This report was researched and written by Kriti Sharma, senior researcher in the Disability Rights Division at Human Rights Watch, based on research conducted by more than 15 Human Rights Watch researchers between 2011 and 2020, including Shantha Rau Barriga, director, Disability Rights Division; Emina erimovi, senior researcher in the Disability Rights Division; Laetitia Bader, senior researcher in the Africa Division; Samer Muscati, associate director in the Disability Rights Division; Carlos Ros Espinosa, senior researcher in the Disability Rights Division; Jonathan Pedneault, researcher with the Conflict and Crisis Division; Abier Almasri, research assistant in the Middle East and North Africa Division; and Anietie Ewang, researcher in the Africa Division. Based on research on shackling across 60 countries, Human Rights Watch has found that the key factors to ensuring the success of governmental programs to end shackling include: With the right kind of support, people with mental health conditions can live and thrive in their communities. 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. A/44/49 (1989), entered into force September 2, 1990; United Nations Convention on the Rights of Persons with Disabilities (CRPD), adopted December 13, 2006, G.A. There is a mental health crisis in America. To help retornados transition back into Salvadoran society, he has designed and facilitated workshops to help build peer psychosocial support relationships among those who have been deported. [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. [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. As a result of this initiative, according to the WHO, 1,700 people were freed from chains in Somalia between 2007 and 2010. 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 the worst of cases, depression can lead to suicide - an estimated 63,000 people kill themselves every year in the Americas. 16; ACRWC, art. 1, U.N. Doc. Learn how you can support MSFs lifesaving care with a gift. Although mental health professionals had suspected mistreatment at the facility for years, the cases only came to light once video footage was anonymously leaked. Thus, an A/39/51 (1984), entered into force June 26, 1987; Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Child: The word child, boy, or girl in this report refers to someone under the age of 18. As of 2018, more than two-thirds of all countries did not cover reimbursement for mental health services in national health insurance schemes. [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. [And] increase the response capacity of the emergency transfer services in critical cases. [20] In low-income countries, government mental health spending decreases to less than 1 percent of health budgets with less than US $0.25 spent annually per person on mental health, compared to $80 in high income countries. Even when people seek mental health services, the quality of care in many countries is substandard. One in five, CDC data says, 30% of American adults had symptoms consistent with an anxiety or depression diagnosis, will waive the residency requirements for J-1, how mental health has changed throughout the pandemic, how healthcare jobs have grown over the past two decades, Health Resources and Services Administration. [6] In some countries, these centers are called prayer camps. It was heart-breaking.[51]. (No. 3, entered into force January 3, 1976, art. Trade is an important part of the American economy and a key driver of many industries. Today, Cohen Veterans Network (CVN), a national not-for-profit philanthropic organization, and National Council for Mental Wellbeing, the unifying voice of Americas health care organizations that delivers mental health and addiction treatment and services, issued the inaugural Americas Mental Health 2018, a comprehensive study of access to mental health care, at the 2018 Cohen Veterans Care Summit in Washington D.C. Hum. [24] Human Rights Watch, Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia, March 2016, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, pp. We keep them in their underclothes. [87] Human Rights Watch, Prison is Not For Me: Arbitrary Detention in South Sudan, June 2012, https://www.hrw.org/sites/default/files/reports/southsudan0612ForUpload_1.pdf, pp. It is typically an administrative process and does not contain any provisions for judicial oversight. [16] WHO, Gender and Women's Mental Health, https://www.who.int/mental_health/prevention/genderwomen/en/. Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. 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. Its not how a human being is supposed to be. 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. [7] Christian faith healers typically use prayer, religious counseling, fasting, and spiritual healing as treatment methods. Between 2005 and 2015, China implemented the 686 pilot program to provide basic mental health services on a large scale, which included an initiative to unlock people with psychosocial disabilities shackled in homes. 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. 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. Rts. There are currently no coordinated international or regional efforts to eradicate shackling. The study offers a comprehensive analysis of the state of mental health care in the U.S. Sophia Majlessi The data collected indicates, however, that only about 25 percent of people with psychosocial disabilities surveyed have access to mental health services. People with real or perceived psychosocial disabilities can be shackled for periods ranging from days and weeks, to months, and even years. Im never invited to happy occasions, weddings or birthdays with my family. The lack of constitutional guarantees or specific protection mechanisms for LGBTI people in El Salvador has fostered systematic and institutionalized violence and discrimination against them. [105], Shackling affects a persons mental as well as physical health. In 2010, Indonesias health ministry launched the Indonesia Free from Pasung, a program that aimed to eradicate the practice by 2014. In an effort to make the Northern Triangle safer and more humane for the millions of people who live there, psychologists are providing psychosocial support for trauma survivors, designing and delivering preventive community workshops and studying what drives residents to migrate north. by Eleanor J. Bader May 12, 2021 9:25 AM Expand A couple watches as workers bury the bodies of people who died from COVID-19 in El Salvador. 