Developing of tool for quality assurance of mental health inpacient services in Azerbaijan

1 Uni e sidade NOVA de Lisboa Faculdade de Ciências Médicas NOVA Medical School Facul y o Medical Sciences De eloping o Tool o Quali y Assu ance o Men al Heal h Inpa ien Se ices in Aze baijan By D . Gum u Ahmado a Mas e ’s Disse a ion in In e na ional Men al Heal h Policy and Se ices Supe iso : P o esso Miguel Xa ie 2017 2 Summa y The quali y o ca e in men al heal h ins i u ions is a se ious conce n in mode n psychia y. People wi h men al disabili ies o en ace iola ion o hei human igh s. They o en expose physical and sexual abuse, neglec , s igma, disc imina ion. Despi e implemen ing he Men al Heal h S a egy adop ed in 2011 in Aze baijan, he e is a lack o moni o ing and e alua ion o he p o ided se ices. The main goal o he s udy is o de elop an ins umen o moni o and e alua e he quali y o men al heal h se ices in he con ex o human igh s in Aze baijan and o de e mine he e e ence in e als associa ed wi h good quali y. The s udy u ilized obse a ional c oss-sec ional design o examine he human igh s, quali y o li e o inpa ien s and hei sa is ac ion wi h he se ices in he Psychia ic Hospi al N#1. A o al numbe o 160 pa icipan s en e ed he s udy (100 inpa ien s, 30 amily membe s and 30 s a membe s). The WHO Quali y Righ s Toolki , he Schizoph enia Quali y o Li e Scale-Re ision 4 and he Clien Sa is ac ion Ques ionnai e we e used as he main ools. The esul s showed ha he quali y o se ices and he human igh s he hospi al we e no ully me , p ecluding he p o ision o comp ehensi e and high-quali y se ices o he pe sons wi h se e e men al diso de s. Unme needs we e highe in a eas such as he igh o exe cise legal capaci y, he igh o pe sonal libe y and secu i y, and he igh o li e independen ly and o be pa o he communi y. Some imp o emen s we e also necessa y o mee needs conce ning he igh o an adequa e s anda d o li ing, o enjoymen o he highes a ainable s anda d o heal h and eedom om o u e o c uel, inhuman o deg ading ea men o punishmen a e p o ec ed and espec ed. Despi e he le el o he quali y o li e and sa is ac ion wi h se ices a e a e age, he e was a posi i e imp o emen in compa ison wi h p e ious s udies. The indings can be used o u he imp o emen o he psychia ic se ices a Aze beijan. Key wo ds: quali y, human igh s, iola ion, moni o ing, Aze baijan. 3 Resumo A qualidade dos cuidados p es ados nas ins i uições de saúde men al é uma p eocupação ele an e na psiquia ia mode na. As pessoas com pe u bações psiquiá icas mui as ezes en en am iolações a ní el dos seus di ei os humanos, incluindo abuso ísico e sexual, negligência, es igma e desc iminação. Apesa da implemen ação da Es a égia de Saúde Men al adop ada em 2011 no Aze baijão, exis e uma al a de acompanhamen o e a aliação dos se iços p es ados. O p incipal obje i o des e es udo é desen ol e um ins umen o pa a moni o iza e a alia a qualidade dos se iços de saúde men al no con ex o dos di ei os humanos no Aze baijão e de e mina os in e alos de e e ência associados com a boa qualidade. Foi elabo ado um es udo com desenho ans e sal e obse acional, cen ado na a aliação do cump imen o dos di ei os humanos e da qualidade de ida dos pacien es in e nados, assim como a sua sa is ação com os se iços p es ado no Hospi al Psiquiá ico N#1. A amos a es udada oi de 160 (100 pacien es in e nados + 30 amilia es + 30 memb os do s a ). Os ins umen os de a aliação o am o WHO Quali y Righ s Toolki , a Schizoph enia Quali y o Li e Scale-Re ision 4 e o Clien Sa is ac ion Ques ionnai e. Os esul ados mos a am que a qualidade dos se iços e os di ei os humanos no hospi al não es a am plenamen e a endidos, impedindo po isso a p es ação de se iços in eg ados e de al a qualidade pa a as pessoas com ans o nos men ais g a es. As necessidades não sa is ei as e am mais ele adas em á eas como o di ei o ao exe cício da capacidade ju ídica, o di ei o à libe dade e segu ança pessoal e o di ei o de i e de o ma independen e e aze pa e da comunidade. Também se e idencia am necessidades não- o almen e sa is ei as em á eas ela i as ao di ei o a um ní el de ida adequado, ao gozo do mais al o ní el possí el de es ado de saúde e à ausência de o u a ou de a amen os ou penas c uéis, desumanos ou deg adan es. Apesa do ní el de qualidade de ida e da sa is ação com os se iços se em apenas medianos, hou e uma melho a posi i a em elação aos es udos an e io es. Os esul ados podem se u ilizados pa a a melho ia dos se iços de psiquia ia no Aze baijão. 4 Resumen La calidad de la a ención en las ins i uciones de salud men al es un aspec o de g an ele ancia en la psiquia ía mode na. Las pe sonas con as o nos psiquiá icos a menudo se en en an a iolaciones de sus de echos humanos, incluyendo abuso ísico y sexual, la negligencia, el es igma y la disc iminación. A pesa de la aplicación de la Es a egia de Salud Men al ap obada en 2011 en Aze baiyán, hay una al a de seguimien o y e aluación de los se icios. El obje i o de es e es udio es desa olla una he amien a pa a moni o ea y e alua la calidad de los se icios de salud men al en el con ex o de los de echos humanos en Aze baiyán y de e mina los alo es de e e encia asociados con buena calidad. Fue desa ollado un es udio de diseño ans e sal y obse acional, pa a e alua el cumplimien o de los de echos humanos y de la calidad de ida de los pacien es hospi alizados, así como su sa is acción con los se icios p es ados en el Hospi al Psiquiá ico N°1. La mues a ue de 160 pacien es hospi alizados (100 ing esados + 30 miemb os de la amilia + 30 p o esionales). Los ins umen os de e aluación ue on el WHO Quali y Righ s Toolki , el Schizoph enia Quali y o Li e Scale-Re ision 4 y el Clien Sa is ac ion Ques ionnai e. Los esul ados mos a on que la calidad de los se icios y los de echos humanos en el hospi al no se cumplie on o almen e, impidiendo de es e modo la p es ación de se icios in eg ados y de al a calidad pa a las pe sonas con as o nos men ales g a es. Las necesidades insa is echas ue on mayo es en á eas ales como el de echo a eje ce la capacidad ju ídica, el de echo a la libe ad ya la segu idad pe sonal y el de echo a i i de o ma independien e y se pa e de la comunidad. También mos ó necesidades no-cubie os en su o alidad en las á eas elacionadas con el de echo a un ni el de ida adecuado, al dis u e del más al o ni el posible de la salud y la ausencia de o u a o a os o penas c ueles, inhumanos o deg adan es. A pesa del ni el de calidad de ida y sa is acción con los se icios de se sólo mediano, hubo una mejo a posi i a en compa ación con los es udios an e io es. Los esul ados se pueden u iliza pa a mejo a los se icios psiquiá icos en Aze baiyán. 5 Decla a ion: This hesis is submi ed in pa ial ul illmen o he awa d o he In e na ional Mas e s in Men al Heal h Policy and Se ices a he Facul y o Medical Sciences, he NOVA Uni e si y o Lisbon. This hesis is a p esen a ion o my o iginal esea ch wo k. Whe e e con ibu ions o o he s a e in ol ed, e e y e o is made o indica e his clea ly, wi h due e e ence o he li e a u e, and acknowledgemen o collabo a i e esea ch and discussions. The wo k has no been p esen ed in pa o whole o any o he uni e si y o esea ch ins i u ion, no has i been submi ed elsewhe e o publica ion. The 25 h Decembe , 2016 D . Gum u Ahmado a 6 Acknowledgmen s Fi s , I wan o hank my supe iso , P o esso Miguel Xa ie o his kind assis ance and ad ices. I am hank ul o all o he academic s a o he In e na ional Mas e s in Men al Heal h Policy and Se ices o hei con ibu ion o my knowledge and u u e ca ee . I would like o show my deepes g a i ude o he Di ec o o he Na ional Men al Heal h Cen e o he Minis y o Heal h, P o esso Fuad Ismayilo , who ga e me inspi a ion and suppo ed my pa icipa ion in he Mas e P og am. I mus also hank o my colleagues, D . Agagasan Rasulo , D . Aydan Ismayilo a, D . Roya Mammado a and Aygun Sul ano a o hei in aluable help in pa ien s‟ assessmen . I am g a e ul o he all he pe sons li ing wi h se e e men al illness, hei amily membe s and he s a o hospi al ha ga e he in o ma ion ha esul ed in his hesis. Finally, I would like o exp ess my hanks o my pa en s o hei g ea suppo ha hey ha e made o me. 7 Table o con en s Uni e sidade NOVA de Lisboa .......................................................................................................... 1 Summa y ............................................................................................................................................. 2 Resumo ................................................................................................................................................ 3 Resumen .............................................................................................................................................. 4 Decla a ion: ......................................................................................................................................... 5 Acknowledgmen s ............................................................................................................................... 6 Lis o Ac onyms ................................................................................................................................. 9 CHAPTER 1 ...................................................................................................................................... 10 INTRODUCTION ............................................................................................................................ 10 1.1. B ie summa y o he p oblem ............................................................................................. 10 1.2. S a e o he a and inno a i e aspec s o s udy .................................................................. 11 1.3. Objec i es and expec ed achie emen s ................................................................................ 12 1.4. S uc u e o he hesis ............................................................................................................ 13 CHAPTER 2 ...................................................................................................................................... 14 CONCEPTUAL BACKGROUND .................................................................................................. 14 2.1. Human igh s issues in psychia ic hospi als ...................................................................... 14 2.2. Legisla ion, policy and se ices in Aze baijan .................................................................... 21 2.3. WHO Quali yRigh Toolki .................................................................................................. 26 CHAPTER 3 ...................................................................................................................................... 27 METHODOLOGY ........................................................................................................................... 27 3.1. S udy design and subjec s ..................................................................................................... 27 3.2. S udy se ing ........................................................................................................................... 27 3.3. Sampling ec ui men plan, inclusion c i e ia .................................................................... 28 3.4. O e all me hod ...................................................................................................................... 28 3.5. Selec ion o ins umen s ........................................................................................................ 29 3.6. T ainings o in e iewe s ..................................................................................................... 30 3.7. S a is ical analysis. ................................................................................................................. 31 3.8. E hical conside a ions ........................................................................................................... 31 8 CHAPTER 4 ...................................................................................................................................... 32 RESULTS .......................................................................................................................................... 32 4.1. Socio-demog aphic cha ac e is ics. ..................................................................................... 32 4.2. Usage o WHO QR Toolki ................................................................................................... 35 4.3. Schizoph enia Quali y o Li e Scale Re ision - 4 and Clien Sa is ac ion Ques ionnai e – 8 ...................................................................................................................................................... 35 4.4. The co ela ion be ween quali y o li e and sa is ac ion wi h se ices p o ided ............. 35 CHAPTER 5 ...................................................................................................................................... 37 DISCUSSION .................................................................................................................................... 37 5.1. Discussion o he esul s. ....................................................................................................... 37 5.2. Limi a ions o he s udy ........................................................................................................ 48 5.3. Conclusions and ecommenda ions ...................................................................................... 49 REFERENCES: ................................................................................................................................ 51 ANNEX I ........................................................................................................................................... 57 The esul s o pa ien s: ................................................................................................................. 57 ANNEX II .......................................................................................................................................... 