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. [67], In countries where people believe mental health is a spiritual issue and robust mental health services are lacking, private institutions and faith-healing facilities flourish. Travel restrictions have since been lifted but outpatient consultations at hospitals and health units remain suspended. Depression is the most common mental illness in the world. Some individuals in Hebron Prayer Camp, north of Accra, Ghana were denied food for up to seven days. 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. The study offers a comprehensive analysis of the state of mental health care in the U.S. Bobele, M., & Slive, A.In Hoyt, M.F., & Talmon, M. Although mental health professionals had suspected mistreatment at the facility for years, the cases only came to light once video footage was anonymously leaked. There are no statistics on the scale of shackling at a global level. [69] Helena Selby, Prayer Camps and Mental Illness, The Chronicle, undated, http://ghanaian-chronicle.com/prayer-camps-and-mental-illness/ (accessed March 28, 2012). [66], In India, in January 2019, the media reported that thousands of people with mental health conditions were chained like cattle, their feet tied with iron chains and padlocked for days, months and years, in the state of Uttar Pradesh. A/39/51 (1984), entered into force June 26, 1987; Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. 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]. In the United States, an immigrant might earn $300 per week cleaning houses, the equivalent of about a months salary in Guatemala, says Cbar Cataln. Your gift helps us provide medical humanitarian aid for hundreds of thousands of people each year. Others think persons with disabilities are useless. Once the person is committed to an institution, they have no right to appeal or leave until the institution discharges them. Karolina Kozik, senior coordinator in the Disability Rights Division, provided research and writing support. Mental Health Services. While mental illness, including addictions, has become more top of mind for the media and Canadians in general over the past few years, it's fair to say that most people still don't have a true understanding of just how big, onerous, and potentially damaging the crisis really ison both a societal and personal level. The main causes of death of these patients are related to metabolic disorders and respiratory and heart problems, which have increased fourfold compared to the first half of last year. Existing mental health services are often under-utilized or do not comply with international human rights standards because of limited understanding and awareness of mental health. Human Rights Watch phone interview with Joshua Duncan, program manager, Mental Health Coalition of Sierra Leone, September 25, 2020. [30] WHO, Mental Health: Massive Scale-up of Resources Needed if Global Targets Are to Be Met, https://www.who.int/mental_health/evidence/atlas/atlas_2017_web_note/en/. The majority (64%) of Americans who have sought treatment believe the U.S. government needs to do more to improve mental health services. Shackling is practiced across socio-economic classes. res. People end up living shackled in institutions for long periods because their relatives do not come to take them home and the institution has nowhere to send them. Celina de Sola 04:32 People who are shackled to one another are forced to go to the toilet or sleep together. [127] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf; 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. 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? [131] Amit Anand Choudhary, Chaining Mentally Ill Patients Is Atrocious and Against Human Dignity: Supreme Court, Times of India, January 3, 2019, https://timesofindia.indiatimes.com/india/chaining-mentally-ill-patients-is-atrocious-and-against-human-dignity-sc/articleshow/67368856.cms (accessed August 16, 2020). [40] Human Rights Watch interview with Ridha, family member, September 2020 (full name and details withheld). In the same period this year, it has happened 37 times18 times in June alone.. [58] Human Rights Watch, Chained Like Prisoners, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, p. 9. [122] UNHRC, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Mndez, A/HRC/22/53, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf, para. Data was aggregated and averaged to each state, resulting in a score between 0 and 100, where 100 indicates the greatest access. Publicly denounce the practice of shackling and actively oppose all forms of shackling, including by affiliated leaders and institutions. For many, mental illness can be challenging to manage on one's own. Personal hygiene is a serious problem since people who are chained often do not have access to a toilet. They have already told him that it is better not to go to get the catheter, that it is better not to go out, that there is no equipment to treat to him. 44/25, annex, 44 U.N. GAOR Supp. Human Rights Watchs research into mental health settings in at least 25 countries has found that people with mental health conditions can face a range of abuses when sent to a psychiatric hospital, such as arbitrary detention, involuntary treatment, including electroconvulsive therapy, forced seclusion as well as physical and sexual violence. [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). [5]. [174] UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. The HRSA also runs several training programs to address the shortage of mental health professionals. [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. Human Rights Watch calls on the international community and national governments to ban shackling, adopt measures to reduce stigma against people with psychosocial disabilities, and develop adequate, voluntary, and community-based mental health services. 