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). [61], In the absence of comprehensive global data, it is difficult to precisely determine the magnitude of this practice. Human Rights Watch, Like a Death Sentence, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana ;Treated Worse than Animals, https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girls-psychosocial-or-intellectual. It was like my mind had gone blank on account of the fright, she said. As of 2018, fewer than half of the 139 countries that have mental health policies had aligned them with international human rights conventions. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system. [146] American Convention on Human Rights (ACHR), adopted at the Inter-American Specialized Conference on Human Rights, San Jos, Costa Rica, 22 November 1966. Many people are afraid to leave their homes for fear of being judged for transmitting the disease or being taken away from family members if they are hospitalized. 3, entered into force January 3, 1976, art. We partner with the government, NGOs, . We refer clients to local rehab centers as needed, and we work with . 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. Mental health, recession, campus violence top students' concerns Retornados often struggle to find work, become targets of gangs who assume they have money, and have problems with addiction and suicidality, Garca Rivera says. Even in Guatemala, which has about 7,700 mental health professionals and 16 million people, rural areas are vastly underserved (Healthcare Access and Conditions in Guatemala, Honduras and El Salvador, Centers for Disease Control and Prevention, 2017). 12; CRC, art. There are currently 10 Steven A. Cohen Military Family Clinics nationwide. 2200A (XX1), 21 U.N. GAOR Supp. Mental health"Total Student Guidance Service" that cannot accommodate Mental health literacy and stigma among Salvadorian youth: anxiety As of September 2020, the program had reached 48 million roughly 70 percent of Indonesian households. As a result, they urinate, defecate, eat, and sleep in a radius of no more than one to two meters. [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. Depression is the most common mental illness in the world. Other ways to share Gender is a major factor in mental health. 40, entered into force November 25, 2005. Persons with disabilities are systematically placed into institutions and psychiatric facilities, or detained at home and other community settings, based on the existence or presumption of having an impairment.[166]. Despite such accomplishments, many psychologists in the Northern Triangle countries feel that they are largely working in isolation with little support and few resources. [114] Human Rights Watch interview with Fiera [not her real name], Maputo, Mozambique, November 20, 2019. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. [41] Human Rights Watch, Better to Make Yourself Invisible: Family Violence against People with Disabilities in Mexico, June 2020, https://www.hrw.org/report/2020/06/04/better-make-yourself-invisible/family-violence-against-people-disabilities-mexico; 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; "Cameroon: People With Disabilities Caught in Crisis," Human Rights Watch news release, August 2019, https://www.hrw.org/news/2019/08/05/cameroon-people-disabilities-caught-crisis; Human Rights Watch, On the Margins: Education for Children with Disabilities in Kazakhstan, March 2019, https://www.hrw.org/sites/default/files/report_pdf/kazakhstan0319_web3.pdf, pp. 12. This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. Malakis story helped shape his community to be more inclusive and accepting. 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. In Indonesia, Human Rights Watch found approximately 90 women living in a room that could reasonably accommodate no more than 30, in Panti Laras 2, a state-run institution in Cipayung, on the outskirts of Jakarta. [60] Human Rights Watch visit to Lawang Mental Hospital, East Java, Indonesia, August 12, 2015. Establish independent and confidential complaints systems that receive and investigate complaints, including ill-treatment of persons with psychosocial disabilities in institutions. [97] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45-46. 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. Guest Opinion: Teenage mental health crisis: The kids are not OK Many think disability is a curse resulting from evil spirits. The increase in people dying at home reflects the enormous strain COVID-19 has put on the health system. Sophia Majlessi What options do people have to stay home? she asks. My aunt has tried her best to support them but she struggles with stigma and the lack of robust mental health services in Oman. In its 2018 Concluding Observations the Human Rights Committee noted El Salvador's lack of legislation in this aspect. 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. 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. The term psychosocial disability is preferred as it expresses the interaction between psychological differences and social or cultural limits for behavior, as well as the stigma that society attaches to people with mental health conditions. [124] Human Rights Watch interview with James [not his real name], man with a psychosocial disability, Kenya, February 2020 (name and details withheld). [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]. Mental Asylum, The Hindu, January 3, 2019, https://www.thehindu.com/news/national/sc-shocked-at-chaining-of-inmates-in-up-mental-asylum/article25901395.ece (accessed August 17, 2020). [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. 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. Download (593.4 kB) WHO Team. 49) at 167, U.N. Doc. Inability to afford proper care. Individuals were either crowded in the few spots where there was shade or baked in the sun. The losses of productivity caused by poor mental health include but are not limited to the following: Negative job performance. Living in Chains: Shackling of People with Psychosocial Disabilities (No.16) at 52, U.N. Doc. The reasons are as varied as our our cultures' pressure due to machismo, a heavy reliance on faith versus therapy, and a general lack of education when it comes to what psychology and psychiatry can do . [4], Psychosocial disability: The preferred term to describe people with mental health conditions such as depression, bipolar, schizophrenia, and catatonia. [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 one case, a person died while tied up and locked in one of the bathrooms, which was used as an isolation room. El Salvador 2020 Alejandra Sandoval/MSF. Access to mental health care in El Salvador: a case study of progress While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. Mental health shortages range in severity across the country. Look at the data on educational progress and challenges. 