BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients. METHODS: QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level. RESULTS: We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled. CONCLUSIONS: This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.

CEDOC and Mental Health Department Faculdade de Ciências Médicas Universidade Nova de Lisboa Campo Mártires da Pátria 130 1169 056 Lisbon Portugal

CIBERSAM Department of Psychiatry Universidad de Granada Avenida de Madrid 11 18012 Granada Spain

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

Department of Psychiatry lst Faculty of Medicine Charles University Ke Karlovu 11 128 00 Prague 2 Czech Republic

Department of Psychiatry Medical University Sofia St Georgi Sofiisky str L Sofia 1431 Bulgaria

Department of Psychiatry Wroclaw Medical University Pasteura 10 Wroclaw 50 367 Poland

Dipartimento di Salute Mentale Via Sai 1 3 Trieste 34127 Italy

Division of Psychiatry University College London Maple House 149 Tottenham Court Road London UK

Population Health Research Institute St George's University London Cranmer Terrace London UK

University Medical Centre Hanzeplein1 Groningen 9700 RB Netherlands

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

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