Clinical Practice & Epidemiology in Mental Health

ISSN: ― Volume ,

Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital

Mauro Giovanni Carta1, *, Rym Ghacem2, Myriam Milka2, Olfa Moula2, Nidhal Staali2, Uta Uali2, Ghassene Bouakhari2, Monica Mannu1, Rym Refrafi3, Souha Yaakoubi3, Maria Francesca Moro4, Marie Baudel5, Simon Vasseur-Bacle6, Natalie Drew5, Michelle Funk5
1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
2 Razi Hospital, Tunis, Tunisia
3 Mental Health Departement ,University Hospital Mongi Slim, Tunis, Tunisia
4 Mailman School of Public Health, Columbia University, New York, NY, USA
5 Department of Public Health, WHO, Geneva, Switzerland
6 WHO Collaborating Centre for Mental Health Lille, Lille, France



The aims were: 1) to measure the attitudes of learners (and future trainers) before and after a course on WHO-Quality Rights (QR); 2) to evaluate a psychiatric ward, by previously trained staff on QR, comparing it with a previous evaluation and discussing an improvement plan.


1) Training sample: 19 subjects (8 males), 41.4±10.6 years, including jurists/lawyers, health professionals, and experts.

The QR team developed the 26-item tool to assess the knowledge and attitudes of participants.

2) Evaluation of quality of care and respect for human rights in the ward was carried out on 20 staff representatives, 20 family members and 20 users with QRToolkit.


1) Learning in QR has partially changed the knowledge and attitudes of trained people.

2) The evaluation shows significant delays in the implementation of the rights advocated by the United Nations Convention on the Human Rights of Persons with Disabilities (CRPD). In Themes 1, 3, 4 and 5, the evaluation shows no differences compared to 2014, but in Theme 2, the level was lower than four years before.


The scarcity of resources due to the economic crisis that Tunisia is going through, cannot be considered the only cause of the delays highlighted. However, it is likely that in a context of uncertainty for the future, scarcity of resources and a decrease in staff (i.e., professionals dedicated to psychosocial intervention) may have demotivated the team towards recovery. The improvement in knowledge and attitudes of many staff members after the training may open future positive scenarios.

Keywords: WHO Quality rights project, Human rights, Mental health, Psychosocial intervention, Disabilities, Degrading treatment.

Article Information

Identifiers and Pagination:

Year: 2020
Volume: 16
First Page: 125
Last Page: 133
Publisher Id: CPEMH-16-125
DOI: 10.2174/1745017902016010125

Article History:

Received Date: 23/02/2020
Revision Received Date: 04/04/2020
Acceptance Date: 04/04/2020
Electronic publication date: 30/07/2020
Collection year: 2020

© 2020 Carta et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Tel: +39 070609349; Fax: +39 0706093498; E-mails:,

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