Soumitra Pathare1, Michelle Funk2, Natalie Drew Bold3, Ajay Chauhan4, Jasmine Kalha5, Sadhvi Krishnamoorthy6, Jaime C Sapag7, Sireesha J Bobbili8, Rama Kawade9, Sandeep Shah10, Ritambhara Mehta11, Animesh Patel12, Upendra Gandhi13, Mahesh Tilwani14, Rakesh Shah15, Hitesh Sheth16, Ganpat Vankar17, Minakshi Parikh17, Indravadan Parikh18, Thara Rangaswamy19, Amritkumar Bakshy20, Akwatu Khenti21. 1. Consultant Psychiatrist and Director,Centre for Mental Health Law & Policy, Indian Law Society,India. 2. Co-ordinator,Mental Health Policy & Service Development, Department of Mental Health and Substance Abuse,World Health Organization,Switzerland. 3. Technical Officer,Mental Health Policy & Service Development, Department of Mental Health and Substance Abuse,World Health Organization,Switzerland. 4. Consultant Psychiatrist and State Nodal Officer,Hospital for Mental Health,Ahmedabad,India&Department of Health & Family Welfare,Government of Gujarat,India. 5. Program Manager and Research Fellow,Centre for Mental Health Law & Policy,Indian Law Society,India. 6. Programme Manager,Centre for Mental Health Law & Policy,Indian Law Society,India. 7. Associate Professor,Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health,Canada;Division of Public Health & Family Medicine,School of Medicine,Faculty of Medicine,Pontificia Universidad Catolica de Chile,Chile; andDivision of Clinical Public Health,Dalla Lana School of Public Health,University of Toronto,Canada. 8. Project Manager,Office of Transformative Global Health,Institute of Mental Health Policy Research, Centre for Addiction & Mental Health,Canada. 9. Co-ordinator of Data Management and Analysis,Centre for Mental Health Law & Policy,Indian Law Society,India. 10. Professor of Psychiatry and Head,Department of Psychiatry,GMERS Medical College,Gotri,Vadodara,India. 11. Professor of Psychiatry and Head,Department of Psychiatry,Government Medical College,Surat,India. 12. Consultant Psychiatrist,Department of Psychiatry,General Hospital,Mehesana,India. 13. Assistant Director,Medical Services,General Hospital,Mehesana,India. 14. Psychiatrist,Gujarat medical services Class 1,Hospital for Mental Health,Bhuj,India. 15. Psychiatrist and Superintendent,Hospital for Mental Health,Vadodara,India. 16. Psychiatrist,Gujarat Health Services,Class I,Hospital for Mental Health,Jamnagar,India. 17. Professor of Psychiatry and Head,Department of Psychiatry,B J Medical College,Ahmedabad,India. 18. Psychiatrist,Gujarat Health Services,Class I,Department of Psychiatry,M G General Hospital,India. 19. Vice-Chairman and Chair, Research,Schizophrenia Research Foundation,India. 20. President,Schizophrenia Awareness Association,India. 21. Senior Scientist,Director of the Office of Transformative Global Health,Office of Transformative Global Health,Institute of Mental Health Policy Research, Centre for Addiction & Mental Health,Canada.
Abstract
BACKGROUND: Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level.AimsTo describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. METHOD: This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. RESULTS: Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50-0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). CONCLUSIONS: To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services.Declaration of interestNone.
BACKGROUND: Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level.AimsTo describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. METHOD: This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. RESULTS: Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50-0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). CONCLUSIONS: To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services.Declaration of interestNone.
Entities:
Keywords:
Human rights; in-patient treatment; low and middle income countries; psychosocial interventions; service users
Authors: Lydia Oeljeklaus; Hannah-Lea Schmid; Zachary Kornfeld; Claudia Hornberg; Christine Norra; Stefan Zerbe; Timothy McCall Journal: Int J Environ Res Public Health Date: 2022-01-28 Impact factor: 3.390