lack of mental health services in el salvador

(No. In 2025, demand may outstrip supply by 6,090 to 15,600 psychiatrists, according to a 2017 National Council for Behavioral Health report that explores the shortage's causes and suggests solutions. [55] In some countries, Human Rights Watch also found evidence of people with intellectual disabilities being shackled. [171], The ICESCR specifies that everyone has a right to the enjoyment of the highest attainable standard of physical and mental health.[172] Under the ICESCR, governments are to progressively realize the right to health to the maximum of their available resources. 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). [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. Stark Disparities in Accessibility at State and Income Levels. In many countries, it is a profitable business. But the work situation is so dire that its almost impossible to make a decent living, she says, because of low pay and limited work opportunities. The Black community, in particular, is affected by mental health, often due to: Lack of health insurance. [45] Human Rights Watch interview with Dr. Kafayah Ogunsola, psychiatrist, Lagos, September 26, 2018; Karoon, What is the state of mental health in Thailand?, post to Pacific Prime Thailand (blog),June 24, 2019, https://www.pacificprime.co.th/blog/state-of-mental-health-in-thailand/(accessed March 23, 2020); Melinda Benjamin, The Promotion of Mental Health Awareness in Cambodia, Borgen Magazine,August 1, 2019,https://www.borgenmagazine.com/mental-health-awareness-in-cambodia/(accessed March 19, 2020); Nivendra Uduman, Mental Health and Stigma in Sri Lanka, post to Ground Views (blog), February 19, 2018, https://groundviews.org/2018/02/19/mental-health-and-stigma-in-sri-lanka/ (accessed March 23, 2020); Mark Tilly,TV series to fight mental health stigma, Khmer Times, August 25, 2017,https://www.khmertimeskh.com/79742/tv-series-fight-mental-health-stigma/(accessed March 19, 2020); Human Rights Watch, We Are Also Dying of AIDS, 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, Southern African Institutefor Policy and Research,August 19, 2013, http://saipar.org/wp-content/uploads/2013/09/Allen-and-Green_Discrimination-and-Stigmitisation_Final-DraftCorrected.pdf (accessed April 2, 2020); Jane Chung,Disabled South Koreans Protect Inhumane Benefits System, Reuters, October25, 2012, https://www.reuters.com/article/us-korea-disabled/disabled-south-koreans-protest-inhumane-benefits-system-idUSBRE89O05X20121025 (accessed March 23, 2020); International Federation for Human Rights and Taiwan Association for Human Rights,The Hidden Face of Taiwan: Lessons learnt from the ICCPR/ICESCR review process,April2013,https://www.refworld.org/pdfid/51e799594.pdf(accessed March 23, 2020); M. Bari Qasem Saleh and A. Mohamed Makki,Mental Health in Yemen: Obstacles and Challenges, International Psychiatry,5.4(2008),https://www.cambridge.org/core/services/aop-cambridge-core/content/view/2F6080907180CF8B9BE1296B6C9D0360/S1749367600002277a.pdf/div-class-title-mental-health-in-yemen-obstacles-and-challenges-div.pdf(accessed March 18, 2020), pp. (No. Explain to me, how is that part of a healing process? The nation needs an additional 6,398 mental health providers to fill these shortage gaps. A/44/49 (1989), entered into force September 2, 1990, art. Just because it is painful, we cannot look away. A/39/51 (1984), entered into force June 26, 1987; Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Three charts on diversity in the federal government's workforce. UNHCR, 2014, Carrying a Heavy Load: Mayan Womens Understandings of Reparation in the Aftermath of Genocide And when natural disasters such as hurricanes strike, aid is not available to help residents recover. The WHOs World Mental Health Survey found that only 1 in 5 people with depression receive minimally adequate mental health services in high-income countries and it falls to 1 in 27 in low and middle-income countries. 25; ICESCR, art. [74] In Togo, prophets can lock up and chain up to 150 people in a single prayer camp. On average, countries spend less than 2 percent of their health budgets on mental health. 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. 14(1)(b); CRPD Committee, Statement on article 14 of the Convention on the Rights of Persons with Disabilities, September 2014, http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=15183&LangID=E#sthash.ErjRRg0s.9wBvLiwR.dpuf (accessed August 12, 2020). [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. [29] Human Rights Watch research in over 25 countries around the world has found that people with mental health conditions can face a range of abuses including arbitrary detention, involuntary treatment, including electroconvulsive therapy, forced seclusion as well as physical and sexual violence in psychiatric hospitals. She expressed her appreciation to WHO for having focused its attention on this priority public health issue, since depression can be prevented. Publicly denounce the practice of shackling and actively oppose all forms of shackling, including by affiliated leaders and institutions. 