Stigma hampers treatment of mental health care
Stigma hampers treatment of mental health care
Emmy Fitri, The Jakarta Post, Jakarta
For the sake of their work, writers, journalists and filmmakers
have a tendency of oversimplifying their stories at the risk of
nurturing a prejudiced attitude in their audience.
For example, Milos Forman's 1975 work One Flew Over the
Cuckoo's Nest had a lasting impression on many, creating --
through its story of a sane man living in a hospital's mental
ward -- a standardized picture of people with mental or
behavioral disorders.
Local film Beth is also preoccupied with the horrors of mental
institutions.
Psychiatrist from the University of Indonesia (UI) Irhamsyah
said that both films and television dramas here showed people who
had mental disorders as being psychopathic or deranged.
Mental institutions are depicted as messy, dirty and
frightening and the patients characterized as wicked, emotional
and weird.
But the products of the entertainment industry are just one of
the perpetrators in stigmatizing people with mental disorders.
Irhamsyah cited media and even health officials as contributing
to this branding process.
"Because of the perpetual stigma, members of their family and
of society see people with mental disorders as disgraces or a
waste of space -- it's an issue that has become for them off-
limits,
"Mental disorders are diseases just like any other," said
Irhamsyah who attended Harvard Medical School's Fogarty Research
International Training Program in 2002.
The World Health Organization has alerted the world to the
seriousness of mental disorders. In its 2001 report, WHO recorded
that there were 450 million people with mental health problems
worldwide.
"Yet, we still see (mentally disturbed) patients are isolated,
and in remote village they are not treated but are locked up in
the backyard," he said.
Irhamsyah's colleague Suryo Dharmono gave, as an example, the
way in which traditional healer Abah Obos treated mentally ill
patients. The story was featured in a recent program aired by
Metro TV.
Abah Obos taught his patients to pray and to do exercises.
Besides drinking traditional herbal concoctions, the patients
were also regularly massaged.
However, the footage of the patients' living quarters had real
shock value.
"In some corners of the room, patients' legs were locked
between two pieces of wood," Suryo said.
Here "sane" people have often violated the rights of the
mentally ill, he added.
Some commonwealth countries have put in place the Mental
Health Act, which functions as a shield for people with mental
disturbances. The act protects the patients from involuntary
admission. A health agency also regularly checks the admitted
patients.
"But here families can just abandon their sick members in
mental hospital for years without even bothering to visit," said
Suryo.
A 2004 survey by The Indonesian Psychiatric Epidemiologic
Network in 11 cities in the country said that 18.5 percent of
adult residents had mental problems. Besides genetic factors,
other causes of mental disorders in the country were not
identified by the network in its survey.
But a study conducted by the mental health directorate general
of the health ministry in 2000 showed drug abuse (44 percent),
mental disabilities (34.9 percent), mental dysfunction (16.2
percent) and mental disintegration (5.8 percent) as the causes of
mental health problems.
Irhamsyah said the Cipto Mangunkusumo Hospital working with
psychiatrists from the UI had set up an early intervention
program for people with serious mental disorders like
schizophrenic patients.
"Medicine plays an important role but other things like
family intervention, psychotherapy for individuals and groups and
rehabilitation programs are also worthwhile," Irhamsyah said.
Irhamsyah and Suryo said the time was ripe for the country to
make a strong mental health law, separate from Law No 23/1992 on
Health.
"There are four articles dedicated to mental health in the No
23/1992 health law and the last article stipulates that the
details and implementation of the law will be carried out under a
government regulation. But so far, no regulation has been issued.
So, what's the point of waiting for a regulation if it takes the
same length of time for us to pass a law on mental health,"
Irhamsyah said.
Cliched but true, the health ministry only allocates one
percent of its budget for mental health care, which makes it
difficult to act or even to do research.
"In general, our resources are far from adequate. Beds for
mentally disturbed patients are only available at a ratio of 0.4
to 10,000 people," Irhamsyah said. The same goes for the demand
for psychiatrists with a ratio of one psychiatrist to 500,000
people.
"It's no wonder that so many mentally ill people are out of
reach and on the streets," Irhamsyah said.
The Indonesian Psychiatrists Association, along with related
institutions like the UI, is now at the stage of compiling an
academic paper -- which will double as the draft of the mental
health bill.
In the meantime, socialization and public education on the
urgency of changing attitudes toward the mentally ill are being
carried out with the help of Wyeth Indonesia and public relations
company Euginia Communication.
Irhamsyah and Suryo, as well as other psychiatrists, hope that
films like A Beautiful Mind, Ordinary People and the series Monk
will continue to be produced, showing the public that every
person, regardless of their mental health, is in need of respect
and compassion.
Some examples of serious and common mental illnesses
- Serious mental illnesses
-- Psychosis (schizophrenia)
-- Manic depression
- Common mental illnesses
-- Anxiety
-- Depression
Serious mental illnesses are difficult to understand for ordinary
people (e.g. hearing voices, having odd ideas)
Common mental illnesses are often like an experience we have had
ourselves (e.g. fear or depression)
Source: The Indonesian University's Medical School