As a result of this initiative, according to the WHO, 1,700 people were freed from chains in Somalia between 2007 and 2010. The study offers a comprehensive analysis of the state of mental health care in the U.S. Exacerbated by such close and unsanitary living conditions, lice and scabies are a major problem in many institutions.[97]. [107] When the city of Taizz, Yemen, was attacked in mid-2017, Jalila al-Saleh Ali fled with her two sons, and in her distress left behind her husband with a psychosocial disability in chains. It requires governments to recognize that people with disabilities are persons before the law who enjoy legal capacity on an equal basis with others in all aspects of life. In El Salvador, for instance, an underfunded and corrupt police force, unable to maintain public safety, has helped spur the formation of gangs as de facto authorities across most of the country (Life Under Gang Rule in El Salvador, International Crisis Group, 2018). 6. If a family fairs poorly on even one indicator, then it is identified as needing assistance. [60] Human Rights Watch visit to Lawang Mental Hospital, East Java, Indonesia, August 12, 2015. Hannah Ritchie and Max Roser, Mental Health, Our World In Data, April 2018, https://ourworldindata.org/mental-health (accessed July 20, 2020); The World Bank, Mental Health, April 2, 2020, https://www.worldbank.org/en/topic/mental-health (accessed June 23, 2020); WHO, Mental disorders, https://www.who.int/news-room/fact-sheets/detail/mental-disorders, [12] WHO, Mental Health, https://www.who.int/news-room/facts-in-pictures/detail/mental-health. [134] WHO, Building Back Better Sustainable Mental Health Care after Emergencies, https://apps.who.int/iris/bitstream/handle/10665/85377/9789241564571_eng.pdf?sequence=1, p. 73. In some cases, the physical location of a mental health facility or residential care institution, next to a prison or tuberculosis sanitarium, can aggravate the stigma for mental health professionals as these locations are often perceived as being undesirable.[53]. [139] Partners in Health, Celebrating New Possibilities at Sierra Leones Only Psychiatric Hospital, June 5, 2020, https://www.pih.org/article/celebrating-new-possibilities-sierra-leones-only-psychiatric-hospital (accessed September 17, 2020). Recently, my suicidal 15-year-old grandson ingested and smoked a cocktail of several drugs. Human Rights Watch phone interview with Dr Irmansyah, psychiatrist and health ministry official, September 23, 2020. While the conditions of confinement may vary based on the method of shackling, location, and country, one thing remains the same: people who are shackled are forced to live in extremely unsanitary and degrading conditions. 85. Rts. In other cases, people have to use a drain or an open toilet in the room. The trained staff in turn educate additional health center staff about the program and mental health. Human Rights Watch, Like a Death Sentence, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana ;Treated Worse than Animals, https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girls-psychosocial-or-intellectual. The Cohen Veterans Network (CVN) is a 501(c)(3) national not-for-profit philanthropic organization for post-9/11 veterans and their families. 31, The Right to Health, http://www.ohchr.org/Documents/Publications/Factsheet31.pdf (accessed September 22, 2020), pp. His loving parents found him nonresponsive, with a heart rate near 200 beats per minute. [98] Human Rights Watch interview with Aisha [not her real name], family member, Gaza, February 15, 2020. 25; ACHPR, art. Celina de Sola 04:32 While the use of restraints can be seen as a spectrum, this report specifically examines the practice of shackling, the most egregious, archaic, and rudimentary form of physical restraints practiced predominantly in non-medical settings. [151], The CRPD rejects the presumption that persons with disabilities are unfit to exercise agency and makes it clear that the will and preferences of the person should be respected. See also, Beijing Declaration and Platform for Action, Fourth World Conference on Women, September 15, 1995, A/CONF.177/20 (1995), art. During house visits, the community health worker collects data, educates the family about mental health, provides counseling, and helps them get a national health insurance card for free or subsidized health services. Share this via Telegram 14; Protocol of San Salvador, art. And women and girls are not supported to manage their menstrual hygiene, for example through the provision of sanitary pads. The bill, in its current draft, provides the authorities with unfettered powers to arbitrarily strip people with mental health conditions of their civil liberties. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. In none of the hundreds of cases that Human Rights Watch documented were people with psychosocial disabilities allowed or given the opportunity to challenge their detention. Based on research on shackling across 60 countries, Human Rights Watch has found that the key factors to ensuring the success of governmental programs to end shackling include: With the right kind of support, people with mental health conditions can live and thrive in their communities. [18] Between 76 and 85 percent of people with mental health conditions who live in middle or low-income countries do not have access to mental health services. Decentralization of psychiatric services remains a major need in El Salvador, resulting in severe hardships on families. Authors Samuel V Nickels 1 , Mariely Campos Tomasino 2 , Nelson A Flamenco Arvaiza 2 , Cynthia A Hunter 3 Affiliations Human Rights Watch found evidence of shackling across 60 countries across Asia, Africa, Europe, the Middle East, and the Americas. The rate of mental health workers in low-income countries is fewer than 2 per 100,000 people, compared with over 70 in high-income countries. In El Salvador, learning disabilities and speech and language disorders are not considered disabilities for purposes of statistical reporting at the national level (MINED, 2015). [25] In Africa, on average, there is fewer than one mental health worker per 100,000 people, compared with 2.5 in South-East Asia and 50 in Europe. [136] The program demonstrated that accessible community-based mental health services were key to ensuring people remained free from chains and proved to be an example of how non-healthcare workers could be mobilized to deliver services in rural and low-resource settings. 51) at 197, U.N. Doc. Once survivors attain a significant level of recovery from their initial trauma, measured using a tool IJM developed called the Assessment of Survivor Outcomes, Beckley guides some of them into leadership roles in the international global survivor network to share their experiences and advocate for other survivors. But through this program, we are working to create a culture of prevention., Other psychologists have turned their attention to a frequently overlooked populationthose who have been deported from the United States, known as retornados.. For the programs nationwide rollout, the Health Ministry trained 25,000 master trainers to train three to five staff members in every community health center across Indonesia. (No. A Guatemalan farmer abandons his coffee farm after years of drought destroy his crops. However, Human Rights Watch estimates that globally hundreds of thousands of people with mental health conditions have been shackledchained or locked in confined spacesat least once in their lives. 49) at 65, UN Doc. The deadline was extended to 2019. 2200A (XX1), 21 U.N. GAOR Supp. The term psychosocial disability describes conditions commonly referred toparticularly by mental health professionals and mediaas mental illness or mental disorders. The Convention on the Rights of Persons with Disabilities recognizes that disability is an evolving concept and that it results from the interaction between people with impairments and social, cultural, attitudinal, and environmental barriers that prevent their full and effective participation in society on an equal basis with others. In Morocco, the government released over 700 people chained in one shrine alone, about 50 kilometers from Marrakesh in the countrys southwest. Globally, an estimated 792 million people or 1 in 10 people, including 1 in 5 children, have a mental health condition. They run away whenever they see me. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems. 24; CEDAW, art 12; CRPD, art. Even people who are released from chains or confined spaces often go back to being shackled as there is little access to support or mental health services, and stigma and bias persists. Please give now to support our work, Share this via Facebook (No. 12. [97] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45-46. 49) at 167, U.N. Doc. I feel sad, locked in this cell. A/44/49 (1989), entered into force September 2, 1990, art. In many countries there is very limited, if any, government oversight of these institutions. [106] Human Rights Watch, Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia. Mental healthcare in the Philippines faces continued challenges including underinvestment, lack of mental health professionals and underdeveloped community mental health services. Read more about how mental health has changed throughout the pandemic and follow how healthcare jobs have grown over the past two decades. We are seeing an increase in the number of people dying in their homes before our ambulance services arrive, said Luis Romero Pineda, MSF project coordinator in El Salvador. The main causes of death of these patients are related to metabolic disorders and respiratory and heart problems, which have increased fourfold compared to the first half of last year. Traditional or spiritual healing centers are also considered types of rudimentary institutions. Psychological work in human rights is very important, says Gina Rodriguez, a Honduran masters-level clinical psychologist and human rights activist. 1516; Human Rights Watch, Like A Death Sentence, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana, p. 30. New Jersey and Massachusetts have the lowest proportions, at 0.4% and 4.0%, respectively. [36] Achieving good health and well-being is one of the SDGs that enables men, women, and children to go to school, work, and participate in their communities. Mental Health Services. ), the poverty rate, the proportion of the area that is either young or elderly, the prevalence of alcohol and substance abuse, and travel time to a facility. Help us continue to fight human rights abuses. 