotic Resistance [Internet]. 2015 [cited 3 December

2015]. Available from:

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm092810.htm

7. National Evidence-Based Guidelines for Preventing Healthcare-Associated

Infections in NHS Hospitals in England, H.P Loveday, J.A Wilson, R.J PRATT,

Journal of Hospital Infections, 8651 (2014) S1-S70.

8. Official WHO website: www.who.int

9. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria:

An international expert proposal for interim standard definitions for acquired

resistance, A.P Magiorakos, A.Srinivasa, R.B Carey et.al, 2011 European

Society of Clinical Microbiology and Infectious disease 18, 268-281.

10. World Antibiotic Awareness Week, Official Article, Official World Health

Organisation Website: http://www.who.int/mediacentre/events/2015/world-

antibiotic-awareness-week/event/en/

11. Mainous A, Everett C, Post R, Diaz V, Hueston W. Availability of Antibiotics for

Purchase Without a Prescription on the Internet. The Annals of Family

Medicine [Internet]. 2009 [cited 16 December 2015];7(5):431-435. Available

from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746509/


http://www.who.int/drugresistance/events/Outcome_Statement_haguemeeting_2014_english.pdf?ua=1

http://www.who.int/drugresistance/events/Outcome_Statement_haguemeeting_2014_english.pdf?ua=1


http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_R13-en.pdf

http://www.cdc.gov/drugresistance/

about:blank

about:blank

http://www.cdc.gov/narms/faq.html

http://www.nhs.uk/NHSEngland/ARC/Pages/AboutARC.aspx

http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm092810.htm

http://www.who.int/

http://www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/event/en/

http://www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/event/en/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746509/

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12. MARKEL H. No Prescription for Antibiotics? No Problem [Internet].

Nytimes.com. 2015 [cited 16 December 2015]. Available from:

http://www.nytimes.com/2002/11/12/health/no-prescription-for-antibiotics-

no-problem.html?_r=0

13. WHO Europe. Pharmacists have decisive role in combating antibiotic

resistance, says new WHO European survey [Internet]. 2014. Available from:

http://www.euro.who.int/__data/assets/pdf_file/0003/263109/Press-release,-

Pharmacists-have-decisive-role-in-combating-antibiotic-resistance,-says-new-

WHO-European-survey.pdf

14. Hafner T, Popp D. China and India as Suppliers of Affordable Medicines to

Developing Countries. [Internet]. 2011 [cited 16 December 2015]. Available

from: http://www.nber.org/papers/w17249

15. Sixty-eighth World Health Assembly, Global Action Plan on antimicrobiral

resistance, WHA68.7, 26 May 2015, available from:


http://www.nytimes.com/2002/11/12/health/no-prescription-for-antibiotics-no-problem.html?_r=0

http://www.nytimes.com/2002/11/12/health/no-prescription-for-antibiotics-no-problem.html?_r=0

http://www.euro.who.int/__data/assets/pdf_file/0003/263109/Press-release,-Pharmacists-have-decisive-role-in-combating-antibiotic-resistance,-says-new-WHO-European-survey.pdf



http://www.nber.org/papers/w17249

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Topic B: Mental health action plan (2013-20):

Promoting care and treatment

Introduction

Mental health presents one of the greatest challenges that current and future

generations will face. In terms of health the burden created by mental health

problems and mental illness is immense and growing. Mental health should be

a concern for us all because it affects us all. On an individual level, mental

health problems affect our ability to function day to day and our overall quality

of life. When you consider such problems collectively, the effect on society is

considerable. Mental health and well-being are not nearly as well understood

as other areas of health. We are not giving mental health the attention

demanded by its impact on society. If we are to promote mental health and

prevent and treat mental illness, better documentation, analysis and

comprehension are crucial. Presenting the facts in a way that is accessible and

useful to the many people who have a contribution to make is vital to

improving understanding.1

Three quarters of people with mental health problems receive no treatment.

We can all understand that mental health problems may destroy lives, often

starting at an early age and they have an impact on families, colleagues,

communities and indeed on the economy. We have opportunities to do far

more to prevent problems occurring, to step in early or to sustain recovery.2


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Depression and anxiety are the most widespread conditions, while only a

small percentage of people experience more severe mental illnesses.

