Jakarta. The House of Representatives has passed a law promising better treatment of people with mental illnesses and intellectual disabilities, including outlawing the shackling of sufferers — a common practice in Indonesia.
The Mental Health Law was endorsed by lawmakers during a plenary session in Jakarta last week, but has garnered little media attention amid the drama surrounding Wednesday’s presidential election. Indonesian health advocates have cheered the passage of the law, hailing it as a more “humane” and “comprehensive” approach to the issue of mental health treatment. Indonesia’s previous mental health law was enacted in 1966, then superseded in 1992 with the passage of a more general health law, later revised in 2009.
“Many [mentally ill people] have remained subject to inhuman treatment, including shackling and abandonment,” Health Minister Nafsiah Mboi said shortly after the passage of the law, adding it was expected to end the inhumane and “discriminatory” treatment of mentally ill patients.
The Health Ministry’s 2013 data shows the prevalence in Indonesia of common mental illnesses such as anxiety disorder and depression at 6 percent of the country’s population, or 16 million people.
People suffering from severe mental disorders, such as psychosis, meanwhile, number an estimated 400,000, or 1.72 people per 1,000 of the population; with 57,000 of them reportedly shackled or having at least once been a victim to shackling.
Lawmaker Nova Riyanti Yusuf of the Democratic Party said it was about time that all shackled people be freed.
“Those [57,000] cases of shackling are violations of human rights. I’m asking House Commission IX [which handles health matters] to free the victims of shackling,” Nova said after the passage of the law.
Nova, accompanied by several activists from the Indonesian Community for Schizophrenia (KPSI), celebrated the enactment of the law with a lighthearted splash in the fountain pond in the front yard of the House of Representatives complex at Senayan in Jakarta.
Nova said she had previously promised to take the dip when the law, whose draft was first submitted to the House five years ago, was finally passed.
The lawmaker said Indonesia needed the reforms because of its vulnerability to mental disorders brought on or exacerbated by the many natural disasters frequently befalling the archipelago’s inhabitants.
Before the passage of the law, Nova said, Indonesia was among the 25 percent of countries without a specific law covering issues around mental illness and intellectual disability.
The task isn’t over, Nova said, as the law still requires a set of regulations to support its implementation.
The Mental Health Law emphasizes that treatments for mentally ill people should “provide protection and guarantee services” and ensure no human rights violations in the process (Article 3).
Article 86 of the law addresses the issue more specifically, stating that “anyone intentionally shackling, abandoning, harassing and/or ordering other people to shackle, abandon and/or harass mentally troubled and mentally ill people or committing other activities violating the rights of [the patients] will be criminalized in accordance with existing regulations.”
Aside from threatening to revoke the licences of health care providers, the law doesn’t specify sanctions for violations, providing for penalties to be set out in enabling regulations.
Health Minister Nafsiah, nevertheless, thinks highly of the law, saying it provides “comprehensive” guidance for the treatment of mentally ill people.
“With this Mental Health Law, the treatments will be more comprehensive — starting with [health] promotion, prevention, treatment and rehabilitation,” she said.
KPSI chairman Bagus Utomo also praised the law, saying it was expected to encourage the government to quickly build mental hospitals across all of Indonesia’s 34 provinces. Currently, he said, seven provinces still did not have such facilities, with those already having at least one often only having them in the provincial capital.
He also advocated the expansion of existing psychiatric wards, as well as increasing the number of the health care practitioners.
“The minimum access to services have left many patients untreated, leading to the widespread use of shackling,” Bagus said. “Health care practitioners must be trained to help look for those who are shackled.”
Aside from mandating every province to have their own mental hospital, the law also orders every district and municipality to build or support the establishment of at least one “non-health care, community-based facility” to help rehabilitation of former patients in their respective areas.
Such facilities include those run by psychologists, social workers and religious institutions — who must first secure a license before opening the facilities, and must work together with health institutions in their areas.
The law also obliges the government to provide treatment for mentally ill people who have no family or money to support their treatment, including those who end up roaming the streets.
Bagus said he hoped this would simplify the procedure to secure treatment for mentally ill people with limited means.
“We also hope the government will be more forthright in educating the [patients’] families in order to curb shackling,” he said.
The law also mandates every psychiatric hospital in Indonesia to allocate 10 percent of their beds to treat drug addicts.
Nova said this marked a shift to a mindset that saw drug addicts as patients requiring treatment, rather than as criminals.
“Through this Mental Health Law, the House wants to accommodate drug victims’ need for rehabilitation,” she said. “It has been difficult for them to access services — not only because of shortage of facilities, but also because of high levels of stigma and discrimination.”
According to data from the National Narcotics Agency (BNN), out of 4 million victims of drug addiction across Indonesia, only around 18,000 people, or less than 0.5 percent, have received therapy or rehabilitation.