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12 and 18. UNHCR, 2014, Carrying a Heavy Load: Mayan Womens Understandings of Reparation in the Aftermath of Genocide 58 (1982), entered into force October 21, 1986. There are no statistics on the scale of shackling at a global level. Making an economic argument for investment in global mental health: The El Salvador - Forum on "Depression and Mental Health" [171], The ICESCR specifies that everyone has a right to the enjoyment of the highest attainable standard of physical and mental health.[172] Under the ICESCR, governments are to progressively realize the right to health to the maximum of their available resources. [67] Thousands Of Mentally Ill People Chained Like Cattle For Years In Sheds In UP, Outlook, January 3, 2019, https://www.outlookindia.com/website/story/india-news-thousands-of-mentally-ill-people-chained-like-cattle-for-years-in-uttar-pradesh-sheds/322874 (accessed July 29 2020); Asian News International, Thousands of Psychiatric Patients Chained in Sheds in Uttar Pradesh's Badaun; SC Asks Govt to Provide Medical Aid, Firstpost, January 3, 2019, https://www.firstpost.com/india/thousands-of-psychiatric-patients-chained-in-sheds-in-uttar-pradeshs-badaun-sc-asks-govt-to-provide-medical-aid-5829361.html (accessed July 29 2020); Mentally challenged man, in chains for 14 yrs, rescued, The Indian Express, September 27, 2020 (accessed September 28, 2020). 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. While most Americans have heard of telehealth as an option for treating mental health issues, only 7% have reported using it. Provide adequate food, shelter, and health services to people with psychosocial disabilities. 9. [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. In many countries, it is a profitable business. 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. [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. This inhumane practicecalled shacklingexists due to inadequate support and mental health services as well as widespread beliefs that stigmatize people with psychosocial disabilities. This study examined (1) adolescent mental health literacy (MHL) and stigma for depression, anxiety and obsessive-compulsive and related disorders (OCRDs), and (2) demographic moderators. With the right kind of support, people with mental health conditions can live and thrive in their communities. Mental Health Atlas 2020 Country Profile: El Salvador Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. In countries where people believe mental health is a spiritual issue and robust mental health services are lacking, private institutions and faith-healing facilities flourish. Cost and accessibility of mental health care in America - CNBC (No. El Salvador: Deaths increase as health system collapses 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. The nature of shackling means that people live in very restrictive conditions that reduce their ability to stand or move at all. 24-64; Treated Worse Than Animals: Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India, December 2014, https://www.hrw.org/sites/default/files/report_pdf/india1214.pdf, p. 34; We Are Also Dying of AIDS: Barriers to HIV Services and Treatment for Persons with Disabilities in Zambia, July 2014, https://www.hrw.org/report/2014/07/15/we-are-also-dying-aids/barriers-hiv-services-and-treatment-persons-disabilities; Like A Death Sentence: Abuses against Persons with Mental Disabilities in Ghana, October 2012, https://www.hrw.org/sites/default/files/reports/ghana1012webwcover.pdf, pp. [20] In low-income countries, government mental health spending decreases to less than 1 percent of health budgets with less than US $0.25 spent annually per person on mental health, compared to $80 in high income countries. A combined federal, state, local view of how funds flow in and out. 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. It made me sad [to chain him]. Shackling is common not just in homes but also in state-run or private institutions, including faith healing centers. Res. Last Updated: 04/22/2022. [127] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf; 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. We keep them in their underclothes. San Salvador/New York, July 9, 2020The health system in El Salvador is on the brink of collapse, with an increasing number of people dying from COVID-19 and other illnesses at home before they can receive medical care, said the international medical humanitarian organization Doctors Without Borders/Mdecins Sans Frontires (MSF). [61], In the absence of comprehensive global data, it is difficult to precisely determine the magnitude of this practice. [120] UNHRC, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Mndez, A/HRC/22/53, February 1, 2013, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf (accessed December 28, 2013), para. Shackling is practiced across socio-economic classes. [29] Human Rights Watch research in over 25 countries around the world has found that people with mental health conditions can face a range of abuses including arbitrary detention, involuntary treatment, including electroconvulsive therapy, forced seclusion as well as physical and sexual violence in psychiatric hospitals. [92] It cannot be discriminatory and should never be justified on the basis of the existence of a disability.