However, estimates of exactly how many people experience which mental

health problems vary, and it is not easy to compare different measures.3

It is estimated that approximately 450 million people worldwide have a mental

health problem. Although mental disorders are widespread, severe cases are

concentrated among a relatively small proportion of people who often

experience more than one mental health problem. Furthermore, 1 in 4 families

worldwide is likely to have at least one member with a behavioral or mental

disorder.3

A recent index of 301 diseases found mental health problems to be one of the

main causes of the overall disease burden worldwide. In 2010, mental health

and behavioral problems such as depression, anxiety and drug use, were

reported to be the primary drivers of disability worldwide, causing over 40

million years of disability in 20 to 29 year-olds. According to the 2010 Global

Burden of Disease Study, the most predominant mental health problems

worldwide are depression and anxiety. The 2010 Global Burden of Disease

Study also found major depression to be the second leading cause of disability

worldwide and a major contributor to the burden of suicide and ischemic

heart disease. Globally, up to 90% of people diagnosed with anxiety and

depression are treated in primary care. However, there are many individuals

who are undiagnosed and therefore do not seek treatment.4

Suicide and self-harm can results from mental health problems. There are also

certain factors that can make individuals more vulnerable to risk of suicide,

including drug and alcohol misuse, history of trauma or abuse, unemployment,

social isolation, poverty, poor social conditions, imprisonment, violence, and

family breakdown. Caution should be exercised when trying to compare

suicide rates between countries. National differences in recording, registration

and reporting of deaths present as challenges when interpreting the data.5

When tackling mental health, it is also important to challenge myths and

stereotypes. One of the most discriminatory stereotypes that persists is the

incorrect association between mental health problems and violent behavior.

The media may play a role in portraying that people with mental health

problems are violent. A 2011 study on discrimination in England reported that

14% of national newspaper articles addressing mental health issues referred to

those with mental health problems as being a danger to others. Most people

with mental health problems are not violent and most people who are violent

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are not mentally ill. Studies have shown that the estimated risk of violence

by people with mental health problems ranges from 3% to 5%. In fact, people

with mental health problems are more likely to be victims of violence.6

The World Health Organisation is committed to tackling mental health by

focusing on four key aspects of this issue:

1. strengthening effective leadership and governance for mental health,

2. providing comprehensive, integrated and responsive mental health and

social care services in community based settings,

3. implementing strategies for promotion and prevention in mental health,

and

4. strengthening information systems, evidence and research for mental

health.

Statement of the Problem

According to the WHO, mental health is “a state of well-being in which the

individual realizes his or her own abilities, can cope with the normal stresses of

life, can work productively and fruitfully, and is able to make a contribution to

his or her community.”7 It is estimated that only about 17% of U.S adults are

considered to be in a state of optimal mental health. There is emerging

evidence that positive mental health is associated with improved health

outcomes. Mental illness, on the other hand, is defined as “collectively all

diagnosable mental disorders” or “health conditions that are characterized by

alterations in thinking, mood, or behavior (or some combination thereof)

associated with distress and/or impaired functioning.” Depression is the most

common type of mental illness, affecting more than 26% of the U.S. adult

population. It has been estimated that by the year 2020, depression will be the

second leading cause of disability throughout the world, trailing only heart

disease. Evidence has shown that mental disorders, especially depressive

disorders, are strongly related to the occurrence, successful treatment, and

course of many chronic diseases including diabetes, cancer, cardiovascular

disease, asthma, and obesity and many risk behaviors for chronic disease, such

as, physical inactivity, smoking, excessive drinking, and insufficient sleep.8

Mental health is related to the promotion of well-being, the prevention of

mental disorders, and the treatment and rehabilitation of people affected by

mental disorders. Mental health problems are usually defined and classified by

medical professionals. But some mental health diagnoses are controversial,

and there is much concern in the field that people are too often treated

according to, or described by, their label. This can have a profound effect on

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their quality of life. For this reason, diagnostic labels should be used with

caution and do not necessarily indicate the severity of illness. Nevertheless,

diagnoses remain the most usual way of dividing and classifying symptoms into

groups.

Around 20% of the world's children and adolescents have mental disorders or

problems. About half of mental disorders begin before the age of 14. Similar

types of disorders are being reported across cultures. Neuropsychiatric

disorders are among the leading causes of worldwide disability in young

people. Yet, regions of the world with the highest percentage of population

under the age of 19 have the poorest level of mental health resources. Most

low- and middle-income countries have only one child psychiatrist for every 1

to 4 million people. Mental and substance use disorders are the leading cause

of disability worldwide. About 23% of all years lost because of disability is

caused by mental and substance use disorders.

