QualityRights: the definitive push towards change
Summary
Mental health care has undergone progressive changes, especially in the last decade, driven largely by associations advocating for the rights of those receiving care and the elimination of coercive practices. Mental health professionals, including nurses and doctors, are receiving earlier training on how to work with people with mental health problems, focused on respecting rights and eradicating restrictive measures. The QualityRights initiative of the World Health Organization offers free online training, promoting knowledge and application of human rights in the field of mental health. This program aims to assess and improve the quality of mental health services and combat stigma, aligning with the Convention on the Rights of Persons with Disabilities.
Mental health care has fortunately been undergoing gradual changes for both patients and professionals, probably perceived as slow by both (especially by the former), becoming particularly more accelerated in the last decade.
It is important for professionals to recognize that many of these changes have come about due to pressure exerted by the grassroots movement , which has increasingly raised its voice demanding how it wants and expects to be treated, a process that began in our country more than 30 years ago through the first family associations. The vast majority of these demands focus on the legitimate defense of their rights, respect for their wishes, and the elimination of coercive measures.
Those of us who work in the field of mental health may have felt challenged or questioned by historical practices that we applied from a way of caring or trying to care that, we must recognize, has not always been the best or in which an excess may have been committed.
Here we could talk to a greater or lesser extent about various ethical questions and principles that may have clashed at some point, and also about the historically low staffing ratios in mental health, the structures, etc.
Training and awareness-raising of mental health professionals from the recovery model
Does this sound like a criticism of some of our past (not so distant, even still present at times) care models? Yes, because even if the end was well-intentioned, which is not up for debate in my opinion, the means have not always been appropriate: mechanical restraints, involuntary admissions, bans on visits, furloughs, etc. Let's remember, for example, that mobile phone use was permitted in acute care units (except in some institutions where the "risk" had already been accepted) because a global pandemic struck. Today, in the vast majority of inpatient facilities, people use their mobile phones during their stay, and there is no evidence that "anything bad" has happened, or anything that couldn't occur in other hospital settings outside of mental health facilities.
It's painful when, even within mental health associations, professionals (I'm a nurse, let's not forget) are sometimes labeled as torturers. This view held by some of those with lived experience can only be understood from the perspective that a historical gap of pain still exists in our relationship with the professionals and those we serve . Fortunately, the vast majority of us have always felt this pain and have strived to help close it, especially in recent years. And that needs to happen.
The change has also reached professionals from their earliest training stages: nurses (EIR), psychologists (PIR), and doctors (MIR) receive meetings and seminars with people with mental health problems during their respective residencies. Part of the key to this cultural shift also lies in the training provided and received.
Did we do worse before (placing that "before" in an unspecified time and place)? I won't be the one to judge, but I can say that, as a professional nomad, having worked in many institutions throughout my 26 years as a mental health nurse, we are now doing better and are beginning to see examples of good practices in eradicating coercive measures and mechanical restraint, as well as other approaches like open-door units. There is a unanimous feeling that this is the path and direction to follow, and that each institution should allocate resources to achieve these goals.
A training program to continue listening to and understanding each other
QualityRights and the training they offer to the general public, professionals, and people with lived experiences should be understood as a tool for continuing to listen to and understand each other, and for taking that definitive leap forward toward fully guaranteeing the rights of people with psychosocial, intellectual, or cognitive disabilities. The World Health Organization designed them to evaluate and improve the quality and human rights of mental health and specialized social services, combating stigma and discrimination, and guiding the reform of national policies and laws in accordance with the Convention on the Rights of Persons with Disabilities.
We have previously mentioned the growing importance of training in transforming the culture of mental health care. QualityRights offers free, open-access training resources based on a modular learning pathway that covers key topics related to human rights, encompassing both theory and practice through participatory activities. The resources range from basic materials to more specialized resources, including guides and supplementary tools, organized into thematic areas: human rights, mental health, disability and human rights, legal capacity, recovery, and protection against coercion, violence, and abuse.
The Department of the Presidency of the Government of Catalonia, through the National Mental Health Pact, has translated all the materials into Spanish and Catalan, and they can be found on Support-Girona and SOM Mental Health 360º. Currently, a group of experts coordinated by Obertament is working on adapting the original material to our specific context.
Until this training and these adapted materials—which we hope will soon be available to future trainers of trainers who can spread the message throughout the country— QualityRights offers free online training (by creating an account) designed to provide people with a basic understanding of the issues raised, with a final certificate awarded upon completion. I already have mine; are you interested?
A quick guide to QualityRights and why they concern you
In short, QualityRights foster our learning, invite us to reflect, make us question how we have done things, how we may still be doing them when we shouldn't, and guide us to sometimes change our care practices, aligning them with the Convention on the Rights of Persons with Disabilities.
QualityRights must be the definitive push for change because, as its promoter, Dr. Michelle Funk, Head of the Policy, Law and Human Rights Unit of the Department of Mental Health and Substance Use of the World Health Organization, rightly stated in an interview given to this same platform: "We need to change attitudes and mindsets about mental health at all levels."
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