Development of methods for WHO quality standards for child and youth mental health services to improve quality of care and patient safety in the WHO European region

Background: Child and youth mental health care is of varying quality across the WHO European Region, with many settings being low-resourced. To improve and standardize quality of care, WHO Regional Office for Europe is developing quality standards for child and youth mental health services. This research aims to develop evidence informed methods to develop these quality standards.

Methods: Desk reviews of grey literature aimed to understand what approaches have been used or recommended to develop quality standards for child and youth mental health/health for use across a range of different countries, and consultation was sought from an expert steering group. A thematic approach was used to synthesize relevant themes. The methods were developed based on the results of these steps.

Results: Desk reviews identified variation in approaches used and recommended to develop quality standards, with limited available guidance applicable across different resource settings. Nine key themes from stakeholder consultations were highlighted. Based on these results, a seven-step methodology was created to develop the quality standards for child and youth mental health which prioritizes using an evidence-based approach and inputs from a wide range of stakeholders.

Discussion: The methods taken to develop quality standards need to be rigorous to ensure that standards accurately define high-quality care for a service. There is a need to develop a unified approach to developing quality standards. It is hoped that this paper will provide inspiration for others developing quality standards for child and youth mental health services and spark research in this area.

1 Introduction

Child and youth mental health is a growing concern in the World Health Organization (WHO) European Region (1) (“the Region”). One in five adolescents aged 15–19 years old (2) are living with a mental health condition, and suicide is the leading cause of death for young people aged 15–29 years old (3). Mental health treatments and interventions provide the opportunity to prevent the onset and escalation of mental health conditions across the life course (4), having positive implications for individuals, families and communities and reducing costs for society as a whole (5).

Many children and young people requiring mental health support do not access the care they need. For those who do access care, inequities in the quality of care received exist. Quality health services should be effective, safe, people-centered, timely, equitable, integrated and efficient (6). Hence patient safety is a core component of quality of care. Challenges to patient safety in child and youth mental health care can arise from ineffective engagement, ineffective practice and adverse events (7). Sources of potential harm in mental health treatment for children and young people include unsafe psychological therapies (8) and unsafe psychotropic treatment (9). For those in inpatient care, potential harm can results from the use of physical restraint (10) and longer admissions which have been associated with increased levels of self-harm (11). High-quality care is also impacted by other factors, such as the number and types of services available, of which there is considerable variation across the Region (12). Hence, there is need to standardize mental health care quality across the Region to improve outcomes for children and young people.

Although there have been calls for parity between physical and mental health care (13), this has not become a reality across the Region: the median percentage of the health budget spent on mental health overall was 3.60% (12), and the median number of health workers in mental health was 4.48 per 10,000 population (12), a small fraction of the median of 130.3 health workers overall per 10,000 population (14). The situation is more critical for child and adolescent mental health, where there are just 1.25 health workers per 10,000 population (12). Despite all countries in the Region being classified as either high or middle income (15), most, if not all, have reported having inadequate resources for child and youth mental health care with multiple calls for more investment in this area (16). Thus, we argue that many—if not all- countries are under-resourced when it comes to child and youth mental health.

One way to reduce inequities and inconsistencies in care is through setting evidence-based quality standards, guidelines and protocols, to lay the framework for quality assessment and improvement (17). At its first meeting, the WHO Pan-European Mental Health Coalition identified reducing inequities in child and youth mental health care through the development of quality standards as a priority (18). Only a few high-income countries in the Region have developed quality standards for child and youth mental health care [e.g., the United Kingdom (19)] and quality initiatives remain concentrated in this handful of high-income countries (20). Hence developing quality standards for child and youth mental health services is the first step to define high-quality care for this group and standardize care quality across the Region.

The relevance and representation of the quality standards depends on the methods used for their development. We aimed to develop quality standards that can be applied across multiple settings, are evidence-based and are applicable in all countries without exception.

We previously conducted a rapid systematic review of published scientific articles to understand whether a unified approach to develop quality standards and indicators for mental health had been detailed in scientific literature. The results will be published elsewhere and showed that no one “gold standard” approach was used that could be easily adapted for our purposes and is consistent with other research (21).

This research aimed to develop robust methods grounded in available evidence for developing quality standards for child and youth mental health across the Region. In the development of our methods, we sought to answer the following question:

Based on existing guidance and experience, what methods should be used to develop quality standards for child and youth mental health services in the WHO European Region?