About 800,000 people commit suicide every year. Over 800,000 people die

due to suicide every year and suicide is the second leading cause of death in

15 to 29 year-olds. There are indications that for each adult who died of suicide

there may have been more than 20 others attempting suicide. 75% of suicides

occur in low- and middle-income countries. Mental disorders and harmful use

of alcohol contribute to many suicides around the world. Early identification

and effective management are key to ensuring that people receive the care

they need.

Furthermore, war and disasters have a large impact on mental health and

psychosocial well-being. Rates of mental disorder tend to double after

emergencies. Moreover, mental disorders are important risk factors for other

diseases, as well as unintentional and intentional injury. Mental disorders

increase the risk of getting ill from other diseases such as HIV, cardiovascular

disease, diabetes, and vice-versa.

Stigma and discrimination against patients and families prevent people from

seeking mental health care. Misunderstanding and stigma surrounding mental

ill health are widespread. Despite the existence of effective treatments for

mental disorders, there is a belief that they are untreatable or that people with

mental disorders are difficult, not intelligent, or incapable of making decisions.

This stigma can lead to abuse, rejection and isolation and exclude people from

health care or support. Within the health system, people are too often treated

in institutions which resemble human warehouses rather than places of healing.

Human rights violations of people with mental and psychosocial disability are

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routinely reported in most countries. These include physical restraint,

seclusion and denial of basic needs and privacy. Few countries have a legal

framework that adequately protects the rights of people with mental disorders.

Globally, there is huge inequity in the distribution of skilled human resources for

mental health. Shortages of psychiatrists, psychiatric nurses, psychologists and

social workers are among the main barriers to providing treatment and care in

low- and middle-income countries. Low-income countries have 0.05

psychiatrists and 0.42 nurses per 100,000 people. The rate of psychiatrists in high

income countries is 170 times greater and for nurses is 70 times greater. And

finally, financial resources to increase services are relatively modest.

Governments, donors and groups representing mental health service users and

their families need to work together to increase mental health services,

especially in low- and middle-income countries. The financial resources

needed are relatively modest: US$ 2 per capita per year in low-income

countries and US$ 3-4 in lower middle-income countries.9 Despite the

challenges of the present, it is important that we look towards the future and

envision a world with good mental health for all.

Key projects

The Mental Health: Evidence and Research team (MER) at the WHO is deeply

committed to closing the gap between what is needed and what is currently

available to reduce the burden of mental disorders worldwide and to promote

mental health. The MER team transforms this objective into action through the

following core projects: Atlas, WHO-AIMS and Mental Health in Emergencies.

All of these projects aim to increase the information and evidence base on

mental health. In turn, this information can be used to strengthen mental health

care systems which will result in better care and services to individuals and

communities.10

The Mental Health Atlas Project is designed to collect and disseminate data

on mental health resources such as policies, plans, financing, care delivery,

human resources, medicines, and information systems in the world. The project

started in 2001 and the data was updated in 2005, 2011 and 2014.11

The World Health Organization Assessment Instrument for Mental Health

Systems (WHO-AIMS) is a new WHO tool for collecting essential information on

the mental health system of a country or region. The goal of collecting this

information is to improve mental health systems and to provide a baseline for

monitoring the change.12 The objectives of the project are to raise public and

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professional awareness of the inadequacies of existing mental health

resources and services and the large inequities in their distribution at national

and global level, and to provide useful information in planning for

enhancement of mental health resources. A pivotal publication that has come

out of this project is the new edition of Mental Health Atlas, published in 2014,

which is providing much of the baseline data against which progress towards

the objectives and targets of the Comprehensive Mental Health Action Plan

2013-2020 is to be measured. The Mental Health Atlas 2014 and the Mental

Health Atlas 2014 country profiles should prove useful in your research.

