Opinion: Both France and Belgium should change their model of care

Recently we have seen a sudden outburst of media attention to the well-known fact that France is sending thousands of persons with disabilities to care institutions in Belgium. As usual, however, there is a risk of superficiality. Although the issue of material conditions in these institutions is important, and although there is a clear need for standards and their enforcement, we risk missing the deeper question if we only focus on material conditions. The 'scandal' should provide an opportunity for a real policy debate. Why do both countries, France and Belgium, continue putting so many people with disabilities into residential institutions? Shouldn’t they be investing in community-based alternatives instead?

Indeed, they should! The Convention on the Rights of Persons with Disabilities, ratified by both States over the last few years, stipulates that persons with disabilities have the right to live independently and to be included in the community. In fact, long before the Convention came into being, many European states (such as most of the Nordic countries) have been systematically replacing institutional-type services with community-based services.

For four years, our office has been part of a coalition that stimulates similar developments in states of Central and Eastern Europe, where the institutional model has long been dominant. The aim is to allow people with disabilities to live in their own homes, in their own communities, close to their families, with adequate support according to their needs.

The whole philosophy of the UN Convention is one in which people with disabilities are active subjects, holders of rights, and not just passive objects of care. Sending them from to one country to be warehoused in another just because of lower costs is not merely incompatible with the emphasis of the Convention on inclusion in the community – it also shows that the persons with disabilities are treated as objects. From the EU perspective of four freedoms, such a transaction resembles free movement of goods rather than of persons. The emphasis on cost-effectiveness as something that overrides human rights and quality of life is problematic.

Finally, apart from the staggering numbers of French persons with disabilities placed in Belgian institutions, reportedly over 6,000, the media also mentioned that there are some 10,000 Belgians in institutional care in their own country. That in itself is a major issue which needs to be addressed. The European Commission has issued a country-specific recommendation to Belgium to develop community-based alternatives to long-term care but it has also done so only under the heading of cost-effectiveness. That is rather unfortunate.

True, community-based alternatives might end up being cheaper than institutions in the long run.  But the process of de-institutionalization cannot be done as a cost-cutting exercise because that would risk replacing institutional care by too little care or no care at all. Affluent societies which have made a commitment to human rights must be ready to finance such services as are necessary to enable persons with disabilities to enjoy the maximum autonomy, the highest possible level of inclusion in the community, and the full spectrum of their human rights.

Jan Jařab, regional representative for Europe of the UN High Commissioner for Human Rights.

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