The government is accepting comments on this draft until November 14, 2013– information on the commenting process can be found HERE
Essential Requirements for Mental Health Social Welfare Institutions
(Draft for solicitation of comments)
Released by the People's Republic of China's Ministry of Civil Affairs
These standards are drafted in accordance with the rules provided by GB/t 1.1-2009.
These standards are proposed and controlled by the National Social Welfare Standardization Technical Committee.
The work-units drafting these standards:The ministry of civil affairs department for promoting social welfare and charity , Chongqing municipal psychiatric hospital, Shanghai Municipal Civil Administration's Second Mental Hygiene Center, Sichuan Province's Chengdu Municipal Psychiatric Hospital, Sichuan Province's Leshan Municipal Psychiatric Hospital, Guangdong Province's Municipal Civil Administration Psychiatric Hospital, Beijing Municipal No. 2 Social Welfare Institute
The principle drafters of these standards: Deng Mingguo, Hu Minhao, Li Chenglin, Deng Xiaofang, Zhang Hongwei, Guo Liyun
Essential Requirements for Mental Health Social Welfare Institutions
These standards regulate the services, facilities, operations management, evaluation and betterment of the nation's mental health social welfare organizations.
These standards apply to the set up and management of the nation's mental health social welfare organizations.
Service areas established for persons with mental disorders by other social welfare organizations may reference these norms.
2. Normative references
The following documents are essential to the application of these standards. For all references that indicate a date, only the version from the date indicated applies to this document. For all references without a date indicated, the newest version (including any amendments) applies to this document.
GB/T10001.1-2006 marking with public information symbols - Part 1: Universal symbols
GB2894-2008 Guidelines for safety signs and their use
GB/t 24421.2 Guide to standardization of work by service organizations, Part 2: standardization system
MZ009-2001 "Basic Norms of Social Welfare Organizations for Persons with Disabilities."
3. Terms and Definitions
3.1 Mental Health Social Welfare Organization
Social welfare organizations funded by the government and social forces, managing and accepting for treatment persons with mental disorders such as those 'with the three absences' or the poor.
3.2 Mental Disorders
Indicates a disturbance or abnormality in perception, emotion, cognition or other mental activity, brought on by any cause, that results in obvious mental suffering or a deficit in abilities such as social adjustment.
3.3 Persons with mental orders that have the "three absences"
Persons with serious mental illnesses in cities or towns who have no ability to work, no way to support themselves, and no person legally designated as having the duty to raise, support or maintain them, or where their designated person has no ability to raise, support or maintain them.
4. Organizational structures
4.1 Organizational functions, tasks and orientation
4.1.1 Organizations' functions, missions and orientation are clear, and appropriate to their size
4.1.2 Adhere to the organizations' social welfare and social assistance attributes, to truly protect the lawful rights and interests of those with mental disorders.
4.1.3 Organizations have the ability to take on the treatment, care, rehabilitation and long term care of mentally ill persons with their service area including those with the 'three absences' , the five rural guarantees, the minimum guarantee, or the impoverished,
4.1.4 Are able to undertake social public interest service projects as entrusts by the civil affairs departments.
4.2 Organization Certificates and Names
4.2.1 A certificate of incorporation and a [Certificate of Authorization to Setup a Social Welfare Organization] are provided and hung in a conspicuous location.
4.2.2 Organizations launching services to diagnose and treat persons with mental disorders should provide a [Medical establishment practice authorization certificate].
4.3.1 organizational scale shall be divided into three classes: 70-199 beds, 200-499 beds, and 500 or more beds
4.3.2 Each bed uses an area of not less than 5 square meters.
4.4.1 The ratio of work staff to beds in actual use is not lower than .8 : 1. The ratio of staff to beds at a mental health social welfare organization that launches diagnostic and treatment facilities for persons with mental disorders is implemented with reference to the [Standards for establishing Medical Treatment and Health Establishments].
5.1 Administrative Management
5.1.1 The organization sets up reasonable, clear job responsibilities and clear decision-making and implementation mechanisms.
5.1.2 Have a complete system of regulations, and staff familiar with job responsibilities and related rules and regulations.
5.1.3 There are development goals, a long-term development plan, annual work plan and summaries
5.2 human resources management
5.2.1 has a sound human resources management system.
5.2.2 has systems for staff recruitment, performance appraisal, rewards and punishments.
5.2.3 Staff are allotted to meet the job qualification requirements.
5.2.4 There are pre-job training, continuing education and team building systems and their is organization to carry them out.
5.2.5 has a perfected occupational safety protection systems and measures.
5.3 Financial Management
5.3.1 has a sound financial system, with decision making mechanisms for regulating economic activities.
