A/HRC/40/54 the same environment. 12 To the extent that persons with disabilities are placed in institutions without their free and informed consent or are not free to leave, they are deprived of their liberty. 19. Children are particularly vulnerable to institutionalization on the basis of impairment. Many jurisdictions permit the forced removal of children with disabilities from their families and their placement in institutions, on the basis of the disabilities of the children and/or parents or guardians. As a result, millions of children with disabilities are confined to institutions, isolated and segregated from their communities.13 In these institutions, they are routinely locked, forced to take medication and often exposed to torture, abuse and neglect. The detrimental effects on child development of the placement of a child in any residential institution, even in small residential homes or “family-like” institutions, have been vastly demonstrated. 14 Any placement of children in a residential setting outside a family must be considered placement in an institution and subject to the protections against deprivation of liberty. 20. Deprivation of liberty as a result of diversion from the criminal justice system is also a common practice across jurisdictions (A/HRC/37/25). When persons with intellectual or psychosocial disabilities have been deemed unfit to stand trial, or declared not responsible for their criminally relevant actions, they are usually diverted to a forensic facility or civil institutions. Frequently, in these facilities, they will have less access to procedural guarantees than others in the criminal justice system and be subjected to forced interventions, solitary confinement and restraint. In such facilities, they are also subject to stricter regimes, and have less access to recreational, educational and health services than those available in mainstream prisons, as well as fewer procedural guarantees. The criterion of “dangerousness” is usually used to assess the need for imposition of these security measures. Police and social services may also act as diversion agents and are in many cases entitled to initiate involuntary hospitalization. 21. In many contexts, despite the absence or limited use of institutions and involuntary hospitalization, many persons with disabilities remain deprived of liberty in their communities. For example, the practice of shackling persons with psychosocial disabilities has been reported in a number of countries. 15 In such instances, persons with disabilities are restrained by families and traditional and religious healers using chains or ropes and/or locked up in a confined space, such as a room, shed or cage. In many cases, they are left outdoors naked for days or even years. These practices are usually the result of deeply rooted stigma and stereotypes, but also a lack of community-based support services. 22. Deprivation of liberty of persons with disabilities at home is not a practice limited to low-income settings. In most parts of the world, many children with disabilities are systematically locked up at home, with little or no interaction with the community.16 Many adults with disabilities living in supported housing are also in practice deprived of their liberty, as they are not free to leave the house. Similarly, older persons with dementia are frequently impeded from leaving their own homes purportedly for their own safety. 17 12 13 14 15 16 17 6 General comment No. 5 (2017) on living independently and being included in the community. United Nations Children’s Fund, The State of the World’s Children 2013, Children with Disabilities (New York, May 2013), pp. 46–47. M. Dozier and others, “Consensus statement on group care for children and adolescents: a statement of policy of the American Orthopsychiatric Association”, American Journal of Orthopsychiatry, vol. 84, No. 3 (2014), pp. 219–225; A.E. Berens and C.A. Nelson, “The science of early adversity: is there a role for large institutions in the care of vulnerable children?”, Lancet, vol. 386, No. 9991 (2015), pp. 388–398; and K. Maclean, “The impact of institutionalization on child development”, Development and Psychopathology, vol. 15, No. 4 (2003), pp. 853–884. Human Rights Watch, “Living in hell: abuses against people with psychosocial disabilities in Indonesia”, 20 March 2016. F. Ellery, G. Lansdown and C. Csáky, “Out from the shadows: sexual violence against children with disabilities” (Save the Children and Handicap International, 2011), p. 14. J. Askham and others, “Care at home for people with dementia: as in a total institution?”, Ageing & Society, vol. 27, No. 1 (2007), pp. 3–24.