14(1)(b); CRPD Committee, Statement on article 14 of the Convention on the Rights of Persons with Disabilities, September 2014, http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=15183&LangID=E#sthash.ErjRRg0s.9wBvLiwR.dpuf (accessed August 12, 2020). [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. [86] Civil Society Organizations Call for the Draft Law on Public Order to be Immediately Discarded, joint statement, August 13, 2020, https://www.hrw.org/news/2020/08/13/civil-society-organizations-call-draft-law-public-order-be-immediately-discarded. [120] UNHRC, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Mndez, A/HRC/22/53, February 1, 2013, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf (accessed December 28, 2013), para. Share this via Twitter Mental health shortages range in severity across the country. Gender is a major factor in mental health. Furthermore, younger Americans (i.e., Gen Z and Millennials) are less sure about resources for mental health services, compared to older generations. 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. When the Special Olympics team had Malaki released, he got the opportunity and training to play football. 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). 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. 48-49. Malakis story helped shape his community to be more inclusive and accepting. Advocate for the integration of people with psychosocial disabilities in the community. Such training includes defining psychological trauma, learning appropriate terminologytrainees are instructed to use the term survivor rather than victimand managing acute distress. Community leaders in the five communities where MSF provides primary healthcare in Soyapango and San Salvador report that since the emergency was declared, more than 50 people have died after showing COVID-19 symptoms or from a lack of treatment for chronic diseases. Priority Ambulance (011-503-2264-7911) is the only private ambulance service with a fleet of vehicles in San Salvador that has trained personnel and medical equipment to manage emergencies. It is comprised of a two-pronged research project that includes an online survey of 5,000 American adults, and a robust analysis of third-party data measuring patients access to mental health services in terms of four pillars providers, facilities, funding and perceived satisfaction among patients. [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. [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. [173], According to the UN Committee on Economic, Social and Cultural Rights, the international expert body charged with monitoring compliance with the ICESCR, access to health facilities, goods and services should be non-discriminatory, especially for the most vulnerable or marginalized sections of the population, including individuals with disabilities. As a result, they urinate, defecate, eat, and sleep in a radius of no more than one to two meters. While Gov. The ACHPR has been ratified by Benin, Burkina Faso, C, African Charter on the Rights and Welfare of the Child (ACRWC), OAU Doc. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. [81] UNHRC, Report of the Special Rapporteur on rights of persons with disabilities, Catalina Devandas-Aguilar, A/HRC/40/54, https://undocs.org/en/A/HRC/40/54, pp.6, 12. Lack of engagement with work. The WHOs QualityRights initiative, introduced in 31 countries around the world, is a groundbreaking effort to improve access to quality mental health and social services for people with disabilities and seeks to transform health systems and services towards a person-centered and human rights-based approach, in line with the UN Convention on the Rights of Persons with Disabilities (CRPD).[142]. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems. From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. 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. Preventing institutionalization should be an important part of this plan. One mother in Bali, Indonesia shared why she chained her son with a mental health condition for over 10 years: Due to prevalent stigma and inadequate support services, families often struggle to cope with the demands of caring for a relative with a psychosocial disability and feel they have no choice but to shackle them. [32], The cost of neglecting mental health is significant; the global economy loses roughly $2.5 to $8.5 trillion per year as a result of reduced economic productivity. 2(1); CEDAW, art. In some cases, the children were fully wrapped in bandages, duct tape or clothing, like mummies. 74(e). Mental health services in the U.S. are insufficient despite more than half of Americans (56%) seeking help. [78] Human Rights Watch interview with a lawyer, Nuevo Len DIF, Monterrey, Mexico, April 11, 2019. [145] African [Banjul] Charter on Human and Peoples Rights (ACHPR), adopted June 27, 1981, OAU Doc. Please give now to support our work, Share this via Facebook Retornados carry a lot of stigma because of the criminal label that comes with deportation, says Juan Carlos Garca Rivera, a marriage and family therapist from El Salvador who is pursuing his doctorate in critical social/personality psychology at the City University of New York. Students and Human Rights Watch researchers also conducted phone interviews with activists, representatives of local NGOs, mental health professionals, and journalists. 95(d). They are run by self-proclaimed prophets and are Christian religious institutions not affiliated with other denominations, but with roots in the evangelical or Pentecostal movements, established for purposes of prayer, counseling, and spiritual healing. 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. 49) at 167, U.N. Doc. Persons with psychosocial disabilities experience physical abuse if they try to run away from institutions or dont obey the staff. It was heart-breaking.[51]. 