Open Access Study protocol

Study protocol for the development of a European measure of best practice for people with long term mental health problems in institutional care (DEMoBinc)

Helen Killaspy1*, Michael King1, Christine Wright2, Sarah White2, Paul McCrone3, Thomas Kallert4, Jorge Cervilla5, Jiri Raboch6, Georgi Onchev7, Roberto Mezzina8, Durk Wiersma9, Andrzej Kiejna10, Dimitris Ploumpidis11 and José Miguel Caldas de Almeida12

Author Affiliations

1 Department of Mental Health Sciences, University College London, 2nd Floor, Royal Free Hospital, London, NW3 2PF, UK

2 Department of Mental Health, St George's University London, Cranmer Terrace, London, SW17 0RE, UK

3 King's College London, Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, London, SE5

4 Department of Psychiatry and Psychotherapy, University Hospital, Technische Universitaet Dresden, Fetscherstrasse 74, 01307 Dresden, Germany

5 Department of Psychiatry, University of Granada, Cuesta del Hospicio s/n, Granada, 18071, Spain

6 Psychiatric Department of the 1st Faculty of Medicine, Charles University, Ovocný trh 5, Praha 1, 116 36, Czech Republic

7 Department of Psychiatry, Medical University Sofia, St. Georgi Sofiisky str. 1, Sofia 1431, Bulgaria

8 Dipartimento di Salute Mentale, Via Sai, 1-3, Trieste, 34127, Italy

9 University Medical Centre, Hanzeplein 1, Groningen, 9700 RB, Netherlands

10 Department of Psychiatry, Wroclaw Medical University, Pasteura 1, Wroclaw, 50-367, Poland

11 University Mental Health Research Institute, Soranou Tou Efessiou 2, Athens 11527, Greece

12 Caldas de Almeida, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056 Lisbon, Portugal

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BMC Psychiatry 2009, 9:36  doi:10.1186/1471-244X-9-36

Published: 13 June 2009



This study aims to build a measure for assessing and reviewing the living conditions, care and human rights of people with longer term mental health problems in psychiatric and social care institutions. Protection of their human rights is imperative since impaired mental capacity secondary to mental illness can make them vulnerable to abuse and exploitation from others. They also constitute a major resource pressure for mental health services, social services, informal carers and society as a whole.


This study uses an iterative methodology to develop a toolkit to assess internationally agreed domains of care that are considered most important for recovery. These domains are identified by collating results from: i) a systematic review of the literature on institutional care for this service user group; ii) a review of the relevant care standards in each participating country; iii) Delphi exercises in partner countries with mental health professionals, service users, carers and advocates. Common domains and cross-cutting themes are agreed by the principal researchers and an international expert panel. Items are developed to assess these domains and incorporated into the toolkit which is designed to be administered through a face to face interview with the institution's manager. The toolkit is refined in response to inter-rater reliability testing, feedback from interviewers and interviewees regarding its utility, and feedback from key stakeholders in each country about its ability to deliver information that can be used within each country's established systems for quality assessment and review. Cross-validation of the toolkit ratings against service users' quality of life, autonomy and markers of recovery tests whether it can deliver a proxy-measure of the service users' experiences of care and the institution's promotion of their human rights and recovery. The ability of the toolkit to assess the "value for money" delivered by institutions is investigated by comparing toolkit ratings and service costs.


The study will deliver the first international tool for the assessment of the quality of institutional care for people with longer term mental health problems that is accurate, reliable, informative, useful and easy to use.