An Indonesian practice known as ‘pasung’, used around the world among poor, uneducated families to restrain relatives with mental illness, has drawn the attention of social activists.
Filmmaker and mental health researcher, Dr Erminia Colucci, has filmed the documentary Breaking the Chains, following a team of health workers and volunteers in a rice growing area around Cianjur, a city in Indonesia’s West Java Province.
“Pasung takes different forms, so in a traditional way it can be chaining, it can be people put inside some kind of cage,” she said.
When the team first came across Yayah she had been locked and chained in a room for nearly 17 years.
Dr Collucci says Yayah’s family believed she had been possessed by evil spirits when she had in fact been diagnosed as a chronic schizophrenic by a psychiatrist.
“The families themselves were in so much pain,” she said.
“They were not doing this because they were bad people… they actually were doing this because they loved the person and they didn’t have a better way to deal with it.”
Professor Harry Minas, the director of the centre for International Mental Health at Melbourne University, says families using pasung are often extremely poor and have little understanding about mental illness.
“They’re people, many of whom are illiterate, many of whom have very little understanding about health and illness, particularly mental disorders… and who are doing the best they can,” he said.
He noticed the practice of pasung was widespread in Indonesia when he visited Aceh after the 2004 tsunami and earthquake.
Professor Minas says the most basic treatment, care and support for people with serious mental illnesses in many parts of the country is virtually non-existant.
“The total number of psychiatrists in Indonesia is about 600 among a population of about 240 million people,” he said.
“By comparison, the total number of psychiatrists in Australia for less than a tenth of the population is probably about 2500.”
Professor Minas provided guidance and support to his colleague, Dr Colucci, who sought permission from every family to document their story.
Dr Colucci says the openness of the families took her by surprise.
“I actually had the problem of people coming while I was filming and dragging me and saying, ‘Can you come, my brother, my sister, my neighbour, is also chained’,” she said.
“They wanted me to actually go and film and also share their story.”
Professor Minas says educating families is an important part of the work of mental health teams on their home visits.
“Many people who have a range of different spiritual beliefs can continue to do the sorts of things that their beliefs require, but at the same time they can understand that somebody with an acute psychotic illness will benefit from being treated with medicine,” he said.
‘Free From Pasung’
The Indonesian government is the first among any low to middle income countries committed to eradicating the practice.
Three years ago, the Indonesian Government established its ‘Free From Pasung’ program, which includes advocacy of human rights, education of mental illness and training mental health professionals.
In that time, about 4500 people have been freed from pasung.
Professor Minas says the government wants to stop the practice across the country.
“The clear commitment of the ministry of health is that this practice will be eliminated from Indonesia,” he said.
“It also shows with real clarity the level of commitment from community organisations, from volunteers, from local health authorities, to do something about this.”
Australian mental illness support worker Ben Rinaudo helped to fund the documentary with his background and work in international community development.
Having been diagnosed with schizo-effective disorder, Mr Rinaudo says he closely identifies with many of the issues raised in Breaking the Chains.
“I just can’t imagine what it would have been like for me if I had experienced this in another country,” he said.
“I was very fortunate to have access to effective and affordable treatments and psychosocial support both in the community and from mental health services.”
This article first appeared on ABC Australia Network News on 6 November, 2013.