Experts of the Committee on the Rights of Persons with Disabilities Raise Questions about the Medical Approach to Disability Used in France
Committee Holds a Minute of Silence in Memory of Committee Expert Soumia Amrani of Morocco who Passed Away
The Committee on the Rights of Persons with Disabilities today concluded its consideration of the initial report of France after its Experts raised questions about its medical approach to disability, issues related to consent, and the education of children with disabilities, among others.
At the beginning of the first meeting, Rosemary Kayess, Chair of the Committee on the Rights of Persons with Disabilities, announced that the disability rights movement had lost a true champion in Committee Expert Soumia Amrani of Morocco, a well-known and well-respected advocate for the rights of people with disability, in particular autistic people. Her tragic passing on Wednesday, 18 August 2021 from coronavirus was marked by holding a minute of silence.
Committee Experts welcomed recent measures by France but noted that they were often not aligned with the Convention, given the fact that France adopted a medical approach to persons with disabilities. The 2005 law that set the medical approach was the main sticking point, particularly article 1, which created confusion between medical associations and organizations of persons with disabilities. This led to systemic discrimination against persons with disabilities – how could France move to a rights-based model? In line with this medical approach, France seemed to support the Additional Protocol to the Oviedo Convention that allowed for a deprivation of liberty for persons with disabilities, in a clear violation of their human rights. Was the State party willing to oppose the adoption of this protocol?
Committee Experts said they had been made aware of inhumane and degrading conditions of custodial measures in residential facilities, including forced medication, solitary confinement, and convulsive therapy without consent. Were there any plans to discontinue the institutionalisation of persons with disabilities, ensuring necessary support for living independently? There were allegations of forced psychiatric drug administration, as well as forced chemical treatments and hospitalisation. Was the State party ready to abolish all legislation related to forced hospitalisation, as it constituted an act of torture?
Experts sought information from the State party regarding the high rate of children with disabilities receiving education in segregated settings. There was a lack of statistics on children with disabilities not attending schools, particularly in overseas territories. More information on the education of deaf children in sign language was requested. Inclusive education required by the Convention did not support setting up special units within mainstream school settings, something that France was pursuing. This could lead to entrenched discrimination by separating children with disabilities from other children.
Sophie Cluzel, Secretary of State for Persons with Disabilities of France, noted that considerable progress had been made in order to ensure a fair system adapted to everyone, and to reaffirm, every day, in each public policy choice, the desire to uphold the values of the Convention on the Rights of Persons with Disabilities. Since 2017, the Secretary of State for Persons with Disabilities had been attached to the office of the Prime Minister, enabling action in a cross-cutting manner. In March 2019, the right to vote was restored to all protected adults; 350,000 French people could now vote and participate in the democratic life of the country. To move away from the logic of hospitalisation, France was developing living facilities specifically adapted to adults with more complex needs (persons with multiple disabilities, severe forms of autism, etc.).
Claire Hédon, Human Rights Defender, stated that the political ambition in France to make disability a priority issue deserved to be welcomed but significant gaps remained.
Magali Lafourcade, National Human Rights Institution, hailed the recent progress to integrate disability in France’s political agenda, and the national awareness raising campaign to dispel prejudices. She expressed alarm that political discourse on the delivery of care was not backed up by the provision of necessary resources.
In response to the Committee’s questions, the delegation of France noted that the law of 2005 and its broader approach to disability was founded on the rights of the individual rather than based on a medical approach . France considered the interactions between individuals with disabilities and external obstacles; the law was in line with the Convention. The draft Additional Protocol to the Oviedo Convention did not run counter to the Convention on the Rights of Persons with Disabilities as it did not hold specific rules on non-consensual treatment of persons with mental health conditions. Non-consensual treatment was not always incompatible, but restrictions from freedoms should be decoupled from disability – all persons should be considered equal in this regard.
The delegation clarified that care or treatment was provided without consent only in cases that persons would be putting themselves, or those around them, in danger, without treatment or care. Only five per cent of cases of care delivered to persons with disabilities was delivered without consent. Constraining was a last resort measure of limited duration, and a strict legal and medical framework existed for such measures, which were only used to de-escalate and pacify someone, preventing immediate danger to the patient and others. Judges, who were informed at every stage, could order these measures to be lifted immediately and judicial oversight could be invoked.
