People shackled in homes typically ate the same meal as the family. However, one of the main concerns about the 686 program was that it predominantly took a medical approach to mental health that focused on freeing people from chains and then admitting them to a psychiatric hospital for treatment or putting them on a regimen of mental health medication. (PDF) Access to mental health care in El Salvador: An assessment of There is also a large disparity in access to mental health care based on level of income and location. 2 July 2020. 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. She began learning about services provided by the state, including "the list" for HCS services. [30] WHO, Mental Health: Massive Scale-up of Resources Needed if Global Targets Are to Be Met, https://www.who.int/mental_health/evidence/atlas/atlas_2017_web_note/en/. E/C 12/2000/4, 2000, https://undocs.org/E/C.12/2000/4 (accessed September 23, 2020), paras. [74] In Togo, prophets can lock up and chain up to 150 people in a single prayer camp. We also work with a local women's crisis center to provide additional resources to our female clients. [102] When children are shackled, they are deprived of playing, making friends, going to school, growing up in a family, and having a normal childhood. In traditional or religious healing centers, there is no medical diagnosis and the basis for admission and discharge is left entirely to the discretion of the faith or religious healer. Mental Health outlines staffing shortages | State Capital Sophia Majlessi 31, no. 2 Such changes may include increased sadness or irritability, loss of appetite, weight changes, insomnia, reduced energy, loss of interest in pleasurable activities, feelings of guilt and hopelessness, difficulty concentrating, and/or Cohen Veterans Network and National Council for Mental Wellbeing partnered with Ketchum Analytics who conducted an online survey among 5,000 Americans, representative of the U.S. population based on age, gender, region, household income and race/ethnicity. Shelter was a major concern for people shackled outdoors without a roof over their heads, protection from the sun or rain, and with constant exposure to mosquitoes and pests. [61], In the absence of comprehensive global data, it is difficult to precisely determine the magnitude of this practice. Human Rights Watch research in Nigeria found that people with mental health conditions were held in iron shackles around their ankles in locked-up wards in a psychiatric hospital and in government-run rehabilitation centers. Ridha, a family member with relatives shackled in Oman, said: Its time for governments to step up so that families arent left to cope on their own.. Train and sensitize government health workers, mental health professionals, and staff in faith-based and traditional healing centers to the rights and needs of people with mental health conditions. People who are shackled to one another are forced to go to the toilet or sleep together. Listening and telling peoples stories is a first step to start humanizing migrants in a society where blaming the victim tends to be the norm., Children on the Run: Unaccompanied Children Leaving Central America and Mexico and the Need for International Protection To that end, Garca Rivera works with the Liberation Psychology Intercambio/Exchange, a knowledge exchange program that connects psychologists, therapists, social workers and immigration lawyers from the United States and Central America to engage with psychological theories and practices originating in Latin America. This study confirmed what we hear from our members every day, that individuals and families continue to struggle to find the help they desperately need, said Linda Rosenberg, President and CEO of National Council for Mental Wellbeing. Dont put a lock on it. For the purpose of this report, shackling is used in a broader sense to refer to the practice of confining a person with a psychosocial disability using chains, locking them in a room, a shed, a cage, or an animal shelter. In addition, compared to Americans living in urban and suburban areas, individuals living in rural areas are less likely to proactively seek mental health specialists they need, and instead go to their primary care doctor or community center for treatment. Faith healers in Ghana, Indonesia, Kenya, and Nigeria reported sharing the little food available among all the residents, especially because some families did not provide food for their relatives, and prayer camps and institutions said they did not have the resources to buy enough food for everyone. 39/46, annex, 39 U.N. GAOR Supp. Support national governments in reducing stigma and discrimination against people with psychosocial disabilities. 38-39. 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. [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). They are run by self-proclaimed prophets and are Christian religious institutions not affiliated with other denominations, but with roots in the evangelical or Pentecostal movements, established for purposes of prayer, counseling, and spiritual healing. COVID-19 and mental health in Indonesia - Policy Forum eCollection 2018. The Mental Health Crisis Is Real | CAMH [32] Graham Thornicroft et al., Undertreatment of People with Major Depressive Disorder in 21 Countries, The British Journal of Psychiatry 210,2 (2017), doi:10.1192/bjp.bp.116.188078 (accessed September 16, 2020), pp. Mental Illnesses are Common, but Care is Lacking | Health Care Policy [173], According to the UN Committee on Economic, Social and Cultural Rights, the international expert body charged with monitoring compliance with the ICESCR, access to health facilities, goods and services should be non-discriminatory, especially for the most vulnerable or marginalized sections of the population, including individuals with disabilities. 