44/25, annex, 44 U.N. GAOR Supp. Even educated and well to-d0 families can resort to shackling. [124] Human Rights Watch interview with James [not his real name], man with a psychosocial disability, Kenya, February 2020 (name and details withheld). Lack of education in the community about mental health. 14; Protocol of San Salvador, art. Shackling occurs in many countries that are party to international and regional human rights treaties that prohibit abusive treatment and related rights. [6] In some countries, these centers are called prayer camps. For example, ECAP, a Guatemalan organization whose name translates to the Community Studies and Psychosocial Action Team, works primarily with indigenous women and children to seek gender equity and restorative justice for past crimes. 1, Equal recognition before the law, U.N. Doc. [95] Staff members hesitated to let Human Rights Watch enter the room asking: How will you enter? The increase in people dying at home reflects the enormous strain COVID-19 has put on the health system. In Mexico, for example, Disability Rights International documented children with psychosocial disabilities in cages or tied down with bandages. My experience establishing mental health clinics across the country, coupled with this study, shows that more needs to be done to give Americans much needed access to mental health services, said Cohen Veterans Network President and Chief Executive Officer Dr. Anthony Hassan. There is a mental health crisis in America. 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. 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. pone.0162305 (accessed September 17, 2020), p.3; J. Edwards, Ghanas Mental Health Patients Confined to Prayer Camps. The Lancet 383: 9911 (2014), doi: 10.1016/s0140-6736(13)62717-8 (accessed September 17, 2020), pp. The program is an ambitious government initiative that seeks to ensure that even the most rural, isolated, and reluctant communities get access to health services. The government identifies shortage areas so it can address them with proper resources. [116] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, November 20, 2019. https://www.hrw.org/sites/default/files/reports/zambia0714_ForUpload_1.pdf, p.16; A. Allen,andE.Green,Discrimination and Stigmatization of People with Epilepsy in Zambia: The Need for Integration of Social, Healthcare, and Policy Reform,, African [Banjul] Charter on Human and Peoples Rights (ACHPR), adopted June 27, 1981, OAU Doc. [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]. 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. 7; CRC, art. 58 (1982), entered into force October 21, 1986. In the eastern metropolitan area of San Salvador, an increasing number of people are dying at home. Most importantly, Human Rights Watch thanks all those who shared their experiences, all of whom spoke with courage and dignity about their personal histories and concerns. [114] Human Rights Watch interview with Fiera [not her real name], Maputo, Mozambique, November 20, 2019. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. 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. Wendy, a doctor working for MSF's ambulance service, said that some patients die while waiting to be transferred to a hospital. . To date, about 20 out of Indonesias 34 provincesincluding Central Java, West Nusa Tenggara, East Java, Jambi, Yogyakarta, and Acehhave a functional pasung-free initiative. [147] Non-discrimination is one of the cardinal principles on which the CRPD is grounded. [52] Human Rights Watch interview with Mahmud Suleiman, a psychiatric nurse, occupational therapist, and member of the Islamic Medical Association of Nigeria, Kano, September 19, 2019. In its 2018 Concluding Observations the Human Rights Committee noted El Salvador's lack of legislation in this aspect. From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. Despite this strong demand and growing societal awareness of the importance of mental health in the U.S., the study revealed that the overwhelming majority of Americans (74%) do not believe such services are accessible for everyone, and about half (47%) believe options are limited. In some cases, families left fake phone numbers and addresses in order to abandon the relative, while in other cases they simply moved homes or failed to show up. [34] WHO, Mental Health in the Workplace, https://www.who.int/mental_health/in_the_workplace/en/. If we miss hygiene, they give us a punishment. Hum. 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). One of their most surprising findings was that deported children did not experience greater psychological harm than a control group of Salvadoran children who remained in the country (El Salvador, in Childhood and Migration in Central and North America: Causes, Policies, Practices and Challenges, 2015). According to the latest available global estimates, 792 million people or 10.7 percent of the global population has a mental health condition. Shackling: Traditionally defined as the practice of confining a persons arms or legs using a manacle or fetter to restrict their movement, historically used to confine slaves or prisoners. 