The delegation said there was data on the number of children who were not in school – in 2014 there were 111,000 children without schooling options, 4.4 per cent less than in 2010. Children with multiple disabilities were most affected. Reasonable accommodations were made in schools, such as changing exam times, the use of support tools such as the Inclusive School platform that helps teachers better understand different disorders. A Public Department for inclusive schooling had been created to ensure children with disabilities had access to education. Around 40,000 students with disabilities followed higher education in universities or secondary schools. This was a 30 per cent increase compared to 2017. Specialised education units were only one part of a plethora of measures provided by the educational system. They did not represent closed classrooms and students could be moved between systems depending on their requirements.
In his concluding remarks, Jonas Ruskus, Committee Member and Country Rapporteur for France, said he was disappointed to see the levels of structural discrimination of persons with disabilities in France, expressing doubt that the French motto of Liberté, Égalité, Fraternité was really applied to people with disabilities.
Sophie Cluzel, Secretary of State for Persons with Disabilities of France, said France sought to bring down barriers to allow everyone to fully exercise citizenship – equal opportunities, freedom of choice, equity and justice for all were core principles. All public policies had to rally to this aim – persons with disabilities must be able to live every moment simply and autonomously.
The delegation of France consisted of representatives of the Secretary of State for Persons with Disabilities, the Permanent Mission of France to the United Nations Office at Geneva, Inter-ministerial Committee on Disability, Ministry of Solidarity and Health, Secretary of State for Child Protection, National Solidarity Autonomy Fund, Ministry of Europe and Foreign Affairs, Ministry of Labour, Employment and Economic Inclusion, Ministry of Public Transformation and Service, Ministry of National Education, Youth and Sports, Ministry of Higher Education, Research and Innovation, Ministry of Justice, Ministry of Culture, Ministry of the Armed Forces, Ministry for the Ecological Transition, Ministry of Territorial Cohesion, Ministry of the Overseas, Ministry of Interior, and Municipal Council of Saint-Herblain.
Information relating to the Committee’s session, including reports submitted by States parties, are available here.
The webcast of the public meetings of the Committee can be found here.
The Committee will next meet in public on Friday, 27 August, to start its consideration of the initial report of Djibouti (CRPD/C/DJI/1).
Report
The Committee has before it the initial report of France (CRPD/C/FRA/1).
Presentation of the Report
SOPHIE CLUZEL, Secretary of State for Persons with Disabilities of France, noted that since the deposit of the two reports of France in 2016 and 2017, considerable progress had been made in order to ensure a fair system adapted to everyone, and to reaffirm, every day, in each public policy choice, the desire to uphold the values of the Convention on the Rights of Persons with Disabilities. Since 2017, the Secretary of State for Persons with Disabilities had been attached to the office of the Prime Minister, enabling action in a cross-cutting manner. As a result, five inter-ministerial committees on disability had been held under the auspices of the Prime Minister. In March 2019, the right to vote was restored to all protected adults; 350,000 French people could now vote and participate in the democratic life of the country. Another major step forward was the introduction of rights to life: people with irreversible disabilities no longer had to go through multiple administrative procedures, giving people back their indispensable dignity. Inclusive living solutions were developed to provide the possibility of living in shared accommodation.
To move away from the mindset of hospitalisation, France was developing living facilities specifically adapted to adults with more complex needs (persons with multiple disabilities, severe forms of autism, etc.). France and Belgium had announced a moratorium on the use of reception centres in Belgium, aiming to create reception solutions on French territory to stop the unconsented departure of French people with disabilities to Belgium. France had profoundly transformed its school model to better educate children with disabilities: at the start of the 2020 school year, 385,000 pupils with disabilities were enrolled, including 41,000 autistic children, who were previously excluded. During the pandemic, France had ensured that the needs of all citizens were addressed, leading to significant progress in the accessibility of communications using French sign language and subtitles. The President had agreed, at the National Disability Conference in February 2020, to launch a major national awareness-raising campaign aimed at changing the representation of persons with disabilities.
