Stark naked and surrounded by people, a middle-aged Balinese woman begs for mercy in the courtyard of a ramshackle family compound in central Bali. Once she’s wrapped in a sarong, family members, the village chief, and NGO volunteers drag her to a communal area where she is pinned to the ground and injected with an anti-psychotic drug in her exposed buttock. She struggles until the drug takes effect and she is allowed to sit up and sob quietly on her niece’s lap.
“Today, I tried giving her an injection to make her more quiet,” explains Professor Luh Ketut Suryani, the founder and director of the Suryani Institute for Mental Health, a nonprofit organization dedicated to going door to door in Bali’s villages to uncover the full extent of the island’s mental health crisis. “We will follow up in two or three weeks, we will give an injection again, and after that we’ll try to interview her better [about] the problem.”
The woman is just one of the thousands of Indonesians deprived of accessible healthcare for their mental health issues. In Indonesia, there are many reasons why people suffering from mental illness go without treatment. Not only is mental health still a taboo—nationwide, there’s a lack of mental healthcare professionals and facilities. There’s also an issue of poverty, the high cost of long-term healthcare, and in some parts of the country, a skepticism of Western medical practices. Many families see little choice but to disown their mentally ill family members or lock them away in their homes, in chains, when all else fails.
The practice, known as pasung, was outlawed in 1977, though it has continued throughout the archipelago, where approximately 18,800 mentally ill Indonesians are still living their lives in chains, according to a 2016 report by Human Rights Watch. And in Bali, this practice is alive and well too.
“We have [found] many patients in chains,” Suryani tells me.
With mental health professionals forbidden by law from making house calls, the full scale of the problem remains a mystery and a solution is still a long way off. Despite the law, Suryani and her team regularly visit to Bali’s villages, relying on tips from concerned community members to point them in the direction of people suffering from mental illness who may have been mistreated by their own families.
“People here think that ‘crazy people’ are a normal thing so they don’t help,” explains Made Sukabawa, a taxi driver and a Suryani Institute volunteer. “They hide the patient at home, and the government never checks deep in the villages, door to door, like we do.”
Without government support and minimal public donations, the organization is having a difficulty taking care of their patients. In 2009, the organization was granted Rp 1 billion ($71,982 USD) by Bali Governor Mangku Pastika, explains Rudi Waiswana, a photographer and volunteer for the institute. But he withdrew 90 percent of the funding the following year, he says.
“Could you imagine? All the money, gone?” says Suryani. “I cannot help patients. After six months all my patient [relapsed], so you can imagine how I’m very, very frustrated.”
The institute is now mostly funded by Suryani herself, her husband, and her husband’s brother, with small donations trickling in from overseas from time to time.
Founded in 2005 in response to the deepening mental health crisis, Suryani employs a unique “sociocultural approach” in treating patients, combining traditional, conventional, and even shamanistic medical practices.
Suryani’s plan is to provide families, along with the mentally ill, with a checklist of symptoms as well as a phone number to call if a patient’s condition deteriorates.
“I teach the patient the early symptoms if they relapse, [like] difficulties sleeping, maybe bad dreams, laziness, and so on,” she says. “And if the patient has symptoms like that, please contact me and we will give an injection. After that I also ask the patient to continue to get purification if the healer asks them. If they have good education maybe I’ll teach them meditation.”
Suryani began her career as a professor of psychiatry at Bali’s Udayana University. Since beginning her under-funded, DIY approach to treating mental illness, however, she has been belittled by senior figures in the psychiatric and pharmaceutical industries who claim she is little more than a new age shaman.
“A senior professor of psychiatry told me, ‘You are not a psychiatrist, you are not a scientist, you are just a healer,” she tells me. “I said it depends on how you see this situation… My patients are not you psychiatrists, my patients are my people, they trust me. It's no problem [whether] you agree or not.”
In order to get access to the mentally ill, the organization is often required to donate food, hygiene products, and sometimes money to families. During a house visit, Suryani and her crew (myself included) find a man held in filthy conditions in a bamboo outhouse. After Suryani interviews him, the volunteers give him a complete makeover. They hack off his matted dreadlocks and leave him with a host of hygiene products. Before moving on, we posed with him for a group photograph. The photographs also features a patient who suffers chronic depression, who had barely left his family’s compound in ten years until Suryani intervened. This transparent and communal approach goes right to the heart of the institute’s vision, says Suryani.
“[We] make the patients like our family, so we will relax and not be distant,” she says. “This can also quickly make the patient recover, like you see today. Who could imagine he could leave the house? And all the neighbors were surprised because for a long time he was at home.”
In 2014, Indonesia introduced so-called “universal” healthcare for its impoverished citizens, including a Mental Health Law designed to provide support for families struggling to care for members in their family who are suffering with mental health issues. It’s a groundbreaking development—on the surface. But Suryani says that it has fallen short of providing real solutions.
“In theory it is good,” she says. “In reality, who wants to do [what] I do? It’s difficult to do but if government give a lot of money maybe they will follow it.”
Today, Indonesia only has 48 mental health hospitals, all of them concentrated in eight of the country's 34 provinces. There are only somewhere between 600 to 800 trained psychiatrists nationwide, the majority working in the island of Java. One expert says that the country needs at least 2,400 more psychiatrists to be able to serve the population.
In 2014, the Suryani Institute of Mental Health hosted a photography exhibition about mental health patients that featured the work of several photographers including Rudi. He said that after viewing the photographs, the governor of Bali thanked the organization for “throwing shit” in his face.
“He was angry,” Rudi tells me. “People think Bali is paradise and [full of] people with high culture who are very polite and friendly. But behind the tourism of Bali we have a very chronic problem about the mental illness. I think the government was sad to see the real facts.”