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

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.

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.

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.

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.