While Gov. [76], In Mexico, officials from the Office of the Prosecutor for Protection of People with Disabilities told Human Rights Watch: Families tie them [people with psychosocial disabilities] up regularly. 1, Equal recognition before the law, U.N. Doc. 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. On a larger scale, the nonprofit International Justice Mission (IJM) works to end impunity for slavery and other human rights violations through legal and justice reform. During the COVID-19 outbreak in El Salvador, MSF teams have continued to provide primary healthcare and mental health services in communities, as well as psychosocial assistance in detention centers for deported people, and expanded ambulance response capacity in support of the Salvadoran Medical Emergency System. Rather, the critical issue is the inhumane treatment of people with psychosocial disabilities forced to stay there. [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. All of our clients from all of our programs are eligible to make appointments. Bobele, M., & Slive, A.In Hoyt, M.F., & Talmon, M. Existing mental health services are often under-utilized or do not comply with international human rights standards because of limited understanding and awareness of mental health. [158] UN General Assembly, Interim Report of the Special Rapporteur on torture and cruel, inhuman or degrading treatment or punishment, Manfred Nowak, A/63/175, July 28, 2008, https://undocs.org/A/63/175(accessed September 23, 2020), para. [144] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. (No. [141] Irmansyah, Free from Pasung one decade on?, Inside Indonesia, July 24, 2020, https://www.insideindonesia.org/free-from-pasung-one-decade-on (accessed September 25, 2020). A young woman raised by her grandmother in Honduras leaves to reunite with her parents after more than a decade. Despite being commonly practiced around the world, shackling remains a largely invisible problem as it occurs behind closed doors, often shrouded in secrecy, and concealed even from neighbors due to shame and stigma. Between 2005 and 2015, China implemented the 686 pilot program to provide basic mental health services on a large scale, which included an initiative to unlock people with psychosocial disabilities shackled in homes. [81] UNHRC, Report of the Special Rapporteur on rights of persons with disabilities, Catalina Devandas-Aguilar, A/HRC/40/54, https://undocs.org/en/A/HRC/40/54, pp.6, 12. 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. 1. 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. 25; Karolina Kozik and Jean-Sbastien Spulchre, Disability Rights Bill Offers Hope in Congo, commentary, Human Rights Watch Dispatch, March 11, 2020, https://www.hrw.org/news/2020/03/11/disability-rights-bill-offers-hope-congo; 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; Cameroon: People With Disabilities Caught in Crisis, Human Rights Watch news release, August 5, 2019, https://www.hrw.org/news/2019/08/05/cameroon-people-disabilities-caught-crisis; Human Rights Watch, From Cradle to Grave: Discrimination and Barriers to Education for Persons with Albinism, June 2019, https://www.hrw.org/video-photos/interactive/2019/06/13/cradle-grave; Treated Worse than Animals, https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girls-psychosocial-or-intellectual. 108(e); United Nations Educational, Scientific, and Cultural Organization (UNESCO), Universal Declaration on Bioethics and Human Rights, adopted October 2005, SHS/EST/05/CONF.204/3 REV, arts. Of the 61 countries considered in this report, 56 are party to ICCPR, 57 are party to ICESCR, 59 are party to CEDAW, 55 are party to CAT, 61 are party to CRC, and 59 are party to CRPD. [105] Yulia Gorbunova, Held in Chains in Russia, commentary, Human Rights Watch dispatch, August 8, 2017, https://www.hrw.org/news/2017/08/08/held-chains-russia. [6] In some countries, these centers are called prayer camps. E/C 12/2000/4, 2000, https://undocs.org/E/C.12/2000/4 (accessed September 23, 2020), paras. [82] In another case, a woman with a psychosocial disability was chained for 24 years (since she was 10 years old) in Egypt.[83]. If a family fairs poorly on even one indicator, then it is identified as needing assistance. And we promote greater understanding of mental wellbeing as a core component of comprehensive health and health care. [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. A/34/46, entered into force September 3, 1981; Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Convention against Torture), adopted December 10, 1984, G.A. Students in UVGs masters program in psychological counseling and mental health, which Cbar Cataln directs, also conduct preventive workshops in agrarian communities in western Guatemala. [115] Human Rights Watch interview with Benjamin Ballal, survivor of shackling and secretary general for cultivation at Cultivation for Users Hope, Nairobi, February 15, 2020. [42] Human Rights Watch, Disability Is Not Weakness: Discrimination and Barriers Facing Women and Girls with Disabilities in Afghanistan, April 2020, https://www.hrw.org/report/2020/04/28/disability-not-weakness/discrimination-and-barriers-facing-women-and-girls. Through the survey, the following groups were identified: veterans, active duty military and those with a secondary relationship with a veteran as well as those who have sought mental health treatment (Mental Health Treatment Seekers). [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. 