Shackled: The Never-Ending Fight for Rights of the Mentally Ill
Updated: Feb 10
“Shackling is a rudimentary form of physical restraint used to confine people with real or perceived psycho-social disabilities.” While the UN and mental-health institutions talk about bringing ‘reforms’ in the lives of mental-health patients, the act of shackling remains a hindrance in reaching these standards and is rather ‘restrictive in nature’. What however should be of concern, is how mental health remains a ‘healing business’ which only the self-proclaimed prophets can cure. It is a ‘stigma’ for the society. While there can be various factors behind the same, the longstanding belief that something that is not normal is a work of the devil continues to persist even today, and ‘shackling’ is considered to be the ‘ideal way’ to chain these ‘evils’. The main objective of the paper is to draw a comparative analysis between India and Ghana concerning the basic rights of the mentally ill population in both the countries. India and Ghana are two such nations, where people have fallen prey to these appalling measures. However, what sets these two nations apart from most of the lot is the presence of laws that protect the rights of the mentally ill and also ban shackling, which is the primary reason, as to why, these nations have been selected. While there are several other nations where shackling has been banned as well, it is the similarity of laws and socio-economic conditions which aid the analysis in this scenario. It is the lack of proper enforcement, education and awareness along with the allocation of funds which become the primary reasons as to why the act tends to exist in these two nations, even after the establishment of said ban and laws. Thus, drawing an analysis involving these two particular nations, would not only help us to derive a basic idea as to the legal structure that is present, but also generate a basic concept over the presence of shackling in several other countries. Another major reason for choosing these two nations is the lack of enforcement that exists. The paper would be divided into the following:
· The Right to Live with Human Dignity
· The Right to Food, Water, Personal Hygiene, Sanitation, and Recreation
· The Restraining Guidelines for Mental Health Services
This would not only aid in getting an idea over the current legal situation in these two nations but also help us to develop a basic idea as to the condition in several countries where the bans have not been established and there have been no whatsoever steps taken by the government for the betterment of these individuals. Thus, following through the same along with the rights mentioned, the paper aims to argue on why shackling is derogatory in nature and should be banned globally.
Keywords: Shackling; Chaining; Dignity; Cells; Movement; Right; Ghana; India; Mental Healthcare Act, 2017 ; Mental Health Act 846, 2012; Food; Hygiene; Restraint; Disregard
India, Ghana and the Tales of Shackling
In 2017, the ‘Mental Health Authority of Ghana’, took steps to release 16 people, who were held in shackles at the ‘Nyakumasi Prayer Camp’, a spiritual healing camp, in the Central Region following which, the government had established a ban on shackling. However, several healing and prayer camps in Ghana continue to shackle these perceived patients, even after the 2017 ban.
India considers shackling an inhumane act and reprimands the same. Yet, on “3rd January 2019, reports surfaced on papers across India on how people with psychological disorders were shackled like cattle, with their feet being tied to iron chains and padlocks from anywhere between days to years.” Faith-based mental asylums in Uttar Pradesh continue to remain the grueling truth of the nation. A continuous reminder of that remains the Erwadi incident which took place on 6th August 2001, when 28 inmates of the asylum died in a fire. All these inmates were bound by chains at that time.
Both these nations have in place, several laws, for the protection of the rights of the patients, however, what these nations have been consistently failing to provide, is substantial funding and regular checks. Mental healthcare is seen as a luxury that can only be afforded the rich. Thus, while the rich are able to afford proper facilities and appropriate care, the underprivileged which form the mass population in both the countries, fail to avail the same. Shackling furthermore is practiced in healing centers which are establishments by self-proclaimed prophets, who appeal to the mass primarily because of the widespread stigma and misunderstanding around mental health. These prophets or ‘babas’ preach the belief that mental illness is an evil that has possessed the individual. Coupled with these beliefs, the lack of better alternatives, forces these individuals and families to resort to un-scientific ways of ‘cure’.