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. Keep up with the latest data and most popular content. There are only 4,600 psychiatrists, 60% of them are in Mexico City, the state of Mexico, Jalisco, and Nuevo Len. 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. Please open the door. Depression is the most common mental illness in the world. The . For more information on the comprehensive study results and how CVN and National Council are working to address mental wellness and accessibly across the country, please visit www.cohenveteransnetwork.org/AmericasMentalHealth or www.TheNationalCouncil.org. For example, in 2015 chaining was widespread in psychiatric as well as in mental health wards of general hospitals in Somaliland. Its heart-breaking that two of my cousins who have mental health conditions have been locked away together in a room for many years. 108(e); United Nations Educational, Scientific, and Cultural Organization (UNESCO), Universal Declaration on Bioethics and Human Rights, adopted October 2005, SHS/EST/05/CONF.204/3 REV, arts. While the government has taken important steps to end shackling, the practice remains to this day. All of our clients from all of our programs are eligible to make appointments. 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. In Russia, residents with psychosocial disabilities were being chained by their wrists or ankles to beds, radiators, and other objects in the Trubchevsk Psycho-Neurological Institution near Briansk, located southwest of Moscow. CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. In the absence of mental health services, people with psychosocial disabilities can also be arbitrarily detained and chained in drug detention centers or prisons. While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. The chaining of people with mental health conditions needs to stop it needs to stop. [33] The World Bank, Mental Health, https://www.worldbank.org/en/topic/mental-health; WHO, Mental Health, https://www.who.int/news-room/facts-in-pictures/detail/mental-health; WHO, Mental Health in the Workplace, https://www.who.int/mental_health/in_the_workplace/en/. See the Shackling chapter for a more detailed description. 35, Article 9: Liberty and security of person, U.N. Doc. 85. Associations between racism and mental health are stronger than those between racism and general medical health ( 2 ). Not only can it be dangerous to live in the United States as an undocumented person, but leaving behind ones home, family and culture is often very painful.. A/61/49 (2006), entered into force May 3, 2008. 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. According to the latest available global estimates, 792 million people or 10.7 percent of the global population has a mental health condition. This is in part due to a lack of government support and monitoring. ABSTRACT Objective To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. None of my relatives want anything to do with me. Look at the data on educational progress and challenges. [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). Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. Feb 28, 2023. This study confirmed what we hear from our members every day, that individuals and families continue to struggle to find the help they desperately need, said Linda Rosenberg, President and CEO of National Council for Mental Wellbeing. Advancing psychology to benefit society and improve lives, Center for Human Rights and International Justice, How the Climate Crisis Is Driving Central American Migration, Liberation Psychology Intercambio/Exchange, Sepur Zarco: In Pursuit of Truth, Justice and Now Reparations, Healthcare Access and Conditions in Guatemala, Honduras and El Salvador, Children on the Run: Unaccompanied Children Leaving Central America and Mexico and the Need for International Protection, Carrying a Heavy Load: Mayan Womens Understandings of Reparation in the Aftermath of Genocide, Preventing Interpersonal Stressors at Work. Human Rights Watch researchers interviewed more than 350 people with psychosocial disabilities, including those who were shackled at the time of research or had been shackled at least once in their lives, and more than 430 family members, caregivers or staff working in institutions, psychiatrists, psychologists, nurses and other mental health professionals, faith healers, lawyers, government officials, representatives of local nongovernmental organizations (NGOs), including organizations of persons with disabilities, and disability rights advocates. In China, about 100,000 people are shackled or locked in cages in Hebei province alone, near Beijing. 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. 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. Media@TheNationalCouncil.org My aunt has tried her best to support them but she struggles with stigma and the lack of robust mental health services in Oman. Rather, the critical issue is the inhumane treatment of people with psychosocial disabilities forced to stay there. CVN focuses on improving mental health outcomes, with a goal to build a network of outpatient mental health clinics for veterans and their families in high-need communities, in which trained clinicians deliver holistic evidence-based care to treat mental health conditions. [20] WHO, Mental Health, undated, https://www.who.int/gho/mental_health/en/ (accessed June 17, 2020). In Latin America, 5% of the adult population suffers from it, but most neither seek - nor receive - treatment, according to the WHO. 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. The largest occupational group is substance abuse, behavioral disorder, and mental health counselors, which generally require a bachelors degree and had a median annual wage of $47,660 in 2020. A combined federal, state, local view of how funds flow in and out. Evidence is emerging in Indonesia of a serious rise in mental health problems associated with the COVID-19 pandemic, and the crisis has revealed the urgent need for investment in the area, Sudirman Nasir writes. We advocate for policies to ensure equitable access to high-quality services. A human being should be free. It focuses on raising awareness about mental health and pasung, integrating mental health into primary health services, providing mental health medication at the 9,909 community health centers, training health staff to identify and diagnose basic mental health conditions, and creating community mental health teams called Tim Penggerak Kesehatan Jiwa Masyarakat (TPKJM) that act as a coordination mechanism between the department of health and others departments at the provincial and district levels to monitor and facilitate the release of people from pasung. [146] American Convention on Human Rights (ACHR), adopted at the Inter-American Specialized Conference on Human Rights, San Jos, Costa Rica, 22 November 1966. [30] Even when mental health services are free or subsidized, in many countries the distance and transport costs are a significant barrier.