The need for strategies on Deinstitutionalisation

Across Europe deinstitutionalisation is stalling or regressing. The adoption of strategies or plans of action on deinstitutionalisation could provide the needed reinvigoration.

Florian Sanden, 28 July 2022 –

Article 19 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) “recognises the equal right of all persons with disabilities to live in the community…to choose their place of residence and where and with whom they live”. In 2017 the Committee on the Rights of Persons with Disabilities published General Comment No. 5 which clarified that the key component of the implementation of Art. 19 of the UNCRPD is the closure of residential institutions. The EU and all 27 member states are party to the UNCRPD.

In 2007 the study “Deinstitutionalisation and community living – outcomes and costs” found evidence of at least 1,294,253 disabled children and adults living in institutions throughout the EU. In 2020 the “Report on the transition from institutional to community-based care calculated that there were at least 1,438,696 disabled children and adults living in institutions. The ENIL shadow report on the implementation of the UNCRPD, published in February 2022, gathered extensive evidence of a trend to replace large institutions with smaller residential settings in many member states. Such small-scale institutions are often called group homes. In these settings the autonomy and self-determination of disabled people is curtailed in the same way as in larger institutions. As a result, the proliferation of group homes does not represent any progress towards deinstitutionalisation.

In our working groups, meetings and committees ENIL members confirm those trends. There is widespread concern that no country intends to fully implement the UNCRP. Many are under the impression that instead of offering serious policy commitments, governments are paying lip service.

A closer look at the adoption and implementation of strategies of deinstitutionalisation or plans of action for deinstitutionalisation confirms this impression. General Comment No 5 recommends all state parties to the UNCRPD “to adopt clear and targeted strategies for deinstitutionalisation”. Strategies or plans of action for deinstitutionalisation should contain “specific time frames and adequate budgets, in order to eliminate all forms of isolation, segregation and institutionalisation of persons with disabilities”. Such plans shall induce “systemic transformations”, “the closure of institutions”, “the elimination of institutionalising regulations”, “the establishment of individual support services” and be executed in “coordinated, cross-government approaches”.

Part I of the ENIL survey on Independent Living in the Council of Europe area, which was published in 2020, revealed that 18 out of 43 countries have adopted deinstitutionalisation strategies (DI strategy). Among EU member states 13 out of 27 countries have introduced deinstitutionalisation strategies: Bulgaria, Croatia, Cyprus, Estonia, Finland, Hungary, Ireland, Lativa, Lithuania, Poland, Romania, Slovakia and Slovenia. Out of 18 countries which have a deinstitutionalisation strategy, only one country, Moldova, has one that is considered adequate by the respondents. The 17 remaining strategies are evaluated as inadequate or requiring improvement. Recent information showed that the plan of action for deinstitutionalisation adopted by Poland in 2020 should be seen as inadequate. Documents adopted by governments as DI strategies are often overly complex and leave the reader without a clear idea on how deinstitutionalisation will unfold in the country. The DI strategies adopted by Lithuania and Poland are illustrative of the problem.

Noticeable absent from the list of EU countries that have a DI strategy, is the entirety of south-west Europe. None of the most populated EU members, France, Italy, Spain and Germany has adopted such a document. Despite the reluctance of countries to adopt DI strategies, the Committee on the Rights of Persons with Disabilities does not tire in recommending governments to do so. In 2014 the Committee criticised Belgium for a “lack of deinstitutionalisation plans”. Belgium received the recommendation “to implement a disability action plan at all levels”. In 2019 the Committee asked Belgium for information on “steps taken to implement disability action plans at the federal, regional and community levels” which indicates that this issue is still unresolved. The review of the implementation of the UNCRPD in France produced a similar pattern. After a country visit in 2017, the special rapporteur on the rights of persons with disabilities recommended the adoption “of a concrete action plan to progressively close all existing institutions”. In 2021 the committee reiterate the recommendation “to adopt a national strategy and plans of action”. In reviewing the reports for other EU countries, the repetition of recommendations for the adoption of DI strategies and lack of response from governments can be found time and again.

According to 20th century political philosopher Max Weber, “politics is the slow drilling of hard boards”. Governments are reluctant. However, to advance in the implementation of the UNCRPD and make progress on deinstitutionalisation we need governments to adopt strategies and plans of action for deinstitutionalisation as envisioned by General Comment No 5. Such strategies would signify a clear policy commitment and entail the necessary provision of budgetary resources. Civil society and disabled people´s organisations should adopt the demand for DI strategies and push governments the comply. The European Union should support the demand for strategies and plans of action of DI and adopt an EU-level deinstitutionalisation strategy. In addition, EU should continuously recommend to member states the adoption of such strategies. If necessary, the disbursement of EU funds should be tied to the adoption of strategies and/or plans of action on DI.