Freeing the Mentally Ill from their Shackles


Over 19 million Indonesians with psychosocial disabilities are falling victim to stigma and discrimination. Erifah, is one of the over 19 million affected by this discrimination who began suffering from schizophrenia affective disorder when she was in the sixth grade. Erihah, is now an activist and advocate for people with psychological disabilities, working for the Indonesian Mental Health Association (PSJ), stating that at a young age her parents did not seek medical care for her when she was a child due to a lack of education and awareness. Erifah stated, “My parents thought I was possessed-they used to put garlic and salt on my body to rid me of evil spirits.”

Erifah only began seeking medical help once she started a family due to the stigma surrounded by psychiatric hospitals as only for “crazy people.” Many people suffering like Erifah, usually do not seek the medical help they need but instead first consult faith or traditional healers.

The lack of availability and access to proper medical treatment in Indonesia is evidenced by the fact that Indonesia only has 48 mental health institutions and about 600 to 800 psychiatrists. Due to the shortage of mental health facilities, families end up shackling their relatives with psychological disabilities because they lack the education and awareness to help them.

Despite a ban on shackling, known as “pasung”, which has been in effect since 1977, the practice continues. According to the Health Ministry, nationwide more than 57,000 people with psychosocial disorders live their lives in chains rather than getting the help they need. These people should not be living their lives in shackles solely because the government is not providing enough access to medical treatment and stigmatizing those with psychosocial disorders.

Indonesia’s new health law, which was approved by parliament on July 8, was enacted to address the country’s pressing healthcare situation in line with the National Convention on the Rights of Persons with Disabilities. The Mental Health Law is supposed to put more of a burden on Indonesia to provide health services on a local and national level such as by making drug treatment more affordable for those suffering with psychosocial disabilities and training more mental health professionals. The law also is an attempt to reduce the stigma and discrimination toward those suffering from these disorders in an effort to protect these persons from “violence, neglect, and exploitation.” The law also provides accountability for abuses, including shackling those with psychosocial disabilities.

However, the law has some problems such as it allows other people to approve the medical treatment of a person with a psychosocial disability if the person is deemed “incompetent.” It also allows medical personal to force treatment on a person whom they feel might “endanger” themselves or others. These provisions could lead to abusive treatment based on lack of informed consent to medical treatment.

Based on international and human rights law, forcing people to take medication without their knowledge or their consent, except when the patient’s life is in imminent danger is in violation of their rights. Under the CPRD, anyone with a disability has the right to make decisions that affect their life. Thus, this right cannot be denied based on a medical diagnosis.

How do you think countries like Indonesia can project a more positive image of people living with psychosocial disabilities? How much power do you think the government should have in determining a person’s medical decisions? What can we do to raise awareness of psychosocial disabilities internationally?

Source: Human Rights Watch, Break the Shackles of Stigma on Mental Health Care in Indonesia 



  1. I think that Indonesia is finally taking a step in the right direction. The new health care law seems to acknowledge the issue and provide mentally ill with the care and options they need. This action needs to be followed by educating the public on various mental illnesses and available treatment. A good way to accomplish that would be by campaigns/ads in public transportation, or billboards. This technique was very effective in other countries, such as China. Educating the society as a whole won’t be an easy task, and that is why utilizing local media would likely be the fastest way to spread the information and knowledge among the highest number of people. Awareness is key for convincing people to seek treatment, and teaching them how to cope with the illness and still be able to enjoy life. Targeting the younger generation should be a priority because this generation can then educate other members of society, thus putting an end to the lack of awareness.

  2. I strongly believe that Indonesia is moving in the right direction as shackling someone because of a mental illness is utterly inhumane. Education and public awareness, with a focus switching from shaming those who have the mental illness to those who shackle their family members, is key. Implementing programs such as medical facilities, treatment centers and rehab programs is also a step in the right direction. Unfortunately though, Indonesia does not have a strong sample to base their system on. I would be interested in knowing how their health laws develop, as I strongly believe that the system the US has adopted is flawed as well.

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