The nation needs an additional 6,398 mental health providers to fill these shortage gaps. [123] Human Rights Watch interview with Halima Gani, woman with a psychosocial disability, Kano, Nigeria, September 23, 2019. Our research indicates that most people want to work to support their families and send their children to school, says M. Brinton Lykes, PhD, a professor of community-cultural psychology and co-director of the Center for Human Rights and International Justice at Boston College. 44/25, annex, 44 U.N. GAOR Supp. [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. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system. 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. Deprivation of liberty is permissible only when it is lawful and not arbitrary, and includes initial and periodic judicial review. Last year, staffing shortages at the Alabama Department of Mental Health caused a temporary halt in admissions at one of three remaining state hospitals that provide long-term mental health care. Rural Americans are also less accepting of mental health services and care. [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). I really wanted to help my aunty but couldnt. [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. [59] Human Rights Watch interview with a psychiatrist, Nigeria, March 27, 2019 (name and location withheld). Individuals were either crowded in the few spots where there was shade or baked in the sun. However, in prayer camps and institutions, many interviewees spoke of persistent, gnawing hunger from forced fasting or inadequate food. Bo . 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. 2200A (XXI), 21 U.N. GAOR Supp. But through this program, we are working to create a culture of prevention., Other psychologists have turned their attention to a frequently overlooked populationthose who have been deported from the United States, known as retornados.. 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). As a result, documenting shackling cases is extremely challenging. It was like my mind had gone blank on account of the fright, she said. [21] Most concerning is that in low- and middle-income countries, 80 percent of government spending on mental health goes to psychiatric hospitals and not community-based services. In Latin America, 5% of the adult population suffers from it, but most neither seek - nor receive - treatment, according to the WHO. 2200A (XXI), 21 U.N. GAOR Supp. Your gift helps us provide medical humanitarian aid for hundreds of thousands of people each year. Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. Mental Health Services. Share this via Printer, Shackling of People with Psychosocial Disabilities Worldwide. 25, 27, 52; I Needed Help, Instead I Was Punished: Abuse and Neglect of Prisoners with Disabilities in Australia, February 2018, https://www.hrw.org/report/2018/02/06/i-needed-help-instead-i-was-punished/abuse-and-neglect-prisoners-disabilities; 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 losses of productivity caused by poor mental health include but are not limited to the following: Negative job performance. Many are forced to eat, sleep, urinate, and defecate in the same tiny area. There are currently no coordinated international or regional efforts to eradicate shackling. 7; CRC, art. Exacerbated by such close and unsanitary living conditions, lice and scabies are a major problem in many institutions.[97]. In some states, over 80% of the population lives in a mental health professional shortage area. Human Rights Watchs research into mental health settings in at least 25 countries has found that people with mental health conditions can face a range of abuses when sent to a psychiatric hospital, such as arbitrary detention, involuntary treatment, including electroconvulsive therapy, forced seclusion as well as physical and sexual violence. Out of the 110 countries on which we conducted research, we found cases of shackling of people with psychosocial disabilities across 60 countries. Admission forms, where they exist, are signed by family members, the guardian, or staff members. [179] UN General Assembly, Report of the Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, A/64/272, August 10, 2009, https://undocs.org/en/A/64/272 (accessed September 23, 2020), para. [56] Any criticism of faith-based institutions is not linked to their religious roots or spiritual nature. [25] In Africa, on average, there is fewer than one mental health worker per 100,000 people, compared with 2.5 in South-East Asia and 50 in Europe. [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). I was fearful that someone would attack me during the nights, without being able to defend myself because of being shackled.[89], People end up living shackled in institutions for long periods because their relatives do not take them home and the institution has nowhere to send them. They dont want to socialize with me because my mental health condition brings shame on them. 56). 8. In 2019, this happened to [our teams] 11 times from January to June. CAB/LEG/67/3 rev. 25; ACHPR, art. 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. [70] Nigeria: People With Mental Health Conditions Chained, Abused, Human Rights Watch news release, November 11, 2019, https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused. El Salvador's citizens have faced multiple traumas in the past decades: war, gang violence, natural disasters and now COVID-19. [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. People with psychosocial disabilities, including children, who are shackled in homes or institutions are routinely forced to take medication or subjected to alternative treatments such as concoctions of magical herbs, fasting, vigorous massages by traditional healers, Quranic recitation in the persons ear, singing Gospel hymns, and special baths. 