lack of mental health services in el salvador

The lack of a community-based mental health system continues to. Thus, an I last took a bath days ago. [156] ICCPR, art. Students in UVGs masters program in psychological counseling and mental health, which Cbar Cataln directs, also conduct preventive workshops in agrarian communities in western Guatemala. 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. 90-92. 14: The Right to the Highest Attainable Standard of Health, U.N. Doc. [1] Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Others think persons with disabilities are useless. [55] Shackling is also used in church-affiliated prayer camps, traditional or religious healing centers as well as in state-run or private social care institutions as a form of restraint, punishment, or treatment.[56]. 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). The numbers simply don't lie. 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. 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. 37; CRPD, art. My aunt has tried her best to support them but she struggles with stigma and the lack of robust mental health services in Oman. The report was edited by Rau Barriga; erimovi; Bader; Muscati; Pedneault; Ros Espinosa; Almasri; Afrah Nasser, researcher in the Middle East and North AfricaDivision; Nisha Varia, advocacy director of the Womens Rights Division; Bede Sheppard, deputy director of the Childrens Rights Division; Mausi Segun, director of the Africa Division; Corinne Dufka, associate director in the Africa Division; Ilaria Allegrozzi and Otsieno Namwaya, senior researchers in the Africa Division; Zenaida Machado and Nyagoah Pur, researchers in the Africa Division; Patricia Gossman, associate director in the Asia Division; Andreas Harsono, and Saroop Ijaz, senior researchers in the Asia Division; Almaz Teffera and Yaqiu Wang, researchers in the Asia Division; Jayshree Bajoria, research consultant in the Asia Division; Eric Goldstein, deputy director of the Middle East and North Africa Division; Ahmed Benchemsi, advocacy director in the Middle East and North Africa Division; Martina Rapido Ragozzino, research assistant in the Americas Division; Csar Muoz, senior researcher in the Americas Division; Tyler Mattiace, researcher in the Americas Division; Tanya Lokshina, associate director in the Europe and Central Asia Division. [92] UN Committee on Civil and Political Rights, General Comment No. [40] Human Rights Watch interview with Ridha, family member, September 2020 (full name and details withheld). A/61/49 (2006), entered into force May 3, 2008; Optional Protocol to the Convention on the Rights of Persons with Disabilities, adopted December 13, 2006, G.A. [57] Human Rights Watch interview with mother of a man with a mental health condition, Bali, Indonesia, November 19, 2020 (full name and details withheld). Specifically, younger Americans need more information on how and where to access care. [105], Shackling affects a persons mental as well as physical health. Create and carry out deinstitutionalization policies and time-bound action plans, based on the values of equality, independence, and inclusion for people with disabilities. Spending on mental health treatment and services reached $225 billion in 2019, according to an Open . Kessler says that mental disorders are treated as acute, episodic ailments instead of chronic illnesses. [70] Nigeria: People With Mental Health Conditions Chained, Abused, Human Rights Watch news release, November 11, 2019, https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused. The stigma attached to psychosocial disabilities extends to the mental health profession, which often discourages doctors from specializing in psychiatry and causes many general physicians and other health care workers to resist mental health training. 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. If we miss hygiene, they give us a punishment. There are currently no coordinated international or regional efforts to eradicate shackling. Personal hygiene is a serious problem since people who are chained often do not have access to a toilet. For others, poverty and lack of work opportunities are the driving forces behind migrationin Honduras, more than 60% of the population lives below the poverty line (World Bank, 2018). In many institutions in Indonesia, people with psychosocial disabilities were fed meals devoid of proper nutrition such as instant noodles for most meals.[113]. In some instances, people are provided with a small bucket to urinate and defecate in, but these are emptied only once a day leaving a putrid smell in the room for most of the day. [79], Shackling is a disability-specific form of deprivation of liberty that occurs around the world, regardless of the economic situation of the country or its legal tradition.