Almost half a million Indonesian people have schizophrenia, and thousands are kept confined. Consequently, their potential is left unfulfilled.
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CIANJUR, KOMPAS — The severe stigma against schizophrenia means that many people with the illness do not receive inadequate treatment. Apart from living as vagrants, thousands are kept bound or confined. As a result, their potential is not realized and they risk being left behind in Indonesia’s pusuit of the Sustainable Development Goals (SDGs).
The Basic Health Research 2018 shows that seven out of 1,000 Indonesian households have family members with schizophrenia, which means that 69 million households would have an estimated 480,000 schizophrenia sufferers. The exact number of schizophrenics on who are homeless or kept confined is unknown. The Health Ministry has recorded 57,000 schizophrenia sufferers who are kept in confinement (2014), but other sources put the total at 18,800. It has recorded 1.8 million displaced people with disabilities (2014), including schizophrenics.
Several homeless people with schizophrenia were spotted last week in the middle of the night on the roads of Sindangbarang, Cianjur regency, West Java. A man with unkempt hair and shabby clothes sat on a bench on a shop terrace. “My name is name. My home is to just walk on and on,” he replied when asked a question.
Afterwards, he sat on the curb. The man is believed to be homeless and a schizophrenia sufferer. His reply suggests a false belief or conviction that somebody is after him, or suspicions that somebody is going to hurt him.
According to Alok, 39, a fried rice vendor, the man had been in the area for several months. He doesn’t disturb the customers, but he frequently asks for cigarettes. It is likely that some people dumped him there from another area.
Aside from being homeless, some schizophrenia sufferers are kept in confinement. One of these is Elis, 38, who lives in Wargasari village, Kadupandak, Cianjur. He has been kept for one month in a bamboo-and-wood cage that measures 1.5 meters on each side, placed next to the house near a goat pen.
“This may be the best way. The important thing is that I clean and bathe him,” said Euis, Elis’ mother. He is being kept confined for fear that other people in the neighborhood might attack him, as Euis was once assaulted.
Apart from schizophrenia sufferers who are homeless or kept in confinement, some people with schizophrenia are being treated or are in rehabilitation programs at mental health hospitals and private institutions. Private institutions apply a variety of approaches, both clinical and non-clinical.
Istana Komunitas Sehat Jiwa (KSJ) in Cipanas, Cianjur, is a mental health rehabilitation center that provides clinical and non-clinical treatments. Mahendra has been on regular medication since his rehabilitation program at Istana KSJ early this year. His condition has improved relatively rapidly since policemen transported him to the center, naked, bound with rope and detained for attacking people. He falsely believed that the military had targeted him for termination, as they had implanted a chip in his brain that was being monitored by a satellite.
Mental health rehabilitation institutions that take a non-clinical approach are easier to find. “We heal with prayer and holy water. Medication isn’t provided, as we do not have any, nor do we have medical knowledge,” said Soleh Musyadad, an executive of the Bina Lestari Mandiri Foundation in Brebes.
Jami’in, who chairs the Penuh Warna Griya Cinta Kasih Foundation in Jombang, says that schizophrenia patients have a mental illness, so the foundation takes a psychological approach. “We don’t regard them as (physically) ill, so they are not medicated right away,” he said.
Medical issue
Schizophrenia is a mental disease, just like any other disease. Besides the biological factors that carry a risk of developing the disease, it is also affected by psychological and social factors.
Any excess in dopamine levels causes disruptions to the mind, emotions and behavior.
Psychiatrist Lahargo Kembaren of the Marzoeki Mahdi Mental Hospital in Bogor, who is also an executive of the Indonesian Psychiatrists Association, said that schizophrenics tended to have excessive levels of the hormone dopamine in their brains. If the dopamine level is too low, it poses a risk of developing Parkinson’s disease. “Any excess in dopamine levels causes disruptions to the mind, emotions and behavior,” he said.
Schizophrenia patients can recover through taking regular doses of medication, which alleviates symptoms of schizophrenia like delusions, hallucinations and behavioral disorders. They can also become productive. After they recover, schizophrenia patients must take the medication for life.
As schizophrenia is a biopsychosocial condition, medication alone isn’t enough. The psychological and social factors affecting the patients’ minds must be identified and addressed.
Istana KSJ founder Nurhamid Karnaatmaja said that the lack of medical understanding had caused schizophrenia to be regarded as a mystical disease stemming from a curse, spells and black magic. Consequently, many people had opted for non-medical measures.
The stigma of being “crazy” that follow schizophrenics had thus become strong. The stigma existed not just among the general public, but also among policymakers and even healthcare personnel.
Another problem in managing people with mental disorders, including those kept in confinement, was limited access to mental health services and professionals, said Fidiansyah, the Health Ministry’s director of mental health and narcotics prevention and management.
Not all provinces have mental health hospitals, while [sychiatrists and clinical psychologists are only found in major cities. Mental health services were not available at all puskemas (community health centers), either.
Schizophrenia patients need to be given greater attention ahead of World Mental Health Day 2019. Utilizing their potential is highly significant towards the demographic bonus and achieving the Sustainable Development Goals.