12; CRC, art. According to Indonesias 2018 Basic Health Survey (Riskesdas), 14 percent of people with serious mental health conditions have been shackled at least once in their lives and about 30 percent of them have been shackled within three months of the survey.[141]. Deprivation of liberty is permissible only when it is lawful and not arbitrary, and includes initial and periodic judicial review. 61-62; Amnesty International, Our Hearts Have Gone Dark The Mental Health Impact of South Sudans Conflict, https://www.amnesty.org/download/Documents/AFR6532032016ENGLISH.PDF, pp. A/61/49 (2006), entered into force May 3, 2008. The desk research included online search, analyses of national mental laws and policies, and review of relevant literature and domestic and international news reports. Services Lacking for People with Mental Health Issues Two studies conclude more people than in the past have multiple mental disorders, and there aren't enough services to help those with. Bilingual patients are evaluated differently when evaluated in English versus Spanish, and Latinx/Hispanic people are more frequently undertreated than whites. In El Salvador, we have strengthened the supply chain to improve availability of essential medicines and worked with the Ministry of Public Health to implement a continuous quality improvement of care model in hospitals. In June 2020, President Maada Bio of Sierra Leone inaugurated the renovated and chain-free Sierra Leone Psychiatric Teaching Hospital. Of the 60 countries where Human Rights Watch found evidence of shackling, only a handful of countries have laws, policies, or strategies in place that explicitly ban or aim to end shackling of people with mental health conditions. Human Rights Watch found evidence of shackling across 60 countries across Asia, Africa, Europe, the Middle East, and the Americas. As a result, they urinate, defecate, eat, and sleep in a radius of no more than one to two meters. 51. 1. 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. Trade is an important part of the American economy and a key driver of many industries. In January 2017, the Indonesian Health Ministry rolled out Program Indonesia Sehat dengan Pendekatan Keluarga (Healthy Indonesia Program with Family Approach), a community outreach program in which health workers use a family-based approach, going house to house to collect data, raise awareness, and provide services relating to 12 measures of family health, including mental health. Those workshops address teen marriage and pregnancy, suicidality, behavioral problems and drug and alcohol misuse in an effort to improve educational and professional outcomes for rural populations. 316, No. E/C 12/2000/4, 2000, https://undocs.org/E/C.12/2000/4 (accessed September 23, 2020), paras. Shackling is practiced across socio-economic classes. We keep them in their underclothes. A/6316 (1966), 999 U.N.T.S. In Russia, residents with psychosocial disabilities were being chained by their wrists or ankles to beds, radiators, and other objects in the Trubchevsk Psycho-Neurological Institution near Briansk, located southwest of Moscow. These include the International Covenant on Civil and Political Rights (ICCPR), International Covenant on Economic, Social and Cultural Rights (ICESCR), Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) Convention on the Rights of the Child (CRC), and Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol. [41], While data disaggregated by disability is hard to come by, available evidence shows that people with psychosocial disabilities often grow up in the confines of their home or an institution, excluded from community life, rarely attending school, getting married and having children, seeking employment, or participating in society. 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). I last took a bath days ago. [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. I eat here once a day. [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. [153] CRPD Committee, General Comment No. [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. Provide training to broader membership, including at grassroots levels, about the rights of people with psychosocial disabilities. [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. [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. However, in prayer camps and institutions, many interviewees spoke of persistent, gnawing hunger from forced fasting or inadequate food. 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. I want to move about, I have asked the baba [faith healer] to take them off, but he wont. The chain is so heavy. [8] World Health Organization (WHO), Gender and Women's Mental Health, undated, https://www.who.int/mental_health/prevention/genderwomen/en/ (accessed July 21, 2020); WHO, Mental disorders, November 28, 2019, https://www.who.int/news-room/fact-sheets/detail/mental-disorders (accessed June 22, 2020); WHO, Mental health in the workplace, May 2019, https://www.who.int/mental_health/in_the_workplace/en/ (accessed June 22, 2020); WHO, Mental Health, October 2, 2019, https://www.who.int/news-room/facts-in-pictures/detail/mental-health (accessed June 22, 2020). When the Special Olympics team had Malaki released, he got the opportunity