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[11] Estimates that include people with conditions related to substance could be as high as 970 million or 13 percent of the global population. 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. From 2007 to 2019, El Salvador experienced some economic progress, with its poverty rate dropping from 39% to 22.3%. [83] Mohamed Rushdie, Torture, Rape and Death Are Crimes That Pursue 8 Million Psychiatric Patients in Egypt, January 29, 2018, https://www.tahrirnews.com/Story/866399/%D8%A7%D9%84%D8%AA%D8%B9%D8%B0%D9%8A%D8%A8-%D9%88%D8%A7%D9%84%D8%A7%D8%BA%D8%AA%D8%B5%D8%A7%D8%A8-%D9%88%D8%A7%D9%84%D9%85%D9%88%D8%AA-%D8%AC%D8%B1%D8%A7%D8%A6%D9%85-%D8%AA%D9%84%D8%A7%D8%AD%D9%82-8-%D9%85%D9%84%D8%A7%D9%8A%D9%8A%D9%86-%D9%85%D8%B1%D9%8A%D8%B6-%D9%86%D9%81%D8%B3%D9%8A-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1/%D8%AC%D8%B1%D9%8A%D9%85%D8%A9 (accessed August 3, 2020). Depression is the most common mental illness in the world. Human Rights Watch calls on the international community and national governments to ban shackling, adopt measures to reduce stigma against people with psychosocial disabilities, and develop adequate, voluntary, and community-based mental health services. [121] UN General Assembly, Report of the Special Rapporteur on violence against women, its causes and consequences, Rashida Manjoo, Advancement of women, A/67/227, August 3, 2012, http://www.ohchr.org/Documents/Issues/Women/A.67.227.pdf (accessed December 10, 2013), pp. [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. Conduct public information campaigns to raise awareness about mental health conditions and the rights of people with disabilities, especially among alternative mental health service providers and the broader community, in partnership with people with lived experiences of mental health conditions, faith leaders, and media. CBP data echo the demographic shiftthe majority of migrants detained at the border are now families or unaccompanied children rather than adult men (Recent Migration to the United States From Central America: Frequently Asked Questions, Congressional Research Service, 2019). 3, entered into force January 3, 1976; Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted December 18, 1979, G.A. Amina, who had a breakdown after her mother died and was taken to various Islamic healers, said she was tied with ropes, beaten, and spat on in one rehabilitation center in Kaduna, and then molested by a traditional healer in Abuja who came to her home: He told me to undress, that it is the part of the healing process, and then he started touching my body, Amina said. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. [36] Achieving good health and well-being is one of the SDGs that enables men, women, and children to go to school, work, and participate in their communities. 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. 49) at 65, UN Doc. In the eastern metropolitan area of San Salvador, an increasing number of people are dying at home. 50, 56-57; Amnesty International, Our Hearts Have Gone Dark The Mental Health Impact of South Sudans Conflict, July 2016, https://www.amnesty.org/download/Documents/AFR6532032016ENGLISH.PDF (accessed September 22, 2020), pp. Many spiritual healing centers that Human Rights Watch visited were located in open fields or forests; some operated out of structures that were half-built and offered only a rooftop for shelter. [131] Amit Anand Choudhary, Chaining Mentally Ill Patients Is Atrocious and Against Human Dignity: Supreme Court, Times of India, January 3, 2019, https://timesofindia.indiatimes.com/india/chaining-mentally-ill-patients-is-atrocious-and-against-human-dignity-sc/articleshow/67368856.cms (accessed August 16, 2020). [6] In Somaliland, these centers are often referred to as Cilaaj from the Arabic word for healing. However, legal capacity is a universal attribute inherent in all persons by virtue of their humanity and people can therefore not be stripped of it. [79], Shackling is a disability-specific form of deprivation of liberty that occurs around the world, regardless of the economic situation of the country or its legal tradition.[81]. Its a crucial part of larger efforts to strengthen our social fabric and to repair the damage caused by sociopolitical violence.. 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. 