Indonesia has reacted positively to a Human Rights Watch report about how mentally ill patients are being treated in the country, with Jakarta admitting shortfalls in dealing with the issue in accordance with modern medical standards.
The Indonesian government has launched several campaigns to eradicate shackling of the mentally ill and disabled, a practice that has officially been banned since 1977.
But among the 400,000 people who suffer from mental illness, more than 57,000 are still shackled at some point, according to the Indonesian Social Ministry.
Just before Human Rights Watch released its report and recommendations last month called “Living in Hell,” the ministry declared a campaign to end the practice, setting a deadline of next year.
Limited access, facilities
In its efforts to end the practice of abuse, the government will have to tackle the problems of limited access and awareness.
The Galuh Foundation, located at Bekasi, just a one-hour drive from Jakarta, is a home for mentally ill patients.
The facility has 254 mentally ill patients of various ages, including children.
The foundation, opened in 1982 and funded by donations and support from the government, once used only herbal medication to treat patients and was one of many institutions that shackled mentally ill patients.
However, Galuh, which is free for people with conditions ranging from Down's Syndrome to methamphetamine psychosis to schizophrenia, said it has changed.
Nina Mardiana, Galuh program director, told VOA the facility had previously had to chain some of the mentally ill patients. She said it was necessary because of a lack of resources and facilities, including lack of a special room to treat new patients, no modern psychiatric techniques, or even regular visits from a doctor or nurse.
“We chained [the patient] not to limit their freedom to move, no, it was temporary only for safety. Mainly, [we did chain] because of limited [workers and facilities],” Mardiana said.
But the foundation is now in far better condition to help the patients, she told VOA.
No longer chain, shackle
The facility now has an isolation room, she said, so they no longer chain or shackle patients.
Galuh is also able to afford to in bring in doctors and nurses, medicine and modern psychiatric techniques. Even so, providing medication is still a struggle.
The HRW report highlighted the lack of facilities and services to mentally ill patients in Indonesia, a problem the government acknowledged.
“We realized it, because of our effort in helping and reaching at the moment is not yet able to cover all,” said Dr. Fidiansyah, director of prevention and mental health control from the Indonesian health ministry.
Fidiansyah added that geography is also a reason why mental health patients cannot always get proper medical services.
The practice of shackling was found in very remote areas, where access to transportation and mental health facilities is limited.
Among Indonesia’s 34 provinces, eight have no mental hospitals.
Of the country’s 48 mental hospitals, half are located on the most populous island of Java.
Government efforts
The Indonesian government said it has launched a campaign to end shackling by 2017.
The national parliament also recently passed legislation on the rights of the mentally ill.
Officials said they are trying to spread the word on the new health law to make people realize that shackling is forbidden and that those who still do it can be charged with a crime.
Indonesia is also sending teams of workers into often-remote hamlets to help free patients kept in chains and ensure they get the medical treatment they need.
Yet, mental illness education and awareness are still lacking among the family members of many patients.
Social stigmas
Nahar, director of social rehabilitation for Indonesian Social Ministry, said families struggle with a family member's mental illness because of social stigmas. Nahar said many also still believe the mentally ill are possessed by demons or under the influence of black magic.
Some patients who show improvement are not always welcomed back by their family or society.
“Family acceptance is one of our problems. When [a mentally ill patient] is ready to go home, but the family has rejected [them], that’s a problem for us,” Mardiana said.
Even if family acceptance isn't an issue, Mardiana said patients are returned to Galuh because of the lack of acceptance by neighbors.
Social Ministry's Nahar said he is optimistic the country will have a better system in place by next year to help the mentally ill and disabled.
"So this two years we are going to do socialization through a stop-shackling campaign and we will maintain that all institutions related to mental disability people or fulfillment effort of mental disability people can be working effectively all around Indonesia,” Nahar said.
The United Nations adopted the Convention on the Rights of Persons with Disabilities in late 2006, which calls on countries to promote, protect and ensure full human rights and freedoms by all persons with long-term disabilities – physical, mental, intellectual or sensory.