65 The esul s o amily membe s: ................................................................................................... 65 ANNEX III ........................................................................................................................................ 73 The esul s o s a : ....................................................................................................................... 73 ANNEX IV ........................................................................................................................................ 81 Sosio-Demoq a ik Gös ə icilə .................................................................................................... 81 ANNEX V .......................................................................................................................................... 82 Üs Key iyyə Və Hüquqla in Qiymə ləndi ilməsi Cəd əli ...................................................... 82 Psixi Sağlamliği Təmin Edən Sahələ də Key iyyə in Və İnsan Hüquqla inin Qiymə ləndi ilməsi. ...................................................................................................................... 82 ANNEX VI ....................................................................................................................................... 100 həya Key iyyə i Şkalasi ............................................................................................................. 100 ANNEX VII ..................................................................................................................................... 104 is i adəçi Məmnunluğu So ğusu ................................................................................................ 104 ANNEX VIII ................................................................................................................................... 106 Məluma li Raziliq ....................................................................................................................... 106 9 Lis o Ac onyms WHO – Wo ld Heal h O ganiza ion EPA – Eu opean Psychia ic Associa ion CRPD – Con en ion on he Righ s o he Pe sons wi h Disabili ies UN – Uni ed Na ions CPT – Eu opean Commi ee o P e en ion o To u e SQLS - R4 – Schizoph enia Quali y o Li e Scale – Re ision 4 CSQ-8 – Clien Sa is ac ion Ques ionnai e -8 ECT – Elec ocon ulsi e he apy WPA – Wo ld Psychia ic Associa ion WHO - AIMS – Wo ld Heal h O ganiza ion Assessmen Ins umen o Men al heal h Sys ems 16 showing bene i s o communi ies men al heal h and he wellbeing o people wi h men al diso de s (26). Al hough no legally compulso y, he esolu ion binds a numbe o undamen al igh s which he in e na ional communi y conside s as unb eakable ei he in he communi y o when pe sons wi h men al heal h p oblems ecei e ea men om heal hca e ins i u ions. The e a e wo gene al ca ego ies o he 25 mos impo an p inciples o he esolu ion: ci il igh s and p ocedu es, and access o and quali y o ca e. P inciples s a e he essen ial eedoms and undamen al igh s o men ally ill pe sons, c i e ia o he de ec ion o men al diso de s, p o ec ion o con iden iali y, s anda ds o ca e and ea men , especially in olun a y admission and consen o ea men , igh s o indi iduals wi h men al illness in men al heal h ca e acili ies, supply o esou ces o men al heal h ca e acili ies, p o ision o sa egua ds o he igh s o men ally ill o ende s, and p ocedu al p o ec ion o he igh s o he people wi h men al diso de s (25) Acco ding o in e na ional and na ional human igh s documen s, all measu es should be aken o suppo olun a y admission and ea men and o a oid coe cion. I in olun a y admission and ea men a e p esumed necessa y, s ong sa egua ds ha e o be p o ided (27). Besides, examina ion o he condi ions o de ainemen , access o g ie ance p ocedu es, ee legal consul a ion and o he ele an assis ance also should be ensu ed. O e he pas hal a cen u y, in he Eu ope and he USA, se e al men al heal h ins i u ions wi h bad condi ions ha e been closed down. To make a signi ican imp o emen in he li es o people wi h se e e men al diso de s, i is necessa y o de elop in LAMIC high-quali y communi y men al heal h and p ima y ca e men al heal h se ices, in conjunc ion wi h gene al hospi al acu e ca e (28). Human igh s iola ions can be educed by deins i u ionaliza ion and eplacemen o hospi al-based ca e by communi y-based men al heal h se ice (29). Viola ion o human igh s among people wi h men al disabili ies in psychia ic hospi als. Du ing hei isi s o di e en psychia ic hospi als in India and Cen al Ame ica, he Human Righ s Commissions ha e e ealed aw ul and unaccep able condi ions o pa ien s (30, 31). Many o he psychia ic hospi als ha e he same p oblems, bo h in de eloped and de eloping coun ies. Many pa ien s we e in pyjamas o naked, li ing in il hy li ing condi ions wi h leaking oo s, e oded and b oken doo s, b oken windows, o e lowing oile s (32). In some acili ies, hese condi ions also in ol e lacking p ope clo hes, clean wa e o d ink, esh ood, hea ing sys em, sui able bedding o hygiene acili ies (33). 17 Besides his pic u e, se ice use s a e o en subjec ed o inhuman and deg ading ea men (34). Hospi al s a some imes pu hem in isola ion ooms o es ain s o a p olonged ime (40). To make hem docile and complian , pa ien s a e o en o e -medica ed (35). People wi h men al heal h p oblems, especially wi h men al disabili ies, a e o en accep ed as ha ing he lack o he capaci y o make decisions abou hei heal h in hei in e es . Many inpa ien s a e imp ope ly admi ed o psychia ic acili ies agains hei will and a e ea ed wi hou in o med consen . All o e he wo ld, he condi ions in many psychia ic acili ies a e insu icien and jeopa dize he pa ien s' human igh s, hus inc easing ch onici y (36). I is con o e sial ha he li ing condi ions and quali y o psychia ic hospi als in de eloped coun ies a e be e han in de eloping ones. Acco ding o Repo o he Special Rappo eu on o u e and o he c uel, inhuman o deg ading ea men o punishmen , Juan E. Méndez (37) ill- ea men in a heal h-ca e sys em was unde es ima ed by he Special Rappo eu 's manda es because only he denial o heal hca e is gene ally conside ed as an obs acle o “ igh o heal h”. When se e al aspec s o mis ea men and o u e in heal hca e se ing iden i ied by he Rappo eu ship and Uni ed Na ions mechanisms, he e occu ed a equi emen o highligh he de ini e in ensi y and dimension o his p oblem, o de ec abuses in he ield o iola ions o he igh s o heal h and o eedom om o u e o c uel, inhuman, deg ading ea men o punishmen . The Special Rappo eu admi s ha he e a e unique obs acles o p e en o u e and mis ea men in he heal hca e sys em, such as, al hough ne e jus i ied, au ho i y de ends pa icula expe iences in heal hca e on accoun o adminis a i e bene i s, modi ica ion o pa ien s‟ beha iou o medical necessi y. The Commi ee agains To u e deciphe s S a e esponsibili y o s op o u e as solid and in e ela ed wi h he u gency o p e en inhuman, c uel o deg ading ea men o punishmen , as hese condi ions inc ease he equency o mis ea men ha acili a es o u e. In ac , he S a e ha e o p e en he o u e in public o icials, such as law en o cemen agen s, as well as physicians, o he heal hca e p o ide s and social wo ke s, including all o he wo king people in p i a e psychia ic acili ies, o he ins i u ions and de en ion cen es. Commi ee agains To u e emphasizes ha he p e en ion o o u e mus be applied in all ypes o ins i u ions. The manda e o men ioned commi ee acknowledges ha i ea men s o an unal e able and ob usi e na u e a e en o ced wi hou a he apeu ic pu pose and he ee and in o med consen , i can be conside ed as o u e o ill- ea men . This is especially he si ua ion when in usi e and i e e sible, non-consensual ea men s a e p o ided o ulne able g oups, o example, people wi h disabili ies, in spi e o he good in en ions o medical needs. Fo ins ance, he disc imina o y na u e 18 o cons ained psychia ic in e en ions, when pe pe a ed owa ds indi iduals wi h psychosocial disabili ies, mee s bo h in en and aim equi ed unde he Con en ion agains To u e, A icle 1 (38) despi e a gumen s o “good in en ions” by medical wo ke s. Unde a icle 1 o he CRPD (13) indi iduals wi h disabili ies include hose who ha e long- e m in ellec ual impai men s, which, in in e ac ion wi h a ious ba ie s, may inhibi hei o al and e icien pa icipa ion in he communi y on an equal basis wi h o he s. They ha e been ei he igno ed o con ined in psychia ic and social ca e ins i u ions, he psychia ic wa ds. Besides, he CRPD p esen s execu i e guidance on he igh s o pe sons wi h disabili ies and o bids in olun a y ea men and in olun a y con inemen on he g ounds o disabili y, eplacing ea lie s anda ds such as he 1991 P inciples o he P o ec ion o Pe sons wi h Men al Illness and o he Imp o emen o Men al Heal h Ca e (17). C i ical abuses, such as negligence, men al and physical abuse and sexual iolence, a e s ill commi ed agains pe sons wi h men al and in ellec ual disabili ies in heal h-ca e se ings. The e can be no he apeu ic a ionale o he use o soli a y con inemen and ex ended es ain o people wi h men al disabili ies in psychia ic acili ies; bo h p olonged isola ion and es ain may cons i u e o u e and ill- ea men (37). The e is well-documen ed e idence o people li ing hei whole li es in such psychia ic o social ca e acili ies. The Commi ee on he Righ s o Pe sons wi h Disabili ies has been e y clea in calling o he p ohibi ion o disabili y-based de en ion. The women li ing wi h disabili ies, especially wi h psychia ic labels a e a isk o a ious o ms o disc imina ion and abuse in heal hca e se ings. (39). Fo ced s e ilisa ion o gi ls and women wi h disabili ies has been widely epo ed (41). Na ional law in Spain, among o he coun ies, pe mi s o he s e ilisa ion o mino s who a e de e mined o ha e se e e in ellec ual disabili ies (42). In 15 s a es o he USA ha e he laws ha ail o de end women wi h disabili ies om in olun a y s e ilisa ion (43). Human igh s o people wi h men al diso de s in Aze baijan P o ision o human igh s p o ec ion o people a ec ed by men al diso de s is egula ed by ele an legisla ion including he Cons i u ion o he Republic o Aze baijan (44), he Law on „Heal h P o ec ion‟ (45), he Law on „Psychia ic Ca e‟ (46), o he legal ac s and in e na ional ea ies adop ed by Aze baijani go e nmen . Lack o awa eness and ecogni ion o hese no ms o en esul s in se ious iola ions o pa ien s‟ igh s. Fo ins ance, some judges a e eluc an o accep cases ela ed o in olun a y hospi alisa ion while men al heal h adminis a ions a e no in e es ed in submi ing such cases o cou s. In ecen yea s, his malp ac ice me sha p c i icism om ele an 19 in e na ional bodies. In 2006, he delega ion o he Eu opean Commi ee o he P e en ion o To u e and Inhuman o Deg ading T ea men o Punishmen (CPT) isi ed se e al men al heal h acili ies in Aze baijan. Du ing he isi , he delega ion assessed p og ess owa ds implemen ing he CPT‟s ecommenda ions. I examined he si ua ion in psychia ic es ablishmen s and e alua ed he legal sa egua ds applicable o in olun a y psychia ic pa ien s unde he Law on „Psychia ic Ca e‟. The isi e ealed signi ican sho comings ela ed o condi ions in he hospi als as well as o he obse ance o exis ing legisla ion. The CPT c i ical epo esul ed in a closu e o he Ci y Psychia ic Hospi al #1 and e u bishmen in he men al hospi al in Sheki. Also, i p omo ed he ac ions on a de elopmen o p ocedu es o implemen ing he Law. Du ing he ollow-up isi s in 2008, CPT delega ion no iced “unlike du ing he 2006 isi , ha dly any accusa ions o ill- ea men by s a we e ecei ed a he men al hospi al in Sheki whe e he as majo i y o he inpa ien s now exp essed posi i e eedback abou he wo ke s. Fu he , in e -pa ien iolence did no appea o be a signi ican p oblem a he es ablishmen (47)”. A he same ime, he delega ion obse ed some signs o in e -pa ien iolence in he la ges men al hospi al in Mash aga, Baku, which o en s emmed om he s ess ul li ing condi ions and he sca ce s a p esence on he wa ds. Many o he pa ien s‟ ooms o e ed no p i acy (wi h beds o en placed close oge he and in some cases ouching), and lacked isual s imula ion and pe sonaliza ion. As o in olun a y admissions, he CPT delega ion poin ed ou a bo h he №1 Psychia ic Hospi al in Mash aga and he egional men al hospi al in Sheki, almos all ci il pa ien s we e o mally admi ed as “ olun a y”. On admission o he acili y, pa ien s we e eques ed o sign a ecen ly-in oduced o m en i led “Applica ion o olun a y hospi alisa ion”. Howe e , pa ien s we e kep in locked wa ds and he o e whelming majo i y o hose wi h whom he delega ion spoke decla ed ha hey had been held in he ins i u ion agains hei will and wan ed o be eleased. I also became e iden om he in o ma ion collec ed by he manda e ha du ing some o hese pa ien s admission hey we e in such a men al s a e ha hey we e nei he able no assis ed in gi ing a ee and in o med consen o hei hospi alisa ion. I is impo an o men ion ha an absence o clea p ocedu es o he discha ge o pa ien s who ha e los amily and social ela ions is a subs an ial ba ie ega ding human igh s p o ec ions. The e a e many examples when amily membe s ejec o accep hei men ally ill pa ien s back home a e e mina ion o hei ea men in hospi al. In such si ua ion bo h doc o s and hospi al adminis a ion expe ience undecidable p oblem o discha ge a pa ien ega dless a high possibili y ha she o he 20 will s ay on he s ee s o o keep a pa ien in he men al hospi al wi hou medical indica ions. In bo h cases, i is a iola ion o pa ien s‟ human igh s and medical e hics. Un o una ely, al hough he e is legisla ion ega ding shel e ed housing and disc imina ion o people wi h men al diso de s, he law is no en o ced. Ye , psychia ic in-pa ien s ha e a lack o adequa e and ee access o legal assis ance. Many o he p oblems ela ed o pa ien s‟ igh s p o ec ion a e due o inadequa e coo dina ion be ween a ious go e nmen al bodies. Fo example, he e is a lack o coope a ion be ween men al heal h acili ies and medical-social commissions wi hin he Minis y o Labo and Social Secu i y. Despi e he legisla ion equi es con o mi y o diagnoses wi h in e na ional s anda ds adop ed in he coun y, he named medical-social commissions use obsole e classi ica ion o assess disabili y, and hey do no accep medical eco ds made by men al heal h acili ies. In 2011, he manda e o CPT e alua ed he imp o emen in p o iding legal sa egua ds o inpa ien s in psychia ic ins i u ions a e hei p e ious isi s and he ex en o which he Commi ee‟s p oposals ha e been achie ed. As a posi i e ac , he manda e no ed he p og ess associa ed wi h econs uc ions in men al heal h acili ies and be e se ices. I was also men ioned ha he di ec o o he №1 Psychia ic Hospi al in Mash aga eleased di ec ions o wo ke s ega ding he applica ion o physical es ain and seclusion, allowing i s use only a e doc o ‟s au ho iza ion and egis a ion. A he same ime, new ecommenda ions we e included in o he CPT epo published a he end o 2012. The CPT isi s, as well as he egula moni o ing by he ep esen a i es o he Ombudsman O ice, has been p omo ing posi i e changes in he ield o human igh s p o ec ion o pe sons wi h men al diso de s. A he same ime, i is impo an o ha e a moni o ing mechanism ca ied ou by ci il socie y. The A icle 42 o he Law on Psychia ic Ca e („Public su eillance on he obse ance o human igh s p o ec ion du ing psychia ic ca e p o ision‟) s ipula es ha men al heal h o ganisa ions could be eligible o moni o he human igh s o pe sons ecei ing ca e a psychia ic se ices. Wi h his ega d, he use s‟ o ganisa ions may become an essen ial pa o a p ocess o human igh s p o ec ion. Along wi h hei o icial in ol emen in consul a ions on men al heal h policy and legisla ion, hey may ake pa in di ec ad ocacy o comba ing s igma, disc imina ion and human igh s iola ion. Use s and amily o ganisa ions a e able o in luence go e nmen s on human igh s p o ec ion and o inc ease public awa eness on social in eg a ion o indi iduals wi h men al diso de s. O ganisa ions o use s can also aise awa eness abou ba ie s o men al heal h, need o 21 men al heal h se ices, inadequa e quali y o ca e, sca ce in o ma ion abou ea men s, abuse and o he iola ions (48). 