Disorder: Indonesia's Mental Health Facilities by Andrea Star Reese

Pasung is the Indonesian term for restraints or restrained. It is used to refer to shackles, but can also refer to being locked in a room or confined in a shed or animal pen.

From January 2011 through the end of 2012, I spent time photographing people in Indonesia being held in homes, shelters, schools and hospitals. Many had not been seen by a psychiatrist or diagnosed with mental illness, stress or a physical condition that might explain symptoms or behaviors they exhibited.

Pasung, banned in 1977, is the widespread traditional response to mental disturbances like these. People resort to pasung when they cannot afford care, fear medications, want to avoid the stigma attached to a diagnosis of mental illness, or most commonly, feel it is necessary to protect family, community and the disturbed individual.

Effective regional programs continue to be rare and underfunded. Common obstacles for Indonesians include access to care, cost of treatment, and the lack of widespread dissemination of basic information. Indonesia’s local and regional officials recognize the important role existing private and licensed shelters can play, despite their current inadequacies.

Differing figures reported by the government indicate that Indonesia has about 600 to 800 psychiatrists—half based in Java, and half of that 50% practice in Jakarta. Some still use only one diagnosis and one prescription. Needed prescriptions can be unavailable for months due to shortages. Patient compliance and lack of family support can also lead to treatment failure. To further complicate efforts for reform, the Department of Health oversees mental hospitals while shelters for the mentally ill are the responsibility of a separate department.

And furthermore, Shamans and traditional healers continue to remain the popular choice of mental health care throughout the country. For Indonesians, it is better and cheaper to attribute confusing or abnormal behavior to spiritual weakness, spells, or possession. There is no stigma attached to being under a spell or possessed.

Mental illness is a disease that can be treated successfully; as my project demonstrates, inadequate access to the medications and treatments commonly available though out much of the world has devastating consequences. The largest may be that many people don’t even know that they can get better.

Andrea Star Reese is a documentary photographer based in New York. A selection from her series Disorder will be exhibited at the 2013 Visa Pour L’Image Photojournalism Festival held in Perpignan, France from August 31st to September 15th.

In addition to publication, photographs from Disorder will be used for education, training and as part of community outreach programs in Indonesia.