CLAIRE HÉDON, Human Rights Defender, stated that the political ambition to make disability a priority issue deserved to be welcomed but significant gaps between this ambition and implementation must also be highlighted. France’s approach to disability remained essentially medical, not rights-based, as per the law of 11 February 2005. The significant delay in France in terms of accessibility and the reluctance of public authorities to consider it as an essential prerequisite for the effectiveness of rights was deplorable. Public decision-makers and other actors in education, health, justice, leisure, and culture, had a lack of awareness and training, resulting in poor implementation. Persons with disabilities were still stigmatised today because of stereotypical, and often negative, perception and representation of disability. Discrimination in employment was of primary concern because of the refusal of many employers to make reasonable accommodation available. There was a lack of data on disability in certain areas, such as the number of children not attending school.
MAGALI LAFOURCADE, National Human Rights Institution, hailed the recent progress to integrate disability in France’s political agenda, and the national awareness raising campaign to dispel prejudices. However, the definition of disability provided in the Convention still needed to be domesticated in national law. The Government had not gone far enough to ensure the principle of mental and legal capacity of all persons. Ms. Lafourcade was alarmed by the fact that political discourse on the delivery of care was not backed up by the provision of necessary resources. The housing law adopted in 2018, reduced the target for accessible housing in new construction from 100 per cent to only 20 per cent. This was particularly important when considering the treatment of persons with disabilities during the COVID-19 pandemic. All the vulnerabilities of age, disability, and loneliness had become entangled. If the specialised structures had become isolated citadels, people at home may find themselves in danger, deprived of care.
Questions by the Country Rapporteur
JONAS RUSKUS, Committee Member and Country Rapporteur for France, welcomed the delegation’s participation, congratulating France for the new Labour Code provision obliging employers to take reasonable accommodation measures, as well as the strategy for the employment of persons with disabilities, among other measures. However, measures were not aligned with the Convention, given the fact that France adopted a medical approach to autism. The 2005 law that set the medical approach was the main sticking point, particularly article 1, which created confusion between medical associations and organizations of persons with disabilities. This led to systemic discrimination against persons with disabilities – how could France move to a rights-based model?
The situation of individuals with psycho-social disabilities was particularly concerning, as the draft Additional Protocol to the Oviedo Convention allowed for a deprivation of liberty for those persons, in a clear violation of their human rights. Was the State party willing to oppose the adoption of this protocol?
Questions by Committee Members
A Committee Expert said France had declared its commitment to harmonising its legal framework with the Convention – could the delegation present information on how it was doing so with regards to protecting the rights of persons with psycho-social disabilities?
Several Committee Experts asked about the National Consultative Council of Persons with Disabilities – the appointment of members was done by a Government Ministry, hence limiting the participation of persons with disabilities. How was the meaningful participation of persons with disabilities ensured?
The representation of autistic people in French media was stereotypical and not in line with the Convention – what measures was the State party taking to educate those in the media and to support persons with autism?
Rights under the Convention were difficult to uphold in courts due to confusion and a lack of understanding. How did France guarantee the effectiveness of rights in legal proceedings?
Another Committee Expert asked the delegation to provide information on measures taken to ensure that websites and virtual platforms were accessible.
Replies by the Delegation
The delegation stated that in 2017, France had reviewed its policy on autism and developmental issues, and in 2018, after a broad consultation process with persons concerned, a new national strategy had been drawn up. More significant financial means were now available, creating a rights-based approach and helping children to benefit from appropriate services. More than 42,000 autistic children studied in mainstream schools in 2020, and their needs were being increasingly taken into account: mass inclusive education was a main part of the broader strategy. Ensuring individual needs were met and providing tailored responses represented the main priority of France’s new service-based approach.
The Oviedo Convention was designed to close legislative gaps in certain European countries. The draft Additional Protocol was intended to guarantee the rights of those undergoing involuntary treatment. France believed this text was not incompatible with the Convention but did introduce two notions to the text to roll out alternative strategies to involuntary treatment.
Clear consent for health care was loud and clear in French legislation. Under certain often temporary circumstances, and only when the situation was urgent and individuals were unable to consent, freedom and liberty could be temporary voided by a judge. Given the high number of appeals against these measures, France was reviewing reforming them.