Finally, the target group for WHO work on mental health and psychosocial

support in emergencies is any population exposed to extreme stressors, such

as refugees, internally displaced persons, disaster survivors and terrorism-, war-

or genocide-exposed populations. A key publication from this group is the

mhGAP Humanitarian Intervention Guide (mhGAP-HIG).13 This guide contains

first-line management recommendations for mental, neurological and

substance use conditions for non-specialist health-care providers. It is a simple,

practical tool that aims to support general health facilities in areas affected by

humanitarian emergencies in assessing and managing acute stress, grief,

depression, post-traumatic stress disorder, psychosis, epilepsy, intellectual

disability, harmful substance use and risk of suicide. Furthermore, the “Building

back better: sustainable mental health care after emergencies” guide shows

how building better mental health systems was achieved in 10 diverse

emergency-affected areas and how much mental health is crucial to the

overall well-being, functioning, and resilience of individuals, societies, and

countries recovering from emergencies.

Discussion of the Problem

1. Difference in the extent of mental health problems

1.1 Gender differences

Men and women experience mental health problems in different ways. For

example, women are more likely to have been treated for a mental health

problem than men (29% compared with 17%). Depression is more common in

women than men. For women, 1 in 4 will require treatment for depression at

some time, compared with 1 in 10 men. The reasons for this are unclear, but

are thought to be due to both social and biological factors. Doctors are more

likely to treat depression in women than in men, even when they present with

identical symptoms. Women are also twice as likely to experience anxiety as

men. Of people with phobias or OCD, about 60% are female. On the other

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hand, men are more likely than women to have an alcohol or drug

problem. All personality disorder categories are more prevalent in men, apart

from the schizotypal category. Men are five times more likely than women to

be diagnosed with anti-social personality disorder. About 75% of people to die

by suicide are men. This proportion has been about the same for more than a

decade.

1.2 Minority ethnic groups

Minority ethnic groups can also disproportionally experience mental health

problems. In general, rates of mental health problems are thought to be higher

in minority ethnic groups in the UK than in the white population, but they are

less likely to have their mental health problems detected by a GP. Depression

in ethnic minority groups has been found to be up to 60% higher than in the

white population. Furthermore, mental health staff including psychiatrists, are

more likely to perceive patients from minority groups as being potentially

dangerous, even though there is no evidence that they are any more

aggressive than other patient populations.

1.3 Cultural differences

Culture may influence psychiatric diagnosis in several ways. Firstly, different

cultural groups have different attitudes to psychological disorders that might

influence the reporting of symptoms and diagnosis, leading to reporting bias.

There is also cultural bias in diagnosis, for example, the clinician may not be

familiar with the expression of distress in a particular culture. Culture-bound

syndromes could also be difficult to recognize for clinicians.

1.4 Children and young people

For children and young people, estimates vary, but research suggests that 20%

of children have a mental health problem in any given year, and about 10%

at any one time. Rates of mental health problems among children increase as

they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to

12.8% of boys aged

11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15. In one

study, 50-60% of adults with a diagnosed mental disorder had received a

mental health diagnosis of some kind before the age of 15.

1.5 Older people

Older people are less likely to have a neurotic disorder (or common mental

health problem), other than depression. Depression affects 1 in 5 people over

the age of 65 living in the community and 2 in 5 living in care homes. However,

it is likely that only a small proportion of older people with depression are in

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contact with a health practitioner or mental health services. An estimated

70% of new cases of depression in older people are related to poor physical

health.

2. Factors related to mental health problems

2.1 Mental health and material deprivation

Having a low income, being unemployed, living in poor housing, low levels of

education are all associated with a greater risk of experiencing a mental

health problem. The poorest fifth of adults are at double the risk of

experiencing a mental health problem as those on average incomes.

2.2 Family-related and social factors

Social isolation is a factor in mental health problems. 20% of people with

common mental health problems live alone, compared with 16% of the overall

population. Taking part in social activities, sport and exercise is associated with

higher levels of life satisfaction. Other social and economic risk factors for

mental health problems include: poor transport, neighbourhood

disorganisation and racial discrimination. Social and economic protective

factors for mental health include: community empowerment and integration,

provision of social services, tolerance, and strong community networks.

2.3 Physical health

People with poor physical health are at higher risk of experiencing common

mental health problems, and people with mental health problems are more

likely to have poor physical health.

2.4 Spirituality

Research literature has consistently reported that aspects of religious and

spiritual involvement are associated with desirable mental health outcomes.

The Royal College of Psychiatrists notes that people who use mental health

services identify the benefits of good quality spiritual care as being: improved

self-control, self-esteem and confidence; speedier and easier recovery; and

improved relationships.

