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The aforementioned WHO Declaration of Helsinki calls for the involvement of users of mental health services in decision-making. Nurses conducted a survey of mental health service users in a number of psychiatric hospitals and specialized social care homes for people with intellectual disabilities in Latvia. The aim of the research was to carry out a quantitative study of the assessment of the needs of users of mental health care services (about satisfaction with existing health and social services in mental health care, conditions in institutions and the state of human rights, and the need for community). based services).

DEFINITION OF TERMS USED IN THE STUDY

Advocacy means providing support that would cause changes in the situation of persons in need of support. To advocate often means to speak in place

THE HUMAN RIGHTS SITUATION IN THE ASSESSMENT OF USERS OF MENTAL HEALTH CARE SERVICES

Of the 408 users of mental health care services surveyed, 163, or 40%, respondents recalled instances when they were involuntarily admitted to a psychiatric hospital. The following diagram shows the views of interviewed hospital patients and residents of social care homes on involuntary hospitalisation. The experts who drafted the questionnaire were also interested in the experience of users of mental health care services in facing human rights violations.

As a result, the open question was asked, thus also allowing consideration of the awareness and orientation of users of mental health care services in human rights issues. A total of 15% of the respondents of all surveyed users of mental health care services indicated that they had experienced human rights violations during their stay at a psychiatric hospital or a social care home. Similarly, none of the 9 residents of social care homes who thought they had suffered human rights violations sought help.

Both patients in hospitals and residents of nursing homes indicated that they first turn to their treating physician. The situation of residents of social care homes is better because only 2% of respondents interviewed lived in rooms with more than seven beds. Breakdown of housing for residents of social care homes (%) by number of beds per room (question 28) N=142.

Regarding living conditions, results of the interviews show that most hospital patients and residents of social care homes are satisfied with existing living conditions in the units. Only 7% of the patients surveyed and 6% of the residents of social care homes are involved in activities of patient councils or social care councils. 6% of hospital patients and only 1% of residents of social care homes are involved in the "Life Skills" programme.

ACCESS TO MEDICAL CARE IN THE ASSESSMENT OF USERS OF MENTAL HEALTH CARE SERVICES

The opinion of the respondents of social care homes about the frequency of treatment in a psychiatric hospital and the need for it in the last 3 years (%) (4th question) N=142. Opinion of users of mental health services about the treatment process in psychiatric hospitals and social care homes (%) (Question 19) N=408. 25% of psychiatric hospital patients and 35% of residents of social care homes believe that visits to a psychiatrist are unnecessary.

The distribution of nursing home residents by frequency of visits to psychiatrists is also relatively even in all given periods of visits. The frequency of visits to a psychiatrist by hospital patients and nursing home residents corresponds to users' opinion about the need for a psychiatrist's consultation. Hospital patients and nursing home residents have problems visiting an outpatient psychiatrist for various reasons.

Opinion of residents of social care homes about the frequency of visits to an outpatient psychiatrist and the need for them over the last 3 years. Number of responses from hospital patients and residents of social care homes about barriers to receiving outpatient psychiatric assistance (Question 3) N=408. Limited choice of doctors is noted in responses from both hospital patients and residents of social care homes, in equal numbers (32 and 42 responses).

To determine the views of mental health service users about consultations received and still needed with other specialists, responses from hospital patients and nursing home residents were collated. 90% of all hospital patients and 86% of residents of social care homes have received outpatient psychiatrist consultations. Responses from nursing home residents mention lack of funds as a reason only once, while hospital patients mention this reason 17 times.

SATISFACTION AND NEEDS OF INTERVIEWED USERS OF MENTAL HEALTH CARE SERVICES

The issue of satisfaction among users of psychiatric services is also related to self-evaluation of necessary forms of daily support. Residents in nursing homes, on the other hand, need the most help with household tasks and laundry, cooking, shopping and planning daily expenses. Responses from hospital patients about types of support needed every day while not in hospital (Question 30) N=266.

