Overuse of institutional care for children in Europe: Table 1

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Abstract
Institutional care is commonplace The recent special issue of the BMJ on Europe in transition identified the problems associated with the reform of healthcare systems from centralised state bureaucracies to health insurance and market led services. The editorial on mental health in post-communist countries highlighted the overuse of institutions for people with mental health problems and intellectual disability and the lack of a public health approach involving primary care and community services.1 A recent survey by the University of Birmingham and the WHO regional office for Europe reported overuse of institutional care for young children in need—with and without disabilities.2 However, institutional care of young children was not restricted to countries in transition and was common throughout the European region (table 1). Institutions were defined as residential health or social care facilities with 11 or more children, where children stay for more than three months without a primary care giver. Small institutions had the capacity for 11-24 children and large institutions 25 or more children, regardless of age.2 View this table: In this window In a new window Table 1 Rates per 10 000 (rounded to the nearest whole number) of children under 3 in institutional care without a parent across the WHO European region in 2002 The recent WHO initiative on the prevention of child abuse3 expressed concern about the lack of community services to uphold the child's right to grow up in a family environment. National child protection policies and legal procedures to rescue children from abuse, neglect, and abandonment have sometimes developed piecemeal and not in parallel with primary care strategies for prevention of abuse and alternative family based care. Thus, in some countries, not enough surrogate family placements are available, so that children may be placed in institutions for long periods.