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 . Bilingual patients are evaluated differently when evaluated in English versus Spanish, and Latinx/Hispanic people are more frequently undertreated than whites. [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. The stigma attached to psychosocial disabilities extends to the mental health profession, which often discourages doctors from specializing in psychiatry and causes many general physicians and other health care workers to resist mental health training. Spending on mental health treatment and services reached $225 billion in 2019, according to an Open . For example, Delaware requires 15 more mental health providers to resolve its shortage, whereas Texas needs an additional 638. [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. [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). Over 400 million people worldwide lack access to essential health services typically delivered through primary healthcare. Even in Guatemala, which has about 7,700 mental health professionals and 16 million people, rural areas are vastly underserved (Healthcare Access and Conditions in Guatemala, Honduras and El Salvador, Centers for Disease Control and Prevention, 2017). In El Salvador, learning disabilities and speech and language disorders are not considered disabilities for purposes of statistical reporting at the national level (MINED, 2015). 14: The Right to the Highest Attainable Standard of Health, U.N. Doc. [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. Ensure coordination between mental health professionals and staff at prayer camps to offer mental health services based on free and informed consent. An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31. (No. Human Rights Watch also consulted international disability expertsat different stages of the research and writing and reviewed relevant domestic and international media reports, official government documents and reports by government-run mental health facilities or institutions, United Nations documents, World Health Organization publications, NGO reports, and academic articles. Human Rights Watch research found that in institutions and healing centers visited, people with psychosocial disabilities often live in severely overcrowded and unhygienic conditions. Limited options and long waits are the norm, but there are some bright spots, with 76% of Americans now seeing mental health as important as physical health. 12 and 18. In the case of private institutions and healing centers, the management may have an incentive to detain people as they are paid by the family. 202-621-1631. [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. Findings of these visits, redacted to protect privacy rights, should be publicly reported. We worked closely with partner organizations to visit private homes and institutions in Afghanistan, Burkina Faso, Cambodia, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, Russia, the self-declared independent state of Somaliland, South Sudan, and Yemen. Mental Health Disparities in the United States 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). Guest Opinion: Teenage mental health crisis: The kids are not OK [51] Human Rights Watch interview with Ying (not her real name), November 2019 (location and details withheld). In June 2020, President Maada Bio of Sierra Leone inaugurated the renovated and chain-free Sierra Leone Psychiatric Teaching Hospital. 2 (2); ICCPR, art. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system. We advocate for policies to ensure equitable access to high-quality services. [88] Human Rights Watch, Prison is Not For Me, https://www.hrw.org/report/2012/06/21/prison-not-me/arbitrary-detention-south-sudan, pp. Nearly 1 in 5 Americans has some type of mental health condition. Provide adequate food, shelter, and health services to people with psychosocial disabilities. 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. Mental health professionals' skills comprise a potentially robust . "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. 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,. When it comes to seeking mental health care, the Latinx community has always struggled with stigmaboth in and outside of the United States. [94] Human Rights Watch interview with Mudinat Genrola, woman with a psychosocial disability, Ibadan, September 9, 2019. [107] Amnesty International, Excluded: Living with Disabilities in Yemens Armed Conflict, December 3, 2019, https://www.amnesty.org/download/Documents/MDE3113832019ENGLISH.PDF (accessed August 3, 2020), p.17. 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. People with real or perceived psychosocial disabilities can be shackled for periods ranging from days and weeks, to months, and even years. Mauricio Gaborit, PhD, a social psychologist who studies the migration of children and adolescents at Universidad Centroamericana Jos Simen Caas in El Salvador, has documented increasing rates of migration among adolescent girls and children under age 12. All of our clients from all of our programs are eligible to make appointments. https://www.hrw.org/sites/default/files/reports/zambia0714_ForUpload_1.pdf, p.16; A. Allen,andE.Green,Discrimination and Stigmatization of People with Epilepsy in Zambia: The Need for Integration of Social, Healthcare, and Policy Reform,, African [Banjul] Charter on Human and Peoples Rights (ACHPR), adopted June 27, 1981, OAU Doc. In China, about 100,000 people are shackled or locked in cages in Hebei province alone, near Beijing. ), the poverty rate, the proportion of the area that is either young or elderly, the prevalence of alcohol and substance abuse, and travel time to a facility. in Somalia.