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. In situation of conflict or crises, and more recently during the Covid-19 pandemic, people who are shackled are at greater risk because they are unable to leave or flee. Some families also use shackling as a way to prevent or control a certain behavior they find disruptive. Globally, an estimated 792 million people or 1 in 10 people, including 1 in 5 children, have a mental health condition. [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. Trade is an important part of the American economy and a key driver of many industries. [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 have to wait for authorization from the public health system to be able to move patients to a care center, since we cannot transfer the patient from [their] home without prior coordination and authorization from the public health system, said Wendy. Informed consent is the bedrock of the right to health, especially when it comes to people with psychosocial disabilities. [62], Human Rights Watch has found evidence of shackling across60 countries across Asia, Africa, Europe, the Middle East, and the Americas. The study offers a comprehensive analysis of the state of mental health care in the U.S. CMS recognized that, for many mental health services, visualization between the patient and clinician may be less critical to provision of the service: "[M]ental health services are different from other services because they principally involve verbal exchanges between patient and practitioner." CMS also responded to comments requesting . [60] Human Rights Watch visit to Lawang Mental Hospital, East Java, Indonesia, August 12, 2015. 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. [90] For example, in Nigeria, in 2019, while the average monthly earning was roughly 18,000 Naira ($47), a traditional healer would charge anywhere between 2,000 to 150,000 Naira ($5 to $388) for spiritual treatment.[91]. Shackling is a rudimentary form of physical restraint used to confine people with real or perceived psychosocial disabilities. 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). In addition to similar financial incentives, the HRSA will waive the residency requirements for J-1 visa holders who agree to deliver health care for three years in a health care professional shortage area, encouraging foreign providers to address the needs of underserved areas. [69] Helena Selby, Prayer Camps and Mental Illness, The Chronicle, undated, http://ghanaian-chronicle.com/prayer-camps-and-mental-illness/ (accessed March 28, 2012). However, it will be a challenge for the country to maintain those numbers considering how the COVID-19 pandemic is impacting the economy and the exports the country relies on. Under the 686 unlocking initiative, 266 people were given mental health medication and 88 percent of all those who were unlocked were admitted to a psychiatric hospital. Accessibility means that health services should be affordable, situated within easy physical reach, and be offered to everyone without discrimination. [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. [61] 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. E/C.12/2000/4 (2000), para. [14] Yet, psychosocial disabilities draw only limited government attention. 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. "In many instances the patient had already died when we arrived at their house, said Angel Sermeo, MSFs medical activity manager in El Salvador. Two months ago, social protection officials tried to discharge me from the hospital and send me to my sisters house, but she refused. [128] Human Rights Watch interview with Tina Mensah, Ghanas deputy health minister, Accra, November 8, 2019. As a result of this initiative, according to the WHO, 1,700 people were freed from chains in Somalia between 2007 and 2010. Children should have access to child psychologists and specialist support services. Shackling is practiced across socio-economic classes. and Zambia. 39-72; Chained Like Prisoners: Abuses against People with Psychosocial Disabilities in Somaliland, October 2015, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, pp. 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. 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. Texas, Wisconsin and Georgia ranked among the lowest in terms of lacking adequate number of providers, facilities and funding to support the states populations. In many countries around the world, there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, having sinned, displaying immoral behavior, or having a lack of faith. [168], Under the CRPD, persons with disabilities have the right to choose their place of residence and with whom they live. People with real or perceived psychosocial disabilities can be shackled for periods ranging from days and weeks, to months, and even years. Platt also teaches classes in El Salvador to local clinical psychologists and psychology students on single session therapy, a solution-focused behavioral practice that aims to serve marginalized communities that may struggle to access psychological treatment because of isolation and limited resources. We are suffering. 9. Community leaders in the five communities where MSF provides primary healthcare in Soyapango and San Salvador report that since the emergency was declared, more than 50 people have died after showing COVID-19 symptoms or from a lack of treatment for chronic diseases. Many of MSFs ambulance calls in recent months have been related to respiratory diseases. I want to look around outside, go to work, plant rice in the paddy fields. Malaki went from playing football in the Nyarugusu camp in Tanzania to the 2019 Special Olympics World Games in Abu Dhabi, United Arab Emirates. We offer counseling appointments in our center with a psychologist. [35] Office of the United Nations High Commissioner for Human Rights (OHCHR), Mental Health Is a Human Right, May 24, 2018, https://www.ohchr.org/EN/NewsEvents/Pages/MentalHealthIsAhumanright.aspx (accessed September 16, 2020); United for Global Mental Health, The Return of the Individual: Time to Invest in Mental Health, undated, https://gospeakyourmind.org/sites/default/files/2020-09/ROI_FullReport_0.pdf (accessed September 25, 2020). CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. 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,. 1366-1379. In addition, the person with a psychosocial disability and their family can visit the community health center for one-on-one counseling with a doctor or nurse, they can get medication, and they can participate in occupational therapy or other activities. Gaborit stresses that psychologists must assemble professionally and partner with nongovernmental organizations such as IJM, UNICEF and local groups to achieve a greater collective impact. 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. 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. Nevertheless, Mexico needs at least 12,000 psychiatrists. Hum. Some institutions are an extension of the faith healers house or situated at a secluded end of the compound. Keep up with the latest data and most popular content. [38] UN, Policy Brief: COVID-19 and the Need for Action on Mental Health, https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf, p. 6. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. 