“Treated Worse Than Animals” RIGHTS Abuses Against Women and Girls with Psychosocial Or Intellectual WATCH Disabilities in Institutions in India
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HUMAN “Treated Worse than Animals” RIGHTS Abuses against Women and Girls with Psychosocial or Intellectual WATCH Disabilities in Institutions in India “Treated Worse than Animals” Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India Copyright © 2014 Human Rights Watch All rights reserved. Printed in the United States of America ISBN: 978-1-6231-32088 Cover design by Rafael Jimenez Human Rights Watch defends the rights of people worldwide. We scrupulously investigate abuses, expose the facts widely, and pressure those with power to respect rights and secure justice. Human Rights Watch is an independent, international organization that works as part of a vibrant movement to uphold human dignity and advance the cause of human rights for all. Human Rights Watch is an international organization with staff in more than 40 countries, and offices in Amsterdam, Beirut, Berlin, Brussels, Chicago, Geneva, Goma, Johannesburg, London, Los Angeles, Moscow, Nairobi, New York, Paris, San Francisco, Sydney, Tokyo, Toronto, Tunis, Washington DC, and Zurich. For more information, please visit our website: http://www.hrw.org DECEMBER 2014 978-1-6231-32088 “Treated Worse than Animals” Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India Terms ................................................................................................................................. 1 Summary ........................................................................................................................... 3 Lack of Government Services and Support ................................................................................ 5 Forced Institutionalization ....................................................................................................... 6 Conditions in Institutions ........................................................................................................ 8 Forced Treatment and Denial of Adequate and Appropriate Healthcare ..................................... 9 Violence and Exploitation ....................................................................................................... 10 Lack of Access to Justice ......................................................................................................... 11 The Way Forward .................................................................................................................... 11 Key Recommendations ..................................................................................................... 13 To the Central Government ...................................................................................................... 13 To State Governments ............................................................................................................. 15 To National and State Human Rights Commissions.................................................................. 16 To National and State Commissions for Women ...................................................................... 16 To National and State Commissions for Protection of Child Rights ........................................... 16 To International Donors, including the World Bank, Asian Development Bank, and Bilateral Government Donors ................................................................................................................ 16 Methodology ..................................................................................................................... 17 I. Background ................................................................................................................... 21 Inadequate Services and Support ........................................................................................... 22 Loss of Legal Capacity and Lack of Support to Exercise it ......................................................... 30 India’s Obligations ................................................................................................................. 32 II. Abuses in Institutions ................................................................................................... 34 Stigma and Discrimination ...................................................................................................... 34 Lack of Alternatives to Institutionalization .............................................................................. 38 Abandonment in Institutions ................................................................................................. 40 Involuntary Admission, Arbitrary Detention ............................................................................. 42 Conditions of Confinement .................................................................................................... 48 Denial of Adequate and Appropriate Healthcare ...................................................................... 55 Physical, Sexual, and Verbal Violence .................................................................................... 64 III. Access to Justice ......................................................................................................... 69 Lack of Faith in Testimonies .................................................................................................... 71 Challenges in Reporting .......................................................................................................... 72 IV. Alternatives to Institutions/Community-Based Strategies ........................................... 75 V. Legal Framework ............................................................................................................ 79 Key International Obligations .................................................................................................. 79 Indian National Laws ............................................................................................................. 84 Full Recommendations ..................................................................................................... 90 To the Central Government ..................................................................................................... 90 To State Governments ............................................................................................................. 95 To the Management of Mental Hospitals and Residential Institutions for Persons with Psychosocial or Intellectual Disabilities ................................................................................. 98 To National and State Human Rights Commissions................................................................. 99 To National and State Commissions for Women ..................................................................... 99 To National and State Commissions for Protection of Child Rights .......................................... 99 To International Donors, including the World Bank, Asian Development Bank, and Bilateral Government Donors ............................................................................................................... 99 Acknowledgments .......................................................................................................... 101 Terms Beggars’ Home A place of detention to which a person who is found guilty of begging in the streets, for the first time, by a court of law can be sentenced for up to three years with a mandatory minimum of one year. Under the Bombay Prevention of Begging Act (1959), enacted by several states in India,1 people with leprosy or psychosocial disabilities can also be detained. Catatonia A syndrome that is usually associated with schizophrenia and mood disorders. A person with catatonia can display striking and extreme variations in movements ranging from a lack of movement (stupor) to excessive movement (excitement). 2 Electroconvulsive therapy is often prescribed for catatonia. Disabled Persons’ Organizations where persons with disabilities constitute the majority of members Organizations (DPOs) and the governing body and which work to promote self- representation, participation, equality, and integration of all people with disabilities.3 Electroconvulsive A psychiatric shock therapy which consists of placing electrodes on the patient’s therapy (ECT) head and passing electricity through the brain to stimulate an artificial seizure. ECT is generally prescribed for severe depression, mania, schizophrenia, and other mental health conditions when other treatment has failed to work or for quicker results. In its modified form, ECT is administered under general anesthesia, with muscle relaxants, and oxygenation and can result in headaches as well as short-term memory loss.4 Unmodified ECT (without anesthesia or muscle relaxants) continues to be practiced in settings with poor access to anesthesia or anesthetists. The risks of unmodified ECT include dental damage, spinal and pelvic fractures, and muscles injuries.5 A typical course of ECT involves six to twelve sessions given two to three times a week.6 1 “The Bombay Prevention of Begging Act, 1959,” undated, http://delhi.gov.in/wps/wcm/connect/f2214e0043383b63b2d1f3cf71a315bd/THE+BOMBAY+PREVENTION+OF.pdf?MOD=AJP ERES&lmod=-716342930&CACHEID=f2214e0043383b63b2d1f3cf71a315bd (accessed February 12, 2014). 2 National Institute for Health and Care Excellence (NICE), “Guidance on the Use of Electroconvulsive Therapy (TA59) - Clinical Need and Practice,” October 2009, http://publications.nice.org.uk/guidance-on-the-use-of-electroconvulsive-therapy-