Abstrakt
Since 2009, numerous stakeholders at European and national level have been working on promoting social inclusion, combating poverty and discrimination, and making the shift from institutional to community-based care a reality for a variety of target groups in European countries. There is strong evidence from research over many decades that community-based alternatives can provide better outcomes.
In addition, costly improvements in the physical conditions of existing institutions or the division/redesign of existing institutions into smaller units fail to change the institutional culture and make it more difficult to close these institutions in the long term. Previous research showed that such an institutional culture is often still present in smaller community-based residential services and relatively resistant to change even in the countries that started the process of deinstitutionalisation much earlier than others.
The report of the Ad Hoc Expert Group on the Transition from Institutional to community-based Care noted the difficulties in defining what an institution is and focused instead on institutional culture. They use the following definition in the report: "any residential care where: users are isolated from the broader community and/or compelled to live together; these users do not have sufficient control over their lives and over decisions which affect them; .the requirements of the organisation itself tend to take precedence over the users' individualised needs." The aim of this report was to collate information about policies and plans, changes over time, strengths and areas of concerns relevant to advancement tin deinstitutionalisation in 27 EU countries and for six target groups: adults with disabilities, adults with mental health problems, children (including children with disabilities), unaccompanied or separated migrant children, homeless persons and older adults.
Considering policy and systems relevant to adults with disabilities, children, adults with mental health problems and older adults, no country had specific policy (legislation or strategy papers) covering all four of these groups although Romania and Hungary were the closest to doing so. In most countries, specific policies applied to only one or two groups (most commonly adults with disabilities and children) or reference to transforming services and deinstitutionalisation was more indirectly referenced in general policies.
Policy in Spain appeared to make no specific reference to deinstitutionalisation and community living for any of the four groups.