Intended for healthcare professionals

Analysis And Comment Child health

Overuse of institutional care for children in Europe

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:485
  1. Kevin Browne, centre director (,
  2. Catherine Hamilton-Giachritsis, senior lecturer1,
  3. Rebecca Johnson, research fellow1,
  4. Mikael Ostergren, regional adviser for child and adolescent health and development2
  1. 1 Centre for Forensic and Family Psychology, University of Birmingham, Birmingham B15 2TT
  2. 2 WHO Regional Office for Europe, Copenhagen, Denmark
  1. Correspondence to: K Browne
  • Accepted 1 December 2005

Children in institutional care are at risk of attachment disorder and developmental delay, but Europe still relies heavily on this form of care for children in adversity

A minority of children live without their parents, either because their biological parents have died or abandoned them or because their parents do not have the means to care for them appropriately. Under the United Nations' Convention on the Rights of the Child all 52 countries in the World Health Organization's European region agreed to provide children in need with temporary or permanent substitute care. Substitute care varies from institutional care to forms of family based care, such as guardianship by relatives or friends, fostering, or adoption. The services that have been offered have changed over time and have been influenced by political, economic, and social changes.

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. …

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