The Charm Toolkit Piloted Findings from Monitoring Visits: Bulgaria, Czech Republic, Hungary and United Kingdom

Dr Sarah Woodin - Mental Disability Advocacy Centre, Ann Craft Trust, Global Initiative on Psychiatry, The League of Human Rights


Experiences of abuse and violence have devastating consequences for children, and in some cases, these consequences are lifelong. Loss of trust, feelings of rejection and abandonment, trauma, fear, anxiety, insecurity, and shattered self-esteem are just some of the impacts of ill-treatment on the wellbeing of children. Consequences are far-reaching, extending well into adulthood, and they include increased prevalence of mental health issues, a higher likelihood of experiencing violence from a wider range of perpetrators and high socio-economic impacts and costs. Further, children with disabilities are one of a number of groups of marginalised children who are at a higher risk of violence, with an estimated fourfold likelihood rate compared with children without disabilities, and children with psycho-social disabilities and/ or intellectual disabilities have a 4.6% prevalence rate of sexual violence. It is well established that being placed in an institution also substantially increases the risk of children experiencing violence as well as discrimination, stigma and a lack of social support.

Violence in European institutions has been consistently reported for over a century. Comprehensive international research has provided evidence of widespread sexual, psychological and physical abuse, while national reports by human rights organisations as well as government-funded research continue to document the issues.

Development towards community living varies between EU countries and there are a range of political priorities. In Central and Eastern European countries, for example, Bulgaria, the Czech Republic and Hungary, institutional care persists as the default option for children with disabilities. High profile media attention has exposed the abusive treatment typical in many institutions despite concerted efforts to combat it. More targeted use of funding streams, such as EU Structural and Investment Funds, to support community living still has a considerable way to go.

In other countries, such as the UK for example, where deinstitutionalisation has been taking place for longer, far fewer children with intellectual disabilities are now placed in institutions compared to past decades. Attention has shifted to a focus on violence arising in the family, with accompanying pressures on monitoring services to keep children safe. At the same time, a significant number of children are placed in mental health assessment and treatment units, where abuse has been, and continues to be, the focus of campaigning by families for improved care.

Monitoring teams noted both positive and negative (abusive) practices in institutions. However, a significant number of reports from Bulgaria, the Czech Republic and Hungary document violence in all its forms, in particular neglect, and physical and psychological forms of violence. In many institutions, conditions were harsh, often with little or no regard for the uniqueness and individuality of children. Restraint and overuse of medication were frequently reported. Some very serious violent incidents and violations of human rights were recorded by some monitoring teams, and evidence is given in the more detailed full report that accompanies this summary.

In contrast, British monitoring teams said that they found an absence of violence in the residential schools visited and that challenging behaviour appeared to be primarily understood as a manifestation of distress by the young people involved. Staff responses were considered by the teams to be appropriate and supportive of children, and in some instances, where it was appropriate, good links were retained with families.

In all four countries, there were reports that many children had experienced trauma and sometimes violence in the past, either in families and/or in institutions. In most instances these issues were not adequately addressed, although British monitoring teams suggested that the issues were met with therapeutic approaches and professionalism.

It is important to neither over-claim nor under-claim the findings from the monitoring visits. In the scope of the project, the institutions visited could not be a representative sample of all places where children are placed in any of the countries. However, the damaging environments described in the reports are a serious concern that needs urgent attention.

Marked differences were apparent in the staffing and resources available in Central and Eastern European institutions compared with those in the UK. Bulgarian, Czech and Hungarian teams often reported staff shortages, burnout, a lack of training and low pay. In contrast, UK institutions were well-resourced, with many children accompanied by their own one-to-one keyworker.

There is considerable evidence that institutions exist in situations where there is a lack of social support for families. Disadvantaged children, especially children with disabilities and Roma children, are more likely to be institutionalised, due to a combination of factors. Children living in poverty have higher rates of institutionalisation and families may face a stark choice between managing alone and putting children in an institution, despite the presence of some as yet underdeveloped community support services. The social stigma of bringing up a child with disabilities is often a “push factor” towards institutionalisation, especially where there is added pressure from professionals to take this course of action.

In the UK, despite the longer history of deinstitutionalisation, there remain persistent problems with the institutionalisation of young people with labels of autism and “challenging behaviour”. Recent years have seen weakening provision of community support services, as budget cuts have affected local authority-funded services. The places visited by UK teams in this project were well-resourced institutions, ostensibly providing good quality care. Nevertheless, there are very evident problems in the UK. The NHS England report, Winterbourne View – time for change, is clear about including children as well as adults in calling for deinstitutionalisation, “supporting children, young people and adults in the community to prevent admissions in the first place” and about the need for improved family support.

In all countries, community support services need to be strengthened significantly to prevent the establishment and continuation of institutions and to ensure that children with disabilities enjoy the right to take part in all aspects of community living throughout life. At the least, steps need to be taken to ensure that institutions are not perpetuated, and that funding, especially that from the EU, is no longer used to this end. Funding should be re-directed to ensure community participation in the context of family life.

Monitoring teams considered the courses of action open to children who needed redress and the extent to which they were used. Means of lodging complaints included the use of anonymous complaints boxes and the existence of information posted on walls about external sources of help, such as independent advocates and helplines for children. Interpersonal ways of resolving problems were also considered, including resolution of problems through informal discussion with staff, through formal meetings where these were held, meetings with external advocates and contact with family members.

Overall, very few children made complaints that were formally recorded, and to the knowledge of visiting teams, there were no complaints made about the violence and abuse that was witnessed in institutions in Central and Eastern Europe. This is perhaps not surprising, as making a formal complaint about serious violence in the absence of anywhere else to live is very difficult for a child and even more so without an advocate. Children also need to be aware of their rights to redress in these circumstances and very few had this information, reflecting the findings of a previous project coordinated by MDAC entitled “Access to Justice for Children with Mental Disabilities” across ten EU countries. Children in UK institutions visited were generally better informed and some expressed knowledge about their rights.

It was clear that there is still significant abuse and widespread human rights violations taking place in institutions. Although the project did not set out to select a random sample of institutions, the findings resonate with the many existing reports that document abuse in such settings. This violence against children is systematic and serious. It was also evident that deinstitutionalisation plans remain chronically underdeveloped and often new, smaller institutions are transferring institutional cultures from services that they were designed to replace.