Working paper

Committee: World Health Organization

Topic: Improving mental healthcare
Sponsor: China

Signatories:

This Council, The World Health Assembly,

Reaffirms the UNSC Resolutions 2178 and 2250 and UNGA resolution A/RES/70/29,

Requests member states to provide all refugees within their territories with all rights mentioned
in the 1951 Refugee Convention to ensure that the deprivation of any rights does not lead to
psychological instability,

1. Recommends the usage of an assessment instrument, Relatives Expressed Emotion

(REE) to investigate the consequences of deinstitutionalization on a patient to patient
basis.

2. Recommends ​FAMED(family education)​, an educational program with a general aim

being to build on the family's strengths and to facilitate their mutual cooperation in coping
with the illness, which, in a stepwise order:

a) conveys to the family information about the causes of the mental disorder, the
symptoms, the likely outcome, and the treatment and management,

b) instructs in problem solving, improving communication, reducing the intensity of

negative emotions, utilizing the family's natural support networks, and developing
realistic expectations for the patient;

3. Recommends the initiation of a ​Global Mental Health movement​ for ​advocacy and
awareness​ raising at all levels , with ​psychiatrists​ and other ​mental health
practitioners​ playing an important role in instigating and supporting this initiative, with
particular contributions from the ​World Psychiatric Association (WPA) ​and ​in-country
professional associations​, in order to:
a) strengthen the lobby​ for increased resources for mental health care,
a) empower​ patients and families to take a more active role in treatment decisions
and to speak out against abuses,
b) raise awareness of ​pertinent ethical issues​ relevant to the particular country
setting by the ones involved in the training of mental health practitioners in
particular, and health workers in general,
 c) opening up debate about ​the complex dilemmas​ that practitioners in LAMIC
settings face on a day- to-day basis in order to stimulate research into this
neglected area,
4. Recommends Community Involvement Plan ​(CIP)​ as a means to incorporate a sense of
awareness and sensitization towards depression and anxiety in the society in order to
mitigate the negative psychological aspects that develop before, during and after wartime
situations which includes :
a. Tools for different stages of involvement, classified into 4 stages as :
i. INPUT TOOLS - to receive the opinions of all strata of society in order to
understand their inclinations, common trends and political affinities to
detect any inter-group cleavages, heightened group allegiances and
radicalization via written and web based platforms - Emails, Frequently
asked Questions Programme, surveys and polls;

ii. OUTPUT TOOLS - to inform the community about the existing wartime
situations and how to deal with it in a proper manner through;
1. Print media such as brochures, leaflets, posters, fact sheets and
Monographs;
2. Online information through websites, mailing lists, newsletters and
E- Forums;

iii. OUTREACH TOOLS - community events and awareness campaigns to

aid in the removal of any taboo associated with wartime psychology;

iv. INVOLVEMENT TOOLS - Public meetings, assistance teams and

community groups;

b. Publishing a​ “KYC - Know Your Community”​ Booklet for civilians, compiled to

help civilians to:
i. Realize the factors that may lead to radicalization :
1. Push factors such as inequality, discrimination, marginalization,
the denial of civil rights and liberties or other socio-economic
Causes;
2. Pull factors that make violent extremism look appealing by
Providing:
a. Economic incentives given by extremist groups;
b. A sense of belonging to a group;
c. A sense of purpose;

ii. Look out for the following initial signs which indicate that an individual
might be engaged in extremism:
1. Showing sudden rebellious attitude, making assertive comments
and non-inflammatory language during conversations;
 2. Preferring isolation rather than social interactions and participation
in community events;
3. Feeling offended while certain ideologies are being discussed and
vehemently defending one’s ideas;
4. Sudden dropping out from educational institutes or workplace;
5. Viewing websites and following channels on various social media
platforms which have controversial content;

