According to the government's own estimate, more than 18,000 people in Indonesia with real or perceived mental illnesses still live shackled or locked up in confined spaces. (Photo courtesy of Human Rights Watch/Andrea Star Reese)
Commentary: Let People With Mental Illness Live in Dignity, Not in Shackles
BY :KRITI SHARMA
OCTOBER 11, 2016
I met Eka (not her real name) in 2014. After traveling for hours on pothole-filled road, I finally reached her village in Cianjur, in West Java. I went to her home, and her father pointed toward a shabby outhouse with a locked door and boarded windows. As I approached, I nearly gagged from the stench of urine and feces. I couldn't believe anyone was living inside. I peered through the cracks in the window, squinting to see her in the dark.
There she was – crouching in the corner, completely naked, in a pile of rubble.
In her 30s, Eka had suddenly exhibited destructive behaviors, digging up crops on the neighbor's land. At that time, her 60-year-old father didn't know what to do. He was ashamed and couldn't afford to keep paying off the neighbors. With no hospital or doctor around, he consulted healers who said Eka was cursed. And when their herbal treatments didn't work, under pressure from other villagers, Eka's father felt he had no choice but to lock her up.
That was 15 years ago.
Since then, Eka has been eating, sleeping, urinating and defecating in the outhouse with virtually no sunlight. The village children taunted her and threw stones through gaps in the windows. She took one of these stones and started digging. Over the years, she had turned the cement floor into rubble and made a hole in the wall trying to escape. But when her father saw she was making headway, he tied her hands behind her back so she had to crouch in the rubble to eat the food her family threw for her.
With the help of a mental health rights organization, Eka was finally released a few months after I met her. But according to the government's estimate, more than 18,000 people in Indonesia with real or perceived mental illnesses still live in pasung — shackled or locked up in confined spaces. The Indonesian government banned pasung in 1977, but the practice persists due to pervasive stigma and a lack of access to mental health care. People spend years locked up in chains, wooden stocks or goat sheds because families don't know what else to do.
Indonesia has only one psychiatrist for 300,000-400,000 people and only 48 mental hospitals in the whole country of 250 million. More than half of the institutions are in just four of Indonesia's 34 provinces. Government data show that 90 percent of people who may need mental health care, cannot get it.
The Indonesian government has taken some steps to do away with pasung. The government started an anti-shackling campaign, created teams to free people from pasung and passed a mental health law requiring the integration of mental health care into primary health services. However, partly because Indonesia's government is so decentralized, implementation at the local level has been very slow.
Last March, Human Rights Watch released a report called "Living in Hell" which documented shackling of people with psycho-social disabilities in Indonesia, including in institutions run, supported, or licensed by the government. In response to the report and the #BreakTheChains social media campaign, Indonesia's health minister, Nila Moeloek, committed herself to providing mental health medication in all 9,500 community health centers (Puskesmas) across the country. The government has also taken steps to train its staff at the provincial level to help eradicate shackling.
These are positive developments, yet much remains to be done. The government should mark World Mental Health Day on October 10 with a commitment to make mental health a priority. It should give muscle to the ban on shackling by regularly monitoring social care institutions, mental health facilities and traditional healing centers. The Ministry of Public Health should allocate the necessary funds and issue a timeline for its plan to provide mental health medication in community health centers.
In partnership with disabled persons' organizations, the government should conduct extensive public awareness campaigns on mental health. It should include information on the right to informed consent, which protects people with disabilities from abuse such as forced treatment and enables them to make their own medical decisions. The government should also develop a wide range of community-based services so that people who are rescued from pasung do not end up back in shackles.
If the government follows through with its promises, people like Eka can live in dignity, instead of in shackles.
Kriti Sharma is a disability rights researcher at the Human Rights Watch. She can be reached through the organization's official website.