Recommendations for Promoting Inclusive, Discrimination-Free Community Mental Health Services - Loreto Region

1. Context and background

Health care can be viewed from three perspectives: first, as a fundamental right, insofar as the constitutional mandate to protect health cannot be understood without considering both physical and mental health. Second, it is also a public service. Whether care is provided by a public or private establishment, health is a public service and must comply with applicable regulations. And finally, access to mental health care is a necessary condition for people's well-being and for the exercise of other fundamental rights. In Peru, Law No. 30947, the Mental Health Law, recognizes that mental health care must be provided without discrimination and from a community-based, comprehensive approach that respects human dignity. In practice, however, many people still face barriers to accessing timely, appropriate and prejudice-free services.

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In the Loreto region, these barriers take a particular form due to geographic dispersion, limited connectivity, gaps in access to public services, and the presence of rural and Indigenous communities. These conditions can more heavily affect people who already face social exclusion, violence or discrimination.

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People of sexual diversity may face family rejection, community violence, harassment, unequal treatment in public services, conversion practices, lack of recognition of their identity, and absence of support networks. These experiences directly impact their mental health and can increase the risk of anxiety, depression, isolation, suicidal ideation, problematic substance use, or other emotional harm.

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Local governments play an important role in promoting safe, inclusive and protective environments. While specialized mental health care mainly falls under the health sector, an area under the authority of Regional Governments, municipalities have responsibilities related to social development, citizen participation, violence prevention, protection of populations in vulnerable situations, community outreach and territorial coordination.

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These guidelines aim to be a practical tool for the Regional Government, as well as the provincial and district municipalities of Loreto. Their purpose is to guide concrete, viable and progressive actions that can be incorporated into municipal management, in coordination with the Regional Health Directorate, health facilities, community mental health centers, social organizations, educational institutions, community authorities and other stakeholders in the territory.

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2. Purpose

To guide the Regional Government and local governments of the Loreto region in implementing municipal measures that promote dignified, timely and discrimination-free access to services, spaces and community mechanisms related to the mental health of people of sexual diversity.

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3. General objective

To strengthen the capacity of the Regional Government, as well as the local governments of Loreto, to incorporate actions on equality, non-discrimination and an affirmative approach into their services, programs, community activities and coordination mechanisms related to promoting mental health.

 

4. Specific objectives

• Promote public services free of discrimination on any grounds, particularly sexual orientation, identity and forms of expression.

• Strengthen the capacities of municipal staff to provide respectful, informed and empathetic care.

• Promote community spaces for listening, guidance and psychosocial support.

• Prioritize actions directed at people of sexual diversity in especially vulnerable situations.

• Improve coordination between the Regional Government, local governments, health facilities, community mental health centers and social organizations.

• Prevent practices that violate the dignity, integrity and mental health of people of sexual diversity.

• Progressively incorporate actions on diversity and mental health into municipal planning, budgeting and monitoring instruments.

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5. Scope of application

• Regional Government of Loreto

• Provincial and district municipalities of Loreto.

• Social Development departments and sub-departments.

• DEMUNA, OMAPED, Neighborhood Participation offices, and municipal family, youth, community, social welfare or social protection programs.

• Municipal staff working in public service, municipal security (serenazgo), inspection and other services with direct contact with the public.

• Local coordination spaces related to health, education, public safety, violence prevention and social development.

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6. Reference regulatory framework

• Political Constitution of Peru.

• Law No. 27972, Organic Law of Municipalities.

• Law No. 30947, Mental Health Law.

• Law No. 28983, Law on Equal Opportunities between Women and Men.

• National Gender Equality Policy.

• Sectoral Mental Health Policy Guidelines.

• Advisory Opinion OC-24/17 of the Inter-American Court of Human Rights.

• International human rights treaties ratified by the Peruvian State.

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7. Approaches for implementation

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7.1. Human rights approach

Recognizes that all people are rights holders and that public institutions must respect, protect and guarantee those rights. In municipal practice, this means providing services with dignified treatment, without mockery, without exclusion, and without denying care on grounds related to sexual diversity.

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7.2. Equality and non-discrimination approach

Makes it possible to identify and correct barriers that prevent all people from accessing municipal services on equal terms. It's not enough to declare that everyone is served; it's also necessary to review forms, messaging, procedures and service practices.

