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Year : 2014  |  Volume : 139  |  Issue : 1  |  Page : 183-184

WHO qualityRights tool kit: Assessing and improving quality and human rights in mental health and social care facilities

Department of Psychiatry Postgraduate Institute of Medical Education & Research Chandigarh 160 012, India

Date of Web Publication6-Mar-2014

Correspondence Address:
Debasish Basu
Department of Psychiatry Postgraduate Institute of Medical Education & Research Chandigarh 160 012
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Basu D. WHO qualityRights tool kit: Assessing and improving quality and human rights in mental health and social care facilities. Indian J Med Res 2014;139:183-4

How to cite this URL:
Basu D. WHO qualityRights tool kit: Assessing and improving quality and human rights in mental health and social care facilities. Indian J Med Res [serial online] 2014 [cited 2020 Sep 21];139:183-4. Available from:

(World Health Organization, Geneva, Switzerland) 2012. 99 pages. Price: CHF 20.00 / US $ 24.00; in developing countries: CHF 14.00 / US $ 16.80

ISBN 978-92-4-154841-0

The human rights of people with various disabilities and especially those with mental, behavioural or substance use disorders have long been neglected in the past and continue to be neglected. The quality of care they receive and the care facilities that they utilize can also vary widely. It is not only important to assess the quality of care for such people with disabilities but also to ensure their rights.

As the title of the book rightly says, this WHO publication is a "Tool Kit" rather than a book, though it is organized into 15 chapters, six annexes, and a very useful compact disc that contains four important documents (the real "tools"). It is based on the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The purpose of this tool kit is to provide assistance in assessing and improving quality and human rights in mental health and social care facilities in any country, irrespective of its low-, middle- or high-income status. The book fulfils this purpose in a series of sequential steps starting from delineating the five major "themes" on which the assessment of quality and rights is based; defining multiple "standards" from each of these five themes; further spelling out specific, objective and concrete "criteria" under each of these standards; and finally providing (in the CD) the detailed interview, observation and reporting forms as the "tools" to be used.

The five themes that form the basis of the rest of the tool kit are as follows: (i) Theme 1: the right to an adequate standard of living (Article 28 of the CRPD); (ii) Theme 2: the right to enjoyment of the highest attainable standards of physical and mental health (Article 25 of the CRPD); (iii) Theme 3: the right to exercise legal capacity and the right to personal liberty and security of the person (Articles 12 and 14 of the CRPD); (iv) Theme 4: freedom from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse (Articles 15 and 16 of the CRPD); and (v) Theme 5: the right to live independently and be included in the community (Article 19 of the CRPD).

Each theme gives rise to 4-5 Standards (Theme 1 yields 7 Standards). An example of a Standard under Theme 4 is Standard 4.1, which details that service users have the right to be free from verbal, mental, physical and sexual abuse and physical and emotional neglect. Furthermore each Standard is then spelt out by several criteria. For example, criteria listed under Standard 4.1 are; 4.1.1 - Staff members treat service users with humanity, dignity and respect; 4.1.2 - No service user is subjected to verbal, physical, sexual or mental abuse; 4.1.3 - No service user is subjected to physical or emotional neglect; 4.1.4 - Appropriate steps are taken to prevent all instances of abuse; and 4.1.5 - Staff support service users who have been subjected to abuse in accessing the support they may want.

The mode of assessment is by interviewing service users, their family members and staff. "Lead questions" have been marked for each of the Standards, with subsidiary "Prompts". For example, there are 9 lead questions for Standard 4.1. The first lead question is: "Could you give your overall impression about how service users are treated by staff (health staff, but also cleaning, security and any other staff at inpatient facilities) in this facility? Are service users regarded with humanity, dignity and respect at all times, and are their well-being and safety, priorities for the facility?" The prompts are: "Can you give examples of how service users are or have been treated respectfully and with dignity? Are there situations in which service users were not treated with dignity and respect? Do you think that the overall well-being and safety of service users is a priority for the facility? If not, why do you think that is?"

The responses are tabulated on a sheet. This is coupled with review of documentation and direct observation of the care facility, its arrangements and amenities, staff, and their interaction with service users (again, with detailed instructions as to what and how to observe) under several headings. All these are recorded and compiled as an Assessment Report, which can be either for individual facilities or for the entire country. Each Criterion, Standard, and finally Theme is assessed to its level of achievement and recorded as one of the following five outcomes: Achieved Fully, Achieved Partially, Achievement Initiated, Not Initiated and Not Applicable. These are arrived at after combining the results of interview, documentation review, and direct observation. Conclusions and recommendations are made based on this report.

The tool kit book takes the reader through the process of planning and carrying out this entire task. Starting from establishing the project management team, assessment committee and assessment framework, it provides guidance regarding training of the members of the assessment committee, establishing the authority of the committee, preparing consent forms, seeking ethical approval, scheduling and conducting the assessment, preparing the report, and using the results of the assessment. The Annexes are also relevant, e.g., Annex 3 is the UN CRPD with all 50 articles, Annex 4 is the essential and complete list of Themes, Standards and Criteria for assessment, and Annex 6 gives sample consent forms for interviewees.

This is a professional work bearing the signature marks of a typical WHO document - detailed, meticulous, organized and comprehensive. The meticulousness and eye for details is exemplified by practical, small, but important details such as "interviewing tips" (panel in Chapter 13, Interview, page 35) and especially "Tips for observation" (panel in Chapter 11, Observation, page 29), where observers are urged to use all five senses to observe - not just see, but also smell, feel, hear and taste (the food)!

If used properly by governmental and non-governmental organizations, the assessment procedure can yield a rich dividend in terms of a quality audit as well as indicating the areas for improvement.

However, the interview protocol could have been shorter. With a near-70 pages protocol (Interview Tool document in the CD), one wonders how many interviewers and interviewees would actually go through the entire interview procedure question-by-question. Probably the individual assessment committee members will need to set their own framework and adapt or shorten the protocol suitably depending upon the focused objective of assessment. Some adaptation may also be needed for such a global and generic document to make it more useful and relevant in a specific country and culture.

This "Tool Kit" should be an essential collection for government authorities, inspection agencies, rights groups, voluntary lobbies and indeed any individual concerned with improving the quality of care and ensuring the human rights of persons with mental health related disabilities. The entire PDF and other tools can be downloaded free from the WHO site.


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