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Draft IDE Program Bebas Pasung



Background

“….there could be more than 30,000 people kept in this state (chained or shacked or pasung). ''It's terrible. It's a situation that should not happen, not only in terms of psychiatric diseases but in terms of humanity,"

-Indonesia's Head of Mental Health Department, Dr Irmansyah,


Chaining or locking people with mental illness have been major concern in Indonesia, specifically in rural areas. Families and society at large do not understand what and why it happened, how to treat them, or when certain medications or training should be given to people with mental disabilities. The lack of education and economic capability drove families and communities in rural areas to choose easy way out: physical restraint such as chaining or locking which are widely known as pasung. According to early research on pasung phenomenon, the primary reason people are applying this method is the dangerous behavior  shown by people with mental illness. The great majority of these people had diagnosis of Schizoprenia[1]. Sadly, its medications are not well accommodated in Indonesia and there is not many expert can be found to help government in overcoming this problem.
Government has been trying to improve mental health situation in Indonesia. On 1977, Ministry of Internal Affairs has issues Decision No: PEM/29/6/15, November 11th 1977 which stipulated citizens to stop practicing pasung towards people with mental illness and to encourage them to go to mental health institution instead. Article 149 Law No. 36 Year 2009 regarding National Health required all people with disabilities to be given medications and treatments by Government, Local Government, and the whole society. Despite the law that protects the rights of people with mental illness, pasung phenomenon still exists and the government’s goal to “Indonesia Bebas Pasung 2014 (Free from Restraints)” was not succeeded. Many people with mental illness are still being restrained. Several cities such as Surabaya[2], Blitar[3], and almost all cities in East Java[4] are reportedly failed upon the program. Several areas such as Riau[5] and Banten provinces[6] just declared to run the “Free from Restraints Project” by the end of 2019 following the Health Minister instruction during national work planning[7]. However, West Java province allegedly not ready yet to implement the program[8]. 
There are many factors that contribute to the failure of the intervention program:  challenges to implementation of mental health care in primary-care settings[9]; the low numbers and few types of workers who are trained and supervised in mental health care[10]. It is worsened each year because people’s mindset stay the same: they tend to believe that people with certain mental illness such as Schizoprenia were possessed by the devils and there was nothing they can do about it except putting them in horribly small place where they eat, sleep, pee, and defecate.

Mission
The mission of this project is to educate the families and the communities about mental illness therefore they can treat people with mental illness in the compliance with human rights standard.

Objectives 
Objectives from this project consists of:
1.      People with mental illness are able to live without chain or locked in a  room
2.      People with mental illness are able to live in harmony with the family and community with small chance to relapse.
a.       The family has a comprehensive knowlegde and attitude about people with mental illness: the cause, trigger, medication, expressed emotion, misleading cultural beliefs, etc.
b.      The Neighboorhod or community has a comprehensive knowlegde and attitude about people with mental illness: the cause, trigger, medication, expressed emotion, misleading cultural beliefs, etc.
3.      Village cadres are well-trained, are able to, and are willing to do the follow up of the project
4.      To create generic model of intervention for pasung case

Goals
The Goals of the project is to treat people with mental illness as a free human being and help them improve their mental health condition. At the end, we aim them to be able to blend with society and live their life akin to other people in their community.

Project Details
Summary:
Free the Chain project will focus on one family as the pilot project located in Yogyakarta as recommended by  the expert on this issue in Indonesia due to the solid network in the city. The program will provides serial workshops for people with mental illness, the family, and the community. Additionally, the program will involve village cadre as the successor obligated to do follow-ups. The involvement of village cadre will be the most crucial issue since most of the previous programs were failed in the terms of conducting the follow up and evaluation.
Free the Chain project will engage “three musketeers” of mental health professional (psychiatrist, psychologist, and social worker) that rarely collaborate in Indonesia. The collaboration of the three mental health professionals is expected to create comprehensive intervention from medication, psychological therapy, as well as counseling. The program will also involve other stakeholders such as NGO, asylum, local government, and local community such as Komunitas Peduli Skizofrenia Indonesia (Indonesian Schizophrenic Care Community or KPSI) and neighboring community to ensure the sustainability of the program. The goal of the program is not only to set people with mental illness free from chain but also to ensure the well-being and the quality of their life in the society.   



