lack of mental health services in el salvador lack of mental health services in el salvador

Human Rights Watch also consulted international disability expertsat different stages of the research and writing and reviewed relevant domestic and international media reports, official government documents and reports by government-run mental health facilities or institutions, United Nations documents, World Health Organization publications, NGO reports, and academic articles. While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. the lack of good-quality epidemiologic data by department, which resulted in the authors' reliance on . Many facilities have low-grade medical equipment, are almost always understaffed, and often run out of medicine. [68] Daniel Arias et al., Prayer Camps and Biomedical Care in Ghana: Is Collaboration in Mental Health Care Possible? PLoS ONE 11(9), September 12, 2016, doi:10.1371/journal. [142] WHO, "Transforming services and promoting human rights in mental health and related areas," undated, https://www.who.int/activities/transforming-services-and-promoting-human-rights-in-mental-health-and-related-areas (accessed September 25, 2020). 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. 6. Additionally, the Social Affairs Ministry has 12 rapid response teams attached to 20 state-run institutions (pantis) across the country that conduct community outreach activities including rescuing people from pasung when they come across them. ), Capturing the Moment: Single Session Therapy and Walk-In Services, Crown House, 2014. [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. El Salvador's citizens have faced multiple traumas in the past decades: war, gang violence, natural disasters and now COVID-19. People shackled in homes typically ate the same meal as the family. Veterans who are experiencing homelessness or at risk of homelessnessand their family members, friends and supporterscan call 1-877-4AID VET ( 877-424-3838) or chat online with the National Call Center for Homeless Veterans, where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week. Traditional or spiritual healing centers are also considered types of rudimentary institutions. [151], The CRPD rejects the presumption that persons with disabilities are unfit to exercise agency and makes it clear that the will and preferences of the person should be respected. For example, Human Rights Watch research in Kenya found about 60 men, women, and children with real or perceived psychosocial disabilities chained, hidden from view, in the compound of the Coptic Church Mamboleo in Kisumu city in western Kenya. [25] In Africa, on average, there is fewer than one mental health worker per 100,000 people, compared with 2.5 in South-East Asia and 50 in Europe. 58. Mental health and addiction providers need adequate funding to hire skilled staff, employ evidence-based practices and adopt innovative technologies all of which will help us meet demand.. These individuals are skewing younger and are more likely to be of lower income and have a military background. Moreover, it also appears that the availability of programs and services may be associated with higher reporting rates (Filmer, 2008). In countries where people believe mental health is a spiritual issue and robust mental health services are lacking, private institutions and faith-healing facilities flourish. Yet, there are very few mental health professionals, especially for the majority of the population who rely on the public health system. Physicians thought Bill Mitchell had dementia and could be a danger to himself or others, according to medical records. Advocate for the integration of people with psychosocial disabilities in the community. [14] Yet, psychosocial disabilities draw only limited government attention. About 80 percent of people with disabilities live in middle or low-income countries where it is often challenging to access healthcare, particularly mental health care. Rural Americans are also less accepting of mental health services and care. 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. In the worst of cases, depression can lead to suicide - an estimated 63,000 people kill themselves every year in the Americas. [179] UN General Assembly, Report of the Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, A/64/272, August 10, 2009, https://undocs.org/en/A/64/272 (accessed September 23, 2020), para. Spending on mental health treatment and services reached $225 billion in 2019, according to an Open . CCPR/C/GC/35, December 16, 2014, para. [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]. [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. Since then Ive been living on the streets. Beckley also teaches professionals to use open-ended questions to obtain important information from survivors without retraumatizing them. [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. [86] Article 25, among other problematic provisions, states that a caregiver or a guardian of a person with a mental disorder shall not allow that person to walk freely in public places. In a country where people with psychosocial disabilities are stigmatized and subjected to abuse, such broad discretion given to authorities to restrict the freedoms of movement and liberties of a person with mental health conditions will facilitate further abuse and entrenchment of the problem. (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. Human Rights Watch, Like a Death Sentence, https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana; Chained Like Prisoners," https://www.hrw.org/report/2015/10/25/chained-prisoners/abuses-against-people-psychosocial-disabilities-somaliland; Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia; "Nigeria: People With Mental Health Conditions Chained, Abused," Human Rights Watch news release, https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused. [123] Human Rights Watch interview with Halima Gani, woman with a psychosocial disability, Kano, Nigeria, September 23, 2019. 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. In Nigeria, amongst the people Human Rights Watch interviewed, the youngest child chained was a 10-year-old boy and the oldest person was an 86-year-old man. 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. [130] In 2019, the Supreme Court of India directed the government to take immediate action, stating that keeping people with mental health conditions handcuffed or chained is in violation of their human rights.[131] In 2017, Dr. Akwasi Osei, CEO of the Mental Health Authority in Ghana, announced the government would enforce the 2012 Mental Health Act provision that people with psychosocial disabilities shall not be subjected to torture, cruelty, forced labor and any other inhuman treatment, including shackling.[132]. If a person does manage to get to a health facility, they are often turned away. 