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

In Mexico, Felipe Orozco, a 41-year-old man, told Human Rights Watch he had been hospitalized five times because he had a mental health condition. Tony Evers declared this as the "year of mental health" in his budget address last month, one psychotherapist says the budget leaves an important component - mental health We are seeing an increase in the number of people dying in their homes before our ambulance services arrive, said Luis Romero Pineda, MSF project coordinator in El Salvador. The testimonies were collected between August 2018 and September 2020 through in-person and phone interviews. Mental health shortages range in severity across the country. Top photo: A young boy in El Salvador, where children face multiple threats to their safety and well-being including gang violence. may well amount to torture.[161], The CRPD and the African Charter both explicitly prohibit all forms of exploitation, violence, and abuse. [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. 2; CRC, art. The limited human and material resources available are concentrated in the respective country capital cities. There are no statistics on the scale of shackling at a global level. [140], The Indonesian government officially banned pasung (shackling) by law in 1977. In the U.S., mental health issues are far more common than many realize. 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. Homelessness Resources: Housing and Shelter | SAMHSA In many countries, it is a profitable business. 2018 Oct 10;42:e172. [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. [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. 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. Many of MSFs ambulance calls in recent months have been related to respiratory diseases. Human Rights Watch visit to Holy Ghost Coptic Church of Africa, Kisumu, February 18, 2020. 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. Exacerbated by such close and unsanitary living conditions, lice and scabies are a major problem in many institutions.[97]. Once the person is committed to an institution, they have no right to appeal or leave until the institution discharges them. Strengthening Health Care in El Salvador - SaportaReport According to WHO, over 10 million children under the age of five who. [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. In El Salvador, learning disabilities and speech and language disorders are not considered disabilities for purposes of statistical reporting at the national level (MINED, 2015). 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 . El Salvador | IntraHealth Over 400 million people worldwide lack access to essential health services typically delivered through primary healthcare. [48] 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; Sophie Morgan, The country where disabled people are beaten and chained, BBC News Online, July 28, 2015, https://www.bbc.com/news/blogs-ouch-33523742 (accessed September 21, 2020); Shantha Rau Barriga (Human Rights Watch), Torture Comes in Many Forms, commentary,The Huffington Post, June 29, 2015, https://www.huffpost.com/entry/torture-comes-in-many-for_b_7691390?guccounter=1 (accessed September 16, 2020). 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. Even in institutions where suitable toilets exist, residents do not always have access to them or they are inadequate. [4] International Disability Alliance, Legal Opinion on Article 12 of CRPD, undated, https://www.internationaldisabilityalliance.org/sites/default/files/documents/legalopinionletterart12final_0.doc (accessed September 14, 2020). In addition, even when there are services, they are often under-utilized or do not comply with human rights standards because of limited understanding and awareness of mental health. (PDF) Access to mental health care in El Salvador: An assessment of [14] "Suicide: One Person Dies Every 40 Seconds," WHO news release, September 9, 2019, https://www.who.int/news-room/detail/09-09-2019-suicide-one-person-dies-every-40-seconds (accessed September 22, 2020). 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. The number of new jobs and the unemployment rate are regularly cited in the news, but theyre just part of the picture. 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. I eat porridge in the morning and if Im lucky, I find bread at night, but not every night. 2200A (XXI), 21 U.N. GAOR Supp. In many of the countries where Human Rights Watch conducted research for this report, there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, or the consequence of some form of sin, displaying immoral behavior, orfor those whose families are adherents of certain religionshaving a lack of faith. 8; UN Office of the High Commissioner for Human Rights/WHO, Fact Sheet No. In addition, the person with a psychosocial disability and their family can visit the community health center for one-on-one counseling with a doctor or nurse, they can get medication, and they can participate in occupational therapy or other activities. States also range in the number of providers needed to fill shortages. [69] In 2019, large prayer camps such as Mount Horeb detained dozens of people in chains. The . We worked closely with partner organizations to visit private homes and institutions in Afghanistan, Burkina Faso, Cambodia, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, Russia, the self-declared independent state of Somaliland, South Sudan, and Yemen. When the Special Olympics team had Malaki released, he got the opportunity and training to play football. Even educated and well to-d0 families can resort to shackling. A Salvadoran teen and his family flee a death sentence from a local gang. In prayer camps and institutions in some countries, many interviewees spoke of persistent, gnawing hunger from forced fasting or inadequate food, and many looked emaciated. Subsequently, those with mental health impairment tend to be complex patients, which may convolute delivery of services. MSF is working . 