10 October 2014

Slow progress on community living in Central and Eastern Europe

Today on World Mental Health Day, MDAC has published snapshot reports on three countries where we have been working for many years: Bulgaria, Czech Republic, and Hungary. The reports provide NGOs and governments with clear evidence that all three countries are falling short on their commitments to shift people with mental health issues and people with intellectual disabilities out of institutions and into communities. The core rights of autonomy and the choice of where and with whom they live – things which the majority of us take for granted – are denied. The government in each country has made numerous commitments, but in reality very little has changed, and very few people with mental disabilities have regained their rightful position in our communities.

MDAC works for community living for people with mental disabilities. Photo: Aneta Genova, Lawyer, with our Bulgarian client Rusi Stanev © MDAC

For decades, the phenomena of dumping people with mental disabilities into grotty, far-away institutions has been deeply embedded in the public psyche and in public law. All three countries have had six years since the entry into force of the UN Convention on the Rights of Persons with Disabilities (CRPD) to make changes to their laws, policies and practices. The CRPD says that governments need to take steps to prevent segregation and isolation from the community. It says that everyone has the legal right to live in the community, with supports they need.

We have taken the CRPD’s provisions on independent living and turned them into 17 indicators. We’ve then looked at the situation in the three countries to measure progress against the indicators. We have found:

The Czech Republic has taken some steps to ‘deinstitutionalise’ people in 40 institutions across the country, but progress has been slow, and the process has not been led and informed by people with mental disabilities themselves. Over 100,000 people remain in institutions, and the government does not have a comprehensive national programme to close all social care institutions. There has been no concrete change in people with mental health issues who continue to be detained in large, outdated and abusive psychiatric facilities (see also our recent report on Cage beds and coercion in Czech psychiatric institutions).

Read My Home, My Choice in the Czech Republic here (English) and here (Czech)

Bulgaria came up with numerous strategies on deinstitutionalisation, but only 100 adults have actually left institutions in recent years. Smaller ‘group homes’ have been established, but many of these are on the grounds of existing large institutions – and sometimes, they are simply rooms which have been legally designated as such in old social care institutions. While there has been progress in cutting the numbers of children in institutions, the government fails to release progress reports on numerous plans, and as yet has still not implemented reforms to guardianship in the country.

Read My Home, My Choice in Bulgaria here (English) and here (Bulgarian)

Hungary has done nothing to evacuate the 25,000 people with disabilities warehoused in institutions. In fact, it is using European money to transfer less than 700 people with mental disabilities to new segregating institutions, mainly to ‘group homes’ which deny residents their right to autonomy. This year, the government was proud to announce that it had adopted a new law on ‘supported decision-making’. What they failed to mention is that ‘support’ can be imposed by the law, and ‘supporters’ are officials appointed by the guardianship authority – and in some cases can ‘support’ up to 40 people.

Read My Home, My Choice in Hungary here (English) and here (Hungarian).


All of the three countries continue to invest significantly more money to the refurbishment and maintenance of residential institutions compared to the money spent on improving the quality and capacity of community-based services.

Earlier this week, MDAC shared the reports with members of the UN Committee on the Rights of Persons with Disabilities. On World Mental Health Day, it is crucial that civil society in these countries and worldwide continue holding governments to account for failing to ensure the inclusion of people with disabilities in our societies.


The reports were supported by a grant from the Open Society Foundations.