THE VISION

People living with injuring mental health issues and other psychiatric concerns often need assistance in different aspects of their lives including work, living, social, and learning environments. One approach that can help people manage symptoms and improve functioning is known as psychosocial rehabilitation. Solemen’s emphasis is on helping people with mental health issues to live as independently as possible and to become fully integrated into the communities in which they live. The approach is centred on the individual’s potential for recovery and is focused on providing empowerment, social inclusion, support, and coping skills. Solemen Psychosocial Rehabilitation Centre will provide specific and specialised recovery model services to those persons with:

rehab centre

Bapak Made Suartana suffered schizophrenia. He was subjected to pasung (shackles) and incarcerated by his family.

A. chronic mental disorders that do not require hospitalisation; and,
B. significant deterioration of their functional capacities and of their
social environment.
The Psychosocial Rehabilitation Centre must meet the needs of two categories of persons:
1. people who either live remotely or do not have the family support to ensure they attend the Centre daily; and,
2. people who live within a reasonable travel radius of the Centre and have the means to be transported to the Centre daily.

The Centre will provide an open and flexible residential community service where functional recovery programs and structured activities for the occupation of free time are carried out throughout the day for up to 15 inpatients and 15 outpatients at any given time.

STATUS QUO

Inhumane treatment of people living with severe mental disorders is very common in Indonesia, of which pasung, the practice of shackling and / or incarcerating a person within a makeshift cell, is a part. Shackling is symptomatic of the reality that access to quality services for mental healthcare is very weak. The 2018 Riskesdas survey shows that while 85% of people living with psychotic disorders have had a history of treatment, only half of them routinely received medication. Meanwhile, for depressive disorders, only 9% of the population group received medication for their conditions. 

The Indonesian Government passed the ambitious but largely unimplemented Mental Health Law in 2014, partially due to the domestic and international attention given to pasung. Apart from criminalising shackling, the Law mandates the provision of mental healthcare access at community health centres (Puskesmas) as well as in community-based services beyond the health sector. Although, the building blocks of a better mental health care system are there, primarily in the form of Indonesia’s National Health Insurance (Jaminan Kesehatan Nasional / JKN) system, there is a critical shortage of mental health care facilities and services.

Status Quo

Three months later, with appropriate medication and treatment, and the ongoing support of the Solemen Outreach Team, Bapak Made Suartana was free.

Bali Provincial Mental Hospital, located in Bangli, is the only psychiatric facility in Bali. However, the 300-bed facility only offers psychiatric treatment and not rehabilitation. The most common reason for a family to admit a patient is because the patient is causing violence related problems in their home communities. Patients can stay in the institution for up to five weeks, before being discharged. However, there is no system for following up patient health and treatment compliance and, the vast majority relapse due to not having access to medication through their primary health care services.

Dr I Gusti Rai Putra Wiguna Sp.KJ is one of only 770 psychiatrists in Indonesia, which is the equivalent of one psychiatrist per 350,000 people or 0.3 per 100,000. In the UK, the ratio of psychiatrists per 100,000 people is 19. Dr Rai is resident psychiatrist at Wangaya Regional General Hospital and has a private practice Sudirman Medical Centre, both in Denpasar. Dr Rai is also the Founder of Rumah Berdaya, a community where people with schizophrenia can gather, learn to express themselves, and be taught a new trade with the help of volunteers. Dr Rai has treated over 200 people with schizophrenia. Another 500 sufferers of schizophrenia have been identified by the Puskesmas in the Denpasar region alone.

In Dr Rai’s extensive experience in severe and chronic mental health disorders, the possibility of a patient receiving efficacious treatment that leads to reintegration into society is extremely low. Patients are often deskilled, especially those having experienced shackling and incarceration. There are no residential psychiatric rehabilitation services in Bali to optimise a patient’s prognosis. The only centre in Indonesia located in Bogor, Java, which is well over 1,200 km away.


The inadequacy in access to care and medication helps perpetuate the mistreatment of people living with mental illness. When a freed pasung patient relapses due to poorly medicated psychosis, terrified family members and neighbours, left to their own devices, are likely to re-shackle the patient. 

Status Que2

The Solemen Outreach Team found Ibu Ketut Bentir shackled to a stone floor, lying
prone in her own excrement, suffering hallucinations caused by schizophrenia.
She was malnourished and had lost any semblence of daily living skills and
social functioning. Ketut’s father had a long history of mental health issues and
committed suicide. Her siblings also live with enduring mental health issues.

