Deinstitutionalisation and community-based care for adults with intellectual disabilities in Hungary: policy change, challenges and outcomes

This thesis explores the processes of policy change and outcomes of deinstitutionalisation and community living for adults with intellectual disabilities in the context of a post-communist country, Hungary. The dissertation begins by presenting the international perspective. Using multiple theoretical perspectives it investigates how policies changed and what forces drove the process of deinstitutionalisation in different countries. Some common themes and experiences such as scandals, ideologies, policy learning, and the influence of advocacy coalitions are identified. This is followed by a review of the evaluation literature on the individual outcomes of different residential arrangements for people with intellectual disabilities. The second part of the dissertation presents the policy and practice in residential care in Hungary. Various interpretations of recent policy developments are put forward based on theoretical models of policy change, and the critical analysis of a broad range of policies suggests that residential care policies are resistant to change because institutions are a functional part of the policy system. The third part of the thesis describes the results of a field study looking at the quality of different residential arrangements in Hungary for people with intellectual disability. The thesis concludes with the discussion of the findings and the consideration of implications for national and international policies. It is argued that effective deinstitutionalisation and community living policies should not be based on existing community care policies in Hungary otherwise they risk replacing one set of institutions with another set of smaller scale institutions in the community. Successful policies will also need to address the underlying factors such as discrimination, poverty and the long-term outcomes of the child protection system. A stronger international commitment and surveillance of deinstitutionalisation is also necessary.