Nearly 19,000 people in Indonesia diagnosed with mental disabilities are currently living shackled in chains or otherwise confined to claustrophobically small spaces — one symptom of a national mental-health-care system characterized by systematic shortcomings and retrogressive science. That’s according to a new report released by Human Rights Watch on Monday morning local time.
The report, succinctly titled Living in Hell, provides a grim portrait of Indonesia’s neglect and abuse of its mentally ill population. It pays particular attention to the practice of pasung — placing those with “real or perceived psychosocial disabilities” in “shackle[s] or locked up in confined spaces,” which persists across the country despite a national ban in 1977. According to the report, 18,000 Indonesians currently live in pasung, with viable mental-health-care alternatives either inaccessible or nonexistent.
The report notes that the culture of mental-health care in Indonesia relies heavily on backward pseudo-science rooted in dated spiritual traditions. The report’s authors observe a “widespread belief that mental health conditions are the result of possession by evil spirits or the devil, having sinned, displayed immoral behavior, or lacking faith.” (In Indonesia, many also condemn homosexuality as a mental disease.) Because of the stigma that shrouds mental illness, families tend to deliver their sick loved ones not to medical treatment but to spiritual healers.
Pasung is a hallmark of this method of “treatment.” In these cases, patients are constrained, often naked, and in many cases left outdoors for days to years. The Human Rights Watch report estimates that as many as 57,000 people in Indonesia — nearly 15% of all seriously mentally ill people in the country, by some estimates — have been subjected to pasung at least once (the figure is higher in rural regions).
On paper, the Indonesian government condemns this practice as inhumane. Six years ago, the country’s Health Ministry embarked on an ambitious mission to completely eliminate pasung from the country by 2014 — a deadline recently extended to 2020. In 2014, the parliament passed the Mental Health Act, a piece of legislation written to further the “promotion, prevention, treatment and rehabilitation” of mental illness.
However, this commitment has yet to yield tangible returns. Less than 1% of Indonesia’s national health care budget goes to funding mental-health-care treatment, according to psychiatrist and former Indonesian lawmaker Dr. Nova Riyanti Yusuf in an essay published in the Jakarta Globe last year. “There is a lack of political will,” she tells TIME.
Disorder: Indonesia's Mental Health Facilities by Andrea Star Reese
The following project was photographed between Jan. 2011 and Nov. 2012.
Galuh Foundation, located on the outskirts of Jakarta, is licensed by Indonesia’s government. No one is turned away if they cannot pay. Galuh receives enough rice, noodles and cooking oil for two months from the local government, the totality of all current government support. Medications are not available.Andrea Star ReeseEvi has been living at Bina Lestari Foundation for more than two years. She was fifteen when she began to first experience hallucinations. Her family pays for her platform bed and for the Islamic based spiritual approach to healing.Andrea Star ReeseAgus, Liana and Jarmoko live in cages at Jasono Alternative Treatment Center. Jasono, the owner, learned his method of treatment from a Pesantren in Jakarta; he sprays water on the men and women and gives them an herbal drink.Andrea Star ReesePesantren METAL offers a refuge for mentally ill women, as well as emotionally traumatized pregnant and unwed mothers, some of them girls as young as ten. At METAL, when the unwed mothers depart, the children stay. Much of the responsibility to care for the youngest is undertaken by boys and girls only slightly older. The sexes are separated.Andrea Star ReesePasung (shackling) at Bina Ahlaq, used after a run-away attempt. Once a Silat (martial arts) college, Bina Ahlaq now houses about 200 students suffering mental distress. Martial arts instructions and herbal remedies are central to treatment.Andrea Star ReeseFour years ago, when Elis was 24, her family brought her to Salafiyah Al-Bajgur, an Islamic boarding school in Madura, East Java. Isolated and locked away in a small crumbling room, she has no furnishings and only a few bits of clothing. Last year, her parents died, leaving only the school owner to look after her.Andrea Star ReeseIbu