Between rice fields and coconut trees on Indonesia’s “paradise” island of Bali, a man lies chained by the ankles to a rotting wooden bed in a garden, staring at roosters tottering by.
I Ketut Lingga, 54, has schizophrenia and is one of more than 15,000 Indonesians with a mental illness who are either chained, caged or placed in primitive stocks, according to health ministry data. They are known as pasung — which loosely translates to “shackled” — and are considered lost causes. Lingga’s family shackled him 30 years ago, and he has never been unchained since. When he is relaxed, he rarely moves or speaks, but during an episode, his family fears him.
“He attacked me one day, so we had no choice but to chain him up,” Lingga’s sister-in-law, Wayan Reti, 50, said at her home in eastern Bali’s Karangasem district. “He ripped off my clothes and tried to strangle me, and he’s been shackled ever since. What else could we do?”
In his early 20s, Lingga began threatening to kill or beat people. He was taken for just three visits to the mental hospital, where he was given medication but no counseling. After that his family could no longer pay the US$15 fee for each visit.
Some 50 pasung exist in Karangasem alone, according to psychiatrist Luh Ketut Suryani, who discovered the extent of the problem early last decade while researching a spike in suicide rates in the district.
Suryani identified 895 people in Karangasem with mental disorders. However, with her thin resources already stretched, she is unable to treat them all.
Helped by her son, who is also a psychiatrist, and three paid volunteers, she treats and monitors almost 700 patients with anti-psychotic drug injections, counseling and meditation. She has also used singing sessions, which she said helps patients to relax and focus.
The Balinese government in 2009 granted Suryani more than US$500,000 to keep up her work, which she had for years funded herself, but that money was cut after complaints about her meditation and singing sessions.
“We include meditation because it’s the Balinese Hindu belief, and using a method patients believe in means they accept us into the community. It helps them heal emotionally,” Suryani said.
In Bali, most people with mental illnesses first see a traditional healer for purification, believing mental disorders are caused by the supernatural.
Suryani claims a success rate of 31 percent, where patients no longer need medication. Only 3 percent have shown no improvement, while the rest are making progress with regular treatment.
“Many disagree with my methods, but these people are the forgotten. If not us, who will help them?” she said.
A health ministry survey in 2007 showed that 11.6 percent, or more than 27 million Indonesians, have some kind of mental or emotional disorder, while around a million have psychotic or serious mental illnesses. Less than 5 percent are treated.
About 2 percent of the national budget is slated for health next year, and only 1 percent of that is typically allocated to mental health, ministry data show.
There are 48 mental hospitals in the country of 240 million people, and only 700 registered psychiatrists. This gross underfunding is evident in Karangasem, where schizophrenic Nengah Surung, 65, lives in a government-built 3m by 4m concrete cell with a barred door and window. His home prison reeks of feces and urine.
He was chained for nine years before Suryani convinced his family to unchain him.
“I don’t remember being chained up that well, but I remember I hated it. I’m happier here,” he said, struggling to sit up on the three slats of wood that form his bed.
Surung is cared for by his 29-year-old son, I Nengah Sarita, who makes 40,000 rupiah (US$4) a day as a laborer when work is available. He lives with a dog and four cats in a hut with thatch-grass walls and a tin roof meters from his father. The men and animals alike eat only rice.
The system is in need of an overhaul, health ministry mental health management director Diah Setia Utami said.
“We have a problem where practitioners don’t follow up on their patients, and the referral system isn’t working,” Utami said. “We aimed to free all pasung by 2014, but we’ve revised our target to 2020. There’s a lot of awareness work is needed to really change this culture and free the mentally ill.”