WHO | Regional Office for the Eastern Mediterranean

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Chain-free initiative

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The chain-free initiative evolved in response to an urgent need to: provide technical and financial support for hospital reform, improve domestic conditions for people with mental illness, develop community care programmes, raise mental health literacy in the community and among health workers, and ensure that basic rights are monitored and guaranteed.

Restraints

Restraints can take different shapes. The most classic, and one of the harshest, which is still common in some resource-poor countries, is to chain a person to a post or a bed, or to chain both legs together.

Even at home, people with mental illness are commonly chained in their homes by their parents or other relatives. This practice and associated attitudes towards patients are often learned from psychiatric hospitals. This is not a harmless cultural preference, many people are physically or emotionally damaged as a result and it is humiliating indignity to the person who is subjected to it.

Fighting stigma

In its pursuit of realizing the dignity and rights of people with mental illness, the Regional Office launched the chain-free initiative in 2008 with the overall objective of contributing to the quality of mental health services. This involves combating existing stigma associated with mental illness and providing people with mental illness with equal opportunities to access basic humanitarian treatment in hospitals, homes and the environments in which they live.

The chain-free initiative is being implemented in homes, hospitals and the wider environment. Special attention has been given to raising the awareness of hospital staff on human rights issues and on more humane and scientific methods of restraining. The initiative also emphasizes the development of users’ and family associations, and the establishment of chain-free committees to work for the rights of users and to lobby for providing basic humanitarian assistance to people with mental illness.

Chain-free hospitals

The initiative in hospitals involves removing chains from patients in hospitals and reforming hospitals into patient-friendly and humane places with minimum restraints.

Chain-free homes

The initiative in homes involves removing chains from people at home suffering from mental illness, providing family psycho-education, training family members on a realistic, recovery-oriented approach and providing home visits.

Chain-free environment

A chain-free environment involves removing the invisible chains of stigma and restrictions on the human rights of people with mental illness and the right to universal access to all opportunities with and for persons with mental illness.