WHO QualityRights Project: Addressing a Hidden Human Rights Emergency

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Posted: 19th December 2014

“I was now a resident or rather an inmate of the hospital”, says one mental health service user, of their experience in an institution. “I saw no one except the other people on the floor, who wore identical striped hospital robes and plastic bracelets with identifying names. Just as the bracelet was a closed stiff bracelet, the door was a locked door which I could not open. The mental health workers were the only ones who could open the locked door. I left my hope on the other side of the locked door.”

All over the world, people with mental and psychosocial disabilities experience a wide range of human rights violations, stigma and discrimination. It is common for people to be locked away in small, prison-like cells with no human contact or to be chained to their beds, unable to move. Inhuman and degrading treatment is common, and people in facilities are often stripped of their dignity and treated with contempt.

In response to this situation, the World Health Organization (WHO) established the QualityRights project, a worldwide initiative that aims to shed light into the darkest corners of mental health treatment but also offers to help countries improve their provision. Launched in 2012, WHO QualityRights aims to improve the quality and human rights conditions in mental health and social care facilities and empower organizations to advocate for the rights of people with mental and psychosocial disabilities.

What are the Objectives of QualityRights Project?

The WHO QualityRights Tool Kit

The WHO QualityRights Tool Kit is one of the key outputs of the project. The toolkit, which was prepared with input from international experts, including people with mental and psychosocial disabilities around the world, aims to provide guidance to countries on the quality and human rights standards that need to be, met in all mental health services.

It provides step by step guidance how to:

conduct a comprehensive assessments of both outpatient and inpatient
report the findings of the assessment
use the results and recommendations to improve quality of care and human rights

It comprises several practical tools and resources including:

A Human Rights Approach

The toolkit is based on the United Nations Convention on the Rights of Persons with Disabilities and covers five human rights themes:

The right to an adequate standard of living and social protection
The right to enjoyment of the highest attainable standard of physical and mental health
The right to exercise legal capacity and to personal liberty and the security of person
Freedom from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse
The right to live independently and be included in the community

Each theme includes sets of standards and criteria against which the situation in facilities can be assessed. Teams undertaking the assessment determine whether these quality and human rights standards are being met in facilities.

How, where and by whom can the WHO QualityRights Tool Kit be used?

The WHO QualityRights Tool Kit is designed for use in low-, middle- and high-income countries. It can be applied in all inpatient and outpatient mental health and social care facilities. It can be used by different groups with an interest in promoting the rights of people with mental and psychosocial disabilities, such as dedicated assessment committees, non-governmental organizations, national human rights institutions, national health and mental health commissions, health service accreditation bodies and national bodies and mechanisms established under international human rights standards.

The QualityRights Projects in Countries

The QualityRights project is currently being implemented using its toolkit in more than 17 countries worldwide including in Asia, Africa, Europe and North America.

In India, the QualityRights project was launched in July 2014 by the Ministry of Health and Family Welfare of Gujarat. The project, which is funded by Grand Challenges Canada, focuses on assessment of quality & human rights conditions in facilities throughout the state of Gujarat, and developing individualized improvement plan for each facility. Additionally Gujarat is implementing a comprehensive plan for capacity building for health care staff, service users and families on rights of people with psychosocial disabilities and quality care issues and establishing peer support groups for service users and families throughout the State. The picture above depicts a training workshop for the QualityRights team in Gujarat/India –September 2014.

In Asturias Spain, the QualityRights project led to some important outcomes including a Bill of Rights for people with psychosocial disabilities, and a new resolution formalising creation of a mental health commission to advise the Ministry and Development of mental health strategic plan.

In Jordan, as well as in Palestine, service user and care givers associations were strongly involved in implementation Quality Rights and in monitoring the human rights standards at mental health care facilities

The Human Rights Day (10^th December) and the International Day of Persons with Disabilities (3^rd December) are opportunities for us all to remember that is now the time to act, unite and empower people to improve mental health and promote human rights. A new paradigm is required, in which services promote recovery and emphasize the key elements of autonomy and participation of service users in all aspects of their treatment and private lives.

Mental health policy and service development: Contact Details

Please contact the WHO Headquarters QualityRights Team if you have any questions or if you plan to implement Quality Rights at your facility or at national level:

Department of Mental Health and Substance Abuse, WHO Geneva