The WHO QualityRights project Michelle Funk and Natalie Drew Mental Health Policy and Service Development

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1 Promoting the rights of people with Psychosocial disabilities The WHO QualityRights project Michelle Funk and Natalie Drew Mental Health Policy and Service Development

2 Global Mental Health Action Plan ( ) WHA resolution calling for action plan covering services, policies, legislation, plans, strategies & programmes Multisectoral web and face-toface consultations in 5 WHO regions Member States: 135 WHO CCs & other academic centres: 60 NGOs: 76 Others: 17

3 Global Mental Health Action Plan Vision A world in which mental health is valued, promoted and protected, mental disorders are effectively prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigma and discrimination. Universal health coverage Human rights Cross-cutting Principles Evidence-based practice Life course approach Multisectoral approach Empowerment of persons with mental disorders & psychosocial disabilities Goal To promote mental well-being, prevent mental disorders, provide care, enhance recovery,promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders 1. To strengthen effective leadership & governance for mental health Target 1.1: 80% countries developed or updated policies/plans in line with int'l human rights instruments Target 1.2: 50% countries developed or updated laws in line with int'l human rights instruments Objectives and Targets 2. To provide comprehensive, integrated & responsive MH and social care services in communitybased settings Target 2: Service coverage for severe mental disorders increased by 20% 3. To implement strategies for promotion and prevention in mental health Target 3.1: 80% countries w/at least two functioning national, multisectoral promotion & prevention Programmes Target 3.2: Rate of suicide in countries reduced by 10% 4. To strengthen information systems, evidence & research for mental health Target 4: 80% countries routinely collecting & reporting core set of mental health indicators every 2 years

4 Global Mental Health Action Plan Actions around Objectives 1-4 Polices, laws and strategies in line with International human rights standards - CRPD Services that emphasise recovery, including the right to employment, housing and education through service user driven recovery plans Promotion and prevention campaigns to reduce stigma, discrimination and violations Operational research with direct relevance to the exercise of human rights by persons with mental and psychosocial disabilities Cross cutting principles ( ) Human Rights: Mental health strategies, actions and interventions must be compliant with the Convention on the Rights of Persons with Disabilities and other international and regional human rights instruments. The Empowerment of persons with mental and psychosocial disabilities: People with mental and psychosocial disabilities should be empowered and involved in mental health advocacy, policy, planning, legislation, service provision, monitoring, research and evaluation.

5 WHO QualityRights Objectives Assess and improve the quality and human rights conditions in inpatient and outpatient mental health facilities Build capacity among people with psychosocial disabilities, families and health workers to understand and promote human rights To support efforts to develop civil society movement of people with psychosocial disabilities Reform national policies and laws in line with best practice and international human rights standards

6 Objectives 1 Improve the quality of services and human rights conditions in inpatient and outpatient mental health services Assessment using the QualityRights Toolkit Feedback and discussion the results Improvement plans

7 Objectives 2 Build capacity among people with psychosocial disabilities, families and health workers to understand and promote human rights People with psychosocial disabilities - so that they can claim their rights Family members and carers - so that they respect rights and support their relative to claim rights Health workers so that they can change their practices

8 Objectives 3 Develop civil society movement of people with psychosocial disabilities Peer support groups Mutual support Sharing knowledge, experiences & information Advocacy organizations Advocate for rights Lobby for change Participate in decision making processes

9 Objectives 4 Reform national policies and legislation in line with best practice and international human rights standards Mental health policies and strategies: Deinstitutionalisation Integration of mh into general health care settings Development of community mh services Mental health legislation: Stop violations and discrimination Promote human rights Encourage autonomy, liberty & exercise of legal capacity Promote access to legal mechanisms

10 QualityRights ToolKit

11 WHO QualityRightsToolkit Practical information, tools & guidance on: How to conduct a comprehensive assessment based on observation, review of documentation and interviews How to report the findings of the assessment How to use the results and recommendations to improve quality of care and human rights