Our previously conducted rapid systematic review of scientific articles failed to identify a unified approach to developing quality standards for mental health. These will be published and are described in more detail elsewhere. Therefore, this research focuses on grey literature and stakeholder consultation, addressing three objectives:

(i) To understand what approaches have been used by international organizations to develop quality standards for use across a wide range of different settings in child and youth health or mental health;

(ii) To understand what methods have been recommended to develop quality standards for health services across different resource settings; and

(iii) To develop a method for the development of quality standards for child and youth mental health services across the WHO European Region.

It is hoped that this will provide a proposed model to guide the development of future quality standards across contexts of varying resources.

2 Methods

To achieve the research objectives, a mixed-method approach was used. A desk review of grey literature related to the development of quality standards was conducted. The results of the desk searchers were triangulated with insights from expert consultation to develop the final methods for the development of the quality standards for child and youth mental health services.

2.1 Grey literature desk review

2.1.1 Search strategy

The websites of international organizations that hold responsibility for health/mental health and children and young people were searched with terms relating to mental health, health, quality standards, guidance, methods, and health and children and adolescents. The following websites and databases were searched:

- WHO global

- WHO Regional websites

- United Nations International Children's Emergency Fund (UNICEF)

- The Organization for Economic Co-operation and Development

- European Commission

- World Economic Forum

- International Society for Quality in Health Care

- Institute for Healthcare Improvement

Results were supplemented by a Google search. Searches were conducted between September 2023 and July 2024 by the primary researcher (JH).

2.1.2 Eligibility criteria

Different eligibility criteria were applied for the two main objectives of the desk searches.

(i) To understand what approaches have been used by international organizations to develop quality standards for use across a wide range of different settings in child and adolescent health or mental health.

Literature relating to quality standards for use across a wide variety of resource settings and for child and adolescent health or mental health services was included as these were considered of most relevance to our research question. See below for inclusion and exclusion criteria.

Inclusion

- Outlined methods to develop quality standards.

- The quality standards are meant to be used across a variety of different resource settings.

- The quality standards are aimed at either child and adolescent health settings or mental health settings.

- Published in English.

Exclusion

- No methods were mentioned in the document.

- The quality standards are meant to be used in a single country or service.

- The quality standards are aimed at other health services/topics to child and adolescent health settings or mental health settings.

- Published in another language to English.

- To understand what methods have been recommended to develop quality standards for health services across different resource settings.

Guidance documents developed for use by other stakeholders were included, and documents that outlined methods used to develop a specific set of quality standards but were not guidance documents were excluded. Since developing quality standards in healthcare is a different process from developing quality standards in other industries, it was decided to include only guidance relating to healthcare.

See below for full inclusion and exclusion criteria.

Inclusion

- Recommended methods to develop quality standards for use by other stakeholders.

- For use in developing quality standards for healthcare.

- Published in English.

Exclusion

- Outlined methods used to develop the organization's own quality standards, but not recommended methods for others.

- Outlined recommended methods to develop quality standards in other industries rather than healthcare.

- Published in another language to English.

2.1.3 Data extraction and synthesis

A data extraction framework was adapted from proposed steps to develop quality indicators for global health (21) (see Tables 1, 2). An additional element on user participation was added due its high priority in the WHO Regional Office for Europe work on child and youth mental health (22).

Table 1

Table 1. Data extraction from included grey literature which outlines methods taken to develop quality standards for use across a wide range of different settings in child and youth health or mental health [objective (i)].

Table 2

Table 2. Data extraction from included grey literature which outlines recommended methods to develop quality standards for health services across different resource settings [objective (ii)].

2.2 Consultation with experts

2.2.1 Recruitment

An expert steering group was set up, consisting of people with professional expertise in child and youth mental health, young people with lived experience expertise of child and youth mental health services, and people with experience of developing and/or implementing quality standards for child and youth health or mental health.

To recruit people who met this criteria, a two pronged approach was taken:

1. A call-out to the WHO Regional Office for Europe Pan European Mental Health Coalition.

2. A request for recommendations from WHO staff members.

This resulted in twenty people with expertise either in developing quality standards for child and youth health/mental health, or lived experience of child and youth mental health services were identified to take part in the expert steering group.

