Transformation of institutional
to community based care
JAN PFEIFFER
MHE-EEG
What is deinstitutionalization?
From institutional culture
To on client oriented culture
Isolation from the community
Inclusion in the community
Clients are compelled to live together
Clients decide where and with whom to
live
Lack of control over their lives
Maximum support for clients to gain
control over their lives
Rigidity of routine
Normalization principle
Block treatment
Needs-based support
Paternalistic relationship
Partnership between staff and clients
Social distance
Team cooperation
Rules of the institution are more
important than the needs of the clients
Flexibility in care provision
Changing a paradigm of support
From disability-medical model
To person centered - recovery model
What is recovery?
“Recovery is a way of living a
satisfying, hopeful and contributing
life, even with limitations caused by
disability-illness.”
(W Anthony, Boston University, 1993)
- and another !
“Recovery isn’t
waiting for the
storm to pass.
……………….
It’s learning to
dance in the
rain.”
Recovery processes: Leamy et al, 2011
Leamy, M., Bird, V.J., Le Boutillier, C., Williams, J. & Slade, M. (2011) A conceptual framework for personal recovery in mental health:
systematic review and narrative synthesis. British Journal of Psychiatry, 199:445-452 http://www.researchintorecovery.com/
Focus on wellbeing
.
UN Convention on the
Rights of Persons
Disabilities
Art.19: Living independently
and being included in the
community

•
•
Equal right of disabled people to live in the
community with choices equal to others
States must take effective and appropriate
measures to facilitate disabled people’s:
– Full enjoyment of this right
– Full inclusion & participation in the
community (note: emphasises that it is not
just about where the person lives)
This includes ensuring that people have:
•
•
•
Equal opportunity to choose where & with
whom to live
Access to range of community-support services
Equal access to mainstream services (that are
responsive to individual needs)
Balance between community and
institutional resources
History counts
Europe and the Cold War
(1947-1991)
Structural Funds allocation
(2007-2013)
 Services neglect basic human rights
 Public opinion- stereotype of
Weaknesses
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segregation
Most of the resources fixed in the
institutional care
Community services do not have
stable financing
DI policy not implemented
Lack of objective knowledge about
alternatives to institutional care
among professionals
Instability of civil servants system
Corruption
Lobby of pharmaceutics companies
 Examples of “reformed” system
 Good examples of creative – inclusive,
Strengths
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recovery based community care services
Examples of deinstitutionalization of
social care homes using a SF
National mental health policy (action
plane)
Revision of legal capacity law
NGO representing opinion of different
groups include NGO “controlled” by
users
National DI platforms
Cases in Human Right Court
CPT recommendations have a
comments to whole system, not only
improving condition
 SF used on refurbishing of
Threat
institutional care
 Closing down community services
due to reduction of resources
 Exhausting of pro reform fighter,
mixing up role of advocacy and
service provider, fragmentation of
the voice
 Leadership in DI missing
Overinvestment in existing institutions
Developing community service without
closing the institution
Alternatives with institutional culture
 Horizontal institutions - group homes in segregated
area, often placed on the ground of the original
institution.
Most frequent fears on the beginning
Fears
Solutions
 There is no money for DI
 Cost analysis research
 Use of Structural Funds as a
 Community care costs more
 Clients are happy in the
institution
 Clients are not capable of living
independently
 Clients are a danger for
themselves or others
 Community will not accept
“clients” among themselves
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bridging fund
Prevention services to avoid
unnecessary new admissions
Share experience with places
where the reform process is
ongoing
Continuous communication: timely
and objective information sharing
at national and local level,
involving concrete personal stories.
Involvement to planning.
Comprehensive, understandable
strategy and implementation plan
Moving out
from the
institution
 Analysis of the needs of clients and
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others involved (family)
Analysis of the resources in the
community
Design of alternative services
Plan for closing down the institution
and development of new services
Preparatory work with clients, staff
and the community
Move from the institution to the
community
Monitoring and evaluation of the
process
Principles of transition process
 Involvement of users
 Prevention of institutionalization
 Restriction of investment to institutions
 Development of community services
 Closure of institutions
 Effective use of all resources
 Development of human resources
 Control of quality
 Holistic coordination
 Continual awareness
Basic principles
 Catchment area responsibility
 Gate keeping
 Referral system
 Focusing and prioritizing
 Coordination structure across different
services and agencies
 Shared philosophy of care
 Allocation of money supporting change –
follows the client
 Quality monitoring and evaluation
 When not to count investments
Costs
running costs are the same as in
institutions
 For people with complex needs,
care is more expensive
 For people with moderate needs,
the cost is the same or lower
 Additional incomes from
employment of the clients
More coherent use of available EU funds
│ 22
Common Strategic
Framework
Partnership
Contract
Operational
Programmes
 Comprehensive investment strategy: aligned with Europe
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2020 objectives
Coherence with National Reform Programmes
Coordination: cohesion policy, rural development, maritime &
fisheries funds
Objectives and indicators to measure progress towards
Europe 2020 targets
Effectiveness: introduction of a performance framework
Efficiency: reinforcement of administrative capacity, cutting
red tape
EU Structural Funds as bridging fund for DI
(experience from pilot projects)
ERDF
ESF
 Housing facilities
 Analysis - policy
 Asylum and crisis centers
 Day program centers
 Mobile teams basis
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 Residential facilities
 Inclusive schools
 New use of buildings of
the institutions
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development
Methodology development
Awareness campaign
Training of new staff for
new services
Requalification of staff in
existing institutions
Specialized foster care
development
 Exchange a good practice in DI
Opportunities
 SF used for moving DI forward,
as bridging funds
 To create national pro DI task
force ( platform)
 CRPD framework to be used to
put DI as political, human right
agenda
 EEG can play a role in linking
local DI group together,
supporting DI lobbying, linking
with good practices and getting in
contact with EU commission
DI is about
balancing
among
different
obstacles but
keep smiling
Thanks for
your attention
For further information
 JAN PFEIFFER
 Mental Health Europe – Santé Mentale Europe
 Boulevard Clovis 7, B-1000, Brussels
 Tel. +32 2 280 04 68
 Fax +32 2 280 16 04
 www.mhe-sme.org
 Or
 md.jan.pfeiffer@gmail.com