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New documentary explores Indonesian practice "pasung"
Across the world, poor, uneducated families with little or no access to health care physically restrain relatives with a mental illness.

In Indonesia, the practice is known as pasung.

But the Indonesian government is the first among any low to middle-income country that's committed to eradicating the practice.

A new, confronting documentary called 'Breaking the Chains' explores pasung and the efforts of social activists to stop it.

Kate Arnott reports.
(Excerpt from Breaking the Chains plays)

ASS. PROF. HARRY MINAS, CENTRE FOR INTERNATIONAL HEALTH, MELBOURNE UNIVERSITY: The individual who is subjected to this kind of thing, it's shocking. In very many cases, it's an expression of the family's love towards the person that they want to protect them and so on, but this is not the best way to do it.

BEN RINAUDO, MENTAL ILLNESS SUPPORT WORKER: If I'd experienced mental ill-health in another country, I probably would have been chained or shackled or put in a pit myself.

(Footage from Breaking the Chains plays)

KATE ARNOTT, REPORTER: Breaking the Chains is a documentary filmed in a rice growing region around Cianjur, a city in Indonesia's West Java province. It follows a team of health workers and volunteers whose aim is to find, treat, and eventually free victims of pasung.

DR ERMINIA COLUCCI, FILMMAKER AND MENTAL HEALTH RESEARCHER: Pasung is an Indonesian term. It indicates the physical confinement of people with mental illness. Pasung takes different forms. More typically it is the chaining or the caging of people inside like a small room or even like animal cages in some cases.

(Footage of Yayah from Breaking the Chains plays)

KATE ARNOTT: When the team first came across Yayah she had been locked and chained in this room for nearly 17 years.

Her family believed she'd been possessed by evil spirits. She had in fact been diagnosed as a chronic schizophrenic by a psychiatrist.

DR ERMINIA COLUCCI: The family were in so much pain. They were not doing this because they were bad people or they were mean, they didn't love the person. They actually were doing it because they loved the person and they didn't have a better way to deal with it.

ASS. PROF. HARRY MINAS: These are people almost invariably who are extremely poor. They're people who, many of whom are illiterate. Many of whom have very little understanding about health and illness, particularly mental disorders, mental illnesses, and who are doing the best they can.

KATE ARNOTT: Psychiatrist Harry Minas realised the scale of the problem when he visited Aceh after the 2004 tsunami and earthquake. It became quickly apparent to him the practice of pasung was widespread in Indonesia.

He says the most basic treatment, care, and support for people with serious mental illnesses in many parts of the country is virtually non existent.

(Photographs of Ass Prof Harry Minas in Indonesia are shown)

ASS. PROF. HARRY MINAS: The total number of psychiatrists in Indonesia is about 600. That's a population for about 240 million people. By comparison, the total number of psychiatrists in Australia for less than a tenth of the population is probably about 2,500.

(Photographs of Dr Erminia Colucci in Indonesia are shown)

KATE ARNOTT: Harry Minas provides guidance and support to his colleague Dr Erminia Colucci who spent a month and a half filming Breaking the Chains last year.

She sought permission from every family to document their story and their openness took her by surprise.

(Footage from Breaking the Chains plays)

DR ERMINIA COLUCCI: Actually the problem people coming while I was filming and dragging me and saying 'can you come, my brother, my sister, my neighbour is also chained, also in a cage.'
They wanted me to actually go and film their story, sharing also what was happening to them.

(Footage from Breaking the Chains plays)

KATE ARNOTT: Eman was locked in this wooden cage two years ago. His family says he was damaging houses in the area.

(Excerpt from Breaking the Chains plays)

MENTAL HEALTH WORKER (subtitled): What efforts have you tried so far to get him better? Any treatment?

EMAN'S RELATIVE (subtitled): We took him to the village to see a tabib (traditional medicine-man).


EMAN'S RELATIVE: Tabib. And nothing.

MENTAL HEALTH WORKER (subtitled): There was no result?


(Excerpt ends)

ASS. PROF. HARRY MINAS: Many people who have a range of different spiritual beliefs can continue to do the sorts of things that their beliefs require, but at the same time they can understand that somebody with an acute psychotic illness will benefit from being treated with medicines, for instance.

KATE ARNOTT: And that's why educating families is such an important part of the work of mental health teams on their home visits.

(Footage from Breaking the Chains plays)

MENTAL HEALTH WORKER (subtitled): You've to do two things. First, you have to him the medicine. Give it to him. Second, your job is to love him.

KATE ARNOTT: Australian Ben Rinaudo said he closely identifies with many of the issues raised in Breaking the Chains.

BEN RINAUDO: I'm really passionate about engaging in advocacy and addressing human rights violations amongst people with mental ill-health, as I personally have experienced mental illness myself. I have a diagnosis of schizo effective disorder.

KATE ARNOTT: Because of his background and work in international community development he helped to fund the documentary.

BEN RINDAUDO: I just can't imagine what it would have been like for me if I had experienced this in another country. I was very fortunate to have access to effective and affordable treatments.

KATE ARNOTT: Three years ago, the Indonesian government established its Free From Pasung Program, which includes advocacy of human rights, education of mental illness and training mental health professionals. In that time, about 4,500 people have been freed from pasung.

ASS. PROF. HARRY MINAS: The clear commitment of the ministry of health is that this practice will be eliminated from Indonesia.

(Excerpt from Breaking the Chains plays -Yayah's chains are sawn off)

KATE ARNOTT: Support for Yayah and her family certainly paid off.

MENTAL HEALTH WORKER (subtitled): I'm free. Say it, I'm free!

(Excerpt ends)

DR ERMINIA COLUCCI: She's talking a bit more. She's helping more in the family life which is fantastic.

ASS. PROF. HARRY MINAS: I think what the documentary provides a really clear insight into this is the terrible circumstances that people who are restrained are in. But it also shows, with real clarity, the level of commitment from community organisations, from volunteers, from local health authorities to do something about this.
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