2.2.2 Data collection

Data was collected from this group in a number of different ways:

1. Individual interviews (n = 16) to learn from their experience of developing quality standards for child and youth health or child and adolescent/youth mental health services, and to understand any challenges, barriers and/or recommendations to be aware of. Detailed written notes were taken during the interview, and written up immediately.

2. A draft version of the methods document was sent out for written review by the whole steering group and updated. Written feedback was collated.

3. A hybrid in person/virtual two day meeting was held in Athens, Greece, where the results from the initial phases of developing the methods were reviewed in more detail and the processes were discussed. Detailed written notes were taken during the meeting, and summarized in a meeting report which was sent around for review to all meeting participants (n = 14).

4. An updated version of the methods was then sent around for final review and was revised based on written feedback (n = 6).

2.2.3 Data synthesis

Data synthesis aimed to extract themes to inform methods to develop our quality standards for child and youth mental health services. Due to time and resource restraints, a thorough thematic analysis [e.g., as outlined by Braun and Clarke (23)] was not possible. Hence a pragmatic approach was taken. Written notes from meetings and written feedback on the methods documents were reviewed, and key themes were coded and identified by the first author (JH). These themes were summarized and sent around to the expert steering group for review, and updated accordingly.

2.3 Writing of methods for WHO quality standards for child and youth mental health services

The data collated from steps (1) and (2), as well as the previously conducted rapid review of scientific literature on methods taken to develop quality standards and indicators for mental health were used to iteratively write and refine the methods document. This was done in parallel with steps (1) and (2).

3 Results

3.1 Desk reviews

Objective (i): To understand what approaches have been used by international organizations to develop quality standards for use across a wide range of different settings in child and youth health or mental health.

Initial searches yielded four documents that outline quality standards for child and youth health or child and youth mental health (24–27). After full text review, two were excluded (24, 25) due to not detailing the methods taken. A description of data extraction from the remaining two documents (26, 27) is provided in Table 1.

Neither document outlined the preparatory work undertaken before developing the quality standards (26, 27). Both documents outlined a process of identifying and prioritizing quality standards (26, 27). To identify potential quality standards, both used desk and literature reviews, with WHO and UNAIDS focusing on facilitators and barriers to improving quality of health care for adolescents (26) but no search criteria was specified by Schools for Health in Europe (SHE) (27). In addition to the literature review, surveys and an analysis of national quality standards were used by WHO and United Nations Programme on HIV and AIDS (UNAIDS) (26). Once potential quality standards had been defined, both SHE (27) and WHO and UNAIDS (26) gathered consultation and peer review to prioritize which quality standards to include in the final set. Involving young people and caregivers was only mentioned by WHO and UNAIDS (26). No consistent approach to developing quality standards for child and adolescent mental health or health services was found in these documents.

Objective (ii): To understand what methods have been recommended to develop quality standards for health services across different resource settings.

Three guidance documents were found which recommended methods to develop quality standards for health services across different resource settings (25,28,29; see Table 2). All three guidance documents had different aims, from how to develop quality standards as a way to implement WHO's adolescent-friendly services (25), to a detailed process for how to develop clinical quality standards for high-priority health areas (28), to a high-level overview to develop quality standards for mental health (29). Not surprisingly, there was variation in the methods described. However, all included the importance of developing a working group in the preparatory work and then a process to develop the structure for the quality standards, including domains and how to measure them (25, 28, 29). Implementation plans were considered by two (25, 28), and the importance of involving patients and carers was highlighted by one (28). The level of detail outlined in the steps varied greatly, with materials to support the development of the quality standards in terms of PowerPoint presentation slides only provided by one (28). Hence, variations were found in the methods to develop quality standards proposed in these guidance materials.

3.2 Consultation with experts

Nine themes (of equal importance) emerged from the consultations with experts, to consider what methods should be used to develop quality standards for child and youth mental health services for use across the WHO European Region.

1. Importance of using and developing robust methodsThe importance of creating robust methods in order to develop quality standards that are themselves of high-quality and can be used across the WHO European Region was confirmed by the majority of the steering group. Robust methods were seen as the starting point to a high-quality end product which could be applied across multiple contexts.

2. The importance of evidence and scientific rigor in all the processes and outputsUsing existing evidence and maintaining scientific rigor throughout was seen as essential to developing quality standards that are reflective of what high-quality care looks like to a broad range of stakeholders.

