A/HRC/40/54 which in turn serves to justify more restrictive policies in psychiatric facilities. 22 Similarly, in many countries health-care and social care professionals encourage parents to place their children with disabilities in institutions under the false claim that they will receive better care than at home (see A/HRC/37/56/Add.2). Child protection authorities may also separate children from their families based on real or perceived disabilities of the parents without offering them the support they may need to keep their children. 29. Sometimes the lack of appropriate community-based support is behind an alleged need for treatment and care, which is used to justify involuntary commitment in mental health facilities or other forms of institutionalization. Regardless of a country’s income level, all persons with disabilities face significant barriers in accessing health, education, employment opportunities and financial support. Furthermore, overall, persons with disabilities have limited access to support services, including personal assistance, support in decision-making and communication, non-medical crisis support, mobility support and housing arrangement services (A/HRC/34/58). This long-term and cumulative impact of exclusion and discrimination often results in deprivation of liberty. 30. Persons with disabilities are regularly deprived of liberty in order to access services that should have been delivered in the community. For example, many families send their children with disabilities to institutions (e.g. special education boarding schools, social institutions, vocational centres) because there is no other way to ensure access to education. Many persons with disabilities are also placed into residential institutions as a way to access social protection benefits. Lack of awareness also plays a role as it is often considered that persons with disabilities need specialized care that cannot be provided in the community. 31. Furthermore, when States fail to provide families with the necessary support, it may result in placement of their relatives with disabilities in institutions. Families that lack the social and financial support to provide adequate assistance to those with disabilities, or are unable to cope with the stress and pressure of providing around-the-clock support, are left with very limited options and driven to take them to institutions or hospitals. 32. Until very recently, and still in many countries today, mental health services were predominantly provided in inpatient settings. While some countries are shifting from institutionalized care to community-based interventions, responses to intense distress and crisis situations (often referred as “acute and emergency situations”) continue to be generally addressed on an involuntary basis within inpatient wards, subjecting individuals to even greater distress and trauma. However, evidence shows that community-based crisis services can deliver the desired outcomes in assisting people during crisis situations. 23 There is a need for psychiatry to transform and embrace a human rights-based approach. 33. The relationship between poverty, homelessness and disability is well recognized. 24 Persons with intellectual or psychosocial disabilities are overrepresented among the homeless population. When the State fails to secure income and housing assistance to this population, it is likely they will end up involuntarily committed or institutionalized. Furthermore, homeless persons with disabilities are continuously exposed to the risk of being deprived of their liberty, as survival behaviours (e.g. begging, sleeping in public spaces, sitting down on sidewalks, loitering) are treated as criminal activity under laws that criminalize homelessness.25 34. In fact, the criminalization of disability is a worrisome trend. In many jurisdictions, legislation is increasingly penalizing atypical behaviours (e.g. running rampant, temper 22 23 24 25 8 J.F. Sowislo and others, “Perceived dangerousness as related to psychiatric symptoms and psychiatric service use – a vignette based representative population survey”, Scientific Reports, vol. 7, No. 45716 (2017). Gooding and others, Alternatives to Coercion, pp. 67–81. C. Mercier and S. Picard, “Intellectual disability and homelessness”, Journal of Intellectual Disability Research, vol. 55 (2011), pp. 441–449; and K. Salkow and M. Fichter, “Homelessness and mental illness”, Current Opinion in Psychiatry, vol. 16, No. 4 (2003), pp. 467–471. National Law Center on Homelessness and Poverty, No Safe Place: the Criminalization of Homelessness in U.S. Cities (2014).