Imagine living in a country where you are shackled or forced into an institution and subjected to unwanted physical and sexual violence, physical restraints and seclusion, and treatments like electroconvulsive “shock” therapy without consent just for having a mental illness. “Pasung” — the shackling or locking up of a person in a confined space for days, months and even years — is a reality for as many as 18,800 people who live in Indonesia, despite the government banning the practice in 1977.
People living in Indonesia continue to be shackled or confined in institutions for having mental illness. There have also been at least 57,000 Indonesians with mental health conditions who have been in “pasung” at least once in their lives, said the Indonesian Ministry of Health in a report by the Human Rights Watch. In one of the longest documented cases of “pasung,” one woman was locked in a room for almost 15 years.
Indonesia’s Mental Health Bill 2014
The practice of “pasung” was condemned as an inhumane and discriminatory treatment by the Indonesian Ministry of Health in 2011. Since then, the government has launched several programs and initiatives to promote mental health and eradicate the practice of “pasung” by 2014, although the deadline was recently extended to 2020. In 2013, after the Health Ministry reported that the number of restrained people with mental disorders had increased from 18,000 to 56,000, a new Mental Health Bill played an ambitious role in providing Indonesia with a foundation for a new mental health care system. The Indonesian Mental Health Bill (Law No. 18/2014) was passed into law on July 18, 2014, but it has been especially difficult to regulate the law due to the lack of mental health care professionals, and the fact that less than 1 percent of the total health budget is set aside for mental health, said Nova Riyanti Yusuf, M.D., a former Indonesian legislator and visiting scientist at the Harvard Medical School.
Lack of availability and access to mental health care treatment in Indonesia
Across Indonesia, mental illnesses such as schizophrenia are still widely believed to be the result of being possessed by the devil or by evil spirits. The widespread lack of mental health resources, education and community support for mental health care is compounded by the fact that Indonesia is the world’s fourth most populous nation in the world.
More than 19 million Indonesians are estimated to have a mental health diagnosis, which contributed to 10.7 percent of the global burden of disease, according to the World Health Organization’s (WHO) Mental Health Atlas 2011. Unfortunately, the practice of “pasung” is still rampant in the community, mental hospitals and other institutions across Indonesia, and even more people do not attempt to seek treatment for mental health problems in fear of the stigma and discrimination that is associated with mental illness.
In Indonesia, the lack of resources and community support for mental health care is clear, with only 48 mental health institutions, which were severely overcrowded and unsanitary, and only 600 to 800 psychiatrists in 2011. It is important to remember that there are more than 250 million people who live in Indonesia, said the Human Rights Watch. In a country with that population, that’s only one psychiatrist for every 300,000 to 400,000 people. The majority of primary health care doctors and nurses had not received any official in-service training on mental health within the last five years, according to the Mental Health Atlas 2011.
The treatment of people with mental illness has come a long way in the United States and the rest of the world, but it is important to remember that not long ago people with mental illness who were living in the United States were also shackled in insane asylums, incarcerated with criminals, left unclothed and in darkness without heat or bathrooms. While being in “pasung” might be against a person’s rights in the United States, the majority of people in the world do not receive treatment for mental illness. The reality is that many people who live in developing countries continue to lack access to much needed physical and mental health care services.
The Sovereign Health Group is a leading provider of comprehensive and individualized behavioral health treatment services to patients with mental illness, alcohol and drug addiction, and co-occurring disorders. For more information about the programs provided by Sovereign Health, please contact our 24/7 helpline.
About the author
Amanda Habermann is a writer for the Sovereign Health Group. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.