Regarding accommodation and accessibility, a great deal of change had taken place recently. New housing did not need to be 100 per cent accessible, but when looking at the text of the 2018 Housing Law as a whole, it contained innovative notions, including “evolving accommodation” that was intended to boost empowerment and independence, allowing persons with disabilities to tailor their housing as they saw fit. Previously bathrooms were often inaccessible, but today new housing was built with “Italian style showers” without barriers, allowing persons with disabilities and elderly persons to use them freely. Lifts were required when a building went above a second floor.
The National Consultative Council of Persons with Disabilities was a key body providing expertise to the Government, designing and consulting public policies. The Council was overhauled in 2019 to ensure better representation of persons with disabilities. It included six bodies that separately represented organizations and persons with disabilities in various fields. The Council reviewed all pieces of draft legislation, its work was public and transparent, and it closely collaborated with other relevant public bodies.
A new set of standards, obligations and sanctions with regard to online platforms had been established in 2019. This set up the Observatory for the quality of online spaces that monitored 250 most popular online activities. All activities were intended to be accessible and understandable, with the Observatory providing regular accessibility assessments of Ministries’ digital outputs. A budget had been created to ensure full digital accessibility of all government digital portals.
Around 250 facilitators had been recruited to support whatever path women with disabilities wanted to follow. Women with disabilities were taken into account in specific policy choices – for instance, in combatting domestic violence, hotline 3919 supporting those that suffered from violence was specifically available to persons with disabilities. Parents with disabilities who had children, or wished to have children, were provided with targeted support, including financial assistance.
Regarding children with disabilities and Down’s Syndrome going to Belgium, France was looking for appropriate solutions within the country. As a result of the moratorium and an inclusive strategy, children could not be systematically sent or placed somewhere without their consent and no forced exile could now occur to Belgium. The Government was seeking to provide options to return people from Belgium.
Follow-up Questions by Committee Experts
A Committee Expert asked about the situation of children with disabilities in medical-social institutions that still existed. The hospitalisation of children with autism treated the issue like a psychiatric problem.
Could persons with disabilities exercise their free and informed consent regarding vaccinations, and why were they underrepresented when it came to populations taking the vaccine?
What mechanism was there for persons with disabilities whose rights were violated to report discrimination? There were cases of deaf persons detained and unable to communicate with their lawyers – what procedures existed to make sure that persons with disabilities, particularly of a psycho-social nature, were placed in appropriate detention centres?
Instances of non-consensual institutionalisation, restraints, threats and even solitary confinement had been reported. International legislation recognised this as torture – what measures were being taken to combat deprivation of liberty due to psycho-social disabilities?
A Committee Expert asked why France believed the draft Additional Protocol to the Oviedo Convention was in line with the Convention on the Rights of Persons with Disabilities, despite hearing the Committee state that they were incompatible?
Committee Experts also asked for more detailed data on various issues, including on cases of violence against persons with disabilities, including women and girls with disabilities, on Roma and Travellers with disabilities, and information on the policing programme. Were there any correlations in the data on gender-based violence and violence against persons with disabilities? Were all shelters intended for female victims of violence accessible to women with disabilities?
JONAS RUSKUS, Committee Member and Country Rapporteur for France, asked if legislation recognised intersectional forms of discrimination. More information on the State party’s commitment to move away from the medical approach towards a rights-based model was required. What measures were being taken to ensure that the voices of children with disabilities were heard?
Replies by the Delegation
SOPHIE CLUZEL, Secretary of State for Persons with Disabilities of France, emphasised that the law of 2005 was founded on the rights of the individual rather than based on a medical approach. France considered the interactions between individuals with disabilities and external obstacles; the law was in line with the Convention.
Combatting discrimination was at the heart of France’s public policy. The 3928 hotline was available to victims, as well as a website, as improving support networks helped fight discrimination. Information was available to citizens to launch complaints to the Attorney General to improve the system. The national outreach campaign was designed at the intersection between the fight against discrimination and the representation of persons with disabilities. The Criminal Code did not recognise multiple or intersecting forms of discrimination, but jurisprudence followed legal reasoning and there were many instances of courts noting the existence of such discrimination.
The delegation stated that the participation of persons with disabilities in decision-making processes was critical. Only about 30 representatives with disabilities ran in the June 2021 elections; there was a hesitance by political parties to put forward candidates with disabilities. To combat this, the Government was publicly encouraging persons with disabilities to stand in local elections and was reviewing accessibility issues in relation to election processes.
