Mental health care institutions in Europe well below standard – new WHO assessment

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A new WHO/Europe report, “Mental health, human rights and standards of care”, assesses the quality of institutional care for adults with psychosocial and intellectual disabilities in the WHO European Region.

A total of 75 institutions across 24 countries1 and Kosovo (in accordance with United Nations Security Council resolution 1244 [1999]) were evaluated in collaboration with national authorities. Out of the more than 2000 ratings made by national assessment teams, only 25% fully complied with internationally agreed standards of care, indicating that every country has work to do to reform their system of institutional care.

The assessments looked at what is going on behind the closed doors of long-term institutions through the lens of the United Nations Convention on the Rights of Persons with Disabilities, in terms of quality of care provided and the extent to which human rights are being protected.

Across countries and facilities, the report reveals a general lack of awareness about mental health and human rights, even among staff. A significant proportion of the assessed institutions were found to be violating the rights of residents, including their dignity, liberty, physical and mental integrity, legal capacity, and freedom from torture and ill treatment.

Quotes from Dr Daniel Chisholm, Programme Manager for Mental Health at WHO/Europe and project lead for the report

“If we want to improve institutional care, we can’t simply renovate or update buildings. The change has to come from inside. We need to build up awareness, skills and literacy around mental health and human rights. This needs to happen at all levels of society, from policy-makers to the staff working in institutions. Armed with this knowledge, we can then start to implement more humane practices and give people more positive experiences within – or, far preferably, outside – institutions.”

“This assessment takes us to the next phase of work, where we move from quality assessment to actual quality improvement. For example, next month we are bringing together 15 country teams for advanced QualityRights training with a view to subsequently roll out better standards in selected institutions from each country.”

“An independent monitoring mechanism is also an important part of raising standards in countries, and WHO recommends countries give full consideration to the creation of such a mechanism.”

“The ultimate goal is to move away from institutionalization and towards community-based care. But that process can be lengthy and requires transitional funding. This report focuses on what we can do right now to equip those already working in the system to change their mindset to see that the people living in institutional care have rights like any of us. Once you start doing this, you begin to understand that long-term institutions really aren’t the right places to care for these people.”

1A total of 24 countries completed phase 1 and 2 of the project: Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czechia, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Poland, Portugal, the Republic of Moldova, Romania, Serbia, Slovakia, Slovenia, the former Yugoslav Republic of Macedonia and Ukraine. Eight countries completed only phase 1: Austria, Belgium, Denmark, Finland, Germany, Luxembourg, Switzerland and Turkmenistan.