44/25, annex, 44 U.N. GAOR Supp. Children should have access to child psychologists and specialist support services. Mental Asylum, The Hindu, January 3, 2019, https://www.thehindu.com/news/national/sc-shocked-at-chaining-of-inmates-in-up-mental-asylum/article25901395.ece (accessed August 17, 2020). Res. [34], Irrespective of age, gender, ethnicity, socio-economic status or cultural background, health and particularly mental health is one of the most basic and necessary assets for human beings. Preventing institutionalization should be an important part of this plan. [51] Human Rights Watch interview with Ying (not her real name), November 2019 (location and details withheld). People with psychosocial disabilities, including children, who are shackled in homes or institutions are routinely forced to take medication or subjected to alternative treatments such as concoctions of magical herbs, fasting, vigorous massages by traditional healers, Quranic recitation in the persons ear, singing Gospel hymns, and special baths. While Gov. It is comprised of a two-pronged research project that includes an online survey of 5,000 American adults, and a robust analysis of third-party data measuring patients access to mental health services in terms of four pillars providers, facilities, funding and perceived satisfaction among patients. Lack of or poor communications with coworkers. [75], It is even more complex to account for chaining in small institutions and homes in which people are shackled behind closed doors. 3, entered into force January 3, 1976, art. The cost of mental health services can be prohibitive. Please open the door. Kessler says that mental disorders are treated as acute, episodic ailments instead of chronic illnesses. [61], In the absence of comprehensive global data, it is difficult to precisely determine the magnitude of this practice. In certain cases throughout the report, people with disabilities and their family members are identified with pseudonyms, and identifying information, such as location or date of interview, has been withheld in order to respect confidentiality and protect them from reprisals from family or staff in institutions. [92] UN Committee on Civil and Political Rights, General Comment No. People in the neighborhood say that Im mad [maluca or nlhanyi]. The report includes field research and testimonies from Afghanistan, Burkina Faso, Cambodia, China, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, the self-declared independent state of Somaliland, South Sudan, and Yemen. Such training includes defining psychological trauma, learning appropriate terminologytrainees are instructed to use the term survivor rather than victimand managing acute distress. [147] ICESCR, art. In Guatemala, for instance, rising temperatures and long droughts are reducing returns from coffee, corn and sugarcane farms. In Honduras, a population of nearly 9 million relies on just 185 mental health professionals, and in El Salvador, 225 mental health workers serve more than 6 million people (Mental Health Atlas Country Profiles, World Health Organization, 2017). Decades of trauma and violence in the Northern Triangleincluding civil wars in Guatemala and El Salvador and ongoing political instability in Hondurashave left behind a trail of crime, poverty, sociopolitical unrest and extreme income inequality in all three countries. The UN special rapporteur on the right to health noted that: In her 2018 report, the UN special rapporteur on the rights of persons with disabilities called on states to ensure that all health-related services include a human rights-based approach to disability, are non-discriminatory, seek informed consent prior to any medical treatment, respect privacy and are free from torture or other cruel, inhuman or degrading treatment.[180]. [64] Mentally Ill Confined at Home Due to Lack of Resources and Public Education, Global Times, June 25, 2015, https://www.globaltimes.cn/content/928917.shtml (accessed July 28, 2020); Caged People, The Beijing News, July 11, 2013, http://www.bjnews.com.cn/feature/2013/07/11/272800.html (accessed July 28, 2020); Chinese Healthcare: The Rural Reality, Collective Responsibility, July 23, 2018, https://www.coresponsibility.com/chinese-healthcare-the-rural-reality/ (accessed May 2020); 26-year-old Mentally Disturbed Man in China Locked in Cage by His Parents, Hong Kong Free Press, January 15, 2016, https://www.hongkongfp.com/2016/01/15/26-year-old-mentally-disturbed-man-in-china-locked-in-cage-by-his-parents/ (accessed May 2020); A Mentally Ill Chinese Man Has Been Locked In A Cage By His Family For 11 Years, Business Insider, May 28, 2013, https://www.businessinsider.com/chinese-man-kept-in-cage-for-11-years-2013-5 (accessed July 28, 2020); Chinese Mentally Ill Woman, Chained in Room for Decades by Family, to Get Medical Treatment, South China Morning Post, undated, https://www.scmp.com/news/china/society/article/1815641/chinese-mentally-ill-woman-chained-room-decades-family-get (accessed July 28, 2020). Even though the healthcare system has many hospitals, clinics, and care centers, the quality of healthcare they provide is deemed inadequate. [23] Consequently, instead of walking a short distance to a primary health center, families may have to give up a days work to travel to reach a psychiatric hospital. 