Evaluating the Indonesia Free Pasung Movement: Understanding continuing use of restraint of the mentally ill in rural Java.

Forcible restraint and confinement of persons suffering from mental illness occurs throughout the world, including in Indonesia. Since 2010, when Gerakan Bebas Pasung (GBP) or the Indonesian Freedom from Forcible Restraint (Pasung) of Mentally Ill Persons movement was launched, national policy has been published to eradicate Pasung in Indonesia by improving the mental healthcare system. This article analyses this policy, specifically the National Mental Health Legislation (2014) and the Ministry of Health Regulation Tackling Forcible Restraint of People with Mental Illness (2017), and evaluates their current state of implementation through a local, in-depth case study. Using mental health institution mapping, two sets of semi-structured qualitative interviews with government officials and healthcare workers, and participant observation in a facility practicing Pasung, we identify the extent to which the 2017 regulation has been implemented in Winong village and discuss current efforts and persistent obstacles to eradicating Pasung. We suggest that despite reforms and the new treatment facility in our case study, the continuing use of Pasung is due to a combination of access to care issues and a widely held explanatory model of mental illness characterized by strong curative beliefs that, when disappointed, lead to a sense of threat and hopelessness.

Integration and organization of trauma memories and posttraumatic symptoms.

To examine the connection between trauma memory integration in personal memory, memory organization, and posttraumatic symptom severity, 47 trauma-exposed adults undertook an event-cuing task for their trauma memory and for a memorable nontraumatic negative event. Measures of integration provided by self-endorsement, rated by naïve judges, or calculated from the language of the memories, did not significantly predict posttraumatic stress disorder symptom severity after adjusting for age, time since the event, anxiety when disclosing, familiarity of the memory, and integration of nontrauma memory. Less use of casual connectives in the trauma memory narrative was associated with higher trauma-related avoidance (r = .33; p = .03), whereas self-rating of the trauma memory as disorganized was associated with higher overall symptom severity (r = .42; p = .006).