Almost 40 years after Indonesia banned the practice of shackling people with mental health conditions, nearly 19,000 are still living in chains, or are locked up in institutions where they are vulnerable to abuse, according to a new report from Human Rights Watch (HRW).

The study says that although pasung – shackling or confining people with psychosocial disabilities – was banned in 1977, enduring stigma and a chronic lack of mental health care and community support services mean its use remains widespread.

People subjected to pasung can have their ankles bound with chains or wooden stocks for hours, days, months or even years. They are often kept outside, naked and unable to wash.

Mental illness one of development's 'invisible crises', says IMC expert Read more

Recent figures from the Indonesian government suggest that more than 57,000 people in Indonesia have endured pasung at least once, while an estimated 18,800 are currently chained or locked up.



In 2014, 1,274 cases of pasung were reported across 21 provinces and people were rescued in 93% of cases. There is, however, no data on how many of those were successfully rehabilitated and how many were later returned to their shackles.

HRW researchers spoke to one man who kept his daughter shackled for 15 years because he feared she had been bewitched and didn’t have the money to take her to a doctor.

“She became destructive, dug up other people’s crops and ate raw corn from the plant. I was ashamed and scared she’d do it again,” he said.

“First I tied her wrist and ankles together with cables but she managed to untie herself so I decided to lock her up because the neighbours were scared.”

Although he released his daughter two months after the visit from HRW, he told the group that, for a decade and a half, she had been left to defecate in her room, which was never cleaned. She was not bathed in all that time, and was neither clothed nor visited. Her only contact with the outside world, beyond the meals pushed twice daily through a hole in the wall, came when local children pelted her with stones.

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

Somaliland faces ‘explosion’ of mental health conditions | Zoe Flood Read more

The report recognises that the government has taken action to address the practice through initiatives such as the “Indonesia free from pasung” programme, which aims to eradicate the practice by 2019. But it says progress is being stymied by the decentralised nature of the governmental system and by inadequate resources and infrastructure.

The study says that Indonesia, a sprawling archipelago country of 250 million people, has only about 800 psychiatrists and 48 mental hospitals, more than half of which are in just four of its 34 provinces.

Noting that the ministry of health’s budget is 1.5% of Indonesia’s central government expenditure for 2015, the report describes mental health spending as negligible, adding that the latest data shows nearly 90% of those who may need to access mental health services are unable to do so.

Those locked up in institutions, meanwhile, can fall prey to physical and sexual violence, or find themselves subjected to involuntary treatments such as electroshock therapy, seclusion, restraint and forced contraception.

HRW found some of the facilities were overcrowded, while personal hygiene levels in many were “atrocious”, with people “routinely forced to sleep, eat, urinate and defecate in the same place”.



The organisation also documented the use of “magical” herbs, Qur’anic recitation and electroconvulsive therapy without anaesthesia and without consent. Cases of physical and sexual violence were noted by researchers: in seven of the institutions visited, male staff were either responsible for the women’s section or were able to come and go as they pleased, raising the risk of sexual violence.

The report calls on the Indonesian government to make mental health a priority by putting an end to pasung, ordering immediate inspections of state and private institutions, and instigating regular monitoring.

Other recommendations include amending the 2014 Mental Health Act to give people with psychosocial disabilities the same rights enjoyed by their fellow citizens, training mental health workers, and developing community-based services.

Equally important, however, is listening to the voices of those affected by mental illnesses, consulting them over their treatment, and seeking their informed consent.

“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,” said Sharma. “So many people told me, ‘This is like living in hell’. It really is.”