Right to Live with Human Dignity
‘Right to Live with Human Dignity’ sounds like a generic, Constitution enshrined right for people which guarantees life and personal liberty to all individuals.[i] Dignity is the right of an individual to be ‘valued’ and ‘respected’ as an individual themselves and be treated equally, respectfully, and ethically. Thus, it ultimately comes down to the sense of self-worth.
“The concepts of dignity and social justice are interlinked. Social Justice deals with the notion of equal opportunities and privileges in society, including those who are most marginalized.” However, many suffering from mental disorders are deprived of their right to be treated equally, with dignity and respect, and are rather discriminated against instead of receiving the care and support that they deserve.
Similarly, human dignity and shackling go hand-in-hand. When an individual is shackled, their right to live with the basic human dignity, which they are entitled to, is taken away. The act in itself is atrocious and it restricts them from moving as they please. Man is born free. Shackling, an individual does not cure them, but rather it pushes them deeper down the rabbit hole of confusion, stigma and induced depression. In short, it is an obstruction to their freedom, their choices, and their opportunity to live a ‘normal’ life, free from any discrimination, i.e., a life with dignity.
The Supreme Court of India, in Accused X v State of Maharashtra judgement, noted that under the Mental Healthcare Act,2017, there is a statutory right for mentally ill persons to live with dignity. Furthermore, it is an issue of their basic right to entitlement. When an individual’s ‘right to live with dignity’ is taken away, so is their basic ounce of self-respect and value. In the end, it is both a health issue and a human rights issue.
India’s battle with mental health and its proper care is continuous and never-ending. Though continuously increasing, there continues to exist a lack of awareness and sensitivity towards this issue.
The situation in Ghana is not any different. These individuals continue to suffer from various forms of discrimination and social exclusion despite the several anti-discriminatory laws in action, which aim to facilitate equality in mainstream socio-political and economic activities. Mental disorders in Ghana are seen as something evil by many and instead of medical care, it is believed that mental disorders require ‘healing’. In 2012, the Mental Health Act 846 was passed which provides that persons with ‘mental disorders’ have the right to ‘humane and dignified’ treatment. The word ‘dignified’, however gets lost somewhere in the process, due to the limited funding that the state provides for the development of the same. Most of these patients are seen as ‘taken by the devil’ in the prayer camps and then chained to trees and walls, for months and years in a row, with very little care being taken of them. “These individuals are provided with very little medication and treatment and have to eat, sleep, defecate at the same spot, where they have been chained for months.” In 2017, Ghana took a huge step forward, when it took the oath of unshackling the patients and freed “15 people who had real or perceived mental health conditions, who had been chained for months.” However, several faith healers in Ghana have shown consistent defiance of the new law in place and continued to chain these perceived patients in inhumane conditions. What further worsens the situation is the stigma, which sometimes leads to the families of these patients refusing to take these individuals back in.
Right to Food, Water, Personal Hygiene, Sanitation, and Recreation
Food, water, sanitation are necessities of every individual and there should be no discrimination in providing the same. However, there have been mass reports of facilities, both in India and Ghana, abusing these basic human rights and failing to provide these individuals with the proper care that they require. Not only does this reflect the failure on the part of the government but also the persisting and percolating ignorance present in the lowest rung of the system.
Article 21 of the Indian Constitution guarantees life and personal liberty to all individuals. The right to food, water, personal hygiene, and recreation is an extension of Article 21 of the Constitution. As mentioned in Chitta Ranjan Bhattacharjee v State of Tripura and Ors. food, water, personal hygiene, sanitation, and recreation are basic human rights and an absolute necessity for an individual. Furthermore, mentally ill persons are entitled to all human rights and fundamental rights. A mentally ill person does not become a non-person on the account of certain disabilities. However, the existent shackling which the state has been ignorant towards is the base of all problems. Being chained forces these individuals to live their lives in a small restricted space. Thus, personal hygiene, sanitation, and recreation become a far-fetched dream.
