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Numerous reports from countries, the UN, NGOs and the media underscore extensive human rights violations experienced by people with psychosocial disabilities, including the denial of the right to exercise their legal capacity. Within the mental health care context people report that services do not respond to their needs and fail to respect their will and preferences or to support community inclusion. This underscores the need to adopt a human rights approach in mental health and to radically shift the way services operate, towards care and support that is recovery and rights oriented and that ensures service users are the drivers of their own healthcare. WHO QualityRights, established in 2012, is an initiative to improve access to good-quality mental health and social services and to promote the rights of people with psychosocial disabilities worldwide in line with the CRPD. The initiative works in several areas: capacity building to combat stigma and discrimination and promote rights and recovery; creating community-based services that respect human rights and person-centered recovery approaches; supporting civil society movements and people with lived experience to conduct advocacy and influence policymaking; and reforming policy and law in line with the CRPD and other human rights standards.
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.
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.
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.
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).
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.
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