In Nigeria, boys as young as 10 were chained together in rooms with adult men, leaving them at risk of abuse. 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. In Mexico, for example, children with psychosocial disabilities in one institution were fully wrapped in bandages, duct tape or clothing, like mummies. Texas, Wisconsin and Georgia ranked among the lowest in terms of lacking adequate number of providers, facilities and funding to support the states populations. [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. Federal tax ID#: 13-3433452, Mdecins Sans Frontires 2022 [19], Governments have long neglected to invest in mental health services. [42] Families can find it challenging to take relatives with psychosocial disabilities out for events or social occasions due to societal stigma and fear the person might say or do something to cause embarrassment. [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. [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). [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. Two months ago, social protection officials tried to discharge me from the hospital and send me to my sisters house, but she refused. 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 lack of good-quality epidemiologic data by department, which resulted in the authors' reliance on . My aunt has tried her best to support them but she struggles with stigma and the lack of robust mental health services in Oman. It was heart-breaking.[51]. Carlos, a man with a psychosocial disability who has been chained and treated against his will in faith healing institutions in Mozambique, told Human Rights Watch: In healing centers, individuals with psychosocial disabilities are forced to partake in all sorts of rituals, including taking baths with special water or chicken blood, and undergo therapeutic massages as part of their treatment. (No. Look at the data on educational progress and challenges. 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. We keep them in their underclothes. 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. eCollection 2018. Both the governments of Ghana and Kenya have recently launched the QualityRights initiative on a country-wide scale. CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. Hum. 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. Institutions: Refers to state-run (unless specified otherwise) psychiatric hospitals, government social care or nongovernmental organization-run residential facilities. 49) at 167, U.N. Doc. Its heart-breaking that two of my cousins who have mental health conditions have been locked away together in a room for many years. 16-18. [48] Karolina Kozik and Jean-Sbastien Spulchre, Disability Rights Bill Offers Hope in Congo, commentary, Human Rights Watch Dispatch, March 11, 2020, https://www.hrw.org/news/2020/03/11/disability-rights-bill-offers-hope-congo; Sophie Morgan, The country where disabled people are beaten and chained, BBC News Online, July 28, 2015, https://www.bbc.com/news/blogs-ouch-33523742 (accessed September 21, 2020); Shantha Rau Barriga (Human Rights Watch), Torture Comes in Many Forms, commentary,The Huffington Post, June 29, 2015, https://www.huffpost.com/entry/torture-comes-in-many-for_b_7691390?guccounter=1 (accessed September 16, 2020). Mental Wellbeing, www.cohenveteransnetwork.org/AmericasMentalHealth, More than 4 in 10 U.S. (Clockwise from top left): 2014 Fadel Senna/AFP via Getty Images; 2011 Andrea Star Reese; 2011 Andrea Star Reese; 2019 Andrea Star Reese; 2018 Andrea Star Reese; 2019 Robin Hammond/Human Rights Watch; 2019 Andrea Star Reese; 2018 HRW. The World Health Organization's new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention . doi: 10.26633/RPSP.2018.172. 66. Their analysis of data from the National Hospital Ambulatory Medical Care Survey (2005-2015) showed that rates of prolonged LOS increased from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS. E/C 12/2000/4, 2000, https://undocs.org/E/C.12/2000/4 (accessed September 23, 2020), paras. 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. [106] Human Rights Watch, Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. [95] Staff members hesitated to let Human Rights Watch enter the room asking: How will you enter? In Nigeria, Human Rights Watch visited 28 facilities in 8 states and the Federal Capital Territory between 2018 and 2019, across which a few hundred people were arbitrarily detained, and where people were regularly chained or shackled. [62], Human Rights Watch has found evidence of shackling across60 countries across Asia, Africa, Europe, the Middle East, and the Americas. 8. [14] Yet, psychosocial disabilities draw only limited government attention. Adults Who Needed Substance Use and Mental Health Care Did Not Get Treatment, National Council will Honor Five Distinguished Recipients with Awards of Excellence During NatCon22, Statement from National Council for Mental Wellbeing President and CEO Chuck Ingoglia on the Senate Finance Committees Hearing on February 8. International human rights law guarantees to persons with disabilities the right to liberty on an equal basis with others. Physicians thought Bill Mitchell had dementia and could be a danger to himself or others, according to medical records. 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. [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. A doctor working at a psychiatric hospital in southern Nigeria said: We have to use chains in some cases.