3. Treatment and care

3.1 How many people seek help and use services?

There are several important questions that should be considered under this

subtitle. Firstly, how many people seek help and use services? In many cases,

people who suffer from mental health problems will not be receiving

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treatment, either because there are no services available to them,

because they have chosen not to go to a doctor at all, or because they have

been misdiagnosed. The majority of 5-15 year-olds with mental health

problems, for example, are not in contact with mental health services.

3.2 What treatment and care is available for mental health problems?

Treatment may come from primary care services, or community care services,

where community mental health teams must provide local specialist mental

health services. The role of hospitals also needs to be examined and the role

of mental health staff. A large portion of care often comes from informal care,

which is help from family and friends.

3.3 Treatment and coping

People with mental health problems report a variety of treatments and coping

mechanisms as helpful. These strategies may include support from family and

friends, medication, counseling or psychotherapy, something worthwhile to do

during the day, peer support, alternative therapies, volunteering and working,

hobbies, physical exercise, advice from a health practitioner, as well as

spirituality and religion. Overall, the most important areas of consideration are

medication, including anti-depressants and anti-psychotics, sleeping and

anxiety medication, mood stabilisers.

4. The costs of mental health problems

4.1 The hidden cost

The “hidden” costs of mental illness have a significant impact on public

finances: it has been estimated that the costs of depression through lost

working days are 23 times higher than the costs to the health service, which

makes sense when we consider that 1 in 4 unemployed people has a common

mental health problem. Childhood mental health problems can have a

significant economic effect on society. It is estimated that a child with a

conduct disorder will, by the age of 28, have generated costs ten times as high

as a child without conduct problems.

4.2 Overall cost

The World Health Organisation estimates that the cost of mental health

problems in developed countries is between 3 and 4% of Gross National

Product. The cost of mental health issues will depend on the country. One

aspect is the health and social care costs. This will include, staff costs, other

costs associated with private care and the voluntary sector, as well as drug

and talking therapy costs. Another aspect is the economic and social factors.

22


Employment forms a big part of this, as people with a common mental

health problem are more likely to be economically inactive. The cost of mental

health problems at work is also massive. Stress, anxiety and depression

accounted for a third of the 168 million working days lost in the UK for health

and related reasons in 2004, translating to a cost of sickness absence of about

£4.1 billion. Each case of stress-related ill health leads to an average of 30.9

working days lost.

4.2 Human costs

The human costs of mental health problems include the costs of mental health

services, as well as the adverse effects of mental health problems on health-

related quality of life and length of life. Many people with common mental

health problems are limited by their condition, and around a fifth are disabled

by it. Mental health problems are associated with a wide range of adverse

personal and social problems, including loneliness, lack of educational

qualification, unemployment, debt problems etc.

There are 5 key barriers to increasing mental health services availability. In

order to increase the availability of mental health services, there are 5 key

barriers that need to be overcome: the absence of mental health from the

public health agenda and the implications for funding; the current

organization of mental health services; lack of integration within primary care;

inadequate human resources for mental health; and lack of public mental

health leadership.

5. WHO response

The WHO’s comprehensive mental health action plan 2013-2020 was adopted

by the 66th World Health Assembly. Dr Margaret Chan, the WHO Director-

General, described the new Comprehensive Mental Health Action Plan 2013 –

2020 as a landmark achievement: it focuses international attention on a long-

neglected problem and is firmly rooted in the principles of human rights. The

action plan calls for changes. It calls for a change in the attitudes that

perpetuate stigma and discrimination that have isolated people since ancient

times, and it calls for an expansion of services in order to promote greater

efficiency in the use of resources.

“The four major objectives of the action plan are to:

strengthen effective leadership and governance for mental health,

provide comprehensive, integrated and responsive mental health and

social care services in community-based settings,

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implement strategies for promotion and prevention in mental health,

and

strengthen information systems, evidence and research for mental

health.” (15)

Each of the four objectives is accompanied by one or two specific targets,

which provide the basis for measurable collective action and achievement by

Member States towards global goals. A set of core indicators relating to these

targets as well as other actions have been developed and are being collected

via the Mental Health Atlas project on a periodic basis.

“The action plan relies on six cross-cutting principles and approaches:

1. Universal health coverage: Regardless of age, sex, socioeconomic

status, race, ethnicity or sexual orientation, and following the principle of

24


equity, persons with mental disorders should be able to access, without

the risk of impoverishing themselves, essential health and social services

that enable them to achieve recovery and the highest attainable

standard of health.