16) at 49, U.N. Doc. In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. [109] "Indonesia: Shackling Reduced, But Persists," Human Rights Watch news release, October 2, 2018, https://www.hrw.org/news/2018/10/02/indonesia-shackling-reduced-persists. 6 and 9; UN Committee on Economic, Social and Cultural Rights, General Comment 14, The right to the highest attainable standard of health (Twenty-second session, 2000), U.N. Doc. and Zambia. Many facilities have low-grade medical equipment, are almost always understaffed, and often run out of medicine. We send regular emails about upcoming events, member spotlights and updates in mental wellbeing. [86] Civil Society Organizations Call for the Draft Law on Public Order to be Immediately Discarded, joint statement, August 13, 2020, https://www.hrw.org/news/2020/08/13/civil-society-organizations-call-draft-law-public-order-be-immediately-discarded. Media@TheNationalCouncil.org If a person does manage to get to a health facility, they are often turned away. Please open the door. A Guatemalan farmer abandons his coffee farm after years of drought destroy his crops. To date, about 20 out of Indonesias 34 provincesincluding Central Java, West Nusa Tenggara, East Java, Jambi, Yogyakarta, and Acehhave a functional pasung-free initiative. 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. [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/. [105] 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. MSF has launched health initiatives in San Salvador and Soyapango, focusing on socially vulnerable people whose access to health services has been affected by insecurity. Feb 28, 2023. Marylin Beckley, a licensed professional counselor and doctoral student in the international psychology program at the Chicago School of Professional Psychology in Washington, D.C., works with IJM in Guatemala, El Salvador and other Latin American countries. 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,. "The lack of community-based mental health solutions, the lack of civil beds, the lack of walk-in centers and crises centers all of that has resulted in the last resort: the emergency. Conduct regular, unannounced monitoring visits to government and private social care institutions as well as faith healing centers, with unhindered and confidential interaction with both staff and patients. Findings of these visits, redacted to protect privacy rights, should be publicly reported. In the absence of mental health services, people with psychosocial disabilities can also be arbitrarily detained and chained in drug detention centers or prisons. 24, 2016). Share this via Email Im only invited to spiritual events because my family thinks I have a spiritual problem, not a mental health condition, said Carlos, a 51-year-old man from Maputo, Mozambique. Ukraine: MSF teams treating patients after missile attack on residenti Bangladesh: New cuts to food rations will have dire health impacts on Somalia and Somaliland: Indiscriminate fighting affects medical care i Mdecins Sans Frontires 2023 [31] 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, https://doi.org/10.1111/hsc.12968, pp. They feel youre possessed and put liquid down your nose to drive out the devil. [135] The Chinese government program to scale-up basic mental health services became known as 686 after initial funding of CNY 6.86 million. 39/46, annex, 39 U.N. GAOR Supp. 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. [22] The emphasis on tertiary facilities means that people are compelled to travel further and to a psychiatric hospital, a location that is more stigmatizing, which studies have shown are often deterrents in seeking support. Students and Human Rights Watch researchers also conducted phone interviews with activists, representatives of local NGOs, mental health professionals, and journalists. It is comprised of a two-pronged research project that includes an online survey of 5,000 American adults, and a robust analysis of third-party data measuring patients access to mental health services in terms of four pillars providers, facilities, funding and perceived satisfaction among patients. [70] Across these 28 facilities, the youngest child chained was a 10-year-old boy and the oldest person who was chained was an 86-year-old man. In Kenya, which launched in November 2019, almost 3,260 people have enrolled and around 732 have completed the training. 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. 16; ACRWC, art. Share this via Printer, Shackling of People with Psychosocial Disabilities Worldwide. 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. Gangs often threaten teens or adults with rape or murder, forcing entire families to flee their homes (World Report 2019, Human Rights Watch). [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). 