Eliminating unnecessary physical restraints in the community: case studies from Aceh Province, Indonesia

Background

In line with the paradigm shift currently taking place in psychiatry, the authors have experienced obstacles and success in developing community based mental health care in Southeast Asia. Objectives: Due to ignorance, prejudice, discrimination and treatment gap persons with mental disorders are often kept in unnecessary restraints. This situation calls for a dramatic change. The authors call attention to the often neglected setting of restraint whilst highlighting resilience and resources of families and the community.

Methods

The case vignettes presented here illustrate restraint in community settings. The stories demonstrate circumstances, some critical details of events and challenges faced in the difficult process of providing the least restrictive treatment milieu in the community.

Results

In this process, sustained partnership between clients, families and mental health workers proved to be essential. In the security of this partnership, space and time are created for healing where recovery would take place and unnecessary restraints eliminated.

Conclusion

In Aceh Province in Indonesia where a unified world view is still present, the family if supported by the mental health workers is an important source of healing. Community workers need to build the trust and to develop partnership with clients and with their families. In addition to sound clinical knowledge, attitude and managerial skills of staff are imperative in order to communicate values, correct attitudes and norms with regards to individual clients and in advocacy. In behavioral problems where control is needed, it can be applied in the least possible restrictive manner.