Treating mental health with shackles in Indonesia
March 21, Jakarta: People with psychosocial disabilities in Indonesia are often shackled or forced into institutions where they face abuse, Human Rights Watch said in a report released today.
The 74-page report, “Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia” examines how people with mental health conditions often end up chained or locked up in overcrowded and unsanitary institutions, without their consent, due to stigma and the absence of adequate community-based support services or mental health care. In institutions, they face physical and sexual violence, involuntary treatment including electroshock therapy, seclusion, restraint and forced contraception.
HRW interviewed 72 people with psychosocial disabilities, including children, as well as 10 family members, caregivers, mental health professionals, heads of institutions, government officials, and disability rights advocates. HRW visited 16 institutions across the islands of Java and Sumatra including mental hospitals, social care institutions, and faith healing centers, and documented 175 cases across five provinces of people who are currently shackled or locked up or were recently released.
More than 57,000 people in Indonesia with mental health conditions have been subjected to pasung – shackled or locked up in confined space – at least once in their lives, with about 18,800 currently shackled, based on latest available government figures. Despite a 1977 government ban on the practice, families, traditional healers, and staff in institutions, continue to shackle people with psychosocial disabilities, sometimes for years at a time.
In one case, the father of a woman with a psychosocial disability told Human Rights Watch that he locked her in a room after consulting faith healers because she was destroying the neighbors’ crops. When she tried to dig her way out of the room, her parents tied her hands behind her back. She stayed naked in the rubble, eating, sleeping, urinating, and defecating in the room for 15 years before they released her.
The Indonesian government has taken some steps to do away with the practice. The Health and Social Affairs ministries each have started an anti-shackling campaign. A new mental health law requires integrating mental health care with primary health care. And teams of government officials, medical personnel, and staff in government institutions are tasked with freeing people from shackling. However, partly because Indonesia’s government is so decentralized, implementation at the local level has been very slow.
A country of 250 million people, Indonesia has only 600 to 800 psychiatrists—one for every 300,000 to 400,000 people—and 48 mental hospitals, more than half in just 4 of Indonesia’s 34 provinces. Government data shows that the 2015 health budget is 1.5 percent of the total and that 90 percent of those who may want access to mental health services cannot due to a paucity of services. The government aims to have universal health coverage, including mental health care, by 2019.
Under Indonesian law it is relatively easy to forcibly admit a person with a psychosocial disability to an institution. Human Rights Watch found 65 cases of arbitrary detention in institutions, and none of those interviewed who were in institutions were there voluntarily. The longest cases HRW documented was seven years at a social care institution and 30 years at a mental hospital.
In some of the facilities, overcrowding and lack of hygiene were a serious concern, leading to widespread lice and scabies. In Panti Laras 2, a social care institution on the outskirts of Jakarta, the capital, Human Rights Watch observed approximately 90 women living in a room that could reasonably accommodate no more than 30.
The Oslo Times