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. In one case, a person died while tied up and locked in one of the bathrooms, which was used as an isolation room. [34], Irrespective of age, gender, ethnicity, socio-economic status or cultural background, health and particularly mental health is one of the most basic and necessary assets for human beings. 90-92. [117], Staff in state-run and private institutions admitted that they hold people down to put pills in their mouth or force-feed them food or drinks laced with medicines. With the right kind of support, people with mental health conditions can live and thrive in their communities. Not just for the migrants leaving, but for those who are staying, those who are coming back and those who are caught between two cultures.. Associations between racism and mental health are stronger than those between racism and general medical health ( 2 ). The chain is so heavy. We offer counseling appointments in our center with a psychologist. The testimonies were collected between August 2018 and September 2020 through in-person and phone interviews. This report includes field research and testimonies collected by 16 Human Rights Watch researchers working in their own countries, including 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. They always beat me up, at times they assigned my own children to beat me up, for instance this one who takes care of my drugs bill. Traditional or religious healing centers: Refers to centers, generally run by traditional or faith healers who practice healing techniques including chaining, recitation of religious texts or songs, fasting, baths, herbal concoctions, and rubbing the body with stones. [22] WHO, Mental health: massive scale-up of resources needed if global targets are to be met, June 6, 2018, https://www.who.int/mental_health/evidence/atlas/atlas_2017_web_note/en/ (accessed July 22, 2020). 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. 51. Sophia Majlessi In China, about 100,000 people are shackled or locked in cages in Hebei province alone, near Beijing. 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. [19] UN, Policy Brief: COVID-19 and the Need for Action on Mental Health, May 13, 2020, https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf (accessed June 22, 2020), p. 5; The World Bank, Mental Health, https://www.worldbank.org/en/topic/mental-health; WHO, Mental disorders, https://www.who.int/news-room/fact-sheets/detail/mental-disorders; see also Rudi Eggers (WHO Kenya Representative) statement in Kenya launches initiative to promote mental health for citizens, Xinhua, November 21, 2019, http://www.xinhuanet.com/english/2019-11/21/c_138573442.htm (accessed June 17, 2020). [140] 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). People are shackled in locations that are out of sight and out of the way for families: in backyards, outhouses, sheds, or animal shelters. People with psychosocial disabilities, including children, who are shackled in homes or institutions are routinely forced to take medication or subjected to alternative treatments such as concoctions of magical herbs, fasting, vigorous massages by traditional healers, Quranic recitation in the persons ear, singing Gospel hymns, and special baths. [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. In the same period this year, it has happened 37 times18 times in June alone.. [67] Thousands Of Mentally Ill People Chained Like Cattle For Years In Sheds In UP, Outlook, January 3, 2019, https://www.outlookindia.com/website/story/india-news-thousands-of-mentally-ill-people-chained-like-cattle-for-years-in-uttar-pradesh-sheds/322874 (accessed July 29 2020); Asian News International, Thousands of Psychiatric Patients Chained in Sheds in Uttar Pradesh's Badaun; SC Asks Govt to Provide Medical Aid, Firstpost, January 3, 2019, https://www.firstpost.com/india/thousands-of-psychiatric-patients-chained-in-sheds-in-uttar-pradeshs-badaun-sc-asks-govt-to-provide-medical-aid-5829361.html (accessed July 29 2020); Mentally challenged man, in chains for 14 yrs, rescued, The Indian Express, September 27, 2020 (accessed September 28, 2020). If a family fairs poorly on even one indicator, then it is identified as needing assistance. In certain cases, people with disabilities and their family members are identified with pseudonyms and identifying information, such as location or date of interview, has been withheld in order to respect confidentiality and protect them from reprisals from family or staff in institutions. The number of new jobs and the unemployment rate are regularly cited in the news, but theyre just part of the picture. Governments should include people with disabilities and their representative organizations in developing and carrying out the plans. [58] Human Rights Watch witnessed several people being shackled in a psychiatric hospital in northern Nigeria. Inability to afford proper care. In many countries, Covid-19 has disrupted mental health services, which can put people with psychosocial disabilities at risk of being shackled. In social care institutions, run by nongovernmental organizations (NGOs) or traditional or religious healing centers, families often use false pretenses to get relatives to enter an institution, or simply provide no explanation at all. 1. Liberation psychology, for example, established in the 1970s by Jesuit priest Ignacio Martn-Bar, PhD, calls on psychologists to redefine their role as sociopolitical and to support oppressed communities. Families who struggle to cope with the demands of caring for a relative with a psychosocial disability may feel they have no choice but to shackle them. 