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 .................................................................................................................................... i Summary and Key Recommendations ..................................................................................... 1 Methodology ...................................................................................................................... 22 I. Background ..................................................................................................................... 26 Inadequate Services and Support ........................................................................................... 27 New Mental Health Policy ................................................................................................. 34 Loss of Legal Capacity and Lack of Support to Exercise it ......................................................... 35 India’s Obligations ................................................................................................................. 37 II. Abuses in Institutions ..................................................................................................... 39 Stigma and Discrimination ...................................................................................................... 39 Social Exclusion .............................................................................................................. 40 Stigma in Institutions ....................................................................................................... 41 Lack of Alternatives to Institutionalization .............................................................................. 43 Abandonment in Institutions .................................................................................................. 45 Involuntary Admission, Arbitrary Detention ............................................................................. 47 Prolonged and Arbitrary Detention .................................................................................... 51 Conditions of Confinement ..................................................................................................... 53 Overcrowding, Poor Sanitation and Hygiene ..................................................................... 53 Denial of Education, Lack of Stimulation ........................................................................... 55 Lack of Adequately Trained Staff ...................................................................................... 59 Denial of Adequate and Appropriate Healthcare ..................................................................... 60 Involuntary Treatment ..................................................................................................... 62 Electroconvulsive Therapy ............................................................................................... 64 Physical, Sexual, and Verbal Violence .................................................................................... 69 Exploitation ..................................................................................................................... 72 III. Access to Justice ............................................................................................................. 74 Lack of Faith in Testimonies .................................................................................................... 76 Challenges in Reporting .......................................................................................................... 77 IV. Alternatives to Institutions/Community-Based Strategies ............................................... 79 V. Legal Framework .............................................................................................................. 83 Key International Obligations .................................................................................................. 83 Right to Equality and Non-Discrimination ......................................................................... 84 Rights of Women with Disabilities ................................................................................... 84 Right to Equal Recognition before the Law ........................................................................ 85 Right to Live in the Community ......................................................................................... 85 Freedom from Exploitation, Violence, and Abuse .............................................................. 85 Right to Liberty and Security of the Person ....................................................................... 86 Freedom from Torture or Cruel, Inhuman, or Degrading Treatment or Punishment and Right to Protection of Personal, Mental, and Physical Integrity .................................................. 86 Right to Health ................................................................................................................. 87 Indian National Laws ............................................................................................................. 88 The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 .................................................................................. 88 The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 ................................................................................................... 89 The Rights of Persons with Disabilities Bill, 2013 ............................................................. 89 Mental Health Legislation ................................................................................................ 90 Full Recommendations ........................................................................................................ 94 To the Central Government ..................................................................................................... 94 For Mental Health Facilities and Residential Care Institutions........................................... 94 For Legal Reform and Policy Implementation ..................................................................... 95 Data Collection to Inform Policy ....................................................................................... 98 For the Promotion of Mental Healthcare and Delivery of Services ...................................... 98 To State Governments ............................................................................................................ 99 For Mental Health Facilities and Residential Care Institutions........................................... 99 For the Promotion of Mental Healthcare and Delivery of Services ..................................... 101 To the Management of Mental Hospitals and Residential Institutions for Persons with Psychosocial or Intellectual Disabilities ................................................................................ 102 To National and State Human Rights Commissions................................................................ 103 To National and State Commissions for Women .................................................................... 103 To National and State Commissions for Protection of Child Rights ......................................... 103 To International Donors, including the World Bank, Asian Development Bank, and Bilateral Government Donors .............................................................................................................. 103 Acknowledgments ............................................................................................................. 104 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