and training to play football. We send regular emails about upcoming events, member spotlights and updates in mental wellbeing. Individuals were either crowded in the few spots where there was shade or baked in the sun. According to the latest available global estimates, 792 million people or 10.7 percent of the global population has a mental health condition. One in five, CDC data says, 30% of American adults had symptoms consistent with an anxiety or depression diagnosis, will waive the residency requirements for J-1, how mental health has changed throughout the pandemic, how healthcare jobs have grown over the past two decades, Health Resources and Services Administration. In the case of social care institutions, NGO-run or traditional or religious healing centers, people sometimes used false pretenses to get their relatives to enter an institution, or simply provided no explanation at all. El Salvador is a republic with three branches of government: the Executive, the Legislature, and the Judiciary. Rural Americans are also less accepting of mental health services and care. There is also a large disparity in access to mental health care based on level of income and location. Many are forced to eat, sleep, urinate, and defecate in the same tiny area. 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. Mental Health Services. 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. The treaty further obligates governments to provide support as may be required to exercise their legal capacity. The cost of mental health services can be prohibitive. An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31. The large majority of Americans (76%) also believe mental health is just as important as physical health. Shackling is common not just in homes but also in state-run or private institutions, including faith healing centers. In 2006, the WHO launched the Chain-Free Initiative in Somalia and Afghanistan. Men, women, and children, some as young as 10, are chained or locked in confined spaces for weeks, months, and even years, in about 60 countries across Asia, Africa, Europe, the Middle East, and the Americas. The HRSA also runs several training programs to address the shortage of mental health professionals. 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. In many countries, Covid-19 has disrupted mental health services, which can put people with psychosocial disabilities at risk of being shackled. In one center in northern Nigeria, Human Rights Watch found a dozen people who showed researchers scars on their arms, chests, and backs that they said were from floggings by staff. Despite this strong demand and growing societal awareness of the importance of mental health in the U.S., the study revealed that the overwhelming majority of Americans (74%) do not believe such services are accessible for everyone, and about half (47%) believe options are limited. 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. support services. The 56-page report, Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide, examines how people with mental health conditions are often shackled by families in their own homes or in overcrowded and unsanitary institutions, against their will, due to widespread stigma and a lack of mental health services. 44/25, annex, 44 U.N. GAOR Supp. As of 2018, more than two-thirds of all countries did not cover reimbursement for mental health services in national health insurance schemes. Download (593.4 kB) WHO Team. These individuals are skewing younger and are more likely to be of lower income and have a military background. Layout, design, and production were coordinated by Travis Carr, publications coordinator; Sakae Ishikawa, senior video editor; Veronica Matushaj, director of documentary video and photography; Paula Beegan, consultant in the Disability Rights Division; Remy Arthur, associate; Jon Nealon, consultant in the Multimedia Division; Fitzroy Hepkins, senior administrative manager; and Karolina Kozik, senior coordinator in the Disability Rights Division. [138] Human Rights Watch phone interview with Joshua Duncan, program manager, Mental Health Coalition of Sierra Leone, September 25, 2020. Islamic faith healers often use Quranic recitations or herbal medicine, including the burning of herbs, as a treatment method. 11, 69-71; sjcintern and Zoya Aleem, Chaining the Mentally Ill, post to The Upstream Journal (blog), January 2012, https://www.upstreamjournal.org/chaining-the-mentally-ill/ (accessed August 17, 2020). [12] The World Health Organization (WHO) reports that one in five of the worlds children and adolescents have a mental health condition. The CRPD establishes the right of all persons with disabilities to live in the community, with choices equal to others, and obligates governments to take the appropriate measures to ensure their full inclusion and participation in the community. Nearly 1 in 5 Americans has some type of mental health condition. Sophia Majlessi [171] Universal Declaration of Human Rights (UDHR), adopted December 10, 1948, G.A. While much attention is focused on the humanitarian crises at the U.S. border, researchers, clinicians and activists are also working to address problems at their source in Guatemala, Honduras and El Salvador. Conduct