The situation is not any different in Ghana. The country follows the Mental Healthcare Act,2012 for the rights of mentally ill individuals. Clause 55 of the Mental Healthcare Act,2012 covers the basic human rights of mentally ill persons. The act provides for equal treatment as well as the accessibility of food, water, and proper sanitation practices. According to Section 55(2), “a person with mental disorder is entitled to humane and dignified treatment at any time with respect to personal dignity and privacy”. However, in reality, the patients are chained and put in a small cell with several other patients which puts all of them at risk, not only of physical or sexual violence but also in terms of health. Lack of proper sanitation can lead to the spreading of infections and contamination. In several traditional healing centers in Ghana, the “patients are often forced to fast, take medications and herbal concoctions, and face physical and sexual violence.” While these abuses are open secrets, very minimal steps have been taken to control the same. The government in Ghana, have been passing around vague promises and establishing bans, but in reality, the same have hardly been implemented.
Restraining Guidelines for Mental Health Services
Restraints are generally put to curb an individual from harming themselves or others. However, for quite a long time, these restraints have been utilized without any such necessity, where the patients have been kept chained for extremely long periods. Restraining and chaining are two sides of the same coin, but extremely different from each other. Restraining is using simple techniques to restrict certain movements which can be harmful, like using a nylon or leather belt, etc. However, chaining or shackling is a type of restraining, where you restrict an individual’s entire movement and chain them to someplace.
The restraining guidelines of mentally ill patients in India are regulated by the Mental Healthcare Act,2017. “Restraints are usually provided when these individuals are dangerous to themselves, others or towards property and the restraint is an utmost need and not a form of punishment.” The use of restraint, as provided under Chapter XII of the Mental Healthcare Act,2017, require a report for every such instance. However, India has been showing a continuous violation of the law under the same, despite of the repercussions. Various institutions lack a proper log of the reports of restraints and often these restraints are used as punishments.India does not support or encourage physical or manual restraints by shackling, and it is usually seen as a last resort measure. However, in several mental health institutions, there have been reports of chaining patients or handcuffing them while keeping them in isolation.
Ghana’s restraint laws fall under the Mental Healthcare Act, 2012 according to which, Clause 58(4) which dealt with seclusion and restraint had been withdrawn. While the law under Clause 58(1) provides that involuntary seclusion and minimal restraints should be provided only in cases of imminent danger, it is evident from mass reports by several human rights committees that, shackling is an extremely common form of restraint used in Ghana. Patients are chained to walls, trees, in tiny cells etc.
As mentioned in Clause 58(2) of the Mental Healthcare Act,2012, “the use of these chains and restraints lies at the discretion of the head of the facilities and the senior nurses.” While the law, as under Clause 57(5) “provides that electro-convulsive therapy and psychosurgery are condemned and not to be performed”, various facilities across Ghana use the same to ‘control’ and ‘cure’ their patients.
“Shackling or chaining itself is an extremely atrocious act which is attached to stigma and discrimination.” When an individual, is shackled, they believe that it is their own fault and have done something wrong. Furthermore, shackling makes the patient continuously question themselves, their actions, beliefs, etc. This act is barbaric in nature, and the treatment meted out to the patients is even worse. When chains are put on an individual, the person is instantly deemed as dangerous. This also aids in the process of gradual exclusion from society. To live a ‘normal’ and ‘peaceful’, a mental-health patient does not need gross exclusion but rather acceptance, proper treatment, and most of all inclusion.
Disregard for laws and improper funding, shape the mental health care structure and facilities for the underprivileged. Mass class divide and discrimination shape the type of care that an individual receives from the various facilities. While countries have been establishing laws, these laws simply remain vague words until proper measures are taken to establish them. Ghana or India, most countries in the world report improper care structure and facilities. These countries report human rights abuses of those who suffer from mental illnesses, however, very limited actions are actually taken to bring about the necessary change. Immediate action is required to ban the act of shackling. The question isn’t that of which countries practice shackling. The question is how long it would take, to bring about the desired change. Mentally ill people do not need prayer camps, they need proper medication, care and treatment. This is only possible when shackling is seen as a derogatory treatment by the mass population and the government takes genuine actions against it, instead of making false promises.
[i] INDIA CONST. art. 21.
Damayanti Bhattacharjee is a second-year student at Jindal Global Law School. H