For how long will people continue to be treated like animals? In Indonesia, there is a lady named Nengah, who slumps like a rag doll amid a pile of tattered pillows in the island’s far eastern reaches.
The poor village of Abang is remote, and Nengah spends her days in a heap, staring at hands that lie in her lap like dry leaves.
Neighbors gathered in the mid-July heat to watch as her brother used a stone to break a chain that had bound her to a concrete pit — her home — for nearly a decade.
Nengah, whose full name is confidential, suffers from schizophrenia. After the 35-year-old violently attacked her stepmother in a blind rage nine years ago, her family decided they had to restrain her. Awareness is rising that restraints are against human rights.
Dr. Irmansyah, the director of mental health at Indonesia’s Health Ministry, said her situation improved after local psychiatrist Luh Ketut Suryani arrived in the village in June to find Nengah naked, caged, and filthy.Â
The doctor consulted the family and prescribed medication. Later, Suryani helped get Nengah’s family to free her from bondage.
Nengah’s situation is not unique in Indonesia, where the mentally ill are often locked in chicken coops or chained up in family yards to prevent them from disturbing the community.
A shortage of psychiatrists, limited mental health services, stigma, and misinformation about mental illness are some of the reasons people here go without treatment. In a country of 240 million people, there are less than 600 psychiatrists, man
y of them based in urban centers.
Dr. Irmansyah, the director of mental health at Indonesia’s Health Ministry, estimates that around 30,000 people are living in restraints, but gathering accurate information about them is difficult.
A few years ago, the department of mental health announced “Meuju Bebas Pasung,” a roadmap to free people in chains.
Officials say they are relying on community members to report cases like Nengah’s. Then it will be up to local health officials to negotiate with the families for their release.
Since taking his position in April 2010, Irmansyah, who goes by
one name, has worked hard to reach out to rural communities and create awareness about mental illness.
But he says mental health remains low on the government’s priority list, particularly as it works toward meeting its Millennium Development Goals, or MDGs, by 2015.Â
The United Nations-designated targets for development fall under eight categories, including reducing child mortality, fighting disease epidemics such as malaria and AIDS, and imp
roving maternal health.
The MDGs have become the universal gauge for development, and countries are judged by their ability to meet them. “But improving mental health services is not part of those goals,” said Irmansyah, “so there is little incentive to spend on them.”
The former Harvard University fellow knits his fingers over his government-issued khaki uniform and sighs through his stiff grey mustache when explaining the uphill battle to improve mental health care here.
“Awareness is rising that restraints are against human rights,” said Irmansyah, but he worries that increasing depression among the elderly, behavioral disorders among teenagers, and side effects of drug use will only increase the need for better care. “We need to be ready for these problems,” he said.
For now, community outreach is limited,
confined to a smattering of volunteers and concerned psychiatrists like Luh Ketut Suryani.
Many Indonesians still regard mental illness as a curse caused by black magic and best treated by a spiritualist rather than a medical doctor. Suryani believes doctors should draw on local beliefs and religious figures to instill trust, a key to helping mentally ill patients recover.
In 2009 the governor of Bali committed $115 million to a program led by her institute to identify and treat people with mental illness in Karangasem, one of Bali’s poorest districts.
Suryani estimates that as many as 2,000 people in the district suffer from chronic mental illness.
With the government’s support, she was able to reach o
ut to more than 320 patients, but a year later her funding was cut. She now works to raise her own funds, but it’s slow going.
Indonesia’s Health Minister, Dr. Endang Rahayu Sedyaningsih, says she understands the need for more resources, but her ministry has a limited amount of money to put toward tackling Indonesia’s raft of health issues.
Still, while only 2.3 percent of the total national budget goes toward health care, less than 1 percent of that amount is put toward mental health.
More people came forward to request help for mental illness when Suryani first began seeing patients under the government-funded program. And despite budget cuts, she still sees as many patients as she can. She currently sees around 450 patients, but her limited time and resources make repeat visits difficult.
When families spend lots of money on assistance and people continue to relapse they give up and turn to restraints. Depression and anxiety affect more than 300 million people worldwide.Â
The way mental health in Indonesia is handled needs to change. Shackled, chained, or put in wooden stocks for years, would you even treat an animal like
this?Â
Thousands of mentally ill Indonesians are treated like this up to this very day. Pasung, the act of shackling or imprisoning someone with psychological disabilities, has been banned since 1977 but 1,274 cases were reported in 2014 alone. Most of the mentally ill of Indonesia are treated worse than animals, not being washed or cared for years.Â
This is inexcusable, the Indonesian government needs to put more funds from their budget into mental health. Every person deserves to have their human rights given to them.Â
While they have attempted other initiatives to help in the past, there still only remains 400 psychiatrists and 48 mental hospitals for the 250 million people of In
donesia. Not to mention that over half of these mental hospitals are located in just 4 of their 34 provinces.