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. Rodriguez supports the Shelter City Network, which relocates human rights defenders forced to move because of threats to their safety and provides psychotherapeutic treatment to Honduran survivors of torture, sexual violence and other crimes as they seek recourse through national and international justice systems. [132] Human Rights Watch, Ghana Breaks the Chains on Mental Health, video, https://www.youtube.com/watch?v=7idmUmMccgw; Shantha Rau Barriga, Ghana Breaks The Chains On Mental Health, commentary, Human Rights Watch Dispatch, October 16, 2017, https://www.hrw.org/news/2017/10/16/ghana-breaks-chains-mental-health; Ghana: Oversight Needed to Enforce Shackling Ban, Human Rights Watch news release, October 9, 2018, https://www.hrw.org/news/2018/10/09/ghana-oversight-needed-enforce-shackling-ban. In El Salvador, learning disabilities and speech and language disorders are not considered disabilities for purposes of statistical reporting at the national level (MINED, 2015). If we want to save lives, save families and save futures we must reimagine our behavioral health system and take concrete steps to improving consumers ability to find the care they need, when they need it, and on their terms., Despite Strong Demand for Mental Health Services, Common Barriers Remain. Amid such far-reaching and systemic challenges, many have fought to defend Central Americans right to migrate, but Lykes says its also time to start considering another inalienable rightthe right to remain. In Nigeria, boys as young as 10 were chained together in rooms with adult men, leaving them at risk of abuse. [152], The Committee on the Rights of Persons with Disabilities, an independent expert body created under the CRPD, clarified that a persons mental capacity, the ability to make decisions, can vary depending on environmental or social factors. 51. 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. Two-thirds of shortage areas are in rural or partially rural parts of the country. In certain cases throughout the report, 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. Create and carry out deinstitutionalization policies and time-bound action plans, based on the values of equality, independence, and inclusion for people with disabilities. A central issue is the lack of mental health care professionals. [6] In Somaliland, these centers are often referred to as Cilaaj from the Arabic word for healing. [47] In a number of countries including the Democratic Republic of Congo, Ghana, Kenya, and Liberia, children with disabilities can face accusations of witchcraft. Media@TheNationalCouncil.org In 15-minute interviews conducted while the Salvadoran immigration authorities processed migrants who had been deported from the United States for reentry into El Salvador, Gaborit and his colleagues assessed children and teens for depression, anxiety and somatization. In the case of private institutions and healing centers, the management may have an incentive to detain people as they are paid by the family. The study offers a comprehensive analysis of the state of mental health care in the U.S. While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. [124] Human Rights Watch interview with James [not his real name], man with a psychosocial disability, Kenya, February 2020 (name and details withheld). In Guatemala, hundreds of children with psychosocial or intellectual disabilities were tied to furniture or locked in cages in orphanages and institutions. Cohen Veterans Network and National Council for Mental Wellbeing partnered with Ketchum Analytics who conducted an online survey among 5,000 Americans, representative of the U.S. population based on age, gender, region, household income and race/ethnicity. In one exercise, facilitators ask children to predict travel time to the United States (most underestimate the length of the journey), then use an enlarged map to measure distances and show that the route is thousands of miles long and can take months. [15] Discrimination, gender-based violence, socioeconomic disadvantage, income inequality, subordinate social status and the pressure of multiple roles are among the most cited at-risk factors that contribute to poor mental health among women. They feel youre possessed and put liquid down your nose to drive out the devil. 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. The nation needs an additional 6,398 mental health providers to fill these shortage gaps. 501(c)(3) nonprofit association Many interviewees appeared undernourished and complained of hunger. [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). 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. 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. support MSFs lifesaving care with a gift. In some instances, people are provided with a small bucket in which to urinate and defecate, but these are only emptied once a day leaving a putrid smell in the room for most of the day. [66] Human Rights Watch, Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia, p. 35; Ministry of Health of Republic of Indonesia, Stop Stigma and Discrimination to People with Mental Disorder, October 10, 2014, http://www.depkes.go.id/article/view/201410270011/stop-stigma-dan-diskriminasi-terhadap-orang-dengan-gangguan-jiwa-odgj.html (accessed August 20, 2015); Marsel Rombe, Indonesian Mental Health Law Passed after Five Years, Jakarta Globe, July 13, 2014, http://jakartaglobe.beritasatu.com/news/indonesian-mental-health-law-passed-five-years (accessed August 19, 2015). 11, 69-71; sjcintern and Zoya Aleem, Chaining the Mentally Ill, post to The Upstream Journal (blog), January 2012, https://www.upstreamjournal.org/chaining-the-mentally-ill/ (accessed August 17, 2020). In Nigeria, Human Rights Watch visited 28 facilities in 8 states and the Federal Capital Territory between 2018 and 2019, across which a few hundred people were arbitrarily detained, and where people were regularly chained or shackled. Human Rights Watch research in Nigeria found that people with mental health conditions were held in iron shackles around their ankles in locked-up wards in a psychiatric hospital and in government-run rehabilitation centers. 