[81]. In India, thousands of people with mental health conditions were found chained like cattle in the state of Uttar Pradesh. 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. The announcement was made via a DOD press release. [9] WHO, Gender and Women's Mental Health, https://www.who.int/mental_health/prevention/genderwomen/en/. Children should have access to child psychologists and specialist support services. While many countries are increasingly starting to pay attention to the issue of mental health, the practice of shackling remains largely invisible. In many countries there is very limited, if any, government oversight of these institutions. We worked closely with partner organizations to visit private homes and institutions in Afghanistan, Burkina Faso, Cambodia, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, Russia, the self-declared independent state of Somaliland, South Sudan, and Yemen. Those who experience sexual violence encounter many barriers to reporting the abuse safely and confidentially, and are unlikely to access time-sensitive health care, for example to prevent sexually transmitted infections or pregnancy or to access A/39/51 (1984), entered into force June 26, 1987; Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Ensure these programs are gender-sensitive. Child: The word child, boy, or girl in this report refers to someone under the age of 18. The government identifies shortage areas so it can address them with proper resources. Ensure coordination between mental health professionals and staff at prayer camps to offer mental health services based on free and informed consent. [120] In addition, the UN special rapporteur on violence against women has condemned forced psychiatric treatment as a form of violence.[121]. Keep up with the latest data and most popular content. However, legal capacity is a universal attribute inherent in all persons by virtue of their humanity and people can therefore not be stripped of it. When the Special Olympics team had Malaki released, he got the opportunity and training to play football. The UN special rapporteur on the right to health noted that: In her 2018 report, the UN special rapporteur on the rights of persons with disabilities called on states to ensure that all health-related services include a human rights-based approach to disability, are non-discriminatory, seek informed consent prior to any medical treatment, respect privacy and are free from torture or other cruel, inhuman or degrading treatment.[180]. 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. A Salvadoran teen and his family flee a death sentence from a local gang. We build the capacity of mental health and substance use treatment organizations. People who are shackled to one another are forced to go to the toilet or sleep together. 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. [92] It cannot be discriminatory and should never be justified on the basis of the existence of a disability.[93]. 35, Article 9: Liberty and security of person, U.N. Doc. Establish independent and confidential complaints systems that receive and investigate complaints, including ill-treatment of persons with psychosocial disabilities in institutions. People with psychosocial disabilities who are shackled in homes and institutions experience physical abuse if they try to run away from institutions or dont obey the staff. The ACHPR has been ratified by Benin, Burkina Faso, Cte dIvoire, Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Kenya, Liberia, Mozambique, Nigeria, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Tanzania, Togo, Uganda, and Zimbabwe; Protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa (Maputo Protocol), adopted July 11, 2003, CAB/LEG/66.6, reprinted in 1 Afr. [48] In March 2019, six people with mental health conditions, including three children, were chained to logs in a Christian faith healing center in Montserrado, Liberia because they were accused of witchcraft. Faith healers in Ghana, Indonesia, Kenya, and Nigeria reported sharing the little food available among all the residents, especially because some families did not provide food for their relatives, and prayer camps and institutions said they did not have the resources to buy enough food for everyone. In 2020, among the 14.2 million adults with SMI, 9.1 million (64.5%) received mental health treatment in the past year. L Guan et al., Unlocking Patients with Mental Disorders Who Were in Restraints at Home: A National Follow-Up Study of Chinas New Public Mental Health Initiatives, PLOS ONE 10(4) (2015), https://doi.org/10.1371/journal.pone.0121425 (accessed September 22, 2020). [46] UNHRC, Report of the Special Rapporteur on the rights of persons with disabilities, Catalina Devandas-Aguilar, A/HRC/40/54, January 11, 2019, https://undocs.org/en/A/HRC/40/54 (accessed July 26, 2020), para. The ACRWC has been ratified by Benin, Burkina Faso, C. American Convention on Human Rights (ACHR), adopted at the Inter-American Specialized Conference on Human Rights, San Jos, Costa Rica, 22 November 1966. 