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).