Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India

Abstract

Background Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. Aims To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. Method This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. Results Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50–0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). Conclusions To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services. Declaration of interest None.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…They include: (1) developing an evidence-based medicine selection process; (2) promoting information and education activities for health-care professionals and users on the selection process; (3) regulating psychotropic medicine availability; (4) implementing a reliable health and supply chain system; (5) ensuring the quality of psychotropic medicines including generics; (6) developing a community-based system of mental health care; (7) developing policies on the affordability of medicines; (8) developing pricing policies and fostering a sustainable financing system; (9) adopting evidence-based guidelines; (10) monitoring the use of psychotropic medicines; and (11) promoting training initiatives for health-care professionals on the critical appraisal of scientific evidence and appropriate use of psychotropic medicines. This is in addition to adequately addressing human rights' issues in patients with mental disorders where these currently exist in LMICs including implementing the QualityRights program building on current successes [61].…”

“…In addition, helping to scale up mental health services using a wide range of different professionals. The WHO also introduced the QualityRights initiative in 2013 to improve the care of patients with mental health disorders [57,58,61,62], with studies in sites such as Gujarat in India showing that the QualityRights programme can be effectively implemented in resource-limited setting to improve the quality of mental health services [61]. We are also aware of the Partnership for Mental Health Development in Africa (PaM-D) to bring together diverse stakeholders to help create an infrastructure to develop mental health research capacity and science.…”

“…Potential strategies to overcome barriers and existing problems to the management of BP-II in LMICs start with recognition of the limited resources currently being spent on mental disorders in a number of these countries compared with current spending on infectious diseases and other NCDs. In addition, recognizing the human rights of patients with mental disorders and addressing issues with the stigma that patients with mental health disorders currently experience [8,35,61]. The lack of focus on mental disorders in some LMICs may be because of an increasing focus on antimicrobial resistance (AMR) in recent years due to high inappropriate use of antibiotics and its associated consequences on morbidity, mortality, and costs [229][230][231][232][233][234][235][236].…”

“…(Continued ) improve the health of their patients with mental disorders in their country, building on the WHO mhGAP initiative, the QualityRights initiative as well as the PaM-D initiative in sub-Saharan Africa (Tables 1 and 2) [59, [61][62][63]241,242]. This will continue as more knowledge about the burden of mental disorders is developed and discussed.…”

Rethinking the concept of insight

“…More challengingly, a focus on the experience of social exclusion may generate momentum away from individual‐level explanations of experience and towards activities to generate collective action to improve mental health and social care system compliance with human rights legislation 9 . Modesty in clinical knowledge claims is empirically justified.…”