Grigaitė Ugnė, Levickaitė Karilė, Juodkaitė Dovilė, Goštautaitė-Midttun Nijolė
Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre/NOVA Medical School, National School of Public Health, NOVA University of Lisbon, Rua do Instituto Bacteriológico 5, Edifício Amarelo, Lisbon 1150-190, Portugal.
NGO Mental Health Perspectives, Vasaros g. 3, Vilnius LT-10309, Lithuania.
Int J Qual Health Care. 2025 Jan 13;37(1). doi: 10.1093/intqhc/mzae118.
Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization's QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania's attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services.
立陶宛于2010年批准了《联合国残疾人权利公约》（UNCRPD），并于2014年开始去机构化改革。这项改革涵盖了为有心理健康问题、心理社会和/或智力残疾的人提供服务的隔离式社会护理机构。其目的是摆脱机构护理，转向基于社区的服务。精神卫生保健服务也是这一复杂情况的一部分，自2022年以来一直在进行自身的改革。本研究旨在评估立陶宛精神病院和社会护理机构在去机构化背景下的人权状况和护理标准。数据收集评估在精神病医院、综合医院的精神科病房、隔离式社会护理院以及基于社区的集体生活之家进行。独立专家通过文件审查、观察以及与服务使用者和工作人员的半结构化访谈收集数据。该研究遵循了世界卫生组织的“质量权利工具包”方法。在所有评估的设施中，无论其类型如何，服务使用者的人权经常受到侵犯，特别是行使法律行为能力的权利、人身自由和安全的权利、免受隔离和约束的权利以及独立生活和融入社区的权利。该研究揭示了《联合国残疾人权利公约》实施过程中的缺陷以及立陶宛在去机构化方面的努力存在的问题。它指出了关键的实际差距和领域，包括社会和精神卫生保健系统之间急需更好的协作。立陶宛政府需要解决这些问题，以使改革更有效，保障人权，并确保精神卫生和社会护理服务的质量。
