Mental Health and Human Rights
This session discussed the human rights violations of people with mental disorders. Case studies from Indonesia were presented, including recent efforts to decrease human rights abuses against people with mental disorders and attempts to ensure the availability of adequate treatment.
Indonesia Bebas Pasung (Free From Restraints) Program
Nearly 0.5% of Indonesians (more than 1 million people) suffer from a severe mental disorder, many of which go untreated due to the lack of professional mental health care in many provinces. This in turn results in many of the mentally ill being restraint in what is known as pasung. Pasung is the physical restraint of the mentally ill in the community, and it is estimated that there are 18,800 people under pasung. Indonesia launched its "Free From Pasung" Program in 2010 to work towards achieving a pasung-free Indonesia. Advocacy of human rights, education of mental illness and building mental health professionals are among the plans for this program.
"Majority of primary health care doctors and nurses (in Indonesia) have not received sufficient and official mental health training in the past five years."
Dr Diah Utami
Director of Mental Health, Indonesian Ministry of Health, Indonesia.
Dr Diah Utami is the Director of Mental Health at the Indonesian Ministry of Health. Dr Utami holds degrees in medicine, psychiatry and hospital administration, and her research interests include drug addiction and mental health. Dr Utami is currently responsible for mental health development nationally. She is a particularly strong advocate of human rights in Indonesia and is highly influential in actively pushing the implementation of the National Bebas Pasung program.
Evaluation of the Indonesia Bebas Pasung Program
Indonesia launched its Free From Pasung Program in 2010 based on the awareness that restraining and isolating people with mental illness using chains, wood stock, rope or isolation rooms prevents them from accessing proper treatment and is a major human rights violation.
An evaluation of the program showed that a governor regulation can mobilize resources easily from many sectors. Yet, there are various models of the program despite the guidelines provided. Resources for the program mainly came from health sector with minimum collaboration with other sectors. Pasung cases monthly report is the only monitoring method and no province is able to develop specific plan to improve the program.
Considering that monitoring and evaluation is the most important component to improve a program, especially in a situation where there is no generic model, the proposed evaluation items to be utilized are policy, regulation, advocacy, financing, collaboration, human resources, services, and infrastructure.
"We cannot develop a better or a good evaluation system if we cannot understand the problems behind Pasung."
Dr Hervita Diatra
Psychiatrist and Lecturer, Department of Psychiatry, University of Indonesia.
Dr Diatri is a Psychiatrist and Lecturer in the Department of Psychiatry at the University of Indonesia. Dr Diatri is actively involved in policy development, advocacy and program development in Indonesia. Dr Diatri has been actively involved in government projects related with health and mental health worker capacity building (through conducting training, developing training modules and guideline) and supporting government in Indonesia Free Pasung Program (releasing people with mental illness from isolation and being restraint in the community).
KPSI: Building a Consumer Network Across Indonesia
Since its establishment in 2009, the Indonesian Community Care for Schizophrenia (KPSI) Facebook group has reached 8000 members throughout Indonesia. Not only in a virtual world, KPSI also organizes activities in real world by having a Jakarta and Jogja secretariat, and also through gathering local groups. 10 cities are also joining the movement. Using Guislain Awards money received in 2012, KPSI developed foundation and community based programme activities implemented in Jakarta and Yogyakarta by providing services ranging from a hotline service, psychological counseling, family psychoeducation, self-help groups for consumer and family, art therapy, a library, and a regular mental health movie screening. These programs had positive responses from mental health consumers as well as the general public, showed from visitor trends to our secretariat. KPSI hopes to fill the gap between mental hospitals and the community by providing psychosocial support to increase consumers' quality of life. By integrating activities and bringing stories of recovery to the community level we hope that consumers can participate directly in eradicating stigma efforts.
"The most important thing (we want to do) is to promote and bring kindess and compassion as a powerful resource to fight stigma."
Chairperson, Indonesia Community Care for Schizophrenia (KPSI).
Mr Utomo is the Chair of Indonesian Community Care for Schizophrenia (Komunitas Peduli Skizofrenia Indonesia, or KPSI). Mr Utomo has been caring for a family member with a mental illness since 1995. His own challenges and the intense need and desire to help other struggling families motivated Mr Utomo to found KPSI (Indonesian Community Care for Schizophrenia). The organization's mission is to educate patients, caregivers and the public on schizophrenia and to actively combat the associated stigma. Mr Utomo has already established himself as a leader in the field though his active involvement in and engagement with policy makers and researchers in policy and service development and Indonesia.
Breaking the Chains: A Film by Erminia Colucci
The practice of using shackles and chains (known in Indonesia as pasung) to physically restrain people with mental illness is widespread in Indonesia (as in many other developing countries) and almost universally ignored. The Indonesian government is the first of any low or middle-income country that has established a national program to eradicate this practice. This documentary, the first of its kind, highlights the activities carried out at several levels in the country to eradicate this form of human rights abuse and give freedom and dignity to the mentally ill.
This film tells an original story about the social and political activism to free them from this practice. In particular, the film will follow the activities that have been initiated by an organization run by people with mental health problems. This film is part of a photo/film-documentary series "Breaking the chains: Human rights violations of people with mental illness" currently under production.
For further information:
Dr Erminia Colucci
Global and Cultural Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia.
Dr Colucci has been a Research Fellow and Lecturer at the Global and Cultural Mental Health since 2007. Her degrees are in Clinical and Community Psychology, Cultural Psychiatry and Visual Anthropology. Her research is in cultural and international mental health, particularly surrounding suicide, suicide prevention, human rights, gender issues, and traditional and alternative healing. She is also involved in the exploration of arts-based visual research and prevention methods, and cultural research methodologies.