WHO assessment identifies key areas of action for adults with mental disabilities living in institutions


The 14 countries represented at the meeting in Lisbon were: Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Georgia, Latvia, Lithuania, Portugal, Romania, Serbia and Ukraine.

An intercountry meeting co-organized by WHO/Europe and the Lisbon Institute of Global Mental Health identified key areas of action in the fields of mental health and human rights. The event, held in Lisbon, Portugal, on 20–21 November 2017, brought together government representatives and national experts from 14 participating countries as well as WHO experts and partners from the Picker Institute Europe. It presented the opportunity to share experience, assess progress and plan future collaboration.

5 key areas for action

Country presentations and panel discussions led to the identification of 5 key areas where action is needed:

  1. knowledge/awareness about mental health and human rights protection, in particular concerning the legal mechanisms through which people with psychosocial disabilities can exercise their legal rights and capacities, for example, through complaints procedures;
  2. a personalized approach to care, for example, through meaningful recovery plans that promote and enable an individual’s integration into community life;
  3. rehabilitative and recreational activities within institutions (residents often have nothing to do and lack opportunities for learning or acquiring skills that might provide them with an occupation);
  4. legal provisions or legal defence/representation for people living in long-term institutions (shared decision-making practices are virtually absent in facilities); and
  5. community alternatives for people living in long-term institutions, such as independent housing, to prevent unnecessarily long stays and present opportunities for living an independent life outside of an institution.

WHO project on adults with mental disabilities living in institutions

The intercountry meeting focused on reviewing the results of a series of country assessments conducted in 2017 as part of the second phase of a WHO project on adults with mental disabilities living in institutions.

Across the WHO European Region, hundreds of thousands of people with psychosocial and intellectual disabilities still live in large institutions. The countries facing the greatest challenges are undoubtedly those of central and eastern Europe, where Europe’s largest institutions are found and where, in many cases, deinstitutionalization has hardly begun.

To address the issue of institutional care, WHO launched the project on adults with mental disabilities living in institutions in 2015. The first phase of this region-wide effort collected the most accurate and complete data possible on the number and characteristics of institutions providing long-term care for adults with psychosocial and intellectual disabilities.

The project is now in its second phase, which focuses on assessing quality of care and observance of human rights in a sample of institutions in 25 participating countries using the WHO QualityRights toolkit.

An anonymized regional report on institutions providing long-term care for adults with psychosocial and intellectual disabilities in the Region will be published in the second quarter of 2018.

Planning the way forward

The findings from these institutional assessments reveal many common issues in countries, which could become a solid platform for moving this work forward at the national and/or intercountry level.

Immediate next steps should include:

  • formalizing the liaison with relevant ministries in the planning and execution of activities;
  • developing and implementing an improvement plan for services in institutions; and
  • training staff in human rights protection, recovery-oriented care, supported decision-making and alternatives to seclusion, restraint and other coercive practices.