Fellowship Program for Georgian Public Policy Analysts Policy Papers 03/07

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1 C I P D D Fellowship Program for Georgian Public Policy Analysts Policy Papers 03/07 SUPPORTING SOCIAL INTEGRATION OF ADULTS WITH INTELLECTUAL DISABILITIES IN GEORGIA FROM THE PERSPECTIVE OF POLISH EXPERIENCE Author: Tamuna Makharadze Supervisor: ElŜbieta Zakrzewska, Warsaw University The papers in the series have been written by policy analysts as a result of study visits to Warsaw in the framework of a fellowship programme, co-ordinated by the Institute of Public Affairs, Warsaw and the Caucasus Institute for Peace, Democracy and Development, Tbilisi co-financed by the Polish aid programme 2007 of the Ministry of Foreign Affairs. The opinions are those of the author. 1

2 1. Executive Summary The main aim of this paper is to find out the most appropriate forms of social integration of adults with intellectual disabilities in Georgia. Over the years these people have experienced extreme poverty, stigma and social isolation lack of access to education and employment. After the Rose Revolution of 2003 improving situation of vulnerable groups of population (including adults with intellectual disabilities) has become one of the main state priorities. This approach has been supported by the foreign policy of the new government. Georgia has a strong will to become a member of the international community (join the EU, NATO)-- however without improving situation of people with disabilities and ensuring protection of their rights these plans will never be carried out. Since 2005 the Ministry of labor, Health and Social Affairs of Georgia (MolSHA) has started new social program encouraging development of social services for people with disabilities. However, after two years people with disabilities (including people with intellectual disabilities) experience the same problems they faced earlier. MolSHA has declared its willingness to cooperate with local NGOs, stakeholders and the experts towards further improving the program. 2. Objectives and Methodology The main aim of this paper is to find out the most appropriate forms of social integration of people with intellectual disabilities in Georgia via (a) analyzing the main obstacles facing effective implementation of above mentioned state program launched by the MoLSHA and (b) studying experience of other countries in this direction. We have narrowed down the target group and focused on adults (18 and above) with intellectual disabilities. A number of studies carried out by the international organizations in Georgia have found out that such problems as social isolation and stigma are more severely experienced by this group of people (5). There is no case of employment of persons with intellectual disabilities, no possibility of vocational training. Attending the day-care centers is an only way for adults with intellectual disabilities to overcome social isolation; however 2

3 even this service is available only to very limited number of beneficiaries and absolutely inappropriate for people with mild intellectual disabilities. It is a fact, that after two years of starting the state program encouraging social integration of people with disabilities, majority of adults with intellectual disabilities experiences the same problems without any improvement (6). The elaborated recommendations are covering all crucial aspects contributing in social integration of adults with disabilities: State policy, employers, international communities and society. Access to employment and vocational training are highly prioritized. To elaborate the recommendations towards improving social integration of adults with disabilities in Georgia, the main obstacles facing effective implementation of above mentioned state program have been analyzed and the experience of other countries (the example of Poland) has been studied. In analyzing of international experience we have focused on the experience of Poland. This choice was supported by the number of arguments: (a) This country has the same soviet past and the same range of socio-economic problems inherited by the soviet system; (b) Poland has had considerable steps forward in improvement situation of people with disabilities, including adults with intellectual disabilities and (c) In 2004 Poland joined Euro Union. For reaching the same results we have found it beneficial to analyze the way Poland has passed through and learned on its lessons. In our analysis we have relied on examining the related documents and a 12-day field study in Poland (in depth interviews with the representatives of state agencies, NGOs and experts). We do realize that 12 days is not sufficient to explore all aspects of the topic in depth, however we think that our interviews have covered all the groups of people with high expertise on the subject. 3. General background main issues and directions in Georgia and abroad Mental health issues are an important part of the state social policy for many countries worldwide, due to the specific nature of the problem. Promotion of the mental health and protection of the rights of people with disabilities and mental problems have become the 3