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. In the absence of mental health services, people with psychosocial disabilities can also be arbitrarily detained and chained in drug detention centers or prisons. The offices of the first two are filled through popular elections; the president serves for five years and members of the legislature serve for three years. As of 2018, more than two-thirds of all countries did not cover reimbursement for mental health services in national health insurance schemes. The report includes field research and testimonies from Afghanistan, Burkina Faso, Cambodia, China, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, the self-declared independent state of Somaliland, South Sudan, and Yemen. In some healing centers, people were allowed to bathe once a day using a hose in their rooms. Turkey-Syria earthquakes: MSF teams in Syria are caring for the injured. We are suffering. The numbers simply don't lie. 316, No. [92] It cannot be discriminatory and should never be justified on the basis of the existence of a disability.[93]. In some states, over 80% of the population lives in a mental health professional shortage area. 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. [162] The CRPD requires that all facilities and programs designed to serve persons with disabilities are effectively monitored by independent authorities.[163], Under the CRPD, the governments are obligated to take all appropriate measures to promote the physical, cognitive, and psychological recovery, rehabilitation, and social reintegration of persons with disabilities who become victims of any form of exploitation, violence, or abuse. [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. Ensure shackling is not practiced by the organizations representatives or at holy sites. Res. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. To be a young person in El Salvador, Guatemala or Honduras is extremely stressful, he says. [110] Fasting would help to starve evil spirits and enable God and prayer to heal them. 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. Support national governments in reducing stigma and discrimination against people with psychosocial disabilities. | Technical document. Retornados often struggle to find work, become targets of gangs who assume they have money, and have problems with addiction and suicidality, Garca Rivera says. Rts. [109] "Indonesia: Shackling Reduced, But Persists," Human Rights Watch news release, October 2, 2018, https://www.hrw.org/news/2018/10/02/indonesia-shackling-reduced-persists. The trained staff in turn educate additional health center staff about the program and mental health. and Zambia. [148] The CRPD states that all persons are equal before and under the law and are entitled without discrimination to the equal protection and equal benefit of the law.[149] The CRPD requires governments to prohibit all discrimination on the basis of disability and guarantee to persons with disabilities equal and effective legal protection against discrimination on all grounds and to take all appropriate steps to ensure that reasonable accommodation is provided. Its a crucial part of larger efforts to strengthen our social fabric and to repair the damage caused by sociopolitical violence.. Many are forced to eat, sleep, urinate, and defecate in the same tiny area. [171] Universal Declaration of Human Rights (UDHR), adopted December 10, 1948, G.A. In 2020, among the 14.2 million adults with SMI, 9.1 million (64.5%) received mental health treatment in the past year. Create and carry out deinstitutionalization policies and time-bound action plans, based on the values of equality, independence, and inclusion for people with disabilities. 40, entered into force November 25, 2005. The . About 80 percent of people with disabilities, including people with psychosocial disabilities, live in middle or low-income countries where it is often challenging to access healthcare,. 171, entered into force March 23, 1976; International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. Help us continue to fight human rights abuses. Treaty Series No. Individuals located in rural areas and of lower-income are less likely to say that mental health services are extremely accessible to them. 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. Media@TheNationalCouncil.org 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. The Health Resources and Services Administration tracks health professional shortage areas, which are geographic areas, population groups, or health care facilities designated as having a shortage of health providers. Rafael Serrano psychiatric hospital in Puebla shackled him naked with a padlock during the nights for two-and-a-half weeks, and he was forced to defecate and urinate in his bed. The ambulance system and hospitals are operating . Bilingual patients are evaluated differently when evaluated in English versus Spanish, and Latinx/Hispanic people are more frequently undertreated than whites. [130] Supreme Court Shocked at Chaining of Inmates in U.P. 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. Human Rights Watch visit to Holy Ghost Coptic Church of Africa, Kisumu, February 18, 2020. His loving parents found him nonresponsive, with a heart rate near 200 beats per minute. res. Aisha, mother who chains her 18-year-old daughter with a psychosocial disability in the Gaza Strip told Human Rights Watch: Archbishop Danokech of the Holy Ghost Coptic Church of Africa in Kisumu, western Kenya, where over 60 men, women, and children with psychosocial disabilities are detained and most of whom are chained, told Human Rights Watch: We do not want them to wear clothes. In Guatemala, we tend to be reactive, she says. 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. 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. Many of the African countries considered in this report are also party to the African Charter on Human and Peoples Rights (ACHPR) and the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa (the Maputo Protocol). Combined, medical and behavioral health costs $37.6 to $67.8 billion (yes, with a B) a year in lost productivity. 