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Indonesia's 'Horrifying' Mental Health Services Exposed By Human Rights Watch

One woman was shackled in a room for 15 years

21/03/2016 16:13 GMT | Updated 21/03/2016 16:53 GMT

Warning: Graphic images and content

A woman was tied up naked with her hands behind her back and locked in a room for 15 years by her father because she was mentally ill.

She is just one of thousands of Indonesians shackled without their consent by their own families or locked up in overcrowded institutions due to stigma and a lack of mental health care in the country.

It is estimated that about 18,800 people are currently shackled, despite a 1977 government ban on the practice, a report from Human Rights Watch (HRW) published on Monday reveals.

Andrea Star Reese
Before she died, this woman lived chained at Bina Lestari healing center in Brebes, Central Java for over two years. Her family paid for her platform bed and for the Islamic-based healing she received at the center.

 Images published with the report show the harrowing reality of Indonesia's mental health services.

“Shackling people with mental health conditions is illegal in Indonesia and yet it remains a widespread and brutal practice,” said Kriti Sharma disability rights researcher at HRW 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.”

The 74-page report 'Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia' examines how people with mental health conditions are often chained or locked up in overcrowded and unsanitary institutions, where they face physical and sexual violence, involuntary treatment including electroshock therapy, seclusion, restraint and forced contraception.

Children are also shackled.

Andrea Star Reese for Human Rights Watch
A woman chained in a room built behind her family home in Ponorogo, East Java. She is forced to eat, sleep, and defecate in this room.

With a population of 250 million people, Indonesia has only 600 to 800 psychiatrists—one for every 300,000 to 400,000 people.

There are 48 mental hospitals spread unevenly across the country.

HRW found that within the few facilities and services that do exist, basic human rights are not observed.

“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 she was forced to live in.

A total of 72 people with psychosocial disabilities were interviewed by HRW. The group also spoke with family members, caregivers, mental health professionals, heads of institutions, government officials, and disability rights advocates.

HRW visited 16 institutions across the islands of Java and Sumatra including mental hospitals, social care institutions, and faith healing centers, and documented 175 cases across five provinces of people who are currently shackled or locked up or were recently released.

More than 57,000 people in Indonesia with mental health conditions have been shackled or locked up in confined space at least once in their lives.

People with psychological disabilities are sometimes shackled for years at a time.

Despite steps taken by the Indonesian government to abolish the practice, implementation at a local level has been very slow. 

The government aims to have universal health coverage, including mental health care, by 2019.

Lice and scabies were widespread in one institution due to overcrowding and a lack of hygiene.

In one social care institution near to Indonesia's capital Jakarta, HRW saw about 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.”

HRW found 65 cases of arbitrary detention in institutions. No one interviewed was there voluntarily.

The longest cases HRW documented was seven years at a social care institution and 30 years at a mental hospital.

Alternative treatments such as concoctions of “magical” herbs, vigorous massages by traditional healers, and Quranic recitation in the person’s ear were practiced on patients.

Andrea Star Reese
Haji Hamden, an Islamic faith healer, chants as his assistant Abdul slaps the leg of a shelter resident at Pengobatan Alternatif Nurul Azha, a traditional healing center, in West Java. Abdul also uses a hard implement to massage patients, causing extensive bruising, as part of the daily healing routine.

In half of the mental hospitals visited HRW saw electroconvulsive therapy being used without anesthesia and without consent. In one, it was also administered to children.

Forced seclusion was used routinely, including as punishment for failing to follow orders, fighting, or sexual activity.

In seven of the institutions HRW 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, HRW found evidence of staff giving women contraception without their consent or knowledge.

HRW is calling on the Indonesian government to immediately order inspections and regular monitoring of all government and private institutions and take action against those who shackle and abuse people with psychosocial disabilities.

“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.”

These images show the conditions people with mental health problems are forced to live in in Indonesia.

