A wide-spread problem, with grave consequences
Persons with disabilities are overrepresented in mainstream detention settings, such as prisons and immigration detention centres. While an estimated 15 per cent of the global population live with disabilities, they represent, in many countries, as much as half of the prison populations.
In addition, they face some forms of deprivation of liberty that are disability-specific. The most common include involuntary hospitalization in mental health facilities, placement in institutions, internment in forensic psychiatric wards, forced treatment in “prayer camps” and home confinement. All these forms share common characteristics and justifications that stem from the medical model of disability, which suggests the need for “specialized care” in specialized institutions, not in the community. The reality is that persons in these situations and settings become extremely vulnerable to sexual and physical violence, sterilization, human trafficking, and many other forms of torture and abuse.
Children with disabilities are particularly vulnerable to institutionalization. Millions are confined to isolation in institutions, segregated from their families and communities. They are routinely locked, forced to take medication and often exposed to torture, abuse and neglect. The detrimental effects of institutionalization on their development, even when placed in small residential homes or “family-like” institutions, have been vastly demonstrated.
Without legal avenues to challenge their situation, persons with disabilities deprived of their liberty become invisible and forgotten by the wider community. Indeed, due to the mistaken belief that those practices are well intentioned and beneficial, their situation and well-being is hardly monitored by national preventive mechanisms or human rights institutions.
Causes: Misperceptions and access to services
While people commonly believe that reasons behind the deprivation of liberty are related to the person’s impairment, the underlying causes are largely social. Stigma and misconceptions often lie at the root of the various forms of deprivation. The need for “specialized care”, which can only be provided in institutions is most common, but cultural or religious beliefs can also play an important role. Persons with disabilities may be accused of being possessed by evil spirits, or being impaired as a result of sin or witchcraft, making families feel ashamed, and prompting social rejection and segregation. In some cases, impairments are believed to be contagious, prompting their confinement away from the rest of the community.
In many countries health and social care professionals encourage parents to place their children with disabilities in institutions under the wrong assumption that they will receive better care than at home. This enables a system of essential services that are removed from the community: Families send their children with disabilities to special boarding schools or vocational centres because there is no other way available to ensure their education. Similarly, many persons with disabilities are placed into residential institutions as a way to access social protection benefits.
In their most pernicious forms, misperceptions about persons with intellectual or psychosocial disabilities characterize them as dangerous and prone to violence. This is a worrisome trend, which translates into legislation that criminalises atypical behaviours like yelling or self-injury, as well as public displays of poverty--lack of maintenance of properties, or homelessness. In some cases, situations of non-compliant behaviour by persons with autism, deaf, or with epilepsy have been considered as threatening by enforcement officials, leading to violence and prosecution.
Going forward: solutions to prevent the deprivation of liberty of persons with disabilities
Deprivation of liberty is a product of the accumulated structural discrimination suffered by persons with disabilities, which can be traced to States' inaction in implementing their fundamental rights. In the absence of legal capacity or access to justice, and without appropriate support or livelihoods, persons are sent to institutions and mental health facilities as if there were no other option.
Ending the deprivation of liberty on the basis of impairment requires a series of commitments by States and all stakeholders. These can be summarized as:
- Law Reform, including repeal all legislation that allows for deprivation of liberty on the basis of actual or perceived impairment, and the criminalisation of homelessness or disability;
- Deinstitutionalization: A process of deinstitutionalization should consider a moratorium on new admissions and should include psychiatric institutions. States must take immediate action to end deprivation of liberty within private and/or faith-based institutions, such as orphanages, small group homes, rehabilitation centres and prayer camps, and to end home confinement and shackling.
- End coercion in mental health: States should invest in community-based responses, including peer-led services, and support services for persons experiencing crises.
- Access to justice: persons with disabilities who have experienced arbitrary deprivation of liberty, exploitation, violence or abuses should be able to access adequate redress and reparations, and the restitution of their liberty.
- Community support: education, health care, employment, housing and other community services, must be inclusive of and accessible for persons with disabilities. They should also be able to choose where and with whom to live, and not be forced into a particular living arrangement.
- Ensure participation and adequate resources: Participation of persons with disabilities and their representative organizations in the planning, implementation and monitoring of programs, services and legislative changes, as well as adequately resourcing them are essential for their success.
A research team of the Melbourne Social Equity Institute is examining alternatives to coercive practices to ensure people experiencing mental health crises are treated with dignity and respect. Their literature review "Alternatives to coertion in mental health settings" is a systematic review of global practices that aim to reduce, prevent and end coercive practices in mental health settings. Download report.