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| Due to financial constraints and because mental illness is often considered a mark of shame, many people still keep mentally challenged loved ones shackled at home, even in parts of Jakarta. (JG Photo/Yudhi Sukma Wijaya) |
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When you
visit state-run Soeharto Heerdjan Mental Hospital in Grogol, West Jakarta,
these days, the old image of a miserable asylum warehousing unwanted castoffs
of society has changed to something much cleaner, more humane and caring.
The change
took decades — and the transformation turned on two victims, a patient and a
banyan tree.
First, the
tree.
Despite
casting badly needed shade in scorching Jakarta, the banyan tree is often
considered to be a “spirit nest” by some superstitious Indonesians and one such
tree was giving the hospital a bad reputation.
“We decided
to cut down the old banyan tree in front of this hospital to remove the
enduring image of a scary place,” said Retno, a spokeswoman for the hospital.
Unfortunately,
it takes more than just the symbolic sacrifice of a banyan tree to change the
image of a mental hospital that was built under the Dutch in 1923 and has long
been seen as frightening.
A decade
ago an incident took place that focused hospital administrators on deeper
problems than a tree full of black magic.
One night a
patient named Uyung was restrained in a two-person isolation room but the
situation went terribly wrong. Another patient in the room somehow broke free
from his chains and gouged out Uyung’s eyes.
The details
have never been fully understood because the staff member on duty that night
fled after locking the isolation room from the outside.
The
hospital only realized something had happened after patients from other rooms
screamed when they saw blood flowing from underneath the isolation room’s door.
Uyung, now
blind, lives permanently in the hospital under state care, meaning he receives
free treatment as compensation. His mother visits once a week because his poor
family can’t afford to have him back in their tiny house.
The
incident shocked and embarrassed officials, who started changing the way things
were done at the facility to emphasize treatment and community outreach instead
of the old solution of just locking up troubled patients to keep them off the
streets.
“We are a
product of the past. After the Uyung incident, radical changes took place in
mental hospitals across the country,” said Laurentius Panggabean, medical
treatment director at Soeharto Heerdjan. “At that time, mental institutions
were more like prisons instead of hospitals.”
Laurentius
said changes include new procedures for treating patients that highlight their
safety and comfort. “The thing is, you can’t measure what happened in the past
by current standards because we had limited resources back then,” he said,
adding that even today sometimes paramedics fail to meet basic requirements,
like avoiding negligence.
Revolutionary
Break
“History
teaches us that sometimes it takes a great revolution to make changes. In this
place, it was Uyung,” said Asmarahadi, a psychiatrist who heads the inpatient
unit at the hospital.
“In those
days, paramedics used a hose to bathe patients and they wouldn’t even realize a
patient had died. … That’s something you won’t see today.”
The
hospital has room for 300 inpatients, although it is currently occupied by 200
patients.
According
to Asmarahadi, most patients at the hospital suffer from chronic mental
disorders that are usually diagnosed at a late stage.
“We need to
educate people through outreach programs so they can spot mental disorders at
an earlier stage,” he said.
“We have to
admit that awareness of mental health has never been a priority,” said
Irmansyah, the director of mental health at the Health Ministry.
“The budget
for mental health is small because we are still trying to reach the UN’s
Millennium Development Goals,” he said.
Mental
health is not one of eight development goals agreed on in 2000, like the
eradication of extreme poverty and improvement of maternal health. Indonesia,
along with other developing countries, is still trying to meet the 2015
deadline.
Another
issue is that while those who have money can seek treatment in private clinics,
poor Indonesians have little choice in a country where mental illness is still
considered a mark of shame. Too often families use shackles instead of costly
treatments in hospitals. The presence of chained patients even in parts of
Jakarta prompted the Health Ministry to promote the “Shackle-free Indonesia”
campaign last year.
Health
Ministry data shows that there are a total of 33 mental hospitals across the
archipelago, 27 of them state-run. There are six provinces without any mental
health facilities, including nearby Banten, where large numbers of shackled
patients are still found.
The limited
options are considered inadequate to treat an estimated 800,000 people
suffering from chronic mental disorders. Another 20 million are struggling with
emotional problems and some 400,000 children experience various mental
illnesses.
“Under
regional autonomy laws, local governments should also be responsible for mental
health,” the Health Ministry’s Irmansyah said.
A New
Approach
It is clear
things have changed for the better at Soeharto Heerdjan.
In the old
days, the hospital would send officers patrolling the streets for
schizophrenics roaming around naked. Today, that task has been taken over by
the provincial social affairs agency, which only provides treatment after a
patient is given an evaluation at the hospital’s emergency room.
One
afternoon, the ER was busy handling patients it had just received from the
social affairs agency. Patients, their names written on their arms, waited
quietly in a hallway before getting a checkup and a free lunch.
Down a
different hallway, the hospital’s social outreach unit had gathered dozens of
patients and family members for therapy. They stretched their arms and legs in
a mental health exercise, following instructions from a psychiatrist.
Siti, 55,
was taking part.
Her son was
diagnosed as a schizophrenic seven years ago. He is undergoing free treatment
under Jakarta’s health care cost-sharing scheme (SKTM), although she has to
renew the qualification letter every 21 days.
“It’s
actually a burden for me to renew the letter every time it expires,” Siti said.
Although
the SKTM is free for the poor, she still has to deal with a bureaucracy she
considers “difficult” and transportation to and from the hospital is expensive.
“I want my
son to just stay here, and I can visit regularly. Every time I bring him home,
he creates problems for the family and my neighbors,” she said.
“That is
exactly why we have this regular meeting. So that the family realizes their
role as the primary support for schizophrenic patients,” said Safyuni, the
hospital’s head of social outreach.
“Our
society is so heavily burdened by the stigma of mental illness that we need to
struggle to promote family support, because they need to know that with regular
control and medication, schizophrenic patients can be treated,” Safyuni said.
It is a
message that does not sit well with Siti, who would like to have her son
institutionalized. “They should just turn mental hospitals into shopping malls
if they refuse to take patients,” she said in disappointment. “What is the use
of a hospital if they don’t want to treat patients?”
For all the
changes, it is clear there is still a long way to go, with or without that
banyan tree.
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