Maliah cooks lunch for 280 mentally ill men and women at Galuh, a family-run shelter. She is assisted by former patients Siti, a ten-year resident, and Datir, 40, a transgender who has been at the shelter for thirteen years.Andrea Star ReeseAt Galuh, there is no actual housing although small rooms have been built for management and staff. Many of the men and woman stay in the large cage enclosed pavilion under a leaking roof without access to the outdoor toilets.Andrea Star ReeseMeta was brought to Galuh, suffering from mental issues complicated by drug use. For eight years she has lived without privacy in a large outdoor cage separated from the men by a wire wall.Andrea Star ReeseMaftukhah is suffering from depression. After her husband left her to marry another woman, her family brought her to Yayasin Bina Lestari, a small foundation under the Brebes Department of Religion.Andrea Star ReeseIt is not unusual to find a sole child among adults being treated in hospitals and shelters.Andrea Star ReeseAgus sings in his cage, his hands moving in an intricate dance. Agus is housed in a cell to ensure he can not run away. He is being held at Jasono Alternative Treatment, a small private shelter in Cilicap, Central Java.Andrea Star ReeseAt Bina Ahlaq boarding school, the large Silat (martial arts)-trained staff is available night and day to respond to emergencies.Andrea Star ReeseEvi, the young woman in the pink dress, is still at Yayasin Bina Lestari. Medications are still not available.Andrea Star ReeseA large challenge to reform is the stigma surrounding the label mentally ill. There is no stigma attached to being possessed or under a spell. Keris Nangtang Foundation is an experimental shelter run by activists for homeless mentally ill and drug addicted men and women. Herbal treatments are used and no one is chained.Andrea Star ReeseAnne’s father believes she does not need much to eat. Her family is distressed by the lack of improvement in her condition.Andrea Star ReeseNurhammed, successfully treated for bi-polar disorder, tells Saepudin that he can get better. For nine years, Saepudin lived shackled in a back room in his family home. The two men met through a controversial program recently suspended for allowing volunteers to obtain diagnostic information and deliver medications. Now people in West Java’s remote villages must be brought to a hospital for treatment.Andrea Star ReesePondok Pesantren Bina Ahlaq is considered a boarding school and requires a tuition fee.Andrea Star ReeseGede, living chained to a post in a shed behind his mother’s home in a remote area of Bali, was reported to the Suriani Foundation. Dr. Suriani founded one of the rare, perhaps the only, outreach programs in Indonesia involving home visits by a psychiatrist.Andrea Star ReeseMustofa, the sole assistant and primary caregiver at Kyai Syamsul's family-run shelter, gives a shower to Akrom, 25 years old. Andrea Star ReeseDidin, 25 years old, receives treatment from Abah Sanuk, a traditional healer using Silat, a martial arts method. Shamans and traditional healers are the most popular and more affordable mental health care providers throughout Indonesia.Andrea Star ReeseMuhammad Ikromudin, 25, was trained by to have special powers. He assists the men and women attending a mass healing that will last throughout the day and night. Participants pray, drink herbal drinks, vomit, and eventually enter a hypnotic trance. Afterwards, cleansed of their sins, they are showered with fragrant herbal water.Andrea Star ReeseNamiratus, the nine-year-old daughter of a traditional healer, likes to help with the care of the men and women that live in a locked section of her home.Andrea Star Reese
The Human Rights Watch report also addresses the fundamental scarcity of the country’s mental-health-care resources: in a country of 250 million — it is the world’s fourth most populous nation after China, India and the U.S. — there are only between 600 and 800 psychiatrists, or one for every 300,000 to 400,000 people. There are also only 48 mental hospitals in the country, many of which are characterized by “severely overcrowded and unsanitary conditions.” At one hospital on the outskirts of Jakarta, the country’s capital, around 90 women live in a room built to accommodate around 30. The report documents rampant sexual and physical abuse ranging from unwanted sexual contact to subjecting patients to electroconvulsive therapy (ECT) without providing anesthesia.
Eight of the country’s 34 provinces have no mental hospitals whatsoever.
