SBS News visits one of Indonesia’s illegal ‘pasung’ centres and asks mental health experts what can be done to end the practice.
“I’m sick, I want doctor. I want doctor. I want, I want, I want doctor.”
The pleading in broken English comes from a man named Amin. He is lying on a concrete floor, complaining of pain. A bandage now separates a steel shackle from his ankle flesh.
Amin has lived at a place known as “Marsiyo’s House” for five months.
From the outside it resembles many other structures in the town of Kebumen in remote Central Java. The ramshackle shelters are outwardly unremarkable, but they mask a sinister 40-year narrative.
Inside, about 30 men with undiagnosed mental health conditions are chained to the floor.
About 30 men with undiagnosed mental health conditions are chained to the floor.
Most are emaciated and none receive treatment or medication while they exist on the end of a one-metre or so rusty chain. They will eat, drink, sleep and defecate there for months on end.
Known as ‘pasung’, the practice of shackling mental health patients remains prolific in Indonesia despite being outlawed in the 1970s. Few records are kept but it is estimated tens of thousands of patients – possibly up to 60,000 - are being restrained across the country, as well as in developing nations around the world.
Half an hour’s drive from Marsiyo’s House, a humble clinic in Kebumen opened by the local government is hoping it can provide a blueprint for ending the practice.
The day SBS News visited, Imam Wahyudi, a 37-year old with an undiagnosed psychotic condition had been released after being chained up for four months.
He was reunited with his mother, who said through a translator: “Of course I am sad. I cannot eat when I think of him. I have to do this because I am the only parent”.
Often families become complicit in pasung when they are unable to deal with the needs and stigma of their family member’s condition.
At the clinic, a disused hospital wing has been converted into a mental health rehabilitation facility. It offers respite from pasung, exposure to health professionals and, where appropriate, medication.
Mental health research assistant Anto Sugianto, himself a pasung survivor, is trying to alter Indonesia’s regressive approach to treatment.
Mr Sugianto, who works at Gadjah Mada University in Yogyakarta, says eliminating stigma around mental health is the first step to finding a solution.
“If the person and family get the right education about mental health and how to deal with mental illness so they can seek the right treatment, there will be no pasung” he said.
Psychiatrist and professor Dr Harry Minas recently began working with Mr Sugianto and heads up the University Of Melbourne’s Centre For Global and Cultural Mental Health. He has been consulting Indonesian government representatives on how to end the practice.
Dr Minas believes the rehab clinic in Kebumen has the makings of a solution and says with political will and funding the system could be replicated elsewhere in Indonesia.
He said: “It proves several things; one is that for very little investment you can do something that improves people’s lives and allow them to be both free and independent, able to live at home, the other … it shows it is possible to solve a problem that at the moment is very complex.”
Budi Satiro is the head of social affairs in Kebumen’s District Government and says mental health is the greatest social problem confronting the district. He wants to rid Kebumen of pasung by the end of 2019 by continuing to develop community-based rehabilitation clinics.
“We have the hope that maybe all the mental health patient have the care in here – it’s not impossible” he said.
Maybe all the mental health patient have the care in here – it’s not impossible.
Dr Minas agrees. He says he has observed a shift in attitude in Indonesia towards mental health and is optimistic that with appropriate pressure and a suitable policy framework, change is possible.
“If the provincial government can be engaged then things start to become possible,” he said
But, until suitable resources are allocated, the mentally ill will remain shackled and untreated.
Researcher and survivor Mr Sugianto says his efforts will continue:
“My dream is there will be no more pasung – that is our goal.”