[31]. (EIN 23-7092671), 1400 K Street NW, Suite 400 CAB/LEG/67/3 rev. Education is crucial to help people understand more about life in the United States as a migrant, says Maria Elena Humphrey, PhD, former executive secretary for Mexico, Central America and the Caribbean at the Interamerican Society of Psychology. [59] Human Rights Watch interview with a psychiatrist, Nigeria, March 27, 2019 (name and location withheld). Even when mental health services are free or subsidized, the distance and transport costs are a significant barrier. The lack of a community-based mental health system continues to. Immediately end the use of chaining, nonconsensual fasting, and any form of detention. [119] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. [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). Marylin Beckley, a licensed professional counselor and doctoral student in the international psychology program at the Chicago School of Professional Psychology in Washington, D.C., works with IJM in Guatemala, El Salvador and other Latin American countries. [73] In Pakistan, the British Broadcasting Corporation (BBC) reported that in a single Sufi shrine near the city of Burewala in Punjab province hundreds of people with mental health conditions from poor families spent their lives chained to trees. Typically, people in these centers have been placed there by their families or by local police, some forcibly. Finally, we must ensure standards of care are consistent through continued adoption of evidence-based practices. The Maputo Protocol has been ratified by Benin, Burkina Faso, Cte dIvoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Mozambique, Nigeria, Senegal, Sierra Leone, South Africa, Tanzania, Togo, Uganda, and Zimbabwe; African Charter on the Rights and Welfare of the Child (ACRWC), OAU Doc. [69] Helena Selby, Prayer Camps and Mental Illness, The Chronicle, undated, http://ghanaian-chronicle.com/prayer-camps-and-mental-illness/ (accessed March 28, 2012). If we understand the individual reasons that force people to migrate, we may be closer to finding the interventions that are relevant and effective, she says. The HRSA manages the Behavioral Health Workforce Education and Training program, which provides training funding for colleges, universities and training schools preparing people for behavioral health jobs with an emphasis helping people from underrepresented minority or disadvantaged backgrounds. [64] 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); Caged People, The Beijing News, July 11, 2013, http://www.bjnews.com.cn/feature/2013/07/11/272800.html (accessed July 28, 2020); Chinese Healthcare: The Rural Reality, Collective Responsibility, July 23, 2018, https://www.coresponsibility.com/chinese-healthcare-the-rural-reality/ (accessed May 2020); 26-year-old Mentally Disturbed Man in China Locked in Cage by His Parents, Hong Kong Free Press, January 15, 2016, https://www.hongkongfp.com/2016/01/15/26-year-old-mentally-disturbed-man-in-china-locked-in-cage-by-his-parents/ (accessed May 2020); A Mentally Ill Chinese Man Has Been Locked In A Cage By His Family For 11 Years, Business Insider, May 28, 2013, https://www.businessinsider.com/chinese-man-kept-in-cage-for-11-years-2013-5 (accessed July 28, 2020); Chinese Mentally Ill Woman, Chained in Room for Decades by Family, to Get Medical Treatment, South China Morning Post, undated, https://www.scmp.com/news/china/society/article/1815641/chinese-mentally-ill-woman-chained-room-decades-family-get (accessed July 28, 2020). An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31. [147] ICESCR, art. Portland students sat down with U.S. Department of Health and Human Services Secretary Xavier Becerra at Faubion K-8 in Northeast Portland Monday to discuss youth mental health. [31] ngela Carbonell, Jos Javier Navarro Prez, Maria Vicenta Mestre, "Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review," Health and Social Care in the Community vol.28:5, https://doi.org/10.1111/hsc.12968, pp. [48] In March 2019, six people with mental health conditions, including three children, were chained to logs in a Christian faith healing center in Montserrado, Liberia because they were accused of witchcraft. [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. 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.. If a person does manage to get to a health facility, they are often turned away. 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. Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. American Psychological Association. Top photo: A young boy in El Salvador, where children face multiple threats to their safety and well-being including gang violence. If a family fairs poorly on even one indicator, then it is identified as needing assistance. 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. 14: The Right to the Highest Attainable Standard of Health, U.N. Doc. [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. 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). The limited human and material resources available are concentrated in the respective country capital cities. As of 2018, fewer than half of the 139 countries that have mental health policies had aligned them with international human rights conventions. Download (593.4 kB) WHO Team. [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). The rate of mental health workers in low-income countries is fewer than 2 per 100,000 people, compared with over 70 in high-income countries. 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. Table of Contents show. [35] Mental health is not just a human right but a public good that is key to achieving the United Nations Sustainable Development Goals (SDG). 16) at 49, U.N. Doc. In some states, over 80% of the population lives in a mental health professional shortage area. Res. In 2019, this happened to [our teams] 11 times from January to June. In June 2020, President Maada Bio of Sierra Leone inaugurated the renovated and chain-free Sierra Leone Psychiatric Teaching Hospital. In the same report, the special rapporteur stressed that States must protect persons with disabilities against home-based deprivation of liberty, including home confinement, shackling and pasung.[167].

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