From Chains to Care: Ending Pasung (Physical Restraint) Among Schizophrenia Patients in Indonesia, A Systematic Review

TL;DR

This review examines the ongoing use of physical restraints for schizophrenia patients in Indonesia, highlighting causes and solutions.

Contribution

The study provides a systematic review of pasung in Indonesia, emphasizing socio-ecological factors and policy gaps.

Findings

Pasung is driven by stigma, poverty, and lack of mental health services in Indonesia.

Consequences include physical and psychological harm to patients.

A multi-level approach is needed to address pasung effectively.

Abstract

Pasung, the physical restraint and confinement of individuals with mental disorders—particularly schizophrenia—continues to occur in Indonesia, despite the national “Free from Pasung” campaign and Mental Health Act No. 18/2014. This systematic review aims to synthesize existing evidence on the prevalence, causes, consequences, and policy responses related to pasung among people with schizophrenia in Indonesia.

A systematic search was conducted using PubMed, PsycINFO, Cochrane Library, and the Garuda Indonesian research repository. The quality appraisal were analyzed using tools from the Joanna Briggs Institute (JBI) and CASP. The included studies were analyzed using thematic synthesis guided by the Socio-Ecological Model (SEM).

Eight studies met the inclusion criteria.

Findings reveal that pasung is driven by persistent stigma, poverty, limited mental health literacy, cultural beliefs attributing illness to supernatural causes, and the lack of accessible, community-based mental health services. The consequences include muscle atrophy, psychological trauma, loss of dignity, and delayed or denied treatment.

The persistence of pasung highlights critical gaps in Indonesia’s mental health system, particularly at the community and policy levels. Addressing this issue requires a multi-level approach, including culturally adapted interventions, stronger mental health governance, and community empowerment to support inclusive, rights-based mental health care.

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