Respeto a los derechos de las personas que se atienden en Servicios de Psiquiatría Ambulatoria en Chile / A survey about quality of care and user’s rights in Chilean psychiatric services

Background: Quality of care and respect for the rights of users are critical to achieve positive health outcomes and respond appropriately to the expectations of people, particularly if they have mental illnesses. Aim: To carry out a baseline diagnosis of quality of care and respect for rights in public outpatient psychiatric services. Material and Methods: Quality of care and respect for patients’ rights was assessed by a mental health professional and a trained psychiatric service user in 15 ambulatory psychiatric services. The WHO QualityRights instrument was used, reviewing documentation and making observations in each facility, as well as interviewing 146 patients, 148 health care workers and 64 relatives of patients. Results: A high level of achievement was accomplished in terms of discrimination-free health care, availability of psychotropic medications, lack of abuse or neglect and use of informed consents. A low level of achievement was found in terms of user support to cope with community living, access to education or work and participation in community activities, respect for user treatment preferences and preventive measures to avoid maltreatment and cruelty. Conclusions: Chile could improve the performance of psychiatry services having laws based on the “Convention of Rights of Persons with Disabilities” and standards of the World Health Organization, having national policies about quality of care and rights of users, reinforcing the community work of mental health care teams, reinforcing and informing users about their rights and promoting research on interventions to improve the respect of their rights.

[A survey about quality of care and user’s' rights in Chilean psychiatric services]. / Respeto a los derechos de las personas que se atienden en Servicios de Psiquiatría Ambulatoria en Chile.

BACKGROUND: Quality of care and respect for the rights of users are critical to achieve positive health outcomes and respond appropriately to the expectations of people, particularly if they have mental illnesses. AIM: To carry out a baseline diagnosis of quality of care and respect for rights in public outpatient psychiatric services. MATERIAL AND METHODS: Quality of care and respect for patients'’ rights was assessed by a mental health professional and a trained psychiatric service user in 15 ambulatory psychiatric services. The WHO QualityRights instrument was used, reviewing documentation and making observations in each facility, as well as interviewing 146 patients, 148 health care workers and 64 relatives of patients. RESULTS: A high level of achievement was accomplished in terms of discrimination-free health care, availability of psychotropic medications, lack of abuse or neglect and use of informed consents. A low level of achievement was found in terms of user support to cope with community living, access to education or work and participation in community activities, respect for user treatment preferences and preventive measures to avoid maltreatment and cruelty. CONCLUSIONS: Chile could improve the performance of psychiatry services having laws based on the “Convention of Rights of Persons with Disabilities” and standards of the World Health Organization, having national policies about quality of care and rights of users, reinforcing the community work of mental health care teams, reinforcing and informing users about their rights and promoting research on interventions to improve the respect of their rights.

[Differences on perceptions of quality of care and respect for rights in mental health between user, family and staff].

BACKGROUND: This study is based on the inadequate quality of care and respect for rights in mental health services and on differences in perceptions on these issues between users, families and staff in other countries. OBJECTIVES: To compare the perceptions of quality and respect of rights between users, families and staff in Chile. METHODS: In 15 randomized specialized outpatient facilities, 146 users, 64 families and 148 staff were interviewed applying the WHO QualityRights instrument. The interviews with users and families were conducted by a user and the interviews with staff were conducted by a mental health professional, both interviewers were external to the 15 centers and trained in the use of the instrument. RESULTS: Total scores for the set of 18 indicators studied show lower values among users and families compared with staff (p <0.001). In three of the four areas studied significant differences were observed, with users and relatives also perceiving a lower percentage of compliance with standards than did the staff. The area of rights to inclusion in the community was the one with the greatest difference among the three groups interviewed, with the 4 standards having significantly lower scores on users and their families CONCLUSIONS: The results of this study contribute to highlight the importance of mental health services really listening the voice of users and their families, in order to understand their needs and expectations about care. The need for users to actively participate in treatment decisions and implementing community interventions to promote greater social inclusion are also concluded.