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, vigorous massages by traditional healers, Quranic recitation in the persons ear, and special baths. 38-39. In prayer camps in Ghana, administrators and pastors told Human Rights Watch that fasting was a key component of curing a psychosocial disability. A special thank you to the Swedish Postcode Lottery; the Samuel Family Foundation; Tracy and Bruce Simpson; Cristina Sainz and Enrique Prez-Hernndez; Renaud and Marina de Planta; Kiran Chandaria; and Nadge and Christophe Hentsch for the financial support that made this research and report possible. [153] CRPD Committee, General Comment No. Central Americans are seeking to escape gang violence, corruption, extreme poverty, the impacts of climate change and other problems, and hoping to resettle in Mexico or the United States. 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). WHO report highlights global shortfall in investment in mental health Many interviewees appeared undernourished and complained of hunger. [68] In the Greater Accra Region, there are an estimated 70 prayer camps. 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. They are run by self-proclaimed prophets and are Christian religious institutions not affiliated with other denominations, but with roots in the evangelical or Pentecostal movements, established for purposes of prayer, counseling, and spiritual healing. 171, entered into force March 23, 1976; International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. 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. In addition, 1.9 million, or 5.1%, of adults in nonmetropolitan areas . We keep them in their underclothes. A doctor working at a psychiatric hospital in southern Nigeria said: We have to use chains in some cases.[59] In eastern Indonesia, Human Rights Watch witnessed a woman being tied around the waist with a twisted cloth and restrained to her 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. The disappointing irony goes beyond unheeded history repeating itself. Rather, the critical issue is the inhumane treatment of people with psychosocial disabilities forced to stay there. His loving parents found him nonresponsive, with a heart rate near 200 beats per minute. [120] 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, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf (accessed December 28, 2013), para. [143] When the Special Olympics team had Malaki released, he got the opportunity and training to play football. The Cohen Veterans Network and National Council for Mental Wellbeing believe that more must be done to improve access to care for everyday Americans. It was like my mind had gone blank on account of the fright, she said. In many countries there is very limited, if any, government oversight of these institutions. In state-run or private institutions, as well as traditional or religious healing centers, they are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence. 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. Even though the healthcare system has many hospitals, clinics, and care centers, the quality of healthcare they provide is deemed inadequate. 58. Latinx/Hispanic Communities and Mental Health [65] Viola Zhou, Mentally ill Chinese Girl, 8, Roped to Tree Outside by Grandparents for Nearly Six Years, South China Morning Post, September 21, 2016, https://www.scmp.com/news/china/society/article/2021288/mentally-ill-chinese-girl-8-roped-tree-outside-grandparents (accessed July 28, 2020). 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, PDF From Rights to Realities: Confronting the Challenge of Educating I was fearful that someone would attack me during the nights, without being able to defend myself because of being shackled.[89], People end up living shackled in institutions for long periods because their relatives do not take them home and the institution has nowhere to send them. In comparison, 1,560 did in the 2014-2015 academic year. A number have also signed the African Charter on the Rights and Welfare of the Child (ACRWC). The Convention on the Rights of the Child states that under the convention, a child means every human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier.[1], Disabled Persons Organizations (DPOs): Organizations in which persons with disabilities constitute the majority of members and the governing body and that work to promote self-representation, participation, equality, and integration of persons with disabilities.[2]. A/6316 (1966), 999 U.N.T.S. (No.16) at 52, U.N. Doc. We dont know if hes dead or alive.