Target support toward community-based support and services, including mental health services. In one center in northern Nigeria, Human Rights Watch found a dozen people who showed researchers scars on their arms, chests, and backs that they said were from floggings by staff. The emergency [67] Thousands Of Mentally Ill People Chained Like Cattle For Years In Sheds In UP, Outlook, January 3, 2019, https://www.outlookindia.com/website/story/india-news-thousands-of-mentally-ill-people-chained-like-cattle-for-years-in-uttar-pradesh-sheds/322874 (accessed July 29 2020); Asian News International, Thousands of Psychiatric Patients Chained in Sheds in Uttar Pradesh's Badaun; SC Asks Govt to Provide Medical Aid, Firstpost, January 3, 2019, https://www.firstpost.com/india/thousands-of-psychiatric-patients-chained-in-sheds-in-uttar-pradeshs-badaun-sc-asks-govt-to-provide-medical-aid-5829361.html (accessed July 29 2020); Mentally challenged man, in chains for 14 yrs, rescued, The Indian Express, September 27, 2020 (accessed September 28, 2020). [146], International and regional human rights law expressly prohibits discrimination and requires parties to these conventions to take steps to eliminate all forms of discrimination against individuals, including persons with disabilities. Inability to afford proper care. Support for Central Americans. 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. Gaborit and his team have also designed and delivered interventions to 3,500 children and adolescents in schools and community settings to help them make more informed decisions about whether to migrate. In several cases, the ambulance was called when patients were already in critical condition. [128] Human Rights Watch interview with Tina Mensah, Ghanas deputy health minister, Accra, November 8, 2019. Traditional or spiritual healing centers are also considered types of rudimentary institutions. [85] In June 2020, the Ministry of Interior proposed a draft Public Order Law, which will further entrench discrimination against people with psychosocial disabilities as well as against other at-risk groups in society and add to existing deep concerns of the continuing practice of shackling in Cambodia. We need to do something.. Treaty Series No. Worryingly, community leaders are reporting deaths in their communities, some of them related to the suspension of primary health care.. What options do people have to stay home? she asks. Stark Disparities in Accessibility at State and Income Levels. 38-39. res. Human Rights Watch interviews with Benjamin Ballal, February 15, 2020; Archbishop Danokech, February 18, 2020; and Fiera [not her real name], November 20, 2019. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems. Findings of these visits, redacted to protect privacy rights, should be publicly reported. [75] Human Rights Watch phone interview with Pascal Douti, Association Vie Libre, September 3, 2019; Benedict Carey, The Chains of Mental Illness in West Africa, New York Times, October 11, 2015, https://www.nytimes.com/2015/10/12/health/the-chains-of-mental-illness-in-west-africa.html (accessed July 30, 2020). El Salvador 2020 Alejandra Sandoval/MSF. Islamic faith healers often use Quranic recitations or herbal medicine, including the burning of herbs, as a treatment method. Emergency workers struggle to get mental health services in El Salvador [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). [87] They were unable to appeal their incarceration, and most were imprisoned with no release date. may well amount to torture.[161], The CRPD and the African Charter both explicitly prohibit all forms of exploitation, violence, and abuse. Once survivors attain a significant level of recovery from their initial trauma, measured using a tool IJM developed called the Assessment of Survivor Outcomes, Beckley guides some of them into leadership roles in the international global survivor network to share their experiences and advocate for other survivors. The El Salvador-based nonprofit has mobilized over 100,000 volunteers, like Emanuel, and trained frontline workers across Central America and Mexico, reaching more than 2 million children and adults. Feb 28, 2023. Mental Health Services | Mission To El Salvador [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. CAB/LEG/67/3 rev. [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. 44/25, annex, 44 U.N. GAOR Supp. The Census Bureau reported that 30% of American adults had symptoms consistent with an anxiety or depression diagnosis as of May 24. Locking them in a confined space such as a room outside or within a house, shed, hut, cage, or animal shelter (including chicken coops, pig pens, or goat sheds). A central issue is the lack of mental health care professionals. It also explicitly requires the full and informed consent of persons with disabilities to medical treatment.[178]. Mental Illnesses are Common, but Care is Lacking | Health Care Policy The large majority of Americans (76%) also believe mental health is just as important as physical health. In certain cases, people with disabilities and their family members are identified with pseudonyms and identifying information, such as location or date of interview, has been withheld in order to respect confidentiality and protect them from reprisals from family or staff in institutions. 