2.2. Legisla ion, policy and se ices in Aze baijan The well-being o he popula ion is a p incipal ocus o go e nmen s. Policies ac oss go e nmen can imp o e men al well-being and dec ease ulne abili y o isk ac o s. Men al illnesses a e one o he signi ican global heal h challenges in he Eu opean Region due o i s high p e alence, he bu den o disease and associa ed disabili y. Men al diso de s, including schizoph enia, dep ession and anxie y a e majo causes o disabili y, ea ly e i emen and economic bu den in many coun ies, hus demanding policy ac ion (26). The legisla ion is necessa y o assu e ha he essen ial human igh s o people wi h men al diso de s a e p o ec ed. Policies and laws should p o ide he espec o human igh s and mee he obliga ions se ou by in e na ional and Eu opean human igh s documen s, aking in o conside a ion he needs o ulne able g oups. The g ea e majo i y o Eu opean coun ies ha e al eady signed he In e na ional Bill o Human Righ s (49) ( he Uni e sal Decla a ion o Human Righ s (50), he In e na ional Co enan on Economic, Social and Cul u al Righ s (22) and he In e na ional Co enan on Ci il and Poli ical Righ s (21)) and he Council o Eu ope Con en ion o he P o ec ion o Human Righ s and Fundamen al F eedoms (15). These ins umen s c ea ed legally bound du y on go e nmen s o espec , secu e and ul il he human igh s wi hin hem. Addi ionally, bo h he Uni ed Na ions and Eu opean human igh s sys ems ha e a ious in e na ionally accep ed s anda ds ela ed o he igh s o indi iduals wi h men al heal h p oblems (9). The cen al pu pose o men al heal h policies and legisla ion is being edi ec ed owa ds de eloping oppo uni ies ha enable people wi h men al diso de s o make use o hei own decisions and o ake pa ully in communi y and amily li e which hey a e en i led. The men al heal h policies equi e combining a e o m o se ices wi h pa icula a en ion o quali y, gua an eeing he deli e y o eliable, e ec i e and app op ia e ea men by he quali ied wo k o ce (26). Also, he policies and p og ammes mus p omo e he igh o p i acy, indi idual au onomy, he igh o equali y and non-disc imina ion, he igh o in o ma ion and pa icipa ion and eedom o eligion, assembly and mo emen . In Aze baijan, p o ision o human igh s p o ec ion o people a ec ed by men al diso de s is egula ed by ele an legisla ion including he Cons i u ion o he Republic o Aze baijan, he Law on „Heal h P o ec ion”, he Law on „Psychia ic Ca e‟, o he legal ac s and in e na ional ea ies 22 adop ed by Aze baijani go e nmen (44, 45, 46). The Law on „Psychia ic Ca e‟ is o adminis e ela ions in he cou se o men al heal h ca e p o ision as well as o de e mine igh s and esponsibili ies o physical and judicial bodies in his espec . In 1996, WHO de eloped he Men al Heal h Ca e Law: Ten Basic P inciples (51) as a u he in e p e a ion o he UN Gene al Assembly Resolu ions such as P inciples o he P o ec ion o Pe sons wi h Men al Illness (17) and as a guide o assis coun ies in de eloping men al heal h laws. The p inciples include p omo ion o men al heal h and p e en ion o men al diso de s, access o basic men al heal h ca e, men al heal h assessmen s in acco dance wi h in e na ionally accep ed p inciples, p o ision o leas es ic i e ype o men al heal h ca e, sel -de e mina ion, igh o be assis ed in he exe cise o sel -de e mina ion, a ailabili y o e iew p ocedu e, au oma ic pe iodic e iew mechanism, quali ied decision-make , espec o he ule o law (51). All hese p inciples ha e been e lec ed in he Law on „Psychia ic Ca e‟, and men al heal h ca e o pe sons wi h men al diso de s should be based on legi imacy, humani y, and obse ance o human and ci il igh s and eedoms (see A .3) Acco ding o he legisla ion, people wi h men al diso de s ha e he same igh s and bene i s as pa ien s ecei ing ca e in o he heal h acili ies. These igh s a e lis ed in he A icle 6 and include he ollowings: - Respec ul a i ude and p ohibi ion o deg ading ea men ; - Access o ee men al heal h ca e mee ing adop ed s anda ds o go e nmen al heal h acili ies; - Access o in o ma ion abou pa ien s‟ igh s as well as abou he men al diso de and me hods o ea men ; - Admission o psychia ic acili y o a pe iod necessa y o assessmen and ea men only; - Recei ing all a ailable ea men in acco dance wi h medical indica ions; - Choice o any p o essional eligible o p o ide psychia ic ca e (a e ob aining his o he consen ); - Choice o any men al heal h acili y; - Access o consul a ions wi h o he medical p o essionals; - Access o lawye ; - Legal ep esen a i e and o he pe sons. In addi ion acco ding o he A icle 15 he go e nmen gua an ees: - Psychia ic ca e in case o eme gency; inpa ien and ou pa ien assessmen , counselling, 23 ea men , p e en ion, and ehabili a ion; - All kinds o psychia ic examina ion including o ensic, psychosocial (disabili y), and consc ip ( i ness o mili a y se ice); - Social ca e and disabili y pension; de e mina ion o gua dianship and us eeship; psychosocial suppo o na u al and human-made disas e s‟ su i o s; - Gene al and p o essional educa ion o non-adul pe sons wi h men al disabili y; - Occupa ional he apy and special p o isions o employmen o people wi h se e e men al illness; - Shel e ed accommoda ion o social wi hd awn and homeless people wi h men al illness; - Gene al heal h ca e o people wi h men al illness; - O he p o isions necessa y o main ain he social secu i y o people wi h men al diso de s. The A icle 5 conside s he issues o olun a y men al heal h ca e. Men al heal h ca e is p o ided on he basis o ee and in o med consen . The consen mus be ob ained in w i en o m eely, wi hou h ea s o imp ope inducemen s and signed by a pa ien (o his/he legal ep esen a i e) and a men al heal h p o essional esponsible o he case. No ea men should be gi en o a pa ien wi hou his o he in o med consen , excep as p o ided o in olun a y admission. A pa ien o his/he legal ep esen a i e has a igh o e use om sugges ed ca e o o s op i a any momen . In his case, hey should be in o med abou possible consequences o his decision (A icle 10). Men al heal h legisla ion also p o ec s con iden iali y by p o iding o sanc ions and penal ies o b eaches o con iden iali y, ei he by p o essionals o men al heal h acili ies. The A icle 7 poin s ou pe sons wi h men al diso de s ha e he igh o con iden iali y o in o ma ion abou hei men al s a e and ea men ; such in o ma ion should no be disclosed o hi d pa ies wi hou hei consen excluding ce ain excep ional cases s ipula ed by he legisla ion. P o essionals and men al heal h acili ies and o he o icial au ho i ies a e esponsible o keeping in sec e he in o ma ion ela ed o pa ien s. Pe sons ecei ing (o ha e been ecei ing) men al heal h ca e ha e a s a u o y igh o ee and ull access o hei clinical in o ma ion main ained by men al heal h acili ies. These pe sons should be p o ided wi h he in o ma ion wi hin wo days a e hei w i en applica ion. Access o in o ma ion may be es ic ed in excep ional si ua ions when clinical eco ds o a pe son pu a isk he sa e y o he pa ien o o he s. The amily membe s may ge he in o ma ion necessa y o be be e able o look a e hei ela i es only, and hey ha e no access o in o ma ion ha may cause se ious ha m o him o he . 24 The A icle 8 ecognises he p inciple o ca e deli e ed in he leas es ic i e al e na i e. Men al heal h ca e is gi en no longe han is necessa y wi hou es ic ion o pa ien s‟ igh s and eedoms and wi h he use o ea men s mee ing c i e ia o good clinical p ac ice. Al hough he legisla ion emphasises ha e e y e o shall be made o a oid in olun a y admission in excep ional cases people wi h men al diso de s may be admi ed and ea ed in olun a ily. The A icle 11 o he Law on „Psychia ic Ca e‟ includes clea c i e ia o in olun a y admission which include he ollowings: - Se ious immedia e dange o a pa ien wi h men al diso de o sel o o he s (examples suicide a emp s, agg essi e beha iou ) - Helplessness i.e. inabili y o mee essen ial li e needs due o men al illness (e.g. ca a onic s upo , se e e demen ia) - I a pe son whose men al illness is se e e and likely o lead o a se ious de e io a ion in his o he condi ion and will p e en he gi ing o p ope ea men ha can only be p o ided by admission o a men al heal h acili y. The A icle 25 desc ibes he p ocedu es ela ed o in olun a y admission in he case o eme gency. A pe son in olun a y admi ed o men al heal h acili y should be e alua ed wi hin 48 hou s, and discha ged immedia ely a e i his/he hospi alisa ion is conside ed as un ounded. In a case o alid easons o in olun a y admission (con i med by a commission o h ee psychia is s), a clinical epo should be submi ed o a local cou no la e han 48 hou s a e hospi alisa ion. The cou checks he adequacy o he easons indica ed in he epo agains he c i e ia lis ed in he A icle 11 and hen ake an app op ia e decision ega ding in olun a y admission and ea men . Rega dless olun a iness o admission, all pa ien s ea ed in men al hospi al a e eligible o apply a any ime o he hospi al adminis a ion, as well as o equi e obse ance o hei igh s and in e es s. They also a e eligible o apply eely o he Head Psychia is o he Minis y o Heal h, he execu i e au ho i ies, he o ice o he P osecu o , he Ombudsman O ice, he cou s and his/he legal ep esen a i e (lawye ). Al hough legisla ion p o ides many igh s o pe sons wi h men al diso de s, hey may be unawa e o hei igh s and hus unable o exe cise hem (WHO Resou ce Book). The e o e he legisla ion includes a p o ision o in o ming pa ien s abou he easons and goals o hospi alisa ion, hei igh s, and hospi al egula ions as soon as possible a e admission as he pa ien ‟s condi ion pe mi s (a icle 23). Besides his legisla ion, The Republic o Aze baijan has also signed he Decla a ion o Helsinki, accep ing i s obliga ions on he ealisa ion o an Ac ion Plan based on he Decla a ion p inciples, 25 and adop ed a new Na ional Men al Heal h S a egy in 2011. The Na ional Men al Heal h S a egy aims o p o ec and p e en he impai men o men al diso de s, o a ange he condi ions o p o iding accessible, e ec i e and comp ehensi e ca e o popula ion, o p o ec he human igh s and in e es s o people wi h men al illnesses and o coun e s igma and disc imina ion, and o imp o e he social suppo o people su e ing om men al diso de s and hei amilies. The e a e i e p io i y a eas, including he ollowings: imp o emen o go e nance and in e sec o al coo dina ion in men al heal h and human igh s p o ec ion, imp o emen o men al heal h esou ces (human esou ces, physical capi al, and in es men ), ex ending measu es o p e en men al diso de s among popula ion, in eg a ion o men al heal h se ices in o p ima y heal h ca e and de elopmen o men al heal h and social wel a e se ices o people wi h men al heal h p oblems. The s a egy co e s a 5-yea s s a egic ac ion plan be ween 2011 and 2015, emphasising he e alua ion o ou comes. Un o una ely, he e is a lack o moni o ing ins umen s o assessmen he ou comes o he s a egy, c ea ing an obs acle o he ull implemen a ion o he men al heal h plan. Men al heal h ca e in Aze baijan con ains an ins i u ional app oach based on he old So ie model. The o al numbe o men al heal h ou pa ien acili ies in Aze baijan is 8, while o men al hospi als is 11. 2 gene al hospi als ha e he psychia ic depa men s. The e a e 5-day ea men acili ies and se en communi y esiden ial acili ies. The numbe o beds in psychia ic hospi als is 3076, 60 o hem a e ese ed o child en and adolescen s, while gene al hospi als con ain only 70 beds o all. Men al heal h expendi u es co e a ound 2-3% o he o al heal h ca e budge . App oxima ely 85% o his expendi u e is alloca ed o men al hospi als (52). The main men al heal h se ices a e p o ided a he psychia is s‟ o ices in ou -pa ien clinics, ou -pa ien psychia ic acili ies, psychia ic hospi als and o ices in se e al p i a e cen es. Day-ca e uni s a e a ailable in some o he psychia ic hospi als. Psychia ic ou pa ien acili ies and hospi als a e loca ed in u ban a eas. Two psychia ic hospi als, one psychia ic uni in gene al hospi al and one ou -pa ien men al heal h cen e a e loca ed in he capi al ci y, while he o he s a e a ailable in he o he ci ies. All s a e heal h acili ies a e ee o cha ge and accessible o all se ice use s, howe e , some addi ional se ices may ha e cha ges (53). The numbe o men al heal h p o essionals such as psychia is s, psychia ic nu ses is insu icien . Thei aining does no mee in e na ional equi emen s o p o essional educa ion a bo h unde g adua e and pos -g adua e le els. The e is no special educa ional p og ams in child and adolescen psychia y, ge ia ic and o ensic psychia y. Special psycho he apy p og ams a e absen . 