Hundreds of thousands of people with mental health conditions in 60 countries are still being chained, according to a comprehensive and damning new study.
Human Rights Watch says that men, women and children – some as young as 10 – are regularly shackled or locked in confined spaces for weeks, months, and even years, across Asia, Africa, Europe, the Middle East, and the Americas.
The report, Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide, examines how people with mental health conditions are often shackled against their will by families in their own homes or in overcrowded and unsanitary institutions because of widespread stigma and a lack of mental health services.
Many of those affected 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 centres, they are shackled for restraint or punishment and 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 is typically practised by families who believe that mental health conditions are the result of evil spirits or an individual 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; when that did not work, he was locked in a room for several years.
Paul, who was interviewed for the report in Kisumu, Kenya, described his conditions: “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.”
Mudinat, who had been shackled in a church in Abeokuta, Nigeria, in September 2019 , described defecating into bags during her confinement.
“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,” said Mudinat, who was described as having a psychosocial disability.
Paul and Mudinat are among 350 people with psychosocial disabilities, including children, whose experiences were looked at by the group.
“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 HRW 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 is no data and no coordinated international or regional effort to eradicate the practice.
HRW has been working with mental health advocates with lived experience, and human rights and anti-torture organisations to launch a global #BreakTheChains campaign to end shackling, ahead of World Mental Health Day on 10 October.
Globally, an estimated 792 million people, or one in 10, including one in five children, have a mental health condition. Yet governments spend less than 2% 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 subsidised, distance and transport costs are significant barriers.
One man from Kenya, who is living in chains, told HRW: “It’s not how a human being is supposed to be. A human being should be free.
Without proper access to sanitation, soap, or even basic healthcare, people who are shackled are at greater risk of contracting 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.
“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.”