[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). Shackling is common not just in homes but also in state-run or private institutions, including faith healing centers. 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. 61/106, Annex II, UN GAOR, 61st Sess., Supp. 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. [37] Despite this, less than 1 percent of international development assistance for health is allocated toward mental health.[38]. Keep up with the latest data and most popular content. The organization provided psychosocial support to survivors during the Sepur Zarco trial, which resulted in the first conviction for sexual slavery during an armed conflict by a national court (Sepur Zarco: In Pursuit of Truth, Justice and Now Reparations, UN Women, 2017). But the work situation is so dire that its almost impossible to make a decent living, she says, because of low pay and limited work opportunities. 46) at 193, U.N. Doc. [14] Yet, psychosocial disabilities draw only limited government attention. [70] Nigeria: People With Mental Health Conditions Chained, Abused, Human Rights Watch news release, November 11, 2019, https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused. For example, in 2015 chaining was widespread in psychiatric as well as in mental health wards of general hospitals in Somaliland. Lack of engagement with work. Lack of education in the community about mental health. 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. 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. Preventing institutionalization should be an important part of this plan. L Guan et al., Unlocking Patients with Mental Disorders Who Were in Restraints at Home: A National Follow-Up Study of Chinas New Public Mental Health Initiatives, PLOS ONE 10(4) (2015), https://doi.org/10.1371/journal.pone.0121425 (accessed September 22, 2020). [28] WHO, Mental Health ATLAS 2017 Member State Profile: Kenya, 2018, https://www.who.int/mental_health/evidence/atlas/profiles-2017/KEN.pdf?ua=1 (accessed June 22, 2020); Mohan Isaac et al., Postgraduate training in psychiatry in Asia, Current Opinion in Psychiatry, vol. The impoverished often live in overcrowded areas. 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. Pennsylvania, New York and Minnesota ranked among the top. A/61/49 (2006), entered into force May 3, 2008. [105], Shackling affects a persons mental as well as physical health. [74] In Togo, prophets can lock up and chain up to 150 people in a single prayer camp. Platt also teaches classes in El Salvador to local clinical psychologists and psychology students on single session therapy, a solution-focused behavioral practice that aims to serve marginalized communities that may struggle to access psychological treatment because of isolation and limited resources. 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. [52] This, in part, contributes to the acute shortage of mental health professionals. People with real or perceived psychosocial disabilities can be shackled for days and weeks, to months, and even years. 501(c)(3) nonprofit association [55] Shackling is also used in church-affiliated prayer camps, traditional or religious healing centers as well as in state-run or private social care institutions as a form of restraint, punishment, or treatment.[56]. Additionally, the Social Affairs Ministry has 12 rapid response teams attached to 20 state-run institutions (pantis) across the country that conduct community outreach activities including rescuing people from pasung when they come across them. [143] Standing unified with refugees at a time of crisis, sportanddev.org, September 21, 2020 (accessed September 28, 2020). 85. Third-party data was gathered to determine access based on four pillars: providers, facilities, funding and satisfaction. Provide counseling and other forms of support to people with psychosocial disabilities and their families. They dont want to socialize with me because my mental health condition brings shame on them. [7] In Indonesia, traditional healers who are versed in magic or dealing with spirits are usually referred to as paranormal or dukun, while Islamic faith healers who use Quranic recitations as a treatment method are known as ustad or kiai. In Sierra Leone, while chaining continues to be practiced in faith healing centers, it is now prohibited at the Sierra Leone Psychiatric Teaching Hospital, the countrys only mental health facility located in Freetown. Persons with disabilities are systematically placed into institutions and psychiatric facilities, or detained at home and other community settings, based on the existence or presumption of having an impairment.[166]. The Protocol of San Salvador has been ratified by Argentina, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, and Peru. 