32 CHAPTER 4 RESULTS 4.1. Socio-demog aphic cha ac e is ics. 100 inpa ien s, 30 amily membe s and 30 s a membe s we e in ol ed in he s udy. Pa ien s: The sample popula ion was 60% male. The age ange was 18 o 60 ( emale: 21 o 60, male: 19 o 57). The e was a p edominance o single (51%) and di o ced (23.4%) pa ien s. Middle- income g oup was p edominan wi h 56%, ollowed by 40% low income g oup. Majo i y o pa ien s (81%) we e unemployed. Numbe o hospi aliza ion a ied be ween 1 o 45 imes while du a ion o hospi aliza ion anges be ween 1 o 276 mon hs (23 yea s). Mos o pa ien s we e diagnosed wi h schizoph enia (68%). Table 1. Socio-demog aphic cha ac e is ics o he pa ien s Va iable Pa ien Gende : Male Female 60 (60%) 40 (40%) Age M (SD): To al Male Female 42.19 (11,031) 39.98 (1,418) 45.50 (1,640) Ma i al s a us: Single Ma ied Di o ced Widow(e ) 51 (51%) 13 (13%) 32 (32%) 4 ( 4%) Educa ional le el: P ima y Seconda y High Voca ional 7 ( 7%) 59 (59%) 16 (16%) 18 (18%) Social s a us: Low Middle High 40 (40%) 56 (56%) 4 ( 4%) Employmen s a us: Yes No 19 (19%) 81 (81%) Diagnosis: Schizoph enia Schizoa ec i e diso de Bipola diso de Dep essi e episode Pe sonali y diso de s Dissocia i e diso de s 68 (68%) 7 ( 7%) 3 ( 3%) 4 ( 4%) 15 (15%) 3 ( 3%) Numbe o hospi aliza ions M (SD): 4,47 (5,458) Leng h o s ay (mon hs) M(SD): 45,06 (62,806) 33 S a : The numbe o emale s a pa icipan s (90%) was highe han he male (10%). The wo ke s' age anged om 23 o 56. The leng h o se ice changes om 1 yea o 22 yea s. The p opo ion o nu ses was 26.7%, ollowing by 46.7% o o he wo ke s including occupa ional he apis s, cook and maid. Table 2. Socio-demog aphic cha ac e is ics o he s a membe s Va iable S a Gende : Male Female 3 (10%) 27 (90%) Age M (SD): To al Male Female 37.90 (10.930) 43.67 (5.897) 37.26 (2.117) Ma i al s a us: Single Ma ied Di o ced Widow(e ) 10 (33.3%) 18 (60%)) 1 ( 3.3%) 1 ( 3.3%) Educa ional le el: P ima y Seconda y High Voca ional 1 ( 3.3%) 10 (33.3%) 8 (26.7%) 11 (36.7%) Social s a us: Low Middle High 11 (36.7%) 18 (60.0%) 1 ( 3.3%) P o ession: Psychia is Psychologis Nu se O he s 5 (16.7%) 3 (10.0%) 8 (26.7%) 14 (46.7%) Leng h o se ice (yea ) M (SD): 6.43 (6.345) Family membe s: The e we e mo e emale amily membe s (63.3%) han male (36.7%). The age ange was 25 o 68. Ma ied amily membe s we e dominan wi h 56.7%. Pa en s we e he mos equen isi o s (33.3 %), ollowed by pa ien s‟ child en (23.3%). 34 Table 3. Socio-demog aphic cha ac e is ics o he amily membe s Va iable Family membe Gende : Male Female 11 (36.7 %) 19 (63.3%) Age M (SD): To al Male Female 45.43 (12.437) 43.55 (4.328) 46.53 (2.628) Ma i al s a us: Single Ma ied Di o ced Widow(e ) 6 (20%) 17 (56.7 %) 4 (13.3%) 3 (10%) Educa ional le el: P ima y Seconda y High Voca ional 0 (0%) 9 (30%) 16 (53.3%) 5 (16.7%) Social s a us: Low Middle High 2 (6.7%) 26 (86.7%) 2 (6.7%) Employmen s a us: Yes No 23 (76.7%) 7 (23.3%) Rela ionship wi h pa ien s: Pa en s Husband/wi e Siblings Child en O he s 10 (33.3%) 5 (16.7%) 6 (20%) 7 (23.3%) 2 (6.7%) K uskal-Wallis es e ealed signi ican di e ence due o educa ional le el be ween he 3 g oups (χ2=12.517; d =2; p=0.002). Oneway ANOVA es showed signi ican di e ences be ween age o pa icipan s ( =3.328; d =2; p=0.036). The Pea son Chi-squa e showed s a is ically signi ican di e ence in ma i al s a us be ween pa icipan g oups ( χ2=43.282; d =6; p=0.000). The e was also s a is ically signi icance in gende (χ2 =24.572; d =2; p=0.000). The a e o male on inpa ien g oup and he a e o emale on s a and amily membe g oup we e highe . The employmen s a us o amily membe s was s a is ically signi ican highe han he pa ien s s a us ( χ2=35.090; d =1, p=0.000). 35 4.2. Usage o WHO QR Toolki The ables o esul s om Table4 o Table18 a e gi en as Annex I ( esul s o pa ien s), Annec II ( esul s o amily membe s) and Annex III ( esul s o s a ). 4.3. Schizoph enia Quali y o Li e Scale Re ision - 4 and Clien Sa is ac ion Ques ionnai e – 8 A e analyzing da a wi h desc ip i e s a is ics, he Table19 demons a ed ha he minimum and maximum sco es o o al SQLS-R8 we e 27.27 and 74.55 (M=49.43; SD = 12.04). Mean o subscale „Cogni ion and i ali y‟ was M=51.37; SD=11.96 and o subscale „Psychosocial eelings‟ was M=48.17; SD=14.35. SQLS-R4 showed good in e nal consis ency (Ch onbach's Alpha = 0.870). The highe sco e indica es lowe quali y o li e. Table19. Minimum, maximum, mean numbe o SQLS-R4 Minimum Maximum Mean To al sco e 27.27 74.55 49.43 ( 37.39-61.47 ) Cogni ion and i ali y 30.77 78.46 51.37 ( 39.41-63.33 ) Psychosocial eelings 24.00 81.00 48.17 ( 33.82-62.52 ) The Spea man's ank co ela ion e ealed ha he e was a signi ican co ela ion be ween cogni ion and i ali y subscale and psychosocial eeling subscale. ( =0.564, p=0.000) In acco dance wi h he able 21, he desc ip i e s a is ics showed ha he minimum sco e o CSQ-8 was 8, while he maximum sco e was 32. (M=21.11; SD=5.980). A he same ime, highe alues indica es highe sa is ac ion. Table20. Minimum, maximum, mean numbe o CSQ-8 Minimum Maximum Mean The sco e o CSQ-8 8 32 21.11 (15.13–27.09) 4.4. The co ela ion be ween quali y o li e and sa is ac ion wi h se ices p o ided Acco ding o Spea man‟s ank co ela ion es he e was s a is ically signi ican nega i e co ela ion 36 be ween he CSQ-8 and o al sco e o SQLS-R4, subscale cogni ion and i ali y, subscale psychosocial eelings. Table21. Co ela ion be ween To al SQLS and subscales Co ela ion To al SQLS Cogni ion and i ali y Psychosocial eelings CSQ-8: Pea son co ela ion Sig. (2- ailed) N -0.459 0.000 100 -0.370 0.000 100 -.435 0.000 100 The e was no co ela ion be ween CSQ-8 sco e and numbe o hospi aliza ion o du a ion o illness. In addi ion, he co ela ion be ween SQLS sco es and numbe o hospi aliza ions o du a ion o illness also was no ound. Howe e , he e is co ela ion be ween ma i al s a us and numbe o hospi aliza ion ( =0.252; Sig.=0.012). 37 CHAPTER 5 DISCUSSION 5.1. Discussion o he esul s. The cu en s udy is he i s ini ia i e o e alua e he quali y o psychia ic hospi als ega ding human igh s in Aze beijan. Fo his s udy, I de eloped an ins umen o assess he quali y o se ices in he hospi al using CRPD a icles, ye conside ing pa ien pe spec i e (55). The s udy demons a ed ha he oolki is alid and cul u ally app op ia e o his kind o assessmen in Aze baijan. Wi hin he pilo ial he ques ions we e clea ed and in he s udy all ques ions we e unde s andable o all pa icipan s. In addi ion, his s udy was he i s o use he SQLS-R4 and CSQ- 8 ools o assess clien sa is ac ion and quali y o li e. A majo s eng h o he esea ch is ha he s udy allowed us o unde s and bo h he achie emen s and he weaknesses occu ed in he psychia ic hospi al since policy has been implemen ed. The hospi al‟s good pe o mance was displayed wi h he ela i ely high sco e by p o iding he igh o an adequa e s anda d o li ing and social p o ec ion (A 28) and he igh o enjoymen o he highes a ainable s anda ds o physical and men al heal h (A 25). The hospi al‟s weakness was shown in wo impo an a eas: he igh o exe cise legal capaci y and he igh o pe sonal libe y and he secu i y o pe son (A 12 and 14), and he igh o li e independen ly and be included in he communi y (A 19). Al hough he e a e many s udies conduc ed abou he quali y o psychia ic hospi als, only wo s udies we e ound wi h he applica ion o he WHO Quali y Righ s Toolki - one in Chile and one in G eece. The s udy in Chile was ca ied ou in ambula o y psychia y ca e se ices which demons a ed ha he le el o espec o igh s o use we e lowe in inpa ien se ices han in ou pa ien ones (66). The G eek esea che s s udied bo h he psychia ic clinic and he u ologic clinic o examine he di e ence human igh issues be ween he se ice use s. Thei s udy showed a dispa i y be ween he wo depa men s in ea men and sus ainmen o human igh s. The clien s in he u ology clinic ha e be e ecogni ion o he igh o an adequa e s anda d o li ing han he pa ien s in he psychia ic one. The psychia ic pa ien s we e no conside ed o ha e legal capaci y and equali y be o e he law. They ace s igmas and ba ie s ha p e en ull pa icipa ion in socie y. The e is he iola ion o undamen al human igh s such as he igh o libe y and secu i y o he pe son, he igh o equal enjoymen o all human igh s and undamen al eedoms and o espec o 38 pa ien s‟ inhe en digni y, he igh o gi e ee and in o med consen o medical ea men in G eece (64). Table 22. O e all conclusion o he heme 1. Theme 1. The igh o an adequa e s anda d o li ing (A icle 28). Pa ien s Family S aFF S anda d 1.1: The building is in good physical condi ion. AF AF AF S anda d 1.2: The sleeping condi ions o se ice use s a e com o able and allow su icien p i acy. AP AF AF S anda d 1.3: The acili y mee s hygiene and sani a y equi emen s. AF AF AF S anda d 1.4: Se ice use s a e gi en ood, sa e d inking-wa e and clo hing ha mee hei needs and p e e ences. AF AF AF S anda d 1.5: Se ice use s can communica e eely, and hei igh o p i acy is espec ed. AP AP AP S anda d 1.6: The acili y p o ides a welcoming, com o able, s imula ing en i onmen conduci e o ac i e pa icipa ion and in e ac ion. AP AP AF S anda d 1.7: Se ice use s enjoy a ul illing social and pe sonal li e and emain engaged in communi y li e and ac i i ies AP AP AP In he i s heme, he e we e no big di e ences be ween he opinion o he se ice use s, amily membe s and s a . The achie emen was a ained in compliance wi h he s anda ds he good physical condi ion o he building, he hygiene and sani a y equi emen s o he acili y, he ood, d ink and clo hing ha mee he pa ien s‟ needs. The s udy ca ied ou in Po ugal has showed ha he le el o disabili y o pa ien s is posi i ely associa ed wi h li ing en i onmen (69). In his ega d, he pa ien s, amily membe s and s a o ally sa is ied wi h hese s anda ds in he acili y. Howe e , all hese g oups we e pa ially pleased wi h an enjoymen o ul illing social and pe sonal li e and 39 emaining engaged in communi y li e and ac i i ies. In he pe cep ion o he se ice use s and ca egi e s, he s anda ds o sleeping condi ions, communica e eely and he espec o hei igh o p i acy, he welcoming, com o able en i onmen conduci e o ac i e pa icipa ion and in e ac ion we e me pa ially, while he s a commen ed on he same only he s anda d o eely communica ion and espec o he igh o p i acy. The obse a ion o he in e iewe s displayed ha he building condi ion is epai ed in good condi ion and is p o ided necessa y ools o p o ec inpa ien s agains i e. Al hough pa icipan s s a ed ha he acili y is accessible o people wi h physical disabili y, he e we e no ele a o s o al e na i es o s ai ways a ailable in he se ing. Two wa ds had a speci ic ligh unpleasan smell. The e a e sepa a e wa ds wi h sha ed ooms o women, men and child en in he hospi al. The sleeping condi ions a e com o able and su icien . Some ooms a e o e c owded. Killaspy e al. (70) e ealed ha he quali y o ca e o pa ien s wi h a de ined expec ed maximum leng h o s ay is highe in smalle uni s han la ge uni s, which ha e poo e quali y. Pa ien s in smalle hospi al uni es (2-6 beds) we e ee o go o bed when hey wan and lay in bed du ing he day. Howe e , he pa ien ‟s had no p i acy. Fu he mo e, pa ien s we e able o s o e hei pe sonal belongs, bu he wa d obes we e no p i a e, lockable spaces. The ba hing and oile acili ies a e gene ally clean. Howe e , he e was a d opping in he ba h oom in one wa d. Ea ing a eas a e clean and cul u ally app op ia e. The ood gi en is in a good quali y, bu some pa ien s we e no sa is ied wi h he die a y op ions. All pa ien s a e p o ided wi h app op ia e clo hing i hey need. Pa ien s we e no allowed o use pe sonal phones and did no ha e access o he in e ne while in he wa ds. Calls we e only allowed o be made h ough s a phones wi h he doc o ‟s pe mission. Se ice use s can ecei e isi s only om hei close ela i es du ing he day and hey a e hen able o hold p i a e con e sa ions. Pa ien s can mo e and communica e eely inside o he wa d. The access o ou doo a eas is gi en only o some pa ien s who a e no agg essi e. Thei communica ion wi h opposi e sex was limi ed. The u ni u e in good quali y is p o ided in wa ds. Howe e , hey a e insu icien . All pa ien s easily communica e wi h s a and wi h each o he in any language. Facili ies p o ide ew leisu e oppo uni ies, including books, TV, some able games, kni ing, and pain ing. Ne e heless many pa ien s do no spend ime wi h hese oppo uni ies. 40 Table23. O e all conclusion o he heme 2. Theme 2. The igh o enjoymen o he highes a ainable s anda d o physical and men al heal h (A icle 25). Pa ien s Family S a S anda d 2.1: Facili ies a e a ailable o e e yone who equi es ea men and suppo . AF AF AF S anda d 2.2: The acili y has skilled s a and p o ides good quali y men al heal h se ices. AP AF AF S anda d 2.3: T ea men , psychosocial ehabili a ion and links o suppo ne wo ks and o he se ices a e elemen s o a se ice use -d i en eco e y plan and con ibu e o a se ice use 's abili y o li e independen ly in he communi y. AP AP AP S anda d 2.4: Psycho opic medica ion is a ailable, a o dable and used app op ia ely AP AP AF S anda d 2.5: Adequa e se ices a e a ailable o gene al and ep oduc i e heal h. AP AP AF In he second heme, he s anda d o a ailabili y o acili y o e e yone who equi es ea men is achie ed ully as a esul o he in e iewees‟ esponse. The pa ien s conside ha he skill o he s a and p o ision o men al heal h se ices in he hospi al me hei needs pa ially while conside ing he amily membe s and s a 's opinion. This s anda d was me ully. Acco ding o he conclusion o he analysis o all in e iews, he s anda d o " ea men , psychosocial ehabili a ion and links o suppo ne wo k a e an essen ial pa s o he se ice use -d i en eco e y plan and con ibu e hei abili y o li e independen ly" is achie ed o a limi ed ex en . Howe e , sa is ac ion wi h a ailabili y o he psycho opic medica ions and adequa e se ices o gene al and ep oduc i e heal h was pa ially eached o he pa ien s and he amily membe s, while s a conside ed hese s anda ds as