[93]. I have to go to the toilet in a bucket. New Jersey and Massachusetts have the lowest proportions, at 0.4% and 4.0%, respectively. [21] WHO, Mental Health in the Western Pacific, undated, https://www.who.int/westernpacific/health-topics/mental-health (accessed June 17, 2020). Although mental health professionals had suspected mistreatment at the facility for years, the cases only came to light once video footage was anonymously leaked. Lack of education in the community about mental health. People end up living shackled in institutions for long periods because their relatives do not come to take them home and the institution has nowhere to send them. A Guatemalan farmer abandons his coffee farm after years of drought destroy his crops. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. [169], In his 2017 report, the UN special rapporteur on the right to health noted that [s]ervices must support the rights of people with intellectual, cognitive and psychosocial disabilities and with autism to live independently and be included in the community, rather than being segregated in inappropriate care facilities.[170], The highest attainable standard of physical and mental health is a fundamental human right enshrined in numerous international human rights instruments. In Morocco, the government released over 700 people chained in one shrine alone, about 50 kilometers from Marrakesh in the countrys southwest. COMMENTARY: Redrawing the battle lines: Vote yes for mental health and Zambia. (London, October 6, 2020) Hundreds of thousands of people with mental health conditions are shackled around the world, Human Rights Watch said in a report released today. support services. Retornados often struggle to find work, become targets of gangs who assume they have money, and have problems with addiction and suicidality, Garca Rivera says. [156] ICCPR, art. The study offers a comprehensive analysis of the state of mental health care in the U.S. It doesnt feel right; it makes me sad. Human Rights Watch interviews with Benjamin Ballal, February 15, 2020; Archbishop Danokech, February 18, 2020; and Fiera [not her real name], November 20, 2019. In Mexico, for example, Disability Rights International documented children with psychosocial disabilities in cages or tied down with bandages. The Black community, in particular, is affected by mental health, often due to: Lack of health insurance. [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. [180] UN General Assembly, Report of the Special Rapporteur on the rights of persons with disabilities, A/73/161, July 16, 2018, https://undocs.org/en/A/73/161 (accessed September 17, 2020), para. People are shackled in locations that are out of sight and out of the way for families: in backyards, outhouses, sheds, or animal shelters. 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. 31, no. States also range in the number of providers needed to fill shortages. Institutions: Refers to state-run (unless specified otherwise) psychiatric hospitals, government social care or nongovernmental organization-run residential facilities. When the fighting happened, we left him next to the house tied up. [116] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, November 20, 2019. As a community, we need to attend to the physical, psychological, emotional, social, economic and familial needs of our people, says Ana Alicia Cbar Cataln, PhD, a clinical psychologist at Proyecto Aigl Guatemala and professor at Universidad del Valle de Guatemala (UVG). The ACRWC has been ratified by Benin, Burkina Faso, C. American Convention on Human Rights (ACHR), adopted at the Inter-American Specialized Conference on Human Rights, San Jos, Costa Rica, 22 November 1966. In El Salvador, Beckley has trained police officers, prosecutors, judges, community leaders, social workers and psychologists in trauma-informed care for people who are seeking justice through the courts. Inside Look: Coping With COVID-19 in El Salvador | UNICEF USA 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. 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. Over 400 million people worldwide lack access to essential health services typically delivered through primary healthcare. In Nigeria, amongst the people Human Rights Watch interviewed, the youngest child chained was a 10-year-old boy and the oldest person was an 86-year-old man. [10] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, November 20, 2019. We can tell by the physical signs on their bodies. For example, Delaware requires 15 more mental health providers to resolve its shortage, whereas Texas needs an additional 638. 1, 3. [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. 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. CAB/LEG/67/3 rev. 