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. Other ways to share 2 (1); ACHPR, arts. The Black community, in particular, is affected by mental health, often due to: Lack of health insurance. (2019, October 1). Travel restrictions have since been lifted but outpatient consultations at hospitals and health units remain suspended. It doesnt feel right; it makes me sad. [79] Human Rights Watch interview with Aisha [not her real name], family member, Gaza, February 15, 2020. [174] UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. Adults Who Needed Substance Use and Mental Health Care Did Not Get Treatment, National Council will Honor Five Distinguished Recipients with Awards of Excellence During NatCon22, Statement from National Council for Mental Wellbeing President and CEO Chuck Ingoglia on the Senate Finance Committees Hearing on February 8. [24] Human Rights Watch, Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia, March 2016, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, pp. [116] Human Rights Watch interview with Carlos [not his real name], man with a psychosocial disability, Maputo, November 20, 2019. 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. In Germany, initial annual mental health service use and general health service use for Syrian refugees with untreated PTSD were much lower than for the local population with similar mental health needs, potentially because of barriers such as mental health stigma, language, coverage restrictions and a lack of awareness of services among . [1] Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Of the 61 countries considered in this report, 56 are party to ICCPR, 57 are party to ICESCR, 59 are party to CEDAW, 55 are party to CAT, 61 are party to CRC, and 59 are party to CRPD. On average, countries spend less than 2 percent of their health budgets on mental health. 5 (2). [137] There is no publicly available current data on whether the people released by the 686 initiative remain free or whether they have access to ongoing support in the community. For the purpose of this report, shackling is used in a broader sense to refer to the practice of confining a person with a psychosocial disability using chains, locking them in a room, a shed, a cage, or an animal shelter. Immediately end the use of chaining, nonconsensual fasting, and any form of detention. [105], Shackling affects a persons mental as well as physical health. This inhumane practicecalled shacklingexists due to inadequate support and mental health services as well as widespread beliefs that stigmatize people with psychosocial disabilities. Of the 60 countries where Human Rights Watch found evidence of shackling, only a handful of countries have laws, policies, or strategies in place that explicitly ban or aim to end shackling of people with mental health conditions. A/44/49 (1989), entered into force September 2, 1990; United Nations Convention on the Rights of Persons with Disabilities (CRPD), adopted December 13, 2006, G.A. The number of new jobs and the unemployment rate are regularly cited in the news, but theyre just part of the picture. [51] Human Rights Watch interview with Ying (not her real name), November 2019 (location and details withheld). [139] After long-term advocacy by organizations such as the Mental Health Coalition of Sierra Leone, chaining was banned in policy. However, even in countries that have formally banned shackling, the practice continues to exist due to prevalent stigma and inadequate support services. Ensure that people who have been released from state and private institutions have access to psychosocial support and social services. 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. [90] Human Rights Watch interviews with Badini Ousseini, country director of CBM Burkina Faso, Ouagadougou, January 22, 2020. Along with hundreds of thousands of others, these Central Americans are migrating north this year seeking asylum, employment and family reunification. [28] WHO, Mental Health ATLAS 2017 Member State Profile: Kenya, 2018, https://www.who.int/mental_health/evidence/atlas/profiles-2017/KEN.pdf?ua=1 (accessed June 22, 2020); Mohan Isaac et al., Postgraduate training in psychiatry in Asia, Current Opinion in Psychiatry, vol. [16] WHO, Gender and Women's Mental Health, https://www.who.int/mental_health/prevention/genderwomen/en/. The programs innovative family-based approach examines 12 measures that together reveal family health: access to clean water, hypertension, tuberculosis, smoking, family planning, access to government health insurance, maternal health, child nutrition, immunization, breast feeding, sanitation, and mental health. Its not how a human being is supposed to be. 6. 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. 51. [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. Teaming up with locally run organizations, such as Grupo de Mujeres Mayas KAQLA, an indigenous group based in Guatemala, can also help foreign psychologists gain cultural competency and establish trust with indigenous people, who may be reluctant to partner with outsiders, says Lykes. 