The prosecutor general in Bulgaria has initiated criminal investigations into 166 deaths and 30 more cases of abuse of children living in state homes for young people with mental disabilities. This was an important signal not only for the Bulgarian authorities but for several other states with similar old-style institutions for children or adults.
In Europe today, thousands of people with disabilities are still kept in large, segregated and often remote institutions. In a number of cases they live in substandard conditions, suffering abject neglect and severe human rights abuses. In too many cases, premature deaths are not investigated or even reported.
Caged beds and other restraints are still used in a number of Council of Europe member states to keep persons with disabilities “under control”. Too little has been done to prevent this and other kinds of abuse and inadequate care in institutions, hidden from public scrutiny. There is an atmosphere of impunity surrounding these violations.
Persons with disabilities are placed under guardianship and have their legal capacity removed. In a number of cases they are detained, deprived of their liberty - sometimes without these decisions being subjected to judicial review. This is not acceptable.
In fact, any detention must be exceptional, brief, closely monitored and only decided when absolutely necessary to protect the life and security of the patient and others.
The right to independent living
The landmark UN Convention on the Rights of Persons with Disabilities defines standards which should be used for a roadmap towards better treatment of people with disabilities. It questions the very existence of these large institutions.
Persons with disabilities, including people with mental health problems or intellectual disabilities, should instead have the right to independent living and to participate in the community. The same approach is taken in the Council of Europe Action Plan 2006-2015 to promote the rights and full participation of people with disabilities in society.
De-institutionalisation has been seriously tried in some countries. In Albania, I noticed that the process of moving persons to community and family-based housing has had some satisfactory results. In the “former Yugoslav Republic of Macedonia” and Serbia ambitious plans for such reforms have also been adopted.
However, since several European countries still lack a system for community-based services, it will take time before large psychiatric and social care institutions are phased out. Thus it is all the more important that those remaining be under regular scrutiny.
Thorough, effective and independent monitoring
It has to be recognised that persons detained in psychiatric and social care institutions are extremely vulnerable. Considering their limited possibility to communicate with the outside world, states have an obligation to set up and support truly independent national monitoring bodies, and to ensure adequate resources for such bodies.
Any reports of ill treatment in psychiatric hospitals must be thoroughly and effectively investigated – in order to prevent and remedy torture, inhuman and degrading treatment or punishment of people in institutions in Europe today. As the initiative of the Bulgarian prosecutor indicated, we cannot accept impunity for violations of the rights of the most vulnerable.