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


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.


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.


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.


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.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mohanraj, A., Patkai, I. & Bayato, V. Eliminating unnecessary physical restraints in the community: case studies from Aceh Province, Indonesia. BMC Psychiatry 7 (Suppl 1), S145 (2007).

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  • Behavioral Problem
  • Mental Health Care
  • Correct Attitude
  • Managerial Skill
  • World View