217A(III), U.N. Doc. It is mostly practiced in non-medical settings, by families, a faith healer, or non-medical staff, often in the absence of support or mental health services. In Morocco, the government released over 700 people chained in one shrine alone, about 50 kilometers from Marrakesh in the countrys southwest. 1366-1379. CRPD/C/GC/1 (2014), http://daccess-ods.un.org/access.nsf/Get?Open&DS=CRPD/C/GC/1&Lang=E, para. Sophia Majlessi If Dylan could get services from HCS, he could live at home. There are currently no coordinated international or regional efforts to eradicate shackling. 61/106, Annex I, UN GAOR, 61st Sess., Supp. Improve quantitative and qualitative data collection at the local and national levels on the current number of people shackled, the reasons families continue to practice shackling, and the support or services they would need to discontinue the practice. [135] By 2012, the program had unlocked 271 people who had been shackled for periods ranging from 2 weeks to 28 years across 26 provinces. The stigma attached to psychosocial disabilities extends to the mental health profession, which often discourages doctors from specializing in psychiatry and causes many general physicians and other health care workers to resist mental health training. There are currently no coordinated international or regional efforts to eradicate shackling. El Salvador is divided politically into 14 departments and 262 municipalities, But the work situation is so dire that its almost impossible to make a decent living, she says, because of low pay and limited work opportunities. "The lack of community-based mental health solutions, the lack of civil beds, the lack of walk-in centers and crises centers all of that has resulted in the last resort: the emergency. [22] WHO, Mental health: massive scale-up of resources needed if global targets are to be met, June 6, 2018, https://www.who.int/mental_health/evidence/atlas/atlas_2017_web_note/en/ (accessed July 22, 2020). Yet, there are very few mental health professionals, especially for the majority of the population who rely on the public health system. In many countries there is very limited, if any, government oversight of these institutions. 2200A (XX1), 21 U.N. GAOR Supp. Retornados carry a lot of stigma because of the criminal label that comes with deportation, says Juan Carlos Garca Rivera, a marriage and family therapist from El Salvador who is pursuing his doctorate in critical social/personality psychology at the City University of New York. [58] Human Rights Watch witnessed several people being shackled in a psychiatric hospital in northern Nigeria. Im never invited to happy occasions, weddings or birthdays with my family. [44] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. The ACHPR has been ratified by Benin, Burkina Faso, Cte dIvoire, Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Kenya, Liberia, Mozambique, Nigeria, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Tanzania, Togo, Uganda, and Zimbabwe; Protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa (Maputo Protocol), adopted July 11, 2003, CAB/LEG/66.6, reprinted in 1 Afr. in Somalia.[134]. [125] Nigeria: People With Mental Health Conditions Chained, Abused," Human Rights Watch news release, https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused. 14; Protocol of San Salvador, art. [138] Until 2018, people with mental health conditions being admitted to the psychiatric hospital were asked to pay for a padlock and chain prior to admission. A combined federal, state, local view of how funds flow in and out. Human Rights Watch research across 60 countries found people with real or perceived psychosocial disabilities are arbitrarily detained against their will in homes, state-run or private institutions, and traditional or religious healing centers. People in the neighborhood say that Im mad [maluca or nlhanyi]. To support the right to remain, some psychologists seek to better understand the complex decision about whether to migrate. While Gov. I stay in a small room with seven men. [110] Fasting would help to starve evil spirits and enable God and prayer to heal them. Of the 60 countries where Human Rights Watch found evidence of shackling, only a handful have laws, policies or strategies in place that explicitly ban or aim to end shackling of people with mental health conditions. As of 2018, fewer than half of the 139 countries that have mental health policies had aligned them with international human rights conventions. [150], The CRPD introduces a significant shift in approach to legal capacity, giving agency to people with disabilities and empowering them to make decisions and exercise rights on their own behalf. Just because it is painful, we cannot look away. In the 2018-2019 academic year, 4,104 people completed behavioral health training programs funded by the HRSA. Top photo: A young boy in El Salvador, where children face multiple threats to their safety and well-being including gang violence. Provide