Socio Today
The Ministry of Health of the Republic of Indonesia has reported that more than 2,000 individuals across the archipelago continue to suffer from the inhumane practice of physical restraint, commonly known as pasung, due to severe mental health conditions. According to the ministry’s official data compiled during the third quarter of 2026, a total of 2,365 people remain subjected to chains, wooden stocks, or confinement in enclosed spaces because of severe psychiatric disorders, including acute psychosis and schizophrenia.
This persistent human rights crisis highlights deep-seated structural challenges within the national healthcare system, social stigma, and administrative disenfranchisement. While the Indonesian government has implemented various programs to eradicate the practice, the data underscores a critical gap between policy intentions and grassroots realities. Public health experts, government officials, and human rights advocates emphasize that resolving this issue requires a comprehensive, multi-sectoral approach encompassing medical intervention, community education, and rigorous administrative protection for vulnerable citizens.
The Scale of the Crisis and Ministerial Response
During a media briefing held in South Jakarta, Dr. Imran Pambudi, Director of Vulnerable Group Health Services at the Indonesian Ministry of Health, addressed the alarming statistics. He asserted that the continuation of pasung is not merely a healthcare failure, but a severe violation of fundamental human rights.
"This involves individuals suffering from psychotic conditions or schizophrenia, and they are the ones we need to liberate," Dr. Pambudi told reporters. "Because this concerns not only health, but also human rights."
Dr. Pambudi detailed the ongoing efforts by the Ministry of Health to combat the practice, noting that the government is aggressively pursuing proactive identification and release operations. As part of these incentives, the ministry has introduced a recognition framework—awarding regencies and cities that successfully achieve and maintain a "free pasung" ( bebas pasung) status. By incentivizing local governments, the central administration hopes to foster grassroots accountability and encourage regional leaders to prioritize mental health infrastructure.
Despite these measures, thousands of individuals remain hidden within households, often secluded by families who lack the financial resources, psychological support, or education required to manage severe psychiatric episodes. The stigma associated with mental illness frequently drives families to resort to confinement as a desperate, albeit harmful, method of maintaining public safety or preventing patients from wandering off.
The Intersecting Crisis of Civil Documentation and Marginalization
The complexity of addressing pasung extends far beyond physical liberation. According to Dr. dr. Hervita Diatri, SpKJ, SubspKom(K), a prominent psychiatrist and Chair of the Division of Community Psychiatry, Rehabilitation, and Psychosocial Trauma at the Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital (FKUI-RSCM), the practice of confinement frequently triggers a cascade of administrative invisibility.
Dr. Hervita highlighted that individuals subjected to long-term confinement often lose their legal identity. In many cases, families fail to update civil registries, omit the confined individual from family registry cards (Kartu Keluarga), or neglect to secure national identity cards (KTP) for them.
"I sometimes find that in households where a family member is confined, that person effectively ceases to exist within the household’s administrative records," Dr. Hervita explained. "When addressing whether the individual is listed on the family card, the family might casually remark that the person does not need a KTP because they are chained anyway, implying they have no use for it."
This administrative erasure strips victims of their legal personhood. Without official identification documents, these individuals are entirely locked out of the social safety net. They cannot access the National Health Insurance scheme (JKN-BPJS Kesehatan), social assistance programs, or subsidized medical treatments. Consequently, even if physical chains are removed, the lack of documentation perpetuates a cycle of marginalization that hinders sustained psychiatric care and social reintegration.
Background Context and the Historical Struggle Against Pasung
The practice of pasung has deep historical and cultural roots in Indonesia, driven by a combination of widespread superstition, limited public psychiatric facilities, and catastrophic shortages of mental health professionals. For decades, traditional and spiritual explanations for mental illness often preceded medical diagnoses, leading families to seek alternative, non-clinical methods of restraint.
In 2014, the Indonesian government officially launched the nationwide "Indonesia Bebas Pasung" (Free Pasung Indonesia) campaign, aiming to eradicate the practice entirely. The initiative sought to integrate mental health services into primary healthcare facilities (Puskesmas), train general practitioners to recognize and treat common psychiatric disorders, and ensure a steady supply of antipsychotic medications across all provinces.
However, progress has been uneven. While urban centers and certain proactive districts have successfully declared themselves free of pasung, remote and economically disadvantaged regions continue to struggle. Factors such as geographical isolation, transportation barriers to psychiatric hospitals, and poverty severely limit access to continuous care. Furthermore, disruptions caused by broader socioeconomic challenges over the years have occasionally strained local health budgets, diverting resources away from community mental health programs.
Medical Implications and the Path to Recovery
From a clinical standpoint, individuals suffering from schizophrenia and acute psychosis require structured, long-term pharmacological treatment coupled with psychosocial rehabilitation. Prolonged physical restraint not only inflicts severe physical trauma—such as muscle atrophy, pressure ulcers, joint contractures, and circulatory problems—but also exacerbates psychological distress, deepening psychosis and severely impairing cognitive functions.
When a patient is freed from pasung, the immediate priority is stabilization through evidence-based psychiatric pharmacotherapy. However, medical experts stress that liberation is merely the first step. Without community-based rehabilitation centers and assertive community treatment teams, relapse rates remain high. Families often feel overwhelmed by the prospect of caring for a recovering patient without adequate respite care or financial support, increasing the risk of re-confinement.
To break this cycle, psychiatric associations have continuously advocated for the decentralization of mental health services. Integrating mental healthcare into community health centers ensures that patients receive routine check-ups and medication close to their homes, reducing the burden on families and preventing crises that might otherwise lead to desperate measures like physical restraint.
Policy Implications and Future Outlook
The release of the third-quarter 2026 data by the Ministry of Health serves as both an urgent warning and a call to action for policymakers, local governments, and civil society organizations. The persistence of over 2,000 cases of pasung indicates that systemic reforms must be accelerated.
Key stakeholders agree that future interventions must focus on three primary pillars:
- Administrative Inclusion: Local civil registration offices (Disdukcapil) must proactively work with health workers to ensure that every individual, regardless of their mental health status, possesses valid civil documentation. This guarantees access to state-funded healthcare and social welfare.
- Strengthened Primary Healthcare: Expanding the capacity of Puskesmas to handle mental health cases ensures early detection, timely intervention, and continuous medication management at the community level.
- Family and Community Support: Implementing robust support systems for caregivers—including financial assistance, psychological counseling, and respite care—alleviates the caregiver burnout that frequently precipitates confinement.
As Indonesia moves forward with its public health agenda, eradicating pasung remains a vital litmus test for the nation’s commitment to human rights, social justice, and universal health coverage. The Ministry of Health’s ongoing initiatives, coupled with academic and clinical advocacy, provide a framework for change, but sustained political will and cross-sectoral collaboration will be indispensable to consigning the practice of pasung to history.