iii. Judge when and how to discuss the issue of radicalization and extremism
within their circle while taking into consideration:
1. Minority group grievances and viewpoints to have a balanced
Discussion;
2. Ethnic and cultural diversity of the people involved;
3. Varied experiences of the individuals which has led them to
develop a different mental outlook;

iv. support-measures that people can take to reduce the influence of extremist
ideologies such as:
1. Helping individuals realize the real risks and consequences of
Extremism;
2. Giving people a sense of direction in their lives by ensuring those
people either study or work hence keeping one’s mind occupied;
c. Highlighting the importance of education in the community to deal with
radicalization as it helps them:
i. Develop interpersonal skills to learn how to have a peaceful approach to
disagreements and changes;
ii. Develop critical and analytical ability to check the validity of claims and
rumours and question the efficacy of extremist means in achieving the
desired goals;
iii. Develop an attitude of respecting the diversity and differences that may
exist between different communities;

5. ​Recommends the deinstitutionalisation implementation plan ​(DIP)​, which will cater to

individual needs through tailored service planning, recognising that patients differ in terms of the
extent of psychological intervention they need, underscoring the fact that one-size-fits-all
approaches are not appropriate for patients as each patient can be considered within a specific
cultural context;

6. Recommends the search and rescue emergency medical personnel present in conflict-stricken
areas to also provide mental healthcare by the ‘​Look Listen and Link’​ approach which entails:
 a. ‘Looking’ for physical symptoms in the patients which convey psychological
distress such as shaking, insomnia, racing heartbeat, edginess and agitation, being
startled easily, edginess and agitation, headaches, signs of exertion, fatigue, aches
and pain;
b. ‘Listening’ to the patients’ grievances such as loss of dear ones, anger, guilt,
shame, perplexity and fear hence providing them consolation, a sense of calmness
and determining whether a person is experiencing disorientation (difficulty in
remembering one’s identity, name, surroundings and whereabouts) by giving
them undivided attention, respecting and sympathising with them;
c. ‘Linking’ the patients with :
i. Similar people or indigenous groups for social support;
ii. Appropriate NGOs and task forces working in the area which might help
his cause and offer basic needs and access to services;
iii. Psychological first aid (PFA) providers to give immediate treatment;

7. Recommends member nations to adopt the ​Refugee Engagement & Development (RED)
approach which entails:

a. mental health services in all refugee camps and making all new refugees undergo a
two-step examination to ensure the psychological stability of all refugees thorough :
i. a multiple-choice based objective test made by the WHO Secretariat
which each new refugee entering the camp would have to give, preferably
in the native language of the refugees would be checked electronically,
which would:
1. Allow to check for the susceptibility to psychological problems
based on the answers filled by the refugee;
2. Allow for better analysis of the situation in the conflict region;
ii. Those who have been screened will further be examined by a mental
health professionals if their answers indicate they may be suffering from
any psychological anomalies;

B. Refugees who may have earlier served as psychologists/psychiatrists may be

employed in the camp, once his credentials as a mental health professional are verified by
the psychologist assigned to the camp as :

I. shortage of resources and mental health specialists that may exist in a

refugee camp;
 Ii. the inhibitions, apprehensions, anxiety and depression experienced by a
refugee can be better understood by refugees themselves;

C. the need to promote social cohesion within refugee camps to maintain a

positive mood in the community prevent any psychological problems like PTSD from
developing through :

i. Recruitment of a sports coordinator, preferably from the camp itself, who

would organize teams from within the camps for different games like
football, badminton and volleyball, establish linkages with local sports
clubs and accordingly organize games with teams with the local clubs;
ii. Recruitment of a cultural supervisor, preferably from the camp itself, who
would organize regular cultural, social and recreational events like plays,
dramas, music and art displays within the community and also arrange for
the local population to attend these events for better integration of
refugees into society;

D. the need for continuation of medication of psychiatric patients who had been
using medication before the conflict, a refugee who claims to have been taking
medication earlier would be examined by a psychiatrist and only then would be
given the respective medicines;