25; ACHPR, art. 24-64; Treated Worse Than Animals: Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India, December 2014, https://www.hrw.org/sites/default/files/report_pdf/india1214.pdf, p. 34; We Are Also Dying of AIDS: Barriers to HIV Services and Treatment for Persons with Disabilities in Zambia, July 2014, https://www.hrw.org/report/2014/07/15/we-are-also-dying-aids/barriers-hiv-services-and-treatment-persons-disabilities; Like A Death Sentence: Abuses against Persons with Mental Disabilities in Ghana, October 2012, https://www.hrw.org/sites/default/files/reports/ghana1012webwcover.pdf, pp. More than three-quarters (78%) report the same or higher levels of severity as this time last year. [39] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. 39/46, annex, 39 U.N. GAOR Supp. Despite access to more affordable healthcare over the last decade, almost 12% of Black Americans do not have . [1] Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. 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. [24], Globally, there is a severe shortage of trained mental health professionals, but the shortfall is particularly acute in low-income countries. Legal capacity: The right of an individual to make their own choices about their life. Gangs often threaten teens or adults with rape or murder, forcing entire families to flee their homes (World Report 2019, Human Rights Watch). 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. 69 (1988), signed November 17, 1988. And throughout the Northern Triangle, sexual assault, murder, and drug and human trafficking are common, with perpetrators emboldened by judicial delays and corruption that essentially result in impunity. [119] The United Nations special rapporteur on torture has noted that involuntary treatment and other psychiatric interventions in health-care facilities can be forms of torture and ill-treatment. Globally, an estimated 792 million people or 1 in 10 people, including 1 in 5 children, have a mental health condition. In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. [37] Despite this, less than 1 percent of international development assistance for health is allocated toward mental health.[38]. [68] In the Greater Accra Region, there are an estimated 70 prayer camps. In Latin America, 5% of the adult population suffers from it, but most neither seek - nor receive - treatment, according to the WHO. 39-72; Mental Disability Advocacy Centre and Mental Health Users Network of Zambia, Human Rights and Mental Health in Zambia, July 2014, http://www.northriseuniversity.com/wp-content/uploads/2017/07/Human-rights-and-mental-health-in-Zambia.pdf (accessed July 31, 2020), pp. Depression, which is the leading cause of disability, is reported to be twice as common in women than men. A World Health Organization (WHO) video describes it as a black dog that follows you everywhere, does not let you sleep or eat well. The demand for mental health services is stronger than ever, with nearly six in 10 (56%) Americans seeking or wanting to seek mental health services either for themselves or for a loved one. 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.. The United States, by comparison, spends about 8% of its health-care budget on mental health (Dieleman, J.L., et al., JAMA, Vol. Malakis story helped shape his community to be more inclusive and accepting. Created by state lawmakers in 2019 and already in more than 300 school districts comprising some 40% of the state's school population, the Texas Child Mental Health Care Consortium of experts. This is the case for Sodikin, a 34-year-old man with a psychosocial disability, who had been released from chains after over 8 years shackled in a shed outside his family home in Cianjur, West Java in Indonesia. Children should have access to child psychologists and specialist support services. Engage spiritual and religious leaders to challenge discriminatory beliefs and practices related to psychosocial disabilities, and offer education opportunities on mental health and the rights and needs of people with psychosocial disabilities. CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. In many institutions visited by Human Rights Watch, male staff would enter and exit womens wards or sections at will or were responsible for the womens sections, including at night, which puts women and girls at increased risk of sexual violence, as well as subjects them to a constant feeling of insecurity and fear. Im never invited to happy occasions, weddings or birthdays with my family. [46], For example, many people in countries such as Afghanistan, Bangladesh, Burkina Faso, Egypt, Ethiopia, Ghana, Guatemala, India, Indonesia, Iraq, Kenya, Mexico, Morocco, Mozambique, Nigeria, Oman, Pakistan, Palestine, Peru, Philippines, Saudi Arabia, Senegal, Sierra Leone, Somalia, including in Somaliland, Sudan, and Yemen believe that psychosocial disabilities are the result of possession by evil spirits or witchcraft. For example, Ghana has several hundred prayer camps, but precise numbers are difficult to come by since they are not state-regulated. The group also administers APAs ACT Raising Safe Kids Program to teach parents and caregivers how to create healthy and nurturing environments for young children. In several cases, the ambulance was called when patients were already in critical condition. Enable people with psychosocial disabilities to freely enter and leave at will, to refuse treatment, and to seek other services, and ensure that everyone in the camps is always fully aware of this. As of 2012, 92 percent of the people who had been unlocked in China remained free from chains. It doesnt feel right; it makes me sad. eCollection 2018. [88] Human Rights Watch, Prison is Not For Me, https://www.hrw.org/report/2012/06/21/prison-not-me/arbitrary-detention-south-sudan, pp.
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