Hundreds of thousands of people with mental illness are handcuffed and shackled around the world, according to a report by Human Rights Watch (HRW).

The report, released on Saturday to mark World Mental Health Day, said most people with mental health problems are detained in crowded or dirty rooms, sheds, cages, or shelters and are often forced to eat online, too sleep, urinate and empty the same area.

Most of these patients become captivated by their families or communities; or the facilities they are housed in for long-term care, the report said.

Shackles are a rudimentary form of physical restraint used to lock in people with real or perceived psychosocial disabilities. This can be done with chains, ropes or rags.

According to HRW, restraint is mostly practiced in non-medical settings by families, a faith healer, or non-medical staff, often without support or psychiatric care.

Cuffed people often suffer from post-traumatic stress, malnutrition, infections, nerve damage, muscle atrophy and cardiovascular problems.

HRW interviewed more than 350 people with psychosocial disabilities, including children, and 430 family members, psychiatrists, faith healers, government officials and disability rights lawyers in 110 countries about their report.

Poverty contributes to the crisis

The shackling occurs primarily in parts of Africa, Asia, and the Americas that have high poverty rates and typically spend less than 2 percent of their annual budget on mental health, according to HRW.

Of the 60 countries the report cites, 24 are in Africa. 48 of them are developing countries, including some of the poorest countries in the world such as Liberia, Mozambique, Sierra Leone and Yemen.

Decades of conflicts in these countries have resulted in large numbers of people suffering from mental health problems. But because their support systems and social safety nets are weak, their families often turn to cultural and religious institutions for help, the rights group said.

“If people do not receive government support, it leads to a situation in which people are handcuffed or chained because relatives or families do not have access to mental health services,” said Michael Njenga, executive director of psychiatric users and survivors in Kenya. said Al Jazeera.

“People often have no choice but to lock people up [up] So they can look for food or look after their children, ”says Njenga.

Human rights

Aoife Nolan, professor of international human rights law at the University of Nottingham, told Al Jazeera that the HRW report raises major concerns, particularly because it threatens the freedom and security of the mentally ill, exposing them to torture and inhuman and degrading treatment.

“Crucially, many governments have failed to ensure the right to the highest possible standards of physical and mental health for people with mental illness,” she said, adding that 171 United Nations member states have signed the International Covenant on Economic, social and cultural rights.

According to HRW, there is a higher risk of contracting COVID-19 due to the lack of adequate access to sanitation or even basic health care.

Made spent two years in a purpose-built cell on his father’s land in Bali, Indonesia. His father, who continues to farm at the age of 94, said he had no choice but to chain his son. [Andrea Star Reese/HRW]The rights group documents the case of Sodikin, a 34-year-old Indonesian with a psychosocial handicap who has been handcuffed in a shed outside his family home in West Java for more than eight years.

Children tied up too

Shackling is not just limited to adults. According to the World Health Organization (WHO), every fifth child worldwide suffers from a mental illness.

Aisha, whose 18-year-old daughter is suffering from a psychosocial illness in the besieged Gaza Strip, told HRW that she was handcuffed from morning to night.

“She can’t use the toilet. She wears diapers all day … We have to chain her, otherwise she will take off her clothes, “said Aisha.

According to Shantha Barriga, director of disability rights at HRW, suicide is the third leading cause of death among children aged 15-19 worldwide. Health experts say poverty, sexual violence, forced migration, substance abuse and early pregnancy are causes of health problems in adolescents.

Shame and stigma

“There are many taboos related to mental illness. This is one reason why governments have overlooked the need to invest more in the mentally ill,” Barriga told Al Jazeera.

“In Ghana, the government has called for a ban on shackles. Years later, the practice continues. The rhetoric does not match reality. “

Barriga said the shackling is taking place “behind closed doors,” making the problem difficult to address.

Shackles are particularly common in West Africa. Huawei Ojeifo, who suffers from a mental illness herself, is the founder and executive director of She Writes Women, a women-led movement in Nigeria.

Ojeifo told Al Jazeera that Nigerians are “unaware” of mental health and the ways in which to address the problem.

“Nigerians are usually very religious, but at the same time there is a lot of ignorance about mental health. The media, music and film industries also need to sell the mental health stories from an informed and humanizing perspective, ”says Ojeifo, who is at the forefront of advocating new mental health laws in her country.

“In Nigeria, the 1958 Lunacy Act still criminalizes attempted suicide and still allows inhuman practices,” she says.

Hundreds of thousands of people with mental illness remain shackled and shackled around the world, according to HRW [Robin Hammond/HRW]Benjamin Ballah is a Liberian mental health activist who was chained in a “spiritual healing center” in Monrovia for almost a year in 2003.

“When you have been chained, life becomes meaningless to you. You are no longer treated as part of society, you feel that all is lost, ”he said.

According to Ballah, the stigma associated with mental illness is compounded by cultural and religious beliefs, with certain churches and spiritual centers promoting the view that the mentally ill are “demon possessed”.


HRW’s report states that governments should urgently ban shackling, reduce stigma surrounding mental health problems, and develop quality, accessible, and affordable community mental health services.

The report goes on to say that governments should immediately order inspections and regular surveillance of state and private institutions and take appropriate action against abusive facilities.


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