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. (Eds. [45] Human Rights Watch interview with Dr. Kafayah Ogunsola, psychiatrist, Lagos, September 26, 2018; Karoon, What is the state of mental health in Thailand?, post to Pacific Prime Thailand (blog),June 24, 2019, https://www.pacificprime.co.th/blog/state-of-mental-health-in-thailand/(accessed March 23, 2020); Melinda Benjamin, The Promotion of Mental Health Awareness in Cambodia, Borgen Magazine,August 1, 2019,https://www.borgenmagazine.com/mental-health-awareness-in-cambodia/(accessed March 19, 2020); Nivendra Uduman, Mental Health and Stigma in Sri Lanka, post to Ground Views (blog), February 19, 2018, https://groundviews.org/2018/02/19/mental-health-and-stigma-in-sri-lanka/ (accessed March 23, 2020); Mark Tilly,TV series to fight mental health stigma, Khmer Times, August 25, 2017,https://www.khmertimeskh.com/79742/tv-series-fight-mental-health-stigma/(accessed March 19, 2020); Human Rights Watch, We Are Also Dying of AIDS, 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, Southern African Institutefor Policy and Research,August 19, 2013, http://saipar.org/wp-content/uploads/2013/09/Allen-and-Green_Discrimination-and-Stigmitisation_Final-DraftCorrected.pdf (accessed April 2, 2020); Jane Chung,Disabled South Koreans Protect Inhumane Benefits System, Reuters, October25, 2012, https://www.reuters.com/article/us-korea-disabled/disabled-south-koreans-protest-inhumane-benefits-system-idUSBRE89O05X20121025 (accessed March 23, 2020); International Federation for Human Rights and Taiwan Association for Human Rights,The Hidden Face of Taiwan: Lessons learnt from the ICCPR/ICESCR review process,April2013,https://www.refworld.org/pdfid/51e799594.pdf(accessed March 23, 2020); M. Bari Qasem Saleh and A. Mohamed Makki,Mental Health in Yemen: Obstacles and Challenges, International Psychiatry,5.4(2008),https://www.cambridge.org/core/services/aop-cambridge-core/content/view/2F6080907180CF8B9BE1296B6C9D0360/S1749367600002277a.pdf/div-class-title-mental-health-in-yemen-obstacles-and-challenges-div.pdf(accessed March 18, 2020), pp. The ACHPR has been ratified by Benin, Burkina Faso, Cte dIvoire, Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Kenya, Liberia, Mozambique, Nigeria, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Tanzania, Togo, Uganda, and Zimbabwe; Protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa (Maputo Protocol), adopted July 11, 2003, CAB/LEG/66.6, reprinted in 1 Afr. During the COVID-19 outbreak in El Salvador, MSF teams have continued to provide primary healthcare and mental health services in communities, as well as psychosocial assistance in detention centers for deported people, and expanded ambulance response capacity in support of the Salvadoran Medical Emergency System. Last Updated: 04/22/2022. [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. Decentralization of psychiatric services remains a major need in El Salvador, resulting in severe hardships on families. 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. Ive been chained for five years. ), 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. Despite such accomplishments, many psychologists in the Northern Triangle countries feel that they are largely working in isolation with little support and few resources. [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. For example, Ghana has several hundred prayer camps, but precise numbers are difficult to come by since they are not state-regulated. In El Salvador, for instance, an underfunded and corrupt police force, unable to maintain public safety, has helped spur the formation of gangs as de facto authorities across most of the country (Life Under Gang Rule in El Salvador, International Crisis Group, 2018). (No. The report was edited by Rau Barriga; erimovi; Bader; Muscati; Pedneault; Ros Espinosa; Almasri; Afrah Nasser, researcher in the Middle East and North AfricaDivision; Nisha Varia, advocacy director of the Womens Rights Division; Bede Sheppard, deputy director of the Childrens Rights Division; Mausi Segun, director of the Africa Division; Corinne Dufka, associate director in the Africa Division; Ilaria Allegrozzi and Otsieno Namwaya, senior researchers in the Africa Division; Zenaida Machado and Nyagoah Pur, researchers in the Africa Division; Patricia Gossman, associate director in the Asia Division; Andreas Harsono, and Saroop Ijaz, senior researchers in the Asia Division; Almaz Teffera and Yaqiu Wang, researchers in the Asia Division; Jayshree Bajoria, research consultant in the Asia Division; Eric Goldstein, deputy director of the Middle East and North Africa Division; Ahmed Benchemsi, advocacy director in the Middle East and North Africa Division; Martina Rapido Ragozzino, research assistant in the Americas Division; Csar Muoz, senior researcher in the Americas Division; Tyler Mattiace, researcher in the Americas Division; Tanya Lokshina, associate director in the Europe and Central Asia Division. We have to wait for authorization from the public health system to be able to move patients to a care center, since we cannot transfer the patient from [their] home without prior coordination and authorization from the public health system, said Wendy. [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. As psychologists, it is our professional ethical duty to get involved with this crisis, Beckley says. 2(1); CEDAW, art. 37; CRPD, art. Malaki went from playing football in the Nyarugusu camp in Tanzania to the 2019 Special Olympics World Games in Abu Dhabi, United Arab Emirates. From 2007 to 2019, El Salvador experienced some economic progress, with its poverty rate dropping from 39% to 22.3%. Finally, we must ensure standards of care are consistent through continued adoption of evidence-based practices. [176] The right to be free from non-consensual medical treatment and experimentation is guaranteed under the ICESCR. [23] 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, September 2020, https://doi.org/10.1111/hsc.12968 (accessed September 25, 2020), pp. [21] Most concerning is that in low- and middle-income countries, 80 percent of government spending on mental health goes to psychiatric hospitals and not community-based services. 