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. Ukraine: MSF teams treating patients after missile attack on residenti Bangladesh: New cuts to food rations will have dire health impacts on Somalia and Somaliland: Indiscriminate fighting affects medical care i Mdecins Sans Frontires 2023 Jos Enrique Hernndez, a nurse from one of the specialist 'family care' teams set up by the Ministry of Health in El Salvador's capital city, San Salvador, has never carried out so many cervical smears, to test for cervical cancer, in a single morning session. Carlos, a man with a psychosocial disability who had been chained and treated against his will in faith healing institutions in Mozambique, said: Human Rights Watch documented physical and sexual violence against people with psychosocial disabilities who were shackled in homes and institutions. [160] UNHRC, Report of the Special Rapporteur on torture, and other cruel, inhuman or degrading treatment or punishment, Juan E. Mndez, A/HRC/22/53, February 1, 2013, https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf, para. 51) at 197, U.N. Doc. As of 2018, fewer than half of the 139 countries that have mental health policies had aligned them with international human rights conventions. 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. Rafael Serrano psychiatric hospital in Puebla shackled him naked with a padlock during the nights for two-and-a-half weeks, and he was forced to defecate and urinate in his bed. 202-621-1631. The exchange, co-founded by clinical psychologist Leticia Gonzalez Pileski, PsyD, and Jason Platt, PhD, a counseling psychologist based in Mexico City, holds one-day conferences where students discuss their work in liberation psychology and organizes trips to war-torn areas of El Salvador to help survivors preserve cultural memory about the violence they endured. There is no space.[96] To walk in, one had to physically tiptoe over hands and feet. [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. It focuses on raising awareness about mental health and pasung, integrating mental health into primary health services, providing mental health medication at the 9,909 community health centers, training health staff to identify and diagnose basic mental health conditions, and creating community mental health teams called Tim Penggerak Kesehatan Jiwa Masyarakat (TPKJM) that act as a coordination mechanism between the department of health and others departments at the provincial and district levels to monitor and facilitate the release of people from pasung. Lt. Gov. Coleman promotes administration's Education First Plan Over one-third of Americans live in areas lacking mental health 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 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). 18 (4) and 28; ACHR, art. [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. International human rights law guarantees to persons with disabilities the right to liberty on an equal basis with others. At the Edumfa Heavenly Ministry Prayer Camp in Cape Coast, Ghana, people with real or perceived psychosocial disabilities are confined in cages and are rarely allowed out of such cages. [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. As of 2018, more than two-thirds of all countries did not cover reimbursement for mental health services in national health insurance schemes. [11] In countries in crisis or conflict, up to 22 percent or 1 in 5 people have a mental health condition. Deprivation of liberty is permissible only when it is lawful and not arbitrary, and includes initial and periodic judicial review. [146] American Convention on Human Rights (ACHR), adopted at the Inter-American Specialized Conference on Human Rights, San Jos, Costa Rica, 22 November 1966. 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.. Malakis story helped shape his community to be more inclusive and accepting. Mental Illnesses are Common, but Care is Lacking | Health Care Policy Two months ago, social protection officials tried to discharge me from the hospital and send me to my sisters house, but she refused. [117] Human Rights Watch, Like a Death Sentence, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana; Chained Like Prisoners," https://www.hrw.org/report/2015/10/25/chained-prisoners/abuses-against-people-psychosocial-disabilities-somaliland; Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia; "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. In China, about 100,000 people are shackled or locked in cages in Hebei province alone, near Beijing. The cost of mental health. 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. [73] In Pakistan, the British Broadcasting Corporation (BBC) reported that in a single Sufi shrine near the city of Burewala in Punjab province hundreds of people with mental health conditions from poor families spent their lives chained to trees. This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. Human Rights Watch researchers interviewed more than 350 people with psychosocial disabilities, including those who were shackled at the time of research or had been shackled at least once in their lives, and more than 430 family members, caregivers or staff working in institutions, psychiatrists, psychologists, nurses and other mental health professionals, faith healers, lawyers, government officials, representatives of local nongovernmental organizations (NGOs), including organizations of persons with