A/HRC/28/37 make alternatives available.17 Other drivers of institutionalization include the lack of adequate knowledge among policymakers, vested interests of institutional care providers, reduction in social and health-care budgets, lack of alternative resources for some persons with disabilities, unavailability of community-based services, and the conditionality of support upon certain living arrangements. In the case of older persons with disabilities, age and impairment, separately or jointly, could increase vulnerability to institutionalization.18 24. Cutting a person off from family, friends, education and employment through institutionalization results in social exclusion, creates barriers to inclusion in the community and reduces or denies the capacity of persons with disabilities to choose and plan their lives. That inhibits their autonomy by fostering dependency, preventing persons with disabilities from reaching their full potential in terms of independence and social participation. In addition, it has been widely documented that institutionalization may render persons vulnerable to violence and abuse, with women with disabilities particularly exposed to such risk. The risk of abuse is further exacerbated by the absence of public scrutiny, a lack of access to remedies, a fear of reporting violations, and disability-related communication barriers.19 Instances of abuse are in direct contradiction to the State’s obligation to protect persons with disabilities from all forms of exploitation, violence and abuse, including their gender-based aspects (art. 16). 3. Deinstitutionalization 25. The Committee on the Rights of Persons with Disabilities repeatedly urges States parties to adopt adequately funded strategies for deinstitutionalization with clear time frames and benchmarks, in cooperation with organizations of persons with disabilities.20 Deinstitutionalization is a process that provides for a shift in living arrangements for persons with disabilities, from institutional and other segregating settings to a system enabling social participation where services are provided in the community according to individual will and preference. Such a shift entails a reclaiming of control over one’s life, and requires that individualized support services (art. 19 (b)) be provided to, and mainstream services and facilities be made available for and accessible to, persons with disabilities (art. 19 (c)). Effective deinstitutionalization requires a systemic approach, in which the transformation of residential institutional services is only one element of a wider change in areas such as health care, rehabilitation, support services, education and employment, as well as in the societal perception of disability. Evidence shows that deinstitutionalization and adequate support enhances the quality of life and improves the personal functioning abilities of persons with disabilities.21 The deinstitutionalization process should also cover children with disabilities; in such cases, institutions should be 17 18 19 20 21 8 See, for instance, the Committee’s concluding observations on Austria (CRPD/C/AUT/CO/1), China (CRPD/C/CHN/CO/1 and Corr.1) and Spain (CRPD/C/ESP/CO/1). See the report of the United Nations High Commissioner for Human Rights on the human rights situation of older persons (E/2012/51) submitted to the Economic and Social Council. For a detailed overview of the consequences of institutionalization, see Council of Europe Commissioner for Human Rights, “The right of people with disabilities to live independently and be included in the community” (Council of Europe, 2012), pp. 37–39. See also the report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment (A/63/175), para. 38. See, for example, the Committee’s concluding observations on Australia (CRPD/C/AUS/CO/1), Austria (CRPD/C/AUT/CO/1), El Salvador (CRPD/C/SLV/CO/1), Paraguay (CRPD/C/PRY/CO/1), China (CRPD/C/CHN/CO/1 and Corr.1) and Hungary (CRPD/C/HUN/CO/1). See World Health Organization (WHO) and World Bank, World Report on Disability (2011), p. 148. The report makes reference to two studies, one in the United Kingdom of Great Britain and Northern Ireland and one in China.