Freedom: a human condition that is the right of all human beings; a moral concept that we strive to achieve for all; and a state we all deserve. Shackling people living with psychological illnesses and psychosocial disabilities with metal chains is a worldwide practice that infringes the most fundamental human right of mobility, individual decision-making and the freedom to direct one’s life.
The Human Rights Watch (HRW), an international human rights organization, published a report in 2020 on ‘Shackling’ which stated that in 60 countries within Asia, Africa, Europe, the Middle East and the Americas, children, women and men with psychological conditions are chained or locked in small spaces. This practice of chaining or locking people living with psychosocial disabilities is called ‘shackling’. According to the report by HRW, this practice is observed in countries including China, Indonesia, India, Nigeria, Saudi Arabia, and Guatemala.
Further, the HRW report states that people with both real and perceived psychosocial disabilities are chained or locked against their will in their homes, in institutions that are private or state-run and at religious or traditional centers. According to the HRW report, nearly 100,000 people in China, 57,000 people in Indonesia and thousands in India are shackled or have been shackled at least once in their lives.
HRW reports that the process of shackling restricts the mobility of people and restricts personal hygiene. Often, people who are shackled do not have access to a toilet. Women and girls are not provided with the necessities to manage their menstrual hygiene. Further, the HRW report describes the impact of shackling on the mental and physical health of these individuals. Conditions such as malnutrition, infections, muscular atrophy and post-traumatic stress further exacerbate the suffering of these individuals.
The human rights violation instigated by shackling has been brought to light by media and human rights organizations such as the Human Rights Watch October 2020 Report and The New York Times in October 2015. Also, according to an Al Jazeera news report in 2019, the Human Rights Watch called on the Nigerian government to ban the chaining of people living with psychological conditions.
The shackling of people living with psychosocial disabilities is yet another discrimination among many against people living with psychological conditions. The American Psychological Association (APA) states that both the United Nations and World Health Organization recognize the significant barrier of social stigma imposed on seeking and receiving mental health care. Further, according to the APA, social stigma associated with mental health conditions negatively impacts both the person living with the mental health condition and their family, friends and caretakers. This burden associated with stigma highlights the need to prioritize mental health support access in rural and resource-limited settings. According to the APA, the social stigma surrounding mental illness can be a result of the complexity and interconnectedness of cultural, religious, political and economic conditions.
It is important to underline that mental health care in multiple countries is often neglected. The APA reported that in low and middle-income countries, governments often spend the least on mental health which in turn constrains the ability to implement anti-stigma initiatives and offer clinical services. The APA recommends that improving access to mental health care, implementing prevention programs to reduce stigmatization of mental health conditions and creating a fertile policy environment to protect the human rights of people living with psychosocial disabilities can promote equitable lives for people with mental health conditions.
Further, on a positive note, the United Nations Sustainable Development Goals for the 2030 Agenda has also incorporated the prevention, treatment and promotion of mental health and well-being in target 3.4. This inclusion highlights that we should prioritize mental health and must advocate for the protection of the fundamental human rights of people living with psychosocial disabilities. Limiting the mobility rights and the freedom of walking on Earth, which all humans have a birth-entitlement to, accentuates the profound injustice instigated by limited access to appropriate tools for caretakers and family members of people living with psychosocial disabilities.
We, as a responsible and kind human race, have a moral obligation to promulgate an effort to understand how families may not have access to resources to gain knowledge on psychosocial disabilities in areas with limited resources. It is important to understand that family members of people living with psychosocial disabilities may feel like they do not have alternate choices to shackling. This is potentially a result of a systematic lack of awareness and the stigmatization of mental health conditions. We should strive to share our knowledge and increase efforts to ensure that health equity and justice are achieved for all people. This in turn could ensure that people living with psychosocial conditions do not have to suffer and that the people taking care of them do not feel as if they must make a decision that infringes upon fundamental human rights.
On the flip side, there is progress to protect the human rights of people living with psychosocial disabilities. In Indonesia, in 1977, a government ban was imposed against shackling. However, the HRW reported in 2016, that the practice of shackling people with psychosocial disabilities has continued in certain institutions – regardless of a government ban. However, on a promising note, the HRW reported in 2018 that the Indonesian government has implemented new measures to improve community-based mental health services. One such initiative is called the ‘Program Indonesia Sehat Dengan Pendekatan Keluarga’ (Healthy Indonesia Program with Family Approach), which aims to utilize a family-based approach to raise awareness and deliver services related to family and mental health. Such initiatives have helped reduce the number of people shackled from about 18,800 to nearly 12,800 in July of 2018. However, according to the HRW report, despite the implementation of such community-based initiatives, when commitment and oversight is reduced, the human rights violation of shackling people with psychosocial disabilities persists in the country.
All governments, multilateral organizations, non-governmental organizations and international human rights organizations must call for urgent action to ban and condemn shackling. However, simply banning this practice will not be sufficient. Further resources must be provided to the public and the caretakers of people living with psychosocial disabilities in an effort to improve access to necessary care and increase fundamental equity for all human beings. Such measures should include community awareness programs to educate and de-stigmatize people living with psychosocial disabilities.
We should profoundly condemn shackling, raise awareness on this issue of infringement of human rights and prevent the discrimination of people living with psychosocial disabilities. Following several successful footsteps taken by countries, such as Indonesia, and improving access to community-based mental health care can help both end shackling and improve access to health and supportive resources for people living with psychosocial disabilities and their families and caretakers.
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