Module:  Improving  the  service  

environment  

How to improve the physical environment in services?

Creating a good physical and social environment within services is critical to
promoting mental health and well-being. Article 28 of the Convention on the
Rights of Persons with Disabilities (CRPD) protects the right to an adequate
standard of living, which includes food, clothing, housing and clean water. It
also promotes ongoing improvement of living conditions.
The WHO QualityRights assessment toolkit defines standards to ensure that
mental health and related services respect quality of care and human rights.

I. What is an adequate standard of living in the context of services?

What is considered an adequate standard of living may differ across cultures

and vary depending on people. However, many basic requirements are likely
to be common to everyone.

The WHO QualityRights assessment toolkit aims to support countries to improve

the quality and human rights of their mental health and social care services. It
aims to do so within the context of an overall deinstitutionalization strategy.
Institutions that are isolated and unconnected to the community should be
phased out and replaced with a network of services based in the community
(including outpatient services, respite houses, halfway homes, supported
apartments, mental health units in general hospitals, home based services
and supports, etc.).In order to ensure a good social environment, it is essential
that people feel comfortable to speak and communicate freely and
privately. Often people staying in mental health and related services lose
these rights.

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The toolkit covers 5 themes drawn from the rights in the CRPD:
The right to an adequate standard of
THEME 1
living (Article 28 of the CRPD)

The right to enjoyment of the highest

THEME 2 attainable standard of physical and
mental health (Article 25 of the CRPD)

The right to exercise legal capacity

and the right to personal liberty and
THEME 3
the security of person (Articles 12 and
14 of the CRPD)

Freedom from torture or cruel,

inhuman or degrading treatment or
THEME 4 punishment and from exploitation,
violence and abuse (Articles 15 and 16
of the CRPD)

The right to live independently and be

THEME 5 included in the community (Article 19
of the CRPD)

Each theme is broken down into a series of standards. Theme 1 consists of 7

standards (i.e. standards 1.1 to 1.7) which ensure that the right to an
adequate standard of living is respected when people stay in mental health
or related services. These standards focus on both the physical and social
environment of services. This document describes the standards related to the
physical environment (i.e. standards 1.1 to 1.4):
• Standard  1.1:  The  building  is  in  good  physical  condition.  
• Standard  1.2:  The  sleeping  conditions  of  service  users  are  comfortable  and  allow  
sufficient  privacy.  
• Standard  1.3:  The  facility  meets  hygiene  and  sanitary  requirements.  
• Standard  1.4:  Service  users  are  given  food,  safe  drinking-­‐water  and  clothing  that  
meet  their  needs  and  preferences.  

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The other themes and their standards can be found in the following
document:
WHO QualityRights toolkit (annex 4, p. 75)
http://apps.who.int/iris/bitstream/10665/70927/3/9789241548410_eng.pdf?ua=
1
Source: World Health Organization

II. Standard 1.1: The building is in good physical condition

A building in good physical condition is necessary to create an environment

where people can be and feel safe and comfortable.
This standard includes the following criteria:

The building is in a good state of repair (e.g. windows are not broken, paint is
not peeling from the walls).

The building is accessible for people with physical disabilities.

The building’s lighting (artificial and natural), heating and ventilation provide
a comfortable living environment.

Measures are in place to protect people against injury through fire.

III. Standard 1.2: The sleeping conditions of service users are

comfortable and allow sufficient privacy

Sleep is an integral part of everyday life and is essential to good physical and
mental health. Often this is a neglected aspect of life in inpatient mental
health and related services where there is overcrowding and where privacy is
limited.
This standard includes the following criteria:

The sleeping quarters provide sufficient living space per service user and are
not overcrowded.

Men and women as well as children and older persons have separate
sleeping quarters.

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Service users are free to choose when to get up and when to go to bed.

The sleeping quarters allow for the privacy of service users.

Sufficient numbers of clean blankets and beddings are available to service

users.

Service users can keep personal belongings and have adequate lockable
space to store them.

IV. Standard 1.3: The facility meets hygiene and sanitary

requirements

Just like homes in the community, inpatient services must be clean and
healthy environments. This allows people to feel comfortable and means that
their health is not being put at risk.
This standard includes the following criteria:

The bathing and toilet facilities are clean and working properly.

The bathing and toilet facilities allow privacy, and there are separate facilities
for men and women.

Service users have regular access to bathing and toilet facilities.

The bathing and toileting needs of service users who are bedridden or who
have impaired mobility or other physical disabilities are accommodated.

V. Standard 1.4: Service users are given food, safe drinking-water

and clothing that meet their needs and preferences

Good quality food, water and clothing are all basic requirements for good
physical and mental health.
This standard includes the following criteria:

Food and safe drinking-water are available in sufficient quantities, are of

good quality and meet with the service user’s cultural preferences and
physical health requirements.

Food is prepared and served under satisfactory conditions, and eating areas
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are culturally appropriate and reflect the eating arrangement in the
community.

Service users can wear their own clothing and shoes (day wear and night
wear).

When service users do not have their own clothing, good-quality clothing is
provided that meets their cultural preferences and is suitable for the climate.

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