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. Shackling is typically practiced by families, faith healers, or staff in institutions who believe that the person with the psychosocial disability is possessed or are worried that they may run away or might hurt themselves or others. [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. Under the 686 unlocking initiative, 266 people were given mental health medication and 88 percent of all those who were unlocked were admitted to a psychiatric hospital. [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). [160] In the 2020 report on psychological torture, the UN special rapporteur also notes that practices like the spiritual healing of mental illnesses. 171, entered into force March 23, 1976; International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. There is a mental health crisis in America. [165] CRPD, art. In Nigeria, boys as young as 10 were chained together in rooms with adult men, leaving them at risk of abuse. 51. 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. Informed consent is the bedrock of the right to health, especially when it comes to people with psychosocial disabilities. 2200A (XX1), 21 U.N. GAOR Supp. Two months ago, social protection officials tried to discharge me from the hospital and send me to my sisters house, but she refused. 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). Although mental health professionals had suspected mistreatment at the facility for years, the cases only came to light once video footage was anonymously leaked. A special thank you to the Swedish Postcode Lottery; the Samuel Family Foundation; Tracy and Bruce Simpson; Cristina Sainz and Enrique Prez-Hernndez; Renaud and Marina de Planta; Kiran Chandaria; and Nadge and Christophe Hentsch for the financial support that made this research and report possible. [107] Amnesty International, Excluded: Living with Disabilities in Yemens Armed Conflict, December 3, 2019, https://www.amnesty.org/download/Documents/MDE3113832019ENGLISH.PDF (accessed August 3, 2020), p.17. In a privately-run social care institution in Russia, staff regularly brought people with psychosocial disabilities to the dining hall chained to each other and forced them to eat in handcuffs. 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. Accessibility means that health services should be affordable, situated within easy physical reach, and be offered to everyone without discrimination. [104] In a privately-run social care institution near Briansk, southwest of Moscow, Russia, staff regularly brought people with psychosocial disabilities to the dining hall chained to each other, and forced them to eat in handcuffs. In 2006, the WHO launched the Chain-Free Initiative in Somalia and Afghanistan. In 2019, this happened to [our teams] 11 times from January to June. If you get exhausted due to a lot of work, and so dont want to work anymore, you get caned.[124] In Nigeria, people in Islamic rehabilitation centers told Human Rights Watch that staff whipped them. doi: 10.26633/RPSP.2018.172. 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. 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]. [99] Human Rights Watch interview with Archbishop Danokech, Archbishop at the Holy Ghost Coptic Church of Africa, Kisumu, Kenya, February 18, 2020. [83] Mohamed Rushdie, Torture, Rape and Death Are Crimes That Pursue 8 Million Psychiatric Patients in Egypt, January 29, 2018, https://www.tahrirnews.com/Story/866399/%D8%A7%D9%84%D8%AA%D8%B9%D8%B0%D9%8A%D8%A8-%D9%88%D8%A7%D9%84%D8%A7%D8%BA%D8%AA%D8%B5%D8%A7%D8%A8-%D9%88%D8%A7%D9%84%D9%85%D9%88%D8%AA-%D8%AC%D8%B1%D8%A7%D8%A6%D9%85-%D8%AA%D9%84%D8%A7%D8%AD%D9%82-8-%D9%85%D9%84%D8%A7%D9%8A%D9%8A%D9%86-%D9%85%D8%B1%D9%8A%D8%B6-%D9%86%D9%81%D8%B3%D9%8A-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1/%D8%AC%D8%B1%D9%8A%D9%85%D8%A9 (accessed August 3, 2020). Human Rights Watch interviewed people with psychosocial disabilities who were shackled to trees, logs, pillars in a courtyard, dilapidated sheds without a roof over their heads, protection from the sun or rain, and with constant exposure to mosquitoes and pests. Amina, who had a breakdown after her mother died and was taken to various Islamic healers, said she was tied with ropes, beaten, and spat on in one rehabilitation center in Kaduna, and then molested by a traditional healer in Abuja who came to her home: He told me to undress, that it is the part of the healing process, and then he started touching my body, Amina said. For example, Ghana has several hundred prayer camps, but precise numbers are difficult to come by since they are not state-regulated. Carlos, a man with a psychosocial disability who had been chained and treated against his will in faith healing institutions in Mozambique, said: Human Rights Watch documented physical and sexual violence against people with psychosocial disabilities who were shackled in homes and institutions. Families or staff in institutions often make the person who is shackled stay naked, dress in very scant clothing, or wear an adult diaper, so it is easier for them to keep the person clean and they do not have to regularly wash soiled clothing. [147] ICESCR, art. 