1 Starting points for Finland’s disability policy
In recent years Finnish disability policy has been resolutely developed by the state,
local authorities (municipalities) and non-governmental organisations. Their co-operation
has brought about improvements in the everyday life of persons with disabilities, though
there are many challenges and much work still left to be done. Society is never perfectly
arranged. Continuous interaction is needed between the authorities and citizens in order
to take into account the rights and life situation of special groups, such as persons with
disabilities, in decision-making. We hope that the basic information included in this
brochure about the everyday life of disabled people and the guidelines of Finnish
disability policy will contribute to constructive developments and to the discussion about
the issue in integrating Europe. Finnish society is today more accessible to persons with
disabilities than ever before. We hope that this review will encourage a similar course in
Europe and help us overcome the barriers and boundaries that persons with disabilities
encounter everywhere.
In 1993 the United Nations adopted Standard Rules on the Equalisation of Opportunities
for Persons with Disabilities. On the basis of these Finland set out its own disability
policy programme in 1995. Its aim is to promote the independent living, equal
opportunities and participation in society of persons with disabilities. These goals can
be achieved by increasing the independent initiative and decision-making power of persons
with disabilities and by eliminating physical, attitudinal and communication related
barriers to access. In the context of the reform of the constitutional acts, the
Constitution Act of Finland was amended in 1995 with a provision on the equal treatment
for persons with disabilities, according to which no one shall be assigned a different
status on the basis of their health or disability. It is required that the state and
municipalities work actively for implementing the rights of persons with disabilities.
There are separate provisions on the obligations of municipalities elsewhere in the law.
Service provision
The Ministry of Social Affairs and Health leads the development of social welfare and
health care legislation and services. The Ministry is in charge of the planning, guidance
and monitoring of services. The municipalities (452) are responsible for providing the
necessary social welfare and health care services. The Social Insurance Institution is in
charge of the medical rehabilitation of severely disabled persons, vocational education
for disabled persons, and their income security during periods of rehabilitation.
Legislation obliges the municipalities to provide the necessary social and health services
for their inhabitants. Municipalities can provide these services by themselves, in
co-operation with other municipalities or by purchasing them. Five Provincial State
Offices guide and monitor the operations regionally.
There is a National Council on Disability linked to the Ministry of Social Affairs and
Health, consisting of eighteen members. It is a co-operative body between the relevant
authorities and disability organisations. Good decisions pertaining to disability policy
can be brought about only by combining the expertise of people with disabilities and that
of the public administration. There are about 220 municipal councils on disability, in
which the different sectors of administration and NGOs co-operate at the local level.
The Advisory Board for Rehabilitation is a co-operative body of the Ministry. The
Advisory Board has eighteen members representing the authorities and institutions in the
field of rehabilitation, disability organisations, municipal central organisations and
labour market organisations. The task of the Advisory Board is to promote the drawing up
of development plans and objectives for rehabilitation and to monitor the implementation
of legislation. In addition, each hospital district has a regional co-operation commission
for client service within rehabilitation. There are corresponding liaison groups for the
local authorities in about 280 municipalities.
Financing of services
The Finnish disability policy is based on the Nordic welfare model. The aim is to
secure all municipal inhabitants the services they need, irrespective of their financial
or social status. The model used is mainly revenue-financed public services, complemented
by private services and NGO activities. The municipalities receive state subsidies for
organising statutory health care and social services. The Finnish Slot Machine Association
finances part of the activities of NGOs and certain foundations. There are about 70
national disability organisations in Finland. They also provide services that are
purchased by municipalities.
Development challenges
The focus of disability policy is being shifted from services and rehabilitation to
removing obstacles to the equal participation of disabled persons. Society as a whole is
responsible for taking into account the needs of persons with disabilities. The improved
accessibility of housing and the living environment, transport, communication and
information would enable their empowerment and participation. Resources are focused so as
to encourage persons with disabilities to be active and take initiatives for themselves.
The different disability groups are treated equally. The goal of the near future is to
maintain and promote the functional and working capacity of persons with disabilities,
with special emphasis on supporting the independent living of severely disabled persons.
2 Disability services and care of mentally handicapped persons
The aim of the Act on Services and Assistance for the Disabled is to promote the
independent living and equal opportunities for persons with disabilities. The Act is,
however, subsidiary, and the necessary services and supportive measures shall be provided
by municipalities primarily on the basis of general legislation. Disability is defined in
relation to how a person copes with everyday situations. Functional capacity cannot
therefore be assessed only medically.
About five per cent (250,000 people) of the Finns have an impairment or disability
involving considerable handicap. Less than one per cent of the population are seriously
disabled and need various services and support measures in order to attain a position
equal to other citizens. Therefore municipalities are by law obliged to provide seriously
disabled people with such services and financial support necessary for independent living.
This responsibility applies to transport services, service housing and interpreter
services. Furthermore, the municipality has to compensate for the costs of alterations and
repairs to flats and of obtaining equipment and devices needed in the home. If a disabled
client considers that the municipality does not provide the statutory services and
support, he or she may apply a decision of the social welfare board to the Provincial
Administrative Court and further to the Supreme Administrative Court.
Transport services
The municipality provides seriously disabled persons with transport services needed for
being able to work, study, participate in society, and for recreation. A person is
considered seriously disabled is he or she has special difficulty in mobility and cannot
therefore use public transport. If needed, these persons are provided with an escort.
Besides journeys to and from work and places of study, they can make up to 18 journeys a
month in their own municipality or in its vicinity. Transport is provided mainly by taxi,
though joint transport and service lines are also becoming more general. The client pays
the same price for this transport as for public transport.
