News and activities of the International Institute of Medicine and Science Asean Chapter of IIMS, Inc. California, USA - Health care, Life Science, Education, Research, Philanthropy. Asean is the economic organization of ten countries located in South East Asia: Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam.
Indonesia - Indonesia To Tackle The Shackling Of The Mentally Ill
Indonesia is seeking to end the lockdown and shackling of thousands of
mental health patients.
Indonesia is seeking to boost its
community mental health services in an effort to end the lockdown and shackling
of thousands of mental health patients.
“The practice of shackling
mentally-ill people still exists and eliminating it is one of our priorities
for 2013,” Diah Setia Utami, director of mental health at the Health Ministry,
told IRIN, noting that the country’s “serious” shortage of mental health
professionals has been one of the biggest obstacles.
The government aims to provide 30
percent of the country’s 9,000 community health clinics and 1,700 general
hospitals with staff to provide basic mental health care by 2014, Utami said.
The Health Ministry estimates 19
million people nationwide have various mental health disorders, including
anxiety and depression, and another one million have severe psychoses.
Currently, 33 specialized mental
health hospitals and 600 psychiatrists offer public mental health care.
“These hospitals are adequately
equipped to treat mental patients, but in the future, patients will be
encouraged to have treatment outside [the] hospital under the care of families
and community caregivers,” Utami added.
The Health Ministry estimates
some 18,000 people with mental disorders, mostly in rural areas and bereft of
any mental health services, are still subjected to ‘pasung’ (shackling) to
prevent them from attacking others. In villages, people with mental disorders
are typically chained behind their homes, while in cities, limited space and
stigma confine a number of them to small rooms.
Opposition to the practice has
grown along with local media reports of people – at times undiagnosed – wasting
away after years in chains.
Yusuf said people still resort to
‘pasung’ – banned since 1977 – because they cannot afford mental health care
and to escape stigma associated with mental illness.
A psychiatric consultation costs
on average US$25, not including drugs. The government plans to implement
nationwide universal health coverage in 2014, which is expected to cover most
mental health costs.
In 2011 the Health Ministry
launched the ‘Menuju Indonesia Bebas Pasung’ program (Towards a Shackle-Free
Indonesia), but lack of trained health professionals and funding have stalled
progress, say officials.
Nova Rianti Yusuf, a member of a
parliamentary health commission, noted the lack of data and research on
‘pasung,’ with the exception of two recent studies of 49 shackled mental health
patients that showed 90 percent of them had schizophrenia and 70 percent were
receiving improper treatment.
The country’s decentralized
health care system accounts for uneven attention to mental health care across
the country’s 34 provinces, said Utami. “There are some regional governments
that pay little or no attention to mental health and, therefore, allocate
little or no budget.”
But, in some places, there are
signs of improvement.
Asmarahadi (one name), a
psychiatrist at the state-run Soeharto Heerdjan mental hospital in Jakarta,
said mental health care has improved there “significantly” over the past 10
years. “People used to call the place a prison, but now it’s like a hotel – at
least a one-star hotel.”
The hospital receives 150
patients daily and has a policy of not turning anyone away even if they cannot
pay, he said.
“People in Jakarta and its
surrounding areas are increasingly aware of mental problems,” he said. “Mental
health care is not expensive and even atypical, third-generation anti-psychotic
drugs are accessible at affordable prices,” he said.
“Treatment failure is usually
caused by a lack of patients’ compliance and family support,” he said.
This is if someone seeks formal
medical treatment at all. Large pockets of the country still believe magic
spells cause mental illness, with families turning to shamans and religious
leaders for cures.
Under the 2013-2020 World Health
Organization (WHO) global mental health action plan, 80 percent of member
countries are expected to update their mental health policies and laws by 2016,
while allocating at least 5 percent of public health expenses to mental health
care by 2020.
It also seeks to decrease the
number of beds used for long-term stays in mental hospitals (which medical
studies link to poor treatment and human rights abuses) by 20 percent by 2020,
and increase the availability of places for community-based residential care
and supported housing.
“The government has the
responsibility to provide mental health care for the poor and it should do so
by involving local communities,” said Yusuf.
The WHO plan also calls for
doubling the treatment of severe mental disorders. Up to 85 percent of such
disorders are not currently treated in low- and middle-income countries,WHO