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Living in Chains: The Shackling of People with Psychosocial Disabilities Worldwide



The Shackling of People with Psychosocial Disabilities Worldwide

The Inhumane Practice of “Shackling” People With Disabilities

Numerous human rights reports have covered the shackling of hundreds of thousands of men, women, and children with mental health conditions worldwide.

The practice known as ‘shackling’ is commonplace in 60 countries worldwide and sees adults and children as young as ten years old restrained or locked up for days, weeks and even years at a time.

Worldwide, people have inadequate support and access to mental health services. People with psychosocial disabilities often stay in overcrowded, filthy rooms, sheds, cages, and animal shelters.

Furthermore, they are forced to eat, sleep, urinate, and defecate in the same tiny space. Additionally, widespread beliefs stigmatize people with psychosocial disabilities, resulting in cruel and degrading treatment.

What is the Impact of Shackling on a Person?

Shackling impacts mental and physical health, leading to post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardiovascular problems. Shackling can also mean people are chained to each other, forcing them to go to the toilet and sleep together without privacy.

An estimated 792 million people have a mental health condition worldwide. These statistics show an average of 1 in 10 people and 1 in 5 children. Across the world, depression is the leading cause of disability. Depression is reported to be twice as common in women than in men.

Read Also: A Neglected Tale: The Sexual Abuse Of Disabled Children.

Human Rights Watch Report On Disabilities By Country

In October 2020, Human Rights Watch published a report, “Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide”, documenting the practice of shackling across 60 different countries worldwide. This practice of shackling occurs in remote areas within several Global South countries, including Afghanistan, Burkina Faso, Cambodia, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Sierra Leone, Palestine, South Sudan, and Yemen.  

Human Rights Watch’s report showcases over 800 interviews with people with psychosocial disabilities in countries like China, Indonesia, and the Philippines. Moreover, reports show that people can live shackled for years in confined spaces. Additionally, reports show disabled persons inhumanely chained to trees, locked in cages and imprisoned in animal sheds.


A report found nearly 1000 “cage people” in the northern Hebei province near Beijing, China. Shockingly, there was a case relating to an 8-year-old girl tied to a tree by her grandparents for nearly six years in Henan province, China. Zhao Ziyi suffered from fever attacks. The Chinese authorities tied her up and classified her as ‘dangerous’.

In January 2022, a video of a woman standing inside a dilapidated shack chained around her neck went viral. The woman had eight children and was a victim of human trafficking. As a result, she developed a psychosocial disability. This video sparked widespread outrage across China.


Some Indonesians believe that mental health conditions represent a possession by evil spirits or the devil displaying immoral behaviour. In 2016, Human Rights Watch published a report, “Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia”. Thus, this report highlighted how people with mental health conditions in Indonesia are subject to pasung, which is the practice of shackling by families in their homes or overcrowded and unsanitary mental institutions.

In Indonesia, an estimated 57,000 people with mental health problems have been subject to pasung at least once in their lives. Currently, an estimated 18,800 people are living in pasung in Indonesia. Pasung goes against the patient’s will due to its widespread stigmatization. In addition, there is a severe lack of community-based support.

Indonesia has a population of 250 million people but only has 48 mental health hospitals. The Ministry of Health estimated that 90% of Indonesians do not have access to mental health services or medications. Additionally, patients in these hospitals are subject to physical abuse if they misbehave or try to escape.

Caption: video obtained from human rights watch. End shackling of people with disabilities.


Nongovernment organizations in the Philippines reported the shackling or arbitrary detention of disabled people, including children, in remote areas. This is due to people living in lower socio-economic areas and having limited access to services.

Many reports have portrayed people with disabilities in severe and degrading conditions. In 2021, in the southern Philippines, twin boys aged 15 years old were reported chained and naked while crawling through mud. Additionally, an 11-year-old girl was reportedly chained to her bed, where she was held for eight years.

Stigmatization of People With Disabilities

There is a widespread belief that people with mental health conditions are bewitched, possessed or sinned as a result of their mental condition.

“Shackling unequivocally amount[s] to torture even if committed by non-State actors under conditions in which the State knows or ought to know about them”.

UN Special Rapporteur on torture, Juan E. Méndez

Global Efforts to End Shackling

The shackling of people with disabilities remains largely out of sight and out of mind. There is insufficient data covering this topic. Furthermore, a coordinated international or regional effort to eradicate shackling is not present.

Worldwide, an estimated 792 million people, or 1 in 10, including 1 in 5 children, have a mental health condition. Yet governments spend less than 2% of their budgets on mental health. Approximatley, two-thirds of countries fail to reimburse for mental health services in national health insurance systems. Even when mental health services are free or subsidized, distance and transport costs are enormous obstacles.

The Shackling of People with Psychosocial Disabilities Worldwide.
Caption: Image obtained from Human Rights Watch report “Living in Chains” (2020). A man with a mental health condition sits shackled at the ankles in a room in western Kenya. Families bring their “bewitched” relatives to the church for spiritual healing © 2020 Kriti Sharma/Human Rights Watch.

Many families feel forced to shackle their relatives without sufficient mental health support and awareness. Shackling results from fear that someone might run away or harm themselves or others.

International Human Rights Obligations

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is one of the most widely-ratified treaties. The CRPD requires humane and equitable treatment of persons with disabilities. Currently, 165 states are legally bound to its provisions. However, enforcing states to comply with the mechanisms remains ineffectual. Many countries within the report above, “Living in Chains”, have restricted shackling practices, but impunity prevails.

Additionally, shackling violates Article 5 of the Universal Declaration of Human Rights, as it is considered an inhumane denial of a person’s basic need to belong and to connect meaningfully with the members of their community.

Concluding Thoughts

The lack of understanding of psychosocial disabilities has led to long-term implications such as discriminatory legislation and policies that deprive people of their legal capacity and liberty. This stigmatization increases their susceptibility to violence and cruel and degrading treatment at home and in institutional settings. 

Shackling people with mental health conditions is a widespread brutal practice that is an open secret in many countries. Unfortunately, there is no data and a coordinated international or regional efforts to eradicate this practice does not exist. We must reform health and social policy to address the needs of people with disabilities better, enabling them to live in dignity.

Furthermore, we must act urgently to prohibit shackling, reduce stigma, and develop accessible and affordable services. It is chilling and uncomfortable to think that hundreds of thousands of people with psychosocial disabilities worldwide are “living in chains”.

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