4 priority for many countries and international organizations. Despite all the efforts made, this group of people worldwide still experience stigma and their rights remain to be restricted. Moreover, they still suffer from limited access to employment and education and the society at large remains largely uneducated about mental problems (6). In 1970s, deinstitutionalization started in West Europe and USA; and community based services were developed for people with mental problems and disabilities (7). Georgian Government started making the first steps in this direction only in Protection of the rights of people with disabilities and development of community based services encouraging social integration of people with disabilities were declared among state priorities after the Rose Revolution of The attitude of the Georgian government to the issue changed since then. Beginning in 2003 the Georgian government took the first steps to support the social integration of people with disabilities through the development of community based services for them. Existing social services carried out by the local NGOs were analyzed; and active networking with the representatives of NGOs and inclusion of experts in elaboration of new social programs began. These actions suggest that the government has a strong intention to improve the situation of people with disabilities (1). In contrast, prior to 2003, there was no state willingness to start development community based services for people with disabilities and there was no state money available to support social integration of this group of population. In effect, new possibilities are appearing for allocating money (even though very limited) from the state budget for implementation of the new state social programs encouraging development of community based services for people with disabilities. Another incentive to improve situation of people with disabilities is the Georgian government s foreign policy. It is clear that without improving the situation of vulnerable groups of population and without ensuring equal rights for them, the plans to join the European Union, NATO and other international organizations will not be realized. The Ministry of Labor, health and Social Affairs of Georgia (MoLSHA) has started elaboration of new social programs encouraging the social integration of people with disabilities. It was recognized that active networking with the local NGOs was needed as the NGOs are the main service providers for people with disabilities in Georgia, developing 4

5 different services for people with disabilities with financial support of foreign donors. However, very few beneficiaries could use these services under the terms of the pilot projects. It became clear that without the state support the programs could not be extended to the entire country and be available for each member of the target group (4). As a result of close networking with the local NGOs and analysis of existing social services for people with disabilities, in 2005 MoLSHA launched a new program encouraging the development of community based day-care services for people with disabilities. Local NGOs were designated as the main actors in the program implementation (1). However, the results of the program have been limited. After 2 years of its operation, extreme poverty, stigma and social isolation extremely limited access to education and actually no access to employment still remain the main problems of people with disabilities (5). 4. How the system works in Poland and Georgia Despite many common features inherited by the common soviet past, Poland and Georgia have rather different approaches in dealing with the problems of adults with intellectual disabilities. The comparative analysis presented here focuses on the following issues: (a) Mechanisms of assessment of intellectual disability and its categorization, (b) Social welfare benefits available for adults with intellectual disabilities and (3) Existing social programs/services and the state policy towards social integration of adults with intellectual disabilities Statistics and Assessment There are no reliable statistical data available on people with intellectual disabilities in Georgia (4). According to unconfirmed data total number of people with intellectual disabilities is 20, 000; about 70% of whom are adults (20), which represents around 0.5% of the total population of Georgia (4,401,300 inhabitants, data for 2006) (21). According to the 2000 data there are about people with intellectual disabilities in Poland (15). This represents around 0.3% of the total population of Poland, estimated at 38,530,080 residents (according to 2002 census). 5