regular, unannounced monitoring visits to government and private social care institutions as well as faith healing centers, with unhindered and confidential interaction with both staff and patients. The majority (64%) of Americans who have sought treatment believe the U.S. government needs to do more to improve mental health services. Once the person is committed to an institution, they have no right to appeal or leave until the institution discharges them. [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). The . Created by state lawmakers in 2019 and already in more than 300 school districts comprising some 40% of the state's school population, the Texas Child Mental Health Care Consortium of experts. It is typically an administrative process and does not contain any provisions for judicial oversight. We can tell by the physical signs on their bodies. Others think persons with disabilities are useless. As of 2012, 92 percent of the people who had been unlocked in China remained free from chains. 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. [2] See Disabled Peoples International, Constitution of Disabled Peoples International, 1993, http://www.disabledpeoplesinternational.org/Constitution (accessed January 15, 2016), art. CAB/LEG/67/3 rev. Central Americans are seeking to escape gang violence, corruption, extreme poverty, the impacts of climate change and other problems, and hoping to resettle in Mexico or the United States. International human rights law guarantees to persons with disabilities the right to liberty on an equal basis with others. Aisha, mother who chains her 18-year-old daughter with a psychosocial disability in the Gaza Strip told Human Rights Watch: Archbishop Danokech of the Holy Ghost Coptic Church of Africa in Kisumu, western Kenya, where over 60 men, women, and children with psychosocial disabilities are detained and most of whom are chained, told Human Rights Watch: We do not want them to wear clothes. Because we currently lack the needed resources many of our. 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. I am not free to walk about. Priority Ambulance (011-503-2264-7911) is the only private ambulance service with a fleet of vehicles in San Salvador that has trained personnel and medical equipment to manage emergencies. 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. James, a man with a psychosocial disability who has been chained for several years in a Christian healing institution in Kenya, said: They cane us if we make a mistake. res. [142] WHO, "Transforming services and promoting human rights in mental health and related areas," undated, https://www.who.int/activities/transforming-services-and-promoting-human-rights-in-mental-health-and-related-areas (accessed September 25, 2020). But even as psychologists seek a broader impact, says Cbar Cataln, its important to remember that the trauma and disenfranchisement driving Central Americans north are deeply personal. [104] In a privately-run social care institution near Briansk, southwest of Moscow, Russia, staff regularly brought people with psychosocial disabilities to the dining hall chained to each other, and forced them to eat in handcuffs. Specifically, younger Americans need more information on how and where to access care. Shackling occurs in many countries that are party to international and regional human rights treaties that prohibit abusive treatment and related rights. A custom index was developed, ranking each state according to its mental health service access. The right to health care, particularly mental health care, on the basis of free and informed consent of the person with a real or perceived psychosocial disability is routinely ignored. [39] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. A World Health Organization (WHO) video describes it as a black dog that follows you everywhere, does not let you sleep or eat well. We build the capacity of mental health and substance use treatment organizations. Nevertheless, Mexico needs at least 12,000 psychiatrists. 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. [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. [161] UNHRC, Report of the Special Rapporteur on torture and other cruel inhuman or degrading treatment or punishment, A/HRC/43/49, March 20, 2020, https://undocs.org/en/A/HRC/43/49, para. Therefore, people first consult faith or traditional healers and often only seek medical advice as a last resort. Governments should include people with disabilities and their representative organizations in developing and carrying out the plans. There are currently 10 Steven A. Cohen Military Family Clinics nationwide. A central issue is the lack of mental health care professionals. Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. 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 Advancing psychology to benefit society and improve lives, Center for Human Rights and International Justice, How the Climate Crisis Is Driving Central American Migration, Liberation Psychology Intercambio/Exchange, Sepur Zarco: In Pursuit of Truth, Justice and Now Reparations, Healthcare Access and Conditions in Guatemala, Honduras and El Salvador, Children on the Run: Unaccompanied Children Leaving Central America and Mexico and the Need for International Protection, Carrying a Heavy Load: Mayan Womens Understandings of Reparation in the Aftermath of Genocide, Preventing Interpersonal Stressors at Work. Liberation psychology, for example, established in the 1970s by Jesuit priest Ignacio Martn-Bar, PhD, calls on psychologists to redefine their role as sociopolitical and to support oppressed communities. 