disabilities, and disability rights advocates. Mental Health: Services Lacking Psychotherapy Center of Waunakee: Evers' budget fails to fund student Access to mental health care in El Salvador: a case study of progress toward decentralization Rev Panam Salud Publica. The report also draws on Human Rights Watchs extensive research on stigma, mental health, and discrimination that people with psychosocial disabilities face around the world, including in Australia, Brazil, Cameroon, Croatia, India, Iran, Kazakhstan, About 80 percent of people with disabilities, including people with psychosocial disabilities, live in middle or low-income countries where it is often challenging to access healthcare, particularly mental health care. The losses of productivity caused by poor mental health include but are not limited to the following: Negative job performance. The ACHPR has been ratified by Benin, Burkina Faso, C, African Charter on the Rights and Welfare of the Child (ACRWC), OAU Doc. For example, Human Rights Watch research in Kenya found about 60 men, women, and children with real or perceived psychosocial disabilities chained, hidden from view, in the compound of the Coptic Church Mamboleo in Kisumu city in western Kenya. Talkspace therapist Bisma Anwar, LMHC. [140] 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). The objective was to combat stigma by raising awareness on mental health and put an end to chaining in homes as well as in hospitals. [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. 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. [145], The Latin American countries discussed here are party to the American Convention on Human Rights and the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights (Protocol of San Salvador). "We took him to a hospital in San Salvador where he was asked to go to one in Soyapango, and from there to another, said Victor. [64] In one case, an 8-year-old girl was tied to a tree by her grandparents for nearly six years in Henan province, in central China. Federal tax ID#: 13-3433452. The survey was conducted between July 31 August 12, 2018, with a margin of error of +/- 1.38 at the 95% confidence level. The number of new jobs and the unemployment rate are regularly cited in the news, but theyre just part of the picture. [139] After long-term advocacy by organizations such as the Mental Health Coalition of Sierra Leone, chaining was banned in policy. Depression, which is the leading cause of disability, is reported to be twice as common in women than men. Res. 46) at 193, U.N. Doc. 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. In many of the countries where Human Rights Watch conducted research for this report, there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, or the consequence of some form of sin, displaying immoral behavior, orfor those whose families are adherents of certain religionshaving a lack of faith. 58. 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. [103], In some cases, people are shackled to each other, forcing them to go to the toilet, bathe, eat, or sleep together. 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. [15] Discrimination, gender-based violence, socioeconomic disadvantage, income inequality, subordinate social status and the pressure of multiple roles are among the most cited at-risk factors that contribute to poor mental health among women. In addition, even when there are services, they are often under-utilized or do not comply with human rights standards because of limited understanding and awareness of mental health. These beliefs are driven by several perceived barriers in Americans ability to seek mental health treatment, including: Several individuals blamed the U.S. government and insurers for not providing enough funding and support for access. 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. 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. [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. Not only can it be dangerous to live in the United States as an undocumented person, but leaving behind ones home, family and culture is often very painful.. It also explicitly requires the full and informed consent of persons with disabilities to medical treatment.[178]. 16; ACRWC, art. CAB/LEG/67/3 rev. 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. U.S. Health and Human Services secretary, Gov. Kotek highlight youth The Mental Health Crisis Is Real | CAMH [11] Estimates that include people with conditions related to substance could be as high as 970 million or 13 percent of the global population. El Salvador's citizens have faced multiple traumas in the past decades: war, gang violence, natural disasters and now COVID-19. 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. People with psychosocial disabilities face pervasive stigma and bias and are among the most marginalized, enduring stigma and discrimination in every sphere of lifepersonal, professional and public. We dont know if hes dead or alive.[108] While Covid-19 has exposed the importance of psychological wellbeing and the need for connection and support within communities, it has exacerbated the risk to people with psychosocial disabilities.