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. El Salvador is a republic with three branches of government: the Executive, the Legislature, and the Judiciary. I eat here once a day. I want to move about, I have asked the baba [faith healer] to take them off, but he wont. In its 2018 Concluding Observations the Human Rights Committee noted El Salvador's lack of legislation in this aspect. [19], Governments have long neglected to invest in mental health services. In addition, the person with a psychosocial disability and their family can visit the community health center for one-on-one counseling with a doctor or nurse, they can get medication, and they can participate in occupational therapy or other activities. [82] In another case, a woman with a psychosocial disability was chained for 24 years (since she was 10 years old) in Egypt.[83]. Services Lacking for People with Mental Health Issues Two studies conclude more people than in the past have multiple mental disorders, and there aren't enough services to help those with. [89] Human Rights Watch teleconference interview with Felipe Orozco, man with a psychosocial disability, August 4, 2020. 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. [126] In healing centers in countries such as Nigeria and Indonesia, men and women are chained next to each other, leaving women no option to run away if they encounter abuse.[127]. The Minister of Health, Dr. Violeta Menjvar, said that in El Salvador anxiety, depression, alcoholism and suicide are the mental disorders with the highest prevalence. | Technical document. Data shines a spotlight on racial inequities in American life. 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. 2 July 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. (PDF) Access to mental health care in El Salvador: An assessment of 5 Facts about Poverty in El Salvador - The Borgen Project [65], In Indonesia, according to government data, 57,000 people with mental health conditions have been in pasung (shackled) at least once in their lives with approximately 15,000 still living in chains as of November 2019. 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. [49] Human Rights Watch interview with Benjamin Ballal, survivor of shackling and secretary general for cultivation at Cultivation for Users Hope, Nairobi, February 15, 2020. [27] For example, there are 0.19 psychiatrists per 100,000 people in Kenya and 0.12 Clinical psychologists usually need a Doctor of Philosophy in psychology (PhD) or a Doctor of Psychology (PsyD) degree. [62] Vikram Patel et al., The Lancet Commission on Global Mental Health and Sustainable Development, The Lancet 392 (10157), October 9, 2018, doi: 10.1016/S0140-6736(18)31612-X (accessed July 29, 2020); Mentally Ill Confined at Home Due to Lack of Resources and Public Education, Global Times, June 25, 2015, https://www.globaltimes.cn/content/928917.shtml (accessed July 28, 2020); Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 35; [63] Human Rights Watch has found evidence of people with psychosocial or intellectual disabilities being shackled in Afghanistan, Argentina, Armenia, Bangladesh, Benin, Bolivia, Brazil, Brunei, Burkina Faso, Cambodia, Chile, China, Colombia, Cte d'Ivoire, Dominican Republic, Democratic Republic of Congo, East Timor, Ecuador, Egypt, El Salvador, Ethiopia, Ghana, Guatemala, Haiti, Honduras, India, Indonesia, Iraq, Israel, Japan, Jordan, Kenya, Laos, Liberia, Mexico, Morocco, Mozambique, Nicaragua, Nigeria, Oman, Pakistan, Palestine, Paraguay, Peru, Philippines, Russia, Saudi Arabia, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Tajikistan, Tanzania, Thailand, Togo, Turkey, Uganda, Yemen, and Zimbabwe. I really wanted to help my aunty but couldnt. [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. CRPD/C/GC/1 (2014), http://daccess-ods.un.org/access.nsf/Get?Open&DS=CRPD/C/GC/1&Lang=E, para. Decades of trauma and violence in the Northern Triangleincluding civil wars in Guatemala and El Salvador and ongoing political instability in Hondurashave left behind a trail of crime, poverty, sociopolitical unrest and extreme income inequality in all three countries. Advocate for the integration of people with psychosocial disabilities in the community. E/C 12/2000/4, 2000, https://undocs.org/E/C.12/2000/4 (accessed September 23, 2020), paras. In many countries around the world, there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, having sinned, displaying immoral behavior, or having a lack of faith. Dont put a lock on it. Res. 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. Rural Mental Health Overview - Rural Health Information Hub [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. [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. It is mostly practiced in non-medical settings, by families, a faith healer, or non-medical staff, often in the absence of support or mental health services. [147] Non-discrimination is one of the cardinal principles on which the CRPD is grounded. TRADEMARKS. While many countries are increasingly starting to pay attention to the issue of mental health, the practice of shackling remains largely invisible. In some instances, people or their families had fashioned bamboo beds and grass-thatched shelters under a tree to get protection from the sun, but many slept on cold, hard concrete floors with no mattress or bedding. Therefore, people first consult faith or traditional healers and often only seek medical advice as a last resort. [39] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, Mozambique, November 20, 2019. [130] Supreme Court Shocked at Chaining of Inmates in U.P. Students and Human Rights Watch researchers also conducted phone interviews with activists, representatives of local NGOs, mental health professionals, and journalists. "In many instances the patient had already died when we arrived at their house, said Angel Sermeo, MSFs medical activity manager in El Salvador. 