Improving the Quality of Mental Health Care

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Objective.

To develop international guidance for improving the quality of mental health care in low- and middle-
income countries.
Design.

A panel developed recommendations based on a comprehensive literature review, consultation with over
100 experts from 46 countries and an analysis of international best practices.
Recommendations. A 5-pronged approach to improving the quality of mental health care is recommended. Quality
improvement requires the alignment of policy and legislation with the attainment of good quality mental health
outcomes. Key partners must be brought into the quality improvement process. Funding can be an important tool for
promoting good quality but needs to be correctly aligned to meet policy objectives and to promote evidence-based
interventions. Accreditation procedures and quality standards need to be carefully developed and resources
allocated for their implementation. Finally, quality improvement must be brought into routine service management
and delivery.
Conclusions.

Through a systematic approach to quality improvement, it is possible to ensure that the best possible
interventions are provided within the constraints of each country and that the rights and well-being of people with
mental disorders is optimally promoted. Quality improvement is not a luxury but an integral part of ensuring that the
best possible services are provided to all who need them.

Introduction
Poor quality mental health services can violate basic human rights, lead to negative therapeutic outcomes and
prevent people from enjoying the highest standard of physical and mental health.[1] However, poor quality of care
can be substantially redressed through concerted and systematic quality improvement strategies.[2] Evidence is now
emerging that the very substantial burden of disease attributable to mental disorder can be significantly reduced
through high-quality evidence-based mental health care.[3] While prescribing methods for improving the quality of
mental health services is challenging, not least because there is tremendous variation in the availability of financial
and human resources in different countries, providing guidance to countries to assist them to attain better quality
mental health care is necessary and important.

What is Meant by Quality?

Quality in health care has been defined by the Institute of Medicine as ‘the degree to which health care services for
individuals and populations increase the likelihood of desired health outcomes and are consistent with current
professional knowledge’.[4] Quality may be viewed from a number of perspectives. For a person with a mental
disorder, quality can mean reduction in symptoms, being able to carry on with ‘normal’ life and being treated with
dignity and with full respect of his/her rights to autonomy and independent decision-making. From the point of view
of a family member, quality may mean being provided with support to help cope with some of the emotional
consequences of having an ill family member and being provided with the information and skills to actively assist a
family member’s integration into the community. A service provider on the other hand may see quality as ensuring
that patients receive the best treatment and care available. For a policy-maker, quality can be seen as the key to
improving the mental health of the population, ensuring value for money expended and accountability. All of these
perspectives are important; in this article, we primarily examine quality from the perspective of public health service

FROM: International Journal for the Quality of Health Care

By: M. Funk; C. Lund; M. Freeman; N. Drew

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