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. [76] 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. 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. 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 order to show the scale and scope of shackling of people with real or perceived psychosocial disabilities worldwide, Human Rights Watch conducted a study of mental health legislation, relevant policies, and practices across 60 countries around the world. [92] It cannot be discriminatory and should never be justified on the basis of the existence of a disability.[93]. Personal hygiene is a serious problem since people who are chained often do not have access to a toilet. Res. Depression, which is the leading cause of disability, is reported to be twice as common in women than men. [35] Mental health is not just a human right but a public good that is key to achieving the United Nations Sustainable Development Goals (SDG). Accessibility means that health services should be affordable, situated within easy physical reach, and be offered to everyone without discrimination. The data collected indicates, however, that only about 25 percent of people with psychosocial disabilities surveyed have access to mental health services. And women and girls are not supported to manage their menstrual hygiene, for example through the provision of sanitary pads. [3] This encompasses the right to personhood, being recognized as a person before the law, and legal agency, the capacity to act and exercise those rights. 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. [132] Human Rights Watch, Ghana Breaks the Chains on Mental Health, video, https://www.youtube.com/watch?v=7idmUmMccgw; Shantha Rau Barriga, Ghana Breaks The Chains On Mental Health, commentary, Human Rights Watch Dispatch, October 16, 2017, https://www.hrw.org/news/2017/10/16/ghana-breaks-chains-mental-health; Ghana: Oversight Needed to Enforce Shackling Ban, Human Rights Watch news release, October 9, 2018, https://www.hrw.org/news/2018/10/09/ghana-oversight-needed-enforce-shackling-ban. (No. (Eds. Hum. Res. 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. Due to these perceptions, people dont want to help or mingle with persons with disabilities.[50], Ying, a young woman from Goungdong province, in southern China, said: All through my childhood, my aunt was locked in a wooden shed and I was forbidden to have contact with her. When it comes to seeking mental health care, the Latinx community has always struggled with stigmaboth in and outside of the United States. From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. [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. Advocate for the integration of people with psychosocial disabilities in the community. [18] The Asia Foundation, Model Disability Survey Of Afghanistan 2019, 2020, https://asiafoundation.org/wp-content/uploads/2020/05/Model-Disability-Survey-of-Afghanistan-2019.pdf (accessed June 18, 2020), p. 26; The World Bank, Disability Inclusion, May 15, 2020, https://www.worldbank.org/en/topic/disability (accessed June 22, 2020). 119. [56] Any criticism of faith-based institutions is not linked to their religious roots or spiritual nature. In Nigeria, Human Rights Watch visited 28 state-run and private facilities between 2018 and 2019, across which a few hundred people were arbitrarily detained, and where people were regularly chained or shackled. In 2010, Indonesias health ministry launched the Indonesia Free from Pasung, a program that aimed to eradicate the practice by 2014. Over 400 million people worldwide lack access to essential health services typically delivered through primary healthcare. A number of factors fuel the shortage, including a greater awareness of mental health problems that has spurred people to seek treatment. [62] Vikram Patel et al., The Lancet Commission on Global Mental Health and Sustainable Development, The Lancet 392 (10157), October 9, 2018, doi: 10.1016/S0140-6736(18)31612-X (accessed July 29, 2020); 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); Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 35; [63] Human Rights Watch has found evidence of people with psychosocial or intellectual disabilities being shackled in Afghanistan, Argentina, Armenia, Bangladesh, Benin, Bolivia, Brazil, Brunei, Burkina Faso, Cambodia, Chile, China, Colombia, Cte d'Ivoire, Dominican Republic, Democratic Republic of Congo, East Timor, Ecuador, Egypt, El Salvador, Ethiopia, Ghana, Guatemala, Haiti, Honduras, India, Indonesia, Iraq, Israel, Japan, Jordan, Kenya, Laos, Liberia, Mexico, Morocco, Mozambique, Nicaragua, Nigeria, Oman, Pakistan, Palestine, Paraguay, Peru, Philippines, Russia, Saudi Arabia, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Tajikistan, Tanzania, Thailand, Togo, Turkey, Uganda, Yemen, and Zimbabwe.
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