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. 10, 13. And across the region, the median percentage of countries health-care budgets allocated to mental health is 0.9%, the vast majority of which funds psychiatric hospitals (WHO-AIMS: Report on Mental Health Systems in Latin America and the Caribbean, 2013). James, a man with a psychosocial disability who has been chained for several years in a Christian healing institution in Kenya, said: They cane us if we make a mistake. Mental Wellbeing, www.cohenveteransnetwork.org/AmericasMentalHealth, More than 4 in 10 U.S. [78] Despite being shackled for most of her life, her case was never counted or included in government data because its a practice that remains invisible and hidden, even from neighbors, the local community, and the authorities. 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. The government identifies shortage areas so it can address them with proper resources. In one institution,near Briansk, Russia, residents who were unruly, would be chained, forcibly sedated.[118]. 58 (1982), entered into force October 21, 1986. [And] increase the response capacity of the emergency transfer services in critical cases. In Honduras, a population of nearly 9 million relies on just 185 mental health professionals, and in El Salvador, 225 mental health workers serve more than 6 million people (Mental Health Atlas Country Profiles, World Health Organization, 2017). The lack of access to primary healthcare services, which has contributed to the deterioration of the health of patients with chronic diseases. While there are formal procedures governing admission in social care institutions, the healing centers Human Rights Watch visited in a number of countries had no formal admission or discharge processes. res. In 2019, this happened to [our teams] 11 times from January to June. [4] International Disability Alliance, Legal Opinion on Article 12 of CRPD, undated, https://www.internationaldisabilityalliance.org/sites/default/files/documents/legalopinionletterart12final_0.doc (accessed September 14, 2020). At the core of this initiative is respect for the rights of people with psychosocial or intellectual disabilities, including the right to live independently in the community. [112], When institutions provided food, people with psychosocial disabilities told Human Rights Watch that it was too meagerat times, just one meal a day. in Somalia.[134]. In the worst of cases, depression can lead to suicide - an estimated 63,000 people kill themselves every year in the Americas. [6] In Somaliland, these centers are often referred to as Cilaaj from the Arabic word for healing. The Social Services Department of The Salvation Army recently (March 1) released a youth survey, and found that more than 70% of the respondents suffered from mental health problems to varying degrees, and 30% of them did not seek external assistance. Shackling impacts a persons mental as well as physical health. 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. It was heart-breaking.[51]. The reasons are as varied as our our cultures' pressure due to machismo, a heavy reliance on faith versus therapy, and a general lack of education when it comes to what psychology and psychiatry can do . 38-39; Jasmine Bauomy, In South Sudan, Stigma and Underfunding Plague Mental Health Care, Al Jazeera, January 18, 2019, https://www.aljazeera.com/indepth/features/south-sudan-stigma-underfunding-plague-mental-health-care-190117180739562.html (accessed August 3, 2020). Furthermore, younger Americans (i.e., Gen Z and Millennials) are less sure about resources for mental health services, compared to older generations. [32] Graham Thornicroft et al., Undertreatment of People with Major Depressive Disorder in 21 Countries, The British Journal of Psychiatry 210,2 (2017), doi:10.1192/bjp.bp.116.188078 (accessed September 16, 2020), pp. 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. 16) at 49, U.N. Doc. [14] "Suicide: One Person Dies Every 40 Seconds," WHO news release, September 9, 2019, https://www.who.int/news-room/detail/09-09-2019-suicide-one-person-dies-every-40-seconds (accessed September 22, 2020). NIMH Mental Illness - National Institute of Mental Health (NIMH) [169], In his 2017 report, the UN special rapporteur on the right to health noted that [s]ervices must support the rights of people with intellectual, cognitive and psychosocial disabilities and with autism to live independently and be included in the community, rather than being segregated in inappropriate care facilities.[170], The highest attainable standard of physical and mental health is a fundamental human right enshrined in numerous international human rights instruments.
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