Indonesians with Mental Disorders Face Stigma, Shackling, Abuse: HRW Report
Jakarta. With the prevailing stigma that they are cursed or possessed and the government failing to provide better alternatives, tens of thousands of people with psychosocial disorders are shackled and locked in confined spaces by their families or sent to institutions where they are treated inhumanely and subject to physical and sexual abuse, a new Human Rights Watch report released on Monday (21/03) finds.
Kriti Sharma, HRW's disability rights researcher and author of the 74-page report spent two years traveling across West, Central and East Java as well as Bengkulu to interview more than 100 people with psychosocial disorders and their families, all of whom are at some point in their lives shackled or locked up in a practice known locally as "pasung."
Sharma said the people she met had many things in common, they are locked up against their will — sometimes for years — in a chicken coop, a goat shed, or a disused room. Sometimes they are chained, or in extreme cases immobilized using wooden stocks.
Confined to such a small space, their limbs grow weak and they defecate and urinate in the same space as they sleep and eat. Almost all emerged even worse than they were originally. Nearly all described their ordeal as “living in hell” a phrase Sharma uses as a title for the report.
Although treatable with medication, counseling and support, people in Indonesia often associate psychosocial disorders, like schizophrenia, bipolar or depression, with superstition, assuming that they are possessed by evil spirits or cursed for their sins.
People with psychosocial disorders, even in urban areas, are taken to witchdoctors and faith healers and ostracized by their communities. So families treat patients as embarrassments, locking them away from society an act which deteriorates their conditions further.
Indonesia officially banned pasung in 1977 but its implementation is still widespread even in public and private mental hospitals and institutions across Indonesia.
Sharma traveled to a privately-run mental institution called Bina Lestari in Brebes, Central Java where officials from the local social affairs agency often send people with psychosocial disorders, despite knowing that people are being shackled there. The facility is run by a faith healer and none of the staff had psychiatric or medical training.
The Galuh Rehabilitation Center she visited in Bekasi, on the outskirts of Jakarta, fared no better. She saw hundreds of people with psychosocial disorders being cramped into a severely overcrowded cells. Sometimes patients are chained or put in isolation and they receive treatments and therapies against their will.
The report quoted one former patient from Brebes identified as Carika, 29, who said she was forced to take medication without her consent.
“The staff would push me down on the bed and give me medicine. They didn't give me a choice. Even when I said 'no,' they didn't listen. Some hospital staff even tied my hands and forced me to swallow the medicine,” she told HRW.
Carika also said the hospital gave her electroshock therapies, which consists of passing electricity through the brain to induce a seizure, which she said was given without her volition or even anesthesia, something which the UN considers as a form of torture or ill-treatment.
“They put electricity on my temples and forehead. It hurt very much. I was awake when they gave it. They tied my hands to the bed. They didn't give me any injection. It lasted for half an hour,” she said.
The HRW documented 25 cases of physical violence and six cases of sexual violence in the mental hospitals and institutions it visited for the report, administered when patients tried to escape, sometimes for the guards' own amusement.
According to the Indonesian Ministry of Health, the country only have 48 mental hospitals in 26 out of 34 provinces. Eight provinces are without any mental hospital and three are without any psychiatrists, including Jakarta's neighbor to the west, Banten. The ministry estimates there are only between 600 to 800 psychiatrists in the entire country.
According to the ministry there could be around 18,000 people who are in pasung across the country, but Sharma believes the actual figure could be much more.
Yanti Rosa Damayanti, a disability rights advocate and head of the Indonesian Mental Health Association said people with psychosocial disorders and their families are left with little choice.
“The problem with pasung is that there is no alternative provided. Families are forced to shackle the patients because there is no social, economic and medical support. So they have no choice but to pasung that person or send the person to an institution and it is that institution which pasung that person,” she said.
Sharma said Indonesia needs to address the problem, pointing the fact that it has ratified the UN Convention on the Rights of Persons with Disabilities in 2011 and pass the Mental Health Law in 2014.
“We want in the short term for the government to conduct monitoring so these abuses don't occur. In the long term, we want them to be able to live in their community, to be able to go to the local community health centers for medication or counseling or support,” she told the Jakarta Globe.
“The government must intervene [in practices of pasung]. They have the obligation to provide better alternatives.”
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