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7.3. Affirmative approach

Recognizes that some populations, such as people of sexual diversity, have historically faced higher levels of violence, invisibility and exclusion, and therefore require specific measures to guarantee real equality. These measures are not privileges but necessary actions to reduce accumulated inequalities. It also involves working to reduce bias among professionals and staff who serve these groups.

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7.4. Intercultural approach

Takes into account the cultural, linguistic and territorial diversity of Loreto. Municipal actions must engage in dialogue with community leaders, respect local forms of organization, use appropriate communication strategies, and avoid imposed interventions that don't take the context into account.

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7.5. Intersectional approach

Helps to understand that discrimination doesn't affect everyone in the same way. A person of sexual diversity may face greater barriers if they are also an adolescent, Indigenous, living with a disability, in a situation of poverty, residing in a rural community, or a victim of violence.

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7.6. Community approach 

Promotes addressing mental health from within the environment where people live. Municipalities can create spaces for listening, information, support, participation and referral, without replacing specialized care from the health sector.

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8. Implementation guidelines

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Guideline 1: Promotion of discrimination-free municipal services

Local governments must promote respectful, inclusive and discrimination-free delivery of all their services. This includes municipal offices, social programs, public activities, DEMUNA, OMAPED, municipal security (serenazgo), inspection, and other spaces of citizen contact. Discriminatory treatment can generate distrust toward institutions and cause people to avoid seeking help even when experiencing violence, emotional crisis or family abandonment.

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Suggested actions

• Ensure compliance with ordinances against discrimination.

• Incorporate guidelines on dignified treatment into citizen service protocols.

• Establish accessible channels for receiving complaints or alerts about acts of discrimination.

• Promote respectful use of the social name and pronouns used by people in municipal services, when requested.

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Guideline 2: Strengthening the capacities of municipal staff

Municipal staff play a central role in the quality of care. Proper guidance, a timely response, or respectful treatment can make an important difference for a person going through violence, rejection or emotional distress. Training should be part of an ongoing process of institutional improvement, not a one-off activity.

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Suggested actions

• Conduct regular training on human rights, community mental health, the affirmative approach, dignified treatment and discrimination prevention.

• Include this content in onboarding processes for new staff.

• Develop a brief guide on inclusive municipal service.

• Coordinate training with DIRESA Loreto, community mental health centers, specialized organizations or competent public institutions.

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Guideline 3: Promotion of community spaces for psychosocial support

Municipalities may promote spaces for listening, guidance and psychosocial support for people of sexual diversity, their families and support networks. These spaces do not replace specialized clinical care: their main function is preventive and community-based — providing information, reducing isolation, strengthening networks and facilitating referrals.

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Suggested actions

• Create community listening groups for adolescents, young people and adults of sexual diversity. Ensure that these listening groups can run traveling campaigns to bring the workshops closer to the population, especially for groups far from cities.

• Hold workshops on emotional well-being, self-esteem, violence prevention and support networks.

• Implement guidance spaces for mothers, fathers, caregivers and families.

• Coordinate with community mental health centers, hospitals and other mental health institutions for timely referrals.

• Guarantee confidentiality, consent and respect for privacy.

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Guideline 4: Prioritization of people in especially vulnerable situations

Municipalities must prioritize actions aimed at people who face the greatest risks of exclusion, violence or harm to their mental health. In Loreto, this vulnerability may be associated with sexual diversity, age, identity, poverty, belonging to Indigenous peoples, territorial isolation, lack of family support or absence of nearby services.

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Suggested actions

• Design specific actions for adolescents and young people in coordination with educational institutions and protection services.

• Promote support and guidance for trans people facing violence, family exclusion or economic hardship.

• Incorporate culturally appropriate strategies for Indigenous people of sexual diversity.

• Coordinate traveling or riverine information and guidance campaigns, when feasible.

• Implement referral pathways for cases of violence, emotional crisis, suicide risk or family abandonment.

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Guideline 5: Inter-institutional coordination for comprehensive care

Mental health doesn't depend solely on psychological care. It is also related to safety, education, employment, protection from violence, family networks and trust in public services. The municipality can play a coordinating role, especially where people don't know where to turn or where services are scattered.