Women with disabilities in low-level jobs were being supported, first by encouraging the opening up of jobs at all levels to women, and second, by providing additional accommodation benefits specifically to women. Recruitment agencies supported women with disabilities and improvements were clear in 2020 when compared with 2016. Gender equality was part of the broader policy, with economic empowerment and fighting sexual and gender-based violence representing priority areas. An emergency hotline was available to women who were victims of violence, including those with disabilities. All provisions of the Istanbul Convention had been domesticated.
Regarding medical practices for autistic children – things had changed considerably due to a new piece of public legislation designed to support autistic children. There were still inequalities in some territories, but an independent authority had been created to apply standards and good practices across the entire territory as per detection, treatment, and diagnosis of autistic children. Certain practices were prohibited, and sectors that resisted these prohibitions had been identified. The assessment of suicide risk of autistic persons was difficult, particularly among high-functioning autistic persons. A broader strategy, national campaigns and a national hotline, accessible to persons with disabilities and targeting the most vulnerable, worked in tandem to combat suicide rates.
A rights-based approach had been adopted, allowing children with disabilities to be treated, cared for and supported just like any other child, preferably in their family, but the suitability of their placement was vital. A considerable effort was being made as part of the national autism campaign to develop support services for autistic children, whether in schools, at home or during after-school activities. There was a considerable waiting list to access these services, but more and more capacity was becoming available. Ties between children and their parents were fundamental, and the State worked with families to find solutions to uphold these ties. France provided financing for family mediation within families, and last year 50,000 persons benefited from this programme.
The delegation noted the importance of the fact that the majority of children with disabilities were not residents or educated in specialised institutions but lived in home and attended regular schools. Over 20,000 were unable to attend a regular school, however, therefore the framework of specialised institutions had to continue. Where possible, overlaps existed with children attending specialised institutions, while also taking up some classes in regular schools, supported by specialised teaching assistants.
The recent figures of death rates in psycho-social medical establishments could be explained by the vulnerability of persons residing in such institutions to COVID-19. Vaccinations had been made available to healthcare personnel working in places where persons with disabilities resided as a matter of priority in January 2021, early in the vaccination campaign. Consent was always sought before administering vaccines. All conferences related to the health crisis were accessible with sign language and captioning. Vaccine coverage in residences with persons with disabilities was higher than average.
Tackling bullying and harassment in schools was critical for the Government and was enshrined in the education charter. Work was concentrated on prevention, including a national day on the prevention of harassment and a media campaign, encouraging students to become anti-harassment advocates. There was also an anti-bullying hotline that engaged experts to follow up and resolve incidents of harassment.
Once a deaf or hard of hearing person was detained, automatically the provision of a sign language interpreter, or another form of communication that the individual was comfortable with, was considered. If communication was impossible, hearings were suspended. Screens were used in some courts, providing subtitles to benefit deaf or hard of hearing persons.
Legally speaking, hospitalisation under restraint was impossible – no care was possible without clear consent. Care could be provided without consent only in emergency situations when persons were in a general state of confusion or a psycho-social crisis. Only five per cent of cases of care delivered to persons with disabilities was delivered without consent. There was a three-month limit on the delivery of such care, after which consent was required. All cases of deprivation of liberty had judicial oversight and the individual under detention could at all times use the court system to overturn it or complain to the Ombudsperson’s office in case they deemed their rights violated.
Follow-up Questions by Committee Experts
JONAS RUSKUS, Committee Member and Country Rapporteur for France, asked if there were any procedural recommendations for deaf and blind persons in administrative and court proceedings?
Was the delegation aware of inhuman and degrading conditions of custodial measures in residential facilities, including forced medication, solitary confinement, convulsive therapy without consent, etc.? With this in mind, were there any plans to discontinue the institutionalisation of persons with disabilities, ensuring necessary support for living independently? Another Committee Expert added that there were allegations of forced psychiatric drug administration, as well as forced chemical treatments and hospitalisation. Was the State party ready to abolish all legislation related to forced hospitalisation, as it constituted an act of torture? Were there any ambitious strategies to reduce the number of specialised institutions, and/or to enact a moratorium on new institutions?