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. [133] WHO, Building Back Better: Sustainable Mental Health Care after Emergencies, 2013, https://apps.who.int/iris/bitstream/handle/10665/85377/9789241564571_eng.pdf?sequence=1 (accessed August 17, 2020), pp. I was chained, beaten, and given devil incense. 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. [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. 51) at 197, U.N. Doc. In the 2018-2019 academic year, 4,104 people completed behavioral health training programs funded by the HRSA. in Bangladesh.[28]. The Convention on the Rights of the Child states that under the convention, a child means every human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier.[1], Disabled Persons Organizations (DPOs): Organizations in which persons with disabilities constitute the majority of members and the governing body and that work to promote self-representation, participation, equality, and integration of persons with disabilities.[2]. 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. [44] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. The treaty further obligates governments to provide support as may be required to exercise their legal capacity. Feb 28, 2023. 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. Acceptability refers to the need to adhere to ethical standards, including the principle of confidentiality and informed consent. A/61/49 (2006), entered into force May 3, 2008; Optional Protocol to the Convention on the Rights of Persons with Disabilities, adopted December 13, 2006, G.A. For example, Delaware requires 15 more mental health providers to resolve its shortage, whereas Texas needs an additional 638. [50] Human Rights Watch interview with a volunteer in a local organization providing services to people with disabilities, Buea, Cameroon, January 2019 (name and details withheld). A Guatemalan farmer abandons his coffee farm after years of drought destroy his crops. In Yemen, Human Rights Watch documented the case of a woman with a perceived mental health condition who was chained to a door handle so she would not wander outside. While most Americans have heard of telehealth as an option for treating mental health issues, only 7% have reported using it. 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. They have already told him that it is better not to go to get the catheter, that it is better not to go out, that there is no equipment to treat to him. [58] Human Rights Watch, Chained Like Prisoners, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, p. 9. 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. Even people who are released from chains or confined spaces often go back to being shackled as there is little access to support or mental health services, and stigma and bias persists. 49) at 65, UN Doc. In a privately-run social care institution in Russia, staff regularly brought people with psychosocial disabilities to the dining hall chained to each other and forced them to eat in handcuffs. 61/106, Annex I, UN GAOR, 61st Sess., Supp. Inability to afford proper care. [101] 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. 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. Over 400 million people worldwide lack access to essential health services typically delivered through primary healthcare. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. Gangs often threaten teens or adults with rape or murder, forcing entire families to flee their homes (World Report 2019, Human Rights Watch). Explain to me, how is that part of a healing process? For example, ECAP, a Guatemalan organization whose name translates to the Community Studies and Psychosocial Action Team, works primarily with indigenous women and children to seek gender equity and restorative justice for past crimes. She began learning about services provided by the state, including "the list" for HCS services. [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. [80] Human Rights Watch interview with Paul [not his real name], man with a psychosocial disability, Kenya, February 2020 (details withheld). [4] International Disability Alliance, Legal Opinion on Article 12 of CRPD, undated, https://www.internationaldisabilityalliance.org/sites/default/files/documents/legalopinionletterart12final_0.doc (accessed September 14, 2020). CAB/LEG/67/3 rev. [98] Human Rights Watch interview with Aisha [not her real name], family member, Gaza, February 15, 2020. 15; CAT; ACHPR, art.5; ACHR, art. [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. [89] Human Rights Watch teleconference interview with Felipe Orozco, man with a psychosocial disability, August 4, 2020. If the family does not come to pick up the relative or abandons them at the institution, the person can end up spending many years or even the rest of their life shackled in the social care institution or healing center. in Somalia.[134]. An additional 6,398 mental health providers are needed to fill the gaps. In one case, a person died while tied up and locked in one of the bathrooms, which was used as an isolation room. They are abusing our rights over here.[84]. Mental health shortages range in severity across the country. The Social Services Department of The Salvation Army recently (March 1) released a youth survey, and found that more than 70% of the respondents suffered from mental health problems to varying degrees, and 30% of them did not seek external assistance. Institutions: Refers to state-run (unless specified otherwise) psychiatric hospitals, government social care or nongovernmental organization-run residential facilities. [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. [107] When the city of Taizz, Yemen, was attacked in mid-2017, Jalila al-Saleh Ali fled with her two sons, and in her distress left behind her husband with a psychosocial disability in chains. 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. [137] There is no publicly available current data on whether the people released by the 686 initiative remain free or whether they have access to ongoing support in the community. Psychological work in human rights is very important, says Gina Rodriguez, a Honduran masters-level clinical psychologist and human rights activist. 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. So stressful, in fact, that the migration route with all its perils barely registers above the daily pressures children and their families face here.. hospital bed.[60]. [39] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. At the core of this initiative is respect for the rights of people with psychosocial or intellectual disabilities, including the right to live independently in the community.