Currently in Indonesia, over 18,000 people with psychosocial disabilities (mental health conditions) are kept in chains – in part because of a dearth of mental health services. But that may begin to change.

During a meeting with Human Rights Watch this week, Indonesia’s minister of health, Nila Moeloek, committed to providing mental health medication in all 9,500 community health centers (puskesmas) across the country. Achieving this could turn the tide against shackling.
 

 People with psychosocial disabilities (mental health conditions) in Indonesia are shackled or forced into institutions where they often face physical and sexual violence, involuntary treatment including electroshock therapy, seclusion, restraint and forced contraception.

More than 57,000 Indonesians with psychosocial disabilities have been subjected to pasung – shackled or locked up in a confined space – at least once in their lives. Despite a ban on shackling since 1977, the practice remains rampant due to a lack of awareness, widespread superstition, and grossly inadequate mental health services.

Take Carika (not her real name), whom I met a year ago. For four years, her family locked her up in a goat shed where she was forced to eat, sleep, urinate, and defecate, simply because she had a psychosocial disability. “My life inside was very sorrowful,” she said. “I could only lie in the shed. I couldn’t even sit up. It was very dirty – there was goat feces all over.”

Carika’s family told me that they felt they had no alternative but to lock her up. Her family struggled to get her mental health care at their local community health center and did not have the money to travel to the provincial hospital.

When Carika did receive access to mental health care, she was able to live just like others in her community and even started a catering business. However, once the medication ran out, her condition deteriorated rapidly and she is now back to being locked up in the shed.

Under a new mental health law, the government is supposed to provide mental health medication in primary health centers, but the law is not being implemented.

Human Rights Watch recently released a report, “Living in Hell,” about shackling and other abuses against people with psychosocial disabilities in Indonesia. We called on the government to enforce the ban on shackling and ensure access to mental health care. As part of a social media campaign, #BreakTheChains, 1,000 people wrote and over 3,500 tweeted to Indonesia’s health minister in support of this call.
 
We were encouraged by what the health minister told us. She now needs to demonstrate her willingness to deliver on that commitment by producing a detailed and sustainable plan for providing community health centers with mental health medication. Lack of medication should no longer be an excuse for shackling people with psychosocial disabilities like Carika.