The WHO QualityRights tool kit provides countries with practical infor- mation and tools for assessing and improving quality and human rights ow mp er & E standards in mental health and social care facilities. The Toolkit is based on e it n the United Nations Convention on the Rights of Persons with Disabilities. U , t c It provides practical guidance on: A • the human rights and quality standards that should be respected, pro- tected and fulfi lled in both inpatient and outpatient mental health and h social care facilities; lt ea H • preparing for and conducting a comprehensive assessment of facil- for Mental ities; and • reporting fi ndings and making appropriate recommendations on the basis of the assessment. QualityRights The tool kit is designed for use in low-, middle- and high-income coun- tries. It can be used by many different stakeholders, including dedicated assessment committees, nongovernmental organizations, national human rights institutions, national health or mental health commissions, WHO QualityRights Tool Kit health service accreditation bodies and national mechanisms established under international treaties to monitor implementation of human rights Assessing and improving quality standards and others with an interest in promoting the rights of people and human rights in mental with disabilities. health and social care facilities The WHO QualityRights tool kit is an essential resource, not only for putting an end to past neglect and abuses but also for ensuring high- quality services in the future. ISBN 978 92 4 154841 0 Mental Health Policy and Service Development Department of Mental Health and Substance Abuse World Health Organization Geneva, Switzerland ow mp er & E e it n U , t c A h lt ea H for Mental QualityRights WHO QualityRights Tool Kit Assessing and improving quality and human rights in mental health and social care facilities WHO Library Cataloguing-in-Publication Data WHO qualityrights tool kit: assessing and improving quality and human rights in mental health and social care facilities. 1.Mental health. 2.Mental health services - standards. 3.Human rights. 4.Quality of health care. 5.National health programs I.World Health Organization. ISBN 978 92 4 154841 0 (NLM classification: WM 30) © World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncom- mercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who. int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expres- sion of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or bounda- ries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distin- guished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Malta Preferred citation: WHO QualityRights tool kit to assess and improve quality and human rights in mental health and social care facilities. Geneva, World Health Organization, 2012. WHO QualityRights Tool Kit Contents Acknowledgements v 1. Introduction 1 2. WHO QualityRights tool kit 3 3. Who can use the tool kit? 9 4. Establish a project management team and objectives 14 5. Establish an assessment framework 15 6. Establish the assessment committee(s) and their working method 22 7. Train the members of the assessment committee(s) 24 8. Establish the authority of the committee(s) 25 9. Prepare consent forms and seek ethical approval 26 10. Schedule and conduct the assessment 27 11. Observe the facilities 28 12. Review facility documentation 30 13. Interview service users, family members (or friends or carers) and staff 33 14. Report the results of the assessment 37 15. Use the results of the assessment 39 Annex 1 Principles of recovery-oriented mental health practice 41 Annex 2 Legal capacity and supported decision-making 44 Annex 3 Convention on the Rights of Persons with Disabilities 46 Annex 4 Themes, standards and criteria of the WHO QualityRights tool kit 75 Annex 5 Examples of sample sizes for different types of facilities, according to number of staff and service users 87 Annex 6 Sample consent forms for interviewees participating in an assessment 90 iii  iv WHO QualityRights Tool Kit Acknowledgements The principal authors of the tool kit were Michelle Funk and Natalie Drew, Mental Health Policy and Service Development, Department of Mental Health and Substance Abuse, World Health Organization (WHO), Geneva, Switzerland. Technical guidance and reviews were provided by: • Melvyn Freeman, National Department of • Tomás Lopéz Corominas, Hierbabuena, Health, South Africa Oviedo Association for Mental Health, • Achmat Moosa Salie, World Network of Spain Users and Survivors of Psychiatry, Ubuntu • Helena Nygren Krug, WHO, Geneva, Centre South Africa, Cape Town, South Switzerland Africa • Gemma Griffin, Mental Health and • Anne Marie Robb, Ubuntu Centre South Addiction, Southern District Health Board, Africa, South Africa New Zealand • Judith Cohen, South African Human • Shekhar Saxena, WHO, Geneva, Rights Commission, South Africa Switzerland • Christine Ogaranko, Canada • David Crepaz-Keay, Mental Health • J. Ramón Quirós, Ministry of Health and Foundation, United Kingdom Health Care, Principality of Asturias’ • Javier Vasquez, WHO Regional Office for Government, Spain the Americas, Washington DC, United • Japheth Ogamba Makana, MindFreedom, States Kenya • Jose Miguel Caldas de Almeida, Faculty • Sawsan Najjir, MindFreedom, Kenya of Medical Sciences, New University of • Charlene Sunkel, Gauteng Consumer Lisbon, Portugal Advocacy Movement; Chairperson, • Soumitra Pathare, Ruby Hall Clinic, Pune, South African Mental Health Advocacy India Movement, South Africa • Benedetto Saraceno, University Nova • Sylvester Katontoka, Mental Health Users of Lisbon, Portugal; Global Initiative on Network of Zambia Psychiatry, The Netherlands We also wish to thank the following people for their expert opinion and technical input: • Victor Aparicio, WHO Subregional Office, • Benjamin E. Berkman, Department of Panama Bioethics, National Institutes of Health, • Gunilla Backman, London School of United States Hygiene and Tropical Medicine, United • Mrs Barbara Bernath, Association for the Kingdom Prevention of Torture, Switzerland • Laurent Benedetti, University of • Andrea Bruni, WHO Country Office, Massachusetts Medical School, United Ethiopia States • Judith Bueno de Mesquita, University of • Laura Bennett, Severn Deanery School of Essex Law School, Colchester, United Psychiatry, United Kingdom Kingdom • Vijay Chandra, WHO Regional Office for South-East Asia, New Delhi, India Acknowledgements v • Hugo Cohen, WHO Subregional Office, • Alana Officer, WHO, Geneva, Switzerland Argentina • Ionela Petrea, Trimbos Institute WHO • Sebastiana Da Gama Nkomo, WHO Collaborating Centre, The Netherlands Regional Office for Africa, Brazzaville, • Matt Pollard, Association for the Democratic Republic of the Congo Prevention of Torture, Geneva, Switzerland • Julian Eaton, CBM West Africa Regional • Jorge Rodriguez, WHO Regional Office Office, Togo for the Americas, Washington DC, United • Marta Ferraz, National Programme for States Mental Health, Ministry of Health, Portugal • Diana Rose, Institute of Psychiatry, King’s • Lance Gable, Wayne State University Law College London, United Kingdom School, Detroit, Michigan, United States • Khalid Saeed, WHO Regional Office for the • Amelia Concepción González López, Eastern Mediterranean, Cairo, Egypt Public Health and Participation, Principality • Tom Shakespeare, WHO, Geneva, of Asturias, Spain Switzerland • Lawrence Gostin, O’Neill Institute • Jessica Sinclair, Maxwell Stamp PLC, for National and Global Health Law, United Kingdom Georgetown University, Washington DC, • Sarah Skeen, WHO, Geneva, Switzerland United States • Peter Stastny, Global Mental Health • Paul Hunt, University of Essex Human Program/RedeAmericas, Columbia Rights Centre, Colchester, United University, New York City, United States Kingdom • Kanna Sugiura, WHO, Geneva, Switzerland • Shadi Jaber, Mental Health Families and • Ezra Susser, Mailman School of Public Friends Society, West Bank and Gaza Health, Columbia University, New York Strip City, United States • Jan Paul Kwasik, Orygen Youth Health, • Stephen Tang, Australian National Melbourne, Australia