A report on long-term mental Health care facilities in Europe has been published this week by The World Health Organisation (WHO). The report, "mental health, human rights and standards of care", indicates subpar standards in the level and quality of care provided at these facilities. Fundamental aspects of care are not being met and just 25% of the 75 institutions represented in the report were reported as completely fulfilling “internationally agreed standards of care.”

The WHO European Region covers 24 countries across Europe and Central Asia.

Background to the report

Mental health problems affect 25% of those living in the WHO European Region and the importance of such persons having access to suitable standards of care and support has been impressed by WHO and others. Beginning in 2013, WHO initiated the European Mental Health Action Plan which aims to increase the quality of care as well as move towards de-institutionalising long-term care in favour of more community-based care. By 2020, the objectives of the plan are intended to have been met.

Part of the plan is WHO’s global QualityRights initiative. It aims to increase levels of care in addition to making sure the human rights of those with psychosocial problems and intellectual disabilities are being respected.

The initiative has a person-centered and recovery focus and is in line with the United Nations Convention on the Rights of Persons with Disabilities (CRPD).

The study used a specially-devised toolkit, WHO QualityRights toolkit, for assessment. The measure was intended to assess 5 care themes based on the CRPD.

Themes included a suitable standard of living and “the highest attainable standard of physical and mental health.”

Report findings

Concerningly, just 5% of institutions were recorded as having achieved in full, WHO’s appropriate standard, that treatment and psychosocial rehabilitation be "service user-driven" and "contribute to a service user's ability to live independently in the community." Instead, for many, the institution was seen as the endpoint of care.

This disappointing statistic conveys one aspect of the volume of work that will be needed to achieve the aimed for de-institutionalisation of long-term care in Europe.

Additionally, the report found that “many facility assessments showed that staff had no understanding whatsoever about human rights and could therefore not inform service users.” Lack of understanding puts the service users at risk from violations of their human rights as well as potentially being unaware of their rights themselves.

Only 25% of institutions were reported as having “achieved in full” the standard of having measures that make sure that no abuse, torture, or degrading treatment occurs. The majority of institutions fell into categories in between “achieved partially” and “achievement initiated”, with 10% not initiating it at all.

A particularly alarming instance, in the section of the report dealing with the right to not be subject to abuse in any way was the noting that, in one institution, a number of female service users had been sexually abused and that these cases were neither “formally investigated” nor resultant in the provision of support to “help them cope with their experience.”

Moreover, concerns of privacy and communications were noted as it was commonplace for communication to be restricted, whether this is with limited visiting hours or access to post, phone, or email is limited or not allowed. When communication was allowed, it was not often private, and lack of privacy was observed in other areas of the service users’ environment too.

General environments were found to vary quite a lot with some facilities being ‘purpose-built’, taking into account the current needs of service users, including rights to privacy. Others were outdated and lacking in space as well as requiring revamping.

Lack of educational and employment opportunities was another area that the vast majority of institutions fell short. Less than 10% of facilities were reported as having achieved this standard in full, and “Not initiated” was the highest category, with over 40% of facilities' provision falling into that category. This prevents service users from being able to achieve their potential and would contribute to the feelings of boredom reported to the assessment teams.

Future of European care institutions

The report indicates that much needs to be done to improve the provision of care for adults in Europe with psychosocial and intellectual disabilities. Initially, steps will need to be taken to ensure that standards set by WHO and CRPD are met to a satisfactory level. Once this is done, action will need to be taken to pave the way for de-institutionalisation by increasing provision of supported community housing and suitable educational, vocational, and recreational activities for those in long-term care.

The WHO’s Programme Manager for Mental Health, Dr. Daniel Chrisholm, has said in response to the report that to improve long-term care, “we can’t simply renovate or update buildings.

The change has to come from inside. We need to build up awareness, skills, and literacy around mental health and human rights.”

It is clear from the report that there is a long way to go for all participating countries.