Living in Shackles: Global Mental Health Human Rights Violations

For years, a man in Indonesia slept on a wooden platform with chains around his ankles. His world became a small space behind his family’s home. Day after day, he remained physically constrained, isolated from his community, and denied freedom and dignity. 

But his story is not unique. 

Across the world, people with mental health conditions and psychosocial disabilities continue to be shackled, caged, and hidden because of stigma, discrimination, and misconceptions surrounding mental health. Human Rights Watch documents these practices in dozens of countries across Asia, Africa, the Middle East, and Latin America. They occur anywhere from family homes to traditional healing centers to religious institutions, and even in government-run facilities. While each situation is different, the result is often the same: people deprived of their liberty and rights because of a disability. 

For many families, shackling emerges from desperation rather than pure cruelty. 

"We took Ngurah to more than 40 traditional healers, where they poked him with a stick and put herbs in his eyes, but it didn't work. We didn't know what to do. When Ngurah kept getting lost, the local police and community blamed and put pressure on us. We felt ashamed, so we decided to chain him,” a family in Indonesia explained. 

Ngurah’s family searched desperately for answers before they turned to the chains. Their story reflects a reality documented across countries. Families may be expected to care for relatives with significant mental health needs while having little access to treatment, community support, or reliable information. In many low- and middle-income countries, mental health services remain scarce, leaving families alone and unequipped to manage their loved one's health. 

Understanding those pressures, however, does not diminish the harm experienced by the person being restrained and mistreated. When families respond to a lack of support by turning to confinement or shackling, it is the person with the mental health condition who loses their freedom, autonomy, and connection to the community. 

That desperation is made even worse when compounded by stigma, even if the physical restraints are absent. 

Carlos, a 51-year-old man from Maputo, Mozambique, described how his diagnoses reshaped his relationships with the people closest to him and alienated him from his family. 

"I'm never invited to happy occasions, weddings, or birthdays with my family. I'm only invited to spiritual events because my family thinks I have a spiritual problem, not a mental health condition."

Exclusion does not always require chains. For people like Carlos, stigma can itself become another form of confinement and isolation. Misconceptions about mental health conditions can shape how individuals are treated within families, communities, education, and employment. 

For some, these misconceptions affect their treatment within the community, resulting in harmful practices, no matter how much families may think it's “for the best.” 

"People in the neighborhood say that I'm mad. 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, a 42-year-old woman from Mozambique. 

Stories like Fiera’s reflect how stigma and limited access to mental healthcare can intersect. When services are unavailable or unaffordable, people with mental health conditions may instead be taken to traditional or faith healers by their families or communities. Traditional and faith healing can provide meaningful cultural and spiritual support, but Human Rights Watch has also documented cases in which individuals went through practices that caused physical harm or prolonged confinement in these settings. 

Physical restraint and confinement take on different shapes around the world. In Indonesia, this practice is known as pasung.

According to researchers, pasung refers to the physical restraint or confinement of a person with a mental health condition or psychosocial disability within the community. Individuals may be restrained with chains, ropes, wooden stocks, locked sheds, or cages. Although Indonesia officially banned pasung in 1977, the practice continues in some communities, particularly where mental health services remain inaccessible or unaffordable.

"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, Bali

A plea, where all he asks is for the ordinary. To work. To live. To walk outside. 

“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

Article 25 of the Universal Declaration of Human Rights recognizes the right to health, while the Convention on the Rights of Persons with Disabilities affirms that people with disabilities are entitled to liberty, dignity, equality before the law, and freedom from torture or cruel, inhuman, or degrading treatment. The Office of the United Nations High Commissioner for Human Rights has repeatedly emphasized that mental health should be approached through a human rights lens rather than one based on coercion or institutionalization.

As Human Rights Watch's findings demonstrate, these rights remain out of reach for many people around the world. However, progress is possible.

The World Health Organization and the United Nations have increasingly called for countries to replace coercive practices with community-based mental healthcare. Rather than isolating people from society, these approaches emphasize accessible treatment, crisis support, housing, employment opportunities, peer support, and services that allow individuals to remain active members of their families and communities. Research consistently shows that community-based care produces better health outcomes while protecting individual dignity and autonomy.

In 2006, the World Health Organization launched the Chain-Free Initiative in Somalia and Afghanistan to support the release of people living in chains and expand access to community-based mental health services. Similar efforts have since emerged in Indonesia through national campaigns to eliminate pasung by improving access to psychiatric care, medication, and community outreach. While challenges remain, these initiatives demonstrate that shackling is not inevitable, but it is the result of policy choices, resource allocation, and stigma, all of which can change.

Although most of the documented cases of shackling occurred in regions within Asia, Africa, and Latin America, coercive treatment is not unique to those geographic areas. Around the world, instances of violations occur, including involuntary hospitalization, seclusion, restraint, and the criminalization of mental illness, underscoring that protecting the rights of people with mental health conditions remains a global challenge.

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The stories of Ngurah, Carlos, Fiera, Paul, Made, and Felipe are not simply examples of inadequate healthcare. They are examples of human rights violations.

"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 have to go to the toilet in a bucket... It is not how a human being is supposed to be. A human being should be free." - Paul, a man living in a faith-healing institution in Kenya. 

His plea is a simple call: the right to live with dignity. 

Human Rights Watch's report echoes this plea. Whether people are restrained with chains in Kenya, locked in small rooms in Indonesia, or confined in cages elsewhere, their desire is often the same. They desire the freedom to move, work, connect with loved ones, and live as members of their communities.

A society's commitment to mental health should not be measured only by the number of hospitals it builds or medications it prescribes. It should also be measured by whether every person, regardless of a diagnosis, is treated with dignity, protected by law, and included within their community. Around the world, advocates, healthcare workers, governments, and people living with mental illness are proving that another future is possible. One that is built not on chains or confinement, but on care, inclusion, and respect for human rights.

References

Baklien, B., Marthoenis, M., Aceh, A. R., & Thurston, M. (2023, June). pasung: A qualitative study of shackling family members with mental illness in Indonesia. Transcultural psychiatry. https://pmc.ncbi.nlm.nih.gov/articles/PMC10486150/ 

Jenkins, N. (2016, March 21). Thousands of mentally ill Indonesians live in chains: Report. Time. https://time.com/4265623/indonesia-mental-illness-chains-pasung-hrw/ 

Kusumawaty, I., & Yunike, Y. (2023, July 23). Investigating the experiences of family caregivers who shackle people with mental disorders. Frontiers. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1062100/full 

Mental Health and Human Rights | Ohchr. (n.d.). https://www.ohchr.org/en/health/mental-health-and-human-rights 

People with mental health conditions living in chains. Human Rights Watch. (2023, May 9). https://www.hrw.org/news/2020/10/06/people-mental-health-conditions-living-chains 

Sharma, K. (2020, October 6). Living in chains. Human Rights Watch. https://www.hrw.org/report/2020/10/06/living-chains/shackling-people-psychosocial-disabilities-worldwide 

World Health Organization. (2021, June 26). Unsdg what if series: “what if ... pasung were ended in Indonesia?” World Health Organization. https://www.who.int/indonesia/news/detail/26-06-2021-unsdg-what-if-series-what-if-pasung-were-ended-in-indonesia