Indonesia Free from “Pasung” (Physical Restraint)

Diah Setia Utami Director of Mental Health

Ministry of Health, Republic of Indonesia

BACKGROUND OF MENTAL HEALTH PROBLEMS IN INDONESIA

Current Situation of Mental Health

•  Severe mental disorder was nearly 0,5% (>1 million people) (Basic Health Research 2007)

•  Treatment gap in Indonesia is more than 90%. Survey in Leuwiliang West Java showed psychosis treatment gap was 96,5%.

Current Situation of Mental Health (cont’d)

• Prevalence of perinatal depression is 20%-30%

• Common mental health issues in the community: 1.  Depression disorder

(15.5%), 2.  Generalized anxiety

disorders (12.1%) 3.  Post- traumatic stress

disorders (8.5%).

*Collaboration research in West Java, 2011

Current Situation of Mental Health (2)

•  Mental health problems due to natural disaster: prevalence of depression & anxiety disorders was about 40% post disaster (Irmansyah et al, FKUI; FK Unpad Jabar, 2010).

Current Situation of Mental Health (3)

Student brawl / Other mass

violence

Migrant workers & Human trafficking

Mental Health Services (1) • 51 Mental Hospitals are available in 27

provinces: – 22 provide subspecialistic services

(Pediatric Psychiatry and/or Drug Dependence)

– Total bed capacity: 7700 (rate 3.31 per 100.000 population)

• 8 provincies do not have mental hospital

• 3 provincies do not have psychiatrist

Fasilities of Mental Health Services (2)

•  61,3% of PHC in Indonesia (around 9000 PHC) provide basic* mental health service (Health Facilities Research, 2011).

•  The majority of primary health care doctors and nurses have not received sufficient & official mental health training in the last five years.

•  252 (33%) general hospitals (government) have mental health services, especially outpatient services

* Early detection, home visit, essential psychopharmacotherapy

Provinces : 34 MHH: 50 (34 Goverment, 17 Private ) 8 has no Mental Hospital (Kepulauan Riau, Banten, Kalimantan Utara, Gorontalo, NTT, Sulbar, Maluku Utara dan Papua Barat)

PROGRAMINDONESIA FREE FROM

“PASUNG”

Pasung problems

Estimation of people who

were restrainst physically were

18.800

Data from 21 Provinces : • 4205 reported

cases: 82% received treatment

Factors of Restraining People with Mental Disorder

• History of chronic and relapsing disease

• Lack of access to mental health services

• Family burden • Low respond towards

pharmacotherapy • Financial issues • Lack of knowledge and understanding

on mental health

2010 - Socialization - Providing regulation

- Problem mapping

2011 - Strengthening HR

- Drug distribution

- Multi-sector commitment building

2012 - Strengthening services

- Community empowerment

2013 Monev in 33 provinces through: a. Basic Health

Research 2013

b. Specific questionnaire on pasung

2014 Remapping for future policy

ROADMAP of INDONESIA FREE FROM

PASUNG

13

Objectives •  To achieve pasung (restraint) free

situation for people with mental disorders in Indonesia, through: 1. Implementation of human rights-

based approach in treating people with mental disorders

2. Increasing mental health knowledge of stakeholders

3. Providing quality mental health service in the community

Objectives (cont’d) 4. Availability of sufficient mental

health budget at all level: national, provincial and district level

5. Availability of multi-sector collaboration and coordination in mental health efforts

6.  Implementation of mental health efforts monitoring and evaluation

Reported and Treated “Pasung” 2010 – July 2013

16

383

1139

1388 1295

238 (62,14%)

990 (86,92%)

488 (60,77%)

1178

0

200

400

600

800

1000

1200

1400

1600

2010 2011 2012 2013

Reported Treated

(82%)

* Data July 2013

Future Plan • Monitoring and Evaluation • Re-scheduling of “Pasung” Roadmap • Providing: guideline, regulation,

evaluation tools • Advocacy to the stakeholders • Capacity building for the health

profesionals

Thank You

Thank You