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. Many of the millions of Central American subsistence farmers are also starting to migrate north as climate change threatens their livelihoods, according to the Climate Reality Project, an activist organization founded by former vice president Al Gore (How the Climate Crisis Is Driving Central American Migration, 2019). Res. It also explicitly requires the full and informed consent of persons with disabilities to medical treatment.[178]. [21] WHO, Mental Health in the Western Pacific, undated, https://www.who.int/westernpacific/health-topics/mental-health (accessed June 17, 2020). Encourage governments to collect quantitative and qualitative data on the current number of people shackled, the reasons families continue to practice shackling, and examine the support or services they would need to discontinue the practice. 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. They run away whenever they see me. [76] 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. Subsequently, those with mental health impairment tend to be complex patients, which may convolute delivery of services. 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. Malakis story helped shape his community to be more inclusive and accepting. A custom index was developed, ranking each state according to its mental health service access. [23] ngela Carbonell, Jos Javier Navarro Prez, Maria Vicenta Mestre, Challenges and Barriers in Mental Healthcare Systems and Their Impact on the Family: A Systematic Integrative Review, Health and Social Care in the Community vol.28:5, September 2020, https://doi.org/10.1111/hsc.12968 (accessed September 25, 2020), pp. [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. Provide counseling and other forms of support to people with psychosocial disabilities and their families. 69 (1988), signed November 17, 1988. CRPD/C/GC/1 (2014), http://daccess-ods.un.org/access.nsf/Get?Open&DS=CRPD/C/GC/1&Lang=E (accessed May 15, 2015), pp. 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). [133] Of these, 1,355 had been chained in Habeb hospital in Mogadishu, the capital, and 417 in the surrounding community. 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. [41], While data disaggregated by disability is hard to come by, available evidence shows that people with psychosocial disabilities often grow up in the confines of their home or an institution, excluded from community life, rarely attending school, getting married and having children, seeking employment, or participating in society. 25; 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; 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; Cameroon: People With Disabilities Caught in Crisis, Human Rights Watch news release, August 5, 2019, https://www.hrw.org/news/2019/08/05/cameroon-people-disabilities-caught-crisis; Human Rights Watch, From Cradle to Grave: Discrimination and Barriers to Education for Persons with Albinism, June 2019, https://www.hrw.org/video-photos/interactive/2019/06/13/cradle-grave; Treated Worse than Animals, https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girls-psychosocial-or-intellectual. 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. Mental health services in the U.S. are insufficient despite more than half of Americans (56%) seeking help. The large majority of Americans (76%) also believe mental health is just as important as physical health. There is also a large disparity in access to mental health care based on level of income and location. (No. 1, U.N. Doc. [160] 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, https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf, para. [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. Pennsylvania, New York and Minnesota ranked among the top. Access to mental health care in El Salvador: a case study of progress toward decentralization Rev Panam Salud Publica. See the Shackling chapter for a more detailed description. Of the Americans that have not sought mental health treatment, more than half, or 53%, were in low-income households. Wendy, a doctor working for MSF's ambulance service, said that some patients die while waiting to be transferred to a hospital. 58 (1982), entered into force October 21, 1986. 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. [58] Human Rights Watch witnessed several people being shackled in a psychiatric hospital in northern Nigeria. [110] Fasting would help to starve evil spirits and enable God and prayer to heal them. [111] People interviewed said there was too little food, sometimes only one meal a day. [91] Human Rights Watch interview with Sheu Abdukhaleed, traditional healer, Ibadan, Nigeria, September 17, 2019. 35, Article 9: Liberty and security of person, U.N. Doc. [143] Standing unified with refugees at a time of crisis, sportanddev.org, September 21, 2020 (accessed September 28, 2020). But through this program, we are working to create a culture of prevention., Other psychologists have turned their attention to a frequently overlooked populationthose who have been deported from the United States, known as retornados..