3. Pragmatic approachWhilst maintaining scientific rigor was essential, so was developing methods which would be feasible within the time and resource limits of the project. Hence, it was recognized that scientific rigor may need to be balanced with pragmatism. For example, it was mentioned that in order to develop quality standards that would be representative of the whole WHO European Region, a qualitative approach would be ideal across all countries. However due to resource limitations, a more rapid or mixed methods approach could be used (e.g., quantitative surveys).

4. Clearly defining the scope and aims of the quality standards from the outsetThe importance of defining the scope and aims of the quality standards from the outset was discussed. Questions included what level of the health system they should be aimed at, how it would fit into the wider health system such as primary health care, how they could fit outside of the health system (e.g., in criminal justice, education, social care), what kind of service would be aimed at, and who would be the main implementers of the quality standards.

5. User engagement at the center of the development of the quality standardsThe expert steering group members highlighted the importance to include young people at every step of the development of the quality standards, and ensure that caregiver and user voices are represented in the quality standards themselves. Challenges to engaging with users under the age of 18 years old were discussed, and ways to ensure emotional and physical safety of users when engaged in the process.

6. Importance of wide stakeholder engagement in the development of the quality standards.In addition to user engagement, the importance of including feedback from wider community members such as teachers, parents, social workers and the general public was highlighted, to develop a representative definition of high-quality care.

7. The challenge of getting representation from across the RegionIt was emphasized that efforts must be taken to ensure feedback from across the whole of the Region in the development of the quality standards, with a particular focus on non-English speaking countries, those that have not already established quality standards, and those which have fewer resources.

8. To consider implementation from the outset and throughout the processPotential challenges for implementation included getting buy-in from countries, engaging those who already have quality standards for child and adolescent mental health, communicating the quality standards to the public, and ensuring an efficient and sustained implementation process. Potential ways to overcome these challenges included developing a self-assessment tool, conducting a pilot implementation, engaging with civil society and service providers to advocate for implementation in a “bottom-up” approach, and engaging with Ministries of Health to implement in a “top-down” approach.

9. Practical sharing of consultation methods to get feedback from citizens, users and stakeholdersDiscussions and materials were shared to aid practical consultation from key stakeholders, including the use of case studies, treatment pathways, creative methods, focus groups, surveys, survey questions and photos.

3.3 Resulting methods for WHO quality standards for child and youth mental health services

Based on results from the desk searches (section 1 of results) and consultations with experts (section 2 of results), as well as the previously conducted rapid review, a seven-step methodology to develop quality standards for child and youth mental health services in the WHO European Region was developed (see Table 3). These methods aimed to align with the themes from consultations with experts as well as taking inspiration from the findings of the desk review and rapid review.

Table 3

Table 3. Methods to develop WHO quality standards for child and youth mental health services.

As can be seen from Table 3, the first steps are to define the steering group and the implementation aims of the quality standards (steps 1 and 2). Next, the definition of high-quality care and hence initial themes of what should be included in the quality standards needs to be developed, including perspectives from a wide range of stakeholders and the evidence (steps 3–4). Consultation across a wide range of stakeholders is then used to iteratively update the themes for high-quality care (steps 5 and 6) until an initial set of quality standards is developed. The final phase is to pilot their implementation (step 7).

4 Discussion

This research showed that there is not a consistent approach used or recommended to developing quality standards for child and youth mental health/health settings in the grey literature. A unified procedure to develop quality standards for child and youth mental health services is needed to ensure that quality standards do not differ in what and whose definition of high-quality care they represent. Furthermore, having a unified approach to quality improvement provides opportunity for more efficient use of resources (30), something particularly pertinent in child and youth mental health services which are often under-resourced. This finding is consistent with wider research which has called for unified approach to develop health quality indicators (21).

Our desk reviews found that published practical resources to support the development of quality standards for health services were limited, making it challenging for those who do wish to follow guidance or replicate methods to develop quality standards. This points to a need for more practical resources and sharing of information to support quality standard development, for example on survey questions, how to balance pragmatism and rigorous scientific rigor, and how to meaningfully involve people with lived experience.