Detailed Aspects:
1.    Human Resources and Allies
-          Group members
This project will be hosted by YSEALI awardee, Justitia Avila Veda and Regisda Machdy in association with Pijarpijarpsikologi.org as media partner.
-          Co-Host
There is a possibility to co-host the project with several NGOs and community such as KPSI, Handicap international, and others NGOs focusing on mental health issues and civil rights.
-          Volunteer Recruitment
We are open to recruting volunteer if it is needed.
2.    Financial Resources and Budgets Details
This project will be funded by YSEALI grant. There is a possibility to propose for funding to others donor such as fundings from Ministry of Social Welfare, Ministry of Health, HiVOS, etc. The allocation of the budgets can be seen below:

Project
Details of the Need
 Price
Amt
 Total
Total $
Publishing Program
Printed Proposal
 IDR 7,000
20
 IDR 140,000
 $10
#1 Workshop
Seminar kit
 IDR 3,000
50
 IDR 150,000
 $11

Snack and Beverages (include committees)
 IDR 30,000
60
 IDR 1,800,000
 $129
Modules making
Professional help
 IDR 1,000,000
1
 IDR 1,000,000
 $71
#2 Workshop
Seminar kit
 IDR 3,000
20
 IDR 60,000
 $4

Snack and Beverages (include committees)
 IDR 30,000
30
 IDR 900,000
 $64
Family Visit
Transportation (car rental + driver)
 IDR 700,000
15
 IDR 10,500,000
 $750
Workshop for community
Snack and Beverages (include committees)
 IDR 30,000
60
 IDR 1,800,000
 $129

Seminar kit
 IDR 2,000
50
 IDR 100,000
 $7
Mental health professionals fee
Psychiatrist (3 months)
 IDR 10,000,000
1
 IDR 10,000,000
 $714

Psychologist (3 months)
 IDR 10,000,000
1
 IDR 10,000,000
 $714

Social Worker (3 months)
 IDR 10,000,000
1
 IDR 10,000,000
 $714

Village cadre (1 year)
 IDR 3,000,000
3
 IDR 9,000,000
 $643




 IDR 55,450,000
 $3,961
3. Technical Executions
Pre-Event
1.      Board Meeting
The Board will conduct a meeting to discuss about the program, funding, technical execution, and other crucial aspects of  the event.
2.      Sponsorship and Allies Networking
The board members will start screening all possible sponsor and allies, whether it is NGO, mass media, youth activity center in university, etc. the board members will start approaching them, offer them the proposals, and pursue the agreement between The Board and the other parties.
3.      Publishing and Promoting the Program
Committee will make promotion materials to be spread on the mass media, social media, posters, and our partner’s platform.
4.      #1 Workshop on existing issue and previous program evaluation
Workshop that engaging three mental health professionals, local government, mental health activist, community, and NGO to address the problem properly.
5.      Modul making
Along with the expert, project leader will create the three moduls for the victim, family, and neighborhood.
6.      #2 Workshop on professional judgment of intervention plan modul
Invite back the stakeholders to give professional judgement of the three moduls.
7.      Selecting Family target
Family target must be sub-village resident family who chained or locked at least one family member in their house. Geographical condition also becomes one of the consideration since the pilot program will promote the victim to has a vocational or clerical job.  Experts will help project officer in defining the family target criteria while local leader will give family recommendation according to it.

Event
After selecting the family, the whole project team will diagnose and do profile assessment toward both family’s and people with mental illness’ background. The result of the assessment will define the next steps as can be seen below.

Complete explanation of the steps:
1.      Building rapport to family
Build relationship with the targeted family and ask the willingnes to participate in the program. From this step, Project Officer and the experts will gather information about both the family and the person with mental illness.