[108] While Covid-19 has exposed the importance of psychological wellbeing and the need for connection and support within communities, it has exacerbated the risk to people with psychosocial disabilities. [134] WHO, Building Back Better Sustainable Mental Health Care after Emergencies, https://apps.who.int/iris/bitstream/handle/10665/85377/9789241564571_eng.pdf?sequence=1, p. 73. Evidence is emerging in Indonesia of a serious rise in mental health problems associated with the COVID-19 pandemic, and the crisis has revealed the urgent need for investment in the area, Sudirman Nasir writes. [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/. Addressing the escalating psychiatrist shortage | AAMC res. The Protocol of San Salvador has been ratified by Argentina, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, and Peru. Budget allocations for mental health care are barely 1% of the total health care budgets; and the psychiatric hospitals located in the national capitals consume at least 90% of those funds. Amid such far-reaching and systemic challenges, many have fought to defend Central Americans right to migrate, but Lykes says its also time to start considering another inalienable rightthe right to remain. [105], Shackling affects a persons mental as well as physical health. Often an extension of the faith healers house or situated within the compound of a church, temple, shrine, mosque, or religious school, these sometimes rudimentary centers primarily cater to individuals with alleged spiritual problems such as bewitchment or possession by the devil or jinn (evil spirits); lack of faith; perceived or real mental health conditions; drug use or deviant behavior, including skipping school, smoking tobacco or marijuana, being greedy, or stealing. 119. Human Rights Watch interviews with Benjamin Ballal, February 15, 2020; Archbishop Danokech, February 18, 2020; and Fiera [not her real name], November 20, 2019. 49) at 65, UN Doc. Due to these perceptions, people dont want to help or mingle with persons with disabilities.[50], Ying, a young woman from Goungdong province, in southern China, said: All through my childhood, my aunt was locked in a wooden shed and I was forbidden to have contact with her. While countries are increasingly starting to pay attention to the issue of mental health, the practice of shackling remains largely invisible. Support for Central Americans - American Psychological Association Using metallic chains, iron manacles or spreader rods, metal leg or hand cuffs, or wooden stocks; Tying or binding them with rope or makeshift cloth; or. 1, Equal recognition before the law, U.N. Doc. Even when mental health services are free or subsidized, the distance and transport costs are a significant barrier. 90-92. 39/46, annex, 39 U.N. GAOR Supp. 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. A custom index was developed, ranking each state according to its mental health service access. [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. 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. [71], In Guatemala, Disability Rights International in a 2018 report found hundreds of children with psychosocial or intellectual disabilities tied to furniture or locked in cages in orphanages and institutions. However, implementation has depended on the provincial governors issuing a decree and deploying adequate resources. In some cases, families left fake phone numbers and addresses in order to abandon the relative, while in other cases they simply moved homes or failed to show up. From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. [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. [146] American Convention on Human Rights (ACHR), adopted at the Inter-American Specialized Conference on Human Rights, San Jos, Costa Rica, 22 November 1966. [165] CRPD, art. We partner with the government, NGOs, . To be a young person in El Salvador, Guatemala or Honduras is extremely stressful, he says. [35] Mental health is not just a human right but a public good that is key to achieving the United Nations Sustainable Development Goals (SDG). Anxiety and depression levels are the lowest since the pandemic began, 48% of Americans are feeling down, depressed, or hopeless during the COVID-19 pandemic, How many teens are vaping? 24; CEDAW, art 12; CRPD, art. Treaty Series No. 61/106, Annex I, UN GAOR, 61st Sess., Supp. Despite being easy to diagnose, there is a lack of mental health experts to treat these illnesses in Mexico. (2019, October 1). Kessler says that mental disorders are treated as acute, episodic ailments instead of chronic illnesses. Human Rights Watch research in Nigeria found that people with mental health conditions were held in iron shackles around their ankles in locked-up wards in a psychiatric hospital and in government-run rehabilitation centers. 74(e). (No. As a result, many governments do not have any data on the number of private institutions in their country, much less the number of people who are detained or shackled in them. [42] Human Rights Watch, Disability Is Not Weakness: Discrimination and Barriers Facing Women and Girls with Disabilities in Afghanistan, April 2020, https://www.hrw.org/report/2020/04/28/disability-not-weakness/discrimination-and-barriers-facing-women-and-girls. CAB/LEG/24.9/49 (1990), entered into force November 29, 1999, art 14. Provide adequate food, shelter, and health services to people with psychosocial disabilities. The increase in people dying at home reflects the enormous strain COVID-19 has put on the health system. The chaining of people with mental health conditions needs to stop it needs to stop. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems. The demand for mental health services is stronger than ever, with nearly six in 10 (56%) Americans seeking or wanting to seek mental health services either for themselves or for a loved one. 5 (2). [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. 