Responses from residents of social care homes about types of support needed every day (Question 30) N=142. These data, obtained during the interviews, correspond to average disability pensions which are the main source of income for most residents of social care homes (according to the Social Services and Social Assistance Act they are entitled to 15% of pensions while staying in social care homes . ) and hospital patients. Of the residents of social care homes surveyed, only 3 had full-time paid work and 9 had paid odd jobs.

In turn, residents working in social care homes had found employment with the help of care home staff. When asked about their efforts in the past year to July (2005) to find work, 87% of care home residents and 51% of hospital patients indicated that they were unable to find work due to their health condition. able to work. 31% of hospital patients and only 1% of residents of social care homes indicated that they were interested in finding work.

Opinion of users of mental health care services about the help needed to find employment (%) (Question 37) N=408.

INVOLVEMENT OF USERS OF MENTAL HEALTH CARE SERVICES IN DECISION MAKING

The organization's main priority is to promote alternative care, employment and protection of the interests of the mentally ill. The organization has 137 members, including 113 patients, 20 employees of the Aknîste psychiatric hospital and 4 representatives of the local community. With the financial support of the Mental Health Initiative of the Open Society Institute (Budapest) and the Soros Foundation-Latvia, “Paspårne” has established a step-by-step program for the integration of patients of the Aknîste psychiatric hospital into society, setting up a halfway house15 , community-based employment programs (café and a shop with artwork for users)16 and developing a group home project where users of mental health services who have been living in the hospital for years with nowhere to go, to leave the hospital.

In 2005-2006, with the support of the Mental Health Initiative of the Open Society Institute (Budapest) and the Soros Foundation-Latvia, the organization organized activities for users of mental health services in the Prei¬i region, where it offered regular consultations with a psychologist and participation in various craft workshops (e.g. silk painting, leatherwork, painting, ceramics, etc.). Since December 2006, the organization plans to organize a course of 10 workshops for the 15 most active users of mental health services with the support of the Mental Health Initiative of the Open Society Institute (Budapest) and the Soros Foundation-Latvia. A regulation on the patients' council was prepared, which regulates its operation and gives it a place in the administrative structure of the hospital.

Since 1996, a law on the involvement of users of mental health services has been in force in the Netherlands.18 The purpose of the law is to encourage users, to give them the opportunity to influence policy and decision-making in institutions. In one of the three mental hospitals in Amsterdam - Buitenamstel, a patient council is established, consisting of five members. The work of the council is aimed at representing group interests and not at dealing with the complaints of individual individuals.

The councils discuss various issues of internal hospital policies, for example, smoking, light, food quality, patients' rights to contact family, etc.

RECOMMENDATIONS

TO POLICY MAKERS AND HEADS OF MENTAL HEALTH CARE FACILITIES

It is necessary to develop and financially support programs for the training of users of mental health services in order to increase their level of knowledge on human rights issues and to promote their ability to combat discrimination. In the future, it is desirable to involve mental health user organizations in the training of police officers and mental health professionals, as mental health user experiences may be best explained by themselves. It is necessary to provide employment to both mental health service users living in institutions and those living in the community.

APPENDICES

How long are you currently undergoing treatment at the hospital or staying at the social care facility. Which of the following activities did you engage in while undergoing treatment at the hospital or while staying at the social care home? Do you have the following specialist consultations available while you are undergoing treatment at the hospital/staying at the social care facility.

Which of the following specialists have you visited in the past 3 months during your treatment in the hospital/stay in the nursing home and/or while you were staying outside of it? How often have you encountered the following situations during your treatment in the hospital or your stay in a nursing home? During treatment in hospital/or a stay in a social care home, you will usually be asked the following questions.

Have you ever encountered any of the following situations while undergoing treatment at the psychiatric hospital or staying at the social care home. Do you have information available at the unit about patients' rights in a brochure or in the form of informative material on the notice board. Do you know where to go if you are not satisfied with the admission procedure at the hospital/care facility, treatment, and attitude of the doctor or staff, living conditions at the hospital/care facility.

Please assess based on your own experience whether descriptions of living conditions at the hospital or social home are true.

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