  • Andrea Star Reese for Human Rights Watch
    A man sings in his cell, his hands moving in an intricate dance, at Pengobatan Alternatif Jasono, a traditional healing center in Cilacap, Central Java.
  • Andrea Star Reese for Human Rights Watch
    Two residents at the Bina Lestari healing center in Brebes, Central Java, are chained to a wooden platform bed while an Islamic faith healer stands nearby. At the center, all residents are chained and receive traditional 'healing' through prayer, consumption of special drinks, or blessings with holy water.
  • Andrea Star Reese for Human Rights Watch
    A man is restrained with chains in the male section of Galuh Rehabilitation Center in Bekasi.
  • Andrea Star Reese for Human Rights Watch
    A male resident staying in the isolation room at the Galuh Rehabilitation Center in Bekasi has wounds on his arms resulting from being tied.
  • Andrea Star Reese for Human Rights Watch
    A woman resident in the female section of Galuh Rehabilitation Center in Bekasi waits for a male staff member to leave before she uses the toilet. Female residents have no privacy and are at heightened risk of sexual violence as the toilets have no doors and male staff oversee the female section, including at night.
  • Andrea Star Reese for Human Rights Watch
    Fathoni locked his two daughters, who both have psychosocial disabilities, in this goat shed for four years before they eventually received media attention that led to them being rescued and taken to a hospital.
  • Andrea Star Reese
    A woman restrained to her bed in the ward for new residents at Lawang Mental Hospital, East Java.
  • Andrea Star Reese
    Men with psychosocial disabilities are locked up in a crowded room in the male section of Galuh Rehabilitation Center in Bekasi.
  • Kriti Sharma/Human Rights Watch
    A woman with a psychosocial disability was locked up in this chicken coop. The coop is located behind the house and is covered in chicken droppings.
  • Andrea Star Reese for Human Rights Watch
    Ekram, a man with a psychosocial disability, eats his dinner in a shed outside the family home where he has been locked up. His family gives him food and water through a small hole in the shed.
  • Kriti Sharma/Human Rights Watch
    A woman with a psychosocial disability living in Panti Laras Dharma Guna, a social care institution in Bengkulu in Sumatra, shows scars from burns she received when she was unable to escape from a fire at her home because her parents had restrained her in wooden stocks. Her family was not home at the time of the fire and she was rescued by a neighbor.
  • Andrea Star Reese for Human Rights Watch
    Ekram, a man with a psychosocial disability has been held in pasung in the shed next to the family home in Cianjur, West Java. .
  • Andrea Star Reese
    This man lived shackled in stocks, a traditional form of pasung, for nine years in a back room in his family's home in Cianjur in West Java. When he was released, his legs had atrophied from disuse.
  • Andrea Star Reese for Human Rights Watch
    Agus, a 26-year-old man with a psychosocial disability, built this sheep shed behind his family home in Cianjur, West Java. When he developed a mental health condition, his parents sold the sheep and locked Agus in the shed for a month because they thought he was possessed by evil spirits.
  • Andrea Star Reese for Human Rights Watch
    Yeni Rosa Damayanti, a disability rights advocate, visits and feeds a young woman at a mental hospital in Jakarta.
  • Andrea Star Reese for Human Rights Watch
    A 24-year-old female resident lies with her wrist and ankle chained to a platform bed at Bina Lestari healing center in Brebes, Central Java. After her husband abandoned her and her 5 year-old daughter to marry someone else, she began to experience depression.
  • Andrea Star Reese for Human Rights Watch
    A young man with a psychosocial disability is chained in a back room at his family home in Ponorogo, East Java.
  • Kriti Sharma/Human Rights Watch
    The isolation room for children with psychosocial disabilities in Grogol mental hospital in Jakarta.
  • Andrea Star Reese for Human Rights Watch
    A man is chained from the wrist in the male section of Galuh Rehabilitation Center in Bekasi.
  • Andrea Star Reese for Human Rights Watch
    Yeni Rosa Damayanti, the head of the Indonesian Mental Health Association, presents a report to the Indonesian House of Representatives in Jakarta.
  • Andrea Star Reese for Human Rights Watch
    For four years, Carika, a woman with a psychosocial disability, and her sister both lived in this cramped goat shed outside the family home, eating and sleeping amid the stench of goat droppings.
  • Andrea Star Reese for Human Rights Watch
    A man is shackled to a wooden bed.
  • Andrea Star Reese for Human Rights Watch
    Newly built isolation rooms in Galuh Rehabilitation Center in Bekasi often house multiple people.
  • Kriti Sharma/Human Rights Watch
    A man held in the isolation cell in Bengkulu mental hospital in Sumatra.