Short report on mental health issue concerning abuse to the mentally disorder in Indonesia.

1. http://www.hrw.org/node/287501
For Immediate Release
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Indonesia: Treating Mental Health With Shackles
People With Psychosocial Disabilities Face Restraints, Abuse
(Jakarta, March 21, 2016) – People with psychosocial disabilities in Indonesia are often
shackled or forced into institutions where they face abuse, Human Rights Watch said in
a report released today.
The 74-page report, “Living in Hell: Abuses against People with Psychosocial
Disabilities in Indonesia,” examines how people with mental health conditions often end
up chained or locked up in overcrowded and unsanitary institutions – without their
consent – due to stigma and the absence of adequate community-based support
services or mental health care. In institutions, they face physical and sexual violence;
involuntary treatment, including electroshock therapy; seclusion; restraint; and forced
contraception.
“Shackling people with mental health conditions is illegal in Indonesia, yet it remains a
widespread and brutal practice,” said Kriti Sharma, disability rights researcher at Human
Rights Watch and author of the report. “People spend years locked up in chains,
wooden stocks, or goat sheds because families don’t know what else to do and the
government doesn’t do a good job of offering humane alternatives.”
Human Rights Watch interviewed 149 people, including adults and children with
psychosocial disabilities, their family members, caregivers, mental health professionals,
heads of institutions, government officials, and disability rights advocates. Human
Rights Watch visited 16 institutions across the islands of Java and Sumatra, including
mental hospitals, social care institutions, and faith healing centers, and documented 175

2. cases across five provinces of people who are currently shackled, locked up, or were
recently released.
More than 57,000 people in Indonesia with mental health conditions have been
subjected to pasung – shackled or locked up in a confined space – at least once in their
lives, with about 18,800 currently shackled, based on latest available government
figures. Despite a 1977 government ban on the practice, families, traditional healers,
and staff in institutions continue to shackle people with psychosocial disabilities,
sometimes for years at a time.
In one case, the father of a woman with a psychosocial disability told Human Rights
Watch that he locked her in a room after consulting faith healers because she was
destroying the neighbors’ crops. When she tried to dig her way out of the room, her
parents tied her hands behind her back. She stayed naked in the rubble, eating,
sleeping, urinating, and defecating in the room for 15 years before they released her.
The Indonesian government has taken some steps to do away with the practice. The
Health and Social Affairs ministries each have started an anti-shackling campaign. A
new mental health law requires integrating mental health care with primary health care.
And teams of government officials, medical personnel, and staff in government
institutions are tasked with freeing people from shackling. However, partly because
Indonesia’s government is so decentralized, implementation at the local level has been
very slow.
A country of 250 million people, Indonesia has only 600 to 800 psychiatrists – one for
every 300,000 to 400,000 people – and 48 mental hospitals, more than half of which are
located in just four of Indonesia’s 34 provinces. Government data shows that the 2015
health budget is 1.5 percent of the total and that 90 percent of those who may want
access to mental health services cannot due to a paucity of services. The government
aims to have universal health coverage, including mental health care, by 2019.
The few facilities and services that do exist often do not respect the basic rights of
people with psychosocial disabilities and greatly contribute to the abuses against them,
Human Rights Watch found. “Imagine living in hell, it’s like that here,” Asmirah, a 22-
year-old woman with a psychosocial disability, said about the religious healing center in
Brebes where she was forced to live.
Under Indonesian law, it is relatively easy to forcibly admit a person with a psychosocial
disability to an institution. Human Rights Watch found 65 cases of arbitrary detention in
institutions, and none of those interviewed who were in institutions were there
voluntarily. The longest cases Human Rights Watch documented was seven years at a
social care institution and 30 years at a mental hospital.

