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

Published online by Cambridge University Press:  20 June 2019

Soumitra Pathare*
Affiliation:
Consultant Psychiatrist and Director, Centre for Mental Health Law & Policy, Indian Law Society, India
Michelle Funk
Affiliation:
Co-ordinator, Mental Health Policy & Service Development, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
Natalie Drew Bold
Affiliation:
Technical Officer, Mental Health Policy & Service Development, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
Ajay Chauhan
Affiliation:
Consultant Psychiatrist and State Nodal Officer, Hospital for Mental Health, Ahmedabad, India & Department of Health & Family Welfare, Government of Gujarat, India
Jasmine Kalha
Affiliation:
Program Manager and Research Fellow, Centre for Mental Health Law & Policy, Indian Law Society, India
Sadhvi Krishnamoorthy
Affiliation:
Programme Manager, Centre for Mental Health Law & Policy, Indian Law Society, India
Jaime C. Sapag
Affiliation:
Associate Professor, Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health, Canada; Division of Public Health & Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Chile; and Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Canada
Sireesha J. Bobbili
Affiliation:
Project Manager, Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health, Canada
Rama Kawade
Affiliation:
Co-ordinator of Data Management and Analysis, Centre for Mental Health Law & Policy, Indian Law Society, India
Sandeep Shah
Affiliation:
Professor of Psychiatry and Head, Department of Psychiatry, GMERS Medical College, Gotri, Vadodara, India
Ritambhara Mehta
Affiliation:
Professor of Psychiatry and Head, Department of Psychiatry, Government Medical College, Surat, India
Animesh Patel
Affiliation:
Consultant Psychiatrist, Department of Psychiatry, General Hospital, Mehesana, India
Upendra Gandhi
Affiliation:
Assistant Director, Medical Services, General Hospital, Mehesana, India
Mahesh Tilwani
Affiliation:
Psychiatrist, Gujarat medical services Class 1, Hospital for Mental Health, Bhuj, India
Rakesh Shah
Affiliation:
Psychiatrist and Superintendent, Hospital for Mental Health, Vadodara, India
Hitesh Sheth
Affiliation:
Psychiatrist, Gujarat Health Services, Class I, Hospital for Mental Health, Jamnagar, India
Ganpat Vankar
Affiliation:
Professor of Psychiatry and Head, Department of Psychiatry, B J Medical College, Ahmedabad, India
Minakshi Parikh
Affiliation:
Professor of Psychiatry and Head, Department of Psychiatry, B J Medical College, Ahmedabad, India
Indravadan Parikh
Affiliation:
Psychiatrist, Gujarat Health Services, Class I, Department of Psychiatry, M G General Hospital, India
Thara Rangaswamy
Affiliation:
Vice-Chairman and Chair, Research, Schizophrenia Research Foundation, India
Amritkumar Bakshy
Affiliation:
President, Schizophrenia Awareness Association, India
Akwatu Khenti
Affiliation:
Senior Scientist, Director of the Office of Transformative Global Health, Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health, Canada
*
Correspondence: Soumitra Pathare, Director Centre for Mental Health Law and Policy, Indian Law Society, Pune 411004, India. Email: spathare@cmhlp.org

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.

Type
Paper
Copyright
Copyright © The Royal College of Psychiatrists 2019

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Footnotes

Declaration of interest None.

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