1, 3. [160] In the 2020 report on psychological torture, the UN special rapporteur also notes that practices like the spiritual healing of mental illnesses. Poor mental health, an obstacle to development in Latin - World Bank The main causes of death of these patients are related to metabolic disorders and respiratory and heart problems, which have increased fourfold compared to the first half of last year. 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. [161] UNHRC, Report of the Special Rapporteur on torture and other cruel inhuman or degrading treatment or punishment, A/HRC/43/49, March 20, 2020, https://undocs.org/en/A/HRC/43/49, para. 316, No. Associations between racism and mental health are stronger than those between racism and general medical health ( 2 ). Psychotherapy Center of Waunakee: Evers' budget fails to fund student Res. 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. 1366-1379. The ambulance system and hospitals are operating . 217A(III), U.N. Doc. Key findings include: Seven out of 10 (71%) of students are experiencing mental health issues such as stress, anxiety and/or depression. Traditional or religious healers: Traditional healers administer therapies based on theories, beliefs, and experiences indigenous to different cultures including ritual and herbal methods of treatment. However, in prayer camps and institutions, many interviewees spoke of persistent, gnawing hunger from forced fasting or inadequate food. [50] Human Rights Watch interview with a volunteer in a local organization providing services to people with disabilities, Buea, Cameroon, January 2019 (name and details withheld). In the worst of cases, depression can lead to suicide - an estimated 63,000 people kill themselves every year in the Americas. 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. 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. Ridha, a family member with relatives shackled in Oman, said: Its time for governments to step up so that families arent left to cope on their own.. [165] CRPD, art. 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]. [49] Human Rights Watch interview with Benjamin Ballal, survivor of shackling and secretary general for cultivation at Cultivation for Users Hope, Nairobi, February 15, 2020. [112], When institutions provided food, people with psychosocial disabilities told Human Rights Watch that it was too meagerat times, just one meal a day. Please open the door. Share this via WhatsApp Share this via Telegram [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]. [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. 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. The bill, in its current draft, provides the authorities with unfettered powers to arbitrarily strip people with mental health conditions of their civil liberties. [100] Human Rights Watch interview with Made, man with a psychosocial disability, Bali, Indonesia, November 19, 2020. Typically, people in these centers have been placed there by their families or by local police, some forcibly. 7; CRC, art. While the conditions of confinement may vary based on the method of shackling, location, and country, one thing remains the same: people who are shackled are forced to live in extremely unsanitary and degrading conditions. Raising awareness on mental health and specifically combating negative stereotypes and beliefs that a mental health condition is the result of being possessed by spirits; A coordinated and inter-ministerial approach that includes the ministries of justice, health, social affairs, housing, education, and employment; Independent and regular monitoring to ensure the ban on shackling is implemented; A targeted program that not only releases people from shackling but also regularly follows up to ensure that once released, people do not go back to being shackled; Access to affordable and quality community-based support and mental health services that help prevent shackling and support someone who is freed from chains in reintegrating the community. [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. Since then Ive been living on the streets. I want to look around outside, go to work, plant rice in the paddy fields. [33] The World Bank, Mental Health, https://www.worldbank.org/en/topic/mental-health; WHO, Mental Health, https://www.who.int/news-room/facts-in-pictures/detail/mental-health; WHO, Mental Health in the Workplace, https://www.who.int/mental_health/in_the_workplace/en/. CCPR/C/GC/35, December 16, 2014, para. 37. There is a mental health crisis in America. In Nigeria, boys as young as 10 were chained together in rooms with adult men, leaving them at risk of abuse. Even though the healthcare system has many hospitals, clinics, and care centers, the quality of healthcare they provide is deemed inadequate. [95] Human Rights Watch, Living in Hell, https://www.hrw.org/sites/default/files/report_pdf/indonesia0316web.pdf, p. 45. 58 (1982), entered into force October 21, 1986. Shackling impacts a persons mental as well as physical health. [147] Non-discrimination is one of the cardinal principles on which the CRPD is grounded. In traditional or religious healing centers, there is no medical diagnosis and the basis for admission and discharge is left entirely to the discretion of the faith or religious healer. Despite being 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. Treaty Series No. [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. E/C.12/2000/4 (2000), para. Human Rights Watch phone interview with Pascal Douti, September 3, 2019. 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. [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. In addition to research conducted by Human Rights Watch researchers, pro-bono desk research was conducted by students at the International Human Rights Program at the University of Toronto Faculty of Law and at the Rotman School of Management at the University of Toronto, Canada, as well as by lawyers at Borden Ladner Gervais LLP, Canada, and OMelveny & Myers LLP in the United States. In addition, compared to Americans living in urban and suburban areas, individuals living in rural areas are less likely to proactively seek mental health specialists they need, and instead go to their primary care doctor or community center for treatment. Malaki went from playing football in the Nyarugusu camp in Tanzania to the 2019 Special Olympics World Games in Abu Dhabi, United Arab Emirates. [98] Human Rights Watch interview with Aisha [not her real name], family member, Gaza, February 15, 2020. Of the Americans that have not sought mental health treatment, more than half, or 53%, were in low-income households. For example, the Health Resource and Services Administration (HRSA) administers the National Health Service Corps, which provides loan repayment or scholarship for those providing health care services in underserved communities. 