achie ed ully. Acco ding o he esea che ‟s obse a ion, no pe son who eques s ea men o se e e men al heal h p oblems is denied o admi ance o he hospi al. All pa ien s a e examined o physical heal h on admission o he hospi al. The blood analyses, es s o check speci ic in ec ions, X- ay a e he essen ial pa o he i s physical examina ion. Acco ding o Choi SK e al (71), he e is a gap in 41 deli e ing men al heal h se ices o dep essed HIV-posi i e pa ien s in On a io. They su e om unequal access o hese se ices. The s a is skilled wi h su icien p o essional skills o p o ide necessa y counseling. Whe eas, aining abou human igh s, especially igh s o he pe sons wi h disabili ies is necessa y. In addi ion, he e is a lack o clinical psychologis s and social wo ke s. S a e e pa ien s o gene al heal h ca e sys em, communi y-based men al heal h se ices i necessa y. They help pa ien s o be in ouch wi h hei close amily membe s. The pa ien s can consul wi h s a when hey wan . Howe e , hey gene ally insis on gi ing ciga e e a he han gaining in o ma ion abou hei ea men which some imes causes a con o e sy. Use s can exp ess hei complain , howe e hei complain s a e no always aken in o conside a ion. Se ices use s ha a e in olun a ily admi ed do no always ha e hei p e e ence conside o hei ca e. In some cases, he use ‟s p e e ence o psycho he apy is no suppo ed. Majo i y o pa icipan s epo ed ha he acili y has comp ehensi e, indi idualized eco e y plan wi h social, medical goals. Howe e , ha inding di e s om wha was obse ed in eali y. The hospi al gene ally p o ides ea men wi h ew medica ions, which include ypical neu olep ics, TSAs, only a ew a ypical an ipsycho ics. This also limi s app op ia e ea men o di e en ype o men al diso de s. S a p o ides he pa ien s wi h he in o ma ion abou hei illness, medica ions, gene al heal h issues when hey ask o . Some pa ien s ha e incomple e in o ma ion om hei expe iences, while o he s a e no in e es ed in ge ing any ones. In some cases, his is ela ed o he nega i e consequences o he illness. On he o he hand, acco ding o he pa ien s‟ epo s, he p esc ip ion o medica ion is a doc o ‟s esponsibili y and hey should no que y as long as hey a e sa is ied wi h he ea men . Al hough ehabili a ion se ices exis in he hospi al, hey a e no well-o ganized. The e is no sys ema ic eco e y plan o ehabili a ion o pa ien s. Al e na i e se ices, such as occupa ional he apy a e used as ” ehabili a ion se ices”. I consis s o pain ing, wood ca ing, making handmade objec s wi h clay, kni ing e c. The pa ien s a e selec ed acco ding o hei abili ies and alen s, which means he mino i y o pa ien s can bene i om hese se ices. Some imes handmade a i ac s c ea ed by pa ien s a e p esen in exhibi ions p o ided by hospi al adminis a ion. Di e en s udies ha e ound ha almos all kind o men al diso de s a e linked o he inc eased isk o ch onic physical diseases. Thus he in e en ions should aim a he p e en ion o ch onic physical condi ions wi h in eg a ion o ea men o men al illnesses (59, 60). A he same ime, i was e ealed ha he inc eased a e o physical diseases in pa ien s wi h schizoph enia can be ela ed no 48 Eb ahimi H e al (75) s ess ha he majo i y o nu ses a e a o o applying social isola ion and es ic ion and hey ha e medium le el o s igma owa d he people wi h men al illness in he neighbo ing coun y - I an. While in Eu opean coun ies (Finland, Li huania, I eland, I aly and Po ugal) nu ses‟ opinions and a i udes owa d pa ien s a e mos ly posi i e, despi e i a ies ac oss coun ies. Po uguese nu ses' a i udes a e signi ican ly mo e posi i e, while Li huanian ones‟ a e mo e nega i e han he o he s (76). The esul o SQLS-R4 demons a ed ha , he ins umen is alid and eliable o use in Aze baijan. Acco ding o he da a analysis, he le el o he quali y o li e among inpa ien s anges widely. The esul shows ha mos o pa ien s‟ quali y o li e is a e age. The le el o sa is ac ion wi h he p o ided se ices we e low, howe e he CSQ-8 p esen ed ha , now he sa is ac ion le el has inc eased, bu pa ien s a e no o ally sa is ied ye . The clinical cha ac e is ics such as du a ion o illness and numbe o hospi aliza ions a e no co ela ed wi h he le el o sa is ac ion and quali y o li e. The nega i e co ela ion was ound be ween he CSQ-8 and o al sco e o SQLS-R4, so subscale cogni ion and i ali y and subscale psychosocial eelings. This indica es ha he pa ien s wi h highe le el o quali y o li e a e mo e sa is ied wi h he se ices. Small co ela ion was ound be ween he ma i al s a us o he pa ien s and he numbe o hei hospi aliza ions. 5.2. Limi a ions o he s udy The main limi a ion o he s udy e e s o he sample. The numbe o he selec ed wa ds and en an s was small in p opo ion o he gene al numbe o acili y‟s wa ds, s a , se ice use s and hei amily membe s. Besides, he andomiza ion o wa ds le ou mos o wa ds including ge on ology, in ec ious, o ensic e c. A he same ime, he amily membe s could no be andomized and he numbe o amily membe s/ca egi e s was no conduc ed exac ly as planned. The a ionale o his is ha mos o amilies do no isi hei ela i es in he hospi al because o s igma and wo k. E en many who isi ed, did no gi e consen o ake a pa in he s udy because o “ha ing no ime”. In addi ion, he ime o conduc ing in e iews was no su icien since mos o amily membe s made hei hospi al isi s gene ally a he weekends. The o he p oblem is abou he since i y o he pa icipan s. Mos o he pa ien s el p essu e as a esul hey we e saying he opposi e (social desi abili y). They migh ha e hid hei eal opinion 49 because o a oiding punishmen . The s a also el unde p essu e, hey did no wish o say any hing w ong ha migh ha e disc edi ed he hospi al and hei wo k. One o he c i ical issues aced du ing he s udy was he analyzing and sco ing he esul . The e is no clea guidance abou calcula ing he achie emen le el. 5.3. Conclusions and ecommenda ions The esul s ha e b oad e ec s on men al heal h se ice moni o ing, planning and imp o emen o men al heal h se ices in Aze baijan. The s udy is an impo an s ep in ul illing he esponsibili y o Na ional Men al Heal h S a egy in he ma e o e alua ion o he se ices in he psychia ic hospi als. The WHO Quali y Rig h Toolki o quali y assessmen o inpa ien acili ies was adap ed. Re e ence in e als o good quali y o selec ed indica o s we e de ined. The ins umen was alida ed o u he implemen a ion in he men al heal h sys em. E idence p esen ed indica es ha he quali y o se ices and human igh s in psychia ic hospi al a e no su icien enough o p o ide comp ehensi e, high-quali y se ices o people wi h he se e e men al illnesses. The pa ien s ace se e al human igh s iola ions in he hospi al. The iola ion co e s he signi ican no ms a icula ed in CRPD, he igh o exe cise legal capaci y, he igh o pe sonal libe y and secu i y o pe son, igh o li e independen ly and be included in he communi y. The igh o an adequa e s anda d o li ing, igh o enjoymen o he highes a ainable s anda d o physical and men al heal h and he igh o eedom om o u e o c uel, inhuman o deg ading ea men o punishmen a e p o ec ed and espec ed, howe e he e is a need o imp o e se ices in hese sphe es. The de elopmen is also necessa y o inc ease he quali y o li e o he pa ien s and he le el o clien sa is ac ion. The s udy showed ha he de en ion o pa ien s and ea men wi hou hei consen is one o he main p oblems. The e is a g ea need o p o ide esiden ial ca e acili ies, shel e s o homeless pa ien s. The pa ien s a e no suppo ed o ha e access o educa ion, o ge employmen , o ake a pa in he poli ical and public li e. The s igma and disc imina ion make a ba ie no only in enjoying ully pa icipa ion in socie y, bu also among he amily membe s. All hese indings can help o de ec undamen al quali y conce ns and o o mula e ecommenda ions o u he imp o emen o psychia ic se ices a he le el o he coun y which will gi e an oppo uni y o p o ide comp ehensi e eco e y o people wi h men al heal h p oblems. 50 Fi s , he s udy should be conduc ed in all psychia ic hospi als in he Aze baijan. In addi ion, i should be ca ied ou in ou -pa ien acili ies which o e men al heal h ca e in o de o unde s and he weaknesses o he se ices in he coun y. The majo ecommenda ions a e ollowing:  Make s ic amendmen s in Na ional Men al Heal h S a egy o nex 5-yea s ac ion plan o ensu e he human igh s;  To c ea e a eam o moni o ing he men al heal h se ices and e alua e he quali y o se ices wi h de eloped ool egula ly;  Inc ease he le el o awa eness abou men al heal h and men al diso de s in o de o educe s igma and disc imina ion;  T ain he s a o he psychia ic acili ies on human igh s and inspi e hem o suppo pa ien s o exe cise hei legal capaci y;  Imp o e psychosocial ehabili a ion and leisu e ac i i ies inside and ou side o he acili ies;  P o ide acili ies wi h newly-de eloped medica ions;  P o ide sa egua ds o a oid o unnecessa y in olun a y admission, dec ease he numbe o beds in psychia ic hospi als which a e mos ly associa ed wi h human igh s iola ions. 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The igh o an adequa e s anda d o li ing and social p o ec ion (pa ien s) S anda ds: C i e ia: AF % AP % NI % NA/ DK% S anda d 1.1.The building is in good physical condi ion. 1.1.1 The building is in a good s a e o epai . 1.1.2 The building is accessible o people wi h physical disabili ies. 1.1.3 The building‟s ligh ing (a i icial and na u al), hea ing and en ila ion p o ide a com o able li ing en i onmen . 1.1.4 Measu es a e in place o p o ec people agains inju y h ough i e. 83 44 70 74 12 32 24 7 5 24 5 13 - - - 6 S anda d 1.2: The sleeping condi ions o se ice use s a e com o able and allow su icien p i acy. 1.2.1 The sleeping qua e s p o ide su icien li ing space pe se ice use and a e no o e c owded. 1.2.2 Men and women as well as child en and olde pe sons ha e sepa a e sleeping qua e s. 1.2.3 Se ice use s a e ee o choose when o ge up and when o go o bed. 1.2.4 The sleeping qua e s allow o he p i acy o se ice use s. 1.2.5 Su icien numbe s o clean blanke s and bedding a e a ailable o se ice use s. 1.2.6 Se ice use s can keep pe sonal belongings and ha e adequa e lockable space o s o e hem. 87 99 60 36 93 40 12 - 5 45 7 40 1 1 35 19 - 20 - - - - - - S anda d 1.3: The acili y mee s hygiene and sani a y equi emen s 1.3.1 The ba hing and oile acili ies a e clean and wo king p ope ly 1.3.2 The ba hing and oile acili ies allow p i acy, and he e a e sepa a e acili ies o men and women. 1.3.3 Se ice use s ha e egula access o ba hing and oile acili ies. 1.3.4 The ba hing and oile ing needs o se ice use s who a e bed idden o who ha e impai ed mobili y o o he physical disabili ies a e accommoda ed. 90 100 71 78 7 - 1 13 3 - 28 5 - - - 4 S anda d 1.4: Se ice use s a e gi en ood, sa e d inking-wa e and clo hing ha mee hei needs and p e e ences. 1.4.1 Food and sa e d inking-wa e a e a ailable in su icien quan i ies, a e o good quali y and mee wi h he se ice use s‟ cul u al p e e ences and physical heal h equi emen s. 1.4.2 Food is p epa ed and se ed unde sa is ac o y condi ions, and ea ing a eas a e cul u ally app op ia e and e lec he ea ing a angemen s in he communi y. 1.4.3 Se ice use s can wea hei own clo hing and shoes (day wea and nigh wea ). 1.4.4 When se ice use s do no ha e hei own clo hing, good-quali y clo hing is p o ided ha mee s hei cul u al p e e ences and is sui able o he clima e. 67 93 79 90 28 6 14 7 5 1 7 3 - - - - S anda d 1.5: Se ice use s can communica e eely, and hei igh o p i acy is espec ed. 1.5.1 Telephones, le e s, e-mails and he In e ne a e eely a ailable o se ice use s, wi hou censo ship. 1.5.2 Se ice use s‟ p i acy in communica ions is espec ed. 2 55 3 19 95 25 - 1 64 Table 8. Theme 5. The igh o li e independen ly and be included in he communi y (pa ien s). S anda ds: C i e ia: AF % AP % NI % NA/ DN% S anda d 5.1: Se ice use s a e suppo ed in gaining access o a place o li e and ha e he inancial esou ces necessa y o li e in he communi y 5.1.1 S a in o m se ice use s abou op ions o housing and inancial esou ces. 5.1.2 S a suppo se ice use s in accessing and main aining sa e, a o dable, decen housing. 5.1.3 S a suppo se ice use s in accessing he inancial esou ces necessa y o li e in he communi y. 15 19 21 12 7 4 73 70 72 - 4 3 S anda d 5.2: Se ice use s can access educa ion and employmen oppo uni ies 5.2.1 S a gi e se ice use s in o ma ion abou educa ion and employmen oppo uni ies in he communi y. 5.2.2 S a suppo se ice use s in accessing educa ion oppo uni ies, including p ima y, seconda y and pos - seconda y educa ion. 5.2.3 S a suppo se ice use s in ca ee de elopmen and in accessing paid employmen oppo uni ies. 13 12 15 2 4 5 83 81 77 2 3 3 S anda d 5.3: The igh o se ice use s o pa icipa e in poli ical and public li e and o exe cise eedom o associa ion is suppo ed. 5.3.1 S a gi e se ice use s he in o ma ion necessa y o hem o pa icipa e ully in poli ical and public li e and o enjoy he bene i s o eedom o associa ion. 5.3.2 S a suppo se ice use s in exe cising hei igh o o e. 5.3.3 S a suppo se ice use s in joining and pa icipa ing in he ac i i ies o poli ical, eligious, social, disabili y and men al disabili y o ganiza ions and o he g oups. 23 15 3 5 3 1 72 79 96 - 3 - S anda d 5.4: Se ice use s a e suppo ed in aking pa in social, cul u al, eligious and leisu e ac i i ies 5.4.1 S a gi e se ice use s in o ma ion on he social, cul u al, eligious and leisu e ac i i y op ions a ailable. 5.4.2 S a suppo se ice use s in pa icipa ing in he social and leisu e ac i i ies o hei choice. 5.4.3 S a suppo se ice use s in pa icipa ing in he cul u al and eligious ac i i ies o hei choice 34 27 26 14 16 15 52 56 58 - 1 1 65 ANNEX II The esul s o amily membe s: Table 9. Theme 1. The igh o an adequa e S anda d o li ing and social p o ec ion ( amily membe s). S anda ds: C i e ia: AF % AP % NI % NA/ DK% S anda d 1.1.The building is in good physical condi ion. 1.1.1 The building is in a good s a e o epai 1.1.2 The building is accessible o people wi h physical disabili ies 1.1.3 The building‟s ligh ing (a i icial and na u al), hea ing and en ila ion p o ide a com o able li ing en i onmen 1.1.4 Measu es a e in place o p o ec people agains inju y h ough i e 86.7 26.7 70 93.3 6.7 36.7 16.7 6.7 6.7 36.7 6.7 - - 6.7 - S anda d 1.2: The sleeping condi ions o se ice use s a e com o able and allow su icien p i acy. 1.2.1 The sleeping qua e s p o ide su icien li ing space pe se ice use and a e no o e c owded. 