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Suggested actions

• Create or strengthen local working groups on mental health, equality and non-discrimination.

• Coordinate with DIRESA Loreto, community mental health centers, health facilities and primary care networks.

• Develop simple referral pathways for cases of violence, emotional crisis or need for specialized care.

• Involve civil society organizations, Indigenous organizations, educational institutions, ombudsman offices, social programs and community authorities.

• Maintain an up-to-date directory of available services.

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Guideline 6: Prevention of practices that violate integrity and mental health

Local governments must promote prevention actions against practices that affect the dignity, integrity or mental health of people of sexual diversity. These include efforts to change sexual orientation, identity or expression, known as "conversion therapies or practices," which are based on the mistaken idea that sexual diversity should be corrected or cured.

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Suggested actions

• Disseminate clear information on sexual diversity, identity and mental health.

• Include prevention messages against practices that promise to "cure," "correct" or "modify" a person's sexual orientation or identity.

• Provide the public with information on channels for reporting or seeking help regarding these practices.

• Report to the Public Prosecutor's Office, National Police, health sector or other entities when there are indications of criminal violations or rights violations.

• Incorporate this topic into municipal campaigns on violence prevention and emotional well-being.

 

Guideline 7: Incorporating the affirmative approach into municipal planning

For these actions to be sustainable, they must not depend solely on isolated initiatives or the will of a single official. Municipalities must progressively incorporate actions on mental health, equality and the affirmative approach into their planning, management and budget instruments. This makes it possible to define responsibilities, schedule activities, allocate resources and measure progress.

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Suggested actions

• Incorporate activities on mental health, equality and non-discrimination into the Institutional Operating Plan.

• Consider actions aimed at guaranteeing the mental health of all people, especially groups in vulnerable situations, such as women, children and adolescents, people with disabilities, Indigenous and rural communities, and people of diversity, among others, in local plans for social development, youth, violence prevention, public safety or neighborhood participation.

• Allocate specific resources or incorporate these actions into existing budget activities.

• Designate a municipal unit responsible for follow-up.

• Prepare an annual report on progress, difficulties and recommendations.

• Gather input from social organizations, community leaders and service users.

 

9. Examples of good municipal practices

The following examples are practical models that a municipality can adapt according to its size, budget, territory and institutional capacities. They don't require creating a new office; they can be incorporated gradually within existing areas.

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Inclusive guidance municipal service window

Designate a reference person or team within Social Development or Citizen Services to guide people of sexual diversity on available services, referral pathways, discrimination complaints and psychosocial support.

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Local directory of safe services

Prepare and update a simple directory with community mental health centers, health facilities, DEMUNA, CEM, reporting services, social organizations and emergency contacts.

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Training sessions with practical cases

Hold short sessions for municipal staff using real-life service situations: use of social name, handling complaints, referral during emotional crisis, treatment of victims of violence, and response to violence.

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Listening spaces for families

Organize confidential gatherings for mothers, fathers and caregivers, aimed at reducing family rejection, providing information and strengthening support networks.

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Riverine or traveling guidance campaigns

When the municipality takes part in decentralized campaigns, include messages on mental health, non-discrimination and help channels for people of sexual diversity.

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Good treatment clause in municipal activities

Include a guideline on respect and non-discrimination in calls for participation, workshops, fairs, cultural activities and social programs funded or promoted by the municipality.

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Internal record of alerts and referrals

Keep a basic, confidential and non-stigmatizing record of cases referred to health, protection or reporting services, to improve follow-up without exposing sensitive data.

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10. Monitoring and evaluation

Implementation should be progressive and adapted to the reality of each municipality. Monitoring should serve to improve municipal management, not just to fulfill an administrative formality. An annual review will make it possible to identify which actions worked, what difficulties arose, which populations are still being left out, and which coordination efforts need to be strengthened.

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Minimum elements for the annual report

• Activities carried out.

• Municipal areas involved.

• Number of people benefited.

• Municipal staff trained.

• Cases referred to specialized services.

• Partner institutions.

• Resources allocated or mobilized.

• Difficulties encountered.

• Good practices identified.

• Recommendations for the following year.