A/HRC/40/54 68. Many strategies are required to end the institutionalization of children with disabilities. These include building up family support, the provision of child services within the community, child protection strategies, inclusive education and the development of disability-inclusive family-based alternative care, including extended kinship care, foster care and adoption. All these forms of alternative care need to be provided with appropriate training, support and monitoring to ensure the sustainability of such placements. States should adopt an immediate moratorium on the institutional placement of children under the age of 3. 69. States must take immediate action to end deprivation of liberty within private and/or faith-based institutions, such as orphanages, small group homes, rehabilitation centres and prayer camps. States have an obligation to protect persons with disabilities against wrongful deprivation of liberty by third parties, including through preventive institutional frameworks, education and monitoring. States must take immediate action to end all forms of home confinement and shackling. C. Ending coercion in mental health 70. States must end all forms of deprivation of liberty and coercion in mental health. For those purposes, States must transform their mental health systems to ensure a rights-based approach and well-funded community-based responses, including peer-led services. Evidence shows that when Governments, service providers, courts and communities take concerted action to move away from coercive practices, they are likely to be successful. 71. States must create support services for persons experiencing crises. The existence of community-based services that do not resort to the use of force or coercion has proven to be effective and is critical to ensure a right-based response. Non-coercive and non-medical community programmes for persons in extreme distress have been established in several places in the world as alternatives to hospitalizations (e.g. crisis or respite houses, crisis respite services, host families and emergency foster care for children). 54 Features of these settings include fewer residents compared with hospital wards, a home-like environment, a de-emphasis on medication and greater contact with staff. The availability of these programmes has been shown to reduce instances of involuntary hospitalization and higher satisfaction rates.55 72. Advance planning can be useful to support the exercise of legal capacity in crisis situations.56 Advance directives allow people to set out their will and preferences as to how they wish to be treated in any future event. They may also include refusals of certain treatments and/or advance requests for particular options the person has found helpful in the past. To be effective, it is critical to ensure that the advance directive is freely chosen by the person, that they have full control over when it should take effect, and that it remains subject to the person’s decision to change their will and preferences at all times. D. Access to justice 73. Persons with disabilities should have access to justice on an equal basis with others to challenge any deprivation of liberty. For that purpose, States must ensure that persons with disabilities have access to procedural, age- and gender-appropriate accommodations, including supported decision-making, in all legal proceedings before, during and after trial. States must also promote appropriate training for those working in the field of the administration of justice. 54 55 56 16 Gooding and others, Alternatives to Coercion, pp. 67–81. C. Obuaya, E. Stanton and M. Baggaley, “Is there a crisis about crisis houses?”, Journal of the Royal Society of Medicine, vol. 106, No. 8 (2013), pp. 300–302. M.H. de Jong and others, “Interventions to reduce compulsory psychiatric admissions: a systematic review and meta-analysis”, JAMA Psychiatry, vol. 73, No. 7 (2016), pp. 657–664.