The Rocky Road to Mental Health

The last trip I took to Mental Health Hospital of Radjiman Wediodiningrat in Lawang, Malang, East Java brought me to the Mental Health Museum, just outside the hospital. I went to the hospital occasionally, to conduct the examination that my students, the future psychologists, had to take. They had their internship there, for two months, working with the patients who underwent their treatments there. 
 
The Mental Health Museum is a small building that once was a part of the hospital. It started years ago, ran by Dutch psychiatrists and their students. It exhibits many of the equipments and tools used by the doctors and their patients, for treatments, recreations, and everyday activities. Many of the equipments are scary and gory, like the brain slicing tool, the straight jackets, the shackles, and electroconvulsive shock apparatus, but some are tame enough, like the bath tub used to calm the patients, and the old vinyl records with the player and the old movie projector to entertain the patients.

As a developing country, Indonesia has 34 mental health institutions, far from enough to accommodate the 5% suffering from some form of mental disorders, out of the 240 millions citizens. As a developing country, Indonesia is still struggling with the welfare and well-being of its people. Many cannot even afford to provide their basic needs, like food, housing, and sanitation. Some also prone to be the victims of criminal acts and abuse, from strangers and (worst) from families or people they know, resulting in suffering and trauma. Mental health is the least priority in their list of surviving their daily lives.  

Many people in Indonesia still don’t know how to differentiate psychologists from psychiatrists. Psychology for them is some fancy field that deals with difficult and complicated subject, which is mental health. Whenever I tell people that I study and teach psychology, usually their first question is, “Well, can you read my personality?” like I’m sort of fortune teller or psychic. When I tell them that one of my field of expertise is mental disorder, I can usually sense their apprehension and the uncomfortable, awkward silence that follows is palpable.

I can understand their reasons for behaving like that. Mental health patients in Indonesia still suffer from discrimination and stigma, making it harder for them to get better and adapting to their medical needs. When someone is brought to see a psychologist, or God forbid, come on their own, most people would automatically think there must be something ‘wrong’ with them. Most people failed to see the simple fact: prevention is always better, and cheaper, in both medical and psychological sense. But most Indonesians come to doctors and mental health practitioners when their conditions already worse, if not in the worst state. Some believe mental illnesses are the results of witchcraft or magic done to make them suffer by their enemies or rivals. When the patients are finally referred to mental health practitioners, it is their last effort to find cure, and they already spent more money necessary.  

For those who are still healthy enough, they often fail to take better care of themselves, and the effects take toll on them, because they just can’t afford their precious time to sense their own bodies and their mental states. All their energy and effort are directed to survive their daily lives: to study the endless subjects and do extracurricular activities in schools, to commute, to work hard and earning minimum wages, to guard themselves against criminal acts, accidents, illness, and natural disasters.    

The heartbreaking cases of people with the worst condition of mental illness first came to light in the Time Magazine report on one of state-owned mental health institutions in suburb Jakarta. The article, along with sad photographs of the patients and their surroundings, became one of the most humiliating stories about Indonesia. Recently, BCC reported about Galuh Foundation, also in suburb Jakarta, a private-own home for Indonesia’s mentally ill patients. The staff interviewed for the piece said that they do not practice shackling patients, but the reality told different story. Many patients are chained to their beds and cannot move around freely. The staff said that they are chained so they will behave themselves and not harming themselves or others. If they get better, they will be release from their chains.

Shackling, or pasung in Bahasa Indonesia, is the act of chaining mentally ill patients to prevent them from harming themselves, others, and from escaping their caregiver or home. Shackling is considered inhumane and banned by the government in 1979. Indonesia is committed to stamp out the shackling of mentally ill patients by 2014. Yet, the reality was far from the promise. Many mentally ill patients, especially in rural areas, are shackled by their families. They often live alone in a hut, separated from the main house, and left to take care of themselves without any stimulation or human company whatsoever. Their mental illness make them powerless to assert themselves, or even to take care of themselves. They often sit and sleep on their own excrement, and rarely clean themselves properly.  

The Galuh Foundation is only one of mental health institutions still using chains to their patients. They also have a cage-like confinement in the middle of their compound, where they keep 30-40 patients, naked, like animals. The stench from urine and feces of the patients are gut wrenching, the report said. Ironically, this foundation finance their work, partly from the funding they receive by the government, through the Social Welfare Ministry, the same ministry that funded Bina Laras, the government institution featured in the Time Magazine article.

As a psychologist, the issue of caring for mental health patients are one of my main concern. In my job as a lecturer, I have the privilege to work with graduate students learning to become psychologists.  I constantly try to remind them to treat the patients as humanely as possible. Even in their worst state, with all of their symptoms, inside there are humans, needing the help and compassion from fellow humans. I also want my students to actively participate in the effort to prevent mental illness and promote mental health habits.

According to the survey conducted by the Health Ministry in 2007, about 14% of 10 millions of Jakartans have some sort of mental disorders or illnesses. This number, like many other statistics, are the reported ones. Many people affected by mental illness, not only the patients. Families, friends, and community are also suffering. The recent cases of mothers murdering their children, rape and abuse cases, and the stress due to poverty are now a common headlines in the Jakarta newspapers and media.

The people suffering from mental illness usually are not aware of their conditions. They come to community health center (Puskesmas) with complaints of physical symptoms like headaches and insomnia. When given the proper medication, their symptoms prevails. Doctors who work in Puskesmas usually overwhelmed by these cases because they’re understaffed and they do not have the proper training to help these patients. They usually refer these patients to mental hospital for further examinations.

I have the opportunity to take part in the current program of Jakarta Sehat Jiwa, an inniative taken by Clinical Psychology Association (IPK) to place psychologists at Puskesmas to give affordable mental health services. I was stationed in Puskesmas Mampang, on one Wednesday last March. I worked along with a medical doctor who referred one of her patients, a mother with some anxiety issues regarding her physical health. She came voluntarily and talked about her problems at home with her husband and children, and were perfectly aware of her problems. I listened to her and asked her some questions, and in the end, we came up with some solutions for her issues.

Not all the sessions in Puskesmas ran smoothly. The different opinions from medical doctors, nurses, and psychologists can interfere with the success of the program. This happened to one of my co-workers, a fellow lecturer and also a psychologist. She met this patient with prolonged anxiety about her health, due to her experience of being domestic violence survivor many years ago. She recommended the patient to undergo a more thorough medical examinations, but one nurse in the Puskesmas disagreed because according to the nurse, the patient must be lying about her complaints. So in my opinion, in order to gain some mutual understanding and to have a successful mental health service program in Puskesmas, the medical service providers also need to have some sort of training in basic mental health knowledge.

The job to promote mental health not only rest in the hands of psychologists or psychiatrists. Medical doctors, nurses, mental health institution workers and staff also need to understand the importance to give the best treatment to the patients, with empathy and free of discrimination or stigma. The media and reporters who reported mental health issues also need the proper training to give better insight and understanding about how to prevent and care for mental illness patients. Families and communities need to work and support people who already diagnosed with mental illness, and give the proper care and fulfill the need of the patients. Last but not least, every individual should learn to get to know themselves better, trying to understand their potentials and their limits in mental health area. We all should be able to take better of ourselves, by maintaining a healthy lifestyle and equipped ourselves with stress-combating ways unique to our needs and personality. By taking care of ourselves, hopefully we can be healthy, both physically and mentally.

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