In the U.S., mental health issues are far more common than many realize. According to WHO, over 10 million children under the age of five who. And we promote greater understanding of mental wellbeing as a core component of comprehensive health and health care. San Salvador/New York, July 9, 2020The health system in El Salvador is on the brink of collapse, with an increasing number of people dying from COVID-19 and other illnesses at home before they can receive medical care, said the international medical humanitarian organization Doctors Without Borders/Mdecins Sans Frontires (MSF). 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. [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]. [168], Under the CRPD, persons with disabilities have the right to choose their place of residence and with whom they live. Human Rights Watch phone interview with Dr Irmansyah, psychiatrist and health ministry official, September 23, 2020. [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. [58] Human Rights Watch witnessed several people being shackled in a psychiatric hospital in northern Nigeria. Its heart-breaking that two of my cousins who have mental health conditions have been locked away together in a room for many years. 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. Today, Cohen Veterans Network (CVN), a national not-for-profit philanthropic organization, and National Council for Mental Wellbeing, the unifying voice of Americas health care organizations that delivers mental health and addiction treatment and services, issued the inaugural Americas Mental Health 2018, a comprehensive study of access to mental health care, at the 2018 Cohen Veterans Care Summit in Washington D.C. 16) at 49, U.N. Doc. Worryingly, community leaders are reporting deaths in their communities, some of them related to the suspension of primary health care.. I was taken to a traditional healing center where they cut my wrists to introduce medicine and another one where a witch doctor made me take baths with chicken blood. This study of decentralization of mental health services in El Salvador supports the concerns of LAC mental health leaders and researchers that progress toward community mental health services has been slow and is far from being achieved. Informed consent is the bedrock of the right to health, especially when it comes to people with psychosocial disabilities. The exchange, co-founded by clinical psychologist Leticia Gonzalez Pileski, PsyD, and Jason Platt, PhD, a counseling psychologist based in Mexico City, holds one-day conferences where students discuss their work in liberation psychology and organizes trips to war-torn areas of El Salvador to help survivors preserve cultural memory about the violence they endured. 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. Children should have access to child psychologists and specialist support services. 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. She began learning about services provided by the state, including "the list" for HCS services. 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. (Clockwise from top left): 2014 Fadel Senna/AFP via Getty Images; 2011 Andrea Star Reese; 2011 Andrea Star Reese; 2019 Andrea Star Reese; 2018 Andrea Star Reese; 2019 Robin Hammond/Human Rights Watch; 2019 Andrea Star Reese; 2018 HRW. The study offers a comprehensive analysis of the state of mental health care in the U.S. The United States, by comparison, spends about 8% of its health-care budget on mental health (Dieleman, J.L., et al., JAMA, Vol. Rural Americans are also less accepting of mental health services and care. Share this via Twitter 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,. For example, Ghana has several hundred prayer camps, but precise numbers are difficult to come by since they are not state-regulated. Photo montage of people being shackled for weeks, months, and sometimes even years in Indonesia, Nigeria, Ghana, and Morocco. [110] Fasting would help to starve evil spirits and enable God and prayer to heal them. Immediately end the use of chaining, nonconsensual fasting, and any form of detention. We remove their clothes so they wont run away or escape.[99] Another supposed reason for keeping the residents naked was to prevent them from attempting to take their own lives by hanging, although staff still gave residents blankets and mosquito nets. [112], When institutions provided food, people with psychosocial disabilities told Human Rights Watch that it was too meagerat times, just one meal a day. 40, entered into force November 25, 2005. [104] Human Rights Watch visit to an NGO-run institution in Herat, Afghanistan (name and details withheld). 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. In the eastern metropolitan area of San Salvador, an increasing number of people are dying at home. [60] Human Rights Watch visit to Lawang Mental Hospital, East Java, Indonesia, August 12, 2015. 51) at 197, U.N. Doc. 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. [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). 31, The Right to Health, http://www.ohchr.org/Documents/Publications/Factsheet31.pdf (accessed September 22, 2020), pp. [150], The CRPD introduces a significant shift in approach to legal capacity, giving agency to people with disabilities and empowering them to make decisions and exercise rights on their own behalf. There are currently 10 Steven A. Cohen Military Family Clinics nationwide. Gangs often threaten teens or adults with rape or murder, forcing entire families to flee their homes (World Report 2019, Human Rights Watch). People with mental health conditions can also be arbitrarily detained and chained in state-run social care institutions and psychiatric hospitals. 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, vigorous massages by traditional healers, Quranic recitation in the persons ear, and special baths. The numbers simply don't lie. To support the right to remain, some psychologists seek to better understand the complex decision about whether to migrate. 