2(1); CEDAW, art. [And] increase the response capacity of the emergency transfer services in critical cases. The large majority of Americans (76%) also believe mental health is just as important as physical health. Even when people seek mental health services, the quality of care in many countries is substandard. People are dying at home amid collapsing health system in El Salvador Media@TheNationalCouncil.org Help us continue to fight human rights abuses. (London, October 6, 2020) Hundreds of thousands of people with mental health conditions are shackled around the world, Human Rights Watch said in a report released today. [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. Its a crucial part of larger efforts to strengthen our social fabric and to repair the damage caused by sociopolitical violence.. [84] Human Rights Watch visit to Adwumu Woho Herbal and Spiritual Centre, Senya Beraku, Ghana, November 6, 2019. Information blackout shrouds new reports of deaths, injuries and abuse When it comes to seeking mental health care, the Latinx community has always struggled with stigmaboth in and outside of the United States. Shelter was a major concern for people shackled outdoors without a roof over their heads, protection from the sun or rain, and with constant exposure to mosquitoes and pests. Preventing institutionalization should be an important part of this plan. I am not free to walk about. In some cases, the children were fully wrapped in bandages, duct tape or clothing, like mummies. We have to wait for authorization from the public health system to be able to move patients to a care center, since we cannot transfer the patient from [their] home without prior coordination and authorization from the public health system, said Wendy. Mental Health and Substance Use. 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. The report includes field research and testimonies from Afghanistan, Burkina Faso, Cambodia, China, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, the self-declared independent state of Somaliland, South Sudan, and Yemen. Portland Public . Keep up with the latest data and most popular content. [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. [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). (No. On the upcoming April 4 ballot, you can vote to increase funding for mental health initiatives and resources within Kankakee County. res. 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. The trained staff in turn educate additional health center staff about the program and mental health. Emergency workers struggle to get mental health services in El Salvador 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. 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. In Indonesia, 57,000 people with mental health conditions have been in pasung (shackles) at least once in their lives. support services. 19. Some families also use shackling as a way to prevent or control a certain behavior they find disruptive. Throughout this program, increasing equity of access to health services, improving the quality of these services and strengthening the monitoring and oversight capacity of the Ministry of Health have been top priorities. [8] Women, given the high incidence of sexual violence they suffer, are also disproportionately affected by Post-Traumatic Stress Disorder (PTSD).[9]. People who are shackled to one another are forced to go to the toilet or sleep together. The nature of shackling means that people live in very restrictive conditions that reduce their ability to stand or move at all. [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. The Cohen Veterans Network (CVN) is a 501(c)(3) national not-for-profit philanthropic organization for post-9/11 veterans and their families. In the United States, an immigrant might earn $300 per week cleaning houses, the equivalent of about a months salary in Guatemala, says Cbar Cataln. [110] Human Rights Watch, Like A Death Sentence, https://www.hrw.org/sites/default/files/reports/ghana1012webwcover.pdf, p. 50. As of 2012, 92 percent of the people who had been unlocked in China remained free from chains. Portland students sat down with U.S. Department of Health and Human Services Secretary Xavier Becerra at Faubion K-8 in Northeast Portland Monday to discuss youth mental health. When the Special Olympics team had Malaki released, he got the opportunity and training to play football. Those workshops address teen marriage and pregnancy, suicidality, behavioral problems and drug and alcohol misuse in an effort to improve educational and professional outcomes for rural populations. [38] UN, Policy Brief: COVID-19 and the Need for Action on Mental Health, https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf, p. 6. Some individuals in Hebron Prayer Camp, north of Accra, Ghana were denied food for up to seven days. Top photo: A young boy in El Salvador, where children face multiple threats to their safety and well-being including gang violence. Mental Health outlines staffing shortages | State Capital As of 2018, more than two-thirds of all countries did not cover reimbursement for mental health services in national health insurance schemes. From 2007 to 2019, El Salvador experienced some economic progress, with its poverty rate dropping from 39% to 22.3%. [73] In Pakistan, the British Broadcasting Corporation (BBC) reported that in a single Sufi shrine near the city of Burewala in Punjab province hundreds of people with mental health conditions from poor families spent their lives chained to trees. ), Capturing the Moment: Single Session Therapy and Walk-In Services, Crown House, 2014. [130] Supreme Court Shocked at Chaining of Inmates in U.P. 16) at 52, U.N. Doc. Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. [143] Standing unified with refugees at a time of crisis, sportanddev.org, September 21, 2020 (accessed September 28, 2020). The response time is often less than ideal because of the heavy traffic in San Salvador. An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31. [113] Human Rights Watch visits to Yaysan Galuh Rehabilitation Center, Yayasan Bina Lestari, Samyul Institution, 2016-2018. In El Salvador, Beckley has trained police officers, prosecutors, judges, community leaders, social workers and psychologists in trauma-informed care for people who are seeking justice through the courts.