adequate food, shelter, and health services to people with psychosocial disabilities. The programs home visits are critically important because they eliminate the need for family members to take time off from work and spend money to travel to health centers. [85] Human Rights Watch, They Treat Us Like Animals: Mistreatment of Drug Users and "Undesirables" in Cambodias Drug Detention Centers, December 2013, https://www.hrw.org/sites/default/files/reports/cambodia1213_ForUpload_1.pdf, p.3. Founded in 1969, the National Council for Mental Wellbeing is a membership organization that drives policy and social change on behalf of over 3,100 mental health and substance use treatment organizations and the more than 10 million children, adults and families they serve. New Jersey and Massachusetts have the lowest proportions, at 0.4% and 4.0%, respectively. [75] Human Rights Watch phone interview with Pascal Douti, Association Vie Libre, September 3, 2019; Benedict Carey, The Chains of Mental Illness in West Africa, New York Times, October 11, 2015, https://www.nytimes.com/2015/10/12/health/the-chains-of-mental-illness-in-west-africa.html (accessed July 30, 2020). [146], International and regional human rights law expressly prohibits discrimination and requires parties to these conventions to take steps to eliminate all forms of discrimination against individuals, including persons with disabilities. If we want to save lives, save families and save futures we must reimagine our behavioral health system and take concrete steps to improving consumers ability to find the care they need, when they need it, and on their terms., Despite Strong Demand for Mental Health Services, Common Barriers Remain. [109] "Indonesia: Shackling Reduced, But Persists," Human Rights Watch news release, October 2, 2018, https://www.hrw.org/news/2018/10/02/indonesia-shackling-reduced-persists. Individuals located in rural areas and of lower-income are less likely to say that mental health services are extremely accessible to them. The United States, by comparison, spends about 8% of its health-care budget on mental health (Dieleman, J.L., et al., JAMA, Vol. In a few countries, government efforts at the national level to eradicate shackling have had some success in creating a roadmap to ending the practice. Moreover, it also appears that the availability of programs and services may be associated with higher reporting rates (Filmer, 2008). We advocate for policies to ensure equitable access to high-quality services. The disappointing irony goes beyond unheeded history repeating itself. [24] Human Rights Watch, Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia, March 2016, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, pp. [44], Human Rights Watch research, media reports, and studies show that in many parts of the world a lack of understanding of disability and mental health can cause many people to believe that psychosocial disabilities have a spiritual origin. In South Sudan, Human Rights Watch in 2012 and Amnesty International in 2016 documented people with real or perceived psychosocial disabilities being chained and detained in prison, not because they had committed a crime but simply because they had a disability. 12. It also explicitly requires the full and informed consent of persons with disabilities to medical treatment.[178]. In an effort to make the Northern Triangle safer and more humane for the millions of people who live there, psychologists are providing psychosocial support for trauma survivors, designing and delivering preventive community workshops and studying what drives residents to migrate north. 10. (No. [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. While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. 90-92. Treaty Series No. doi: 10.26633/RPSP.2018.172. In many countries, Covid-19 has disrupted mental health services, which can put people with psychosocial disabilities at risk of being shackled. We send regular emails about upcoming events, member spotlights and updates in mental wellbeing. But Garca Rivera says that in light of the crisis in Central America, psychologists must do more than conduct research, provide clinical services and design community interventions. In Tanzania, Malaki, a boy with an intellectual disability was chained to a pole by his family to ensure he remained safe in his home in Nyarugusu refugee camp in Kigoma province in Tanzania in 2017. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. The Minister of Health, Dr. Violeta Menjvar, said that in El Salvador anxiety, depression, alcoholism and suicide are the mental disorders with the highest prevalence. [104] Human Rights Watch visit to an NGO-run institution in Herat, Afghanistan (name and details withheld). Mental health shortages range in severity across the country. Many facilities have low-grade medical equipment, are almost always understaffed, and often run out of medicine. [19], Governments have long neglected to invest in mental health services. [9] WHO, Gender and Women's Mental Health, https://www.who.int/mental_health/prevention/genderwomen/en/. [48] Karolina Kozik and Jean-Sbastien Spulchre, Disability Rights Bill Offers Hope in Congo, commentary, Human Rights Watch Dispatch, March 