39/46, annex, 39 U.N. GAOR Supp. Despite being commonly practiced around the world, shackling remains a largely invisible problem as it occurs behind closed doors, often shrouded in secrecy, and concealed even from neighbors due to shame and stigma. In Mexico, Felipe Orozco, a 41-year-old man, told Human Rights Watch he had been hospitalized five times because he had a mental health condition. In comparison, 1,560 did in the 2014-2015 academic year. MSF is also hearing worrying reports about the situation in some communities in San Salvador and Soyapango. For example, in 2017 India passed a landmark mental health care bill that explicitly prohibited people with mental health conditions from being chained in any manner or form whatsoever.[129] While the provision has proven challenging to implement, it enabled a lawyer to challenge in court cases of people shackled in homes and faith-based institutions in the state of Uttar Pradesh, India. 171, entered into force March 23, 1976; International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. In some healing centers, people were allowed to bathe once a day using a hose in their rooms. No mother on earth wants to chain her son.[57], Human Rights Watch has also found evidence of shackling or chaining in psychiatric hospitals in some countries. Yet, there are very few mental health professionals, especially for the majority of the population who rely on the public health system. [139] 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). As part of the project, WHO developed a toolkit with practical information and resources for countries to assess and improve the quality of and human rights standards in mental health services. 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. [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. Physicians thought Bill Mitchell had dementia and could be a danger to himself or others, according to medical records. [12] The World Health Organization (WHO) reports that one in five of the worlds children and adolescents have a mental health condition. However, in prayer camps and institutions, many interviewees spoke of persistent, gnawing hunger from forced fasting or inadequate food. Pennsylvania, New York and Minnesota ranked among the top. Turkey-Syria earthquakes: MSF teams in Syria are caring for the injured. 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). For example, in Bali, Indonesia, a mother from a wealthy family said: We are from a high caste and when my son gets lost and wanders on the streets without proper clothing, without showering, its a cause for shame. 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. 37. [99] Human Rights Watch interview with Archbishop Danokech, Archbishop at the Holy Ghost Coptic Church of Africa, Kisumu, Kenya, February 18, 2020. Many are forced to eat, sleep, urinate, and defecate in the same tiny area. It is typically an administrative process and does not contain any provisions for judicial oversight. [And] increase the response capacity of the emergency transfer services in critical cases. 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. Individuals were either crowded in the few spots where there was shade or baked in the sun. [94] Human Rights Watch interview with Mudinat Genrola, woman with a psychosocial disability, Ibadan, September 9, 2019. In 2025, demand may outstrip supply by 6,090 to 15,600 psychiatrists, according to a 2017 National Council for Behavioral Health report that explores the shortage's causes and suggests solutions. Share this via Telegram When asked if they would be open to using it, almost half, or 45%, of Americans who have not already tried telehealth services said they would be open to the idea of trying a service to address a current or future mental health need. Around the world, hundreds of thousands of men, women, and children with mental health conditions have been shackledchained or locked in confined spacesat least once in their lives. Bobele, M., & Slive, A.In Hoyt, M.F., & Talmon, M. 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. And when natural disasters such as hurricanes strike, aid is not available to help residents recover. [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. Traditional or spiritual healing centers are also considered types of rudimentary institutions. 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). [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. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. 1. As a result of this initiative, according to the WHO, 1,700 people were freed from chains in Somalia between 2007 and 2010. 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. [43] Despite modest governmental efforts to raise awareness in some countries, mental health conditions remain taboo and highly misunderstood. The chain is so heavy. The World Health Organization's new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention . E/C.12/2000/4 (2000), para. [177], The CRPD further provides that health information be accessible to persons with disabilities and that the delivery of health services not discriminate on the basis of disability. Support national governments in reducing stigma and discrimination against people with psychosocial disabilities. We offer counseling appointments in our center with a psychologist. [3] This encompasses the right to personhood, being recognized as a person before the law, and legal agency, the capacity to act and exercise those rights. 2200A (XX1), 21 U.N. GAOR Supp. Budget allocations for mental health care are barely 1% of the total health care budgets; and the psychiatric hospitals located in the national capitals consume at least 90% of those funds. 2 Such changes may include increased sadness or irritability, loss of appetite, weight changes, insomnia, reduced energy, loss of interest in pleasurable activities, feelings of guilt and hopelessness, difficulty concentrating, and/or (No. The losses of productivity caused by poor mental health include but are not limited to the following: Negative job performance. 