Deinstitutionalisation of persons with disabilities
- Author(s):
- Parliamentary Assembly
- Origin
- Assembly
debate on 26 April 2022 (12th sitting) (see Doc. 15496, report of the Committee on Social Affairs, Health and
Sustainable Development, rapporteur: Ms Reina de Bruijn-Wezeman;
and Doc. 15509, opinion of the Committee on Equality and Non-Discrimination,
rapporteur: Ms Liliana Tanguy). Text
adopted by the Assembly on 26 April 2022 (12th sitting).See
also Recommendation 2227
(2022).
1. All human beings are born free
and equal in dignity and rights. A precondition for anyone to enjoy
their rights and fundamental freedoms is that they live in and are
included in the community. For a long time however, persons with
disabilities have been merely viewed as passive objects of care.
A growing understanding of disability and movements pushing for
equal rights have enabled a shift to a human rights-based approach
in which society must accommodate human diversity and enable persons
with disabilities to be an active part of it.
2. The rights of persons with disabilities to equality and inclusion
are now recognised at the international level, in particular thanks
to the United Nations Convention on the Rights of Persons with Disabilities
(CRPD), adopted in 2006 and ratified by all Council of Europe member
States but one. This convention represented an important milestone
in the shift to a human rights-based approach to disability. Under
the CRPD, States Parties are obliged to take effective and appropriate
measures with a view to achieving full inclusion and participation of
persons with disabilities in the community.
3. The United Nations Committee on the Rights of Persons with
Disabilities is currently working on “Living independently and being
included in the community: Guidelines on deinstitutionalization
of persons with disabilities, including in emergency situations”
with the support of the Global Coalition on Deinstitutionalization composed
of representative organisations of persons with disabilities and
civil society organisations advocating the rights of persons with
disabilities. The purpose of the guidelines is to supplement the committee’s
General Comment No. 5 by providing concrete guidance to States Parties
and other stakeholders on how to carry out deinstitutionalisation
processes, including in emergency situations, in line with the CRPD. These
guidelines, once adopted, should be implemented by Council of Europe
member States as a matter of urgency.
4. Placement in institutions affects the lives of more than a
million Europeans and is a pervasive violation of the right, as
laid down in Article 19 of the CRPD, which calls for firm commitment
to deinstitutionalisation. Many persons with disabilities are isolated
in their own communities because of a lack of accessibility to facilities
such as schools, healthcare and transportation, as well as a lack
of community-based support schemes. Community-based support services
and supportive living arrangements provide a better quality of life
for persons with disabilities, as well as being more human rights-compliant
and cost-effective.
5. However, persons with disabilities are often presumed to be
unable to live independently. This is rooted in widespread misconceptions,
including that persons with disabilities lack the ability to make
sound decisions for themselves and that they need “specialised care”
provided for in institutions. In many cases, cultural and religious
beliefs may also feed such stigma, as well as the historical influence
of the eugenics movement. For too long, these arguments have been
used to wrongfully deprive persons with disabilities of their liberty
and to segregate them from the rest of the community by placing
them in institutions. Measures must be taken to combat this culture
of institutionalisation resulting in social isolation and segregation
of persons with disabilities, including at home or in the family,
preventing them from interacting in society and being included in
the community.
6. A systemic approach to the process of deinstitutionalisation
is needed in order to achieve good results, namely a genuine and
successful transition to independent living in accordance with Article
19 of the CRPD. Concrete action must be taken towards ending the
practice of institutionalisation and ensuring that these persons
and their families are met with appropriate support in the process
of reintegrating into society.
7. The Parliamentary Assembly recommends that Council of Europe
member States, in line with their obligations under international
law, and inspired by the work of the United Nations Committee on
the Rights of Persons with Disabilities:
7.1 develop, in co-operation with organisations of persons
with disabilities, adequately funded, human rights-compliant strategies
for deinstitutionalisation with clear time frames and benchmarks
with a view to a genuine transition to independent living for persons
with disabilities in accordance with Article 19 of the CRPD, in
which:
7.1.1 the rights of the user groups are respected,
the risk of harm is minimised and positive outcomes for the persons
concerned are ensured;
7.1.2 the transformation of residential institutional services
is only one element of a wider change in areas such as healthcare,
rehabilitation, support services, education and employment, and
in which the societal perception of disability and the social determinants
of health, as well as gender and other stereotypes, are adequately
addressed;
7.1.3 institutions run by non-state stakeholders are fully included;
7.1.4 independent mechanisms are empowered to properly monitor
the process of deinstitutionalisation and contribute to its success;
7.2 run public awareness-raising campaigns, in conformity
with Article 8 of the CRPD, in order to overcome stereotypes and
prejudices surrounding disability and promote the full inclusion
in society of persons with disabilities;
7.3 make the child-centred, human rights-compliant deinstitutionalisation
of children with disabilities a top priority.
8. The Assembly calls on parliaments to take the necessary steps
to progressively repeal legislation authorising the institutionalisation
of persons with disabilities, as well as mental health legislation
allowing for treatment without consent and detention based on impairment,
with a view to ending coercion in mental health.
9. The Assembly welcomes the active role the Council of Europe
Development Bank (CEB) has played in funding and underwriting the
restructuring of institutional service provision and the building
up of more inclusive, community-based services. It calls on the
CEB, the World Bank and other social development funds such as the
European Structural and Investment Funds to support member States
to allocate adequate resources for support services that enable
persons with disabilities to live in their communities, such as
the strengthening, creating and maintaining of community-based services.
It is important that funds are directed towards sustaining systemic
reforms that enable member States to fulfil their obligations under
international law. In no way should funds be given to projects that
involve maintaining, refurbishing or building new institutions,
unless this is part of a clearly delineated transitional phase during
which community-based services exist alongside institutions before
these can be closed.
10. The Assembly welcomes the QualityRights initiative of the
World Health Organization, which provides essential guidance on
the implementation of mental health services and on community-based
responses from a human rights perspective and offers a path towards
ending institutionalisation and involuntary hospitalisation and
treatment of persons with disabilities.
11. Finally, in line with its unanimously adopted
Resolution 2291 (2019) and
Recommendation 2158 (2019) “Ending
coercion in mental health: the need for a human rights-based approach”,
the Assembly calls on all stakeholders, including the governments
and parliaments of Council of Europe member States, not to support or
endorse draft legal texts which would make successful and meaningful
deinstitutionalisation more difficult, and which go against the
spirit and the letter of the CRPD – such as the draft additional
protocol to the Convention for the protection of Human Rights and
Dignity of the Human Being with regard to the Application of Biology
and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164,
Oviedo Convention) concerning the protection of human rights and
dignity of persons with regard to involuntary placement and involuntary
treatment within mental healthcare services. Instead, it calls on
them to embrace and apply the approach set out by the CRPD, a convention
which marks a paradigm shift, and fully guarantee the fundamental
human rights of all persons with disabilities.