5.3.2 The use of special funds shall comply with relevant regulations.
5.4 Archive Management
5.4.1 There are archive management and usage systems, norms and procedures, with appropriate facilities and personnel.
5.4.2 Archives shall be established and preserved for persons suffering from mental disorders, includes materials provided by the relevant units at admission, registration forms, physical inspection forms, photos, and more.
5.4.3 Organizations providing diagnosis and treatment service, should make records in accordance with the [basic standards for writing medical histories] . and preserve their medical history and preserve their medical history.
5.4.4 Have systems for protecting archives and information security, to prevent their loss, destruction, illegal borrowing or disclosure.
6,Buildings and facilities
6.1 Organization buildings meet the requirements of national standards and fire codes, and satisfy requirements appropriate to their scale and achieving their functions, to having a reasonable layout and and rational processes, being appropriately equipped, environmentally friendly and energy-efficient, and having safe operations.
6.2 Planning and site selection
6.2.1 mental health social welfare organizations shall be located in areas close to communities, with convenient transportation, good public infrastructure, and a pleasant environment.
6.2.2 Building density should be less than 30%, and capacity should be less than 0.8.
6.2.3 Beds should all occupy not less than 35 square meters.of building.
6.2.4 Area for oustside of bed activities should not be less than 2 square meters.
6.3 Building Standards
6.3.1 Organization buildings may be single or multiple stories。
6.3.2 The wards' environment should be quiet, and have an appropriate temperature and humidity, soft lighting and sufficient sunlight, with good ventilation.
6.3.3 Ward walls should have warm colors, be smooth, and easily washed, the floor should be of a non-slip material.
6.3.4 The ward doors and windows should be solid and secure, with less than 10 centimeters between safety bars.
6.3.5 Interior clearance heights no lower than 2.8 meters, and corridor clearance widths of not less than 3 meters.
6.3.6 Water, electricity, heating equipment should be safe and reliable. Water quality shall comply with the [Health Standards for Potable Water].
6.3.7 Should have appropriate information systems, communication systems and safety and security systems.
6.3.8 There should be a standardized, simple, clear, conspicuous signage system.
6.3.9 Should have sewage and waste disposal facilities compliant with regulations
7, Facilities and equipment
7.1 Necessary equipment should be available in rooms, and there should be no sharp corners or protruding parts.
7.2 Dining rooms should have tables, chairs, sterilizing cabinets, sinks, drinking water equipment, and equipment to keep out flies.
7.3 bathrooms should have urinals, toilets, safety rails, and wash basins.
7.4 shower rooms should have , safe shower equipment. safety handrails, anti-slip pads, and ventilation equipment.
7.5 have the necessary equipment for washing, disinfection and drying.
7.6 transportation equipment to meet business needs.
7.7 organizations engaged in diagnosis and treatment services, should allot medical equipment in accordance with the relevant requirements of the Ministry of Health
8, Personal care
8.1 develop daily activities plans, and post them in a conspicuous location
8.2 rooms are kept clean, the air is fresh, there are no unusual odors.
8.3 periodically wash bed sheets, covers, and pillow cases, and periodically air out bedding and change it when necessary.
8.4 provide clean, and dignified clothing for the persons with mental disorders.
8.5 maintain good individual personal hygiene. Periodically trim patients nails (toenails), bathe them, give haircuts, and oral hygiene care..
8.6 Properly use safety protective devices, to prevent self-mutilation, injuries or other accidents.
8.7 should arrange sufficient time for outdoor activities.
8.8 There should be attention paid to ensuring that the personal rights and interests of female patients are not violated.
9, Infection control
9.1 Have an infection management system, organs, personnel and and emergency plan.
9.2 Have a system for sterilization and for monitoring the efficacy of sterilization and anti-bacterial measures; to ensure the treatment and safety of persons with mental health disorders.
9.3 Have systems for preventing, screening, and reporting infectious diseases. Properly dispose of contaminated items.
9.4 Promptly isolate and treat persons with mental disorders who have infectious diseases.
10, Nutrition and diet
10.1 Cafeterias should obtain a [Food health certificate]
10.2 nutritionists and chefs should bring their credentials to their post and follow regulations to have a medical examination.
10.3 Have weekly menus, reasonable food allotments and a nutritional balance. Be able to provide special diets as necessary for the conditions of the illness.
10.4 Maintain hygienic utensils, promptly cleaning and disinfecting tableware after meals.
10.5 Hold periodic dietary management meetings, seek the views of patients and their families.
10.6 Have a 24 hour food retention system to to prevent food poisoning incidents.
10.7 respect the dietary customs of ethnic minorities.
11. Emergency management and security
11.1 Have safe working codes and an accident prevention and management system.
11.2 Have contingency plans to to respond to unforeseen security incidents.
11.3 Should be set up based on the characteristics for effective hospital safety environment and facilities, to prevent patients from getting lost and hurting each other.
