(London) – Hundreds of thousands of people with mental health conditions are shackled around the world, Human Rights Watch said in a report released today. Men, women, and children, some as young as 10, are chained or locked in confined spaces for weeks, months, and even years, in about 60 countries across Asia, Africa, Europe, the Middle East, and the Americas.
The 56-page report, “Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide,” examines how people with mental health conditions are often shackled by families in their own homes or in overcrowded and unsanitary institutions, against their will, due to widespread stigma and a lack of mental health services. Many are forced to eat, sleep, urinate, and defecate in the same tiny area. 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. The report includes field research and testimonies from Afghanistan, Burkina Faso, Cambodia, China, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, the self-declared independent state of Somaliland, South Sudan, and Yemen.
“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.”
While a number of countries are paying greater attention to the issue of mental health, shackling remains largely out of sight. There are no data or coordinated international or regional efforts to eradicate shackling. In response, Human Rights Watch has been working with mental health advocates with lived experience, and human rights and anti-torture organizations around the world to launch a global #BreakTheChains campaign to end shackling of people with mental health conditions, ahead of World Mental Health Day on October 10.
Human Rights Watch interviewed over 350 people with psychosocial disabilities, including children, and 430 family members, staff working in institutions, mental health professionals, faith healers, government officials, and disability rights advocates. Based on a study of 110 countries, Human Rights Watch found evidence of shackling of people with mental health conditions across age groups, ethnicities, religions, socioeconomic strata, and urban and rural areas in about 60 countries.
Globally, an estimated 792 million people, or 1 in 10, including 1 in 5 children, have a mental health condition. Yet governments spend less than two percent of their health budgets on mental health. More than two-thirds of countries do not reimburse people for mental health services in national health insurance systems. Even when mental health services are free or subsidized, distance and transport costs are a significant barrier.
In the absence of proper mental health support and lack of awareness, many families feel they have no option but to shackle their relatives. They are often worried that the person might run away or hurt themselves or others.
Shackling is typically practiced by families who believe that mental health conditions are the result of evil spirits or having sinned. People often first consult faith or traditional healers and only seek 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, locked in a room for several years.
In many countries, families take relatives – including children as young as 10 – to traditional or faith healing centers where they are shackled for restraint or punishment. Shackled people live in extremely degrading conditions. They are also 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 person’s ear, Gospel hymns, and special baths.'
Shackling impacts both mental and physical health. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems. Shackling also forces people to live in very restrictive conditions that reduce their ability to stand or move. Some people are even shackled to another person, forcing them to go to the toilet and sleep together.
One man from Kenya who is currently living in chains said, “It’s not how a human being is supposed to be. A human being should be free.”
“In many of these institutions, the level of personal hygiene is atrocious because people are not allowed to bathe or change their clothes, and live in a two-meter radius,” Sharma said. “Dignity is denied.”
Without proper access to sanitation, soap, or even basic health care, people who are shackled are at greater risk of Covid-19. And in countries where the Covid-19 pandemic has disrupted access to mental health services, people with mental health conditions may be at greater risk of being shackled.
National governments should act urgently to ban shackling, reduce stigma, and develop quality, accessible, and affordable community mental health services. Governments should immediately order inspections and regular monitoring of state-run and private institutions and take appropriate action against abusive facilities, Human Rights Watch said.
“It’s horrifying that hundreds of thousands of people around the world are living in chains, isolated, abused, and alone,” Sharma said. “Governments should stop brushing this problem under the rug and take real action now.”
“I’ve been chained for five years. 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.”
—Paul, a man with a mental health condition in Kisumu, Kenya, February 2020
“The chaining of people with mental health conditions needs to stop – it needs to stop.”
—Tina Mensah, Ghana’s deputy health minister, Accra, Ghana, November 8, 2019
“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.”
—Made, a man with a psychosocial disability locked in a purpose-built cell on his father’s land for two years, Bali, Indonesia, November 2019
“I was fearful that someone would attack me during the nights, without being able to defend myself because of being shackled.”
—Felipe, a man with mental health conditions who was shackled with a padlock, naked in a psychiatric hospital in Puebla, Mexico, 2018
“I go to the toilet in nylon bags, until they take it away at night. I last took a bath days ago. I eat here once a day. I am not free to walk about. At night I sleep inside the house. I stay in a different place from the men. I hate the shackles.”
—Mudinat, a woman with a psychosocial disability chained at a church, Abeokuta, Nigeria, September 2019
“All through my childhood, my aunt was locked in a wooden shed and I was forbidden to have contact with her. My family believed her mental health condition would stigmatize the whole family. I really wanted to help my aunty but couldn’t. It was heartbreaking.”
—Ying (not her real name), young woman who grew up in Guangdong province, China, November 2019
“People in the neighborhood say that I’m mad [maluca or n’lhanyi]. I was taken to a traditional healing center where they cut my wrists to introduce medicine and another one where a witch doctor made me take baths with chicken blood.”
—Fiera, 42, woman with a psychosocial disability, Maputo, Mozambique, November 2019
“It’s heartbreaking that two of my cousins who have mental health conditions have been locked away together in a room for many years. My aunt has tried her best to support them but she struggles with stigma and the lack of robust mental health services in Oman. It’s time for governments to step up so that families aren’t left to cope on their own.”
—Ridha, family member with relatives shackled in Oman, September 2020
“I was chained, beaten, and given devil incense. They feel you’re possessed and put liquid down your nose to drive out the devil.”
—Benjamin, 40, mental health advocate who was chained at a church in Monteserrado, Liberia, February 2020
“Families tie them [people with mental health conditions] up regularly. We can tell by the physical signs on their bodies. They have scars.”
—A Mexican official from the Office of the Prosecutor for Protection of People with Disabilities