E. In refugee camps where all-time specialized mental health professionals cannot

be allocated due to economic reasons or otherwise :

i. Part-time mental health professionals may be hired;

ii. In places where even a part-time health professional cannot be hired, those
who show symptoms of mental health disorders, a provision for video
calling a mental health professional can be made;

F. Urges the establishment of an online database - United Nations Immigrants

Tracking Entity (UNITE) in collaboration with the International Organization for
 Migration (IOM) to help reunite family-members of refugees that may get separated
in-transit which includes:

i. The details (name, age, sex, home town, address before shifting) and
photographs of each new refugee that enters a camp are put into the
central database along with names of the relatives that may have gotten
separated while shifting;
ii. Those who have gotten separated would put in their details and search for
his/her other family members on the database;
iii. Member States would share the list of refugees currently residing within
their territories to IOM for building up the database of UNITE;

Since family plays a quintessential role in providing mental stability and recovery
from previously experienced adverse circumstances by the refugees, serving as a
healing mechanism;

8. Recommends the Secretariat to publish a guidebook to make religious and political leaders
understand how they can provide psychological first aid to the masses during or post-conflict;

9. Recommends the member nations to adopt the RAPID model: Reflective listening,
Assessment of needs, Prioritization, Intervention, and Disposition - as an effective means of
giving Psychological First Aid (PFA) which:

a. provides perspectives on injuries and trauma that are beyond physical in nature;
b. is readily applicable to public health institutions, the workplace, the military,
faith-based organizations, mass disaster venues, and even the demands of more
critical wartime events, example, dealing with the psychological aftermath of
accidents, robberies, suicide, homicide, genocide or community violence found
effective in promoting personal and community resilience;

10. Recommends the Secretariat to publish a guidebook to make religious and political leaders
understand how they can provide psychological first aid to the masses during or post-conflict;

11. Recommends member nations to adopt ‘Ayurveda, Yoga, Unani, Siddha and Homeopathy
(AYUSH) which is an extremely cost-effective treatment method, requiring negligible
prerequisites while ensuring a holistic balance of physical and psychological elements
(samadosha) wherein:

a. Ayurveda includes the usage of herbs and organic substances in aiding mind’s
stability such as ;
 b. Yoga entails an eight-fold approach collectively termed as the "Ashtanga Yoga"
for all-round development of human beings, containing - Yama, Niyama, Asana,
Pranayama, Pratyahara, Dharana, Dhyana and Samadhi as the pillars of serene
mental development by:
i. enhancing circulation of oxygenated blood in the body and fresh supply of
blood to the brain leading to better thinking ability ;
ii. Meditational practices preventing psychosomatic disorders and improves
an individual’s resistance and ability to endure stressful situations;
iii. Acting as an evolutionary process in the development of human
consciousness by taking the following steps;

12. Encourages member nations to exploit the positive aspects of social media and internet based
platform by launching:

a. #You, a social media campaign which would:

i. Spread awareness about mental health problems which the general
practitioner may not be able to identify which may or may not have arisen
due to an armed conflict, including but not limited to anxiety and panic
attacks, clinical depression, bipolar disorder, dissociative disorders and
post-traumatic stress disorder and schizophrenia;
ii. Aim at reducing the stigmatization and discrimination that people
suffering from mental health may face by sensitizing the people;
b. Create an application software and website ‘ASK’ - ‘Anonymous Seekers Knob’
wherein people suffering from anxiety, depression, suicidal tendencies, fear and
extremism can:
i. Consult certified therapists, counselors, mental healthcare professionals to
deal with their problems and determine what course of action is best for
them;
ii. Write motivating anonymous or named blogs to share their stories and
problems and how they dealt with the situation;
iii. Feel free to avail an active 24/7 therapy session if they feel angry and
agitated due to certain factors;
iv. watch and share uploaded content such as videos, articles and other
guidelines, only after scrutinization by mental healthcare experts, to:
1. Help them cope with their problems;
2. Informing them about standard set of instructions to be followed in
cases such as community violence, armed conflict or public
outrage occurs;
 3. Help them in dealing with any stigmatization that they may face
due to their psychologically different behaviour;
4. Persuade them to get professional help ;
5. Promote coping mechanisms such as breathing and calming
exercises and praying ;
6. teach them yoga exercises and meditation techniques to help them
develop the serenity of mind and soul;

