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