Human Rights Watch interviews with Benjamin Ballal, February 15, 2020; Archbishop Danokech, February 18, 2020; and Fiera [not her real name], November 20, 2019. Victor, a patient from Soyapango, told MSF that his grandfather has chronic health problems and has to have his catheter changed every few months. 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. In Tanzania, Malaki, a boy with an intellectual disability was chained to a pole by his family to ensure he remained safe in his home in Nyarugusu refugee camp in Kigoma province in Tanzania in 2017. 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. [6] In some countries, these centers are called prayer camps. [84] Human Rights Watch visit to Adwumu Woho Herbal and Spiritual Centre, Senya Beraku, Ghana, November 6, 2019. The testimonies were collected between August 2018 and September 2020 through in-person and phone interviews. [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. 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. [86] Civil Society Organizations Call for the Draft Law on Public Order to be Immediately Discarded, joint statement, August 13, 2020, https://www.hrw.org/news/2020/08/13/civil-society-organizations-call-draft-law-public-order-be-immediately-discarded. Amid such far-reaching and systemic challenges, many have fought to defend Central Americans right to migrate, but Lykes says its also time to start considering another inalienable rightthe right to remain. [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). Very few governments collect data on this practice at a country-level as it often occurs in remote areas, and families are reluctant to speak about shackled relatives. Many had old and leaking roofing. Bobele, M., & Slive, A.In Hoyt, M.F., & Talmon, M. 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. There is also a large disparity in access to mental health care based on level of income and location. The study offers a comprehensive analysis of the state of mental health care in the U.S. [130] In 2019, the Supreme Court of India directed the government to take immediate action, stating that keeping people with mental health conditions handcuffed or chained is in violation of their human rights.[131] In 2017, Dr. Akwasi Osei, CEO of the Mental Health Authority in Ghana, announced the government would enforce the 2012 Mental Health Act provision that people with psychosocial disabilities shall not be subjected to torture, cruelty, forced labor and any other inhuman treatment, including shackling.[132]. Mental health professionals' skills comprise a potentially robust . [105] 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. Both the governments of Ghana and Kenya have recently launched the QualityRights initiative on a country-wide scale. Malakis story helped shape his community to be more inclusive and accepting. Provide training to broader membership, including at grassroots levels, about the rights of people with psychosocial disabilities. [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. Urge national governments to ban shackling of people with real or perceived mental health conditions and develop adequate, quality, and voluntary community-based support mental health services. 1366-1379. 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. Individuals located in rural areas and of lower-income are less likely to say that mental health services are extremely accessible to them. in Bangladesh.[28]. [80] Human Rights Watch interview with Paul [not his real name], man with a psychosocial disability, Kenya, February 2020 (details withheld). Based on the analysis of third-party data, states are struggling to keep up with demand due to lack of funding and facilities, and, to a lesser extent, providers. [173], According to the UN Committee on Economic, Social and Cultural Rights, the international expert body charged with monitoring compliance with the ICESCR, access to health facilities, goods and services should be non-discriminatory, especially for the most vulnerable or marginalized sections of the population, including individuals with disabilities. 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. In Guatemala, we tend to be reactive, she says. [44] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. [23] Consequently, instead of walking a short distance to a primary health center, families may have to give up a days work to travel to reach a psychiatric hospital. 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. 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. And women and girls are not supported to manage their menstrual hygiene, for example through the provision of sanitary pads. Rural Mental Health Overview - Rural Health Information Hub In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. Often an extension of the faith healers house or situated within the compound of a church, temple, shrine, mosque, or religious school, these sometimes rudimentary centers primarily cater to individuals with alleged spiritual problems such as bewitchment or possession by the devil or jinn (evil spirits); lack of faith; perceived or real mental health conditions; drug use or deviant behavior, including skipping school, smoking tobacco or marijuana, being greedy, or stealing. Two months ago, social protection officials tried to discharge me from the hospital and send me to my sisters house, but she refused. In Nigeria, Human Rights Watch visited 28 state-run and private facilities between 2018 and 2019, across which a few hundred people were arbitrarily detained, and where people were regularly chained or shackled. ), Capturing the Moment: Single Session Therapy and Walk-In Services, Crown House, 2014. 66. 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. No mother on earth wants to chain her son.[57], Human Rights Watch has also found evidence of shackling or chaining in psychiatric hospitals in some countries. 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. Help us! Mental health"Total Student Guidance Service" that cannot accommodate Despite being commonly 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. 