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). [47] In a number of countries including the Democratic Republic of Congo, Ghana, Kenya, and Liberia, children with disabilities can face accusations of witchcraft. At the core of this initiative is respect for the rights of people with psychosocial or intellectual disabilities, including the right to live independently in the community. [107] When the city of Taizz, Yemen, was attacked in mid-2017, Jalila al-Saleh Ali fled with her two sons, and in her distress left behind her husband with a psychosocial disability in chains. [170] UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pras, A/HRC/35/21, March 28, 2017, https://undocs.org/A/HRC/35/21 (accessed September 17, 2020), para. These beliefs often lead people with psychosocial disabilities and their families to first consult faith or traditional healers and only seek medical advice or psychosocial support, such as counseling, as a last resort. TRADEMARKS. 2200A (XXI), 21 U.N. GAOR Supp. In Guatemala, she has helped organize a group of survivor leaders to raise public awareness of the psychological impacts of sexual violence and problems with the countrys justice system. [20] WHO, Mental Health, undated, https://www.who.int/gho/mental_health/en/ (accessed June 17, 2020). [110] Fasting would help to starve evil spirits and enable God and prayer to heal them. The bill, in its current draft, provides the authorities with unfettered powers to arbitrarily strip people with mental health conditions of their civil liberties. 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). In Russia, residents with psychosocial disabilities were being chained by their wrists or ankles to beds, radiators, and other objects in the Trubchevsk Psycho-Neurological Institution near Briansk, located southwest of Moscow. [92] It cannot be discriminatory and should never be justified on the basis of the existence of a disability.[93]. 10, 13. [61], In the absence of comprehensive global data, it is difficult to precisely determine the magnitude of this practice. 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.. The program is an ambitious government initiative that seeks to ensure that even the most rural, isolated, and reluctant communities get access to health services. Human Rights Watch research in 2013 in Cambodia found that people with real or perceived psychosocial disabilities are forcibly locked up and often chained in drug detention centers, or in sporadic crackdowns to clean the streets ahead of high-profile international meetings or visits by foreign dignitaries. [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. 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. There are no statistics on the scale of shackling at a global level. Since the launch of QualityRights in Ghana in February 2019, around 15,000 people have enrolled in the course and around 7,430 people have completed the training. [159], The UN special rapporteur on torture has noted that forced psychiatric intervention on the grounds of disability alone is a form of torture and ill-treatment. Ensure shackling is not practiced by the organizations representatives or at holy sites. Mental health shortages range in severity across the country. 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. 1, U.N. Doc. In Kenya, which launched in November 2019, almost 3,260 people have enrolled and around 732 have completed the training. If a family fairs poorly on even one indicator, then it is identified as needing assistance. 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. The Protocol of San Salvador has been ratified by Argentina, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, and Peru. 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. 25, 27, 52; I Needed Help, Instead I Was Punished: Abuse and Neglect of Prisoners with Disabilities in Australia, February 2018, https://www.hrw.org/report/2018/02/06/i-needed-help-instead-i-was-punished/abuse-and-neglect-prisoners-disabilities; 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. The report also draws on Human Rights Watchs extensive research on stigma, mental health, and discrimination that people with psychosocial disabilities face around the world, including in Australia, Brazil, Cameroon, Croatia, India, Iran, Kazakhstan, As a result of this initiative, according to the WHO, 1,700 people were freed from chains in Somalia between 2007 and 2010. In one case, a person died while tied up and locked in one of the bathrooms, which was used as an isolation room. [165] CRPD, art. Human Rights Watch researchers interviewed more than 350 people with psychosocial disabilities, including those who were shackled at the time of research or had been shackled at least once in their lives, and more than 430 family members, caregivers or staff working in institutions, psychiatrists, psychologists, nurses and other mental health professionals, faith healers, lawyers, government officials, representatives of local nongovernmental organizations (NGOs), including organizations of persons with disabilities, and disability rights advocates. 119. The chain is so heavy. When the Special Olympics team had Malaki released, he got the opportunity and training to play football. Roxanna Alizadeh, Elise Fabre, Alexis Kallen, and Liam Turnbull, interns in the Disability Rights Division, provided important research support. (No. Stigma and fear of contracting the disease are also delaying people from seeking medical care, sometimes with fatal consequences. 37. [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. Help us continue to fight human rights abuses. [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/. 1, Equal recognition before the law, U.N. Doc. Depression, which is the leading cause of disability, is reported to be twice as common in women than men. If we understand the individual reasons that force people to migrate, we may be closer to finding the interventions that are relevant and effective, she says. 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. (No. Admission forms, where they exist, are signed by family members, the guardian, or staff members. On a larger scale, the nonprofit International Justice Mission (IJM) works to end impunity for slavery and other human rights violations through legal and justice reform. [106] Human Rights Watch, Living in Hell, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia. 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. 58 (1982), entered into force October 21, 1986. In many countries around the world, there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, having sinned, displaying immoral behavior, or having a lack of faith. [176] The right to be free from non-consensual medical treatment and experimentation is guaranteed under the ICESCR. So stressful, in fact, that the migration route with all its perils barely registers above the daily pressures children and their families face here.. [13] Every 40 seconds, someone dies by suicide. 