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Development of a European Measure of Best Practice for People with Long Term Mental Illness in Institutional Care

This study aims to develop a toolkit for assessing and reviewing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care institutions in European countries. Protection of their human rights is imperative since impaired mental capacity secondary to their mental illness and can make them vulnerable to abuse and exploitation. They constitute a major resource pressure for mental health services, social services, informal carers and society as a whole. This study aims to use an iterative methodology to develop a toolkit to assess internationally agreed domains of care relevant to commissioners and providers of services and service users. The study will assess the ability of the toolkit to feed into established systems to improve care and it will assess value for money.

The toolkit will constitute a structured interview with clinical managers of psychiatric institutions that will assess domains considered most important for recovery. The domains will be identified through Delphi exercises in partner countries with professionals, service users and carers and common domains will be agreed by an international expert panel including experts in rehabilitation and recovery for this service user group and the research teams in each country. These domains are not known at this stage but might, for example, include: the built environment; treatments and content of care; clinical governance; organisational climate; the use of restraint and other coercive practices; social dislocation; the promotion of social inclusion; the use of recovery based practices. We will ensure that the domains will incorporate cross-cutting themes to assess the institution’s promotion of human rights e.g. the freedom, choice, dignity and privacy of their clients.

The toolkit will be refined through the course of the study to maximise a) its reliability b) its usability c) its ability to deliver assessments that translate into action plans within each country’s established systems of change at local, regional and national level. Data will be collected to carry out a health economic analysis of its ability to provide information that can be used to provide an assessment of the institution’s “value for money”. The toolkit will also be cross-validated against service users’ quality of life, autonomy and markers of recovery to test whether it can deliver a proxy-measure of the promotion of individuals’ human rights and recovery.

www.ucl.ac.uk/mental-health-sciences/Current%20research/DEMoBinc.htm 

  ITHACA - A European Project on Human Rights and Physical Health of Residents in Psychiatric and Social Care Institutions



ITHACA stands for “Institutional Treatment, Human Rights and Care Assessment”. In the framework of a European Commission funded project the ITHACA toolkit was developed by users and professionals in order to provide a clear and practical way of monitoring human rights and general health care in psychiatric and social care institutions across Europe. It is anchored in several recently published international documents. The ITHACA toolkit covers 30 areas, such as access to and involvement in the development of care plans, involuntary commitment, correspondence and visitors, and access to general health care. It is available in 13 languages.

www.ithaca-study.eu 

www.ithacastudy.eu