Community Based Pasung Release on Schizophrenia

Open Access Macedonian Journal of Medical Sciences

BACKGROUND: Pasung is an act using a block of wood on someone’s hands and/or feet, tied or chained, exiled in a separate place in the house or in the forest. Mental disorders are still a serious mental health problem in Indonesia. There are still many schizophrenics who do not receive medical treatment or who drop out of medical treatment and eventually put in a Pasung. CASE REPORT: We found several cases of patients with schizophrenia who were incarcerated, men aged 43 years and 40 years. They were diagnosed with schizophrenia with different characteristics of the disorder, different treatments, and in the end the Pasung became the last alternative completed by the family. CONCLUSION: Ignorance of the family and surrounding community over the early detection and forced treatment at the Mental Hospital (asylum), causing patients not handled properly. It is only culturally known by the family to handle it, Pasung that is to prevent people with severe mental disorders from endangering...

BMC Psychiatry

Background: Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. Methods: A case-control study was conducted in Bogor Regency from May-June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012-16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. Results: A total of 114 case and 136 control subjects were studied. Patient's aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52-8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09-6.9) and informal employment (AdjOR: 2.5, 95%CI: 1. 1-5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43-4.43) were associated with pasung. Patient's aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. Conclusions: Patient's aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.

International Journal of Mental Health Systems

Background: The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung. Objective: To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017. Methods: This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation. Results: Family members and society in general perceived that pasung is necessary for security reasons due to the patient's aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient's request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community. Conclusion: Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.

International Journal of Mental Health Systems, 2008

Background: Physical restraint and confinement (pasung) by families of people with mental illness is known to occur in many parts of the world but has attracted limited investigation. This preliminary observational study was carried out on Samosir Island in Sumatra, Indonesia, to investigate the nature of such restraint and confinement, the clinical characteristics of people restrained, and the reasons given by families and communities for applying such restraint.

Jurnal Psikiatri Surabaya

sIntroductions: Schizophrenia is a long-term, severe mental disorder involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. Methods: The treatment of schizophrenia requires a holistic approach such as psychopharmacology therapy and psychosocial rehabilitation. The combined treatment has some advantages compared to medication alone. Assertive Community Treatment is one of the psychosocial rehabilitation. It is a healthcare program with multidisciplinary approaches and team members. Results: They have got to work as a team to provide intensive care to patients with severe mental disorders. They serve to treat the patient holistically in the patient’s environment rather than in the hospital. Conclusions: Some studies showed that Assertive Community treatment could reduce hospitalizatio...

International Journal of Nursing and Health Services (IJNHS)

Physical restraint and confinement (pasung) by families of people with mental illness is known to occur in many parts of the world Pasung is a common human right violation on people with mental illness found on every country in the world especially in developing countries like Indonesia. In Indonesia the term pasung refers to the physical restraint or confinement of "criminals, crazy and dangerously aggressive people. Despite the classification as Human Right Violation, pasung is constantly performed in Indonesia. In 2018, around 18% people with mental ilness experienced pasung. This study aimed to identify factors related to pasung. The researcher conduct the literature review on the credible sources. Five databases were used including Science Direct, Proquest, Scopus, Ebsco, and Google Scholar. Study result identified that factors related to pasung come from person with mental illness, family and community. The pasung phenomena within the community on people with mental ill...

International Journal of Mental Health Systems, 2011

Background: Physical restraint and confinement of the mentally ill (called pasung in Indonesia) is common in Aceh. In early 2010, the local government initiated a program called Aceh Free Pasung 2010. The main goal of the program is to release the mentally ill in the province from restraint and to provide appropriate medical treatment and care.

Proceedings of the Third International Conference on Sustainable Innovation 2019 – Health Science and Nursing (IcoSIHSN 2019), 2019

Background. Pasung (physical restraint) in people with mental illness is commonly found in Lamongan. In 2014, Lamongan Government launched the 2017 Lamongan Free from Pasung program based on Community Mental Health Nursing (CMHN). The aim of this program was to free all patients in pasung throughout Lamongan. The purpose of this study was to describe the evaluation results of Free from Pasung program in Lamongan. Methods. This study used a descriptive design with a retrospective observation carried out on all patients in pasung in Lamongan Community Health Center during 2014-2017. Results. The number of mental illness patients in 2014-2017 was 3002 patients, 186 (6.2 %) were in pasung, consisting of 127 men (68.3%) and 59 women (31.7 %). At the end of 2017, all patients in pasung had been released. Discussions. The community-based 2017 Lamongan Free from Pasung program is a very important program and has been proven to be successful in releasing all patients in Pasung. Conclusions. This program should be carried out continuously to evaluate the possibility of re-pasung cases and early detection of new pasung cases so that interventions can be carried out as early as possible.

2010

Background: Although various pharmacological treatments are available for persons suffering with positive psychotic symptoms, symptoms often continue to occur even when medications are taken. Traditional psychosocial methods such as family therapy and cognitive-behavioral alleviate symptoms in this population, but interventions are often lengthy and difficult. Furthermore, directly targeting the reduction of psychotic symptoms could produce paradoxical effects; acceptance, cognitive defusion, and valued action could therefore serve as valuable coping methods. At the level of process, ACT is characterized by a rapid reduction in the believability of negative thoughts or the unacceptability of negative feelings, even if these thoughts and feelings continue at some frequency and thus seems well suited for addressing chronic problems. Aim: The present study intended to study the impact of brief protocol based on principles of Acceptance and Commitment Therapy (ACT) on patients with Chronic Schizophrenia. Method: 60 patients suffering from Schizophrenia for at least 2 years, were selected through purposive sampling from Central Institute of Psychiatry, Ranchi. Out of them, 30 each were randomly allotted to the experimental group (receiving ACT+TAU), and control group (Treatment As usual-TAU). All participants were assessed on Ryff Psychological Wellbeing Scale, Acceptance and Action Questionnaire 2, at 3 points in time: Before intervention, at time of discharge and at 1 month follow up. Results: The results show a significant intervention effect on the psychological well being of the patients, and in the process variable of psychological flexibility. Conclusion: ACT may provide an alternative mode of managing distress faced by people with Schizophrenia, facilitate coping with symptoms and may also be given in booster sessions after discharge.