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Page type: 
Evaluation
Publication date: 
2016

This report assesses the quality of mental health services and human rights conditions in the Kabul Mental Health Hospital (KMHH), using the WHO QualityRights Toolkit, and provides recommendations for development of an improvement plan.


Objective

To assess the quality of mental health services and human rights conditions in the Kabul Mental Health Hospital (KMHH) and provide recommendations for development of an improvement plan and to update and revise the National Mental Health Policy, Strategy and Plan.

Methods

The assessment was conducted in January 2015 in the KMHH and the Burn Ward of Isteqlal Tertiary Hospital (to measure and compare parity between the two facilities) by a multidisciplinary team using the WHO Quality Rights Tool Kit. Interviews were conducted with 16 service users, 17 hospital staff members, and 7 family members, in addition to document review and observation of inpatient units and interpersonal interactions.

Results & Discussion

There were serious gaps regarding service provision levels and respect for human rights of service users and their family members. Policies, guidelines and procedures related to patients’ human rights were absent. The extensive human rights violations that service users were experiencing included: Inadequate treatment environment and standard of living; poor quality of care and services; violations of the right to exercise legal capacity and personal liberty; being chemically (by medications) and physically (chain, leather belts and even wristbands) restrained; being exposed to verbal, physical and emotional abuse; and emphasis on institutional treatment rather than assisting users to develop their abilities in order to recover and reintegrate into the community.

Assessment also revealed that hospitalized individuals in KMHH did not receive the same standards of health care and respect for their rights as compared to individuals hospitalized in the Burn Ward of Isteqlal Tertiary Hospital. To overcome existing challenges, there is a serious need for both KMHH and the Ministry of Public Health to start taking fundamental steps toward improving quality of care which incorporates human rights principles, protecting people’s inherent dignity and changing classic behavior of healthcare providers. 
 
Conclusions & Recommendations 

The available services for mental health service users are questionable due to mistrust and lack of awareness about the rights of people with disabilities, and they need to be positively changed. The existing Mental Health Act has a large number of disparities with the Convention on the Rights of Persons with Disabilities (CRPD) and requires revision and adaptation in accordance to CRPD. The assessment also unmasked human rights violations and discrimination to be accepted practice.

Suggestions and recommendations are made separately for the Kabul Mental Health Hospital and the Ministry of Public Health in Afghanistan to improve these conditions. It is recommended that KMHH make fundamental changes at management and administrative levels and develop a practical operational plan to improve quality of services and promote human rights in the facility. Although specific suggestions are made based on each theme of the tool kit, the general recommendation is that KMHH should be more focused on management procedures, staff capacity building, coordination with relevant and related sectors, efficient service provision, and effective monitoring in order to ensure quality improvement and promotion of human rights.

Additional suggestions and recommendations are addressed at the MoPH in order to modify their laws, policies, and strategies in light of the CRPD. Certainly, a series of necessary actions such as changes and revisions in laws, policies and strategies are needed, but revision of policies and legislation alone cannot bring changes to the issues in real life; therefore, it should be practically implemented.

Approach: 
Policy and legislation
Human rights
Empowerment and service user involvement
Advocacy
Treatment, care and rehabilitation
Disorder: 
All disorders
Setting: 
Specialist care
Population: 
Humanitarian and conflict health
Region: 
Middle East
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