Breaking the Chains of ‘Pasung’: The Potential Roles of Primary Health Centres and Pharmacists in an Indonesian Setting
Abstract
Introduction: Healthcare for patients in pasung is often neglected. Limited data is available on the roles of Primary Health Centres (PHCs) as the main providers of primary care in Indonesia. This research aims to explore health services provided for patients in pasung at PHCs and to identify the roles of pharmacists.
Methods: This descriptive qualitative research used in-depth interviews with a range of stakeholders [i.e., patients in pasung (n=14) or the representative family caregivers (n=12), mental health nurses (n=5), pharmacists (n=5)] at 5 PHCs in Trenggalek, Indonesia from May to July 2023. Inductive thematic analysis was used to address the research questions. Ethical approval was obtained from the Research Ethics Committee of Universitas Surabaya (number 130/KE/V/2023), and participants provided written informed consent.
Results: Patients in pasung have generally had adequate access to PHCs with no charge for their treatments. Health services provided for patients in pasung at PHCs were categorised into two main themes: outpatient services (i.e., medication supply, and home-care), and referral to inpatient services. Pharmacists’ roles have largely related to drug supply, while clinical pharmacy services have been very limited (e.g., providing drug information when patients obtained their medications at the pharmacy units).
Conclusion: In conclusion, findings in this study have provided a baseline for future development of mental healthcare for patients in pasung. Pharmacists have the potential to take up more clinical roles to ensure quality use of medicines among patients in pasung. Supporting policy and resources should be allocated for PHCs to expand pharmacist’s services.
References
Hert M, Dirix N, Demunter H, Correll C. Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. Eur Child Adolesc Psychiatr. 2011;20:221–230. doi: 10.1007/s00787-011-0160-x.
Goulet M, Larue C, Dumais A. Evaluation of seclusion and restraint reduction programs in mental health: a systematic review. Aggress Violent Behav. 2017;34:139–46. doi: 10.1016/j.avb.2017.01.019.
Guan L, Liu J, Wu X, Chen D, Wang X, Ma N, et al. Unlocking Patients with Mental Disorders Who Were in Restraints at Home: A National Follow-Up Study of China’s New Public Mental Health Initiatives. PLoS One. 2015;10(4):e0121425. https://doi.org/10.1371%2Fjournal.pone.
Drew N, Funk M, Tang S, Lamichhane J, Chávez E, Katontoka S, et al. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet. 2011;378(9803):1664–1675. doi:10.016/S0140- 6736(11)61458-X.
Suryani L, Lesmana C, Tiliopoulos N. Treating the untreated: applying a community-based, culturally sensitive psychiatric intervention to con fned and physically restrained mentally ill individuals in Bali. Indonesia. Europ Arch Psychiatr Clin Neuroscience. 2011;261:140–144. doi: 10.1007/s00406-011-0238-y. Europ Arch Psychiatr Clin Neuroscience. 2011;261:140–4. doi: 10.1007/s00406-011-0238-y.
Hidayat M, Lawn S, Muir-Cochrane E, Oster C. The use of pasung for people with mental illness: a systematic review and narrative synthesis. Int J Ment Health Syst 2020 Dec 7;14(1):90 doi: 101186/s13033-020-00424-0 2020.
Asher L, Fekadu A, Teferra S, De Silva M, Pathare S, Hanlon C. Asher L, Fekadu A, Teferra S, De Silva M, Pathare S, Hanlon C. “I cry every day and night, I have my son tied in chains”: Physical restraint of people with schizophrenia in community settings in Ethiopia. Globalization Health. 2017;14;37 https://doiorg/101186/s12992-017-0273-1 2017.
Katuuk H, Daulima N, Wardani I. Families’ experience caring for mentally ill patients with re-pasung. Enfermeria Clinica. 2019;29(S2):270-274. https://doi. org/10.1016/j.enfcli.2019.04.032. .
Broch H. The Villagers’Reactions Towards Craziness: an Indonesian Example. Transcult Psychiatr. 2001;38(3):275–305. https://doi.org/10.1177/136346150103800301.