2 July 2020. Res. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. Support national government efforts to develop adequate, quality, and voluntary community-based support and services, including access to housing, education, employment, and mental health services. People with psychosocial disabilities, including children, who are shackled in homes or institutions are routinely forced to take medication or subjected to alternative treatments such as concoctions of magical herbs, vigorous massages by traditional healers, Quranic recitation in the persons ear, and special baths. My family believed her mental health condition would stigmatize the whole family. Men, women, and children are chained or locked in confined spaces in 60 countries across Asia, Africa, Europe, the Middle East, and the Americas, simply because they have a mental health condition. [19] UN, Policy Brief: COVID-19 and the Need for Action on Mental Health, May 13, 2020, https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf (accessed June 22, 2020), p. 5; The World Bank, Mental Health, https://www.worldbank.org/en/topic/mental-health; WHO, Mental disorders, https://www.who.int/news-room/fact-sheets/detail/mental-disorders; see also Rudi Eggers (WHO Kenya Representative) statement in Kenya launches initiative to promote mental health for citizens, Xinhua, November 21, 2019, http://www.xinhuanet.com/english/2019-11/21/c_138573442.htm (accessed June 17, 2020). In state-run or private institutions, as well as traditional or religious healing centers, they are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence. Share this via Email [55] Shackling is also used in church-affiliated prayer camps, traditional or religious healing centers as well as in state-run or private social care institutions as a form of restraint, punishment, or treatment.[56]. 16) at 49, U.N. Doc. Mental Health and Substance Use. Gender is a major factor in mental health. Provide training to broader membership, including at grassroots levels, about the rights of people with psychosocial disabilities. In several cases, the ambulance was called when patients were already in critical condition. 72. Res. August 28, 2022 by Sandra Hearth. Share this via LinkedIn This inhumane practicecalled shacklingexists due to inadequate support and mental health services as well as widespread beliefs that stigmatize people with psychosocial disabilities. This report includes research and testimonies collected by 16 Human Rights Watch researchers in their own countries. [162] The CRPD requires that all facilities and programs designed to serve persons with disabilities are effectively monitored by independent authorities.[163], Under the CRPD, the governments are obligated to take all appropriate measures to promote the physical, cognitive, and psychological recovery, rehabilitation, and social reintegration of persons with disabilities who become victims of any form of exploitation, violence, or abuse. We have to wait for authorization from the public health system to be able to move patients to a care center, since we cannot transfer the patient from [their] home without prior coordination and authorization from the public health system, said Wendy. [112] Ghana: Faith Healers Defy Ban on Chaining, Human Rights Watch news release, November 27, 2019, https://www.hrw.org/news/2019/11/27/ghana-faith-healers-defy-ban-chaining. In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. The fight was just beginning. Moreover, the numbers are likely to fluctuate. When asked if they would be open to using it, almost half, or 45%, of Americans who have not already tried telehealth services said they would be open to the idea of trying a service to address a current or future mental health need. Learn how you can support MSFs lifesaving care with a gift. Victor, a patient from Soyapango, told MSF that his grandfather has chronic health problems and has to have his catheter changed every few months. 2200A (XXI), 21 U.N. GAOR Supp. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system. [112], When institutions provided food, people with psychosocial disabilities told Human Rights Watch that it was too meagerat times, just one meal a day. Stark Disparities in Accessibility at State and Income Levels. support MSFs lifesaving care with a gift. [133] Of these, 1,355 had been chained in Habeb hospital in Mogadishu, the capital, and 417 in the surrounding community. For example, Delaware requires 15 more mental health providers to resolve its shortage, whereas Texas needs an additional 638. [153] CRPD Committee, General Comment No. In addition, 1.9 million, or 5.1%, of adults in nonmetropolitan areas . It was like my mind had gone blank on account of the fright, she said. Nearly 1 in 5 Americans has some type of mental health condition. 