A74 page report has recently revealed a shocking reality that epitomises the fight against the discrimination of mental health. The abuse suffered by Indonesians with a psychosocial disability is witnessed in the tens of thousands, estimated to be as high as 57,000, with no hope of escaping the pain and neglect in the near future.
The research carried out in 2014 by Human Rights Watch shed light on the relatively unknown practice of pasung, where people are forced into shackles and confined to small spaces for years at a time. This tradition also subjects people to starvation, physical and sexual violence, and the inability to fight for their freedom.
people are forced into shackles and confined to small spaces for years at a time
Despite the ban of pasung in 1977, this restraint method is still widely used in both institutions and home environments. Kriti Sharma, who investigated and wrote the report ‘Like Living in Hell’ reported having to “step over limbs to enter a room…. they had a 2-3 meter radium to move, defecate and urinate”.
Further anti-shackling campaigns by the Health and Social Affairs ministries have had little success in tackling the deep rooted tradition in a country of approximately 250 million people. The inability to truly understand the causes of mental health problems has led people to direct their beliefs toward spirits and possession.
Dr Erminia Colucci visited Indonesia in 2013, and visited a woman, Yayah, who had been chained in a room for nearly 17 years by her family. They believed she had been possessed by evil spirits. Yarah had been diagnosed as schizophrenic by a psychiatrist, but in a country with almost no education and awareness of the biological causes of mental health, it is somewhat understandable that people are unwilling to believe something they themselves cannot comprehend.
there is still a long way to go before everyone is guaranteed the human rights they deserve
The inadequate healthcare facilities are one of the main obstacles that needs to be tackled in order to prevent pasung. It is estimated that among the 48 hospitals across the country, there is only one working psychiatrist for 300,000 to 400,000 people. This is exemplified through the use of “unmodified” Electroconvulsive Shock Therapy, whereby no anaesthesia is provided, in four of the hospitals. The lack of trained anaesthesiologists and modern technology throughout Indonesia has been attributed to the main cause. Comparing this to Australia, where there are over 2,000 psychiatrists for less than a tenth of the population, the government evidently needs to provide more support and guidance for both healthcare employees and families themselves.
The Indonesian government passed the Mental Health Act in 2014, which aimed to give equal rights to all those with disabilities, with the security of not being subjected to torture and neglect. Despite these recent advances, there is still a long way to go before everyone is guaranteed the human rights they deserve.
Parliament should look toward budgeting more for the ministry of health. Last year, they were only allocated 1.5 per cent of the central government expenditure for 2015, meaning that over 90 per cent of people were unable to access the health services they require. This has been addressed somewhat by the World Health Organisation who have put forward the global mental health action plan 2013-2020. It states that member countries are expected to allocate at least 5 per cent of public health expenses to mental health care by 2020.
Ensuring that mental health hospitals and institutions are inspected is a priority, as evident from the multitude of mistreatment cases witnessed over the years. This should be followed by regular check-ups and a standard to which they must adhere too.
it is therefore vital to address the discrimination that is also rampant in first world countries
A more integrative role of Non-Governmental Organisations (NGOs) is another avenue to be explored. They can speak on behalf of mental health patients, in order to facilitate treatment in the most appropriate and respectful manner. These organisations do not work for the government, neither are they similar to profit goaled businesses. They are an influence that may help to increase awareness of mental health issues, and fight the stigma that is prevalent in many developing countries. Recent reports have shown that most developing countries similarly allocate less than 2 per cent of their total budget to mental health causes, demonstrating the vast inadequacies across the world.
There are many charities set up that aim to provide funding and support for developing countries. For example, Minds for Health has a number of partner organisations in India, contributing over £70,000 in research and mental health services. However, the success of these charities are hindered by marketability. Physical health problems are external, the symptoms are visible and the empathy generated from marketing campaigns is substantially higher than for mental health. This means that mental health charities struggle to raise funds to an equal manner.
To tackle the stigma of mental health in developing countries, it is therefore vital to address the discrimination that is also rampant in first world countries. Raising awareness of the multitude of snowball effects that mental issues have upon society will help to implement research and laws that give people their human rights back.