March 22, 2016, 6:05 a.m.
Almost 19,000 mentally ill Indonesians are still being shackled or locked up in a confined place despite a 1977 ban on the practice, according to Human Rights Watch.
Jakarta: Almost 19,000 mentally ill Indonesians are still being shackled or locked up in a confined place – sometimes for years – despite a 1977 ban on the practice, according to Human Rights Watch.
A report issued on Monday calls on the government to immediately order inspections of all government and private institutions and take action against those that practice shackling or abuse people with mental illnesses.
Between November 2014 and January 2016 Human Rights Watch visited 16 government and private institutions across Java and Sumatra and found evidence of physical and sexual violence, involuntary treatment including electroshock therapy, seclusion, restraint and forced contraception.
In three of four mental hospitals, electroconvulsive therapy was administered without anaesthesia, muscle relaxants and oxygen
Human Rights Watch documented 175 cases of mentally ill people being shackled or locked up – a practice known in Indonesia as pasung – the longest case being a woman who was locked in a room for nearly 15 years.
Families also often shackle mentally-ill relatives, particularly in remote areas, because they are afraid they will escape or feel pressured from neighbours who fear they are dangerous.
Disability rights researcher Kriti Sharma says there is still a lot of stigma in the community, with many believing mental health conditions like schizophrenia and depression are as a result of being possessed by the devil or cursed.
"In addition there is a real dearth of support – families asked us 'What is the alternative?'," Ms Sharma said.
One man in West Java told her he was unable to go to a mental hospital to obtain medication for his son because it was too far away and he would have to give up a day's work.
"Just imagine being locked in a goat shed where you are eating, sleeping, urinating and defecating in the same space for years at a time," Ms Sharma said.
"You can't get out to have a bath and are surrounded by the stench of your own excrement. I heard this phrase again and again 'It's like living in hell'."
In 2010 Indonesia's former director of mental health, Dr Irmansyah, launched an ambitious health ministry program to eradicate Indonesia of pasung by 2014. This has now been extended to 2019.
Although the practice still continues, Dr Irmansyah told Fairfax Media that last year 8000 people were freed from shackles and awareness, at the executive level at least, has emerged.
"Of course the situation has improved since 2010 when we first launched the Indonesia bebas pasung (Make Indonesia free from pasung)," he said.
The Minister of Social Affairs launched another program to eradicate pasung on January 29.
And the drug Risperidone, which is widely used to treat schizophrenia and bipolar disorder, is also covered by the national health insurance system and is available at health clinics for free.
"What is lacking is the unity of action," Dr Irmansyah said.
"Ideally there should be a standardised procedure in the treatment of mental health patients from when they are admitted to hospital to the day they return to their families."
Dr Irmansyah now works at a mental hospital called Marzoeki Mahdi in Bogor, a city south of Jakarta.
He said patients were only put in isolation rooms as a last resort and for no longer than 24 hours.
But he admitted there were still cases of patients being restrained because there were insufficient doctors and nurses.
And Dr Irmansyah said he believed 70 to 80 per cent of people with schizophrenia did not go to hospitals because of the stigma. "They will go to traditional healers instead who will spit on the patient's face or ask them to bathe using water or flowers but in the end they remain mentally ill."
With Karuni Rompies
Source: 'Living in hell', shackled and confined: Indonesia's mentally ill
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