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. Preventing institutionalization should be an important part of this plan. However, one of the main concerns about the 686 program was that it predominantly took a medical approach to mental health that focused on freeing people from chains and then admitting them to a psychiatric hospital for treatment or putting them on a regimen of mental health medication. For example, in Yemen, Amnesty International documented cases of people with psychosocial disabilities who were unable to flee from violence because they were chained. doi: 10.26633/RPSP.2018.172. 2(1); CEDAW, art. In some states, over 80% of the population lives in a mental health professional shortage area. The exchange, co-founded by clinical psychologist Leticia Gonzalez Pileski, PsyD, and Jason Platt, PhD, a counseling psychologist based in Mexico City, holds one-day conferences where students discuss their work in liberation psychology and organizes trips to war-torn areas of El Salvador to help survivors preserve cultural memory about the violence they endured. Other ways to share It also explicitly requires the full and informed consent of persons with disabilities to medical treatment.[178]. Personal hygiene is a serious problem since people who are chained often do not have access to a toilet. 39-72; Chained Like Prisoners: Abuses against People with Psychosocial Disabilities in Somaliland, October 2015, https://www.hrw.org/sites/default/files/report_pdf/somaliland1015_forupload_0.pdf, 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. Human Rights Watch research across 60 countries found people with real or perceived psychosocial disabilities are arbitrarily detained against their will in homes, state-run or private institutions, and traditional or religious healing centers. 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). In South Sudan, Human Rights Watch in 2012 and Amnesty International in 2016 documented people with real or perceived psychosocial disabilities being chained and detained in prison, not because they had committed a crime but simply because they had a disability. 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). Clinical psychologists usually need a Doctor of Philosophy in psychology (PhD) or a Doctor of Psychology (PsyD) degree. Most mental health professions require at least a bachelors degree, except for psychiatric nurses, and many require additional post-graduate education and certification. 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 . support services. 35, Article 9: Liberty and security of person, U.N. Doc. Undertake community support programs and independent and supported living arrangements for people with psychosocial disabilities, particularly those who have been freed from shackling. [56] Any criticism of faith-based institutions is not linked to their religious roots or spiritual nature. 2200A (XXI), 21 U.N. GAOR Supp. 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. Lack of engagement with work. [49], A volunteer from an organization providing services to people with disabilities in Cameroon said: People in Cameroon have negative perceptions about disability. Washington DC, 20005, 2023 National Council for [54] Human Rights Watch interview with mother of a man with a mental health condition, Bali, Indonesia, November 19, 2020 (full name and details withheld). CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. 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. 2200A (XXI), 21 U.N. GAOR Supp. 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. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system. 1. 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. [92] It cannot be discriminatory and should never be justified on the basis of the existence of a disability.[93]. International human rights law guarantees to persons with disabilities the right to liberty on an equal basis with others. CAB/LEG/67/3 rev. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. 44/25, annex, 44 U.N. GAOR Supp. What is the US national debt and how has it grown over time? 316, No. In many institutions in Indonesia, people with psychosocial disabilities were fed meals devoid of proper nutrition such as instant noodles for most meals.[113]. The emergency 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. "In many instances the patient had already died when we arrived at their house, said Angel Sermeo, MSFs medical activity manager in El Salvador. [153] CRPD Committee, General Comment No. 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.