1366-1379. In 2025, demand may outstrip supply by 6,090 to 15,600 psychiatrists, according to a 2017 National Council for Behavioral Health report that explores the shortage's causes and suggests solutions. [122] UNHRC, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Mndez, A/HRC/22/53, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf, para. For more information on the comprehensive study results and how CVN and National Council are working to address mental wellness and accessibly across the country, please visit www.cohenveteransnetwork.org/AmericasMentalHealth or www.TheNationalCouncil.org. Many had old and leaking roofing. [58] Human Rights Watch, Chained Like Prisoners, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, p. 9. (Eds. [65], In Indonesia, according to government data, 57,000 people with mental health conditions have been in pasung (shackled) at least once in their lives with approximately 15,000 still living in chains as of November 2019. (No. 16) at 52, U.N. Doc. MSF has continued to operate non-COVID-19 healthcare activities in the two most populated cities, Soyapango and San Salvador, which are now epicenters of the outbreak. I was taken to a traditional healing center where they cut my wrists to introduce medicine and another one where a witch doctor made me take baths with chicken blood. 8; UN Office of the High Commissioner for Human Rights/WHO, Fact Sheet No. The limited human and material resources available are concentrated in the respective country capital cities. As a result, they urinate, defecate, eat, and sleep in a radius of no more than one to two meters. For example, in Yemen, Amnesty International documented cases of people with psychosocial disabilities who were unable to flee from violence because they were chained. Look at the data on educational progress and challenges. Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. We need to do something.. Human Rights Watch interviewed people with psychosocial disabilities who were shackled to trees, logs, pillars in a courtyard, dilapidated sheds without a roof over their heads, protection from the sun or rain, and with constant exposure to mosquitoes and pests. Celina de Sola, Glasswing's co-founder, says people in these places, where violence is endemic, urgently need help. Lack of education in the community about mental health. Community leaders in the five communities where MSF provides primary healthcare in Soyapango and San Salvador report that since the emergency was declared, more than 50 people have died after showing COVID-19 symptoms or from a lack of treatment for chronic diseases. MSF has launched health initiatives in San Salvador and Soyapango, focusing on socially vulnerable people whose access to health services has been affected by insecurity. The ACHR has been ratified by Argentina, Bolivia, Chile, Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, and Peru; Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights (Protocol of San Salvador), O.A.S. Last year, staffing shortages at the Alabama Department of Mental Health caused a temporary halt in admissions at one of three remaining state hospitals that provide long-term mental health care. [66], In India, in January 2019, the media reported that thousands of people with mental health conditions were chained like cattle, their feet tied with iron chains and padlocked for days, months and years, in the state of Uttar Pradesh. These beliefs often lead people with psychosocial disabilities and their families to first consult faith or traditional healers and only seek medical advice or psychosocial support, such as counseling, as a last resort. In the United States, an immigrant might earn $300 per week cleaning houses, the equivalent of about a months salary in Guatemala, says Cbar Cataln. Malakis story helped shape his community to be more inclusive and accepting. It is typically an administrative process and does not contain any provisions for judicial oversight. As part of the project, WHO developed a toolkit with practical information and resources for countries to assess and improve the quality of and human rights standards in mental health services. The report was edited by Rau Barriga; erimovi; Bader; Muscati; Pedneault; Ros Espinosa; Almasri; Afrah Nasser, researcher in the Middle East and North AfricaDivision; Nisha Varia, advocacy director of the Womens Rights Division; Bede Sheppard, deputy director of the Childrens Rights Division; Mausi Segun, director of the Africa Division; Corinne Dufka, associate director in the Africa Division; Ilaria Allegrozzi and Otsieno Namwaya, senior researchers in the Africa Division; Zenaida Machado and Nyagoah Pur, researchers in the Africa Division; Patricia Gossman, associate director in the Asia Division; Andreas Harsono, and Saroop Ijaz, senior researchers in the Asia Division; Almaz Teffera and Yaqiu Wang, researchers in the Asia Division; Jayshree Bajoria, research consultant in the Asia Division; Eric Goldstein, deputy director of the Middle East and North Africa Division; Ahmed Benchemsi, advocacy director in the Middle East and North Africa Division; Martina Rapido Ragozzino, research assistant in the Americas Division; Csar Muoz, senior researcher in the Americas Division; Tyler Mattiace, researcher in the Americas Division; Tanya Lokshina, associate director in the Europe and Central Asia Division.
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