indonesia mentally ill pkg kinkade_00011622.jpg
Many of Indonesia's mentally ill are living in chains
02:11 - Source: CNN

Story highlights

Around 18,800 people are kept in pasung or confinement, Human Rights Watch says

Many Indonesians believe that people with psychosocial disabilities are possessed by spirits

Government passed laws in 1977 to eradicate confinement but they have not been enforced across the nation

Jakarta CNN  — 

Engkos Kosasih kept his 50-year-old daughter locked in a room in the house because he thought someone had cast a spell on her. The windows were boarded up so she couldn’t escape.

For 15 years, she lived in darkness and isolation.

“She became destructive, dug up other people’s crops and ate raw corn from the plant. I was ashamed and scared,” Kosasih said.

He first bound her wrists and ankles with cables but she managed to untie herself. So for years, Kosasih kept her in the room, pushing in plates of food twice a day through a hole in the wall. No one entered to clean up. His daughter used stones to dig up the cement floor in an attempt to escape and slept on the rubble.

Common practice

Pasung – the practice of confining or restraining relatives with mental health problems – was banned in Indonesia in 1977 but remains startlingly common.

According to Human Rights Watch (HRW), more than 57,000 people in Indonesia “with real or perceived psychosocial disabilities” have been shackled or locked up in confined spaces at least once in their lives.

Around 18,800 people are kept in pasung today, HRW said in a new report released Monday.

A spokesman for the Indonesian Health Ministry has not yet responded to a request for comment.

Kriti Sharma, a researcher with HRW who researched and wrote the report, found Kosasih’s daughter in a rural part of Cianjur, West Java.

Sharma said many Indonesians believe people with psychosocial disabilities are possessed by the devil or evil spirits.

“Superstition is so prevalent that the first step is to find a faith healer,” she said.

Two months after HRW visited the family, Kosasih’s daughter was released by her family.

Aid workers suffer mental health crisis

Persistent beliefs

The government has long tried to eradicate pasung, however superstitious beliefs, stigma against mental illness and a lack of understanding of mental health is keeping many in chains, even after they are rescued.

In Central Java, 29-year-old Carika was locked in a filthy, cramped goat shed for four years, “barely able to stand or move around and forced to eat, sleep and defecate amid the nauseating stench of goat droppings,” according to HRW.

Carika was released five years ago but her family ran out of money to pay for her medication and her condition worsened.

Just a few days ago, Carika was returned to the shed.

“It’s a vicious cycle. The medicine ran out and she got worse. It was too expensive for the family to get her treatment,” Sharma said.

Survey: Mental health stigmas are shifting

Access to care

According to the World Health Organization Ministry of Health, there are only 48 mental hospitals in Indonesia for a population of more than 250 million. More than half of those hospitals are located in just four of the country’s 34 provinces.

Even when a province does have a hospital, many families can’t afford transportation costs to get there.

While basic medical services are provided by village health centers, there are few trained mental health professionals outside of big cities.

There are around 800 psychiatrists in Indonesia, or one for every 300,000 people.

Those patients that are taken to hospitals are frequently subject to abuse and unorthodox treatments such as electro-shock therapy. At traditional centers, healers often recite the Koran into patients’ ears, force feed them herbal concoctions and subject them to vigorous, even violent massages that result in painful, extensive bruising, according to HRW.

“The few facilities and services that do exist often do not respect the basic human rights of people with psychosocial disabilities and greatly contribute to the abuses against them,” HRW said.

The situation can often be only a slight improvement on being confined at home.

“People are routinely forced to sleep, eat, urinate, and defecate in the same space,” Sharma said.

Breaking the taboo: It’s time to talk about mental health

Government response

In 2014, the Indonesian parliament passed the Mental Health Act to improve the dire state of mental health services in the country.

Next month, Indonesian President Joko Widodo is expected to sign the Rights of Persons with Disabilities Bill, designed to protect and promote the rights of those with disabilities.

While HRW is supportive of the government’s desire to promote mental health and end the practice of home confinement, it warned that policies must be fully implemented on the ground.

That means affording basic and equal rights to a person with psychosocial disabilities or mental health conditions, according to HRW

“The thought that someone has been living in their own excrement and urine for 15 years in a locked room, isolated and not given any care whatsoever is just horrifying,” Sharma said.

“So many people told me, ‘This is like living in hell.’ It really is.”