Human rights of the mentally ill in Indonesia

Background: The mentally ill are vulnerable to human rights violations, particularly in Indonesia, where shackling is widespread. Aim: The aim of this study was to understand the provision of mental health care in Indonesia, thereby identifying ways to improve care and better support carers. Methods: Grounded theory methods were used. Study participants included health professionals, non-health professionals and individuals living with a mental disorder who were well at the time (n=49). Data were collected through interviews conducted in 2011 and 2012. Results: The core category of this grounded theory is connecting care' a term coined by the authors to describe a model of care that involves health professionals and non-health professionals, such as family members. Four main factors influence care-providers' decision-making: competence, willingness, available resources and compliance with institutional policy. Health professionals are influenced most strongly by institutional policy when deciding whether to accept or shift responsibility to provide care. Non-health professionals base their decisions largely on personal circumstances. Jointly-made decisions can be matched or unmatched. Unmatched decisions can result in forced provision of care, increasing risks of human rights violations. Limitations: Generalization of this grounded theory is difficult as the research was conducted in two provinces of Indonesia. Conclusion: Institutional policy was important in the process of connecting care for the mentally ill in Indonesia and needs to be underpinned by legislation to protect human rights. Implications for nursing and health policy: Strengthening mental health legislation in Indonesia will allow nurses to connect care more effectively.