Institutionalization has served as a prominent source of disability discrimination. In the early days of treatment for mental disabilities, people with disabilities were often institutionalized in government-sanctioned mental hospitals.[1] Perceptions of disability vary greatly between cultures. Western beliefs historically suggested that people with disabilities were “meager, tragic, pitiful individuals unfit and unable to contribute to society.”[2] Many African cultures believe that mental health disabilities are “caused by a curse or evil spirits.”[3] However, over the past decade, societal perceptions on disabilities have shifted; this shift has encouraged the expansion of community-based treatment for people with disabilities.[4] Community-based care provides people with disabilities the opportunity to receive healthcare services in the most integrated setting possible.[5] Proponents suggest that such care is more humane, therapeutic, and cost-effective than hospital care.[6]
The focus on disability rights has expanded over the past four decades; however, in various regions, people with disabilities are often precluded from receiving health care in integrated, community-based settings.[7] In many countries, the inability to receive community-based care has led to segregation from mainstream society, which significantly impacts people with disabilities.[8] To ensure that people with disabilities receive community-based healthcare, the United Nations should strengthen its enforcement of the U.N. Convention on the Rights of Persons with Disabilities and work alongside non-governmental organizations (“NGOs”) to encourage the establishment of community-based treatment.
On December 13, 2006, the United Nations adopted the Convention on the Rights of Persons with Disabilities.[9] The convention created specific guidelines for countries to follow to increase accessibility for people with disabilities, minimize disability discrimination, and decrease societal stigma around disability.[10] Parties to the convention recognize that people with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability.[11] State parties are required to take all appropriate measures to ensure persons with disabilities have access to health services that are gender-sensitive, including health-related rehabilitation.[12] States are further required to provide these health services as close as possible to people’s own communities, including in rural areas.[13]
The UN Convention on the Rights of Persons with Disabilities was a monumental recognition of disability rights; the Convention notably recognized the importance of community-based treatment options for people with disabilities.[14] However, many signatory countries lack community-based treatment options for people with disabilities.[15] In most countries, non-community-based care leads to individuals with disabilities being placed into institutional settings.[16] For example, the United Kingdom has recently faced criticism for the involuntary, compulsory treatment and detention of people with disabilities inside and outside of hospitals.[17] Croatia’s 2015 report to the UN Convention, and a Human Rights Watch Report, showed that more than eight thousand people remained in institutions, in many cases without their consent.[18]
Institutionalization, as it is commonly understood, is not the only threat to the rights of persons with disabilities.[19] Throughout the world, individuals with mental health disabilities or psychosocial disabilities are often shackled, which not only segregates them from society, but chains them in a room for up to a year at a time.[20] In a 2020 report, Human Rights Watch found evidence of shackling in sixty countries across Asia, Africa, Europe, the Middle East, and the Americas.[21] Because shackling is “among the most egregious, archaic, and rudimentary forms of physical restraints,” Human Rights Watch has encouraged the UN Committee on Disabilities to adopt language that would end this practice.[22] Despite this recommendation, this inhumane practice continues in many countries.[23]
Community-based treatment provides effective treatment options without unnecessary segregation.[24] In Canada, for example, offering free community-based treatment services for people with mental health disabilities has served as an effective mechanism to prevent involuntary hospitalization and forced treatment.[25] Community-based treatment services provide undeniable benefits to people with disabilities; because of this, the United Nations and member countries should work alongside NGOs to increase funding for community-based treatment services.
[1] How America’s Mental Health System Evolved, The CHAS Foundation, https://thechasfoundation.org/how-americas-mental-health-system-evolved/ (last accessed Dec. 29, 2024).
[2] A Brief History of the Disability Rights Movement, Anti-Defamation League, (Nov. 22, 2024), https://www.adl.org/resources/backgrounder/brief-history-disability-rights-movement [hereinafter Disability Rights Movement History].
[3] https://www.hrw.org/news/2024/07/12/ghana-submission-un-committee-rights-persons-disabilities.
[4] See The Importance of Community Integration for People with Disabilities, UDS Foundation (Mar. 2, 2021), https://udservices.org/community-integration-people-with-disabilities/#:~:text=UDS%20Care%20Manager-,What%20is%20Community%20Integration?,them%20to%20their%20disability%20label.
[5] Id.
[6] H. Richard Lamb & Leona L. Bachrach, Some Perspectives on Deinstitutionalization, 52 Psychiatric Services 1039, 1040 (2001).
[7] See Melanie Greaux et al, Health Equity For Persons With Disabilities: A Global Scoping Review On Barriers And Interventions In Healthcare Services, 23:236 Int’l J. Equity Health 1, 4 (2023).
[8] Id. at 10.
[9] Convention on the Rights of Persons with Disabilities, United Nations Department of Economic and Social Affairs, https://social.desa.un.org/issues/disability/crpd/convention-on-the-rights-of-persons-with-disabilities-crpd (last accessed Mar. 21, 2025).
[10] G.A. Res 61/106, art. 25(c). (Dec. 12, 2006).
[11] Id.
[12] Id.
[13] Id.
[14] Id.
[15] See generally One Billion People with Disabilities and Older People Leading Change Around the World, Human Rights Watch (Oct. 16, 2023), https://www.hrw.org/video-photos/interactive/2023/10/16/one-billion-people-with-disabilities-and-older-people-leading-change-around-the-world.
[16] Id.
[17] UN Body Calls on UK to End Detention of People with Disabilities, Human Rights Watch (Apr. 4, 2024, 8:54AM), https://www.hrw.org/news/2024/04/04/un-body-calls-uk-end-detention-people-disabilities.
[18] Croatia: UN Calls for Critical Disability Rights Reforms, Human Rights Watch (Apr. 27, 2015 12:00AM), https://www.hrw.org/news/2015/04/27/croatia-un-calls-critical-disability-rights-reforms.
[19] https://www.hrw.org/sites/default/files/media_2020/10/global_shackling1020_web_1.pdf (39).
[20] Id.
[21] Id. n. 9.
[22] Living in Chains Shacking of People with Psychosocial Disabilities Worldwide, Human Rights Watch (2020), https://www.hrw.org/news/2022/07/07/human-rights-watch-submission-committee-rights-persons-disabilities-draft#_ftnref10.
[23] See Indonesia: Submission to the UN Committee on the Rights of the Child, Human Rights Watch (Mar. 27, 2024, 11:50AM), https://www.hrw.org/news/2024/03/27/indonesia-submission-un-committee-rights-child; Ghana: Submission to the UN Committee on the Rights of Persons with Disabilities, Human Rights Watch (Jul. 12, 2024, 8:50AM), https://www.hrw.org/news/2024/07/12/ghana-submission-un-committee-rights-persons-disabilities; India: End Lifelong Warehousing of People with Disabilities, Human Rights Watch (Jan. 28, 2024, 6:00 PM), https://www.hrw.org/news/2024/01/28/india-end-lifelong-warehousing-people-disabilities; Togo: Submission to the UN Committee on the Rights of Persons with Disabilities, Human Rights Watch (Feb. 21, 2023, 4:00AM) https://www.hrw.org/news/2023/02/21/togo-submission-un-committee-rights-persons-disabilities.
[24] Mental Health Crisis Support Rooted in Community, Human Rights Watch (Nov. 15, 2023, 10:00AM), https://www.hrw.org/news/2023/11/15/mental-health-crisis-support-rooted-community.
[25] Id.