Interpreter services
The municipality provides free interpreter service for the deaf-blind and for persons
with serious hearing impairment or severe speech impairment. Interpreter services are
provided in sign language or by other forms of communication using new technology. The
deaf-blind are entitled to 240 hours and others to 120 hours of interpretation a year.
Interpreters are mainly employed on a freelance basis. Various ways of organising
interpreter exchange regionally have also been developed. Interpreter services vary from
one municipality to another.
Service housing
Service housing covers, besides the flat, services related to housing that enable even
seriously disabled persons to live normal lives independently. Services are provided to
seriously disabled persons who owing to their impairment or illness need regular
assistance in everyday life for a certain period during a day. Institutional services
guarantee continuous care and attendance on 24-hour basis. Service housing can be arranged
in the client’s own home by means of home and nursing services and personal
assistance. Service housing is also arranged in service flats and group homes designed for
the purpose. The need for services varies, and therefore they are planned together with
the disabled person concerned. A disabled person pays rent and other costs in the same way
as other people do, though the additional assistance needed because of disability is free.
Home alterations and equipment and devices
A seriously disabled person must be reimbursed for the costs of alterations to the flat
and obtaining equipment and devices needed in it. The alterations must be necessary for
the person’s independent living, owing to his or her disability or illness. Usual
alterations comprise changes in the bathroom and kitchen, making doors broader, removing
thresholds and building ramps. The costs of planning the alterations and removing barriers
in the immediate environment are also covered.
The equipment and devices needed in the home include fixed hoists, safety alarm
devices, lifts, textphones, fixed high technology equipment and induction loops. If a
person needs household appliances, the municipality pays half of the costs or delivers an
appliance free of charge for the disposal of the person. The requirement for compensation
is that the piece of equipment is needed owing to the person’s handicap.
Personal assistance
The municipality may at its discretion reimburse a disabled person for the costs of
employing a personal assistant. The system of personal assistance has been created to
enable the independent living of seriously disabled persons. It contributes to reducing
dependence on the family and avoiding placement in an institution. A personal assistant is
needed to assist a disabled person in everyday situations at home and in activities and
hobbies outside home. The aim is that persons with disabilities should be able cope
independently in working life and studies. Disabled children are provided with an
assistant at school and in day care, if needed.
A personal assistant is employed by the disabled person. Therefore it is required that
the disabled person or his or her guardian is able to function as an employer and fulfil
the obligations of an employer. The municipality may give guidance to disabled employers.
The aim of the system is to reduce the level of the disabled person’s dependency, and
therefore it is recommendable that a close relative should not be employed as personal
assistant, though this may be justified in some cases.
Adaptation training and rehabilitation counselling
Adaptation training helps a disabled person to lead a full life despite his or her
impairment. Adaptation training is usually arranged in the form of residential courses.
There is favourable experience from groups that convene at regular intervals. New stimuli
to adaptation training have been given by peer support activities where a disabled person
guides and supports other disabled persons. Adaptation training has very definite goals,
such as learning how to live independently. Training is also arranged for the families of
children with disabilities.
Through rehabilitation counselling persons with disabilities are referred for services.
A rehabilitation counsellor draws up an individual service and rehabilitation plan
together with the disabled client and authorities. Rehabilitation counsellors work mainly
in health care and in disability organisations. Municipal social work can also be regarded
as rehabilitation counselling in identifying a person’s service needs and referral
for services.
Service plan
In order to find out which services and supportive measures a disabled person needs and
to co-ordinate these, the authorities draw up an individual service plan together with the
disabled person and his or her custodian or family members. The starting point is the
client’s service needs. The purpose of the service plan is to improve the
client’s right of self-determination and leverage. The service plan is a co-operation
instrument based on the client’s involvement and a close co-operation between
different authorities. The plan is checked at regular intervals, and a person is appointed
with the responsibility for co-ordinating the services and liaising with the relevant
authorities.
Special care of mentally handicapped persons
The special care of mentally handicapped persons is based on separate legislation,
which is secondary in nature. Finland is divided into sixteen districts for special care,
which must organise the special care that the local authorities are obliged to provide. In
addition, there is a specific district for the Swedish-speaking population, consisting of
Swedish-speaking and bilingual municipalities. The districts provide the services needed
by mentally incapacitated persons. Municipalities may also arrange special care or buy
services from another municipality or private service producers. They mainly concern
housing services, day activities and leisure activities, family care and residential care.
The special care districts also complement with their special expertise the services
provided by municipalities.
In Finland, about 22,000 mentally handicapped persons need special services to
complement the municipal social welfare and health care services. About 14% of them are in
institutional care, about 6% in family care, about 20% are provided with housing services,
and about 20% live independently. About 40% of them live with their families.
The special care of the mentally handicapped has undergone much change in the
1990’s. In practice the responsibility for providing services has been shifted from
the special care districts to municipalities. The role of institutions has been gradually
reduced and the focus shifted to services arranged by municipalities in the community
where the mentally handicapped person lives. There are great differences in different
parts of the country in how services for the mentally handicapped are provided. The number
of clients also varies greatly from one municipality to another.
Seriously mentally handicapped persons are also provided with suitable services in the
local community. This requires developing new housing facilities and support services in
municipalities, an adequate number of professionals and development of the general
services of municipalities. Quality services, respecting the clients’ autonomy and a
functioning social network provide a basis for a good life for mentally handicapped
persons in the local community.
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