Cutting some budgets may be a good thing
Alphia Abdikeeva, CIDH Pro Igual
Budget deficit and impending cuts, most commonly in public sector, are on the news every day. There is a lot of uncertainty about who will be affected and to what extent. But usually there is understanding that budget cuts are a bad thing. But I keep thinking about one human rights report I had a chance to edit last year, about the mental health care budget in Romania. That report made me think differently about certain budget cuts.
The report was written by the Institute for Public Policy (IPP) and among other things it presented some figures about the costs of running institutions versus community-based services for people with disabilities. Contrary to popular beliefs, community-based services are not more expensive than institutions-based services. Actually, community-based services are sometimes several times cheaper (sic!) than institutional ones. And as to the outcomes, one need not be an expert to figure out that life in closed, remote institutions can turn even a healthy person into a wreck.
Many people in Eastern Europe dread of a possibility to end up in some nursing home when they are old, and certainly would not choose to live there. People in Eastern Europe also often take pity on orphans or abandoned children who end up in institutions, again because people have a pretty good idea of what is happening inside. Life in institutions can be especially devastating for people with disabilities, especially mental or developmental, who do not even have that choice of where to be. The IPP report referred to dozens of unexplained deaths of patients in Romanian institutions.
But what did strike me most was that if the data on comparative costs were available to the government (and they surely were in case of Romania), how come the government did not immediately jump at an opportunity to save money by starting to switch to community-based services? Wouldn´t it be a rational thing to do? Even in a healthy economy, there are always areas that badly lack funding. Ways to redistribute funding from wasteful and inefficient projects to cost-efficient and necessary ones, seems to me, should always be on the government radar. Perhaps, there are some other concerns that I do not understand, like public dislike of the idea. But that surely cannot and should not trump rational cost-efficiency (not even mentioning humane) considerations. Or am I still missing something?
In any event, there are now budget cuts on the agenda in Romania, Bulgaria, Hungary, and other countries badly affected by the current economic crisis. Perhaps, the governments — with a bit of help from NGOs — should seize on it as an opportunity in disguise for deinstitutionalization. Then, if done wisely, the budget cuts can actually turn out to be a good thing leading to the closure of expensive and ineffective institutions for people with disabilities and/or mental health problems and the shift towards community-based services and care.