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
Mental Health Programme
WHO Regional Office for EuropeWHO Regional Office for Europe
Mental Health Programme
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
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WHO Regional OfficesWHO Regional Offices
PAHO EURO AFRO EMRO SEARO WPRO
Americas, Europe, Africa, Eastern Mediterranean, South East Asia, Western Pacific
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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
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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
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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
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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
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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)
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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.
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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)
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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
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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
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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.
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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
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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
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Social Determinants of HealthSocial Determinants of Health
Exposures vulnerabilities
Differential health status
Social stratification
Lack of priority?
Lack of power!
Mental Health Programme