[59] In eastern Indonesia, Human Rights Watch witnessed a woman being tied around the waist with a twisted cloth and restrained to her 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. The governments target was to ensure full coverage of over 65 million households in Indonesia through all 9,909 community health centers by the end of 2019. [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. If you get exhausted due to a lot of work, and so dont want to work anymore, you get caned.[124] In Nigeria, people in Islamic rehabilitation centers told Human Rights Watch that staff whipped them. We also work with a local women's crisis center to provide additional resources to our female clients. According to WHO, over 10 million children under the age of five who. [43] Human Rights Watch, Like A Death Sentence, https://www.hrw.org/sites/default/files/reports/ghana1012webwcover.pdf; Treated Worse Than Animals, https://www.hrw.org/sites/default/files/report_pdf/india1214.pdf; Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia, March 2016, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf. Res. 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. The Black community, in particular, is affected by mental health, often due to: Lack of health insurance. Malakis story helped shape his community to be more inclusive and accepting. Mental health shortages range in severity across the country. 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. A combined federal, state, local view of how funds flow in and out. 2 (2); ICCPR, art. [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. And we promote greater understanding of mental wellbeing as a core component of comprehensive health and health care. Media@TheNationalCouncil.org 39/46, annex, 39 U.N. GAOR Supp. Families who struggle to cope with the demands of caring for a relative with a psychosocial disability may feel they have no choice but to shackle them. Malaki went from playing football in the Nyarugusu camp in Tanzania to the 2019 Special Olympics World Games in Abu Dhabi, United Arab Emirates. [49] Human Rights Watch interview with Benjamin Ballal, survivor of shackling and secretary general for cultivation at Cultivation for Users Hope, Nairobi, February 15, 2020. While the government has taken important steps to end shackling, the practice remains to this day. This is critical to help attract new providers into the field and more must be done to train and retain providers to help ensure people can get help when they need it. Wyoming and Utah have the largest proportion of population living in mental health shortage areas, at 96.4% and 83.3%, respectively. [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. COVID-19 presents a serious threat to both physical and mental health, but policymakers in Indonesia have so far mostly . [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). 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. Shackling is common not just in homes but also in state-run or private institutions, including faith healing centers. Federal tax ID#: 13-3433452. [7] Christian faith healers typically use prayer, religious counseling, fasting, and spiritual healing as treatment methods. 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. Child: The word child, boy, or girl in this report refers to someone under the age of 18. [33] The WHO has found that spending $1 on mental health services can yield a return of $4 in the form of improved productivity and health. 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. Shackling is practiced across socio-economic classes. Mental Health and Substance Use. [4], Psychosocial disability: The preferred term to describe people with mental health conditions such as depression, bipolar, schizophrenia, and catatonia. Acceptability refers to the need to adhere to ethical standards, including the principle of confidentiality and informed consent. [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. I am not free to walk about. ), Capturing the Moment: Single Session Therapy and Walk-In Services, Crown House, 2014. [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. In some states, over 80% of the population lives in a mental health professional shortage area. [160] In the 2020 report on psychological torture, the UN special rapporteur also notes that practices like the spiritual healing of mental illnesses. 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 While the expectation was that families would regularly bring food for relatives, this rarely happened. Shackling is typically practiced by families, faith healers, or staff in institutions who believe that the person with the psychosocial disability is possessed or are worried that they may run away or might hurt themselves or others. The cost of mental health. [86] Article 25, among other problematic provisions, states that a caregiver or a guardian of a person with a mental disorder shall not allow that person to walk freely in public places. In a country where people with psychosocial disabilities are stigmatized and subjected to abuse, such broad discretion given to authorities to restrict the freedoms of movement and liberties of a person with mental health conditions will facilitate further abuse and entrenchment of the problem. 