The Committee was concerned about various laws, policies and practices that significantly impacted the right to physical and mental integrity. Was the State party prepared to abolish abortion and sterilisation of women and girls with disabilities without their informed consent? The same question was asked about behaviour modification practices, and medical treatments seeking to “cure” autistic people. Regarding referrals of intersex children to medical intervention – how did it ensure the prohibition of medical intervention prior to children being able to provide consent?
Were gender and disability experts available during court proceedings?
Replies by the Delegation
The delegation noted that the 2007 law on the legal protection of adults always underscored the need for proportionality and promoted the independence and autonomy of adults. Only a disability to the degree that an individual was not able to take care of themselves would lead to a court order for guardianship. There was an ongoing reform process, with continual improvements, such as the recent focus on tailored approaches to provide judges with many tools that fit individual circumstances.
Disabilities were factored in the Criminal Code, ensuring access to justice for persons with disabilities. The Ministry of Justice had a raft of measures, including 2,000 special advisers who provided disability-related information and guidance during legal proceedings. There was a particular legal measure to ensure experts could be heard during proceedings.
The delegation clarified that care or treatment was provided without consent only in cases when persons would be putting themselves, or those around them, in danger, without treatment or care. All such treatment was proportionate and limited in time, upholding the dignity of the person, pursued under judicial review. Persons were informed about the treatments throughout, as far as they were able to understand them. Digitalisation of hospital registers to improve their accessibility was ongoing.
Several steps were being taken to address unnecessary medication provided to persons with autism, such as Government recommendations to all medical professionals prioritising behavioural approaches. Training for professionals who may encounter autistic persons had been updated, covering education, justice, hospitals, social work sectors, and more. A set of guidelines covering medical-clinical aspects regarding the prescription of psychotropic medicines to adults and children with autism was being drawn up. A choice had been made to set up residence units for young adults and adolescents with severe cases of autism that led to social disorders.
Questions by Committee Experts
JONAS RUSKUS, Committee Member and Country Rapporteur for France, sought information from the State party regarding the high rate of children with disabilities receiving education in segregated settings. There was a lack of statistics of children with disabilities not attending schools, particularly in overseas territories. More information on the education of deaf children in sign language was requested, including any measures and effects related to COVID-19.
A Committee Expert asked the State party about the measures in place to ensure that public information was available and accessible to all persons with disabilities , including deaf, blind or deafblind persons and persons with intellectual disabilities.
The May 2018 law on personal data protection contained provisions to monitor data on persons undergoing treatment without consent. At the same time, the law of 2016 allowed this data to be considered when looking into radicalisation and terrorism. What measures were being taken to protect the private lives of persons with disabilities caught up in these intelligence processes? How was this data useful in counter-terrorist operations?
A Committee Expert noted that there was a disconnect between the information provided by the delegation, and information the Committee received from other sources. Many persons with disabilities were working in segregated sectors. It seemed that the Government was encouraging the development of such sectors, rather than working to integrate persons with disabilities into the broader labour market. What measures had France taken to make the labour market more inclusive?
Moving beyond social welfare and protection, how did the Government intend to guarantee that its policies were not in conflict with the process of de-institutionalisation? Considering that 30 per cent of persons with severe disabilities were living under the poverty threshold, was the Government able to guarantee appropriate living standards to these persons, given they were living on the margins of society?
Replies by the Delegation
SOPHIE CLUZEL, Secretary of State for Persons with Disabilities of France, affirmed that the Government was fully mobilised to strengthen the autonomy of people, including those with disabilities, in their daily lives – starting with ensuring that persons were able to choose where they lived. An inter-ministerial development plan had been designed to help people set up their housing solutions and various departments were involved in finding these solutions. Only 100,000 out of 12 million persons with disabilities in France were living in institutions. All needs were covered in local areas, so those in institutions could live locally.
There was data on the number of children who were not in school – in 2014 there were 111,000 children without schooling options, 4.4 per cent less than 2010. Children with multiple disabilities were most affected. Reasonable accommodations were made in schools, such as changing exam times, and the use of support tools such as the Inclusive School platform that helped teachers better understand different disorders. Deaf children and those communicating in sign language used to go to specialised institutions in the past, but the Government was working with associations to develop bilingual teaching, with 6 out of 30 academies proposing a full bilingual path. A Public Department for inclusive schooling had been created to ensure that children with disabilities had access to education. Around 40,000 students with disabilities followed higher education in universities or secondary schools. This was a 30 per cent increase compared to 2017. When taking exams, students with disabilities could benefit from extended time, individual rooms, adapted materials, and other measures.