2. Human rights: Mental health strategies, actions and interventions for

treatment, prevention and promotion must be compliant with the

Convention on the Rights of Persons with Disabilities and other

international and regional human rights instruments.

3. Evidence-based practice: Mental health strategies and interventions for

treatment, prevention and promotion need to be based on scientific

evidence and/or best practice, taking cultural considerations into

account.

4. Life course approach: Policies, plans and services for mental health

need to take account of health and social needs at all stages of the life

course, including infancy, childhood, adolescence, adulthood and

older age.

5. Multi-sectorial approach: A comprehensive and coordinated response

for mental health requires partnership with multiple public sectors such

as health, education, employment, judicial, housing, social and other

relevant sectors as well as the private sector, as appropriate to the

country situation.

6. Empowerment of persons with mental disorders and psychosocial

disabilities: Persons with mental disorders and psychosocial disabilities

should be empowered and involved in mental health advocacy, policy,

planning, legislation, service provision, monitoring, research and

evaluation.”15

“Effective implementation of the global mental health action plan will require

actions by international, regional and national partners. These partners include

but are not limited to:

development agencies including international multilateral agencies (for

example, the World Bank and United Nations development agencies),

regional agencies (for example, regional development banks), sub-

regional intergovernmental agencies and bilateral development aid

agencies,

academic and research institutions including the network of WHO

collaborating centres for mental health, human rights and social

determinants of health and other related networks, within developing

and developed countries,

civil society, including organizations of persons with mental disorders and

psychosocial disabilities, service-user and, other similar associations and

25


organizations, family member and carer associations, mental health and

other related nongovernmental organizations, community-based

organizations, human rights-based organizations, faith-based

organizations, development and mental health networks and

associations of health care professionals and service providers.”15

Your discussion and research should focus on how these different partners can

apply the six aforementioned principles and approaches effectively and

sustainably, to achieve the four key objectives of the Mental Health Action

Plan.

Points a resolution should address

Strengthening effective leadership and governance for mental health

Developing and updating the plans and policies of countries for mental

health according to international and regional human rights standards

Developing and updating the laws of countries for mental health

according to international and regional human rights standards

Policies, plans or laws for mental health may be stand-along or

integrated into other general health or disability laws

Providing comprehensive, integrated and responsive mental health and social

care services in community-based settings

Increasing service coverage for severe mental health disorders,

especially in the case of estimates of severe health disorders which are

restricted

Health facilities may range from primary care centers, to general and

specialized hospitals, they may offer social care and support as well as

psychosocial and/or pharmacological treatment on an outpatient or

inpatient basis

Implementing strategies for promotion and prevention in mental health

Implementing functioning national, multi-sectorial mental health

promotion and prevention programmes covering both universal,

population-level promotion or prevention strategies (for example, mass

media campaigns against discrimination) and those aimed at locally

identified vulnerable groups (for example, children exposed to adverse

life events)

Strengthening information systems, evidence and research for mental health

26


Reporting and submission of core mental health indicators by countries

to the WHO every two years, relating to the specified targets of the

Action Plan, alongside other essential indicators of health and social

system actions (for example, training and human resource levels,

availability of psychotropic medicines, and admissions to hospital), with

the data being aggregated by sex and age groups

Further reading

Comprehensive mental health action plan 2013–2020, WHO


This is the key document on which most of our discussions will be based on. It outlines what the

objectives of the WHO have been so far with regards to mental health.

Mental Health Atlas 2014, WHO

http://www.who.int/mental_health/evidence/atlas/executive_summary_en.pdf?ua=1

This new edition of Mental Health Atlas, carried out in 2014, assumes new importance as a

repository of mental health information in WHO Member States because it is providing much

of the baseline data against which progress towards the objectives and targets of the

Comprehensive Mental Health Action Plan 2013-2020 is to be measured.

Mental Health Atlas 2014 country profiles, WHO

http://www.who.int/mental_health/evidence/atlas/profiles-2014/en/

This link will hopefully prove useful to you when doing your research as it provides data and

statistics with regards to mental health that have been collected by the WHO for most

countries.

mhGAP Intervention guide for mental, neurological and substance use disorders in non-

specialized health setting, WHO

http://apps.who.int/iris/bitstream/10665/44406/1/9789241548069_eng.pdf

This guide is aimed towards helping healthcare providers, decision-makers, and programme

managers in meeting the needs of people with mental, neurological and substance use

disorders.