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. 55. Some institutions are an extension of the faith healers house or situated at a secluded end of the compound. The deadline was extended to 2019. 1, 3. While most Americans have heard of telehealth as an option for treating mental health issues, only 7% have reported using it. [86] Article 25, among other problematic provisions, states that a caregiver or a guardian of a person with a mental disorder shall not allow that person to walk freely in public places. In a country where people with psychosocial disabilities are stigmatized and subjected to abuse, such broad discretion given to authorities to restrict the freedoms of movement and liberties of a person with mental health conditions will facilitate further abuse and entrenchment of the problem. Children should have access to child psychologists and specialist support services. None of my relatives want anything to do with me. may well amount to torture.[161], The CRPD and the African Charter both explicitly prohibit all forms of exploitation, violence, and abuse. A combined federal, state, local view of how funds flow in and out. Worryingly, community leaders are reporting deaths in their communities, some of them related to the suspension of primary health care.. Shackling occurs in many countries that are party to international and regional human rights treaties that prohibit abusive treatment and related rights. The government identifies shortage areas so it can address them with proper resources. 2018 Oct 10;42:e172. [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. In Guatemala, she has helped organize a group of survivor leaders to raise public awareness of the psychological impacts of sexual violence and problems with the countrys justice system. Acceptability refers to the need to adhere to ethical standards, including the principle of confidentiality and informed consent. In Guatemala, hundreds of children with psychosocial or intellectual disabilities were tied to furniture or locked in cages in orphanages and institutions. Worldwide Campaign to End Shackling, Shame, Human Rights Watch defends the rights of people in close to 100 countries worldwide, spotlighting abuses and bringing perpetrators to justice, Human Rights Watch is a 501(C)(3)nonprofit registered in the US under EIN: 13-2875808, Click here to download an Easy-to-Read version of the report, Karoon, What is the state of mental health in Thailand?, post to Pacific Prime Thailand (blog), Melinda Benjamin, The Promotion of Mental Health Awareness in Cambodia,, Mark Tilly,TV series to fight mental health stigma,. Mental Health Atlas 2020 Country Profile: El Salvador Although it is noteworthy that some governments have put in place measures to tackle the practice of shackling, their laws and policies are not always effectively implemented, and on-the-ground monitoring remains weak overall. Shackling is practiced across socio-economic classes. The number of new jobs and the unemployment rate are regularly cited in the news, but theyre just part of the picture. [25] WHO, Mental Health Atlas 2017, 2018, https://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1 (accessed July 21, 2020), p. 30. 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). [119] The United Nations special rapporteur on torture has noted that involuntary treatment and other psychiatric interventions in health-care facilities can be forms of torture and ill-treatment. A central issue is the lack of mental health care professionals. 2200A (XXI), 21 U.N. GAOR Supp. I eat here once a day. 64. 35, Article 9: Liberty and security of person, U.N. Doc. Education is crucial to help people understand more about life in the United States as a migrant, says Maria Elena Humphrey, PhD, former executive secretary for Mexico, Central America and the Caribbean at the Interamerican Society of Psychology. 16-18. [13] Every 40 seconds, someone dies by suicide. Human Rights Watch research in 2019 at an NGO-run marastoon (institution) in Herat, Afghanistan, found dozens of men with psychosocial disabilities chained in pairs to others ankles. 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. What options do people have to stay home? she asks. The cost of mental health. It was like my mind had gone blank on account of the fright, she said. Of the Americans that have not sought mental health treatment, more than half, or 53%, were in low-income households. Despite being 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. 58 (1982), entered into force October 21, 1986. 61/106, Annex I, UN GAOR, 61st Sess., Supp. Other ways to share 3, entered into force January 3, 1976, art. 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. As of 2012, 92 percent of the people who had been unlocked in China remained free from chains. CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. 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. 66. 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. Shelter is a major concern for people shackled outdoors at home, in prayer camps, or in open-air institutions. 1, 16; They Stay until They Die: A Lifetime of Isolation and Neglect in Institutions for People with Disabilities in Brazil, May 2018, https://www.hrw.org/report/2018/05/23/they-stay-until-they-die/lifetime-isolation-and-neglect-institutions-people;I Would Like To Go To School: Barriers to Education for Children with Disabilities in Lebanon, March 2018, https://www.hrw.org/sites/default/files/report_pdf/lebanon0318_web.pdf, pp. Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. In some cases, the health center facilitates formation of peer support groups through the messaging application WhatsApp, links people to training on how to start a small business, and helps them get funding to start the business. Share this via Email [124] Human Rights Watch interview with James [not his real name], man with a psychosocial disability, Kenya, February 2020 (name and details withheld). res. E/C.12/2000/4 (2000), para. Third-party data was gathered to determine access based on four pillars: providers, facilities, funding and satisfaction. The Maputo Protocol has been ratified by Benin, Burkina Faso, Cte dIvoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Mozambique, Nigeria, Senegal, Sierra Leone, South Africa, Tanzania, Togo, Uganda, and Zimbabwe; African Charter on the Rights and Welfare of the Child (ACRWC), OAU Doc. Federal Register :: Expansion of Induction of Buprenorphine via COMMENTARY: Redrawing the battle lines: Vote yes for mental health Emergency workers struggle to get mental health services in El Salvador Res. 38-39; Jasmine Bauomy, In South Sudan, Stigma and Underfunding Plague Mental Health Care, Al Jazeera, January 18, 2019, https://www.aljazeera.com/indepth/features/south-sudan-stigma-underfunding-plague-mental-health-care-190117180739562.html (accessed August 3, 2020). In certain cases, 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. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. 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. [118] 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. [46] UNHRC, Report of the Special Rapporteur on the rights of persons with disabilities, Catalina Devandas-Aguilar, A/HRC/40/54, January 11, 2019, https://undocs.org/en/A/HRC/40/54 (accessed July 26, 2020), para. [54] Human Rights Watch interview with mother of a man with a mental health condition, Bali, Indonesia, November 19, 2020 (full name and details withheld). [47] In a number of countries including the Democratic Republic of Congo, Ghana, Kenya, and Liberia, children with disabilities can face accusations of witchcraft. Latinx/Hispanic Communities and Mental Health Families or staff in institutions often make the person who is shackled stay naked, dress in very scant clothing, or wear an adult diaper, so it is easier for them to keep the person clean and they do not have to regularly wash soiled clothing. Very few governments collect data on this practice at a country-level as it often occurs in remote areas, and families are reluctant to speak about shackled relatives. It also explicitly requires the full and informed consent of persons with disabilities to medical treatment.[178]. Psychologists in El Salvador, Guatemala and Honduras are working to help citizens cope with the dire conditions that are compelling thousands to leave those countries. [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). On average, countries spend less than 2 percent of their health budgets on mental health. 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. The lack of a community-based mental health system continues to. [3] United Nations Committee on the Rights of Persons with Disabilities (CRPD Committee), General Comment No. In 2019, this happened to [our teams] 11 times from January to June. 5, 21 I.L.M. While countries are increasingly starting to pay attention to the issue of mental health, the practice of shackling remains largely invisible. While the expectation was that families would regularly bring food for relatives, this rarely happened. James Ross, legal and policy director, provided legal review; and Babatunde Olugboji, deputy program director, provided programmatic review. The study offers a comprehensive analysis of the state of mental health care in the U.S. And across the region, the median percentage of countries health-care budgets allocated to mental health is 0.9%, the vast majority of which funds psychiatric hospitals (WHO-AIMS: Report on Mental Health Systems in Latin America and the Caribbean, 2013). The data collected indicates, however, that only about 25 percent of people with psychosocial disabilities surveyed have access to mental health services. 10, 13. [109] When his community went into lockdown and Sodikin lost access to community-based mental health services, his family was unable to support him and locked him in a room. [174] UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. Of all sectors of health care, mental health is best equipped to stand against racism. A/6316 (1966), 999 U.N.T.S. In the absence of mental health services, people with psychosocial disabilities can also be arbitrarily detained and chained in drug detention centers or prisons. 39-72; Mental Disability Advocacy Centre and Mental Health Users Network of Zambia, Human Rights and Mental Health in Zambia, July 2014, http://www.northriseuniversity.com/wp-content/uploads/2017/07/Human-rights-and-mental-health-in-Zambia.pdf (accessed July 31, 2020), pp. Depression is the most common mental illness in the world. Share this via Reddit 12 and 18. Mental health literacy and stigma among Salvadorian youth: anxiety Admission forms, where they exist, are signed by family members, the guardian, or staff members. [82] In another case, a woman with a psychosocial disability was chained for 24 years (since she was 10 years old) in Egypt.[83]. I go to the toilet in nylon bags, until they take it away at night. 2(1); CEDAW, art. [100] Human Rights Watch interview with Made, man with a psychosocial disability, Bali, Indonesia, November 19, 2020. Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. 