11.4 should ensure that first-aid medical supplies are available and that medical personnel are on duty 24 hours, and that resuscitation equipment is working properly.
11.5 Should have work safety responsibility documents for prevention of accidents and to ensure safety.
12. Management of admission and discharge
12.1 Have an admission registration management system.
12.2 When handing admissions registrations, should be checking items on their persons, review relevant evidentiary materials, and sign an admission agreement.
12.3 Have a system of health inspections, short-term observation, and risk assessment upon admission.
12.4 Have a system for discharge and transfers to other hospitals, to complete necessary formalities according to procedures.
12.5 When admitting vagrants and beggars with mental disorders or suspected of having mental disorders , there should be a form registering their receipt, their history of custody, materials relevant to property or proofs on the patient's person, and formalities for their successful receipt shall be completed.
13, Treatment Management
13.1 Have a treatment management organization division, have reasonable personnel appointments, and corresponding systems for work and workplace responsibility.
13.2 have specifications for establishing treatment and work plans, and organize their implementation.
13.3 Have complete quality control throughout the course of treatment.
13.4 Have a core system for ensuring treatment quality and safety.
13.5 Have a system for managing shortcomings in treatment and promptly discovering and correcting accidents.
14. Care management
14.1 Caregivers should bring their credentials to work, wear badges and uniforms.
14.2 have measures for preventing persons with mental disorders from wandering off.
14.3 Follow the law in the use of restraints and protective measures and in emergency handling.
14.4 have full control of the quality of care in all processes.
14.5 Have core systems for managing the quality and safety of care
14.6 have systems for managing shortcomings in care, and for prompt discovery and correction of accidents.
15 mental health social work and social adjustment
15.1 Have a mental health social work department and launch mental health social work efforts.
15.2 Have systems relevant to social work and rehabilitation services, workplace responsibility, course of services; and systems for managing and carrying out the standardization of the form of services.
15.3 Have measures for training patients in social adaptation at different phases in their stay at the hospital.
16、Evaluation and Improvement
16.1 Review and assess professional responsibility and keep assessment record forms; and also organize periodic review, oversight and According to the relevant regulatory system and evaluation; in accordance with the relevant regulatory system.
16.2 Accept the oversight and management of the authorities above.
16.3 Evaluation methods should be objective and fair, simple and easy to implement, and able to comprehensively ascertain the implementation conditions of all aspects of the organization's work.
16.4 responses to existing work issues should clearly indicate the responsible departments or division, and corrections made within a specified time; the circumstances of the corrections should be monitored.
16.5 Periodically conduct surveys of satisfaction with services, include the results in a report and analyze them, to make a sustainable basis for improvement.
16.6 Sustainable mechanisms for improvement should be established, and improvement may be implemented in accordance with the PDCA (plan, do, check, adjust) model.
This document seems tedious, but I had a few things to say: My own thoughts, giving only big picture areas.
1. The document is curiously specific in some situations (painting the walls in warm colors 6.3.3) and wildly unspecific in others , even important ones, where simply ‘systems’ are required. See 5.4 et seq. This isn’t just bad style, but problematic as the least guidance is often given in critical areas. More harmful than any articles in the document are its omissions.
For example, the few equipment type issues that could be rights related are not given sufficient credence at all. While we are given discussion of no-slip mats in showers 7.4, where is the guarantee of access to phones, mails, computers and designated visitation areas, to exercise one’s rights to communicate with the outside world? See Mental Health Law Article 46.
2. The Role of the Doctor– this document primarily governs equipment and facilities, not treatment, but the judgment of the medical professional is conspicuously absent. Why should the doctor not be able to determine what color the walls are, whether outdoor activities are advisable, whether some patients can have sharp objects etc. While most of these articles are unobjectionable and meant to ensure the basic dignity of patients, the doctor’s role in making decisions should be included in here, particularly in the treatment and care management sections.
3. Role of patient’s and their guardians– This document in introducing systems for controlling the quality of treatment discusses soliciting patients opinions once, and this is in terms of selecting meals 10.5. There is another vague mention to satisfaction surveys, but if this is evaluation by ‘consumers’, it should be more clearly labeled as such. If there are going to be systems designed to prevent abuse, there should be a role for input by patient’s or the guardians charged with protecting their rights– even if this document only goes so far as to require a system for handling complaints . Notice that the one mention of soliciting opinions from consumers arbitrarily mentions ‘families’ rather than ‘guardians’, failing to follow the new mental health law.
4. Lack of rights focus– again, this document is primarily about facilities, but it includes treatment and care norms.
Where are the or a system for identifying a patient’s guardian that should be clearly specified in the admissions section, or system for ensuring access to legal counsel?