6 What mechanisms are used for the assessment and categorization of people with intellectual disabilities? In Georgia, assessment and diagnosis of intellectual disabilities were made by a special committee of Psycho-Neurological Dispensary, which was the only institution in the country authorized to make such assessment. Following the reforms in the national health care system, assessment and diagnosis of intellectual disability have been entrusted to all the psycho-neurological institutions complying with all the required procedures. The level of intellectual disability is categorized according to DSM-10 categories: mild, moderate, severe and profound. In Poland the procedures of diagnosis of intellectual disabilities vary according to the purpose of assessment: different procedures are used to assess intellectual disability for educational purposes (in case of children), in getting of legal status of disabled and in receipt of social insurance benefits (in case of adults). Assessment of intellectual disability according to the above mentioned DSM-10 four categories is carried out for educational purpose to choose right educational institution for children with intellectual disabilities. Such diagnosis is made by a Psychological Educational Counseling Centers by a multidisciplinary team of specialists. Categorization of disability is essential for getting legal status of disabled person. In this case categorization is made according to three categories: mild, moderate and severe; however this categorization is different from the categories offered by DSM-10; Only The Disability Assessment Boards are authorized to make assessment and define eligibility for getting the legal status of disability (9). In Poland, as well as in Georgia, assessment of intellectual disability is based on DSM-10 definition and categorization of intellectual disability (19, 9). However in case of Poland procedures of diagnosis vary according to the purpose of assessment. In both countries there are no commonly used assessment tools for categorization of intellectual disability and assessment often is based on subjective viewpoint of examiner Social welfare Benefits Despite the fact, that social welfare benefits available for adults with intellectual disabilities are rather different in Georgia and in Poland, socio-economic situation of this group of people remains difficult in both counties (5, 9). Eligibility for getting social welfare benefits 6

7 for people with disabilities in Poland is determined by the Social Insurance Institute and based on ability of the person with disability to work and to live independently. People with disabilities are eligible for two types of social benefits: social pension or pension due to inability to work. The adults with intellectual disabilities are eligible for social pension as they do not meet the requirements for the pension due to inability to work (social insurance coverage, working experience, etc). The value of the social pension is about 85% of the pension due to inability to work and equals 500 PLN (125 EUR). This amount is more than officially defined subsistence wage 460 PLN (115 EUR), however it is far from a social minimum. It should be mentioned that people assessed by DSM-10 classification as mildly disabled intellectually are not eligible for a pension. In addition to social pension the adults with intellectual disabilities and their family members are eligible for transportation and other type of benefits which are financed by the local governments and different foundations (17). In Georgia people with intellectual disabilities receive the same pension as the other pensioners 48 Gel (~20.5 EUR) in the capital city and 38 Gel (~16.5 EUR) in the rest of the country. This amount is considerably less than the subsistence wage according to the data of the Statistic Department of Georgia, subsistence wage for October 2007 equals Gel (~49 EUR) (21). In addition to pension, people with disabilities, including intellectual disabilities, were for some time eligible for the allowance for utilities, however recently these benefits were canceled State Policy and Existing Social Services Engaging adults with intellectual disabilities in working process is an integral and main part of their social integration (11). For this reason, this section focuses on (a) social services encouraging inclusion people with intellectual disabilities in employment and (b) encouraging development of vocational and social-adaptive skills. Development of social services encouraging social integration of people with disabilities has only started in Georgia. Since 2005 MoLSHA has implemented a program of the development of Day-Care Services for people with disabilities. The main purpose of the centers is the development of social-adaptive skills. It is also supposed that such services will 7

8 help care-takers (mainly mothers) to have a free time and use this time to find a job (however this is not an easy task in Georgia) and improve family s welfare level (1,2). The program is implemented mainly by the local NGOs working on disability issues. This program covers both children and adults with intellectual disabilities--adults may participate in social service financed by the state through this program only. According to the experts evaluation this program can not be considered as the effective means encouraging social integration of people with disabilities. Criticism refers to conceptual and a technical part of the program and is mainly based on the following arguments (18): 1. The assigned amount 8 GEL (~3.40 EUR) per beneficiary per day is very limited and can not ensure a qualitative service. 2. Participant organizations service providers are selected through tenders. The tender procedures contains many bureaucratic requirements, which are problematic for the organizations. Financing of service providers does not have a form of grant and these organizations go through the existed tax regulations. 3. Money is transferred to the service providers only after the delivery of the service. This is a great problem for majority of local organizations, which need additional sources of financing. 4. Only a very limited number of beneficiaries has been involved in the program. ; According to data for January-May people with disabilities participated in the program (19). This number includes children as well as adults of both categories developmental and intellectual disabilities. Estimates show that the number of people with disabilities in Georgia is as high as 180,000, or nearly 5% of the population (22). 5. Family members of the beneficiaries, representatives of NGOs and experts are not involved in monitoring. Despite all the weaknesses of the above mentioned program, starting state financing of the program supporting development of social services for people with disabilities are considered as a step forward towards social integration of this vulnerable group of 8