The Superior Audiovisual Council had been strengthened through legislative measures, paying particular attention to health alerts and significant events. A new law obliged public television channels to make their programming accessible to deaf or hard of hearing persons. Private news channels had followed and were providing some accessible coverage as well.
The application “Hopsyweb” was designed to help better manage timeframes and other organizational aspects of psychiatric care that was administered without consent. It did not manage full medical files, and only contained administrative information, protecting the medical data of patients. In 2019, authorities had put in place verifications to check whether certain persons listed in these files were vulnerable to radicalisation. This enabled local state prefects to be informed when persons in the Hopsyweb file were also on the list of those vulnerable to radicalisation – the prefects were only informed, and did not have access to the files themselves, thereby personal data was protected.
A proactive approach to go to persons with disabilities and bring them to the healthcare providers, ensuring professional advice, had been adopted. Information on COVID-19 in Braille and easy-read had been made widely available. Accessible consultations within a medical environment tailored to individuals were available. Across France, 75 dedicated centres enabled persons with complex issues to access healthcare. A pilot committee involving a number of ministerial departments with a 10 million euro budget in 2021 focused at a local level to provide assistive devices in order to increase the number of points of sale of assistive devices and improve insurance coverage of assistive devices.
Employment was crucial and had prime importance in the lives of persons with disabilities. Sustainable access to employment was prioritised together with encouraging personal projects. Sheltered employment centres did not have the same labour rules as other employers, and rules on holidays and mobility were being aligned. This was part of a broader strategy to increase mobility between the specialised sheltered employment activities and the broader labour market, such as encouraging the possibilities of working part time within both systems. The Government was seeking to address discrimination at work, including by employers, via the Duo Day awareness campaign, and encouraged companies to reform their recruitment practices to be more inclusive.
The poverty line in France was 1,094 euros per month. The rate of poverty was not very high among adults with disabilities, at 19.5 per cent, lower than the general average of 24.6 per cent. In 2020, the combination of benefits available to persons with disabilities enabled a single adult person to have a standard of living of 1,275 Euro per month, 19 per cent above the poverty line. These benefits included housing benefits of 224 euros per month, severe disability benefits of 105 euros per month, and more.
Voting rights were given to all protected adults with no obstacles. There was no information on how many persons under guardianship were in the voting list – and some information was available that some of those had difficulties accessing their voting rights. An inter-ministerial commission had been created to assess this situation and look at possible solutions for persons under guardianship to vote effectively and independently. According to national statistics, during regional elections of 2015, 64 per cent of persons with disabilities voted, compared to the general 66 per cent average. More had to be done to ensure the access of persons with disabilities to voting, and a working group was set up in 2019 with this goal. Regarding upcoming presidential elections next year, legal measures were being taken to encourage candidates to hold inclusive campaigns. In June 2023, a report would be submitted to the Parliament to assess these measures.
Regarding care for persons with psycho-social disabilities, the delegation had already given an answer on isolation and constraints. Constraining was a last resort measure of limited duration, and a strict legal and medical framework existed for such measures, which were only used to de-escalate and pacify someone, preventing immediate danger to the patient and others. Judges, who were informed at every stage, could order these measures to be lifted immediately and judicial oversight could be invoked. Instances of non-consensual treatment were severely reduced, and the National Council had called for the review of the law to reduce them further. Shock therapy was not considered inhumane and degrading if it was used based on the recommendation of the higher medical authorities. There was strict monitoring of all establishments authorised to use this technique: persons undergoing shock therapy must give consent, and all establishments were inspected by the highest medical authority.
Follow-up Questions by Committee Members
A Committee Expert noted that the Intergenerational Equality Forum held in June-July 2021 was hosted by the French Government with the support of UN Women. It was set up in an inaccessible virtual forum and did not provide captioning, international sign language interpretation or other accessible features. This had excluded many interested persons with disabilities from participating, accessing information and even from expressing themselves. What measures were being taken to ensure that this kind of exclusion did not occur in the future?
