Institutions for persons with disabilities When persons with disabilities have pain, it is sometimes not perceived or played down by the care staff. Commission 3 reported about a facility in which no pain assessment was Lack of knowledge conducted. It is obvious that this is untenable particularly for a group of persons who is reliant on a considerable amount of support services. The reasons for this are not ostensibly the negligence of the care staff but are above all the lack of knowledge and a complex diagnostic environment. The magazine “Behinderte Menschen” (“Persons with disabilities”) focussed on this topic in the No. 2/17 edition. It is particularly important to address this issue from a human rights perspective because both the right to health (Article 25 UN CRPD), the right to physical and mental integrity (Article 17 UN CRPD) and in serious cases even the right to protection against violence (Article 16 UN CRPD) or protection against degrading treatment (Article 15 UN CRPD) are violated if pain is not treated. It is often difficult for persons who are unable to speak and have complex disabilities to communicate their needs. Expressions of pain in whatever form Communication barriers must be overcome are sometimes not taken seriously and attributed to the respective disabilities. This is why the caregiver has a crucial role in perceiving the sensitivities of persons with disabilities in particular. Communication barriers that lead to misunderstandings can only be overcome by care staff if there is a stable, longterm relationship to the clients and if they are familiar with their gesticulation and facial expressions. The professional support of persons with disabilities who are suffering from pain on the part of doctors and the care staff is thus indispensable, and the refusal to give the necessary attention is inhuman. For this reason, qualified staff must have the necessary knowledge to notice when these persons are in Knowledge dissemination on the topic of pain is necessary pain and take the right steps for treatment. Care staff should also be routinely instructed in alternative pain treatments and apply the same as an alternative or supplement to medication-based treatments. Positioning aids, suitable seating, customised wheelchairs and the like can help to reduce pain. But breathing exercises, reducing tension or aromatherapies are also examples of ways of alleviating pain. Persons with complex disabilities should not be merely passively observed, perceived and diagnosed. In the interest of self-determination and the independence of the clients, it is necessary to provide them with the most suitable tools possible or to develop the same with them so that they can communicate their needs themselves. In the Report 2016, the NPM already criticised the frequent lack of willingness to apply supported communication. This has considerable negative effects in the area of pain diagnosis. 95