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Indonesia’s Mentally Ill Face Neglect, Mistreatment

A shortage of health workers, lack of treatment options and widespread misconceptions about psychological disorders often leads to poor and inhuman treatment of mentally ill patients in Indonesia. Ray Suarez reports.

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    Yayasan Galuh may be one of the saddest places on earth.

    Located in Bekasi, on the outskirts of Jakarta, it's a facility for the mentally ill where some 260 patients spend their days on a hard tile surface rimmed by open sewers.

    Dozens are locked in a large cage. Others are chained to poles.

    Many are naked. The air is thick with their weeping and screaming, and with the stench of human excrement in the intense heat.

    The conditions may seem cruel, but employees at the foundation see themselves as healers who give these much-neglected patients ancient and what they say are effective therapies. Many of the patients have been left here by family members at wit's end, not sure where to turn for help, when the choices are so few.

    In a country of almost 240 million people, there are only 500 psychiatrists. So into that enormous vacuum, left by the near total absence of clinics, occupational therapy or modern drugs, moves traditional medicine: a combination of massage, prayer and herbal therapy.

    During our visit a traditional healer prayed over chain used to restrain a patient. Herbs were made into eye drops, and a drink made from coconuts.

    Jajat Sudrajat one of leaders at the foundation says these traditional healing medicines treat people who suffer from dark spirits.

    JAJAT SUDRAJAT, head nurse at Galhuh Foundation: It's because of a problem in their house or a problem in their family.


    So these people have a spiritual sickness, not a physical sickness?


    They have a spiritual problem. Because physically, they are in good shape. But it's in their heart. It's in their spirit that they are sick.


    It's a common sentiment, not only in Indonesia but in much of the developing world generally, that mental illness isn't a neurological disorder, but instead is the result of evil spirits.

    It's a misconception that the country's mental health director, Dr. Irmansyah, is trying desperately to change.


    What's the biggest problem in treating mental health in Indonesia?

    DR. IRMANSYAH, director of mental health services at Indonesia's Ministry of Health: Ignorance by the people because some members of our population still believe about superstitions and other things. They don't have any idea that this kind of behavior is caused by brain malfunction.


    Harvard trained Dr. Irmansyah has begun a crusade, of sorts, to educate people about mental illness.

    We followed him as he went about his work in a village outside Cianjur.

    We met a 29-year-old man who has been locked up by his family for more than ten years. According to Dr. Irmansyah, some 30,000 mentally ill people are restrained in cages, stocks or chains.

    This man's brother and sister say it's to prevent him from wandering off, frightening neighbors, and getting into trouble.

    Dr. Irmansyah has convinced them their brother needs to be on medicine for schizophrenia instead. And he has brought along a living example: someone with a powerful story to tell.

    Two and a half years ago, Nurhamid Karnatmaja went to his local health clinic in Cianjur to seek treatment because he knew something was wrong.

    NURHAMID KARNATMAJA, outreach volunteer: I have bipolar, which means I suffer from two extremes of emotions. I would cry when I was laughing and laugh when I was crying. But that was a long time ago. Now I am healed.


    Once you got the treatment, were you better quickly?


    Yes. I feel so much better now. My emotions are stable. I feel better than even before I was ill.


    Nurhamid now volunteers for the clinic as an outreach worker visiting homes where mentally ill people are being restrained by their families and telling them there's a better way.

    A year ago he discovered Kikin Sodikin, who was locked up by his family when he began showing signs of schizophrenia.


    My family was very afraid, very worried. They had to restrain me in a cage for three months.


    Nurhamid introduced Kikin to Dr. Syafari Soma who developed the mental health community outreach program, and who provides psychological services at the Cianjur clinic two days a week.

    Dr. Syafari is a psychiatrist, and he knows there aren't enough doctors like him. In fact, the world health organization estimates that Indonesia needs ten times the psychiatrists it currently has.

    To make up some of that deficit, Dr. Syafari is training others to help out.

    DR. SYAFARI SOMA, psychiatrist: That is why we are working with other professionals like nurses. Also we are training the families of the patients and we're training former patients. It's the key to the wellness of the patients. And it's proven that it's working here in Cianjur.


    While Dr. Syafari is pleased with the results he has been getting with his community medicine project, he is frustrated the government doesn't provide more resources.


    A very small amount of money is allocated because they don't think mental illness is the same as physical illness. We want the government to know that it is. Patients need to be treated the same. And mental health doctors need the budgets to treat people with medicine.

    Dr. Endang Rahayu Sedyaningsih is Indonesia's health minister. She agrees that mental health is a major problem, but says that she is faced with a wide variety of health issues that need funding.

    DR. ENDANG RAHAYU SEDYANINGSIH, Minister of Health, Indonesia: It is not easy. Here we have limited money. The health budget is only 2.3 percent of the total national budget. So very small, and everything is important, so we are trying our best, trying to balance our budget with the problems.


    In fact, only 1 percent of that limited health budget is spent on mental health. Dr. Endang says the U.N.'s Millennium Development Goals don't stress mental health, so there's little incentive to spend more among nations straining to meet the targets.


    We are not valued or judged at the end of 2015 by mental health. So you must understand also if ministers of health in other countries do not spend their money there because the indicators are not there.


    It's a problem that Harvard medical anthropologist Byron Good sees the world over: Issues like HIV and infant mortality get most of the attention, and most of the money.

    BYRON GOOD, medical anthropologist: One of the reasons that mental illnesses tend not to show up on public health statistics is because many people have a chronic illness that doesn't kill them. So if you're using primarily mortality statistics, you find infants and maternal mortality to be a much more dramatic problem. As we've begun to move toward NCDs, non-communicable diseases, then people begin to measure years of life with disability etc. And to everybody's surprise, when they began to measure disability and years of life with disability, mental illnesses came right up to the very top made up three or four of the top 10 most disabling illnesses.


    Four years ago, Good studied mental health needs in Aceh, the war-torn region in the northern part of the country hit by a devastating tsunami in 2004. Many survivors suffered severe mental and emotional side effects.


    We asked over 1,000 people, "Before you got ill, how many hours a week on average did you work?" Young people to old people, average 28 hours a week that I worked in the fields, etc. "When you got sick with this mental illness, how many hours could you work?" It dropped down to 10 hours. That says to me that there's an enormous economic cost.


    In a country urgently seeking to grow its economy, health minister Endang says industry should invest in health services, if it wants a productive work force.


    We understand that the health development cannot be done only by the government. And cannot be done only by the minister of health. So we include all stakeholders. We ask participation from industries, from civil society as well as from the communities themselves.


    In the meantime, Drs. Irmansyah and Syafari will continue their work of educating people about the benefits of modern medicine. It's their hope that by 2014, Indonesia will be rid of places like Yayasan Galuh, and all cages and stocks that restrain the mentally ill.

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