During the COVID-19 pandemic, what specific measures had been taken to ensure tailor-made services for persons with hearing impairments and autistic persons?
A Committee Expert noted that inclusive education required by the Convention did not support setting up special units within mainstream school settings, something that France was pursuing. This could lead to entrenched discrimination by separating children with disabilities from other children. Instead, children with disabilities should be included in the mainstream school settings themselves.
What was the exact justification for the delegation’s view that the draft Additional Protocol to the Oviedo Convention was compatible with the Convention on the Rights of Persons with Disabilities?
JONAS RUSKUS, Committee Member and Country Rapporteur for France, asked the delegation to inform the Committee about measures being taken to recognise the professional status of sign language interpreters, and to recognise sign language in all areas of life. The high level of poverty among persons of disabilities, especially of persons with high support requirements, was a concern – what measures were being taken to effectively systemise and enhance existing support systems?
Mr. Ruskus said he had been informed of the low-level rate of professional qualifications of persons with disabilities, consequent from the lack of access to professional training programmes and resulting in unskilled and low-wage employment.
Replies by the Delegation
The Intergenerational Equality Forum was organized by UN Women, but the accessibility issues reported by the Committee were unacceptable. The delegation said they had not heard of this situation before and that it would be investigated. All events advertised on Government websites had to be accessible – if France had been the sole organizer, the forum would have been accessible.
During COVID-19, there was a 142-fold rise of medical appointments online to 19 million. The Government in January 2021 had set up a working group to make sure that appointments could be more accessible, drawing up recommendations and tools for professionals and telephone operators. An online podcast was created to give advice to companies.
The draft Additional Protocol to the Oviedo Convention did not run counter to the Convention on the Rights of Persons with Disabilities as it did not hold specific rules on non-consensual treatment of persons with mental health conditions. Non-consensual treatment was not always incompatible, but restrictions on freedoms should be decoupled from disability – all persons should be considered equal in this regard. Mental health conditions did not mean that someone could automatically be subject to non-consensual treatment. Interpretation of the provisions in the Convention should be done in the context of other Conventions.
Regarding specialised education units – they were only one part of a plethora of measures provided by the educational system. They did not represent closed classrooms and students could be moved between systems depending on their requirements. Medical-social establishments had specialised units for students with autism. The creation of separate units for students with autism was not favoured, and the system encouraged the integration of schooling.
France was committed to providing job opportunities for women and migrants with disabilities. A long-term investment programme developing skills of job seekers, disbursing one billion Euros over a five-year period, had been launched in 2018 and specifically focused on migrants, fostering innovation in the area of employment.
Concluding Remarks
SOPHIE CLUZEL, Secretary of State for Persons with Disabilities of France, thanked the Committee for the very constructive dialogue – it really met the standard and ambition of the Convention. France sought to bring down barriers to allow everyone to fully exercise citizenship – equal opportunities, freedom of choice, equity and justice for all were core principles. All public policies had to rally to this aim – persons with disabilities must be able to live every moment simply and autonomously.
CLAIRE HÉDON, Human Rights Defender, reiterated that the paradigm shift imposed by the Convention was not culturally embedded in the French approach to disability. Traditionally, and still today, this approach was essentially based on the person's incapacities, to which responses were provided through national or even family solidarity. Ms. Hédon called on the Committee to ensure that France’s inclusive approach was not to the detriment of the most vulnerable.
MAGALI LAFOURCADE, National Human Rights Institution, stated that to remedy the current painful situation, the Institution encouraged the Government to implement a strategic plan aimed at: (1) revising all its legislation to bring it into line with the Convention; (2) implementing the provisions of the Convention in practices within the territories; (3) reviewing the fair representation of persons with disabilities in decision-making bodies.
JONAS RUSKUS, Committee Member and Country Rapporteur for France, stated that he liked France, having lived there for four happy years in a community of people with intellectual and psychosocial disabilities. He was, however, disappointed to see the levels of structural discrimination of persons with disabilities in France, expressing doubt that the French motto of Liberté, Égalité, Fraternité was really applied to people with disabilities.
ROSEMARY KAYESS, Chair of the Committee on the Rights of Persons with Disabilities, thanked the French delegation for its constructive dialogue with the Committee, and closed the meeting.
CRPD21.005E