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. A/810 at 71 (1948), art. Once survivors attain a significant level of recovery from their initial trauma, measured using a tool IJM developed called the Assessment of Survivor Outcomes, Beckley guides some of them into leadership roles in the international global survivor network to share their experiences and advocate for other survivors. 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. This inhumane practicecalled shacklingexists due to inadequate support and mental health services as well as widespread beliefs that stigmatize people with psychosocial disabilities. My family believed her mental health condition would stigmatize the whole family. 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, People with Mental Health Conditions Living in Chains, https://www.hrw.org/report/2020/06/04/better-make-yourself-invisible/family-violence-against-people-disabilities-mexico, https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused, https://www.hrw.org/sites/default/files/report_pdf/kazakhstan0319_web3.pdf, https://www.hrw.org/sites/default/files/report_pdf/iran0618_web_1.pdf, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, https://www.hrw.org/sites/default/files/report_pdf/india1214.pdf, https://www.globaltimes.cn/content/928917.shtml, http://www.bjnews.com.cn/feature/2013/07/11/272800.html, https://www.scmp.com/news/china/society/article/2021288/mentally-ill-chinese-girl-8-roped-tree-outside-grandparents, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana, https://www.pih.org/article/celebrating-new-possibilities-sierra-leones-only-psychiatric-hospital, https://undocs.org/en/A/HRC/31/57/Add.2,para. The majority (64%) of Americans who have sought treatment believe the U.S. government needs to do more to improve mental health services. [41] Human Rights Watch, Better to Make Yourself Invisible: Family Violence against People with Disabilities in Mexico, June 2020, https://www.hrw.org/report/2020/06/04/better-make-yourself-invisible/family-violence-against-people-disabilities-mexico; 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; "Cameroon: People With Disabilities Caught in Crisis," Human Rights Watch news release, August 2019, https://www.hrw.org/news/2019/08/05/cameroon-people-disabilities-caught-crisis; Human Rights Watch, On the Margins: Education for Children with Disabilities in Kazakhstan, March 2019, https://www.hrw.org/sites/default/files/report_pdf/kazakhstan0319_web3.pdf, pp. Many had old and leaking roofing. 6 and 9; UN Committee on Economic, Social and Cultural Rights, General Comment 14, The right to the highest attainable standard of health (Twenty-second session, 2000), U.N. Doc. I was chained, beaten, and given devil incense. The programs home visits are critically important because they eliminate the need for family members to take time off from work and spend money to travel to health centers. Access to mental health care in El Salvador: a case study of progress toward decentralization Rev Panam Salud Publica. Tony Evers declared this as the "year of mental health" in his budget address last month, one psychotherapist says the budget leaves an important component - mental health An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31. Thus, an 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. [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. 58-60; Once You Enter, You Never Leave: Deinstitutionalization of Persons with Intellectual or Mental Disabilities in Croatia, September 2010, https://www.hrw.org/report/2010/09/23/once-you-enter-you-never-leave/deinstitutionalization-persons-intellectual-or. 49) at 65, UN Doc. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. [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. Turkey-Syria earthquakes: MSF teams in Syria are caring for the injured. [136] The program demonstrated that accessible community-based mental health services were key to ensuring people remained free from chains and proved to be an example of how non-healthcare workers could be mobilized to deliver services in rural and low-resource settings. This report includes research and testimonies collected by 16 Human Rights Watch researchers in their own countries. Psychological work in human rights is very important, says Gina Rodriguez, a Honduran masters-level clinical psychologist and human rights activist. 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. Through the survey, the following groups were identified: veterans, active duty military and those with a secondary relationship with a veteran as well as those who have sought mental health treatment (Mental Health Treatment Seekers). 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. We offer counseling appointments in our center with a psychologist. Therefore, people first consult faith or traditional healers and often only seek medical advice as a last resort. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. E/C.12/2000/4 (2000), para. [122] However, Human Rights Watch research found that people with psychosocial disabilities were forcibly treated, even in non-life threatening situations. [144] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. 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. [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. El Salvador is a republic with three branches of government: the Executive, the Legislature, and the Judiciary. [114] Human Rights Watch interview with Fiera [not her real name], Maputo, Mozambique, November 20, 2019.

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