11, 2020, https://www.hrw.org/news/2020/03/11/disability-rights-bill-offers-hope-congo; Sophie Morgan, The country where disabled people are beaten and chained, BBC News Online, July 28, 2015, https://www.bbc.com/news/blogs-ouch-33523742 (accessed September 21, 2020); Shantha Rau Barriga (Human Rights Watch), Torture Comes in Many Forms, commentary,The Huffington Post, June 29, 2015, https://www.huffpost.com/entry/torture-comes-in-many-for_b_7691390?guccounter=1 (accessed September 16, 2020). Key findings include: Seven out of 10 (71%) of students are experiencing mental health issues such as stress, anxiety and/or depression. In Indonesia, 57,000 people with mental health conditions have been in pasung (shackles) at least once in their lives. Some institutions are an extension of the faith healers house or situated at a secluded end of the compound. A central issue is the lack of mental health care professionals. [65] Viola Zhou, Mentally ill Chinese Girl, 8, Roped to Tree Outside by Grandparents for Nearly Six Years, South China Morning Post, September 21, 2016, https://www.scmp.com/news/china/society/article/2021288/mentally-ill-chinese-girl-8-roped-tree-outside-grandparents (accessed July 28, 2020). Malakis story helped shape his community to be more inclusive and accepting. In some instances, people or their families had fashioned bamboo beds and grass-thatched shelters under a tree to get protection from the sun, but many slept on cold, hard concrete floors with no mattress or bedding. 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. Rodriguez supports the Shelter City Network, which relocates human rights defenders forced to move because of threats to their safety and provides psychotherapeutic treatment to Honduran survivors of torture, sexual violence and other crimes as they seek recourse through national and international justice systems. There is a mental health crisis in America. CVN focuses on improving mental health outcomes, with a goal to build a network of outpatient mental health clinics for veterans and their families in high-need communities, in which trained clinicians deliver holistic evidence-based care to treat mental health conditions. August 28, 2022 by Sandra Hearth. [24], Globally, there is a severe shortage of trained mental health professionals, but the shortfall is particularly acute in low-income countries. The data collected indicates, however, that only about 25 percent of people with psychosocial disabilities surveyed have access to mental health services. For example, in 2015 chaining was widespread in psychiatric as well as in mental health wards of general hospitals in Somaliland. 14(1)(b); CRPD Committee, Statement on article 14 of the Convention on the Rights of Persons with Disabilities, September 2014, http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=15183&LangID=E#sthash.ErjRRg0s.9wBvLiwR.dpuf (accessed August 12, 2020). The Census Bureau reported that 30% of American adults had symptoms consistent with an anxiety or depression diagnosis as of May 24. 37; CRPD, art. It made me sad [to chain him]. Travel restrictions have since been lifted but outpatient consultations at hospitals and health units remain suspended. This is the case for Sodikin, a 34-year-old man with a psychosocial disability, who had been released from chains after over 8 years shackled in a shed outside his family home in Cianjur, West Java in Indonesia. [32], The cost of neglecting mental health is significant; the global economy loses roughly $2.5 to $8.5 trillion per year as a result of reduced economic productivity. For others, poverty and lack of work opportunities are the driving forces behind migrationin Honduras, more than 60% of the population lives below the poverty line (World Bank, 2018). In Indonesia, Human Rights Watch found approximately 90 women living in a room that could reasonably accommodate no more than 30, in Panti Laras 2, a state-run institution in Cipayung, on the outskirts of Jakarta. Ensure these programs are gender-sensitive. Pennsylvania, New York and Minnesota ranked among the top. 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. 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. 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. (Eds. Shackling occurs in many countries that are party to international and regional human rights treaties that prohibit abusive treatment and related rights. While the expectation was that families would regularly bring food for relatives, this rarely happened. Nevertheless, Mexico needs at least 12,000 psychiatrists. Some families also use shackling as a way to prevent or control a certain behavior they find disruptive. Families who struggle to cope with the demands of caring for a relative with a psychosocial disability may feel they have no choice but to shackle them. Immediately end the use of chaining, nonconsensual fasting, and any form of detention. support services. [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. Texas, Wisconsin and Georgia ranked among the lowest in terms of lacking adequate number of providers, facilities and funding to support the states populations. [175] Availability refers to the presence of functioning healthcare facilities, trained personnel, as well