Mental health institutions in Europe are failing to safeguard residents’ human rights, with many described as shocking by experts who have found not one institution among 75 visited across the continent fully met all of the standards set by the United Nations.
While some institutions took care to train staff to deal with crises, create individual recovery plans and provide access to legal support, others failed to even partially meet such standards.
The findings are part of a broader report, produced by the World Health Organization (WHO), with the assessment of institutions such as mental hospitals and social care homes covering 25 countries across Europe. It notes instances of patients sleeping on floors, bedbug infestations, lack of toilet paper and broken windows with many facilities not even having toilet doors and shower screens or curtains. In addition, most did not offer patients any form of occupation.
“Residents often had literally nothing to do and were not given opportunities for learning or training in skills that might provide them with an occupation,” the authors write.
The report also reveals that most institutions restricted patients’ communication with people outside its walls – for example only allowing them to contact family, or allowing communication only at certain times. “Furthermore, only a few institutions respected service users’ right to privacy in communications,” the authors note, adding that at most institutions patients where not free to roam.
And while in general staff were found to treat patients well, neglect, isolation and even sexual abuse of female patients was found in some institutions – with one reportedly conducting forced abortions of resulting pregnancies.
What’s more, the authors note that most institutions did not help to rehabilitate patients into the community, with staff often seeing institutions as a permanent step for patients due to factors including a lack of community supported-housing.
Daniel Chisholm, head of the WHO’s mental health programme and a co-author of the report, said the findings were shocking, although not surprising. “This is well known as a long-standing problem,” he said.
When asked whether the attitude within institutions was to admit patients and forget about them, Chisholm said: “In the worst case you can say that is true.”
Teams of trained assessors were sent to 75 mental institutions across 25 countries and to examine whether they were meeting the standards set out by the UN Convention on the Rights of Persons with Disabilities (CRPD). The UK did not take part in the study. However, the Care Quality Commission last year criticised mental health care providers for what it called “outdated and sometimes institutionalised care” for large numbers of patients.
Each assessment involved rating 25 standards across five main areas, including the right to an adequate standard of living, the right to enjoy the highest achievable standard of physical and mental health, and freedom from torture, abuse and punishment.
The results reveal that while some institutions met or partially met standards across the board, others had not made any attempt to put certain standards in place. Only 28% of the 2,450 ratings made by the teams of assessors were classed as achieving a standard in full.
“The implication is that countries who have signed up to the UN convention on the rights of persons with disabilities are not fully meeting the requirements of that convention,” said Chisholm.
The study had limitations, including that institutions were not randomly selected, assessors differed from team to team, and that the governments themselves chose who assessed facilities.
Dr James Kirkbride, a psychiatric epidemiologist at University College London, described the findings as a wake-up call: “It really is quite shocking that the level of care in some inpatient psychiatric settings in parts of Europe is so behind what we would expect a 21st century mental health care system to look like.”
The Liberal Democrat MP and former health minister Norman Lamb said many of the report’s “dreadful findings” reflected situations founds in parts of the UK, including the use of physical restraint. “We are lacking a global movement to address the systematic violation of the basic rights of people with mental ill health which, as this report shows, is happening right across Europe,” he said, adding that the injustice extends beyond inadequate healthcare provision to other areas including legal rights. “The treatment of people with mental health problems as second-class citizens is a global scandal which demands a global response.”