13. Emphasizes the need to integrate psychological services in primary health care(PHC) and the
need to train and supervise PHC workers in basic mental health knowledge and skills;

14. Urges the expansion and the creation of the Disease Early Warning System (DEWS) and the
Electronic Disease Warning Division (E-DWARD) under the Global Outbreak Alert and
Response Network (GOARN) alongside the World Bank, United Nations Development Fund
comprising the data already provided by the Global Public Health Intelligence (GPHIN),
Country Cooperation Strategy (CCS), Healthmap.org and epiSPIDER in order to provide active
surveillance, monitoring and response as well as early identification of communicable diseases in
regions menaced by epidemic relapse:

a. The DEWS will:

i. Classify institutions across the country in Rural Health Centers (RHC),
Basic Health Units (BHU), Hospitals and Community Health Care
Centers, in accordance with their geographical position in order for them
to organize into reporting units;
ii. Create National Surveillance Systems within National Health Ministries,
comprised of national health workers, NGO’s representatives, and WHO
Representatives of each nation particularly trained in the field of
epidemiology in order to provide up to date monitoring of epidemiological
activity in the country;
iii. Reporting units will fill out the standardized forms for the recompilation
of information of communicable diseases common in the country or on the
brink of reaching epidemic status in the region;
iv. Conclusions will be drawn from the forms and presented to national health
authorities and the WHO in order to examine the status of the problem;
b. The E-DWARD will:
i. Regarding disease spread: The diseases will be displayed whether by
listing or by mapping their locations, taking into consideration their
potential spread in nearby locations and occurrence within a certain
perimeter;
 ii. Regarding the origin of the information: The data displayed can be
collected from media reports, as well as other non-official channels of
communications and social networks;
iii. Regarding the establishment of the system: The character of the platform
will be international, owned by the World Health Organization and
managed by WHO workers and practitioners, furthermore the maintenance
will as well be run under the WHO budget and will not be a duty limited
to a group of countries;
iv. Regarding the publication of data: Information should be available taking
into consideration local languages and needs;
v. Regarding local response: The platform should include information and
mapping of already existing treatment centers of infectious diseases,
whether established by the WHO, local governments or NGO’s, as well as
their contact in case of emergencies;
vi. Each events will be classified as reported, which refers to reported cases
of disease infection without any confirmation and validation, confirmed
which refers to reported cases of diseases infection confirmed by any
second non-official source nearby the incident, and validated which refers
to confirmed cases that were validated by official sources, including
certified health practitioners or WHO officers;
vii. Regarding confirmation of reported events: The platform should provide a
message-based service in order to establish a channel of communication
with people under the event’s perimeter in order to change the current
status of the incident;

15.Recommends United Nations Development Fund for Women (UNIFEM) to be approached

for funding the programs to mitigate the negative impacts of victims of rape and sexual violence
by using:

a. Trauma Screening Questionnaire (TSQ) which;

b. the Global Assessment of Functioning scale (GAF) and an assessment scale to
address medico-psychological care in emergencies and analysing needed criteria
for PTSD diagnosis from the TSQ;

16. In refugee camps where all-time specialized mental health professionals cannot be allocated
due to economic reasons or otherwise :

a. Part-time mental health professionals may be hired;

b. In places where even a part-time health professional cannot be hired, those who show
symptoms of mental health disorders, a provision for video calling a mental health
professional can be made;