9 population. MoLSHA declares its willingness to cooperate with the representatives of NGOs, stakeholders and experts towards further improvement of the program (3). In comparing with Georgia, the experience of Poland in development of social services for adults with intellectual disabilities has been quite wide and well developed (9). As a member of the EU, Poland has developed different forms of services for rehabilitation and integration of people with disabilities, including adults with intellectual disabilities. The services are mainly financed from the State Fund for the Rehabilitation of People with Disabilities and the central state budget (9). High level of decentralization within the state bodies considerably encourages flexibility of financing different social programs and service providers; local governments have been making important contribution in development of different social services for people with intellectual disabilities (16). Support of foreign donors is not as important as in the case of Georgia. However, the essential contribution of EU structural funds should be noted for improving the situation for people with disabilities in Poland. In the period of , Million Euro has been allocated for development of social programs and welfare system for people with disabilities. 72% from this amount was covered by the social funds of EU and 28% by the State Fund for the Rehabilitation of People with Disabilities (9). In Poland support for the employment and vocational training of adults with intellectual disabilities has been a high priority, considered as an integral part of their social integration. Quota system is the most important way in which the Government encourages the employment of people with disabilities. In 1991 a new financial support of social and vocational rehabilitation of people with disabilities was adopted, based on a system of quotas obliging employers to hire people with disabilities (9). According to this Act, employers with minimum 25 employees should hire at least 6% of employees with disabilities. The employers that do not fulfill their quota of hiring of people with disabilities are obliged to pay a fine (1000 PLN) to the State Fund for the Rehabilitation of People with Disabilities (9). However, despite financial support given by the government to the employers hiring people with disabilities, in most cases employers prefer to pay into the State Fund for the Rehabilitation of People with Disabilities rather than engage a person with disabilities. 9

10 In Poland involving adults with intellectual disabilities in the working process has been carried out towards the following directions: (a) Employment on the open markets, (b) Sheltered workplaces, (c) Occupational workshops and (d) Occupational therapy workshops (9). Employment on the open market (supportive employment) means involving a person with disabilities in an ordinary working environment with non-disabled employees. In Poland employment on the open market is supported by the quota system. According to 2007 data about 250,000 people with disabilities are employed on the open market, about 20,000 of them are people with intellectual disabilities (15). Mainly people with mild intellectual disabilities are involved in the employment on the open market. Sheltered employment is one of the most widespread forms of employment people with disabilities in Poland. An organization can be considered as a sheltered workplace if 30-40% of employees are people with disabilities. Since 2004, sheltered workplaces have been receiving state financing for the salaries of disabled employees; also these organizations receive a number of tax benefits. According to 2002 data 208,800 people with disabilities were employed at 2,864 sheltered workplaces; 9.5%-of them are people with intellectual disabilities (9). In the period of almost the whole state money assigned for supporting employment of people with disabilities was allocated to the development of sheltered employment. However this service has been available only for a small part of disabled people mainly people with mild disability have been benefited; people with moderate and severe disabilities have again stayed aside. Sheltered workplaces also have often been criticized for inadequate working environment and exploitation of employees (9). Occupational workshops are a new form of sheltered employment in Poland. These workshops aim to offer employment to people with moderate and severe disabilities, also encourage their social and vocational rehabilitation. In this way occupational workshops prepare people with disabilities for life in an open environment. Occupational workshops have been introduced into the legislation since 1998 as a result of advocacy of NGOs. Currently about 200 people with disabilities are working in 7 occupational workshops; 40 of them are people with intellectual disabilities (9). 10

