Addressing mental health, human rights and standards of care in Europe

WHO

To address the identified need for better standards of care in large psychiatric and social care institutions across the European Region, WHO has capacitated a new cadre of mental health professionals from more than a dozen Member States. These professionals will work to implement quality improvements and ensure the appropriate protection of human rights in these care settings.

In many countries in Europe and beyond, large psychiatric and social care institutions are still the main care setting for those deemed to require long-term support, despite years of stated policies in support of a process of deinstitutionalization. Many of these institutions are run down, poorly maintained and, too often, the setting for practices that are inhumane and antithetical to safe, effective and high-quality care.

The single most common recommendation in the reports from 98 long-term facilities that were assessed in 2017 concerned the need to train institution staff and other stakeholders on how to realize rights-based and recovery-oriented mental health care.

As a first step in realizing this recommendation, a capacity-building workshop on mental health, human rights, recovery and service improvement was held in Vilnius, Lithuania, on 18–22 June 2018. A total of 42 representatives and future trainers from 14 participating countries attended. The training, delivered by WHO experts, covered the following topics:

  • introduction to human rights in mental health;
  • realizing recovery and the right to health in mental health and related services;
  • taking risks in recovery and communication;
  • service improvement plans and igniting culture change; and
  • specialized topics on recovery and service improvement.

The participants are now in a position to implement the WHO QualityRights approach by training local health and social care professionals in institutions. They can also evaluate the impact of service changes with a view to engendering policy dialogue and legislative reform concerning the rights of people with psychosocial and intellectual disabilities.

Dr Michelle Funk, Coordinator of Mental Health Policy and Service Development in the Department of Mental Health and Substance Abuse at WHO headquarters in Switzerland, summarized the key issues: “I think people are still struggling with the issues around forced treatment and how they can change that in their countries. It is commonly assumed that people with mental health conditions do not know what is best for them. It is a huge challenge to change the attitude of the professionals, to be able to respect the choice of people to take or to not take treatment.”

She also addressed the major issue of seclusion and restraint in mental health services in all countries of Europe. “The challenge arises when services are under-resourced and there are preconceived ideas that people with mental health conditions are dangerous or unpredictable and that there is a need to use seclusion and restraint to control them.”

Dr Funk noted that people are challenged by the idea of how to end seclusion and restraint in practice, asking, “What can we feasibly do to change this situation and to think of alternatives to use instead?”