2.      Diagnosis and Profile Assessment
Diagnose the condition and set individual plan following the modules
Psychiatrist will diagnose the victim of pasung whether she/he needs to be recovered in asylum and discuss it with the other experts.
3.      To the Asylum
If the person with mental illness needs medical prescribes and further treatments, we will send him/her to the Mental Asylum and report the assessment result as the guidance. Sending the person to the asylum doesn’t stop the project because it still needs follow ups. The follow ups should be done by the whole team because Mental Asylum will not likely  to do it. This is the same mistake all govermental projects always did and became the sole reason why it was never succeeeded.
4.      Series of workshop for the family
Series of workshop on the cause of mental illness, trigger, medication, expressed emotion, relapse, false cultural beliefs, stigma, etc., for the family. The workshop will be conducted according to the modules.  
5.      Series of workshop for village cadres
Series of workshop on the cause of mental illness, trigger, medication, expressed emotion, relapse, false cultural beliefs, stigma, etc., for the village cadres. The workshop will be conducted according to the modules.
6.      Back to the Village: Social Adaptation
Person with mental illness who went to asylum is now back at home. He/she will learn how to socialize with either family or society. Experts and psychologist will explain to the family what kind of treatment was given to the people with mental illness.
7.      Vocational Training
Person with mental illness will be given training to encourage their ability to blend and socialize with family and the community. The training could be very simple, it depends on the family’s background. If the family is farmer, person with mental illness can be trained to harvest rice for the example.
8.      Skill Assessment of Village Cadres
Considering the importance of village cadres’ role in this project, evaluation towards their skills is necessary. All the experts will gather to do assessment by asking them to answer questionnaire.
9.      Follow up
The last but not least, village cadres need to do the follow ups by checking the medications given to the person with mental illness, progress in his/her behavior, condition in the family, etc. Village cadres will fill up some forms on certain period of time, it could be weekly or monthly, depends on the need.

Post-Event
1.      Project Officer Evaluation
Project Officer will conduct an evaluation about the program and it involves evaluation from both the victim, family, neighborhood, and the village cadre
2.      Submitting report to other stakeholders
After doing the evaluation, project officer will start write the report to submit to other stakeholders such as sponsor, donor, co-host, allies, etc.
3.      Follow Up
The project officer will do follow-up towards the village cadre and the family.


[1] Puteh, I., Marthoenis, M., & Mians, H. (2011). Aceh Free Pasung: Releasing the Mentally Ill from Phsyical Restraint. International Journal Mental Health System, page 10.
[2] http://www.rri.co.id/surabaya/post/berita/139067/sosial/dinkes_ target _jatim_bebas _pasung_2015 belum_terealisasi.html 
[4]“Program Bebas Pasung Tidak Direspon Bupati dan Walikota”, Jaring News,  http://jaringnews.com/hidup-sehat/umum/52951/program-bebas-pasung-tidak-direspon-bupati-walikota accessed on October 18th 2015.
[5]“Provinsi Riau Canangkan Program Bebas Pasung”, Detak Riau News,  http://detakriaunews.com/news/berita-provinsi-riau-canangkan-program-bebas-pasung.html accessed on October 18th 2015.
[6]“Program Banten Bebas Pasung 2019 Dicanangkan”, DPRD Provinsi Banten, http://dprd-bantenprov.go.id/post/detail/program-banten-bebas-pasung-2019-dicanangkan.html accessed on October 18th 2015.
[7]“Kementerian Kesehatan Ajak Pemuda Wujudkan Indonesia Bebas Pasung”, Berita Satu, http://www.beritasatu.com/kesra/183215-menkes-ajak-pemda-wujudkan-indonesia-bebas-pasung.html accessed on October 18th 2015.
[8]“Jawa Barat Tidak Berani Canangkan Bebas Pasung”, Gala Media News, http://m.galamedianews.com/bandung-raya/7583/jabar-tidak-berani-canangkan-bebas-pasung-.html accessed on October 18th 2015.
[9] Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney J., Sridhar D., & Underhill C. (2007). Global Mental Health 5: Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet , 1164-1174.
[10] Op.Cit. 






















Draft IDE Program Bebas Pasung Draft IDE Program Bebas Pasung Reviewed by Regis Machdy on November 23, 2016 Rating: 5
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