5 (2). Establish independent and confidential complaints systems that receive and investigate complaints, including ill-treatment of persons with psychosocial disabilities in institutions. The WHOs World Mental Health Survey found that only 1 in 5 people with depression receive minimally adequate mental health services in high-income countries and it falls to 1 in 27 in low and middle-income countries. 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. [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. At night I sleep inside the house. 2 (2); ICCPR, art. As a result, documenting shackling cases is extremely challenging. [24], Globally, there is a severe shortage of trained mental health professionals, but the shortfall is particularly acute in low-income countries. In India, thousands of people with mental health conditions were found chained like cattle in the state of Uttar Pradesh. I feel sad, locked in this cell. Its very challenging to navigate domains where we may be told we dont belong, he says. 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. When the fighting happened, we left him next to the house tied up. Exacerbated by such close and unsanitary living conditions, lice and scabies are a major problem in many institutions.[97]. [51] Human Rights Watch interview with Ying (not her real name), November 2019 (location and details withheld). [174], The committee further stated that it is the governments responsibility to ensure that health services are available, accessible, acceptable, and of good quality. She began learning about services provided by the state, including "the list" for HCS services. [168], Under the CRPD, persons with disabilities have the right to choose their place of residence and with whom they live. In 2019 at Adwumu Woho Herbal and Spiritual Centre in Senya Beraku, Ghana, about 60 kilometers from the capital, Accra, several men who were shackled and arbitrarily detained shouted out to a Human Rights Watch researcher: Help us get out of the chains. A/44/49 (1989), entered into force September 2, 1990, art. Due to these perceptions, people dont want to help or mingle with persons with disabilities.[50], Ying, a young woman from Goungdong province, in southern China, said: All through my childhood, my aunt was locked in a wooden shed and I was forbidden to have contact with her. The cost of mental health services can be prohibitive. Improve quantitative and qualitative data collection at the local and national levels on the current number of people shackled, the reasons families continue to practice shackling, and the support or services they would need to discontinue the practice. We dont know if hes dead or alive.[108] While Covid-19 has exposed the importance of psychological wellbeing and the need for connection and support within communities, it has exacerbated the risk to people with psychosocial disabilities. hospital bed.[60]. 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 one case, a person died while tied up and locked in one of the bathrooms, which was used as an isolation room. Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. [118] Yulia Gorbunova, Held in Chains in Russia, commentary, Human Rights Watch Dispatch, August 8, 2017, https://www.hrw.org/news/2017/08/08/held-chains-russia. [164], The CRPD introduces strong safeguards against arbitrary detention and deprivation of liberty for people with disabilities, stating that the existence of a disability shall in no case justify a deprivation of liberty.[165], In her 2019 report, the UN special rapporteur on the rights of persons with disabilities stated that: The deprivation of liberty on the basis of impairment is a human rights violation on a massive scale. [19], Governments have long neglected to invest in mental health services. When it comes to seeking mental health care, the Latinx community has always struggled with stigmaboth in and outside of the United States. 10. 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. Not only has the lack of access to primary health care services contributed to the deterioration of the health of patients with chronic diseases, resulting in more deaths, but both the ambulance system and hospitals are operating at full capacity. On average, countries spend less than 2 percent of their health budgets on mental health. 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. Founded in 1969, the National Council for Mental Wellbeing is a membership organization that drives policy and social change on behalf of over 3,100 mental health and substance use treatment organizations and the more than 10 million children, adults and families they serve. 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.. According to the Results from the 2021 National Survey on Drug Use and Health: Detailed Tables, approximately 8.6 million nonmetropolitan adults reported having any mental illness (AMI) in 2021, accounting for 22.7% of nonmetropolitan adults. In addition to similar financial incentives, the HRSA will waive the residency requirements for J-1 visa holders who agree to deliver health care for three years in a health care professional shortage area, encouraging foreign providers to address the needs of underserved areas. The number of new jobs and the unemployment rate are regularly cited in the news, but theyre just part of the picture. As of September 2020, the program had reached 48 million roughly 70 percent of Indonesian households. [53] Human Rights Watch, Treated Worse Than Animals, https://www.hrw.org/sites/default/files/report_pdf/india1214.pdf, p. 38. 