[134]. People are shackled in locations that are out of sight and out of the way for families: in backyards, outhouses, sheds, or animal shelters. Table of Contents show. Throughout this program, increasing equity of access to health services, improving the quality of these services and strengthening the monitoring and oversight capacity of the Ministry of Health have been top priorities. | Technical document. In one case, a man with a psychosocial disability spent 37 years chained in a dark, sweltering cave in the mountains in Wadi Al-Sabab, Saudi Arabia. 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). She began learning about services provided by the state, including "the list" for HCS services. In Mexico, for example, children with psychosocial disabilities in one institution were fully wrapped in bandages, duct tape or clothing, like mummies. [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. Shackling in the community is a form of home or community-based deprivation of liberty in which the person is entirely in the familys power with no possibility of challenging the detention. 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. In some instances, people are provided with a small bucket in which to urinate and defecate, but these are only emptied once a day leaving a putrid smell in the room for most of the day. Specifically, younger Americans need more information on how and where to access care. 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. Human Rights Watch found evidence of shackling across 60 countries across Asia, Africa, Europe, the Middle East, and the Americas. 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. Psychotherapy Center of Waunakee: Evers' budget fails to fund student MSF is also hearing worrying reports about the situation in some communities in San Salvador and Soyapango. Mental Health Services | Mission To El Salvador [68] In the Greater Accra Region, there are an estimated 70 prayer camps. 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. For example, in Bali, Indonesia, a mother from a wealthy family said: We are from a high caste and when my son gets lost and wanders on the streets without proper clothing, without showering, its a cause for shame. [5] World Network of Users and Survivors of Psychiatry, Implementation Manual for the United Nations Convention on the Rights of Persons with Disabilities, February 2008, http://www.wnusp.rafus.dk/documents/WNUSP_CRPD_Manual.doc (accessed December 20, 2015), p. 9. Mental health"Total Student Guidance Service" that cannot accommodate 85. Ensure that people who have been released from state and private institutions have access to psychosocial support and social services. 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. [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). 31, no. [6] In some countries, these centers are called prayer camps. Support national governments in reducing stigma and discrimination against people with psychosocial disabilities. Mental healthcare in the Philippines faces continued challenges including underinvestment, lack of mental health professionals and underdeveloped community mental health services. The WHOs QualityRights initiative, introduced in 31 countries around the world, is a groundbreaking effort to improve access to quality mental health and social services for people with disabilities and seeks to transform health systems and services towards a person-centered and human rights-based approach, in line with the UN Convention on the Rights of Persons with Disabilities (CRPD).[142]. The limited human and material resources available are concentrated in the respective country capital cities. James Ross, legal and policy director, provided legal review; and Babatunde Olugboji, deputy program director, provided programmatic review. A custom index was developed, ranking each state according to its mental health service access. CRPD/C/GC/1 (2014), http://daccess-ods.un.org/access.nsf/Get?Open&DS=CRPD/C/GC/1&Lang=E, para. [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. El Salvador is divided politically into 14 departments and 262 municipalities, COVID-19 and mental health in Indonesia - Policy Forum Share this via Twitter In many countries there is very limited, if any, government oversight of these institutions. 