{
  "abstract": "Introduction People with mental health conditions and psychosocial disabilities frequently experience human rights violations. This study assessed the efficacy of the WHO QualityRights e-training in promoting their rights within the mental healthcare system.Methods In this cluster-randomised trial in three psychiatric hospitals in Ghana, we randomly selected units within each hospital and randomised them 1:1 to the intervention (WHO QualityRights e-training) or control arm (COVID-19 e-training). The intervention included presentations, videos, interactive exercises and forum discussions. Mental health professionals in these facilities were eligible participants. Primary outcomes were changes in knowledge about the rights of persons with mental health conditions and in the attitudes towards them, measured post-intervention using the WHO QualityRights Knowledge and Attitudes questionnaires. Secondary outcomes included changes at 3 and 6 months in knowledge, attitudes and mental health professionals’ practices related to substitute decision-making and coercion. Data analysts were masked to group assignment.Results Between 11 August 2021 and 13 April 2022, 28 clusters (14 per arm) were randomised and 252 participants enrolled (126 per arm); 179 (71%) were women. 206 (81.8%) completed the post-training follow-up. The intervention group showed significantly greater improvements in scores on the WHO QualityRights Knowledge (mean difference: 4.61 [95% CI 3.49 to 5.72], d=1.12) and Attitudes (−7.99 [95% CI −10.32 to −5.66], d=0.92) compared with the control group, with similarly significant results at 3 and 6 months. Additionally, intervention participants reported less frequent use of substitute decision-making and restraint (−2.60 [95% CI −4.05 to −1.16], d=0.52 at 3 months; −1.76 [95% CI −3.11 to −0.40], d=0.36 at 6 months).Conclusion This study showed that the WHO QualityRights e-training effectively improves mental health professionals’ knowledge and attitudes and can lead to reduction in providers’ use of substitute decision-making and coercion practices, thus suggesting a need for improved investment in rights-based interventions and further research.Trial registration number NCT04728243.",
  "authors": [
    {
      "affiliations": [
        "World Health Organization, Geneva, Switzerland",
        "Columbia University Mailman School of Public Health, New York, New York, USA"
      ],
      "name": "Maria Francesca Moro"
    },
    {
      "affiliations": [
        "WHO Country Office for Ghana, Accra, Ghana"
      ],
      "name": "Leveana Gyimah"
    },
    {
      "affiliations": [
        "Columbia University Mailman School of Public Health, New York, New York, USA",
        "New York State Psychiatric Institute, New York, New York, USA"
      ],
      "name": "Ezra Susser"
    },
    {
      "affiliations": [
        "WHO Country Office for Ghana, Accra, Ghana"
      ],
      "name": "Joana Ansong"
    },
    {
      "affiliations": [
        "Columbia University Mailman School of Public Health, New York, New York, USA"
      ],
      "name": "Jeremy C Kane"
    },
    {
      "affiliations": [
        "Mental Health Authority, Ghana Ministry of Health, Accra, Ghana"
      ],
      "name": "Akwasi Osei"
    },
    {
      "affiliations": [
        "WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria"
      ],
      "name": "Oye Gureje"
    },
    {
      "affiliations": [
        "Mental Health Society of Ghana, Accra, Ghana"
      ],
      "name": "Humphrey Kofie"
    },
    {
      "affiliations": [
        "MindFreedom Ghana, Accra, Ghana"
      ],
      "name": "Dan Taylor"
    },
    {
      "affiliations": [
        "World Health Organization, Geneva, Switzerland"
      ],
      "name": "Natalie Drew"
    },
    {
      "affiliations": [
        "WHO Country Office for Ghana, Accra, Ghana"
      ],
      "name": "Sally-Ann Ohene"
    },
    {
      "affiliations": [
        "Mental Health Society of Ghana, Accra, Ghana"
      ],
      "name": "Abdul Fatawu"
    },
    {
      "affiliations": [
        "MindFreedom Ghana, Accra, Ghana"
      ],
      "name": "Nii Lartey Addico"
    },
    {
      "affiliations": [
        "University of Cagliari, Cagliari, Italy"
      ],
      "name": "Michela Atzeni"
    },
    {
      "affiliations": [
        "University of Cagliari, Cagliari, Italy"
      ],
      "name": "Silvia D’Oca"
    },
    {
      "affiliations": [
        "World Health Organization, Geneva, Switzerland"
      ],
      "name": "Michelle Funk"
    },
    {
      "affiliations": [
        "University of Cagliari, Cagliari, Italy"
      ],
      "name": "Mauro Giovanni Carta"
    }
  ],
  "title": "Evaluating the efficacy of the WHO QualityRights e-training in promoting the rights of persons with mental health conditions and psychosocial disabilities: a cluster randomised controlled trial in Ghana",
  "uid": "e9c2a941-ff60-558b-a6f8-8b4136ac0239"
}