Students for Global Health UCL
Pasung: Is chaining the answer?
"All persons with a mental illness... shall be treated with humanity and respect for the inherent dignity of the human person.” UN Resolution 46/119
Pasung: physical constraint and confinement of people with mental illness. This practice occurs in many parts of the world, particularly in resource limited settings. Despite being banned in Indonesia in 1977, Pasung continues today even in the face of strong social and political activism, with an estimated 57,000 people living in shackles in the country in 2013.
Whilst the principles of ‘Pasung' are almost impossible to comprehend coming from a Western background of healthcare, it would be naive to suggest that this abuse of human rights is a product of the ignorance of families and communities. The fact that the practice continues is more attributable to neglect from governments to provide basic mental health services, which gives the families of those with mental illness no alternative but to use forms of restraint not only to protect the ill person themselves but also to prevent harm to others.
Nevertheless little protest about the use of shackles and other forms of maltreatment is from the communities themselves. This lack of resistance could be down to the fact that the practice is so engrained within sociocultural meaning or perhaps due to the lack of knowledge of a feasible alternative. Yet this is changing. In 2010, the Indonesian government recognised the issue and launched a campaign to end the practice of Pasung.
What is the answer to achieving its elimination? Well, it is evident that the only way to bring an end to Pasung is to provide a viable alternative. Through the provision of sustainable treatment and access to mental hospitals, this seemingly unattainable goal can be achieved. But this is not just the responsibility of the government. Everyone including policy makers, health service provides and families must work together to make sure the new law is implemented. Only through a united approach to tackling this issue can the practice of Pasung be brought to an end. It might be a last resort for treatment now but if the underlying causes of this practice are tackled appropriately, equitable access to basic mental health services could be a reality for all.