11 Occupational therapy workshops are not considered as a workplace. However these workshops have been contributing a lot in social and vocational rehabilitation of people with disabilities, in particular people with intellectual disabilities. Occupational therapy workshops have been working since 1991 and mainly are carried out by local NGOs (9). 6. What can be done for more success in social integration of adults with intellectual disabilities in Georgia? The lessons from Polish experience International communities (European Union, United Nations, etc) consider the inclusion of people of disabilities (including people with intellectual disabilities) in employment as an integral part of their social integration (11). This approach takes account of the nature of an adult person in order to feel himself/herself as a full member of society and live with dignity, an adult needs to be involved in a working process and in this way contribute in a social life. The example of Poland shows that people with different levels of disability need different forms of employment. Also we have seen (by the example of quota system) that legal acts and regulations are not sufficient in themselves to make employers interested in social programs raising access to employment for people with intellectual disabilities. Without favorable attitudes and support of employers and society social integration of adults with intellectual disabilities will never be successful even when strongly supported by the state and international organizations and communities. Nothing can be done if there is no well organized and integrated data base of adults with intellectual disabilities with precise figures and categorization. Based on the above arguments and comparative analysis of the Georgian and Polish experience we can consider the following as the main steps towards more successful social integration of adults with intellectual disabilities in Georgia: 1. Creation of integrated database of adults with intellectual disabilities including categorization according to the disability level, socio-economic needs, etc 11

12 2. Development of different social programs appropriate for encouraging social and vocational rehabilitation of adults with different levels of intellectual disability (mild, moderate, severe and profound). Involvement of experts and stakeholders in the implementation of these programs. 3. Involving the employers in the elaboration of the state programs (including changes in legislation), encouraging support for the employment of adults with intellectual disabilities. 4. Development of networking with international communities and donor organizations in order to get financial support for implementation of social programs for adults with intellectual disabilities (considering the limited financial resources of the Georgian government for such programs). 5. Ensuring academic education of professionals working with people with intellectual disabilities social workers, social therapists, occupational therapists and psychologists. 6. Enhancing public awareness about the issues of intellectual disabilities. 12

13 References 1. Report on State Program for People with Disabilities, 2005, The Ministry of Labor, Health and Social Affairs of Georgia 2. Report on State Program for People with Disabilities, 2006, The Ministry of Labor, Health and Social Affairs of Georgia 3. State program supporting social integration and adaptation of people with Disabilities, 2006, The Ministry of Labor, Health and Social Affairs of Georgia 4. Sharashidze M., Voriseck J. (2005) Situation of people with mental problems and disabilities in Georgia, Needs Assessment. 5. The World Bank, Qualitative Survey on Disability and Living Standards in Georgia, Survey Report April Makharadze T. Mental Health Key Component of National Health Policy, NISPAcee; News Volume XII. No. 1. Winter Lamb R., Bachrach L. Some Perspectives on Deinstitutionalization, Psychiatric Services, 52: , August Statistics Department of Georgia, Quarterly Report, 2006/III, Tbilisi, Rights of People With Intellectual Disabilities: Access to Education and Employment-Poland. (2005) EUMAP-EU Monitoring and Advocacy Program, Open Society Mental Health Initiative 10. International Convenant on Civil and Political Rights (CCPR), 23 March 1976, 999 U.N.T.S International Conveninet on Economic, Social and Cultural Rights (CESCR), 3 January 1976, 993 U.N.T.S International Conveninet on the Rights of the Child (CRC), 2 September 1990, 44 U.N.GAOR Supp. (No. 49) at 167, U.N Doc. A/44/49 (1989). 13. European Conveninet for the Protection of Human Rights and Fundamental Freedom (ECHR), 3 September 1953, E.T.S. 005, available on the COE website 13

14 14. European Social Charter (ESC), 1 July 1999, C.E.T.S Interview with the Head of the Office of the government plenipotentiary of the Ministry of Labor and Social Affairs of Poland 16. Interview with leader of Polish Association of the parents of Children with Down s Syndrome 17. Interview with the specialist of Polish Association for Person with Mental Handicap 18. Letter 41/227 29/11/2006 to the Ministry of Labor, Health and Social Affairs of Georgia, Association For People in Need of Special Care 19. Letter # 01-07/07/8278, to the Ministry of Labor, Health and Social Affairs of Georgia, Tamar Makharadze