12 and 18. This study confirmed what we hear from our members every day, that individuals and families continue to struggle to find the help they desperately need, said Linda Rosenberg, President and CEO of National Council for Mental Wellbeing. There are currently 10 Steven A. Cohen Military Family Clinics nationwide. 69 (1988), signed November 17, 1988. As of 2018, fewer than half of the 139 countries that have mental health policies had aligned them with international human rights conventions. In the same report, the special rapporteur stressed that States must protect persons with disabilities against home-based deprivation of liberty, including home confinement, shackling and pasung.[167]. Due to a lack of resources, coordination, and training, both the TPKJM and the rapid response teams struggle to successfully rescue people from pasung. The ACHPR has been ratified by Benin, Burkina Faso, Cte dIvoire, Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Kenya, Liberia, Mozambique, Nigeria, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Tanzania, Togo, Uganda, and Zimbabwe; Protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa (Maputo Protocol), adopted July 11, 2003, CAB/LEG/66.6, reprinted in 1 Afr. Target support toward community-based support and services, including mental health services. [15] WHO, Gender and Women's Mental Health, https://www.who.int/mental_health/prevention/genderwomen/en/; WHO, Mental disorders, https://www.who.int/news-room/fact-sheets/detail/mental-disorders; WHO, Mental health in the workplace, https://www.who.int/mental_health/in_the_workplace/en/; WHO, Mental Health, https://www.who.int/news-room/facts-in-pictures/detail/mental-health. Mental health services in the U.S. are insufficient despite more than half of Americans (56%) seeking help. How is that Islamic?[125], In institutions visited by Human Rights Watch in Indonesia, male staff would enter and exit womens wards or sections at will or were responsible for the womens section, including at night, which put women and girls at increased risk of sexual violence, as well as subjected them to a constant sense of insecurity and fear. Ensure that people who have been released from state and private institutions have access to psychosocial support and social services. But even as psychologists seek a broader impact, says Cbar Cataln, its important to remember that the trauma and disenfranchisement driving Central Americans north are deeply personal. [132] Human Rights Watch, Ghana Breaks the Chains on Mental Health, video, https://www.youtube.com/watch?v=7idmUmMccgw; Shantha Rau Barriga, Ghana Breaks The Chains On Mental Health, commentary, Human Rights Watch Dispatch, October 16, 2017, https://www.hrw.org/news/2017/10/16/ghana-breaks-chains-mental-health; Ghana: Oversight Needed to Enforce Shackling Ban, Human Rights Watch news release, October 9, 2018, https://www.hrw.org/news/2018/10/09/ghana-oversight-needed-enforce-shackling-ban. [174] UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. [8] World Health Organization (WHO), Gender and Women's Mental Health, undated, https://www.who.int/mental_health/prevention/genderwomen/en/ (accessed July 21, 2020); WHO, Mental disorders, November 28, 2019, https://www.who.int/news-room/fact-sheets/detail/mental-disorders (accessed June 22, 2020); WHO, Mental health in the workplace, May 2019, https://www.who.int/mental_health/in_the_workplace/en/ (accessed June 22, 2020); WHO, Mental Health, October 2, 2019, https://www.who.int/news-room/facts-in-pictures/detail/mental-health (accessed June 22, 2020). The Protocol of San Salvador has been ratified by Argentina, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, and Peru. In Nigeria, Human Rights Watch visited 28 state-run and private facilities between 2018 and 2019, across which a few hundred people were arbitrarily detained, and where people were regularly chained or shackled. Based on the analysis of third-party data, states are struggling to keep up with demand due to lack of funding and facilities, and, to a lesser extent, providers. 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. [49], A volunteer from an organization providing services to people with disabilities in Cameroon said: People in Cameroon have negative perceptions about disability. [110] Fasting would help to starve evil spirits and enable God and prayer to heal them. Crosby, A., et al., Journal of Genocide Research, 2016, One Session at a Time: When You Have a Whole Hour While many countries are increasingly starting to pay attention to the issue of mental health, the practice of shackling remains largely invisible. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. As a result of this initiative, according to the WHO, 1,700 people were freed from chains in Somalia between 2007 and 2010. Others think persons with disabilities are useless. [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. In one case, a man with a psychosocial disability spent 37 years chained in a dark, sweltering cave in the mountains in Wadi Al-Sabab, Saudi Arabia. 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. We need to do something.. We are particularly grateful to the law firm Borden Ladner Gervais LLP (BLG), to students at the University of Torontos International Human Rights Program and Rotman School of Management, and to Hope Blain, Jason Han, Paras Shah, Sophie Tarazi, Emma Tehrani, and Elena Zarabozo, Attorneys at OMelveny & Myers LLP, who provided invaluable research support.