Strengthening Mental Health Care for the Young
Study Guide
Introduction to the WHO
The World Health Organization is a specialised agency of the United Nations focused on the improvement of global public health. Its headquarters lie in the Swiss city of Geneva, though the agency has offices on all continents. A successor to the “Health Organisation'' (an agency of the League Of Nations), it was established in 1948, primarily to tackle the precarious public health situation following World War II. Since its founding, it has amongst other things played a vital role in fighting international epidemics such as malaria, HIV/AIDS, Ebola and tuberculosis.
Mandate & Scope of the WHO
At initial inspection, the WHO’s mandate appears fairly broad, since it covers “global public health”. According to its constitution, it aims at “the attainment by all peoples of the highest possible standard of health”. That seems like a tall order, but the WHO’s more specific core function, as also outlined by the constitution, is to be “the directing and coordinating authority on international health work”. More broadly speaking, the WHO carefully monitors the state of health around the world and takes steps to improve the health status of both individual countries and of the global community.
The WHO operates on three levels of governance, those being the executive board, the secretariat and the World Health Assembly. Our committee is concerned with the latter. The World Health Assembly is the supreme decision-making body of the WHO and consists of the health ministers of 191 member states, who meet annually. The decisions taken by this assembly are then implemented by the executive board, a body consisting of 32 scientists and/or qualified health professionals. The director general heads the secretariat and is elected by the assembly.
One of the WHO’s primary tasks is to further the eradication of diseases by improving nutrition, sanitation, housing, working conditions etc. Its functions and responsibilities also more specifically include assisting national governments in strengthening their health(care) services, establishing health related administrative and technical services (epidemiological and statistical services), conducting research in the field of global health, developing international health standards (relating to food and biological/pharmaceutical products), encouraging increased collaboration among scientists, health professionals and health groups, as well as promoting a well informed public opinion on all matters relating to health.
A History of Mental Health
Mental Health at its most basic definition is generally understood to mean the condition of someone's mind and whether or not they are suffering from any mental illness. Of course, definitions of what constitutes a mental illness have heavily varied in the course of time and so have treatment methods.
Since the dawn of time, humans have “diagnosed” or rather recognized (to varying degrees of accuracy) that certain abnormalities in human behaviour could constitute a “mental illness” and also that this condition would therefore be related in some way to the mind or brain. Early archeological evidence shows that trepanation, the act of drilling or scraping a hole into a patient’s skull so as to release “evil spirits”, was carried out as early as neolithic times. Of course, many patients did not survive this surgical intervention, though those who did were said to have changed significantly in terms of their behaviour (for better or for worse).
During large periods of human history, religion also played an important role, both when it came to determining what constituted a mental disorder and in terms of outlining the treatment options. Procedures like exorcisms, the practice of driving out “demons” or other “bad” supernatural entities from a “possessed person”, had been performed since antiquity.
Though these treatment methods may seem completely ineffectual or barbaric to us today, it wasn’t until very recently that risky or highly inefficient procedures were entirely abandoned.
Lobotomy, a neurosurgical intervention in the prefrontal cortex of the brain, was a mainstream procedure in the US and Europe in the mid-20th century that was performed on thousands of patients each year. Results were mixed, sometimes reportedly succeeding to reverse certain disorders, but usually also bringing about incredibly severe side-effects. Some patients even became suicidal or died during the procedure. It was among a whole array of radical new physical therapies devised in the early 20th century, including “deep sleep therapy”, “insulin shock therapy” and “pyrotherapy”, most of which, like lobotomy, were subsequently abandoned. They followed a brief period of “therapeutic nihilism”, a time where most mental disorders were actually believed to be entirely incurable.
Since then, the field of mental health has broadened to include a wider range of conditions and gradually moved towards fewer physical interventions or generally less radical procedures. Modern day mental health treatment options include: pharmacotherapy, physical activity, expressive therapies, psychotherapy and meditation. Thus, our current understanding of mental health is significantly different to what it was just a century ago.
The term “mental health” itself also appears to be of relatively recent creation (mid 20th century), though references to virtually the same concept can be found dating back to the 19th century, then still referred to as “mental hygiene”. However, it wasn’t until 1908 and the beginnings of the “American mental hygiene movement”, founded by Clifford Beers, following his traumatic experiences in various mental institutions, that the term would properly gain traction. Several national councils and one international commission (the “International Committee on Mental Hygiene”) were established soon thereafter.
