In Indonesia, institutions have shackled and chained as many as 57,000 mentally ill patients, according to a Human Rights Watch report. The underfunded and understaffed medical sector, as well as mental health stigma, have led to this inhumane practice known as “shackling” or pasung in Indonesia. Indonesia’s shackling problem is improving, but the country has not entirely eradicated it yet. Additionally, the country is progressing toward improving mental health in Indonesia through its mental health sector.

Here is some information about the initiatives contributing to the improvement of mental health services and the reduction of stigma in Indonesia. The ultimate goal of these initiatives is to prevent mental health patients from experiencing cruel and insufficient treatments.

Indonesia Free from Pasung

The Indonesian government officially banned shackling in 1977 but has been working to formally end the process to this day. In 2010, the Indonesia Ministry of Health started a program called Indonesia Free from Pasung. It asked the government to collaborate with communities to address shackling.

The program provided mental health medications and training to community centers, and made mental health a primary mental health service. It also created community health teams intended to directly release and identify people with mental illnesses.

These teams include Tim Penggerak Kesehatan Jiwa Masyarakat (TPKJM) and the PIS-PK program. TPKJM works to monitor and facilitate the release of people from shackles. The PIS-PK program sends representatives from community health centers to identify families’ mental health statuses through home visits. The program was necessary because people were not frequently visiting medical posts, so were not receiving treatment. The program helped to identify Indonesians with mental health issues and direct them to resources.

The frequency of shackling has improved in the 10 years since the implementation of the program. Additionally, people do not stigmatize mental illness as much in Indonesia anymore. Moreover, community centers are more equipped to identify and treat people with mental health disorders. More groups are arising to address mental health issues and end the practice of shackling as well. However, only 20 out of the 34 provinces in Indonesia have successfully implemented programs to free people from shackling. Without full implementation, these programs are unable to free as many people as they aim to.

The Center for Indonesia Medical Students’ Activities (CISMA)

UNICEF partnered with the Center for Indonesian Medical Students’ Activities (CISMA) to promote mental health support for young people through online sessions on health on Zoom and YouTube. The sessions cover a range of mental health topics such as “Coping with stress during the COVID-19 pandemic.” Their partnership’s aim is to provide awareness and information about mental health.

CISMA’s sessions are an amazing resource because they are accessible and provide psychological support for people who may not be able to see a therapist. CISMA’s initiative is also beneficial to Indonesia’s mental health sector because it raises awareness and tackles mental health stigma. The type of awareness it is spreading can keep people with mental illnesses out of shackles.

The WHO QualityRights Initiative

The WHO QualityRights initiative supports countries in implementing policies and services to improve the conditions of mental health services globally. It developed a toolkit of information to provide guidance on how to improve mental health services. This includes information on assessing mental health services and quality standard goals. It also provides e-training and other materials for mental health professionals, NGOs and people with mental illness and disabilities. This program is encouraging a human rights-based approach to mental health issues.

Indonesia has been improving in awareness and identification of mental health issues. The next steps are for the implementation of policies and programs to improve resources, as well as the quantity and quality of community centers.

International aid can assist in building community centers and medical schools. However, more is necessary, such as quality training and funds to hire nurses, therapists and psychiatrists. The country must also address the availability of medications and adequate facilities by providing more funding for mental health programs.

The country is moving in the right direction to improve its mental health in Indonesia. With increased development and a continued focus on the mental health sector, Indonesia may be able to eradicate the practice of shackling.

– Stephanie Jackson
Photo: Flickr