Freedom a first step for Aceh's mentally ill

Freedom a first step for Aceh's mentally ill

Aceh is a world leader  in ending the horrific practice of “pasung” – the locking up of severely  mentally ill people in medieval stocks, chains and tiny rooms. The Indonesian  province this year started a program to achieve this goal but much more needs  to be done, cautions Associate Professor Harry Minas, the Director of the  Centre for International Mental Health within the Melbourne School of  Population Health.
 
After six years of collaborating with his  Indonesian colleagues over the issue, Associate Professor Minas justifiably  says that Aceh’s new program, Aceh Free Pasung, to which he had been appointed  technical advisor, is a major mental health and human rights advance. The  program locates and releases these patients and brings them for free treatment  to the Banda Aceh Mental Hospital. Following Aceh’s lead, Indonesia’s Ministry  of Health has also committed to ending pasung throughout the country by 2014.
 
However, Associate Professor Minas’s relief is  tempered by concern at what lies ahead for these severely ill patients, who  have been confined for up to 15 years and bear the scars of their ordeal. In  most cases, family members fearing physical harm from their mentally ill  relative have enforced the pasung practice.
 
Associate Professor  Minas applauds the program, with reservations. “What the Government of Aceh is  doing is impressive but we have consistently said the practice will not be  eliminated unless there is some really good research on what are the social and  economic factors that lead families and communities to this obviously  end-of-the-line option, and to understand what is needed for sustainable  release from pasung.”
 
About 200 pasung patients were located in  rural Aceh. Their families are not bad people, he says. “They are scrabbling  out a living, are very poor, they need all hands on deck to survive. They can’t  afford to have a family member devoted full time to the mentally ill relative’s  welfare and being responsible for the ill person’s safety and the safety of  others.”

He does not know whether  Aceh has succeeded in meeting its commitment to end pasung in the province by  the end of 2010 because there is no follow up monitoring or treatment. “There  is a danger the government will say, ‘We’ve succeeded, we’ve taken everybody we  could find out of stocks, or unchained them. We’ve done our job’. But it’s what  happens in the medium to long term that is important,” he says.
 
He fears that as the  government’s message that pasung is unacceptable gets through it could drive  the practice underground because without ongoing support and accessible and  affordable mental health services families won’t be able to cope.

Pasung graphically  demonstrates what happens when there are no basic health services available.  “Aceh Free Pasung is a very significant program because it’s an example of  necessary action to eliminate human rights abuses and governments assuming  responsibility for taking that action. That’s not so common.”
 
Getting funding to  ensure the program is sustainable is the next challenge. “It would be a very  great pity if it were not possible to find support for ensuring that all of the  issues around this practice are understood so they can be moved into practice  and policy.”
 
Caption: A young man with schizophrenia who  had been chained for years by the neck, wrists and ankles (written consent  given for publication of image).