Deinstitutionalisation of children with disabilities in Europe

In February 2010 the Committee of Ministers of the Council of Europe, the body where the member states of the Council take decisions, adopted Recommendation CM/Rec(2010)2 on deinstitutionalisation and community living of children with disabilities. It was addressed to all member states and it said something that should not have needed saying: if a child with a disability cannot live with their own family, the answer is another family, not an institution.

The Recommendation builds on instruments that were already binding on most of those states, among them the UN Convention on the Rights of the Child, the European Convention on Human Rights and the revised European Social Charter. It sets out that children with disabilities have the same right to family life, to education and to health care as other children, and that placement in residential institutions should end, with community-based services put in place first rather than afterwards.

Sixteen years later it remains one of the clearest statements on the subject, and one of the least implemented.

Why institutions are the wrong answer even when they are well run

The argument is often heard as a criticism of staff, and it is not. The evidence on institutional care of young children concerns the setting rather than the intentions of the people working in it.

Children raised in institutions show measurable delay in cognitive and language development and in physical growth, and elevated rates of attachment disorder. The mechanism is structural: a rotating staff at institutional ratios cannot provide the individual responsiveness that early development depends on, however committed each person is. The effects are largest for the youngest children and for the longest placements, which is why the strongest formulations across European guidance concern children under three.

Segregation compounds it. A child placed in an institution is usually also placed outside the mainstream school system, which pushes the inclusive education question out of reach at the same time, and removes the ordinary social contact that would make later community living workable.

What the CRPD adds

Article 23 of the CRPD requires states to prevent concealment, abandonment, neglect and segregation of children with disabilities, and to provide early and comprehensive support to children and their families. It also requires that where the immediate family cannot care for a child, states make every effort to provide alternative care within the wider family, and failing that within the community in a family setting.

Article 19 covers the same ground for adults and is set out on our page on independent living. General Comment No. 5 makes the point that institutions are defined by their regime rather than their size: compulsory sharing of assistants, no choice over who provides support, no control over daily decisions, isolation from the community. A small facility with those features is an institution. This matters because a common reform pattern is to close a large institution and open several small ones with the same rules, and report it as deinstitutionalisation.

Where the money goes

The most-used lever in the EU has been funding conditions. European structural and investment funds are meant not to finance institutional care, and to support the transition to community-based services instead. Independent monitoring has repeatedly found EU funds nonetheless flowing into the renovation or construction of residential institutions, sometimes described as modernisation.

That is the recurring failure mode. Transition requires community services to exist before the institution closes: family support, personal assistance, respite, accessible housing, inclusive schooling. Where the services are not built first, closure produces re-institutionalisation elsewhere or families left without support, and the resulting political backlash slows everything down.

What has changed and what has not

Several central and eastern European states have closed large children’s institutions and built foster care systems, in some cases reducing residential placement of young children dramatically within a decade. Those are real results and they were driven by a combination of EU funding conditions, litigation and domestic advocacy.

Two problems have proved stubborn across the whole region, including in western Europe.

The first is that children with the most complex support needs are the last to leave and are often excluded from the transition entirely, on the argument that their needs cannot be met in a family setting. That argument is what the Recommendation was written against.

The second is definitional. Placements described as educational, therapeutic or medical rather than as care sit outside the count. A residential special school and a long-stay paediatric unit are not always recorded as institutional placement, and a country can report progress while the number of children living away from a family remains flat.