Dr Ágnes Kozma Hungary / Tizard Centre, University of Kent, UK Violence against persons in institutional living arrangements Human Rights: a Reality of All conference March, 27-28, 2017 Nicosia, Cyprus Dr Ágnes Kozma Hungary / Tizard Centre, University of Kent, UK

What are institutional living arrangements? Institutions are not defined by their size but by their ‘institutional culture’. Institutions are places where residents: are physically and / or socially isolated from the broader community; forced to live together; do not have sufficient control over their lives and over decisions which affect them; The requirements of the organisation take priority over the residents’ needs (leading to rigid routines, block treatment, depersonalisation, dehumanisation). European Expert Group on the Transition from Institutional to Community-based Care: Common European Guidelines, (p. 25)

How many people live in institutions? Research* suggests at least one million people with disabilities live in institutional living arrangements in Europe. Most countries do not collect adequate data on institutions. Even where services are smaller or ‘community-based’ people are not necessarily having good lives. * DECLOC (2007): https://www.kent.ac.uk/tizard/research/DECL_network/documents/DECLOC_Volume_2_Report_for_Web.pdf * Mapping Exclusion (2012): http://www.mhe-sme.org/fileadmin/Position_papers/Mapping_Exclusion_-_ind.pdf * Included in Society (2004): http://www.enil.eu/wp-content/uploads/2012/07/ECCL_Included-in-Society.pdf

What do we know about violence in institutional living arrangements? Can be perpetrated by staff or service users. Some well-documented forms of violence: Use of seclusion and mechanical restraint, such as caged beds, seclusion rooms, straps etc.* Very widespread use of psychoactive medication (pharmacological restraint).** Physical and psychological violence. Sexual abuse/violence against women and men. However, no systematic and reliable data. Very high latency, violence is often exposed by the media. * MDAC reports (2003, 2014) http://www.mdac.info/en/cage-beds * Kopasz et al. (2016). http://www.tarki.hu/en/news/2016/items/20160408_fszk_meth_en_summ.pdf Caged beds: MDAC reports (2003, 2014) http://www.mdac.info/en/cage-beds Psychoactive medication: a recent study in Hungary found that people in institutional living arrangements were significantly more likely to take psychoactive medication: 85% in institutions compared to 45% in smaller group homes and 31% in private households. Among people with more severe intellectual disabilities these figures were even more alarming: 93%, 68% and 35%. Data refers to people with no reported psychiatric diagnosis.

Why does it happen? Important to recognise the systemic / organisational / societal factors in institutional violence. The nature of these settings and the status of individuals: segregation, deprivation of legal capacity, many vulnerable people, lack of adequate support, hierarchical and bureaucratic systems, dehumanisation. Inward looking services, inadequate management, lack of training etc.

What can be done? Institutions must be replaced with support and services that enable people to live in the community. Substituted decision-making systems must be replaced with supported decision-making. Systems to prevent and detect violence must be created or strengthened.

Thank you for your attention! Contact: A.V.Turnpenny@kent.ac.uk