1.2.2 Men and women as well as child en and olde pe sons ha e sepa a e sleeping qua e s. 1.2.3 Se ice use s a e ee o choose when o ge up and when o go o bed. 1.2.4 The sleeping qua e s allow o he p i acy o se ice use s. 1.2.5 Su icien numbe s o clean blanke s and bedding a e a ailable o se ice use s. 1.2.6 Se ice use s can keep pe sonal belongings and ha e adequa e lockable space o s o e hem. 70 100 66.7 20 93.3 66.7 30 - 13.3 80 6.7 26.7 - - 20 - - 6.7 - - - - - - S anda d 1.3: The acili y mee s hygiene and sani a y equi emen s 1.3.1 The ba hing and oile acili ies a e clean and wo king p ope ly 1.3.2 The ba hing and oile acili ies allow p i acy, and he e a e sepa a e acili ies o men and women. 1.3.3 Se ice use s ha e egula access o ba hing and oile acili ies. 1.3.4 The ba hing and oile ing needs o se ice use s who a e bed idden o who ha e impai ed mobili y o o he physical disabili ies a e accommoda ed. 73.3 100 70 86.6 20 - - 6.7 - - 30 - 6.7 - - 6.7 S anda d 1.4: Se ice use s a e gi en ood, sa e d inking-wa e and clo hing ha mee hei needs and p e e ences. 1.4.1 Food and sa e d inking-wa e a e a ailable in su icien quan i ies, a e o good quali y and mee wi h he se ice use s‟ cul u al p e e ences and physical heal h equi emen s. 1.4.2 Food is p epa ed and se ed unde sa is ac o y condi ions, and ea ing a eas a e cul u ally app op ia e and e lec he ea ing a angemen s in he communi y. 1.4.3 Se ice use s can wea hei own clo hing and shoes (day wea and nigh wea ). 1.4.4 When se ice use s do no ha e hei own clo hing, good-quali y clo hing is p o ided ha mee s hei cul u al p e e ences and is sui able o he clima e. 80.0 93.3 86.7 70 13.3 6.7 13.3 30 - - - - 6.7 - - - S anda d 1.5: Se ice use s can communica e eely, and hei igh o 1.5.1 Telephones, le e s, e-mails and he In e ne a e eely a ailable o se ice use s, wi hou censo ship. 1.5.2 Se ice use s‟ p i acy in communica ions is 13.3 76.7 33.3 23.3 53.3 - - - 66 p i acy is espec ed. espec ed. 1.5.3 Se ice use s can communica e in he language o hei choice, and he acili y p o ides suppo (e.g. ansla o s) o ensu e ha he se ice use s can exp ess hei needs. 1.5.4 Se ice use s can ecei e isi o s, choose who hey wan o see and pa icipa e in isi s a any easonable ime. 1.5.5 Se ice use s can mo e eely a ound he acili y. 100 56.7 13.3 - 30.0 53.3 - 13.3 33.3 - - - S anda d 1.6: The acili y p o ides a welcoming, com o able, s imula ing en i onmen conduci e o ac i e pa icipa ion and in e ac ion. 1.6.1 The e a e ample u nishings, and hey a e com o able and in good condi ion. 1.6.2 The layou o he acili y is conduci e o in e ac ion be ween and among se ice use s, s a and isi o s. 1.6.3 The necessa y esou ces, including equipmen , a e p o ided by he acili y o ensu e ha se ice use s ha e oppo uni ies o in e ac and pa icipa e in leisu e ac i i ies. 1.6.4 Rooms wi hin he acili y a e speci ically designa ed as leisu e a eas o se ice use s. 80.0 100 63.3 66.7 20.0 - 36.7 - - - - 26.7 - - - 6.7 S anda d 1.7: Se ice use s enjoy a ul illing social and pe sonal li e and emain engaged in communi y li e and ac i i ies. 1.7.1 Se ice use s can in e ac wi h o he se ice use s, including membe s o he opposi e sex. 1.7.2 Pe sonal eques s, such as o a end weddings o une als, a e acili a ed by s a . 1.7.3 A ange o egula ly scheduled, o ganized ac i i ies a e o e ed in bo h he acili y and he communi y ha a e ele an and age-app op ia e. 1.7.4 S a p o ide in o ma ion o se ice use s abou ac i i ies in he communi y and acili a e hei access o hose ac i i ies. 1.7.5 S a acili a e se ice use s‟ access o en e ainmen ou side he acili y, and en e ainmen om he communi y is b ough in o he acili y. 73.3 43.3 40.0 20.0 20.0 6.7 16.7 50.0 30.0 16.7 20.0 40 10.0 50.0 63.3 - - - - - 67 Table 10. Theme 2. The igh o enjoymen o he highes a ainable S anda d o physical and men al heal h ( amily membe s). S anda ds: C i e ia: AF % AP % NI % NA/ DN% S anda d 2.1: Facili ies a e a ailable o e e yone who equi es ea men and suppo 2.1.1 No pe son is denied access o acili ies o ea men on he basis o economic ac o s o o his o he ace, colou , sex, language, eligion, poli ical o o he opinion, na ional, e hnic, indigenous o social o igin, p ope y, disabili y, bi h, age o o he s a us. 2.1.2 E e yone who eques s men al heal h ea men ecei es ca e in his acili y o is e e ed o ano he acili y whe e ca e can be p o ided 2.1.3 No se ice use is admi ed, ea ed o kep in he acili y on he basis o his o he ace, colou , sex, language, eligion, poli ical o o he opinion, na ional, e hnic, indigenous o social o igin, p ope y, disabili y, bi h, age o o he s a us. 100 86.7 26.7 - - - - 13.3 66.7 - - 6.7 S anda d 2.2: The acili y has skilled s a and p o ides good quali y men al heal h se ices 2.2.1 The acili y has s a wi h su icien ly di e se skills o p o ide counselling, psychosocial ehabili a ion, in o ma ion, educa ion and suppo o se ice use s and hei amilies, iends o ca e s, in o de o p omo e independen li ing and inclusion in he communi y. 2.2.2 S a a e knowledgeable abou he a ailabili y and ole o communi y se ices and esou ces o p omo e independen li ing and inclusion in he communi y. 2.2.3 Se ice use s can consul wi h a psychia is o o he specialized men al heal h s a when hey wish o do so. 2.2.4 S a in he acili y a e ained and licensed o p esc ibe and e iew psycho opic medica ion. 2.2.5 S a a e gi en aining and w i en in o ma ion on he igh s o pe sons wi h men al disabili ies and a e amilia wi h in e na ional human igh s S anda ds, including he CRPD. 2.2.6 Se ice use s a e in o med o and ha e access o mechanisms o exp essing hei opinions on se ice p o ision and imp o emen . 70 16.7 83.3 100.0 70.0 43.3 23.3 46.7 16.7 - 30.0 50.0 6.7 36.7 - - - - - - - - - 6.7 S anda d 2.3: T ea men , psychosocial ehabili a ion and links o suppo ne wo ks and o he se ices a e elemen s o a se ice use -d i en eco e y plan and con ibu e o a se ice use 's abili y o li e independen ly in he communi y 2.3.1 Each se ice use has a comp ehensi e, indi idualized eco e y plan ha includes his o he social, medical, employmen and educa ion goals and objec i es o eco e y. 2.3.2 Reco e y plans a e d i en by he se ice use , e lec his o he choices and p e e ences o ca e, a e pu in o e ec and a e e iewed and upda ed egula ly by he se ice use and a s a membe . 2.3.3 As pa o hei eco e y plans, se ice use s a e encou aged o de elop ad ance di ec i es10 which speci y he ea men and eco e y op ions hey wish o ha e as well as hose ha hey don‟ , o be used i hey a e unable o communica e hei choices a some poin in he u u e. 2.3.4 Each se ice use has access o psychosocial 50.0 53.3 20.0 20.0 30.0 33.3 43.3 30.0 20.0 6.7 36.7 43.3 - 6.7 - 6.7 68 p og ammes o ul illing he social oles o his o he choice by de eloping he skills necessa y o employmen , educa ion o o he a eas. Skill de elopmen is ailo ed o he pe son‟s eco e y p e e ences and may include enhancemen o li e and sel -ca e skills. 2.3.5 Se ice use s a e encou aged o es ablish a social suppo ne wo k and/o main ain con ac wi h membe s o hei ne wo k o acili a e independen li ing in he communi y. The acili y p o ides assis ance in connec ing se ice use s wi h amily and iends, in line wi h hei wishes. 2.3.6 Facili ies link se ice use s wi h he gene al heal h ca e sys em, o he le els o men al heal h se ices, such as seconda y ca e, and se ices in he communi y such as g an s, housing, employmen agencies, day-ca e cen es and assis ed esiden ial ca e. 70.0 33.3 30.0 50.0 - 10.0 - 6.7 S anda d 2.4: Psycho opic medica ion is a ailable, a o dable and used app op ia ely 2.4.1 The app op ia e psycho opic medica ion (speci ied in he na ional essen ial medicines lis ) is a ailable a he acili y o can be p esc ibed. 2.4.2 A cons an supply o essen ial psycho opic medica ion is a ailable, in su icien quan i ies o mee he needs o se ice use s. 2.4.3 Medica ion ype and dosage a e always app op ia e o he clinical diagnoses o se ice use s and a e e iewed egula ly. 2.4.4 Se ice use s a e in o med abou he pu pose o he medica ions being o e ed and any po en ial side e ec s. 2.4.5 Se ice use s a e in o med abou ea men op ions ha a e possible al e na i es o o could complemen medica ion, such as psycho he apy. 80.0 63.3 70.0 66.7 33.3 13.3 16.7 10.0 26.7 10.0 - - 6.7 6.7 56.7 6.7 20.0 13.3 - - S anda d 2.5: Adequa e se ices a e a ailable o gene al and ep oduc i e heal h 2.5.1 Se ice use s a e o e ed physical heal h examina ions and/o sc eening o pa icula illnesses on en y o he acili y and egula ly he ea e . 2.5.2 T ea men o gene al heal h p oblems, including accina ions, is a ailable o se ice use s a he acili y o by e e al. 2.5.3 When su gical o medical p ocedu es a e needed ha canno be p o ided a he acili y, he e a e e e al mechanisms o ensu e ha he se ice use s ecei e hese heal h se ices in a imely manne . 2.5.4 Regula heal h educa ion and p omo ion a e conduc ed a he acili y. 2.5.5 Se ice use s a e in o med o and ad ised abou ep oduc i e heal h and amily planning ma e s. 2.5.6 Gene al and ep oduc i e heal h se ices a e p o ided o se ice use s wi h ee and in o med consen . 93.3 73.3 86.7 56.7 56.7 66.7 6.7 20.0 6.7 23.3 - 33.3 - - - 20.0 43.3 - - 6.7 6.7 - - - 69 Table 11. Theme 3.The igh o exe cise legal capaci y and he igh o pe sonal libe y and he secu i y o pe son ( amily membe s). S anda ds: C i e ia: AF % AP % NI % NA/ DN% S anda d 3.1: Se ice use s' p e e ences o he place and o m o ea men a e always a p io i y 3.1.1 Se ice use s‟ p e e ences a e he p io i y in all decisions on whe e hey will access se ices. 3.1.2 All e o s a e made o acili a e discha ge so ha se ice use s can li e in hei communi ies. 3.1.3 Se ice use s‟ p e e ences a e he p io i y o all decisions on hei ea men and eco e y plan. - 56.7 63.3 - 43.3 26.7 - - 10.0 100 - - S anda d 3.2: P ocedu es and sa egua ds a e in place o p e en de en ion and ea men wi hou ee and in o med consen 3.2.1 Admission and ea men a e based on he ee and in o med consen o se ice use s. 3.2.2 S a espec he ad ance di ec i es o se ice use s when p o iding ea men . 3.2.3 Se ice use s ha e he igh o e use ea men . 3.2.4 Any case o ea men o de en ion in a acili y wi hou ee and in o med consen is documen ed and epo ed apidly o a legal au ho i y. 3.2.5 People being ea ed o de ained by a acili y wi hou hei in o med consen a e in o med abou p ocedu es o appealing hei ea men o de en ion. 3.2.6 Facili ies suppo people being ea ed o de ained wi hou hei in o med consen in accessing appeals p ocedu es and legal ep esen a ion 50 46.7 60.0 46.7 20.0 43.3 10 26.7 10.0 6.7 - 36.7 40 26.7 30.0 23.3 80.0 20.0 - - - 23.3 - - S anda d 3.3: Se ice use s can exe cise hei legal capaci y and a e gi en he suppo hey may equi e o exe cise hei legal capaci y 3.3.1 A all imes, s a in e ac wi h se ice use s in a espec ul way, ecognizing hei capaci y o unde s and in o ma ion and make decisions and choices. 3.3.2 Clea , comp ehensi e in o ma ion abou he igh s o se ice use s is p o ided in bo h w i en and e bal o m. 3.3.3 Clea , comp ehensi e in o ma ion abou assessmen , diagnosis, ea men and eco e y op ions is gi en o se ice use s in a o m ha hey unde s and and which allows hem o make ee and in o med decisions. 3.3.4 Se ice use s can nomina e and consul wi h a suppo pe son o ne wo k o people o hei own ee choice in making decisions abou admission, ea men and pe sonal, legal, inancial o o he a ai s, and he people selec ed will be ecognized by he s a . 3.3.5 S a espec he au ho i y o a nomina ed suppo pe son o ne wo k o people o communica e he decisions o he se ice use being suppo ed. 3.3.6 Suppo ed decision-making is he p edominan model, and subs i u e decision-making is a oided. 3.3.7 When a se ice use has no suppo pe son o ne wo k o people and wishes o appoin one, he acili y will help he use o access app op ia e suppo . 70.0 60.0 76.7 93.3 80.0 46.7 43.3 30.0 - 23.3 6.7 20.0 - 20.0 - 40.0 - - - 46.7 30.0 - - - - - 6.7 6.7 S anda d 3.4: Se ice use s ha e he igh o con iden iali y and access o hei pe sonal 3.4.1 A pe sonal, con iden ial medical ile is c ea ed o each se ice use . 3.4.2 Se ice use s ha e access o he in o ma ion con ained in hei medical iles. 26.7 40.0 - 13.3 6.7 26.7 66.7 20.0 70 heal h in o ma ion 3.4.3 In o ma ion abou se ice use s is kep con iden ial. 3.4.4 Se ice use s can add w i en in o ma ion, opinions and commen s o hei medical iles wi hou censo ship. 36.7 6.7 6.7 - 46.7 86.7 10.0 6.7 Table 12. Theme 4. F eedom om o u e o c uel, inhuman o deg ading ea men o punishmen and om exploi a ion, iolence and abuse ( amily membe s). S anda ds: C i e ia: AF % AP % NI % NA/ DN% S anda d 4.1: Se ice use s ha e he igh o be ee om e bal, men al, physical o sexual abuse and physical o emo ional neglec 4.1.1 S a membe s ea se ice use s wi h humani y, digni y and espec . 4.1.2 No se ice use is subjec ed o e bal, physical, sexual o men al abuse. 4.1.3 No se ice use is subjec ed o physical o emo ional neglec . 4.1.4 App op ia e s eps a e aken o p e en all ins ances o abuse. 4.1.5 S a suppo se ice use s who ha e been subjec ed o abuse in accessing he suppo hey may wan . 53.3 70.0 80.0 80.0 86.7 46.7 23.3 6.7 6.7 - - 6.7 6.7 13.3 - - - 6.7 - 13.3 S anda d 4.2: Al e na i e me hods a e used in place o seclusion and es ain as means o de- escala ing po en ial c ises 4.2.1 Se ice use s a e no subjec ed o seclusion o es ain . 4.2.2 Al e na i es o seclusion and es ain a e in place a he acili y, and s a a e ained in de-escala ion echniques o in e ening in c ises and p e en ing ha m o se ice use s o s a . 