16-18. [18] Between 76 and 85 percent of people with mental health conditions who live in middle or low-income countries do not have access to mental health services. 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. Malakis story helped shape his community to be more inclusive and accepting. Mauricio Gaborit, PhD, a social psychologist who studies the migration of children and adolescents at Universidad Centroamericana Jos Simen Caas in El Salvador, has documented increasing rates of migration among adolescent girls and children under age 12. 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. 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. A/810 at 71 (1948), art. The nation needs an additional 6,398 mental health providers to fill these shortage gaps. Despite being easy to diagnose, there is a lack of mental health experts to treat these illnesses in Mexico. Thus, an Support for Central Americans. [112] Ghana: Faith Healers Defy Ban on Chaining, Human Rights Watch news release, November 27, 2019, https://www.hrw.org/news/2019/11/27/ghana-faith-healers-defy-ban-chaining. The response time is often less than ideal because of the heavy traffic in San Salvador. The ambulance system and hospitals are operating . Please open the door. Crosby, A., et al., Journal of Genocide Research, 2016, One Session at a Time: When You Have a Whole Hour It is also essential to guarantee access to primary health care and improve case detection and follow-up to prevent cases from becoming serious, whether they are COVID-19 or not.". [59] Human Rights Watch interview with a psychiatrist, Nigeria, March 27, 2019 (name and location withheld). 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. In addition, the local and national governments dont have coordinated detection and hospitalization mechanisms for COVID-19 cases. [117], Staff in state-run and private institutions admitted that they hold people down to put pills in their mouth or force-feed them food or drinks laced with medicines. Layout, design, and production were coordinated by Travis Carr, publications coordinator; Sakae Ishikawa, senior video editor; Veronica Matushaj, director of documentary video and photography; Paula Beegan, consultant in the Disability Rights Division; Remy Arthur, associate; Jon Nealon, consultant in the Multimedia Division; Fitzroy Hepkins, senior administrative manager; and Karolina Kozik, senior coordinator in the Disability Rights Division. People shackled in homes typically ate the same meal as the family. In Guatemala, hundreds of children with psychosocial or intellectual disabilities were tied to furniture or locked in cages in orphanages and institutions. Many facilities have low-grade medical equipment, are almost always understaffed, and often run out of medicine. In the worst of cases, depression can lead to suicide - an estimated 63,000 people kill themselves every year in the Americas. However, it will be a challenge for the country to maintain those numbers considering how the COVID-19 pandemic is impacting the economy and the exports the country relies on. In South Sudan, Human Rights Watch in 2012 and Amnesty International in 2016 documented people with real or perceived psychosocial disabilities being chained and detained in prison, not because they had committed a crime but simply because they had a disability. 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. 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. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. A/61/49 (2006), entered into force May 3, 2008. [8] World Health Organization (WHO), Gender and Women's Mental Health, undated, https://www.who.int/mental_health/prevention/genderwomen/en/ (accessed July 21, 2020); WHO, Mental disorders, November 28, 2019, https://www.who.int/news-room/fact-sheets/detail/mental-disorders (accessed June 22, 2020); WHO, Mental health in the workplace, May 2019, https://www.who.int/mental_health/in_the_workplace/en/ (accessed June 22, 2020); WHO, Mental Health, October 2, 2019, https://www.who.int/news-room/facts-in-pictures/detail/mental-health (accessed June 22, 2020). [153], In its interpretation of the treaty provisions, the committee stated, At all times, including in crisis situations, the individual autonomy and capacity of persons with disabilities to make decisions must be respected.[154], The UN special rapporteur on torture has noted that shackling unequivocally amount(s) to torture even if committed by non-State actors under conditions in which the State knows or ought to know about them.[155], The core human rights treaties prohibit subjecting any person to torture or to cruel, inhuman, or degrading treatment or punishment, including non-consensual medical or scientific experimentation. [45]In urban as well as rural areas in numerous countries there is a widespread belief that mental health conditions are the result of a variety of factors, including witchcraft, black magic, a curse, past sins, or possession by evil spirits or the devil. In the case of social care institutions, NGO-run or traditional or religious healing centers, people sometimes used false pretenses to get their relatives to enter an institution, or simply provided no explanation at all. Its very challenging to navigate domains where we may be told we dont belong, he says. The Cohen Veterans Network (CVN) is a 501(c)(3) national not-for-profit philanthropic organization for post-9/11 veterans and their families. Provide counseling and other forms of support to people with psychosocial disabilities and their families. A/6316 (1966), 993 U.N.T.S. [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). In Nigeria, boys as young as 10 were chained together in rooms with adult men, leaving them at risk of abuse. Last year, staffing shortages at the Alabama Department of Mental Health caused a temporary halt in admissions at one of three remaining state hospitals that provide long-term mental health care.
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