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]. [68] Daniel Arias et al., Prayer Camps and Biomedical Care in Ghana: Is Collaboration in Mental Health Care Possible? PLoS ONE 11(9), September 12, 2016, doi:10.1371/journal. Advocate for the integration of people with psychosocial disabilities in the community. Top photo: A young boy in El Salvador, where children face multiple threats to their safety and well-being including gang violence. There are currently no coordinated international or regional efforts to eradicate shackling. In the absence of mental health services, people with psychosocial disabilities can also be arbitrarily detained and chained in drug detention centers or prisons. [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. [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). While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. 56). Yet, mental health draws only limited government attention. For example, Ghana has several hundred prayer camps, but precise numbers are difficult to come by since they are not state-regulated. MSF has launched health initiatives in San Salvador and Soyapango, focusing on socially vulnerable people whose access to health services has been affected by insecurity. The ambulance system and hospitals are operating . [115] Human Rights Watch interview with Benjamin Ballal, survivor of shackling and secretary general for cultivation at Cultivation for Users Hope, Nairobi, February 15, 2020. During house visits, the community health worker collects data, educates the family about mental health, provides counseling, and helps them get a national health insurance card for free or subsidized health services. A Salvadoran teen and his family flee a death sentence from a local gang. [65] Viola Zhou, Mentally ill Chinese Girl, 8, Roped to Tree Outside by Grandparents for Nearly Six Years, South China Morning Post, September 21, 2016, https://www.scmp.com/news/china/society/article/2021288/mentally-ill-chinese-girl-8-roped-tree-outside-grandparents (accessed July 28, 2020). I hate the shackles. Over one-third of Americans live in areas lacking mental health 58. 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. [174], The committee further stated that it is the governments responsibility to ensure that health services are available, accessible, acceptable, and of good quality. Res. In prayer camps in Ghana, administrators and pastors told Human Rights Watch that fasting was a key component of curing a psychosocial disability. Mental health literacy and stigma among Salvadorian youth: anxiety Not just for the migrants leaving, but for those who are staying, those who are coming back and those who are caught between two cultures.. 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. Addressing the escalating psychiatrist shortage | AAMC [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). Institutions: Refers to state-run (unless specified otherwise) psychiatric hospitals, government social care or nongovernmental organization-run residential facilities. Many are held in overcrowded, filthy rooms, sheds, cages, or animal shelters and are forced to eat, sleep, urinate, and defecate in the same tiny area. Look at the data on educational progress and challenges. In Morocco, the government released over 700 people chained in one shrine alone, about 50 kilometers from Marrakesh in the countrys southwest. The Cohen Veterans Network (CVN) is a 501(c)(3) national not-for-profit philanthropic organization for post-9/11 veterans and their families. This report includes research and testimonies collected by 16 Human Rights Watch researchers in their own countries. [16] According to WHO, given the high incidence of sexual violence they suffer, women are also disproportionately affected by Post-Traumatic Stress Disorder (PTSD). [176] The right to be free from non-consensual medical treatment and experimentation is guaranteed under the ICESCR. 64. 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. 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. QualityRights also focuses on empowering advocates and self-advocates to influence policy-making and push for national legal reforms to meet the standard set by the CRPD. There is no space.[96] To walk in, one had to physically tiptoe over hands and feet. We keep them in their underclothes. Comprehensively investigate state and private institutions in which people with mental health conditions live, with the goal of stopping chaining and ending other abuses. While the expectation was that families would regularly bring food for relatives, this rarely happened. Share this via LinkedIn Moreover, it also appears that the availability of programs and services may be associated with higher reporting rates (Filmer, 2008). Making an economic argument for investment in global mental health: The Although it is noteworthy that some governments have put in place measures to tackle the practice of shackling, their laws and policies are not always effectively implemented, and on-the-ground monitoring remains weak overall. Travel restrictions have since been lifted but outpatient consultations at hospitals and health units remain suspended. 2(1); CEDAW, art. Areas are designated as having a shortage if they meet certain criteria: the ratio of mental health providers (e.g., psychiatrists, clinical social workers, therapists, etc. In one exercise, facilitators ask children to predict travel time to the United States (most underestimate the length of the journey), then use an enlarged map to measure distances and show that the route is thousands of miles long and can take months. [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. In Mexico, for example, Disability Rights International documented children with psychosocial disabilities in cages or tied down with bandages. [30] Even when mental health services are free or subsidized, in many countries the distance and transport costs are a significant barrier.[31]. While much attention is focused on the humanitarian crises at the U.S. border, researchers, clinicians and activists are also working to address problems at their source in Guatemala, Honduras and El Salvador. Veterans who are experiencing homelessness or at risk of homelessnessand their family members, friends and supporterscan call 1-877-4AID VET ( 877-424-3838) or chat online with the National Call Center for Homeless Veterans, where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week. [58] Human Rights Watch, Chained Like Prisoners, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, p. 9.