4.2.3 A de-escala ion assessmen is conduc ed in consul a ion wi h he se ice use conce ned in o de o iden i y he igge s and ac o s he o she inds help ul in di using c ises and o de e mine he p e e ed me hods o in e en ion in c ises. 4.2.4 The p e e ed me hods o in e en ion iden i ied by he se ice use conce ned a e eadily a ailable in a c isis and a e in eg a ed in o he use ‟s indi idual eco e y plan. 4.2.5 Any ins ances o seclusion o es ain a e eco ded (e.g. ype, du a ion) and epo ed o he head o he acili y and o a ele an ex e nal body. 80.0 66.7 46.7 36.7 - 20.0 - 46.7 - 20.0 - 13.3 - 10.0 6.7 - 20.0 6.7 53.3 73.3 S anda d 4.3: Elec ocon ulsi e he apy, psychosu ge y and o he medical p ocedu es ha may ha e pe manen o i e e sible e ec s, whe he pe o med a he acili y o e e ed o ano he acili y, mus no be abused and can be adminis e ed only wi h ee and in o med consen 4.3.1 No elec ocon ulsi e he apy is gi en wi hou he ee and in o med consen o se ice use s. 4.3.2 Clea e idence-based clinical guidelines on when and how elec ocon ulsi e he apy can o canno be adminis e ed a e a ailable and adhe ed o. 4.3.3 Elec ocon ulsi e he apy is ne e used in i s unmodi ied o m (i.e. wi hou an anaes he ic and a muscle elaxan ). 4.3.4 No mino is gi en elec ocon ulsi e he apy. 4.3.5 Psychosu ge y and o he i e e sible ea men s a e no conduc ed wi hou bo h he se ice use s‟ ee and in o med consen and he independen app o al o a boa d. 4.3.6 Abo ions and s e iliza ions a e no ca ied ou on se ice use s wi hou hei consen . 10.0 - - - - 70.0 - - - - - - 33.3 - - - - - 56.7 100 100 100 100 30.0 71 S anda d 4.4: No se ice use is subjec ed o medical o scien i ic expe imen a ion wi hou his o he in o med consen 4.4.1 Medical o scien i ic expe imen a ion is conduc ed only wi h he ee and in o med consen o se ice use s. 4.4.2 S a do no ecei e any p i ileges, compensa ion o emune a ion in exchange o encou aging o ec ui ing se ice use s o pa icipa e in medical o scien i ic expe imen a ion. 4.4.3 Medical o scien i ic expe imen a ion is no unde aken i i is po en ially ha m ul o dange ous o he se ice use . 4.4.4 Any medical o scien i ic expe imen a ion is app o ed by an independen e hics commi ee. 30.0 6.7 20.0 30.0 - - - 13.3 20.0 13.3 - 16.7 50.0 80.0 80.0 40.0 S anda d 4.5: Sa egua ds a e in place o p e en o u e o c uel, inhuman o deg ading ea men o o he o ms o ill ea men and abuse 4.5.1 Se ice use s a e in o med o and ha e access o p ocedu es o ile appeals and complain s, on a con iden ial basis, o an ou side, independen legal body on issues ela ed o neglec , abuse, seclusion o es ain , admission o ea men wi hou in o med consen and o he ele an ma e s. 4.5.2 Se ice use s a e sa e om nega i e epe cussions esul ing om complain s hey may ile. 4.5.3 Se ice use s ha e access o legal ep esen a i es and can mee wi h hem con iden ially. 4.5.4 Se ice use s ha e access o ad oca es o in o m hem o hei igh s, discuss p oblems and suppo hem in exe cising hei human igh s and iling appeals and complain s. 4.5.5 Disciplina y and/o legal ac ion is aken agains any pe son ound o be abusing o neglec ing se ice use s. 4.5.6 The acili y is moni o ed by an independen au ho i y o p e en he occu ence o ill- ea men . 26.7 83.3 100 86.7 53.3 93.3 36.7 6.7 - 6.7 - - 36.7 10.0 - 6.7 46.7 6.7 - - - - - - 72 Table 13. Theme 5. The igh o li e independen ly and be included in he communi y ( amily membe s). S anda ds: C i e ia: AF % AP % NI % NA/ DN% S anda d 5.1: Se ice use s a e suppo ed in gaining access o a place o li e and ha e he inancial esou ces necessa y o li e in he communi y 5.1.1 S a in o m se ice use s abou op ions o housing and inancial esou ces. 5.1.2 S a suppo se ice use s in accessing and main aining sa e, a o dable, decen housing. 5.1.3 S a suppo se ice use s in accessing he inancial esou ces necessa y o li e in he communi y. 13.3 36.7 50.0 56.7 20 20.0 30 43.3 30.0 - - - S anda d 5.2: Se ice use s can access educa ion and employmen oppo uni ies 5.2.1 S a gi e se ice use s in o ma ion abou educa ion and employmen oppo uni ies in he communi y. 5.2.2 S a suppo se ice use s in accessing educa ion oppo uni ies, including p ima y, seconda y and pos - seconda y educa ion. 5.2.3 S a suppo se ice use s in ca ee de elopmen and in accessing paid employmen oppo uni ies. - - - 20.0 - - 80.0 100 100 - - - S anda d 5.3: The igh o se ice use s o pa icipa e in poli ical and public li e and o exe cise eedom o associa ion is suppo ed. 5.3.1 S a gi e se ice use s he in o ma ion necessa y o hem o pa icipa e ully in poli ical and public li e and o enjoy he bene i s o eedom o associa ion. 5.3.2 S a suppo se ice use s in exe cising hei igh o o e. 5.3.3 S a suppo se ice use s in joining and pa icipa ing in he ac i i ies o poli ical, eligious, social, disabili y and men al disabili y o ganiza ions and o he g oups. - - 20.0 20.0 - 167 80.0 93.3 56.7 - 6.7 6.7 S anda d 5.4: Se ice use s a e suppo ed in aking pa in social, cul u al, eligious and leisu e ac i i ies 5.4.1 S a gi e se ice use s in o ma ion on he social, cul u al, eligious and leisu e ac i i y op ions a ailable. 5.4.2 S a suppo se ice use s in pa icipa ing in he social and leisu e ac i i ies o hei choice. 5.4.3 S a suppo se ice use s in pa icipa ing in he cul u al and eligious ac i i ies o hei choice 26.7 - 6.7 36.7 36.7 43.3 36.7 63.3 50.0 - - - 73 ANNEX III The esul s o s a : Table14. Theme 1. The igh o an adequa e S anda d o li ing and social p o ec ion (s a ). S anda ds: C i e ia: AF % AP % NI % NA/ DK% S anda d 1.1.The building is in good physical condi ion. 1.1.1 The building is in a good s a e o epai 1.1.2 The building is accessible o people wi h physical disabili ies 1.1.3 The building‟s ligh ing (a i icial and na u al), hea ing and en ila ion p o ide a com o able li ing en i onmen 1.1.4 Measu es a e in place o p o ec people agains inju y h ough i e 90.0 43.3 86.7 100 10.0 26.7 13.3 - - 30.0 - - - - - - S anda d 1.2: The sleeping condi ions o se ice use s a e com o able and allow su icien p i acy. 1.2.1 The sleeping qua e s p o ide su icien li ing space pe se ice use and a e no o e c owded. 1.2.2 Men and women as well as child en and olde pe sons ha e sepa a e sleeping qua e s. 1.2.3 Se ice use s a e ee o choose when o ge up and when o go o bed. 1.2.4 The sleeping qua e s allow o he p i acy o se ice use s. 1.2.5 Su icien numbe s o clean blanke s and bedding a e a ailable o se ice use s. 1.2.6 Se ice use s can keep pe sonal belongings and ha e adequa e lockable space o s o e hem. 83.3 100 76.7 60.0 96.7 60.0 16.7 - 6.7 33.3 3.3 33.3 - - 16.7 6.7 - 6.7 - - - - - - S anda d 1.3: The acili y mee s hygiene and sani a y equi emen s 1.3.1 The ba hing and oile acili ies a e clean and wo king p ope ly 1.3.2 The ba hing and oile acili ies allow p i acy, and he e a e sepa a e acili ies o men and women. 1.3.3 Se ice use s ha e egula access o ba hing and oile acili ies. 1.3.4 The ba hing and oile ing needs o se ice use s who a e bed idden o who ha e impai ed mobili y o o he physical disabili ies a e accommoda ed. 90.0 100 96.7 93.3 10.0 - - - - - 3.3 6.7 - - - - S anda d 1.4: Se ice use s a e gi en ood, sa e d inking-wa e and clo hing ha mee hei needs and p e e ences. 1.4.1 Food and sa e d inking-wa e a e a ailable in su icien quan i ies, a e o good quali y and mee wi h he se ice use s‟ cul u al p e e ences and physical heal h equi emen s. 1.4.2 Food is p epa ed and se ed unde sa is ac o y condi ions, and ea ing a eas a e cul u ally app op ia e and e lec he ea ing a angemen s in he communi y. 1.4.3 Se ice use s can wea hei own clo hing and shoes (day wea and nigh wea ). 1.4.4 When se ice use s do no ha e hei own clo hing, good-quali y clo hing is p o ided ha mee s hei cul u al p e e ences and is sui able o he clima e. 90 100 93.3 93.3 10 - 6.7 6.7 - - - - - - - - S anda d 1.5: Se ice use s can communica e eely, and hei igh o p i acy is espec ed. 1.5.1 Telephones, le e s, e-mails and he In e ne a e eely a ailable o se ice use s, wi hou censo ship. 1.5.2 Se ice use s‟ p i acy in communica ions is espec ed. 3.3 30.0 13.3 33.3 83.3 36.7 - - 80 Table18. Theme 5. The igh o li e independen ly and be included in he communi y (s a ). S anda ds: C i e ia: AF % AP % NI % NA/ DN% S anda d 5.1: Se ice use s a e suppo ed in gaining access o a place o li e and ha e he inancial esou ces necessa y o li e in he communi y 5.1.1 S a in o m se ice use s abou op ions o housing and inancial esou ces. 5.1.2 S a suppo se ice use s in accessing and main aining sa e, a o dable, decen housing. 5.1.3 S a suppo se ice use s in accessing he inancial esou ces necessa y o li e in he communi y. 23.3 10.0 13.3 3.3 10.0 6.7 73.3 80.0 76.7 - - - S anda d 5.2: Se ice use s can access educa ion and employmen oppo uni ies 5.2.1 S a gi e se ice use s in o ma ion abou educa ion and employmen oppo uni ies in he communi y. 5.2.2 S a suppo se ice use s in accessing educa ion oppo uni ies, including p ima y, seconda y and pos - seconda y educa ion. 5.2.3 S a suppo se ice use s in ca ee de elopmen and in accessing paid employmen oppo uni ies. 20.0 6.7 6.7 3.3 6.7 13.3 76.7 86.7 80.0 - - - S anda d 5.3: The igh o se ice use s o pa icipa e in poli ical and public li e and o exe cise eedom o associa ion is suppo ed. 5.3.1 S a gi e se ice use s he in o ma ion necessa y o hem o pa icipa e ully in poli ical and public li e and o enjoy he bene i s o eedom o associa ion. 5.3.2 S a suppo se ice use s in exe cising hei igh o o e. 5.3.3 S a suppo se ice use s in joining and pa icipa ing in he ac i i ies o poli ical, eligious, social, disabili y and men al disabili y o ganiza ions and o he g oups. 16.7 6.7 16.7 6.7 6.7 13.3 76.7 86.7 70.0 - - - S anda d 5.4: Se ice use s a e suppo ed in aking pa in social, cul u al, eligious and leisu e ac i i ies 5.4.1 S a gi e se ice use s in o ma ion on he social, cul u al, eligious and leisu e ac i i y op ions a ailable. 5.4.2 S a suppo se ice use s in pa icipa ing in he social and leisu e ac i i ies o hei choice. 5.4.3 S a suppo se ice use s in pa icipa ing in he cul u al and eligious ac i i ies o hei choice 86.7 66.7 60.0 10.0 26.7 23.3 3.3 6.7 16.7 - - - 81 ANNEX IV Sosio-Demoq a ik Gös ə icilə Cins Yaş Ailə əziyyə Təhsil İş Maddi-sosial s a usu Diaqnoz: S asiona laşmala ın sayı: S asiona laşmanın müddə i: Vəzi əsi:(işçi) Iş s ajı(işçi) Qohumluğu(qohum): 1. Kişi 2. Qadın 1. Subay 2. E li 3. Boşanmış 4. Dul 1. Ib idai 2. O a 3. İx isaslaşmış o a 4. Ali 1. İşləyi 2. İşsiz 1. Yüksək 2. O a 3. Aşağı 1. Sch 2. Sch-a 3. BAP 4. Dep es 5. Şəxs poz 6. DKP 1.Həkim 2.Psixoloq 3.Tibb bacısı 4.Digə 1. Valideyn 2. Ö lad 3. Bacı/qa daş 4.H/yoldaşı 5. Digə 82 ANNEX V Üs Key iyyə Və Hüquqla in Qiymə ləndi ilməsi Cəd əli Psixi Sağlamliği Təmin Edən Sahələ də Key iyyə in Və İnsan Hüquqla inin Qiymə ləndi ilməsi. MÖVZU 1 Qənaə bəxş həya sə iyyəsi hüququ (Maddə 28, ƏHHK) S anda d 1.1 Müəssisə exniki cəhə dən sazdı . 1.Sizcə, müəssisənin(binanın) ümumi əziyyə i, əmi i s anda la a uyğundu mu? (məs.pəncə ələ qı ıq deyil, di a ın boyası/su ağı ökülmü ə s.) Tam Qismən Qə iyyən 2.Müəssisə iziki qüsu lu şəxslə in(əlillə in) is i adəsi üçün münasibdi mi? Tam Qismən Qə iyyən 3.Müəssisənin ilboyu işıqlandı ılması, qızdı ılması, ha alandı ılması o ada qalmaq üçün aha şə ai i əmin edi mi? Tam Qismən Qə iyyən 4.Sizcə, bu müəssisədəki insanla yanğın hadisələ inə qa şı nə də əcədə qo unu ? Lazımi əhlükəsizlik ədbi lə i gö ülü mü? (yanğınsöndü ən balonla , yanğın siqnalla ı, yanğın zamanı ya ılı xəs ələ in əxliyəsi ə s.) Tam Qismən Qə iyyən S anda d 1.2 İs i adəçilə in ya aq şə ai lə i aha dı ə məx ilik əmin olunu . 1.Ça payıla ın sayı o aqla da ki ayə qədə di mi? Hə bi xəs əyə ça acaq qədə ça payı a mı, ə ya o aqda ça payıla ın sayı həddindən çoxdu mu? Tam Qismən Qə iyyən 83 2.Kişilə , qadınla , uşaqla ə yaşlıla üçün ya aq o aqla ı ay ıdı mı? Bəli Xey 3.Siz yuxudan is ədiyiniz ax oyanıb, is ədiyiniz ax ya mağa ge məyə özünüz qə a e ə bili sinizmi? Bəli Bəzən Xey 4.Ya aq o aqla ında sizin məx iliyiniz qo unu mu? (Məsələn, pal a dəyişə kən başqala ı sizi na aha edi mi?) Qapını özünüz kilidləyə bili sinizmi? Tam Qismən Qə iyyən 5.Ya aq dəs lə i ki ayə sayda, aha ə is idi mi? Tam Qismən Qə iyyən 6.Sizin hə bi inizin öz şəxsi əşyala ınızı qoymaq üçün şəxsi şka la ınız/çəkməcələ iniz a mı? Onla ı aça la bağlaya bili sinizmi? Bəli Qismən Xey S anda 1.3 Müəssisə gigiyenik ə sani a cəhə dən ələba la a am uyğundu . 1.Sani a qo şaqla ı (hamam- uale ) nə də əcədə əmiz ə işlək əziyyə dədi ? (mün əzəm ola aq əmizləni mi, k anla , duşla işləyi mi, daimi is i suyu olu mu, ki ayə qədə uale kağızla ı olu mu ə s.) Tam Qismən Qə iyyən 2.Qadın ə kişilə üçün sani a qo şaqla ı ay ıdı mı? Məx ilik(özəllik) əmin olunu mu? Bəli Xey 3.Siz is ədiyiniz ax uale ə hamamdan is i adə edə bili sinizmi? (olu mu ki bəzən is i adənizə məhdudiyyə lə qoyulsun) Bəli Xey 84 4.Eh iyac olduqda, məsələn əlillə ə, ya aq xəs ələ inə uale ə ya hamamdan is i adə e mək üçün işçilə köməklik gös ə i lə mi? Kömək e diklə i zaman bunu necə edi lə , əsəbi olu la mı) Tam Qismən Qə iyyən S anda 1.4 İs i adəçilə in ə zaq, əmiz su ə geyimə olan ələba la ı am əmin olunu . 1.Sizə ki ayə qədə key iyyə li ə zaq ə su e ili mi? İs əmədiyiniz yeməklə dən im ina edə bili siniz, yoxsa məcbu yeyi siniz? Tam Qismən Qə iyyən 2.Mə bəx ə yeməkxana aha ə əmiz olu ? Yeməklə əmiz şə ai də hazı lanıb e ili ? Tam Qismən Qə iyyən 3.Öz is ədiyiniz geyimlə i geyinə bili siniz? Sizə əmiz geyimlə e ili ? ( ax lı- ax ında yuyulu la ?) Bəli Bəzən Xey 4.Əgə kiminsə pal a ı, geyimi yoxdu sa, onla a xəs əxanadan key iyyə li pal a la e ili mi? Tam Qismən Qə iyyən S anda 1.5 İs i adəçilə sə bəs şəkildə ünsiyyə qu a bili lə ə onla ın məx iliyinə hö mə lə yanaşılı . 1.Xəs əxanada ele on, mək ub, e-mail ə in e ne dən sə bəs şəkildə is i adə edə bili siniz? Tam Qismən Qə iyyən 2.Yaxınla ınızla ünsiyyə zamanı( ele onla, mək ubla ə s.) məx ilik əmin olunu mu? İşçilə ə ə indən danışıqla ınız dinlənili ə ya mək ubla ınız oxunu mu? Tam Qismən Qə iyyən 3.İs ədiyiniz dildə sə bəs danışmağa icazə e ili ? 85 Tam Qismən Qə iyən 4.İs ədiyiniz şəxslə is ədiyiniz zaman gö üşə bili siniz? Bununla bağlı sizə məhdudiyyə lə qoyulu mu? Bəli Bəzən Xey 5.Müəsisənin içində ə ə a ında is ədiyiniz kimi sə bəs gəzə bili siniz? Tam Qismən Qə iyyən S anda 1.6 Müəssisə ak i iş i ake mə ə qa şılıqlı əlaqələ in ya anması üçün qonaqpə ə , aha ə hə əsləndi ici mühi i əmin edi . 1.Pasiyen lə üçün ki ayə qədə yaxşı əziyyə də olan mebellə (o u acaqla , s olla ə s.) a mı? Tam Qismən Qə iyyən 2.Binanın qu uluşu, dizaynı, xüsusilə hə kəsin o aq is i adə e diyi zalla digə pasiyen lə lə, işçilə lə, gələn qonaqla la qa şılıqlı əlaqələ qu mağa am imkan e i mi? Tam Qismən Qə iyyən 3.Boş ax la ınızı keçi mək üçün sizə müs əli asi ələ dən – qəze , ju nal, ki ab, musiqi, kompü e , TV ə s. is i adə e məyə şə ai ya adılı ? Tam Qismən Qə iyyən 4.Boş ax la ınızı keçi mək üçün xüsusi o aqla a mı? (TV zalı, oxu zalı ə s.) Bəli Xey S anda 1.7 İs i adəçilə sosial ə şəxsi həya dan amamən zö q ala bili ə icma həya ı ə məşğuliyyə lə ində iş i akına da am edi . 