12 QR Toolkit establishes key standards, based on the CRPD, to be met in all inpatient and outpatient facilities Themes 1. Right to an Adequate Standard of Living (CRPD Art 28) 2. Right to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (CRPD Art 25) 3. Right to Exercise Legal Capacity and to Personal Liberty and the Security of Person (CRPD Art 12 & 14) 4. Freedom from Torture or Cruel, Inhuman or Degrading Treatment or Punishment and from Exploitation, Violence and Abuse (CRPD Art 15 & 16) 5. The Right to Live Independently and Be Included in the Community (CRPD Art 19)

13 Unique features of the QualityRights ToolKit Applicable in low, middle and high income countries Applicable in a range of facilities in & out-patient Participatory approach people with psychosocial disabilities, families & health staff Promotes a recovery approach Allows comparison between mental health and general health to determine parity Can be used by government and NGOs

14 QualityRights Implementation in countries

15 Implementing QualityRights Asturias, Spain Palestine Somaliland Greece Country Completed Initiated & Ongoing To be initiated soon Brazil (Salvador, Bahia) Chile Libya (on hold) Jordan Brazil (MOH - National) India (Gujarat) Sierra Leone (on hold) Argentina (Buenos Aires Province) Afghanistan Malaysia Nigeria (substance abuse) Paraguay Liberia

16 Asturias, Spain 28 facilities (general hospital, communities services, residential facilities) Specific recommendations based on assessment to promote rights and improve quality Project has produced some important outcomes Bill of Rights for people with psychosocial disabilities A new resolution formalising creation of a mental health commission to advise the Ministry Development of mh strategic plan

17 Hargesia Hospital, Somaliland As a result of the QualityRights intervention: The practice of chaining service users ceased Many long-term service users were released - several found jobs Hygiene standards were improved Additional health professionals were appointed

18 QualityRights: Gujarat Key interventions: Assessment of quality & human rights conditions in facilities Feed back results and develop improvement plans Capacity building on human rights & quality Rights of people with psychosocial disabilities (CRPD) Recovery approach Autonomy, legal capacity and supported decision making Alternatives to seclusion and restraint other human rights areas Establish service user and family support groups how to set up a support group recovery and self care building relationships & communication stress management assertiveness and decision making Accessing services and supports in the community (legal and social supports, housing, employment and educational opportunities) self-advocacy

19 Thank you!

20 Promoting the rights of people with Psychosocial disabilities The WHO QualityRights project Michelle Funk and Natalie Drew Mental Health Policy and Service Development

21 Format of the action plan Objective 1: Leadership and governance for mental health Objectives Proposed actions for: Member States Secretariat International and national partners Targets to measure progress Options for implementation Target 1.1:80% countries developed/updated policies/plans in line with int'l HR instruments Target 1.2: 50% countries developed/updated laws in line with int'l HR instruments Action areas for Member States Policy & law Empowerment Resource planning implementation options I. Sensitize national policy-makers to mental health and human rights - preparation of policy briefs, scientific publications and leadership courses in mental health II. Mainstream mental health and rights into health and other sector policies and strategies III. Set up mechanisms to monitor and prevent torture or cruel, inhuman and degrading treatment IV. Repeal legislation that perpetuates stigmatization, discrimination & violations V. Monitor & evaluate the implementation of policies and legislation for compliance with CRPD I. Support the formation of independent national and local organizations of people psychosocial disabilities and their involvement in decision making processes II. Involve people with psychosocial disabilities in monitoring of mental health services III. Include people with psychosocial disabilities in training of health workers I. Etc. Engagement with all stakeholders I. Etc.

22 The context Violence & abuse Degrading treatment & punishment Coercion No autonomy or participation Discrimination in education & employment Denial of civil and political rights CRPD sets new paradigm End violence, torture and abuse Promote legal capacity Services and supports for independent living in the community Civil, political, economic, social and cultural rights

Mental Health Declaration for Europe

Mental Health Declaration for Europe WHO European Ministerial Conference on Mental Health Facing the Challenges, Building Solutions Helsinki, Finland, 12 15 January 2005 EUR/04/5047810/6 14 January 2005 52667 ORIGINAL: ENGLISH Mental Health