10. Human Rights Watch interviewed people with psychosocial disabilities who were shackled to trees, logs, pillars in a courtyard, dilapidated sheds without a roof over their heads, protection from the sun or rain, and with constant exposure to mosquitoes and pests. Photo montage of people being shackled for weeks, months, and sometimes even years in Indonesia, Nigeria, Ghana, and Morocco. In situations in which a person cannot give consent to admission or treatment at that moment, and their health is in such a state that if treatment is not given immediately, their life is exposed to imminent danger, immediate medical attention may be given in the same manner it would be given to any other person with a life-threatening condition who is unable to consent to treatment at that moment. When it comes to seeking mental health care, the Latinx community has always struggled with stigmaboth in and outside of the United States. 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. 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. The response time is often less than ideal because of the heavy traffic in San Salvador. 69 (1988), signed November 17, 1988. [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). It doesnt feel right; it makes me sad. [85] Human Rights Watch, They Treat Us Like Animals: Mistreatment of Drug Users and "Undesirables" in Cambodias Drug Detention Centers, December 2013, https://www.hrw.org/sites/default/files/reports/cambodia1213_ForUpload_1.pdf, p.3. 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]. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. The ACHR has been ratified by Argentina, Bolivia, Chile, Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, and Peru; Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights (Protocol of San Salvador), O.A.S. Therefore, people first consult faith or traditional healers and often only seek medical advice as a last resort. 66. (No.16) at 52, U.N. Doc. Recently, my suicidal 15-year-old grandson ingested and smoked a cocktail of several drugs. 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. [140] Partners in Health, Celebrating New Possibilities at Sierra Leones Only Psychiatric Hospital, June 5, 2020, https://www.pih.org/article/celebrating-new-possibilities-sierra-leones-only-psychiatric-hospital (accessed September 17, 2020). The objective was to combat stigma by raising awareness on mental health and put an end to chaining in homes as well as in hospitals. 61-62; Amnesty International, Our Hearts Have Gone Dark The Mental Health Impact of South Sudans Conflict, https://www.amnesty.org/download/Documents/AFR6532032016ENGLISH.PDF, pp. Anxiety and depression levels are the lowest since the pandemic began, 48% of Americans are feeling down, depressed, or hopeless during the COVID-19 pandemic, How many teens are vaping? I was fearful that someone would attack me during the nights, without being able to defend myself because of being shackled.[89], People end up living shackled in institutions for long periods because their relatives do not take them home and the institution has nowhere to send them. When the Special Olympics team had Malaki released, he got the opportunity and training to play football. See also, Beijing Declaration and Platform for Action, Fourth World Conference on Women, September 15, 1995, A/CONF.177/20 (1995), art. Rts. [116] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, November 20, 2019. 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. They feel youre possessed and put liquid down your nose to drive out the devil. To support the right to remain, some psychologists seek to better understand the complex decision about whether to migrate. Im not allowed to wear clothes, only underwear. 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. [109] When his community went into lockdown and Sodikin lost access to community-based mental health services, his family was unable to support him and locked him in a room. In Indonesia, Human Rights Watch found approximately 90 women living in a room that could reasonably accommodate no more than 30, in Panti Laras 2, a state-run institution in Cipayung, on the outskirts of Jakarta. El Salvador is a republic with three branches of government: the Executive, the Legislature, and the Judiciary. There are currently over half a million people working in mental health roles like psychiatry, psychology, counseling, and therapy. 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. In addition, the local and national governments dont have coordinated detection and hospitalization mechanisms for COVID-19 cases. Warren County Public Schools Director of Student Services Todd Hazel speaks about the increase in WCPS students' mental health issues since the pandemic and the December 2021 tornadoes beside Lt . In Juba and Malakal prisons, people with psychosocial disabilities were chained to the floor day and night or tied outside to tree naked, and soiled with their own excrement.[88]. 24, 2016). 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). Many are forced to eat, sleep, urinate, and defecate in the same tiny area.