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Findings from a Parliamentary Commission on Human Rights

During the course of MDRI’s investigation, we received numerous independent reports about abuses at the Saray Rehabilitation Center. In addition to the reports by staff and parents of children with intellectual disabilities interviewed by MDRI as part of this investigation, there has been independent corroboration of our findings (and, in some cases, far more serious abuses reported) by the press and the Human Rights Commission of the Turkish Parliamentary Commission. They did not prepare an official report but the findings were reported in Turkish newspapers. As reported in Milliyet in January 2005, the investigative committee of the Parliamentary Commission “came across scenes that could compete with Nazi concentration camps.”⁸⁴ As reported in Sabah, both medical

and dental care is inadequate at the facility.⁸⁵ Based on the investigation, the Parliamentary Commission concluded that people with mental retardation were subject to

conditions of “psychological torture.”⁸⁶ The Commission reportedly found that “girls were locked up in rooms, tied up to their beds from their waists….”⁸⁷ Seclusion and restraint were used as a form of punishment:

Three girls aged 12-13 were found locked in a very small cold barren room on this cold winter day and they were naked. The reason for locking them up was that they had tried to escape from the institution. The institution director told the parliamentarians that the girls were there for a few hours, but it was discovered that they had been there for the last 12 hours. One of the girls had diabetes. In addition, the committee found out that the bathrooms and toilets were in very bad condition as opposed to the nice rooms of the social workers. Thirty to 40 people were staying in wards with a capacity of 15.⁸⁸

3. In the Community: No alternatives to institutions

Throughout the world, there is a growing consensus that the overwhelming majority of people with mental disabilities – including both people with psychiatric and intellectual disabilities – can live in the community with appropriate services and support systems.⁸⁹ UN Special Rapporteur on the Right to Health, Paul Hunt, has observed that:

As a result of increased knowledge about mental disabilities and new models of community-based services and support systems, many people with mental disabilities, once relegated to living in closed institutions, have demonstrated that they can live full and meaningful lives in the community. People once thought incapable of making decisions for themselves have shattered stereotypes by showing that they are capable of living independently if provided with appropriate legal protections and supportive services. Moreover, many people once thought permanently or inherently limited by a diagnosis of major mental illness have demonstrated that full recovery is possible.⁹⁰
Twenty years ago, the World Health Organization found in Europe “a remarkable degree of common ground” regarding the importance of shifting away from reliance on large psychiatric institutions and promoting community-based services that permit the maximum possible integration into the community.⁹¹ In a study of 30 European countries published in 1985, the WHO found that:

During the last 30 years, psychiatric practice has undergone profound changes, and in consequence so too has the organization of services for the care and treatment of the mentally ill. New mental health programs, policies and legislation have been developed in many countries and continue to be developed in others.... Institutional psychiatry has given way to community psychiatry. ⁹²

Over the last three decades, the shift toward community mental health has come to be recognized not just as good mental health practice – but as a basic human right under international law. As early as 1971, the United Nations adopted the Declaration on the Rights of Mentally Retarded Persons to promote the integration of people with intellectual disabilities “as far as possible in normal life.”⁹³ In 1991, the United Nations General Assembly stated that “[e]very person with a mental illness shall have the right to live and work, as far as possible, in the community.”⁹⁴ The Montreal Declaration on Intellectual Disability, adopted in 2004, states that “[f]or persons with intellectual disabilities, as for other persons, the exercise of the right to health requires full social integration….”⁹⁵ For people capable of living in the community, the UN has established that segregated inpatient service systems “inherently discriminate” against people with mental disabilities.⁹⁶ To avoid such discrimination, “[s]tates should take steps to ensure a

full package of community-based mental health care and support services conducive to health, dignity, and inclusion.”^g

The structure of Turkey’s mental health and social service system for people with psychiatric and intellectual disabilities is out-of-step with changes that have taken place in Europe over the last thirty years. The lack of alternatives to institutional care constitutes a form of discrimination against people with mental disabilities, which is impermissible under international human rights law.⁹⁷
Large numbers of people detained or receiving treatment in rehabilitation centers, orphanages, and psychiatric facilities are improperly and unnecessarily detained because of a lack of community-based services. The great majority of people with mental disabilities in Turkey live in the community with family members – yet they receive little assistance from the mental health or social service system. Without adequate community supports or community-based treatment, family members often become impoverished and socially marginalized by the responsibility of taking care of a disabled relative. While there is some income support for people with mental disabilities (either psychiatric or intellectual disabilities), Turkey’s state disability pension is well below what any person would need to live in the community.
While many mental health professionals we interviewed support the creation of improved community-based services in theory, there is a widespread impression among psychiatrists at state psychiatric institutions that Turkey has a shortage of inpatient beds. Instead of investing in the creation of community services, the Ministry of Health is directing resources to increasing inpatient services. In Izmir, for example, a university hospital has just been rebuilt, a new psychiatric ward of a general hospital is being created, and the nearby Manisa state psychiatric hospital is being expanded from 400 to 600 beds. New in-patient beds for short-term acute care stays at a general or university hospital are an improvement over long-term placements in a large psychiatric facility such as Manisa. Without a broader plan to create follow-up care for these inpatient services, however, these new services will not be as effective in helping people live and receive treatment in the community. There appears to be a similar direction in services

^g UN Special Rapporteur on the Right to Health, Paul Hunt, describes the “full package” of community- based mental health services as “including medication, psychotherapy, ambulatory services, hospital care for acute admissions, residential facilities, rehabilitation for persons with psychiatric disabilities, programmes to maximize the independence and skills of persons with intellectual disabilities, supported housing and employment, income support, inclusive and appropriate education for children with intellectual disabilities, and respite care for families looking after a person with a mental disability 24 hours a day. In this way, unnecessary institutionalization can be avoided.” Paul Hunt, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Commission on Human Rights, 61^st session, Item 10, E/CN.4/2005/51, para. 43 (Feb. 11 2005) [hereinafter Hunt Report]. “Persons with intellectual disabilities often require specialized support services which are tailored to their individual needs. This might include habilitation, speech pathology, occupational therapy, physiotherapy, and behavioral therapy. . . . Support is also essential for the families of persons with severe intellectual disabilities, given the acute demands that care and support can place on them. For some individuals with intellectual disabilities and their families, a good environment may include access to a small, open community house with a stable staff and specialized support services.” Id. para. 81.

under the authority of SHCEK. In 2003, SHCEK authorities reported that seven new residential rehabilitation centers were being created. At Saray, new buildings are being constructed. Despite these investments in new residential facilities, the vast majority of people with mental disabilities living in the community do not receive the basic supports that they need.

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