National Preventive Mechanism 2.4 Institutions and facilities for persons with disabilities 2.4.1 Introduction In 2014, the commissions carried out 78 monitoring and control visits in institutions and facilities created especially for persons with disabilities. As was the case in the previous year, public and private operators were monitored and controlled, whereby the range of institutions included homes, shared accommodations, day care centres, sheltered workshops and nursing wards. These types of institutions and facilities are encompassed both by the OPCAT mandate and by the mandate set out in Section 16 (3) of the UN Convention on the Rights of Persons with Disabilities (CRPD). The monitoring activities turned out to be very complex due to differing levels of need, the broad range of offerings and the diversity of the institutions and organisational forms. At the same time, the commissions also found qualitative and quantitative deficits with regard to care, especially for people with double and multiple diagnoses (learning disability and mental disorder or psychiatric impairment). Persons with intellectual impairment, who additionally are experiencing a psychosocial crisis or a mental illness, sometimes show extremely aggressive behaviour toward themselves or others; this creates a great deal of stress for themselves, the care staff and their families. Mentally disabled persons exhibit mental health issues and classic psychiatric disorders three to four times more frequently than the average population. This statement by the World Health Organisation (WHO), is based on the higher degree of vulnerability of this group of persons. At the same time, mental illness creates a particular challenge to caretakers, as the capability of these persons to comprehend and verbalise their disorder is frequently impaired. Therefore, persons employed in social institutions and facilities must address these psychiatric conditions, learn to understand them and find individual responses to behaviours to which they had previously not had a connection. As a result, situations arise during their day-to-day work that often overwhelm them. Broad range of offerings but deficits in care nevertheless Emphasising their mandate to prevent violence, the commissions have found that deficits in care result in crises that sometimes lead to very dramatic physical assaults on other residents and staff. It is by no means rare that these persons, who require intensive care, are passed on from facility to facility and in the process lose their support systems again and again, producing and exacerbating hospitalisation effects. This is the consequence of the lack of an environment with person-centred care and therapeutic support by qualified staff. If institutions and facilities are not successful in finding adequate resources and preventing these escalations, this can have fatal consequences, which must then be borne by the persons with disabilities who are thus cheated of opportunities for development and happiness. For example, Commission 1 encountered a 15-year-old in the forensic ward at Violence as a consequence of unsuitable conditions 119