1.Digə qadın ə kişi pasiyen lə lə sə bəs ünsiyyə qu mağınıza icazə e ili mi? Hə hansı qadağala qoyulu mu? 86 Bəli Bəzən Xey 2.Sizin üçün xüsusi olan günlə də – yaxınla ınızın oy ə ya yas mə asimlə ində – iş i ak üçün ge məyinizə xəs əxanadan icazə e ili mi? Bəli Bəzən Xey 3.Müəyyən ax la da bu ada sizin üçün hə hansı əaliyyə lə əşkil olunu mu? Əgə olunu sa, iş i ak edib-e məməyi seçmə hüququnuz olu mu? Bəli Bəzən Xey 4.Xəs əxanadan kəna da, cəmiyyə də hə hansı əaliyyə lə də iş i ak edə bili siniz? Bu əaliyyə lə haqqında sizə işçilə məluma e i mi? Bəli Bəzən Xey 5.İşçilə xəs əxanadan xa ic əyləncələ də iş i ak e məyiniz üçün icazə e i lə mi, ə ya əyləncələ in xəs əxanada əşkil olunmasına şə ai ya adı la mı? Bəli Bəzən Xey MÖVZU 2 Fiziki ə psixi sağlamlığın ən yüksək əlça an sə iyyəsindən is i adə hüququ (Maddə 25, ƏHHK) S anda 2.1 Eh iyacı olan hə bi kəs müəssisədə lazımi müalicə ə dəs əkdən is i adə edə bilə . 1.Olu mu ki, maddi imkanı olmadığı üçün, başqa milliyyə dən, dindən olduğu üçün, ə ya siyasi baxışla ına gö ə insanla ın xəs əxanaya qəbulu ə müalicəsindən im ina edili ? Xey Bəli 2.Eh iyacı olan şəxs bu ada müalicə ala bilmədikdə, başqa xəs əxanala a, ya dım mə kəzlə inə 87 yönləndi ili mi? Bəli Xey 3.Sizcə xəs əxanada müalicə alıb s abilləşdiyi üçün e ə yazılmalı olan xəs ələ in bu ada başqa səbəblə dən xəs əxanada saxlanılmağı da am edili mi? Nəyə gö ə (i q, cins, din, siyasi səbəblə , yoxsulluq, ailə is əmədiyi üçün ə s.) Xey Bəli S anda 2.2 Müəssisədə am baca ıqlı işçilə əaliyyə gös ə i ə əhalini key iyyə li psixi sağlamlıq xidmə lə i ilə əmin edi . 1.Sizcə, işçilə in pasiyen lə ə am hə ə ə li ya dım gös ə mək üçün ki ayə qədə lazımi baca ıqla ı a mi? Hansı nö işçilə a bu ada, saya bilə sinizmi? Tam Qismən Qə iyyən 2.İşçilə sizin sə bəs yaşamağınıza dəs ək üçün müx əli icma xidmə lə i/poliklinikala ə digə ya dım mə kəzlə i ( məşğulluq, e lə əmin e mə, əhsil, sosial əmina ) ə s. haqda sizə nə də əcədə məluma la e i lə ? Tam Qismən Qə iyyən 3.İşçilə lə (həkim, psixoloq, sosial işçi, ibb bacısı ə s.) konsul asiya üçün is ədiyiniz ax gö üşə bili siniz? Bəli Bəzən Xey 4.Bu ada sizə də manla ı kim əyin edi , dəyişdi i ? Sizcə onun buna lisenziyası/səlahiyyə i a mı? Bəli Xey 5.Sizcə, işçilə insan hüquqla ını, pasiyen lə in hüquqla ını am bili lə ? Tam Qismən Qə iyyəm 6.Pasiyen lə aldığı xidmə lə lə bağlı, onla ın daha da inkişa e di ilməsi üçün öz iki lə ini, şikayə lə ini bildi ə bili lə ? 88 Bəli Bəzən Xey S anda 2.3 Müalicə psixososial eabili asiya ə dəs ək şəbəkələ i ə digə xidmə lə lə əlaqələ is i adəçi okuslu bə pa planının bi hissəsidi ə is i adəçilə in cəmiyyə də/icmada müs əqil yaşamağına kömək edi . 1.Hə bi pasiyen in özünəuyğun, onun məqsədlə inə yönəlmiş bə pa planı a mı? Bu plana nələ daxildi ? (iş, əhsil, sosial həya , ibbi aspek lə ə s.) Tam Qismən Qə iyyəm 2.Bə pa planla ı Sizin öz müalicə seçimlə inizi əks e di i mi, mün əzəm ola aq yenidən gözdən keçi ili mi? Tam Qismən Qə iyyəm 3.Hə hansı bi xoşagəlməz hadisə zamanı ( psixoz, xəs ə özü qə a e mək iq ida ında olmadıqda) pasiyen lə in müalicə ak ikala ı işçilə ə ə indən onla ın is əklə i nəzə ə alınmadan məcbu i ola aq həya a keçi ili ? Qə iyyən Qismən Tam 4.Müəssisədə psixososial eabili asiya, həya i baca ıqla ə özünəqulluq p oq amla ı a mı? Onla dan səmə əli is i adə olunu mu? Tam Qismən Qə iyyən 5.İşçilə sizi, ailənizlə ə digə sizə dəs ək olan insanla la əlaqələ inizin da am e məsi üçün hə əsləndi i lə mi/bu cəhə dən sizə kömək gös ə i lə mi? Tam Qismən Qə iyyəm 6.İşçilə sizin digə xəs əxanala la, sağlamlıq mə kəzlə i ilə ə sosial xidmə lə lə əlaqələ qu mağınıza komək edi lə mi? Tam Qismən Qə iyyən 89 S anda 2.4 Psixo op də manla mö cuddu , ucuzdu ə mü a iq is i adə olunu . 1.Müəssisədə lazım olan bü ün də man asi ələ i a mı? Tam Qismən Qə iyyən 2.Də manla ın sayı hə kəsə da amlı ola aq ça mağa ki ayə edi mi? Olu ki, hə hansı bi də man asi əsinə eh iyac olduğu halda o də man xəs əxanada olmasın? Tam Qismən Qə iyyən 3.Də manla hə kəsə öz diaqnozla ına, ə ya əziyyə lə inə uyğun ola aq e ili ? Heç ele bi hal eşi misinizmi ki, kiməsə səh də man e ilsin? Tam Qismən Qə iyyən 4.Sizə qəbul e diyiniz də manla ə onla ın əla ə əsi lə i haqqında məluma e ili mi? Tam Qismən Qə iyyən 5.Sizə mümkün ola biləcək başqa müalicə nö lə i haqqında, məsələn psixo e apiya, məluma e ilibmi? Bəli Xey S anda 2.5 Ümumi ə ep oduk i sağlamlıq üçün mü a iq xidmə lə mö cuddu . 1.Xəs əxanada qəbul zamanı ümumi iziki müayinədən(diş daxil olmaqla) keçmisiniz? Digə xəs əliklə in olub-olmadığı yoxlanılıbmı? Tam Qismən Qə iyyəm 2.Eh iyac ya andıqda, xəs ələ in digə soma ik xəs əliklə i müalicə olunu mu? Müalicə bu ada apa ılı , yoxsa başqa xəs əxanala a yönləndi ili lə ? Tam Qismən Qə iyyəm 3.Cə ahi əməliyya la , ə ya hə hansı digə ibbi p osedu la a eh iyac ya andıqda, xəs ələ mü a iq xidmə lə lə əmin olunu la ? (Bu ada, ə ya başqa müəssisədə) 96 Xey Bəli 5.Pasiyen lə ə bu ada hə hansı cə ahi əməliyyə edildiyini eşi misiniz? Bu ada psixocə ahiyyə (beynində, başda) əməliyya la apa ılı mı? Və ya hə hansı ge iyədönməz əsi lə i olan müalicələ apa ılı mı? Əgə hə, pasiyen lə ə bu p osedu la haqqında məluma e ilib, azılıq alını mı? Bəli( azılıq alını ) Xey ( azılıq alınmı ) 6.Bu ə ya başqa xəs əxanada pasiyen lə ə azılıqla ı olmadan abo ə ya s e ilizasiya edilibmi? Xey Bəli S anda 4.4 Heç bi İs i adəçi özünün məluma lı azılığı olmadan ibbi ə ya elmi əc übəyə mə uz qala bilməz. 1.Heç olubmu ki, bu ada pasiyen lə hansısa yeni elmi ə ya ibbi ekspe imen də (məsələn, yeni bi də man ekspe imen ində) öz azılığı olmadan iş i ak e sin? Xey Bəli 2.Pasiyen lə in elmi əc übələ də iş ak e məsinə gö ə işçilə ə müka a e ili mi? Xey Bəli 3.Heç olubmu ki, belə bi ekspe imen pasiyen üçün zə ə li ə əhlükəli olub? Təhlükəli olduğu halda da am e di ilibmi? Xey Bəli 4.Tibbi ə ya elmi əc übə üçün azılıq p osedu la ı hansıla dı ? Müs əqil e ik komi ə ə ə indən bu əc übələ ə icazə alını mı? Bəli Bəzən Xey S anda 4.5 İşgəncədən, qədda , qey i-insani ləyaqə alçaldan ə digə xoş olmayan ə a la dan qo unmaq üçün lazımi ədbi lə gö ülü . 1.Sizə aydın ə anlaşılan şəkildə şikayə p osedu la ı ( azılığınız olmadan müalicə, sizə qa şı olan 97 zo akılıqla , əhqi lə ) ba əsində məluma e ilibmi? Şikayə lə inizi kimə, ha a, necə bildi ə bilə siniz? Bəli Qismən Xey 2.Olu mu ki, kimsə şikayə e diyi üçün cəzalandı ılsın? Pasiyen lə qo xudulduqla ı üçün şikayə e mədiyi halla olu mu? Xey Bəzən Bəli 3.Öz qanuni nümayəndəniz ilə əklikdə gö üşmək imkanınız a mı? Onunla şikayə lə iniz haqqında danışa bili siniz? Bəli Bəzən Xey 4.İs ənilən ax Öz hüquqla ınızı qo umaq üçün hansısa ə di ə ya əşkila la la (əlillə i cəmiyyə i,insan hüquqla ını qo uyan cəmiyyə lə , əkillə ) gö üşüb dəs ək ala bili siniz? Bu ə d ə əşkila la la gö üşmək imkanınız a mı? Bəli Bəzən Xey 5.Bili sinizmi ki, kobud ə a ə əhqi lə ə gö ə həmin şəxslə məsuliyyə ə cəlb oluna bilə lə ? Xəs əxanada elə bi hadisə ilə(məsuliyyə ə cəlb olunma) as laşmısınızmı? Bəli Xey 6.Xəs əxana mü əmadi ola aq belə halla ın (kobud ə a , əhqi ə s.) aşka lanması ə qa şısının alınması üçün əhbə lik ə ya başqa o qanla ə ə indən yoxlanılı mı? Bəli Xey MÖVZU 5 Müs əqil həya ə zi ə ye li icmaya cəlb olunma hüququ (Maddə 19, ƏHHK) S anda 5.1 İs i adəçilə ə e lə əmin olunmaq ə yaşamaq üçün lazımi maddi əsai lə in əldə edilməsi üçün dəs ək e ili . 1.,İşçilə Sizə xəs əxanadan çıxdıqdan son a eh iyac ola sa, e lə ə ya maddi ya dımla necə əmin 98 olunmaq haqqında məluma la e i mi? Belə bi xidmələ in olması haqqında məluma ınız a mı? Bəli Qismən Xey 2.İşçilə Sizə qalmaq üçün ye apmaqda köməklik gös ə i lə mi? Bəli Qismən Xey 3.İşçilə Sizə maddi ya dımla əmin olunmağa köməklik gös ə i lə mi? Bəli Qismən Xey S anda 5.2 İs i adəçilə əhsil ə iş ü sə lə i əldə edə bili lə . 1.Sizə cəmiyyə də əhsil almaq, ka iye a qu maq ə iş ü sə lə i əldə e mək haqqında məluma la e ili mi? Bu ü sə lə i necə əldə e mək ə ya dəyə ləndi mək haqqında məluma ınız a ? Bəli Qismən Xey 2.Sizə, ə ya sizin uşaqla ınıza mək əb ə ya uni e si e lə də əhsil almaq üçün köməklik gös ə ili mi? Bəli Qismən Xey 3.İşlə əmin olunmağınıza köməklik gös ə ili mi? Bəli Qismən Xey S anda 5.3 İs i adəçilə in siyasi ə ic imai həya da iş i ake mə hüququ ə öz üs ünlük e diyi bi liklə ə( ica ə bi liklə i, siyasi pa iyala ə s.) sə bəs daxil ə xa icolma hüquqla ı dəs əkləni . 1.Siyasə də necə iş i ak edə biləcəyiniz haqda sizə məluma e ili mi?Məsələn, səs e mə hüququnuz, psixi sağlamlıqla bağlı qə a la ın e ilməsində iş i ake mə hüququnuz ə s.? Bəli Qismən Xey 2.Səs e mə zamanı iş i ak e məklə bağlı sizə kömək gös ə ili mi? Necə? Bəli Qismən Xey 99 3.Sizə Psixi pozun udan əziyyə çəkən insanla bi liklə i/ əşkila la ı, Əlillə Cəmiyyə i, ə ya hə hansı bi digə siyasi, dini ə ya sosial əşkila la da ak i iş i ak e məyiniz üçün ya dım edili mi? Bəli Qismən Xey S anda 5.4 İs i adəçilə in sosial, mədəni, dini ə asudə əaliyyə lə də iş i akı dəs əkləni . 1.İşçilə sizə boş ax la ınızda məşğul ola biləcəyiniz əaliyyə ə haqqında, ə ya sosial, mədəni, dini ədbi lə haqqında məluma la e i ? Bəli Qismən Xey 2.Sosial əaliyyə lə , ədbi lə də iş i ak e mək üçün sizə hansı ya dımla edili ? Məsələn, anspo ə ya bile əşkil edili mi? Bəli Qismən Xey 3.Mədəni ə ya dini əaliyyə lə də, ədbi lə də iş i ak e mək üçün sizə hansı ya dımla gös ə ili ? Bəli Qismən Xey 100 ANNEX VI Həya Key iyyə i Şkalasi 1. İş gö mək üçün ene jinizin ça madığı anla olu mu? heç ax nadi halla da bəzən  ez – ez həmişə 2. İş gö məyə özünüzü məcbu edə bilmədiyiniz halla la üzləşmisinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 3. Gələcəyiniz üçün na aha olu sunuzmu? heç ax nadi halla da bəzən  ez – ez həmişə 4. Tənhalıq hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 5. Ümidsizlik hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 6. Təş iş, həyəcan hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 7. Gündəlik işlə inizi edə bili sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 8. İnsanla ın sözlə ini yalnış anladığınız halla olu mu? heç ax nadi halla da bəzən  ez – ez həmişə 9. Fik inizi cəmləmə p oblemi ilə qa şılaşı sınızmı? heç ax nadi halla da bəzən  ez – ez həmişə 10. İnsanla la münasibə qu mağa çə inlik çəki sinizmi? 101 heç ax nadi halla da bəzən  ez – ez həmişə 11. Sıxın ı ə uh düşkünlüyü hiss e diyiniz anla olu mu? heç ax nadi halla da bəzən  ez – ez həmişə 12. “Mən baca a bilə əm” hissi sizə nə də əcə yaxındı ? heç ax nadi halla da bəzən  ez – ez həmişə 13. Çox qa ışıqlıq ə əminsizlik hiss e diyiniz halla la qa şılaşmısınızmı? heç ax nadi halla da bəzən  ez – ez həmişə 14. Yuxu ilə bağlı na aha lığınız olu mu? heç ax nadi halla da bəzən  ez – ez həmişə 15. Əh al dəyişkənliyi ( gah yüksək, gah da enmiş) sizə nə də əcə yaxın bi hissdi ? heç ax nadi halla da bəzən  ez – ez həmişə 16. “Daha yaxşı ola bilməyəcəm” düşüncəsi sizi na aha edi mi? heç ax nadi halla da bəzən  ez – ez həmişə 17. “Nələ sə” haqqında na aha olu sunuzmu? heç ax nadi halla da bəzən  ez – ez həmişə 18. Sizə elə gəli mi ki, insanla dan sizdən çəkini ə uzaq du mağa çalışı ? heç ax nadi halla da bəzən  ez – ez həmişə 19. Keçmiş haqqında düşündükdə məyusluq hissi keçi i sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 20. Əşyala ı xa ı lamağa çə inlik çəki sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 102 21. Dünyadan əc id olunduğunuzu hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 22. İnsanla ın yanında özünüzü na aha hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 23. Aydın düşünməkdə çə inlik çəki sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 24. Sizi məyus edən düşüncələ iniz olu mu? heç ax nadi halla da bəzən  ez – ez həmişə 25. Özünə zə ə e mə haqqında iki lə iniz a mı? heç ax nadi halla da bəzən  ez – ez həmişə 26. Özünüzü xoşbəx hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 27. Əh al- uhiyyəniz aşağı olu mu? heç ax nadi halla da bəzən  ez – ez həmişə 28. Gün ə zində özünüzü yuxulu hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 29. Özünüzü na aha hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 30. Sosial həya ınızla bağlı na aha olu sunuzmu? heç ax nadi halla da bəzən  ez – ez həmişə 31. Yo ğun hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 103 32. Fiziki ola aq özünüzü gücsüz hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 33. No mal həya yaşamadığınızı hiss edi sinizmi? heç ax nadi halla da bəzən  ez – ez həmişə 104 ANNEX VII İs i adəçi Məmnunluğu So ğusu Zəhmə olmazsa, aldığınız xidmə lə haqqında bəzi sualla a ca ab e əsiniz. Bununla siz gös ə diyimiz xidmə lə in daha da yaxşılaşdı ılmasına kömək edəcəksiniz. Bizim üçün müsbə ə ya mən i olmasından asılı olmaya aq sizin həqiqi iki lə iniz acibdi . Sizdən bü ün sualla a ca ab e məyinizi xahiş edi ik. Həmçinin siz öz i ad ə əkli lə inizi də qeyd edə bilə siniz. Biz sizin ya dımınızı yüksək dəyə ləndi i ik. Təşəkkü lə . Aldığınız xidmə lə in key iyyə ini necə qiymə ləndi i siniz? 1 2 3 4 Pis O a Yaxşı Mükəmməl İs ədiyiniz nö ya dımı aldınızmı? 1 2 3 4 Xey , qə iyyən Xey , am yox Bəli, ümumən Bəli, amamilə Bizim xidmə lə sizin eh iyacla ınızı nə qədə qa şılayı ? 1 2 3 4 Heç bi Yalnız az bi Əksə hissəsini Demək ola ki hamısını hissəsini hissəsini Əgə yaxınınız bənzə köməyə eh iyac duya sa, bizim xidmə lə i ona məsləhə gö ə dinizmi? 1 2 3 4 Xey , heç bi Xey , böyük Bəli, böyük Bəli, amamilə eh imalla eh imalla eh imalla Aldığınız xidmə lə in həcmindən məmnunsunuzmu? 1 2 3 4 105 Xey , qə iyyən Çox az Demək ola ki Tamamilə məmnunam məmnun deyiləm məmnunam məmnunam Aldığınız xidmə lə sizə p oblemlə inizi daha yaxşı həll e məyə kömək e dimi? 1 2 3 4 Xey , daha da Xey , heç bi Bəli, demək ola ki Bəli, amamilə pisləşdi di kömək e mədi kömək e di kömək e di Ümumilikdə, aldığınız xidmə lə dən nə də əcədə məmnunsunuz? 1 2 3 4 Qə iyyən məmnun Çox az ə ya Demək ola ki Tamamilə deyiləm ə q e mi məmnunam məmnunam Əgə yenidən ya dıma eh iyacınız olsa, yenidən bizim xidmə lə dən is i adə edə dinizmi? 1 2 3 4 Xey , heç bi Xey , böyük Bəli, böyük Bəli, amamilə eh imalla eh imalla eh imalla So ğuda iş i ak e diyiniz üçün əşəkkü edi ik! 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