Human Right Watch. Indonesia Shackling reduced but persist: Oversight Crucial to End Abuse of People with Disabilities. Jakarta: Human Right Watch; 2018. Available at: https://www.hrw. org/news/2018/10/02/indonesia-shackling-reduced-persists (Accessed 27 Sept 2023).
Badan Pusat Statistik (BPS) Indonesia. Statistical yearbook of Indonesia. Jakarta: BPS; 2019. Available at: https://www.bps.go.id/pub- lication/2019/07/04/daac1ba18cae1e90706ee58a/statistik-indonesia-2019. Html (Accessed 3 February 2024).
Hidayat M, Oster C, Muir-Cochrane E, Lawn S. Indonesia free from pasung: a policy analysis. International Journal of Mental Health Systems. 2023;17:12. https://doi.org/10.1186/s13033-023-00579-6. .
Daulima N. Pasung dalam perspektif keluarga pasien gangguan jiwa di wilayah Jabodetabek [unpublished]. Jakarta;2011.
Laila N, Mahkota R, Shivalli S, Bantas K, Krianto T. Factors associated with pasung (physical restraint and confnement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia. BMC Psychiatry. 2019;19(1):162. https://doi.org/10.1186/s12888-019-2138-z.
Minas H, Diatri H. Pasung: physical restraint and confinement of the mentally ill in the community. International journal of mental health systems. 2008;2(1):8. https://doi.org/10.1186/1752-4458-2-8.
Rekhoningsih W, Daulima N, Putri Y. Studi fenomenologi pengalaman keluarga dalam merawat pasien paska pasung. Medica Hospitalia: J Clin Med. 2014;2(3). https://doi.org/10.36408/mhjcm.v2i3.193.
Buanasari A, Daulima N, Wardani I. The experience of adolescents having mentally ill parents with pasung. Enfermeria Clinica. 2018;28(Suppl 1):83–87.
Yusuf A, Tristiana D. Fenomena pasung dan dukungan keluarga terhadap pasien gangguan jiwa pasca pasung. Jurnal Keperawatan Padjadjaran. 2018;5(3):309-321. https://doi.org/10.24198/jkp.v5i3.653.
Daulima N, Rasmawati R, Wardani I. Penurunan Kemampuan Kepala keluarga dalam memenuhi kebutuhan ekonommi keluarga: study fenomology pengalaman orang dengan gangguan jiwa pasca pasung. Jurnal Keperawatan Indonesia. 2019;22(2):139–146.
Agustina R, Dartanto T, Sitompul R, Susiloretni K, Suparmi S, Achadi S, et al. Universal health coverage in Indonesia: concept, progress, and challenges. Lancet. 2019;393(10166):75-102. doi: 10.1016/S0140-6736(18)31647-7.
Pols H. The future of mental health care in Indonesia Inside Indonesia. Inside Indonesia. 2020;141:Jul 24. https://www.insideindonesia.org/the-future-of-mental-health-care-in-indonesia#:~:text=The%0Indonesian%0government%0currently%0dedicates,much%0lower%0than%0the%0demand.
Badan Pusat Statistik (BPS) Indonesia. Jumlah puskesmas di Indonesia (2017 - 2022). Jakarta: BPS; 2022. Available at: https://dataindonesia.id/kesehatan/detail/ada-10292-puskesmas-di-indonesia-pada-2022#:~:text=Badan%20Pusat%20Statistik%20(BPS)%20mencatat,sebanyak%2010.374%20unit%20pada%202022 (Accessed 4 March 2024).
Ministry of Heatlh Republic of Indonesia (MoH-RI). Regulation Number 74 in 2016: standard for pharmacy services in Primary Health Centres. Jakarta: MoH-RI; 2016.
Trenggalek Social Office. Report on patient with mental disorders. Trenggalek: Trenggalek Social Office; 2022.
Creswell J. Research design: qualitative, quantitative, and mixed methods approaches. 4th Edition. London: SAGE Publications, Inc.; 2013.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006. 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa. 2006.
