Closure call for institutions for disabled


Madam, – The report by Carl O’Brien (Front page, July 12th) suggested that the main conclusion of an unpublished report by the working group established by the Health Service Executive (HSE) was calling for the closure of all institutions for people with intellectual disabilities within the next seven years because they are in breach of residents’ basic rights.

While I agree with general tenor of this article I think it is necessary to look behind the rhetoric – moving people from one setting to another is not what’s required – what is required is a complete configuration of how disability services are planned and provided.

It is wonderful your paper is in a position to give its readership the heads-up on the Review of the Congregated Settings when a Dáil question addressed to Minister of State John Moloney on June 16th was unable ascertain whether the Minister for Health had completed the review; or indeed to garner details of the report due to industrial action in the HSE. Maybe the Ministers might now wish to comment on the report as its details are now in the public domain?

The closure of institutions for people with disabilities is an assumed panacea for the complex issues facing people with disabilities in congregated settings. Just replacing such establishments with supported or independent placements in the community will not in or of itself address the complex needs of this group in our society.

While I can accept the interpretation of the report’s contention that suggests that thousands of people in congregated settings are separated from the community and stripped of dignity, privacy and independence – people with disabilities living geographically within our society are also socially excluded and continue to be so, in a context where our Government is reluctant to ratify the Optional Protocol of the UN Convention on the Rights of Persons with Disabilities.

While the report suggests that the continued operation of these institutions is in breach of Ireland’s obligations under various United Nations conventions and that the continued operation of such establishments contradicts official Government policies, it is important to note what the official Government position now is.

In response to a parliamentary question, Minister of State John Moloney stated that no decision has been taken on the signing by Ireland of the Optional Protocol of the UN Convention on the Rights of Persons with Disabilities.

The new model of supported or assisted living in the community advocated by the report needs to reflect a way of meeting the complex health needs of people with disabilities. Additional funding will need to be made available to mainstream health and social services, as the complexity of healthcare needs of those with intellectual disabilities with will place much greater resource demands on already stretched mainstream health system,

We should learn from the UK where resettlement of people from congregated settings has been very much completed. Research shows people with intellectual disability have much greater health needs than the general population. Among other issues, people with intellectual disability experience a greater prevalence of gastrointestinal disorders, pneumonia, sensory impairments, epilepsy, dental disease and osteoporosis.

The suggestion that revenue from the sale of existing institutions would help fund the move towards community-based care is clearly not a serious contention in the current property climate.

The process of closing down institutions will not simply be a case of replacing one set of buildings for another and will undoubtedly need to see the development of well-researched and well-planned services which are responsive and needs-driven and not philosophy laden.

I’m not sure I would agree with a HSE official being charged with driving and implementing a seven-year programme to close down inappropriate settings, as the shocking reality is that the majority of services provided for people with disabilities have never been provided by the State. Approximately 80 per cent of all such services are provided in the private and voluntary sector – the State has historically reneged on its responsibility to this group of people. Are we to believe we can trust that State or an organ of the State to make amends and devise a much better system of service provision?

Where the Government is going to find a “congregated settings fund” is a curious proposition, although a curbing of departmental entertainment, travel and subsistence budgets might be a good place to start looking for some spare cash to begin the process. – Yours, etc,


Lecturer in Intellectual


Nursing School of Nursing


Trinity College,

Dublin 2.