How Indonesia's mentally-ill are shackled and forgotten
More than 15,000 Indonesian psychiatric patients are kept in primitive conditions, but a Bali doctor has pioneered more humane treatments
Between rice fields and coconut trees on Indonesia's "paradise" island of Bali, a man lies chained by the ankles to a rotting wooden bed in a garden, staring at roosters tottering by.
I Ketut Lingga, 54, has schizophrenia and is one of more than 15,000 Indonesians with a mental illness who are either chained, caged or placed in primitive stocks, according to health ministry data.
They are known as pasung - which loosely translates to "shackled" - and are considered lost causes.
Lingga's family shackled him 30 years ago, and he has never been unchained since. When he is relaxed, he rarely moves or speaks, but during an episode, his family fears him.
"He attacked me one day, so we had no choice but to chain him up," Lingga's sister-in-law, Wayan Reti, 50, said at her home in eastern Bali's Karangasem district. He ripped off my clothes and tried to strangle me, and he's been shackled ever since. What else could we do?"
While in his early 20s, Lingga began threatening to kill or beat people. He was taken for just three visits to the mental hospital, where he was given medication but no counselling. After that his family could no longer pay the US$15 fee for each visit.
Some 50 pasung exist in Karangasem alone, according to psychiatrist Dr Luh Ketut Suryani, who discovered the extent of the problem early last decade while researching suicide rates.
Suryani identified 895 people in Karangasem with mental disorders. But with her thin resources already stretched, she is unable to treat them all.
Helped by her son, who is also a psychiatrist, and three paid volunteers, she treats and monitors almost 700 patients with anti-psychotic drug injections, counselling and meditation.
She has also used singing, which she said helps patients to relax and focus. The Bali government in 2009 granted Suryani more than US$500,000 to keep up her work, but that money was cut after complaints about her meditation and singing sessions.
"We include meditation because it's the Balinese Hindu belief, and using a method patients believe in means they accept us into the community. It helps them heal emotionally," she said.
Suryani claimed a success rate of 31 per cent, defining success as a patient no longer needing medication. Only three per cent have shown no improvement.
A health ministry survey in 2007 showed that 11.6 per cent, or more than 27 million Indonesians, have some kind of mental or emotional disorder, while around a million have psychotic or serious mental illnesses. Less than five per cent are treated.
"Many disagree with my methods, but these people are the forgotten. If not us, who will help them?" she said.