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. With the right kind of support, people with mental health conditions can live and thrive in their communities. 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. 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. 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. Progressively develop voluntary and accessible community-based support and services, including access to housing, education, employment, and mental health services, in consultation with people with lived experiences of mental health conditions and with the support of international donors and partners. 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. [147] Non-discrimination is one of the cardinal principles on which the CRPD is grounded. More in This Topic Guide. 8. Ensure that people who have been released from state and private institutions have access to psychosocial support and social services. Turkey-Syria earthquakes: MSF teams in Syria are caring for the injured. Share this via Printer, Shackling of People with Psychosocial Disabilities Worldwide. [130] Supreme Court Shocked at Chaining of Inmates in U.P. The governments target was to ensure full coverage of over 65 million households in Indonesia through all 9,909 community health centers by the end of 2019. Nearly one in five of Americans, or 17%, noted they have had to choose between getting treatment for a physical health condition and a mental health condition due to their insurance policy. 217A(III), U.N. Doc. [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). Nevertheless, Mexico needs at least 12,000 psychiatrists. 31, The Right to Health, http://www.ohchr.org/Documents/Publications/Factsheet31.pdf (accessed September 22, 2020), pp. Governments are to ensure access to a range of in-home, residential, and other community support services to prevent isolation from the community, including personal assistance, and ensure that community services and facilities are available and responsive to their needs. For example, ECAP, a Guatemalan organization whose name translates to the Community Studies and Psychosocial Action Team, works primarily with indigenous women and children to seek gender equity and restorative justice for past crimes. States also range in the number of providers needed to fill shortages. [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. [76], In Mexico, officials from the Office of the Prosecutor for Protection of People with Disabilities told Human Rights Watch: Families tie them [people with psychosocial disabilities] up regularly. 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. Shackling is practiced across socio-economic classes. Poor communication with health care providers is often an issue. 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. Persons with psychosocial disabilities experience physical abuse if they try to run away from institutions or dont obey the staff. [21] WHO, Mental Health in the Western Pacific, undated, https://www.who.int/westernpacific/health-topics/mental-health (accessed June 17, 2020). One mother in Bali, Indonesia shared why she chained her son with a mental health condition for over 10 years: Due to prevalent stigma and inadequate support services, families often struggle to cope with the demands of caring for a relative with a psychosocial disability and feel they have no choice but to shackle them. [148] The CRPD states that all persons are equal before and under the law and are entitled without discrimination to the equal protection and equal benefit of the law.[149] The CRPD requires governments to prohibit all discrimination on the basis of disability and guarantee to persons with disabilities equal and effective legal protection against discrimination on all grounds and to take all appropriate steps to ensure that reasonable accommodation is provided. Others, inspired by the mission of liberation psychology, have launched or joined human rights organizations to more directly address systemic issues such as gender-based violence, public corruption and income inequality. [136] The program demonstrated that accessible community-based mental health services were key to ensuring people remained free from chains and proved to be an example of how non-healthcare workers could be mobilized to deliver services in rural and low-resource settings. The lack of a community-based mental health system continues to. From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. [99] Human Rights Watch interview with Archbishop Danokech, Archbishop at the Holy Ghost Coptic Church of Africa, Kisumu, Kenya, February 18, 2020. One in five, CDC data says, 30% of American adults had symptoms consistent with an anxiety or depression diagnosis, will waive the residency requirements for J-1, how mental health has changed throughout the pandemic, how healthcare jobs have grown over the past two decades, Health Resources and Services Administration. See also, Beijing Declaration and Platform for Action, Fourth World Conference on Women, September 15, 1995, A/CONF.177/20 (1995), art. And when natural disasters such as hurricanes strike, aid is not available to help residents recover. To support the right to remain, some psychologists seek to better understand the complex decision about whether to migrate. We offer counseling appointments in our center with a psychologist. Human Rights Watch phone interview with Joshua Duncan, program manager, Mental Health Coalition of Sierra Leone, September 25, 2020. In Guatemala, for instance, rising temperatures and long droughts are reducing returns from coffee, corn and sugarcane farms. I have to go to the toilet in a bucket. In one institution,near Briansk, Russia, residents who were unruly, would be chained, forcibly sedated.[118]. 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. The response time is often less than ideal because of the heavy traffic in San Salvador. However, implementation has depended on the provincial governors issuing a decree and deploying adequate resources. What is the US national debt and how has it grown over time? Some institutions are an extension of the faith healers house or situated at a secluded end of the compound. "In many instances the patient had already died when we arrived at their house, said Angel Sermeo, MSFs medical activity manager in El Salvador. El Salvador's own 2015 National Survey on Non-communicable Diseases (NCDs) in the Adult Population -which the World Bank helped fund- revealed high levels of factors that can trigger non-communicable diseases, such as sedentary lifestyles, at-risk drinking, smoking, poor nutritional choices on salt, sugar or highly processed foods.