Dr Matt Muijen Regional Adviser for Mental Health Bristol 14 May 2010

Mental Health Programme

WHO Europe Initiative on WHO Europe Initiative on Health of Children and Young Health of Children and Young

People with Intellectual Disabilities People with Intellectual Disabilities and their Familiesand their Families

Dr Matt MuijenRegional Adviser for Mental Health

Bristol14 May 2010


WHO Regional Office for EuropeWHO Regional Office for Europe


World Health OrganizationWorld Health Organization

• WHO was established in 1948 by 61 governments to promote health of all people

• The WHO Constitution was ratified on 7 April – World Health Day

• WHO is a specialized agency of the United Nations (unlike UNDP, UNFPA, UNICEF, etc.)

• Today there are 192 Member States


WHO Regional OfficesWHO Regional Offices

PAHO EURO AFRO EMRO SEARO WPRO

Americas, Europe, Africa, Eastern Mediterranean, South East Asia, Western Pacific


WHO’s missionWHO’s missionis global and permanentis global and permanent

“The mission of WHO is the attainment by all peoples of the highest possible level of health”

WHO’s Constitution


Health is more than physicalHealth is more than physical

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

WHO’s Constitution

• “More than 1.45 m people with disabilities in Europe live in residential care, 70% in services with over 30 places.” Residential services in Europe –

findings from the DECLOC study

• Across the EU there are some 150,000 children living in residential care settings Report of the Ad Hoc Expert Group on Transition from Institutional to Community-based Care

• At least 317,000 children with disabilities in the region live in residential institutions, often for life. Innocenti Insight,

Children and Disability in Transition in CEE/CIS and Baltic States

children with disabilities in institutional care (Data from Innocenti Insight, Children and Disability in CEE/CIS and Baltic States)

CEE Rates per 10,000 of relevant population

CIS Rates per 10,000 of relevant population

1990 2002 1990 2002

Slovenia 23 20 Belarus 68 60

Czech Republic 31 42 Ukraine 28 18

Hungary 11 10 Russia 64 65

Croatia 19 22 Georgia 12 19

Poland 19 21 Moldova 103 58

Slovakia 20 20 Armenia 1.5 4.5

Lithuania 80 47 Kyrgyzstan 15 15

Estonia 15 36 Uzbekistan 14 15

Latvia 7 16 Tajikistan 1 6

Bulgaria 67 82 Kazakhstan - 6

Romania 10 2 Azerbaijan 21 16

FYR Macedonia 19 11

Serbia and Montenegro

38 -

Country Places Children ID

Belgium 25750 6940 13345

Bulgaria 13269 4752 8482

Czech 66865 3292 16047

Denmark 62081 23673

Estonia 22421 1134 1945

Finland 18032 418 12532

France 224827 108903 107188

Ireland 9369 317 8073

Italy 117241 1041

Latvia 13463 5819 2405

Poland 73741 1957 17294

Portugal 11422 1002 360

Romania 32783 611 7040

Sweden 29578 1315

Turkey 9494 992 2805

UK 129548 2445 46877

Total 1186962 180702 264968


Why Why priority for WHOpriority for WHO

Failure of health care for CID in European society associated with:

• Barrier to full enjoyment of human rights, including right to highest attainable health

• Discrimination and abuse • Obstacle to development• Exclusion from society

Objectives of initiativeObjectives of initiative

• Awareness raising

• Identify national challenges

• Create opportunities

• Initiate partnerships

• Disseminate best practice

• Support sustainable activities



Major Major challenges 1challenges 1

• Neglect, abuse and discrimination• Instances in institutions and the community

• Overreliance on long stay residential institutions• poor living conditions, low quality care, lack of

educational opportunities• national de-institutionalization strategies variable

• Lack of community services• number of children with ID in community increasing • No adequate increase in community support services


Major challenges Major challenges 22

• Under-serving the health needs of CID:• Poor knowledge and training of health staff

on disability issues (prevailing medical model of disability)

• Communication difficulties• Negative attitudes• Poor intersectoral collaboration

Major Challenges 3Major Challenges 3

• Lack of reliable health monitoring data.

“It is essential that we understand that this statistical neglect .... is indicative of a major failure to recognize and support this group that has led to a massive hidden population of children and adults with ID who are unknown to the official systems.” (Background Paper)



AimAim of WHO 1 of WHO 1

• To ensure that all children and young people with ID are fully participating members of society, integrated in the community, receiving appropriate health care and support, proportional to their needs.


Aim of WHO 2Aim of WHO 2

• To offer specific contribution to the implementation of the UN Convention on the Rights of Persons with Disabilities and other relevant European commitments, including the CoE Disability Action Plan (2006-2015), the EU Disability Action Plan (2003-2010), and the WHO Disability and Rehabilitation Action Plan (2006-2011)


Project CoordinationProject Coordination

• Managed by WHO Europe • Declaration supported by a multi-

stakeholder Steering Group, chaired by Professor Sheila Hollins

• In partnership with Member States’ representatives

• In cooperation with the UNICEF, (the European Commission, the Council of Europe), and NGOs


OutputsOutputs• A Declaration on Children and Young People with

Intellectual Disabilities and their Families, stating the priorities and responsibilities.

• An action plan, specifying evidence based interventions.

• A Background Paper, identifying key issues and challenges, good practice examples and ways forward.

• A set of Expert Papers to form a resource bank for developing national action plans.

DeclarationDeclaration

• Statement of vision and intent

• Responsibilities Member States and WHO

• Role partners

• Balance political and technical aspects

• Endorsed by signatories



WHO and Health of Children with IDWHO and Health of Children with ID

• Health Needs

• Combination of most vulnerable groups

• Concern of Member States

• Commitment funders: – Shirley Foundation– Romanian Govt.


Follow upFollow up

• WHO Europe is committed to:

• Offer leadership on the role and functioning of health systems

• Engage in partnerships with other agencies to facilitate the implementation of the Declaration

• Provide technical support to MS to promote quality in service provision and to establish sustainable capacity


TimelineTimeline

• Initiative planned-April 2008

• Romanian offer to host-June 2008

• 1st Steering Group meeting – February 2009

• Consultation meeting with international NGOs –

December 2009

• Pre-meeting of MS representatives – March 2010,

hosted by the Serbian Minister of Health, Belgrade

• High-level Conference – 26-27 Nov 2010, Bucharest

Challenges

• Leadership

• Fragmentation

• Conceptualisation

• Evidence base

• Stigma

• Social determinants

• Political priorities


Social Determinants of HealthSocial Determinants of Health

Exposures vulnerabilities

Differential health status

Social stratification

Lack of priority?

Lack of power!


Documents

Dr Matt Muijen Regional Adviser for Mental Health Bristol 14 May 2010