There were limitations in our methods. Our desk searches were not systematic literature reviews, instead we took a programmatic approach due to time and resource constraints. We focused specifically on the development of quality standards relating to child and youth mental health/health services from international organizations. This means that our searches may have been incomplete. The methods taken to gather feedback from key stakeholders were not scientifically rigorous. We did not record and transcribe interviews, instead relying on notes from meetings. To mitigate this, the resulting methods document was reviewed by all stakeholders to provide them with the opportunity to input anything else which may have been missing.

However, the process did allow for us to meet the aims of the research, that is to develop a methodology grounded in available evidence for developing quality standards for child and adolescent mental health across the WHO European Region.

Quality standards define how care should ideally be provided, and quality assessment and improvement efforts centre around implementing these quality standards. Hence it is essential that the quality standards developed accurately define high-quality care. If the original definition is not evidence-based or agreed upon by multiple stakeholders, then subsequent quality assessment and improvement efforts may be misguided. Standardization can also reduce waste, add value and save resources. Future directions include the need to develop a consistent methodology to create quality standards which are evidence-informed and represent views of multiple stakeholders, and to understand how quality improvement efforts can reduce waste in low-resource settings.

Engaging with citizens and users is an established strategy to improve the quality of care (31). Hence the engagement of citizens and users should be a requirement when developing quality of care standards, to ensure that services and quality improvement efforts are embedded in the needs and preferences of the users. Further research can support this through understanding what the needs and preferences are of citizens and users when accessing child and youth mental health care. In particular, more research is needed from low-resource and middle-income countries.

Piloting the quality standards was emphasized as a key step to understand and adapt implementation based on barriers and facilitators. It is likely that the implementation of the quality standards will need to be adapted based on the context of implementation, including the resources available, whether a continuous culture of quality improvement exists, as well as individual staff motivation. Given the lack of published research on how to improve quality of child and adolescent mental health services (32), it is recommended that implementation efforts include a strong research component, and aim to understand what approaches are the most effective as well as any unintended negative consequences, across all resource settings.

In order to effectively improve the quality of child and youth mental health care, it is essential to first develop a shared definition of high-quality care through quality standards. The extent to which this definition will be representative of multiple stakeholders and the evidence depends on the methods used. By detailing the methods used to develop quality standards for child and youth mental health services, it is hoped that this paper will provide direction to others wishing to develop quality standards and spark further research in this area. Proposed future directions include developing a unified approach to developing quality standards, more research to understand the preferences and needs of users of child and youth mental health services, how to best improve quality of care and patient safety in child and youth mental health care, practical resources on how to develop quality standards, and to use quality improvement to guide more efficient use of resources, particularly in under-resourced settings.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

Author contributions

JH: Writing – original draft, Project administration, Conceptualization, Writing – review & editing, Formal analysis, Methodology. KA: Writing – review & editing, Methodology, Writing – original draft. RB: Methodology, Writing – original draft, Writing – review & editing. CB-S: Writing – review & editing, Writing – original draft, Methodology. LC: Methodology, Writing – review & editing, Writing – original draft. AGi: Writing – review & editing, Writing – original draft, Methodology. AGu: Writing – review & editing, Methodology, Writing – original draft. PK: Writing – review & editing, Methodology, Writing – original draft. CK: Writing – review & editing, Writing – original draft, Methodology. KK: Writing – review & editing, Writing – original draft, Methodology. DO: Methodology, Writing – original draft, Writing – review & editing. CP: Methodology, Writing – original draft, Writing – review & editing. AR: Writing – original draft, Methodology, Writing – review & editing. DR: Writing – review & editing, Writing – original draft, Methodology. CR: Methodology, Writing – original draft, Conceptualization, Writing – review & editing. TS: Methodology, Conceptualization, Writing – review & editing, Writing – original draft. RS: Conceptualization, Writing – review & editing, Writing – original draft, Methodology. AT: Writing – original draft, Methodology, Writing – review & editing. LL: Supervision, Writing – original draft, Funding acquisition, Methodology, Resources, Conceptualization, Writing – review & editing. JB: Funding acquisition, Resources, Writing – review & editing, Conceptualization, Writing – original draft, Methodology, Supervision.

Funding

The author(s) declare that financial support was received for the research and/or publication of this article. This was conducted under the WHO Programme on Quality of Child and Adolescent Mental Health Care which is supported by funds from the Ministry of Health under the Government of the Hellenic Republic.

