Treating the untreated: applying a community-based, culturally sensitive psychiatric intervention to confined and physically restrained mentally ill individuals in Bali, Indonesia

Abstract

This study identified, mapped and treated the clinical features of mentally ill people, who had been isolated and restrained by family and community members as a result of a functional failure of the traditional medical, hospital-based mental health model currently practiced in Indonesia. A 10-month epidemiological population survey was carried out in Karangasem regency of Bali, Indonesia. A total of 404,591 individuals were clinically interviewed, of which 895 individuals with mental health problems were identified, with 23 satisfying criteria of physical restraint and confinement. Of the latter, twenty were males; age range was 19-69 years, all diagnosed by the researchers with schizophrenia-spectrum disorder (ICD-10 diagnostic criteria). Duration of restraint ranged from 3 months to 30 years (mean = 8.1 years, SD = 8.3 years). Through the application of a holistic intervention model, all patients exhibited a remarkable recovery within 19 months of treatment. We conclude that the development of a community-based, culturally sensitive and respectful mental health model can serve as an optimum promoter of positive mental health outcomes.

“I cry every day and night, I have my son tied in chains”: physical restraint of people with schizophrenia in community settings in Ethiopia

“…With one exception, participants in this study experienced or discussed restraint in the family home. The core drivers of restraint reported by participants accorded with the findings of most previous studies that considered community settings [6, 15, 16, 19, 40, 41]. Conceptualising restraint as a component of care, in settings with few formal mental health services and in particular lack of access to anti-psychotic medication, has been emphasised previously in studies from Ghana [6] and India [40], as well in the context of Ethiopia [22].…”

“…This study is one of only a small number of reports [15, 19, 40, 41] that focus on restraint of individuals with mental disorders in private community settings in LMIC, rather than wholly or partly on traditional or spiritual healing centres [6, 16, 23] or mental health institutions [18, 20]. With one exception, participants in this study experienced or discussed restraint in the family home.…”

“…Conceptualising restraint as a component of care, in settings with few formal mental health services and in particular lack of access to anti-psychotic medication, has been emphasised previously in studies from Ghana [6] and India [40], as well in the context of Ethiopia [22]. The perceived risk of violence posed by people with severe mental illness and a desire to protect the welfare of the individual were familiar themes [6, 15, 16, 19, 41], along with the specific issue of transporting individuals to health facilities [6, 16]. Read et al have also described the relevance to restraint of emotional and financial burden on caregivers [6].…”

Effect of an expansion in private sector provision of contraceptive supplies on horizontal inequity in modern contraceptive use: evidence from Africa and Asia

“…The explanation for why the private commercial share increased in the study countries is not entirely clear. In Nigeria and Uganda, and Indonesia the increase may have been the result of both an explicit programmatic strategy to socially market contraceptive supplies, as well as a fluctuating public sector support for family planning due to political and macro-economic forces [10-17]. In Bangladesh, the increase may have been the result of the government's strategy to increase the role of private sector [18,19].…”

Use of coercive measures in mental health practice and its impact on outcome: a critical review

“…The vast majority of reviewed studies have been carried out in Western countries, and only a few trials have been conducted in developing countries such as Brazil [29] and Indonesia [72]. However, what emerges is that the practice of coercion No significant differences were found in terms of level of psychopathology and functioning between voluntarily and involuntarily admitted patients at followup [43] Iversen et al…”