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. MSF is also hearing worrying reports about the situation in some communities in San Salvador and Soyapango. The desk research included online search, analyses of national mental laws and policies, and review of relevant literature and domestic and international news reports. Mental Health Services Help Health Workers Improve HIV Services in Central America . 2200A (XX1), 21 U.N. GAOR Supp. Bo . Feb 28, 2023. Covid-19 is an extreme threat to people with psychosocial disabilities who are shackled in homes or overcrowded institutions without proper access to sanitation, running water, soap, or even basic health care. 48, 51; I Am Equally Human: Discrimination and Lack of Accessibility for People with Disabilities in Iran, June 2018, https://www.hrw.org/sites/default/files/report_pdf/iran0618_web_1.pdf, pp. 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. Many had old and leaking roofing. [22] The emphasis on tertiary facilities means that people are compelled to travel further and to a psychiatric hospital, a location that is more stigmatizing, which studies have shown are often deterrents in seeking support. Tony Evers declared this as the "year of mental health" in his budget address last month, one psychotherapist says the budget leaves an important component - mental health In Guatemala, for instance, rising temperatures and long droughts are reducing returns from coffee, corn and sugarcane farms. And women and girls are not supported to manage their menstrual hygiene, for example through the provision of sanitary pads. [16] According to WHO, given the high incidence of sexual violence they suffer, women are also disproportionately affected by Post-Traumatic Stress Disorder (PTSD). res. Human Rights Watch found evidence of shackling across 60 countries across Asia, Africa, Europe, the Middle East, and the Americas. Anxiety and depression levels are the lowest since the pandemic began, 48% of Americans are feeling down, depressed, or hopeless during the COVID-19 pandemic, How many teens are vaping? [49], A volunteer from an organization providing services to people with disabilities in Cameroon said: People in Cameroon have negative perceptions about disability. 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. While the government has taken important steps to end shackling, the practice remains to this day. I am not free to walk about. In Nigeria, boys as young as 10 were chained together in rooms with adult men, leaving them at risk of abuse. [14] Yet, psychosocial disabilities draw only limited government attention. In addition, 1.9 million, or 5.1%, of adults in nonmetropolitan areas . | Technical document. 90% of our funding comes from individual donors. [13] WHO, Mental Health, https://www.who.int/news-room/facts-in-pictures/detail/mental-health); The World Bank, Mental Health, https://www.worldbank.org/en/topic/mental-health). Out of the 110 countries on which we conducted research, we found cases of shackling of people with psychosocial disabilities across 60 countries. 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. In situations in which a person cannot give consent to admission or treatment at that moment, and their health is in such a state that if treatment is not given immediately, their life is exposed to imminent danger, immediate medical attention may be given in the same manner it would be given to any other person with a life-threatening condition who is unable to consent to treatment at that moment. Shackling impacts a persons mental as well as physical health. An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31. The treaty further obligates governments to provide support as may be required to exercise their legal capacity. Ensure shackling is not practiced by the organizations representatives or at holy sites. [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. Explain to me, how is that part of a healing process? [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. The offices of the first two are filled through popular elections; the president serves for five years and members of the legislature serve for three years. There is no space.[96] To walk in, one had to physically tiptoe over hands and feet. We offer counseling appointments in our center with a psychologist. In the same period this year, it has happened 37 times18 times in June alone.. Because we currently lack the needed resources many of our. In prayer camps and institutions in some countries, many interviewees spoke of persistent, gnawing hunger from forced fasting or inadequate food, and many looked emaciated. On March 20, the Salvadoran government declared a state of national emergency, suspending primary health care services in hospitals and health units and imposing and absolute lockdown, preventing people from leaving their homes. [175] Availability refers to the presence of functioning healthcare facilities, trained personnel, as well as adequate supply of medication. Carlos, a man with a psychosocial disability who has been chained and treated against his will in faith healing institutions in Mozambique, told Human Rights Watch: In healing centers, individuals with psychosocial disabilities are forced to partake in all sorts of rituals, including taking baths with special water or chicken blood, and undergo therapeutic massages as part of their treatment. In some cases, families left fake phone numbers and addresses in order to abandon the relative, while in other cases they simply moved homes or failed to show up. [27] For example, there are 0.19 psychiatrists per 100,000 people in Kenya and 0.12 14; Protocol of San Salvador, art. [PDF] Access to mental health care in El Salvador: a case study of