Indonesia's mentally ill 'abused and stigmatized'

The Human Rights Watch (HRW) report, entitled "Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia" explores the social stigma surrounding mental health in Indonesia.

Despite a ban imposed on "pasung," or shackling, of people with mental health conditions in 1977, the practice continues in the Southeast Asian country. Shantha Rau Barriga, director of disability rights at HRW, told DW the Indonesian government needs to do more to enforce the ban.

DW: According to your research, what sort of conditions do people with mental health problems deal with in Indonesia?

Shantha Rau Barriga: Nearly two years ago, Human Rights Watch started researching abuses against people with mental health and psychosocial conditions such as depression, schizophrenia and bipolar disorder. We found that despite a ban on shackling, thousands of people were shackled, put in chains and wood stocks, or locked in rooms simply because they had a mental health condition.

We conducted nearly 150 interviews with people with disabilities, their families, mental health professionals and advocates, and time and again we heard people telling us it was like "living in hell."

We documented cases of electroshock therapy being given to children, which has also been identified on the international level as a practice that has no benefit, and should not be continued.

There are a number of abuses that people experience in hospitals or in social care institutions run by the government or private organizations. We have documented cases of sexual abuse, physical abuse, and people put in isolation for long periods of time. We have even documented cases of women who were given birth control pills without their knowledge because the staff wanted to control pregnancies or "unintended consequences." All this leaves them more vulnerable to sexual abuse.

What is behind the stigma associated with mental health conditions in Indonesia?

Mental health conditions are often perceived as being the result of a curse or someone possessed by evil spirits. And people often turn to traditional healers instead of seeking mental health care.

There is so much superstition and so much misinformation about mental health, schizophrenia and bipolar disorders. There is also shame associated with these conditions, so much so that people often don't want to talk about it. These people are hidden away in their homes and in institutions run by the government as well as faith healers.

What services are available to people with mental health conditions in Indonesia?

Indonesia has a robust health care system, and, in principle, everyone should be able to access health care on a local community level. But when it comes to mental health care, services are few and far between: There are 48 mental hospitals across the country, for a population of 250 million. There are 600 to 800 psychiatrists - one for every 300-400,000 people.

So, there are very limited mental health services, and those that do exist are often not on the local levels that are easily accessible for people. In some cases, families have to travel long distances to the provincial hospitals in order to get any kind of care, any kind of medicine. That is not something that every person, in rural communities in particular, can afford. And what often happens is they don't return to the hospital to get the medication, or counseling and other services, and then people's conditions start to decline.

The practice of ''pasung'" - the shackling of people - has been banned since 1977, and yet it continues in Indonesia. What is being done to end the practice?

The government has made some efforts to end the practice of shackling. The ministry of health and the ministry of social affairs have initiated an "end pasung" campaign. We are trying to put some pressure for them to turn the rhetoric in Jakarta into real change on the ground.

And that will require the government to, first of all, enforce the ban, actually go out and send monitoring teams to the communities and institutions. In some cases they are state-run and state-licensed institutions that are practicing pasung. We want the government to apply sanctions against the institutions where the practice continues.

What solutions are needed to support people with mental health conditions?

The report recommends that in the short-term there needs to be monitoring and enforcement of the shackling ban. But in the long term, there needs to be a shift from locking people up in institutions, forced mental health care, locking people up in chains, animal pens or wooden stocks as the only way to "cure" a mental health condition.

Instead, the shift needs to move towards community-based mental health services in their communities. And that will require significant investment from the government to make this issue a priority. It will also require international donors to invest in the mental health care system in Indonesia in order to have the services available for people at the local level.

Shantha Rau Barriga, director of Disability Rights at Human Rights Watch, oversaw the research of the report 'Living in Hell.'

The interview was conducted by Charlotta Lomas.