Thursday, November 4, 2010

Are we creating new institutions for people with disabilities?

by Noelin Fox

On October 20th John Moloney, Minister of State for Health officially opened ten new houses for people with intellectual disability in the ground of St Ita’s psychiatric hospital in Portrane, County Dublin. The houses will provide accommodation to 60 people with intellectual disability who are long-term residents of St Joseph’s Intellectual Disability Services in the hospital. The need to provide more appropriate accommodation for people with intellectual disability housed in the State’s long stay psychiatric facilities has been recognized for several years by the HSE and the Department of Health and Children. In addition the families of people living in St Ita’s have campaigned for many years for proper accommodation for their family members. As such, this development must be welcomed as a vast improvement on the conditions which pertained in the hospital. The development is part of a wider deinstitutionalization strategy articulated in the government’s mental health policy document, A Vision for Change. The strategy aims to see an end to all of the older long-stay psychiatric hospitals in the State and their replacement by community-based alternatives for people with mental illness and people with intellectual disability. Minister Moloney in his address stated that the work completed in St Ita’s would be replicated throughout the country.

There are some aspects of this development which are worrying. It is widely recognized that large institutional settings represent a breach of the fundamental human rights of residents. However, can we be sure that newer more modern buildings, which accommodate groups of people with disability, in the ground of these old institutions represent the opposite? Are the State’s obligations to promote and protect the human rights of individuals being realized in these newer settings? Ireland has signed up to several international treaties enumerating these rights – at UN level these include the International Covenant on Economic, Social and Cultural Rights (CESCR). Most recently Ireland has signed, but not yet ratified the UN Convention on the Rights of Persons with Disabilities – the government has signaled its intention to ratify the CRPD when new legal capacity is passed.

1. Right to Adequate Housing:
In terms if human rights the right to adequate housing is recognized in the CESCR at Article 11. This convention explicitly applies to everyone and defines the right to ‘adequate housing’ as including not just an assurance that housing will be habitable but also that people have security of tenure and that it be located so as to ensure access to employment options, health-care services, schools, child-care centres and other social facilities. (See UN Office of the High Commissioner for Human Rights, The right to adequate housing (Art.11 (1)) : 13/12/91. CESCR General comment 4. (General Comments)). Does the new development provide security of tenure? Does the location ensure access to community facilities?

2. Congregated Settings Report
The report of the HSE ‘Congregated Settings’ working group Time to Move on from Congregated Settings: A Strategy for Inclusion is due to be published over the coming months. The key tasks of this group were to identify the numbers of people with intellectual disability living in congregated settings, to outline a framework to guide the transfer of people to the community based on international best practice and to identify the likely costs of this. From the point of view of the development in Portrane and its proposed replication across the State it is significant that the report (which was due to be published at the end of 2009 and was leaked to the media in July this year) defines a congregated setting as one where ten or more people share a single living unit or where the living arrangements are campus-based. The building of accommodation in the grounds of an existing psychiatric hospital or other institution must raise questions about the level of integration possible with the local community. Does this represent just another form of segregated housing for people with disability – albeit of a higher physical standard?

Although Ireland has not yet ratified the CRPD the intention is that this will happen in the not too distant future. Article 19 of the CRPD defines the Right to Independent Living and Inclusion in the Community. The core elements of this are the right to choose where and with whom to live and not to be obliged to live in any particular living arrangement and the right to supports to ensure access to community. Although the people moving to the new houses in Portrane had choice about whom among their fellow residents they wished to live with, this surely is a very limited choice. It is questionable whether a policy of building residences to accommodate groups of people with disability in the grounds of old institutions can ensure that the States obligations under Article 19 of the CRPD will be met. Can such arrangements ensure that people have real choice about where they live or with whom? Are ex residents not obliged to live in the new houses built for them? Can such housing ensure that people have access to the local community?

There is a real danger that in moving people from large institutions to alternative grouped living arrangements, especially where these are located in close proximity to existing institutions, that we will create new mini-institutions which replicate many of the features of the old, and which will have to be deconstructed in years to come. The challenge facing us is how do we take account of the real wishes and needs of people with disability who have been institutionalized for many years and ensure that they can lead the lives of their choosing in the community. A first step in this must be providing access to mainstream housing in the community. One must ask why we are building more ‘special needs’ housing when there is a surplus of regular housing available in regular communities. The provision of specialized or generic community-based supports to enable people to live in their own home will involve a re-examination of how such supports are currently configured.