It’s through the cracks that light gets in

By Ines Wynn

Mental illness is an insidious and progressive disease, especially when it is not properly diagnosed and treated or, as happens so often in Bali, the people suffering from psychopathic conditions are considered to be living out their due karma and must bear their lot. Hence these people are typically hidden from public view as much for their own safety and that of their family and community as to hide the shame of having a karma-heavy relative reside in the family unit.

Even in current times, many of these cases are not treated properly and you often hear horrid stories of people being chained up to prevent them from wandering or worse, from hurting themselves and their immediate caregivers. Stories of being chained up for 20 years or more are not rare. Clearly, the stigma attached to this disease is heavy and shameful to the people afflicted and their families.

These unfortunates are mostly found in remote regions and among impoverished families. But not always. Even among the better off or educated families, their mentally challenged relatives are not always treated better. In part this can be attributed to the fact that historically, professional psychiatric care in Bali has not been widespread and people with mental issues were typically treated – very unsuccessfully at that – by local shamans and the village balians or healers. Psychiatric care is a specialty health service.

Sadly, in the past few young medical students would choose that field and therefore, competent psychiatric care was, for a long time, unavailable or very restricted. You could say that in terms of mental health services, Bali has long lived in the dark ages and has only in recent times been waking up to the reality that mental illness should be treated like any other physical disease, out in the open, by competent doctors and with effective therapies.

From slow beginnings that knowledge is now rapidly expanding and coming into the light of day. Unfortunately there are still some places in Bali where that realisation has not yet taken a secure foothold or is at best just slowly creeping through the cracks. Many Balinese people, especially among the older generation, still accept mental health issues fatalistically as a karma disease and few believe in successful treatments and rehabilitation of mental health patients.

Fortunately there are some NGOs in Bali who have been aware of that arrears for many years and seek out and treat people with mental health problems and psychiatric conditions. One of these is Yayasan Solemen Indonesia whose Outreach team has made it a point to seek out the hidden cases and tear away the ignorance that keeps people shackled and away from competent medical care. Solemen has booked some dramatic successes and shared a few of their cases.

Caged Made, as he came to be known at Solemen, is a poster child for the successful rehabilitation of mental illness. The Solemen Outreach team first met Made in 2014 when he was shackled in a dirty cage with no running water, a bare cement floor and no facilities whatsoever. At 45, he had a 10-year history of mental illness that was eventually diagnosed as Schizophrenia. Although he had no history of physical violence he was caged because he went around his village asking for cigarettes while holding a machete so the community was concerned he might become violent and pose a threat to their safety.

Solemen arranged for medical assessments and began treating him. Made received medication and psychiatric care by Solemen’s partner and volunteer psychiatrist dr. Gusti Rai. At the same time the team renovated his house, released him from his cage and began taking him on socialisation trips with his family. In 2016 and 2017 Made had a number of relapses with hallucinations and began wandering the streets again looking for cigarettes and displaying some violent behaviour. As a result he was admitted at a mental health facility in Bangli, his medication was reassessed and increased. After his release he was put under observation to ensure that his medication was taken correctly. Currently Made receives ongoing assessments and periodic revaluations of medications and living conditions. Made appears to be doing well now but must continue regular mental health assessments.

Other cases may not be as dire as that of Made but can still be heart-breaking. Like that of Ketut, a women in her mid-thirties with serious mental development issues and suffering from Schizophrenia. She was living in her family’s compound in a dirty and dilapidated shack, could not tend to her own needs or personal hygiene and spent her days grovelling around in the dirt or the mud crying and in utter disarray and confusion. The Solemen Team took charge of her rehabilitation by getting her condition assessed, upgrading her sleeping and living quarters, providing her with clean clothes and bedding and putting her on medication and better nutrition. Today, Ketut is in much better shape thanks to frequent monitoring visits by the team and squeals with delight when she spots them coming into her compound.

These stories are attention-grabbing because their recoveries were swift and the Before and After situations are remarkable. It took a relatively straight forward and focused approach to make an enormous difference in the quality of the lives of these two people. More people like Made and Ketut are being helped thanks to the Solemen CSR partnership programme and the generous efforts of Solemen corporate sponsors like Finn’s Beach Club, the Hard Rock Hotel and the Bali Dynasty Resort who underwrite medical care and treatments.

CSR programmes such as these create wonderful opportunities for small NGOs such as Solemen to enable the work they do with the disadvantaged in Bali. It allows them to seek out the people who are most in need, yet are most likely to be bypassed by existing programmes. They are the people who slip through the cracks. And there are many of them, mostly in remote, impoverished areas or from families or communities who don’t want their misery or poverty exposed and try to keep their suffering loved ones hidden and hence removed from a treatment system they do not trust or simply do not know about.

Doctors, hospitals and medical attention cost money and that can be reason enough for impoverished families to abandon all hope for treatment for their loved ones. They simply do not have money and therefore cannot afford to seek treatment. They rely instead on local healers (balians) or shamans and hope for the best. While these balians can help in many cases, some diseases or conditions, like mental health issues, are too complex for their skills.

Mental illness does not have to be hidden. Each affected person, like all people, has a right to competent and dignified treatment because each person is unique in their own right and mental health rehabilitation can make a huge difference in their lives. Today, a lot more is being done in Bali to treat these patients and thanks to organisations like Solemen and their CSR partners, the cracks are widening and letting more light seep in.

The Solemen corporate sponsorship programme is an impressive opportunity for the Bali business community to join Solemen’s efforts to let the light of understanding, empathy, healing and rehabilitation bring succour and help to the people who need it.


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