Initially, the “mental hygiene movement” was focused on improving the treatment of patients in mental institutions, usually involving more severe cases of mental illness, as they frequently suffered abuse by staff. However, over time the commisions’ tasks were expanded to also include milder mental conditions or more general health problems related to the mind. Though many of the treatment methods prescribed to “mentally ill” patients at that time were also still largely questionable, that was not of much concern to the first mental hygiene movements. However, the abandonment of ineffective or dangerous procedures still went hand in hand with a broadened understanding of mental health and treatment options.
The final important step towards today’s understanding of mental health and it’s current role in our medical and political discourse was the founding of the WHO on the 7th of April 1948. The WHO has actually had a special division dedicated purely to mental health since its very creation, as a result of several member states demanding it be added. Amongst other things, the preamble to the WHO constitution states, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
Present Situation
In the present day and age we have a much better understanding of what diseases exist and a variety of approaches have been taken to classify and categories the different mental health illnesses that exist. For this WHO Committee we will be following the International Statistical Classification of Diseases and Related Health Problems in its 10th Revision from 2016. Namely we will be discussing and dealing with letters F00-F99 of Chapter 5 Mental and behavioural disorders. Since the focus of our committee will be on the young it is important that we stick to those mental conditions most severe and preventable. Eating disorders, Depressive disorders, developmental disorders amongst others spring to mind as key areas therefore.
Mental Health is still a very difficult topic to deal with today. Mainly because it is not only the people with mental health conditions, but also their families, friends and communities that have to deal with the consequences. This is made even harder by the many Stigmas that still prevail that can lead to discrimination, violations of their rights and social exclusion by members of the general public, social welfare or educational systems, and even at times the health-care system. This comes as a big surprise, when one considers that according to Global Burden of Disease estimates from 2017 around 970 million people live with a mental health condition (almost an 8th of the entire human population).
Suicide goes hand in hand with many mental health conditions, and the WHO estimated in 2019 that around 1 million people die of suicide every year, which equates to a death from suicide every 40 seconds. The WHO further reports that In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 (male and female). It was also identified that in 90% of these suicide cases the individual was suffering from a mental health condition (particularly depression and substance abuse). Suicide and mainly suicide prevention is therefore definetley in the scope of any mental health discussion. Staggeringly enough as of September 9th 2019 only 38 out of the 191 member states of the WHO have suicide prevention strategies in place at all.
Differing approaches
There exist today a variety of different approaches toward mental health care, this includes not only governmental strategies, but also the medical approaches to treating the mental health conditions.
In the medical field there are a range of models to explain and treat “models of abnormal behaviour” (aka. mental health conditions) these include but are not limited to biological, behavioral, cognitive, holistic, personality structure and Psychodynamic models. These vary mainly in the way they explain the origin of mental health conditions, as well as identifying the best ways to then deal with these conditions. It is not necessary in the scope of our debate to know these models by heart, the main takeaway is merely, that there exists not one “correct” way to deal with mental health conditions.
The differences in the medical approaches can also at least partially explain the different strategies implemented by governments. Amongst other things while some strategies focus on treating mental health with medication (which is in line with the biological method) others focus on psychological counselling (Psychodynamic and cognitive models amongst others) and yet others again focus on eliminating root problems such as childhood trauma or socioeconomic triggers (holistic model amongst many). The key word here, however, is *focus*, because most of these methods are not mutually exclusive and so governmental strategies tend to boil down to simply an allocation of the limited resources available. This is likely going to be one of the main points of contention in our debates, as mental healthcare is notoriously underfunded and oftentimes it is a question of where to allocate not if at all.
This lack of resources is evident if you look at the mental health treatment gap. According to the WHO around two thirds of all people with mental health conditions do not receive any kind of treatment and while this naturally heavily affects low- and middle-income countries (LMICs) the situation is not perfect in high-income countries either (HICs). Fewer than 1 in 5000 people with depression receive treatment in low-income countries, in middle income countries it is 1 in 3000 and in high-income countries it is 1 in 300. It is crucial therefore that any solutions proposed by the WHO factor in, that many countries do not currently have comprehensive mental health care plans or even a national budget dedicated specifically for it.
Conclusion
It is imperative that you find out what (if any) mental health care system exists in your country, to inform and decide what approach your country will take on the global stage. It is also important that any solutions accepted in the assembly be viable not only for one country, but for every member state. Different countries have different health care systems afterall and creating a strong basis for future generations to grow up with less mental health issues should be the ultimate goal
Written by August Norup and Andrew Oakeshott
