Der Spiegel, Germany reveals the mentally ill people chained up in Bali

Before Luh Ketut Suryani leaves paradise, she applies lipstick in the rearview mirror of her SUV. Suryani wants to look good when she encounters the horrors of the day. On this particular morning, she selects a deep red color. Then she takes her iPad from the passenger seat and spends a few minutes in preparation. Calmly moving her fingers across the screen, she reviews the medical histories of her patients, including their names, how long they have been kept locked up, and their diagnoses. Some of the case histories are 30 pages long, an attempt at order in the face of madness.

“Many don’t know what is wrong with their mentally ill family member, or why he or she began to change”, explained Professor Luh Ketut Suryani to Katrin Kuntz from Der Spiegel, Germany as she and Christian Werner as the photographer following Suryani’s works in community. Every year, three million tourists visit the island, where they go surfing and diving, get massages during the day and party in the clubs at night. Tourists come to Bali to unwind, oblivious to those locked up in chains because they are mentally ill, only a few hours’ drive from the island’s resorts. Witnessing the mentally ill in chains, in the island of paradise, was so horrified. “We will try our best to reveals how the mentally ill are kept in chained up on Bali”, promise Katrin with tears.



“Society only takes notice of the mentally ill when they become a problem. As soon as they improve, the families forget to administer the drugs”, said Suryani. She could call the police whenever she finds people in chains. Pasung is illegal in Indonesia. The government has adopted a program that aims to eliminate pasung by 2014, but Suryani finds the  plan laughable. And she doesn’t notify the police, either. “Where exactly are the police supposed to take the patients?” she asks. Bali has only one government-run psychiatric hospital, in Bangli in the middle of the island.The Bangli psychiatric hospital resembles a prison, and yet it is one of the better facilities in Indonesia, especially as there are no chains.

Finding the Hidden One in Paradise

Some severely mentally ill men and women are chained and secluded in their own homes in small dark rooms or metal cages for up to 30 years duration in the fabulously beautiful and spiritual island of Bali, Indonesia. They are hidden from family, villagers, and are unknown to mental health workers at community health centers.

“They are not given any sustained treatment with antipsychotic medications that could relieve their symptoms to the extent they would no longer need to be chained up and be confined in inhuman conditions” said Professor Luh Ketut Suryani as the leading psychiatrist in the island who regularly seeking for the Hidden One. No doctors see them, and most do not even know they exist. “Psychiatrists and government mental health workers deny there are any untreated severely mentally ill in all of Bali”, add Dr Cokorda Bagus Jaya Lesmana as the secretary of the Suryani Institute.



“There are 300 more patients are still hidden in the community without any treatment”, said Professor Suryani as she wish Bali’s government will willing to take a step in helping the mentally ill patients in community. The patient in confinement may live in unreal conditions. There is likely to be feces on the floor, and they sleep on a concrete floor, usually without a bed or blanket. There is no running water, and no toilet in the room or cage.  Food may be given only once a day. A contrast situation in an island with glamor tourism industry.

Balancing Mind, Body and Spirit in ACSR 2013

Asia has the largest population in the world, and the region is expected to continue developing both on an economic and academic level. In recent decades, there has been a considerable advancement in the study of schizophrenia,although there are still many aspects that have not been revealed.

Members of the Suryani Institute for Mental Health had the chance to present the clinical approach of Spiritual-Hypnosis Assisted Therapy (SHAT) in the 3rd Asian Congress on Schizophrenia Research (ACSR) join with the 2nd Biological Psychiatry and Psychopharmacology National Symposium. This event were held on 14 – 16 February 2013 at Sanur Paradise Plaza Hotel, Bali, Indonesia. This approach was developed by Professor Suryani had been successfully utilize in Bali for the past 10 years for the treatment of psychosis spectrum disorders. More specifically in this workshop will cover Epidemiological survey findings of schizophrenia prevalence in Bali, A culturally sensitive community based intervention for the treatment of schizophrenia, Introduction to the practice of Spiritual-Hypnosis Assisted Therapy (SHAT), and a demonstration of the approach.

ACSR 2013
(Left to Right): Dr Lesmana, Professor Suryani, Dr Basudewa, Dr Tiliopoulos

Improving quality and human rights in mental health with community-based setting

All over the world, people with mental illness are subject to poor-quality care and violations of their human rights. Mental health services in Bali and in Indonesia fail to integrate evidence-based treatment and practices, resulting in poor recovery outcomes. The stigma associated with these conditions means that people experience exclusion, rejection and marginalization by society.

“It is critical to improve quality of human rights in order to change this situation”, said Professor Luh Ketut Suryani during her regular visit to her catchment area of community mental health services in Abang, Karangasem. A comprehensive and regular visit can help to identify problems in existing mental health care practices and to plan effective means to ensure that the services are of good quality, respectful of human rights, responsive to the users’ requirements and promote the users’ autonomy, dignity and right to self-determination, add Dr Cokorda Lesmana as the secretary of the institute.

Manggis 2013

Manggis 2013 02

“We need to modify the old system of mental health that only want to use hospital based intervention”, explain Professor Suryani with hope that the government of Indonesia and Bali willing to take the risk for changes. The situation in inpatient facilities is often far worse: people may be locked away for weeks, months and sometimes years in psychiatric hospitals or social care homes, where they experience terrible living conditions and are subject to dehumanizing, degrading treatment, including violence and abuse. “It’s time to make a change”, said Dr Lesmana as he hopes that the lives of people with mental illness in Bali will have a better quality when the integrated and community-based intervention put on works.