In order to obtain their entitlements all Belgians, including those with a disability, must be clear about who they are (i.e. Flemish or French-speaking) and where they live. This is because some entitlements are provided nationally by the federal government, while others are provided regionally. There are three regions in Belgium: Flanders (mainly Flemish), Wallonia (mainly francophone or French-speaking) and Brussels which is bi-lingual. As a further complication, the country is also divided into three linguistic communities i.e. Flemish, French and a small German-speaking community in the east. The final level of administration is the commune which provides local government services, provides information on how to access services, and issues identity documents.
Disability and family payments are paid by the federal ministry for social affairs, public health and environment. The disability benefit consists of two payments, one of which is an income replacement for those whose ability to earn is reduced by at least 30%. The other is an integration payment to assist with the costs of integrating into society, e.g. transport, household help, communication. The integration payment is assessed separately, with four levels of payment. Application is made with a medical certificate to the local commune, which adds information on the applicant’s identity and sends it on to the ministry. There are supplementary child benefits not only for the parents of a disabled child but also for a disabled parent whose child lives with him or her. Further details are on the Belgian government website http://socialsecurity.fgov.be/guide.
Medical, healthcare and rehabilitation expenses are reimboursed by the ‘mutuelle’—the mutual insurance association to which all employed people pay contributions. An unemployed person with a disability pays a small contribution. Medical services and facilties in Belgium are generally of a very high standard in comparison with Ireland or the UK.
In the Brussels region, access, information and advice on education, training, employment and other support services are through the ‘Service Bruxellois francophone des personnes handicapees’ (SB). There is an initial assessment by a multidisciplinary team, which includes doctors and psychologists, who then decides with the applicant what assistance is needed. The ‘service d’accompagnement’ for adults aims to help with independent living and with accessing the appropriate services such as housing, day centres or respite care. The ‘aide precoce’ service provides educational, psychogical and social assistance for disabled children and their families from birth to school age. There is a ‘service d’accompagnement’for school-age children providing psychological and social support. At the end of school or before starting training an assessment at a ‘centre d’orientation’ facilitates a decision on the most appropriate training or career.
The SB assists disabled people seeking employment with various subsidies and grants. If a disabled person finds a job, the SB will pay 85% of their salary for a year. This is renewable for three years and is intended to lead to a full contract of employment. Another subvention, to compensate for loss of output, pays 65% of salary for a year to the employer of a disabled person. There are also grants for workplace adaptation and equipment.
There are a number of ‘Entreprises de Travail Adapte’ (formerly known as sheltered workshops) registered with the SB. The workers there have the same contracts of employment and minimum wages as other employments. One example is Ferme nos Pilifs, a non-profit organisation which employs 90 people, 75 of whom are disabled. Its activities include garden design and maintenance, a children’s farm, a garden centre, farm shop and restaurant. Other parts of the organisation include sheltered housing, a day centre for severely disabled people, and a nursery for preschool children (www.fermenospilifs.be).
In Wallonia, the non-profit Association Francophone d’Aide aux Handicapes Mentaux (AFrAHM) provides supports similar to the ‘Service Bruxellois’. They include ‘aide precoce’, psychological and social services. It also has a ‘Support-AHM’ which is a commitment between AFrAHM and the parents of a mentally disabled person to supervise their care with regard to his/her wishes. The Support-AHM also provides an advocacy service for a person whose parents are dead or who can no longer manage (http://users.skynet.be/anahm.nvhvg in French only).
Education and schools are administered by the French, Flemish or German language communities. Admission to a special or integrated school is based on an assessment by a doctor, a psychologist and a social worker. Generally there is no shortage of suitable school places. The International School of Brussels (www.isb.be), one of the schools which cater for the English-speaking community, has a special education program taught through English, for children 4–18 with developmental disabilities. Each child has an individual education plan and is provided with a range of therapies. The fees are very high, but 90% of pupils are paid for by their parents’ employers.
In order to get an overview, I contacted a support group for English speaking parents living in Belgium who have a child with a disability. In general they find that medical treatment and facilities are much better in Belgium than in the UK. Although there is much more administrative bureaucracy when applying for benefits, once that is achieved the social security payments are higher owing to the additional child benefit. Educationally it is felt that the integration of children with learning disabilities into mainstream schools in more advanced in the UK; In Belgium it is very difficult to integrate a child at secondary level.