Acknowledgments

The authors would like to acknowledge Natasha Azzopardi-Muscat, Director Division of Health Systems, WHO Regional Office for Europe for her strategic technical support.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Author disclaimer

Dr Jennifer Hall, Penny Kalpaxi, Cassie Redlich, Ana Tijerino, Dr Ledia Lazeri and Dr Joao Breda are all staff members at the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or the stated policy of the World Health Organization.

References

1. Park M, Budisavljević S, Alemán-Díaz AY, Carai S, Schwarz K, Kuttumuratova A, et al. Child and adolescent health in Europe: towards meeting the 2030 agenda. J Glob Health. (2023) 13:04011. doi: 10.7189/jogh.13.04011

PubMed Abstract | Crossref Full Text | Google Scholar

2. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2021 (GBD 2021). Seattle, United States. (2024). Available online at: https://vizhub.healthdata.org/gbd-results?params=gbd-api-2021-permalink/139985cd1171dcb698db6d49c077558a (Accessed September 9, 2025).

Google Scholar

3. World Health Organization. Global Health Estimates 2021: Disease burden by Cause Age, Sex, by Country and by Region, 2000–2021. (2024). Available online at: https://www.who.int/data/global-health-estimates (Accessed 2025 May 14).

Google Scholar

4. Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The lancet commission on global mental health and sustainable development. Lancet. (2018) 392(10157):1553–98. doi: 10.1016/S0140-6736(18)31612-X

PubMed Abstract | Crossref Full Text | Google Scholar

5. Centre for Mental Health, Centre for Young Lives, Children & Young People’s Mental Health Coalition, Prudence Trust, Young Minds. Future Minds Why investing in children’s mental health will unlock economic growth unlo. UK. (2025).

Google Scholar

6. World Health Organization. Quality of care. (2024). Available online at: https://www.who.int/health-topics/quality-of-care#tab=tab_1 (Accessed March 31, 2024).

Google Scholar

7. Wolpert M, Deighton J, Fleming I, Lachman P. Considering harm and safety in youth mental health: a call for attention and action. Adm Policy Ment Health. (2015) 42(1):6–9. doi: 10.1007/s10488-014-0577-x

PubMed Abstract | Crossref Full Text | Google Scholar

8. Mercer J. Evidence of potentially harmful psychological treatments for children and adolescents. Child Adolesc Soc Work J. (2017) 34(2):107–25. doi: 10.1007/s10560-016-0480-2

Crossref Full Text | Google Scholar

9. Panagiotopoulos C, Ronsley R, Elbe D, Davidson J, Smith DH. First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents. J Can Acad Child Adolesc Psychiatry. (2010) 19:124–37. Available online at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2868560/ (Accessed May 14, 2025).20467549

PubMed Abstract | Google Scholar

10. Nielson S, Bray L, Carter B, Kiernan J. Physical restraint of children and adolescents in mental health inpatient services: a systematic review and narrative synthesis. J Child Health Care. (2021) 25(3):342–67. doi: 10.1177/1367493520937152

PubMed Abstract | Crossref Full Text | Google Scholar

11. Ougrin D, Corrigall R, Stahl D, Poole J, Zundel T, Wait M, et al. Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry. (2021) 30(9):1427–36. doi: 10.1007/s00787-020-01617-1

PubMed Abstract | Crossref Full Text | Google Scholar

12. Mental Health Atlas. Geneva: World Health Organization (2020). Licence: CC BY-NC-SA 3.0 IGO.

Google Scholar

13. Millard C, Wessely S. Parity of esteem between mental and physical health. Br Med J. (2014) 349:g6821. doi: 10.1136/bmj.g6821

PubMed Abstract | Crossref Full Text | Google Scholar

14. Core health indicators in the WHO European Region. Special focus: European Programme of Work measurement framework. Copenhagen: WHO Regional Office for Europe (2023). Licence: CC BY-NC-SA 3.0 IGO.

Google Scholar

15. The World Bank. World Bank Country and Lending Groups – World Bank Data Help Desk. (2025). Available online at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups (Accessed May 14, 2025).

