Innovation summary

In Indonesia, the use of physical restraint (pasung) is a common way of dealing with mental illness, resulting from the lack of available viable treatment options.  The Indonesian Ministry of Health estimate that 18,800 people with mental health problems are currently physically restrained.1

The aim of the program is the nation-wide elimination of pasung to protect the human rights of people with severe mental illness.

The innovation consists of intensive education campaigns and multi-sector government initiatives to provide quality mental health services and empower the community.

Impact summary

  • Since the program started in 2012, 4205 cases of people in pasung have been reported
  • 82% of the reported cases have received treatment and been released

"I went to a rural area looking for patients with schizophrenia. Some had been restrained for years. That was not every schizophrenic’s fate, but it wasn’t unusual."

 

Dr. Irmansyah, Director of Mental Health (2010) 

Innovation details

  • Implemention of human rights-based approach for treating people with mental disorders
  • Intensive education campaigns to increasing the mental health knowledge of stakeholders
  • Provision of quality mental health services in the community
  • Ensuing allocation of sufficient mental health budget at all levels: national, provincial and district
  • Ensuring multi-sector collaboration and coordination of mental health efforts
  • Routine monitoring and evaluation of mental health efforts

These components were implemented in a stepped manner, starting with regulation and problem mapping in 2010, followed by capacity building to strengthen human resources for the program, drug distribution and building commitment for the program from the multiple sectors involved. In 2012, services were strengthened and community empowerment activities started.

Key drivers

8 major enabling elements  were identified that needed to be developed to ensure successful implementation and sustainability:

  1. Legislation, regulation, policy and plans
  2. Adequate financing
  3. Inter-sectoral collaboration
  4. Advocacy and community (including consumer and family) empowerment
  5. Human resource development
  6. Mental health services
  7. Infrastructure
  8. Monitoring and evaluation strategy to evaluate impact

Challenges

Legislation, Regulation, Policy and Plans

  • The lack of appropriate mental health laws hindered progress, as regulation from the local government is needed to mobilize resources
  • National Mental Health Policy 2009-2014 exists however the absence and lack of distribution of operational documents (planning, guideline, etc) created implementation and funding problems

Financing

  • Insufficient and unstable national and provincial level funding for mental health

Inter-sectoral Collaboration

  • Program focused on the health sector because it was initiated by the Ministry of Health. Collaboration with other sectors was challenging

Human Resources

  • Insufficient number and unequal distribution of staff
  • Lack of high quality mental health workers in the field due to implementation of curriculum in educational programs as a substitute for hands-on fieldwork

Mental Health Services

  • Most services are centralized in psychiatric  hospitals as there are insufficient services in general hospitals and in primary health centers

Infrastructure

  • Lack of medication and safe equipment especially for treating people with acute mental illness

Monitoring and Evaluation Strategy

  • Weak reporting and information system
  • Low monitoring and evaluation capacity

Continuation

The program will be implemented in an additional 13 provinces to cover all 34 provinces in Indonesia. In addition, the number of people held in pasung will be added to province level development indicators, to ensure that the program remains a priority.

Partners

National level

  • Academic Institutions
  • Developmental Planning Bureau
  • Health Offices at the Province and District Level
  • Health Services in primary, secondary (through psychiatric intensive care unit in general hospital), and tertiary levels (psychiatric hospitals)
  • Human Right Commission
  • Ministry of Social Welfare
  • Ministry of Health
  • Ministry of Internal Affairs
  • Ministry of Social Affairs
  • Professional mental health organisations

International Agencies


Funders

  • Ministry of Health (Indonesia)
  • Provincial and district governments (Indonesia)
  • International donors through several projects (see International Agencies, above)

Evaluation methods

Mental health system case studies have been conducted in three provinces including the number of cases which have been identified, released and treated.

References

  1.  Utami D (2013) Indonesia Bebas Pasung (Free From Restraints) program, in Movement for Global Mental Health: 3rd Summit. Bangkok.
  2. Fogarty Interntional Center (2010) Improving mental health care in Indonesia. [Accessed 27 November 2013].

Research

Tools

Multimedia
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