Common European Guidelines on
De-institutionalisation and Toolkit
on the use of Structural Funds
Based on the presentation of Ines Bulic,
Researcher
European Expert Group
Background
• Report of the Ad Hoc Expert Group (so-called
Spidla’s Report), 2009
• European Expert Group on the Transition from
Institutional to Community-based Care (EEG)
• Advising European Commission (DG
Employment and DG Regional Policy) on the
use of Structural Funds
Membership
Confederation of Family Organisations in the EU (COFACE)
Eurochild
European Network on Independent Living (ENIL) - European
Coalition for Community Living (ECCL)
European Disability Forum (EDF)
European Association of Service Providers for People with
Disabilities (EASPD)
European Social Network (ESN)
Inclusion Europe
Lumos
Mental Health Europe
UNICEF / OHCHR
Common European Guidelines
Project Objectives
• Offer expertise and advice to Member States and
EU institutions
• Gather and promote practical examples of good
practice
• Ensure that EU and national policies and funding
mechanisms support DI
• Raise awareness about the right to live in the
community at EU level
• Encourage Member States to fully involve user
groups
Project Outputs
• Common European Guidelines (common =
children, people with disabilities, people with
mental health problems, older people)
• Toolkit on the use of Structural Funds
• Training module
• Mutual learning events in Finland, Lithuania,
Bulgaria and Croatia
• Training session for the European Commission
Target groups
• Politicians and civil servants in Member States
• European Commission and Member State
officials (Structural Funds)
• EU level officials (Social Agenda)
• Local authorities
• Service providers
• NGOs and disabled people’s organisations
advocating for change
Guidelines Chapters
•
•
•
•
Executive Summary
Introduction and preface
Definition of the key terms
Moving from institutional care to community-based services
•
•
•
•
•
•
•
•
•
•
Making the case for developing community-based alternatives to institutions
Developing strategies and action plans
Analysing the situation
Developing community-based services
Allocating financial, material and human resources
Developing individual plans
Preparing the individuals and communities for the transition
Defining, monitoring and evaluating the quality of services
Developing the workforce
Establishing the legal framework for community-based services
• Frequently Asked Questions
Introduction
• Key principles highlighted:
– Vision
– Engaging with civil society
– Stakeholder involvement
– Leadership for change
Hunt Report
• Hunt, P. : Report of the Special UN Rapporteur on
the right of everyone to the enjoyment of the
highest attainable standard of physical and
mental health. E/CN.4/2005/51, 11. February
2005. Hunt 2005 odvodil z práva na zdraví právo
na začlenění do komunity (right to community
integration):
„Segregation and izolation of the people with
mental health problems is in a conflict with a
right for health and secondary right of to be
integrated in the community“.
Human right framework
UN Convention on the
Rights of Persons
Disabilities (CRPD).
Art.19: Living independently and
being included in the community
live in the community- with
needed assistance
full inclusion and participation –
accessibility of the services for
general public
 choices equal to others:
 with whom to live
 where to live
Obligation coming up from CRPD
• To respect, protect and fulfill a right of people
with disability to live in the commuity.
• To respect right of living in the community states
can not institutionalised any person becouce of
their disability.
• To fulfil and obligation of the rights living in the
community states has to close down institutions
and transforme then to the community
seervices.
• State is obligated to assure a rights guarantie in
CRPD can be fully „consumed“
Definitions
• No size-based definition of institution –
instead, definition of institutional care
• De-institutionalisation
• Alternative care, including difference between
family-based and family-like care (based on
UN Guidelines)
• Community-based services and Independent
Living
• User groups
Toolkit on the use of
Structural Funds
• To help those involved in the programming
and implementation of Structural Funds (and
other EU funds) ensure they support the
transition to community-based services
• Targeting desk officers at EC, managing
authorities, intermediate bodies, monitoring
committees and project promoters in EU MS,
acceding, candidate and potential candidate
countries
Main principles
• Understanding what de-institutionalisation is about
• Strong case for the use of EU funds to support
development of community-based alternatives to
institutional care
• – EU Charter and CRPD
– Better use of taxpayers’ money – Evidence of
misuse
• Supporting structural change
• Supporting sustainable reforms
• Deinstitutionalisation = social innovation
Legal context
Regulations for the use of Structural funds in years
2014 – 2020.
For the first time in history the European Union (EU)
has put regulations in place which make it clear that
EU Structural Funds should be spent on the
transition from institutional to community based
care. This regulation will come into force on 1
January 2014 and will last for seven years. This is a
significant achievement that will benefit hundreds
of thousands of children and adults in Europe.
Implications of CRPD
• Instruments developed based on separate
provisions of CRPD
• For monitoring, assessing the situation on
human rights and health care quality
• Recommending ways forward to promote,
protect and realize rights of PWMD
Instruments developed and based
on the CRPD provisions
• ITHACA
• WHO QualityRights toolkit
• European Guidelines for deinstitutionalisation
What is ITHACA?
• “Institutional Treatment, Human Rights And Care
Assessment” (ITHACA)
• 3 year international study on human rights and
general health care in psychiatric institutions.
• Funded by one division of the European Commission
(PHEA).
• 16 countries involved:
• Coordinated by King’s College in London.
• Started in 2007 and lasted until end of 2010.
What ITHACA produced
• The purpose of ITHACA was to develop a systematic assessment of two
important components of psychiatric institutions - human rights and general
health care.
• During the project monitoring tool was developed and tested.
• Researchers involved in developing the monitoring tool, as well as testing it via
monitoring visits came from a number of different disciplines including law,
social sciences, psychology and psychiatry.
• The tool was applied/tested in six institutions in each country.
• The data from the total of 96 institutions provide the picture of the conditions
in mental health services across Europe.
Monitoring tool/Content
•
Background / statistical information to be collected before the monitoring
–
–
–
–
•
•
•
•
•
•
Location, Material/ Physical Conditions of Institution
Admission Criteria and Procedures
Access to Community
Privacy/ Home/ Family
Access to Information
Health Care
–
–
–
•
•
•
•
•
•
Context (background research)
Residents
Staff
Organization/ Rules
Prevention
Diagnosis
Treatment
Consent to Treatment
Decision making: supported vs. substituted
Protections from torture, inhuman, cruel and degrading punishment and exploitation, violence and abuse
Education
Work and Employment
Discharge
Aim of the WHO QualityRights tool
kit
• to support countries in assessing and improving the
quality and human rights of their mental health and
social care facilities.
• The United Nations Convention on the Rights of
Persons with Disabilities (CRPD) is the basis for human
rights standards that must be respected, protected and
fulfilled in facilities.
Five themes, drawn from the CRPD, are covered by
the tool kit
• The right to an adequate standard of living and social protection (Article 28)
• The right to enjoyment of the highest attainable standard of physical and
mental health (Article 25)
• The right to exercise legal capacity and the right to personal liberty and the
security of person (Articles 12 and 14)
• Freedom from torture or cruel, inhuman or degrading treatment or
punishment and from exploitation, violence and abuse (Articles 15 and 16)
• The right to live independently and be included in the community (Article 19)
• Each of the ‘themes’ or ‘rights’ outlined above
is broken down into a series of ‘standards’,
which are further broken down into a series of
‘criteria’.
• The criteria form the basis of the quality and
human rights assessment.
Thank you
Lithuanian forum for the disabled
Dovilė Juodkaitė
d.juodkaite@lnf.lt