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. In its 2018 Concluding Observations the Human Rights Committee noted El Salvador's lack of legislation in this aspect. Track how COVID-19 is spreading in the US, plus key indicators for pandemic recovery. According to the latest available global estimates, 792 million people or 10.7 percent of the global population has a mental health condition. [155] UNHRC, Follow up report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment on his follow-up visit to the Republic of Ghana, Session 31, A/HRC/31/57/Add.2, February 25, 2015, https://undocs.org/en/A/HRC/31/57/Add.2,para. 95(d). In many healing centers, in countries such as Nigeria and Indonesia, men, women, and children were chained next to each other, leaving them no option to escape if they encountered abuse from staff or other chained individuals. Hispanic/Latinx | NAMI: National Alliance on Mental Illness 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]. Mental health, recession, campus violence top students' concerns Most importantly, Human Rights Watch thanks all those who shared their experiences, all of whom spoke with courage and dignity about their personal histories and concerns. [80] Human Rights Watch interview with Paul [not his real name], man with a psychosocial disability, Kenya, February 2020 (details withheld). 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). One mother in Bali, Indonesia shared why she chained her son with a mental health condition for over 10 years: Due to prevalent stigma and inadequate support services, families often struggle to cope with the demands of caring for a relative with a psychosocial disability and feel they have no choice but to shackle them. [113] Human Rights Watch visits to Yaysan Galuh Rehabilitation Center, Yayasan Bina Lestari, Samyul Institution, 2016-2018. [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). [58] Human Rights Watch, Chained Like Prisoners, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, p. 9. 72. [105], Shackling affects a persons mental as well as physical health. Celina de Sola, Glasswing's co-founder, says people in these places, where violence is endemic, urgently need help. 49) at 65, UN Doc. When the fighting happened, we left him next to the house tied up. [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. [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). [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. And women and girls are not supported to manage their menstrual hygiene, for example through the provision of sanitary pads. See also, Beijing Declaration and Platform for Action, Fourth World Conference on Women, September 15, 1995, A/CONF.177/20 (1995), art. [78] Human Rights Watch interview with a lawyer, Nuevo Len DIF, Monterrey, Mexico, April 11, 2019. eCollection 2018. El Salvador's public healthcare system is considered poor. [69] Helena Selby, Prayer Camps and Mental Illness, The Chronicle, undated, http://ghanaian-chronicle.com/prayer-camps-and-mental-illness/ (accessed March 28, 2012). Mental Illnesses are Common, but Care is Lacking | Health Care Policy Access to mental health care in El Salvador: a case study of - PubMed Worryingly, community leaders are reporting deaths in their communities, some of them related to the suspension of primary health care.. In some instances, people or their families had fashioned bamboo beds and grass-thatched shelters under a tree to get protection from the sun, but many slept on cold, hard concrete floors with no mattress or bedding. [170] UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pras, A/HRC/35/21, March 28, 2017, https://undocs.org/A/HRC/35/21 (accessed September 17, 2020), para. Kessler says that mental disorders are treated as acute, episodic ailments instead of chronic illnesses. In 15-minute interviews conducted while the Salvadoran immigration authorities processed migrants who had been deported from the United States for reentry into El Salvador, Gaborit and his colleagues assessed children and teens for depression, anxiety and somatization. But Garca Rivera says that in light of the crisis in Central America, psychologists must do more than conduct research, provide clinical services and design community interventions. 16) at 49, U.N. Doc. In addition to research conducted by Human Rights Watch researchers, pro-bono desk research was conducted by students at the International Human Rights Program at the University of Toronto Faculty of Law and at the Rotman School of Management at the University of Toronto, Canada, as well as by lawyers at Borden Ladner Gervais LLP, Canada, and OMelveny & Myers LLP in the United States. Res. Raising awareness on mental health and specifically combating negative stereotypes and beliefs that a mental health condition is the result of being possessed by spirits; A coordinated and inter-ministerial approach that includes the ministries of justice, health, social affairs, housing, education, and employment; Independent and regular monitoring to ensure the ban on shackling is implemented; A targeted program that not only releases people from shackling but also regularly follows up to ensure that once released, people do not go back to being shackled; Access to affordable and quality community-based support and mental health services that help prevent shackling and support someone who is freed from chains in reintegrating the community. 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. support services. 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. 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.