Reporter’s Notebook: Indonesia’s Mentally Ill, Caged and Bound

BY Ray Suarez  June 23, 2011 at 11:48 AM EDT


Mentally ill man chained at the Yayasan Guluh facility in Bekasi, Indonesia. Photo by Cat Wise.

It’s hard to describe something sadder than the forlorn face of a man peering out at the world through the slats of a make-shift cell his family built.

We are in Indonesia, four hours drive from the sprawling capital of Jakarta, in the city of Cianjur. This is rice and tea country, with breathtaking vistas of terraced fields, but we’ve come here with a different purpose — to visit some of the country’s mentally ill, misunderstood and mistreated.

The 29-year-old’s brother and sister told the NewsHour team they would love to give their brother his liberty. They don’t know what to do, they explained, he has been out of control for years, wandering around the neighborhood, taking buses far away, taking goods from local shops, and taking drugs. Reluctantly, they say, they must lock him up for his own good and for the good of the community. The young man appears healthy. During our visit the one-room structure that is his home and prison is opened and he sits in the yard.

On this day, he is visited by a volunteer community health worker with an important story to tell that pushes back against the appalling treatment of the mentally ill in communities like this one. Nurhamid is 52, and suffered from bipolar disease for years. Finally treated, and finally well, he visits families and their suffering loved ones, urging them to get diagnoses and medicine from the pioneering staff at the nearby regional hospital.

Psychiatric services are not widely available in Indonesia or in much of the developing world. In fact, this nation of nearly 240 million people has only 500 psychiatrists. It is widely believed by Indonesians that mental illness is not the result of identifiable neurological problems, but instead comes from curses, evil spirits, and bad luck.

Nurhamid brought us, along with doctors from the Cianjur mental health practice, to the home of a man recently unshackled by his family after more than a decade in confinement. The man is hard to follow, has difficulty making himself understood, but seems placid and happy after beginning a course of psychiatric medication. Everything seems to be going well, but the woman who keeps a shop in the compound tells the doctors the patients’ wandering and crying out frightens the neighbors, who then stay away from the shop. Change comes slowly in a place like this neighborhood. A new approach to people in mental distress won’t come overnight.

That old way of thinking and the shortage of help becomes obvious when visiting another “treatment” facility. A ride down a narrow rural road brings us to a nondescript wrought iron fence locked not to keep outsiders from entering, but insiders from leaving. The Yayasan Guluh facility is in Bekasi, a short trip from Jakarta. It is home to 265 people, mostly men, who suffer from a range of mental illnesses and get a series of treatments based on traditional healing approaches.

A few dozen patients roam the grounds, talking to themselves or yelling at no one in particular. One woman, in a heartrending series of cries, sobs face down on the ground. Bad enough…all of it, but across the courtyard it gets much, much worse.

On the other side of the sun-blasted yard stands an enormous cage and an alley covered by a metal roof. The stench of urine and feces are overwhelming, like being slapped across the face in the intense heat. Men sit in various states of undress, talking to themselves, rocking back and forth, staring into space. Some have stripped off their clothes, and stare passively at the visitors. Others, chained to posts, rave and strain against their bonds, circling the pole that is their world for the day.

In the vast cage, which holds maybe a hundred men, not a single member of staff is interacting with the patients. There is no occupational therapy, no words of comfort, little in the way of treatment.

During our visit, the family that runs the facility prepares a runny green paste from the leaves of a local herb. Then, seemingly at random, they approach various patients, lay them on the ground, and pour the paste in their eyes. A few struggle before giving in. Others, who seem to know what’s coming, acquiesce, getting it over with quickly. I ask a member of the staff what the green goop does, and he tells me it calms the people in his care, and helps them feel better.

Later another herbal treatment, made from greens and fresh coconut juice, is administered. The staff appears to sincerely believe it’s a superior form of treatment to what the ill would get in a hospital. The drink is blessed by a traditional healer, as are the chains used to tether residents to posts scattered around the place. When I asked if many leave, I was assured the cures are effective and some do get to go home. Many, I was told, have no place to go: villagers are too frightened of the released to welcome them home and families don’t want them.

Police officers drop off some of the residents at the gates. They simply can’t fit in with the daily life of communities scattered across this vast sprawl outside the capital, and without treatment, never will. Fees are often paid by families who can no longer handle an ailing relative, but after a time the payments often taper off and disappear. Yet the resident is not sent out the front gate once the money stops. Charities chip in a little. Families able to afford more are pressed to up the payments. To give you an idea of the level of support provided in this place, I was told running the entire facility costs about a million Indonesian rupiah a day. At something like 8500 rupiah to the dollar and 265 patients the entire cost for a year of housing someone here is around $160 U.S. per year. Even at the significantly lower costs of life here in Indonesia, that amount doesn’t provide much.

Right now, the government cannot simply order places like the one I visited closed. Until there are options for the thousands locked up in them, they will remain open. The Indonesian Health Minister, Dr. Endang Rahayu Sedyangsih, told me she would like to close them down, but as the head of a ministry only able to spend one U.S. dollar per Indonesian for public health, she cannot supply the psychiatrists, psychologists, nurses, social workers or psychiatric drugs needed to supply alternative care. The tragedy remains that, untreated, the patients — really the inmates — I saw will only get worse and move beyond effective treatment while they are locked up.

The mentally ill have a champion in Dr. Irmansyah, the country’s director of mental health, who like many Indonesians goes by a single name. He hopes the sight of formerly severely distressed patients back in the community after treatment can turn around his country’s attitudes toward mental illness and its treatment. Once properly looked after, many can work, others at the very least can better control the impulses that disturb so many around them. Pushing back against such entrenched ideas looks like a tough, uphill battle, but spending time with some of the success stories leaves an outsider pulling for the mentally ill of this country.