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. [8] Women, given the high incidence of sexual violence they suffer, are also disproportionately affected by Post-Traumatic Stress Disorder (PTSD).[9]. Rural Americans are also less accepting of mental health services and care. There are currently no coordinated international or regional efforts to eradicate shackling. Mental Wellbeing, www.cohenveteransnetwork.org/AmericasMentalHealth, More than 4 in 10 U.S. Please give now to support our work, Share this via Facebook I hate the shackles. In a few countries, government efforts at the national level to eradicate shackling have had some success in creating a roadmap to ending the practice. 31, no. During the COVID-19 outbreak in El Salvador, MSF teams have continued to provide primary healthcare and mental health services in communities, as well as psychosocial assistance in detention centers for deported people, and expanded ambulance response capacity in support of the Salvadoran Medical Emergency System. And when natural disasters such as hurricanes strike, aid is not available to help residents recover. [25] WHO, Mental Health Atlas 2017, 2018, https://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1 (accessed July 21, 2020), p. 30. support MSFs lifesaving care with a gift. Dont put a lock on it. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems.[106]. 5, 21 I.L.M. (No. [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/. I am not free to walk about. 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, particularly mental health care. [90] For example, in Nigeria, in 2019, while the average monthly earning was roughly 18,000 Naira ($47), a traditional healer would charge anywhere between 2,000 to 150,000 Naira ($5 to $388) for spiritual treatment.[91]. In addition, as the state's . There are currently over half a million people working in mental health roles like psychiatry, psychology, counseling, and therapy. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. Res. My family believed her mental health condition would stigmatize the whole family. The COVID-19 pandemic has only made the situation more complex. A 2019 evaluation conducted by the Institute of Mental Health, University of Nottingham found that people who completed the QualityRights e-training course showed significant improvements in attitudes and practices towards a human rights based approach to mental health, including the need to end force and coercion in mental health services and to provide information and choice as well as respect peoples decisions concerning treatment. [147] Non-discrimination is one of the cardinal principles on which the CRPD is grounded. QualityRights also focuses on empowering advocates and self-advocates to influence policy-making and push for national legal reforms to meet the standard set by the CRPD. Along with hundreds of thousands of others, these Central Americans are migrating north this year seeking asylum, employment and family reunification. Jos Enrique Hernndez, a nurse from one of the specialist 'family care' teams set up by the Ministry of Health in El Salvador's capital city, San Salvador, has never carried out so many cervical smears, to test for cervical cancer, in a single morning session. 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. While Gov. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. Sophia Majlessi As of September 2020, the program had reached 48 million roughly 70 percent of Indonesian households. In Latin America, 5% of the adult population suffers from it, but most neither seek - nor receive - treatment, according to the WHO. Institutions: Refers to state-run (unless specified otherwise) psychiatric hospitals, government social care or nongovernmental organization-run residential facilities. 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. [56] Any criticism of faith-based institutions is not linked to their religious roots or spiritual nature. (No.16) at 52, U.N. Doc. Urge national governments to ban shackling of people with real or perceived mental health conditions and develop adequate, quality, and voluntary community-based support mental health services.