Ghana has been counted among about 60 countries across Africa, Asia Europe, the Middle East and the Americas that hundreds of thousands of people with mental health conditions are shackled and treated poorly, says Human Right Watch report.

Thus, men, women and children, some as young as 10, are chained or locked in confined spaces for weeks, months, and even years.

The 56-page report titled: “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 space.

In state-run or private institutions, as well as traditional or religious healing centres, 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, 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.

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, was 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.” 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