Hundreds of thousands of men, women and children with mental health conditions are being shackled or locked in confined spaces in countries all across the world, a new report from Human Rights Watch has found.
This “brutal practice”, which occurs in about 60 countries across Europe, Asia, Africa, the Middle East and the Americas, can leave individuals with mental health conditions - some as young as 10 - bound in chains and rope or locked in confined spaces for years in some cases.
The report, titled ‘Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide’, reveals how people with conditions such as depression, bipolar and schizophrenia are often shackled by families in their own homes or in overcrowded and unsanitary institutions against their will.
Highlighting the under-funding of mental health services across the world alongside the stigma that many with a mental illness face, the report found that many are forced to eat, sleep, urinate, and defecate in the same tiny area, as well as being forced to fast and take herbal concoctions in both state-run or private institutions and religious healing centres.
About 80 per cent of people with disabilities, including mental health conditions, live in middle or low income countries, where mental health provision is often poor and difficult to access. Further still, existing mental health services are often under-utilized or do not comply with international human rights standards because of limited understanding and awareness of mental health, according to Human Rights Watch.
The report also found that people with mental health problems face physical and sexual violence. In some of the institutions visited by Human Rights Watch researchers they found that male staff would “enter and exit women’s wards or sections at will”.
They also found that men were in charge of women’s areas, including at night - a practice which puts women and girls at increased risk of sexual violence, and subjects them to a “constant feeling of insecurity and fear”.
Similarly, in many centres run by faith or traditional healers in countries such as Nigeria and Indonesia, men, women and children were chained next to each other.
In Nigeria, boys as young as 10 were chained together in rooms with adult men.
“I’ve been chained for five years,” said Paul, a man with a mental health condition in Kisumu, Kenya. “The chain is so heavy. It doesn’t feel right; it makes me sad. I stay in a small room with seven men. I’m not allowed to wear clothes, only underwear. I eat porridge in the morning and if I’m lucky, I find bread at night, but not every night.”
Made, a man locked in a purpose-built cell on his father’s land for two years in Bali, Indonesia, said: “I feel sad, locked in this cell. I want to look around outside, go to work, plant rice in the paddy fields. Please open the door. Please open the door. Don’t put a lock on it.”
In the absence of proper mental health support coupled with a lack of awareness, many families feel they have no option but to shackle their relatives. Families often believe that mental health conditions are the result of evil spirits or sin and they often consult faith or traditional healers, only seeking out mental health services as a last resort.
Mura, a 56-year-old man in Bali, Indonesia, was taken to 103 faith healers and when that did not work, was locked in a room for several years.
In many countries, families take relatives – including children – to traditional or faith healing centres where they are shackled for restraint or punishment.
Carlos, a man with a mental health condition who had been chained and treated against his will in faith healing institutions in Mozambique, said: "I’ve been tied many times and given bitter medicines through the nose…. They give you roots, leaves as medicine. Their treatment was always unsuccessful. My mother and father would come and take shifts.
"One time I escaped with the rope tied to a log. They caught me and I pleaded with my mother to bring me home, I really suffered in that place."
But while a number of countries are paying greater attention to the issue of mental health, shackling remains largely out of sight, the report argues.
Although an estimated one in 10 people globally have a mental health condition, governments on average spend less than two per cent of their health budget on mental health, and more than two-thirds of countries do not reimburse people for mental health services in their national health insurance systems.
Of particular concern is the fact that there are no data or coordinated international or regional efforts to eradicate shackling - something that campaigners hope to change.
Human Rights Watch has worked with mental health advocates, human rights activists and anti-torture organisations around the world to launch a global #BreakTheChains campaign to end the shackling of people with mental health conditions, ahead of this year’s World Mental Health Day on October 10.
The organisation is calling on national governments to urgently ban shackling, reduce stigma around mental health, and develop affordable community mental health services.
Governments should also immediately order inspections and regular monitoring of state-run and private institutions and take appropriate action against abusive facilities, they said.
“Shackling people with mental health conditions is a widespread brutal practice that is an open secret in many communities,” said Kriti Sharma, senior disability rights researcher at Human Rights Watch and author of the report. “People can spend years chained to a tree, locked in a cage or sheep shed because families struggle to cope and governments fail to provide adequate mental health services.”