Google Scholar

16. McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, et al. The lancet psychiatry commission on youth mental health. Lancet Psychiatry. (2024) 11:731–74. doi: 10.1016/S2215-0366(24)00163-9

PubMed Abstract | Crossref Full Text | Google Scholar

17. Delivering quality health services: a global imperative for universal health coverage. Geneva: World Health Organization, Organisation for Economic Co-operation and Development, and The World Bank (2018). Licence: CC BY-NC-SA 3.0 IGO.

Google Scholar

18. First meeting of the Pan-European Mental Health Coalition: from debate to action. Copenhagen: WHO Regional Office for Europe (2023). Licence: CC BY-NC-SA 3.0 IGO. Available online at: https://www.who.int/europe/publications/i/item/WHO-EURO-2022-5769-45534-65202 (Accessed May 14, 2025).

Google Scholar

19. Quality Network for Community CAMHS Service Standards, 5th ed. (2019). London: Royal College of Psychiatrists. Available online at: https://www.rcpsych.ac.uk/docs/ default-source/translation/qncc-standards-fifth-edition.pdf?sfvrsn=fc4069f4_4 (Accessed May 14, 2025).

Google Scholar

20. Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O’Brien RW, Tomoyasu N, et al. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry. (2018) 17(1):30. doi: 10.1002/wps.20482

PubMed Abstract | Crossref Full Text | Google Scholar

21. Dudley L, Mamdoo P, Naidoo S, Muzigaba M. Towards a harmonised framework for developing quality of care indicators for global health: a scoping review of existing conceptual and methodological practices. BMJ Health Care Inform. (2022) 29(1):e100469. doi: 10.1136/bmjhci-2021-100469

PubMed Abstract | Crossref Full Text | Google Scholar

22. Hall J, Nesrallah S, Ras D, Baillie A, Brunskill H, Jutten E, et al. Youth participation in strengthening the quality of child, adolescent, and youth mental health in the world health organization European region. J Adolesc Health. (2024) 75(3):519–21. doi: 10.1016/j.jadohealth.2024.04.025

PubMed Abstract | Crossref Full Text | Google Scholar

23. Braun V, Clarke V. Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher. Int J Transgender Health. (2023) 24(1):1–6. doi: 10.1080/26895269.2022.2129597

Crossref Full Text | Google Scholar

24. A Global Framework for Youth Mental Health: Investing in Future Mental Capital for Individuals, Communities and Economies. Cologny/Geneva: Orygen, World Economic Forum (2020). Available online at: https://www.orygen.org.au/About/Orygen-Global/Files/Orygen-WEF-global-framework-for-youth-mental-healt.aspx (Accessed May 15, 2025).

Google Scholar

25. Making Health-Services Adolescent Friendly Developing National Quality Standards for Adolescent-friendly health services. Geneva: World Health Organization (2012). Licence: CC BY-NC-SA 3.0 IGO.

Google Scholar

26. Global Standards for Quality Health-care services for Adolescents: A Guide to Implement a Standards-driven approach to Improve the Quality of Health-care services for Adolescents. Geneva: World Health Organization (2015). Licence: CC BY-NC-SA 3.0 IGO.

Google Scholar

27. Schools for Health in Europe Network Foundation. European Standards and Indicators for Health Promoting Schools. (2019). Available online at: www.schoolsforhealth.orgwww.schoolsforhealth.org (Accessed May 14, 2025).

Google Scholar

28. NICE. Principles for developing clinical Quality Standards in low and middle income countries. (2014), p. 1–45. Available online at: www.nice.org.uk (Accessed May 14, 2025).

Google Scholar

29. Quality improvement for Mental Health. Geneva: World Health Organization (2003). Licence: CC BY-NC-SA 3.0 IGO.

Google Scholar

30. King B, Patel RM. Using quality improvement to improve value and reduce waste. Clin Perinatol. (2023) 50(2):489–506. doi: 10.1016/j.clp.2023.01.009

PubMed Abstract | Crossref Full Text | Google Scholar

31. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. (2018) 6(11):e1196–252. doi: 10.1016/S2214-109X(18)30386-3

PubMed Abstract | Crossref Full Text | Google Scholar

32. Forman-Hoffman VL, Middleton JC, McKeeman JL, Stambaugh LF, Christian RB, Gaynes BN, et al. Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review. Implement Sci. (2017) 12(1):1–21. doi: 10.1186/s13012-017-0626-4

PubMed Abstract | Crossref Full Text | Google Scholar