as adequate supply of medication. Human Rights Watch visit to Holy Ghost Coptic Church of Africa, Kisumu, February 18, 2020. In prayer camps in Ghana, administrators and pastors told Human Rights Watch that fasting was a key component of curing a psychosocial disability. [143] When the Special Olympics team had Malaki released, he got the opportunity and training to play football. Res. Discover how we bring lifesaving care to those who need it most, Explore our work in more than 70 countries, Learn about the diseases and medical conditions we treat, Understand the complex crises we're responding to, A global movement providing lifesaving care, Get our annual financial statements and nonprofit tax filings, Understand our founding principles and the history of our work, Get the latest from our projects around the world, Read features from our quarterly magazine, Become a part of MSFs most important lifesaving work today, Discover the many ways you can support our lifesaving work, Individuals like you provide 90% of our funding, We make it easy to raise money to support the MSF movement, Learn how to get involved with our university student groups. [14] "Suicide: One Person Dies Every 40 Seconds," WHO news release, September 9, 2019, https://www.who.int/news-room/detail/09-09-2019-suicide-one-person-dies-every-40-seconds (accessed September 22, 2020). 24, 2016). Human Rights Watch research across 60 countries found people with real or perceived psychosocial disabilities are arbitrarily detained against their will in homes, state-run or private institutions, as well as traditional or religious healing centers. (No. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. Despite such accomplishments, many psychologists in the Northern Triangle countries feel that they are largely working in isolation with little support and few resources. Talkspace therapist Bisma Anwar, LMHC. Spending on mental health treatment and services reached $225 billion in 2019, according to an Open . [128] Human Rights Watch interview with Tina Mensah, Ghanas deputy health minister, Accra, November 8, 2019. [176] The right to be free from non-consensual medical treatment and experimentation is guaranteed under the ICESCR. Moreover, the numbers are likely to fluctuate. This system effectively gives mental health the same importance as all other indicators and ensures that community health workers provide immediate and ongoing mental health services to meet their target of 100 percent coverage. 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. Not only has the lack of access to primary health care services contributed to the deterioration of the health of patients with chronic diseases, resulting in more deaths, but both the ambulance system and hospitals are operating at full capacity. [152], The Committee on the Rights of Persons with Disabilities, an independent expert body created under the CRPD, clarified that a persons mental capacity, the ability to make decisions, can vary depending on environmental or social factors. The response time is often less than ideal because of the heavy traffic in San Salvador. Amid such far-reaching and systemic challenges, many have fought to defend Central Americans right to migrate, but Lykes says its also time to start considering another inalienable rightthe right to remain. Help us! Inability to afford proper care. Shackling is also used as a temporary measure to restrain a person for short periods while the family goes out to work or when the person is having a crisis. The . Islamic faith healers often use Quranic recitations or herbal medicine, including the burning of herbs, as a treatment method. Locking them in a confined space such as a room outside or within a house, shed, hut, cage, or animal shelter (including chicken coops, pig pens, or goat sheds). In one case, a person died while tied up and locked in one of the bathrooms, which was used as an isolation room. https://www.hrw.org/sites/default/files/reports/zambia0714_ForUpload_1.pdf, p.16; A. Allen,andE.Green,Discrimination and Stigmatization of People with Epilepsy in Zambia: The Need for Integration of Social, Healthcare, and Policy Reform,, African [Banjul] Charter on Human and Peoples Rights (ACHPR), adopted June 27, 1981, OAU Doc. The NSDUH defines mental health services as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health. [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. The ambulance system and hospitals are operating . [28] WHO, Mental Health ATLAS 2017 Member State Profile: Kenya, 2018, https://www.who.int/mental_health/evidence/atlas/profiles-2017/KEN.pdf?ua=1 (accessed June 22, 2020); Mohan Isaac et al., Postgraduate training in psychiatry in Asia, Current Opinion in Psychiatry, vol. 58. The El Salvador-based nonprofit has mobilized over 100,000 volunteers, like Emanuel, and trained frontline workers across Central America and Mexico, reaching more than 2 million children and adults. The study, which assesses Americans' current access to and attitudes towards mental health services, revealed American mental health services are insufficient, and despite high demand, the root of the problem is lack of access - or the ability to find care.
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