Suharto B. Budaya pasung dan dampak yuridis sosiologis (studi tentang upaya pelepasan pasung dan pencegahan tindakan pemasungan di kabupaten wonogiri). IJMS?Indonesian J Med Science. 2014;1(2):1-10. http://ejournal.poltekkesbhaktimulia.ac.id/index.php/ijms/article/view/21.
Katuuk H, Daulima N, Wardani I. Families’ experience caring for mentally ill patients with re?pasung. Enfermeria Clinica. 2019;29:270-274. https://doi.org/10.1016/j.enfcli.2019.04.032.
Badan Pusat Statistik (BPS) Indonesia. Statistical yearbook of Indonesia 2022. Jakarta: BPS; 2022. Available at: https://webapi.bps.go.id/download.php?f=oTQDOji4JVPPbL9JTXrILJp8YxrF0kP9JZXKemxINIGMo615Th5QDcmEsCKy51+eiOeQza+bye5oHdG22pYcTqK4KrCAD5itjl/rT15n1wFkYiYBfxcdW3XOfT3Vnsvm2/XSavl+T0ahCJ8eAiyxJNxF/Vi2q82tC5UIAVsWF/eyxTcF685AywF7UiQgxqaBV574glS6J4r/k5BLsg8gNnbkcHwx00ooq2ODiZgFXEqSgl8FcpWweQGWc42b5hcJx+hGEx7HRFawrS/BK053jQ== (Accessed 31 Jan 2023).
Maj M, van Os J, de Hert M, Gaebel W, Galderisi S, Green M, et al. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry. 2021;20(1):4-33. doi: 10.1002/wps.20809. 2021.
McIntyre R, Alda M, Baldessarini R, Bauer M, Berk M, Correll C, et al. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry. 2022;21(3):364-387. doi: 10.1002/wps.20997. 2022.
Dewi A, Daulima N, Wardani I. Managing family burden through combined family psychoeducation and care decision without pasung therapies. Enferm Clin. 2019;29(S2):76-80. https://doi.org/10.1016/j.enfcli.2019.04.012. 2019.
Suhron M, Yusuf A, Subarniati R. Assessment potential of families increasing ability to care for schizophrenia post restrain at east java, indonesia. Indian J Pub Health Res Development. 2018;9(10):369–374.
Tanaka C, Reyes Tuliao M, Tanaka E, Yamashita T, Matsuo H. A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines. BMC Psychiatry. 2018;18 Okt:325. http://doi. org/10.1186/s12888?018?1902?9.
Tay J, Chan C, Ho Z, Lal M. The ties that bind—a case report about restraining a mentally unwell family member at home for over a decade. Asian J Psychiatr. 2017;26:146–148.
Gisev N, Bell J, O'Reilly C, Rosen A, Chen T. An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiatry Psychiatr Epidemiol. 2010;45(11):1071–1079. doi: 10.1007/s00127-009-0148-8. . 2010.
Mohammed M, Moles R, Chen T. Impact of pharmaceutical care interventions on Health-Related Quality-of-Life outcomes: a systematic review and meta-analysis. Ann Pharmacother. 2016;50(10):862–881. doi: 10.1177/1060028016656016.
Chong W, Aslani P, Chen T. Shared decision-making and interprofessional collaboration in mental healthcare:a qualitative study exploring perceptions of barriers and facilitators. J Interprof Care. 2013;27(5):373–379. doi: 10.3109/13561820.2013.785503.
Chong W, Aslani P, Chen T. 15. Chong WW, Aslani P, Chen TF. Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare. J Interprof Care. 2013;27(3):223–230. doi: 10.3109/13561820.2013.767225.
Chong W, Aslani P, Chen T. Pharmacist-patient communication on use of antidepressants:a simulated patient study in community pharmacy. Res Social Adm Pharm. 2014;10(2):419–437. doi: 10.1016/j.sapharm.2013.05.006.
Copyright (c) 2025 Journal of Public Health and Pharmacy
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