3. In some of the facilities, overcrowding and lack of hygiene were a serious concern,
leading to widespread lice and scabies. In Panti Laras 2, a social care institution on the
outskirts of Jakarta, the capital, Human Rights Watch observed approximately 90
women living in a room that could reasonably accommodate no more than 30.
“In many of these institutions, the level of personal hygiene is atrocious because people
are simply not allowed to get out or bathe,” Sharma said. “People are routinely forced to
sleep, eat, urinate, and defecate in the same space.”
In 13 of the 16 institutions that Human Rights Watch visited, people were routinely
forced to take medication or subjected to alternative “treatments” such as concoctions of
“magical” herbs, vigorous massages by traditional healers, and Quranic recitation in the
person’s ear. In three out of the six mental hospitals visited, Human Rights Watch
documented the use of electroconvulsive therapy without anesthesia and without
consent. In one, it was also administered to children.
Human Rights Watch found forced seclusion used routinely, including as punishment for
failing to follow orders, fighting, or sexual activity.
Human Rights Watch documented cases of physical and sexual violence. In seven of
the institutions visited, male staff could enter women’s sections at will or were
responsible for the women’s section, putting women and girls at increased risk of sexual
violence. In healing centers, men and women were chained next to each other, leaving
women no option to run away if abused. In three institutions, Human Rights Watch
found evidence of staff giving women contraception without their consent or knowledge.
The Indonesian government should immediately order inspections and regular
monitoring of all government and private institutions and take action against facilities
that practice shackling or abuse people with psychosocial disabilities. Indonesia should
also take steps to ensure that people with psychosocial disabilities can make decisions
about their lives and to require informed consent for treatment.
The government should amend the 2014 Mental Health Act to ensure that people with
psychosocial disabilities have the same rights as other Indonesians. The government
should also amend and pass the Rights of Persons with Disabilities Bill, bringing its
legislation in line with the United Nations Convention on the Rights of Persons with
Disabilities, which Indonesia ratified in 2011.
The government should develop voluntary and accessible community-based support
and mental health services in consultation with people with psychosocial disabilities
themselves, as well as train mental health workers, from nurses to psychiatrists, Human
Rights Watch said.

4. “The thought that someone has been living in their own excrement and urine for 15
years in a locked room, isolated and not given any care whatsoever, is just horrifying,”
Sharma said. “So many people told me, ‘This is like living in hell.’ It really is.”
For more information on selected testimonies in the report, please see below.
“Living in Hell: Abuses against People with Psychosocial Disabilities in
Indonesia” is available at:
https://www.hrw.org/node/287537/
For more Human Rights Watch reporting on disability rights, please visit:
https://www.hrw.org/topic/disability-rights
For more Human Rights Watch reporting on Indonesia, please visit:
https://www.hrw.org/asia/indonesia
For more information, please contact:
In Jakarta, Kriti Sharma (English, Hindi, French): +62-897-2743468 (mobile); +1-646-
207-5963; or sharmak@hrw.org. Twitter: @ks7s
In Jakarta, Andreas Harsono (English, Indonesian): +62-815-950-9000 (mobile); or
harsona@hrw.org. Twitter: @andreasharsono
In Jakarta, Shantha Rau Barriga (English, German, Kannada): +1-917-361-5245; or
shantha.barriga@hrw.org. Twitter: @ShanthaHRW
Selected accounts
“You can throw a stone anywhere in Java and you will hit someone in pasung. That’s
how prevalent it is.”
Yeni Rosa Damayanti; head of Perhimpunan Jiwa Sehat-Indonesian Mental Health
Association; Jakarta
“Even when someone gets diarrhea they don’t let them go to the toilet; they do it in the
drain [in the dormitory]. It smells. They used to give us medicine for scabies but they’ve
run out of it.”
Sinta, 36; woman with a psychosocial disability; Galuh Rehabilitation Center, Bekasi
“They forced me to have a ‘massage.’ They held me down. One person held my legs
and another my arms. It was like someone was whipping me. They rubbed me till my
whole body became red. It wasn’t a massage. It was torture. I don’t know what they did
but it hurt so much I couldn’t walk afterward.”
Kasmirah, 43; woman with a psychosocial disability, describing her experience with an
Islamic healer and his assistants; Kebon Pedes
“A lot of people try to escape and if they catch them, they put them in the isolation room

5. for three days. There are many who try to escape.”
Endra, 42; a man with a psychosocial disability; living in a social care institution in
Sukabumi
“When I take a shower, the men, the staff watch me. Male staff members even change
women’s [clothes] if necessary. One male staff member touched my vagina this
morning. He was doing it just for fun.”
Tasya, 25; a woman with a psychosocial disability; living in a healing center in Brebes
“They put electricity on my temples and forehead; it hurt very much. I was awake when
they gave it – I could see it all. They tied my hands to the bed…. The doctor gave me
the shocks. They didn’t give me any injection. It lasted for half an hour. I couldn’t
understand what they were doing; no one had bothered to explain to me what was
happening. Not even my family told me. I couldn’t say anything but in my heart I refused
it. If I had resisted, my family would have punched me. They had done it before. They
considered me crazy.”
Carika; 29-year-old woman with a psychosocial disability; Central Java