85. In Mexico, for example, children with psychosocial disabilities in one institution were fully wrapped in bandages, duct tape or clothing, like mummies. Institutions: Refers to state-run (unless specified otherwise) psychiatric hospitals, government social care or nongovernmental organization-run residential facilities. 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. Of all sectors of health care, mental health is best equipped to stand against racism. [106] Human Rights Watch, Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia. The . [72] Disability Rights International, Still in Harms Way - International Voluntourism, Segregation and Abuse of Children in Guatemala, July 16, 2018, https://www.driadvocacy.org/wp-content/uploads/Still-in-Harms-Way-2018.pdf (accessed August 1, 2020), p. V. [73] Moroccan Minister of Health to Close Bouya Omar Shrine, Morocco World News, April 16, 2015, https://www.moroccoworldnews.com/2015/04/156319/moroccan-minister-of-health-to-close-bouya-omar-shrine/ (accessed April 1, 2020). Its a crucial part of larger efforts to strengthen our social fabric and to repair the damage caused by sociopolitical violence.. 50, 56-57; Amnesty International, Our Hearts Have Gone Dark The Mental Health Impact of South Sudans Conflict, July 2016, https://www.amnesty.org/download/Documents/AFR6532032016ENGLISH.PDF (accessed September 22, 2020), pp. There is a shortage of bilingual or Spanish speaking mental health professionals. Typically, people in these centers have been placed there by their families or by local police, some forcibly. 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. [179] UN General Assembly, Report of the Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, A/64/272, August 10, 2009, https://undocs.org/en/A/64/272 (accessed September 23, 2020), para. Over 400 million people worldwide lack access to essential health services typically delivered through primary healthcare. 90% of our funding comes from individual donors. El Salvador's citizens have faced multiple traumas in the past decades: war, gang violence, natural disasters and now COVID-19. Target support toward community-based support and services, including mental health services. [147] Non-discrimination is one of the cardinal principles on which the CRPD is grounded. Many think disability is a curse resulting from evil spirits. Human Rights Watch would also like to thank the many disabled persons organizations, nongovernmental organizations, activists, lawyers, and mental health professionals working in the fields of disability rights and mental health who shared their insights and analyses with us or otherwise provided assistance. 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. 1516; Human Rights Watch, Like A Death Sentence, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana, p. 30. In other cases, people have to use a drain or an open toilet in the room. Due to a lack of resources, coordination, and training, both the TPKJM and the rapid response teams struggle to successfully rescue people from pasung. [138] Human Rights Watch phone interview with Joshua Duncan, program manager, Mental Health Coalition of Sierra Leone, September 25, 2020. The HRSA also runs several training programs to address the shortage of mental health professionals. In Yemen, Human Rights Watch documented the case of a woman with a perceived mental health condition who was chained to a door handle so she would not wander outside. In 2019, this happened to [our teams] 11 times from January to June. (No. 8. But Garca Rivera says that in light of the crisis in Central America, psychologists must do more than conduct research, provide clinical services and design community interventions. Many had old and leaking roofing. While the expectation was that families would regularly bring food for relatives, this rarely happened. [48] Karolina Kozik and Jean-Sbastien Spulchre, Disability Rights Bill Offers Hope in Congo, commentary, Human Rights Watch Dispatch, March 11, 2020, https://www.hrw.org/news/2020/03/11/disability-rights-bill-offers-hope-congo; Sophie Morgan, The country where disabled people are beaten and chained, BBC News Online, July 28, 2015, https://www.bbc.com/news/blogs-ouch-33523742 (accessed September 21, 2020); Shantha Rau Barriga (Human Rights Watch), Torture Comes in Many Forms, commentary,The Huffington Post, June 29, 2015, https://www.huffpost.com/entry/torture-comes-in-many-for_b_7691390?guccounter=1 (accessed September 16, 2020). With the right kind of support, people with mental health conditions can live and thrive in their communities. UNHCR, 2014, Carrying a Heavy Load: Mayan Womens Understandings of Reparation in the Aftermath of Genocide 46) at 193, U.N. Doc. 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. In state-run or private institutions, as well as traditional or religious healing centers, they are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence. CBP data echo the demographic shiftthe majority of migrants detained at the border are now families or unaccompanied children rather than adult men (Recent Migration to the United States From Central America: Frequently Asked Questions, Congressional Research Service, 2019). (No. A young woman raised by her grandmother in Honduras leaves to reunite with her parents after more than a decade. 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. [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). And women and girls are not supported to manage their menstrual hygiene, for example through the provision of sanitary pads. Human Rights Watch research found that in institutions and healing centers visited, people with psychosocial disabilities often live in severely overcrowded and unhygienic conditions. 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. We send regular emails about upcoming events, member spotlights and updates in mental wellbeing. 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.