Mental health publications, WHO

http://www.who.int/mental_health/publications/en/

It is important for you to have a look at the current publications produced by the WHO,

particularly those under mental health and gender and child and adolescent mental health.


http://www.who.int/mental_health/evidence/atlas/executive_summary_en.pdf?ua=1

http://www.who.int/mental_health/evidence/atlas/profiles-2014/en/

http://apps.who.int/iris/bitstream/10665/44406/1/9789241548069_eng.pdf

http://www.who.int/mental_health/publications/en/

27


Sources

1. Cdc.gov. 'CDC - Mental Health Basics - Mental Health'. N.p., 2015. Web. 4 Dec. 2015.

2. Illness, Rethink, and Rethink Illness. 'Types Of Discrimination - Rethink Mental Illness, The

Mental Health Charity'. Rethink.org. N.p., 2015. Web. 4 Dec. 2015.

3. Iriss.org.uk. 'Understanding Suicide and Self-Harm Amongst Children In Care And Care

Leavers IRISS Insights, No.21 | Iriss'. N.p., 2015. Web. 4 Dec. 2015.

4. Justiceforfroggy.org. 'Mental Health Facts. | Justice For Froggy'. N.p., 2015. Web. 4

Dec. 2015.

5. Mentalhealth.org.uk. N.p., 2015. Web. 4 Dec. 2015.

6. Mentalhealth.org.uk. 'Mental Health Statistics: UK & Worldwide'. N.p., 2015. Web. 4

Dec. 2015.

7. Who.int, (2015). WHO | Mental health: strengthening our response. [online] Available

at: http://www.who.int/mediacentre/factsheets/fs220/en/ [Accessed 16 Dec. 2015].

8. Thelancet.com. 'Global Burden Of Diseases, Injuries, And Risk Factors Study 2013'. N.p.,

2015. Web. 4 Dec. 2015.

9. Who.int. 'WHO | 10 Facts On Mental Health'. N.p., 2015. Web. 4 Dec. 2015.

10. Who.int. 'WHO | Comprehensive Mental Health Action Plan 2013-2020'. N.p., 2015.

Web. 4 Dec. 2015.

11. Who.int. 'WHO | Mental Disorders Affect One In Four People'. N.p., 2015. Web. 4 Dec.

2015.

12. Who.int. 'WHO | Mental Health And Psychosocial Support In Emergencies'. N.p., 2015.

Web. 4 Dec. 2015.

13. Who.int. 'WHO | WHO-AIMS - General Information'. N.p., 2015. Web. 4 Dec. 2015.

14. World Health Organization. 'Mental Health Evidence And Research (MER)'. N.p., 2015.

Web. 4 Dec. 2015.

15. World Health Organization. 'Project Atlas'. N.p., 2015. Web. 4 Dec. 2015.

28


Conference Information When looking for information regarding LIMUN 2016 (and

subsequent editions) your first step should be to visit our website:

www.limun.org.uk

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Agenda & Rules of Procedure

The agenda for the 2016 conference is available online at

www.limun.org.uk/agenda

The Rules of Procedure can be accessed here:

http://limun.org.uk/rules

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Position Papers

What is a position paper?

A position paper is a statement of policy, which is intended to

communicate an overall position of a country on a particular topic

debated in the committee. Position papers should be brief and

outline the general policies rather than specific measures.

Each delegate should submit one position paper per topic to be

debated by the committee (note: most of the committees have

two proposed topics). Each paper should be approximately one

page per topic.

LIMUN offers a short guide on how to write a position paper. It is

available on our website:

http://limun.org.uk/FCKfiles/File/PP_Guide.pdf

Deadlines

The deadline for the submission of delegates’ position papers is 20

February 2016. Failure to submit by this deadline will render

delegates ineligible for Diplomacy Awards.

Positions Papers will have to be submitted in a publicly-accessible

Dropbox, to be provided by committee directors. At their

discretion, directors may provide feedback in individuals cases if so

requested.

The most worthy work submitted in a committee will earn the

delegate a Best Position Paper Award. The length of any one paper

should not exceed 500 words.

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Contact Details

For any enquiries relating to your committee proceedings or if you

want to get in touch with your committee’s directors, or for

submission of position papers:

- please e-mail: [email protected]

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section on our website: http://limun.org.uk/faq