BENEFITS

Severe and chronic mental health disorders often negatively affect aspects of a patient’s life, including the person’s employment status, housing situation, and family life. With many patients having lost the support of their families and communities, residential psychosocial rehabilitation is
the only opportunity available for restoring functioning and learning or re-learning the life, social, and self-care skills they need to live full and satisfying lives.


The current model of mental health care in Indonesia has zero opportunity for success, despite the ratification of the 2014 Mental Health Law as it is treatment-focused and fails to address the need for subsequent rehabilitation. 

Solemen Psychosocial Rehabilitation Centre will provide psychiatric patients with the essential bridge between the treatment available at Bali Provincial Mental Hospital and a fully functioning life that generates socioeconomic outcomes. The Centre also provides opportunity for patients’ families to participate in educational and other programs that support
the patients to full and lasting recovery. 


Whilst the Centre offers its services free of charge to ensure access for all sufferers of severe mental health disorders, it will generate income to sustain itself through the economic output of recovering inpatients and participating outpatients who work in the various social enterprises within the Centre. This rehabilitation model moves the Centre from being
a charitable recipient to a selfsustaining, income generating enterprise.


The social enterprise component of Solemen Psychosocial Rehabilitation Centre will include the development of relevant skills for occupations that inpatients and outpatients can perform to earn a meaningful living. 

Now stabilised with pharmacalogical
treatment and rehabilitated with the
support of Solemen, Ibu Ketut Bentir
lives independently and is emloyed to
harvest feed for cows with her mother.

OPERATIONS

Solemen Psychosocial Rehabilitation Centre will be managed by a Senior Mental Health Nurse Practitioner in the role of Ward Manager and overseen by psychiatrist Dr I Gusti Rai Putra Wiguna Sp.KJ. and a licensed General Medical Practitioner connected to a nearby Puskesmas. Permanent staff will consist of 24-hour coverage of mental health nurses; cooks and housekeepers to assist with patients’
education and training in daily living skills; drivers to transport patients to outside appointments; security officers; and, premises caretakers. Work skill educators, art therapists and yoga teachers will contribute to the centre on a voluntary basis. All Rehabilitation Centre staff and volunteers will be thoroughly screened and will undergo rigorous training in mental health care service standards, safety and security.
Solemen Psychosocial Rehabilitation Centre will offer a two-stage rehabilitation service, each with a minimum 6-week attendance. The first stage focuses on essential daily living skills and the second on social integration and workforce skills. Solemen teams will be involved in all stages of patient care, from identification and assessment for intake to postprogram support.

Patient referrals to the Centre will come from one or more of three patient points of contact:

1. Personal – family
2. Community – banjars, Puskesmas
3. Institutional – hospitals


All patients will be assessed by Dr Rai for suitability prior to admission, ensuring that each patient has
been prescribed and is taking appropriate medication for their diagnosis; poses no physical danger to
staff and other patients; and, has the capacity for compliance throughout the rehabilitation programs.

operations

Key domains addressed through psychosocial rehabilitation include basic living skills, family relationships, peer and social relationships, employment, education, recreation, health, and wellness.


The Centre takes a whole-person approach and recognises that other physicians and professionals may be needed during the rehabilitation, recovery and reintegration processes.

SERVICES

Solemen Psychosocial Rehabilitation Centre treatments will be multidisciplinary and often biopsychosocial in nature. This perspective recognises that mental illness impacts multiple areas of life including the biological, social and psychological systems. Not only are each of these systems affected by mental conditions but they are also inextricably interlinked. Psychosocial rehabilitation focuses on
empowering patients to form a foundation upon which other important life skills can be developed through observation, modelling, education, and practice.

Key domains addressed through psychosocial rehabilitation include basic living skills, family relationships, peer and social relationships, employment, education, recreation, health, and wellness.


The Centre takes a whole-person approach and recognises that other physicians and professionals may
be needed during the rehabilitation, recovery and reintegration processes.

Along with psychological therapy, both inpatients and outpatients will have access to two stages of training and experience in life domains such as:
• Personal care – learning or re-learning personal hygiene, dressing, food preparation and eating
• Relationships – emotional understanding, verbal and conversational abilities, interpersonal problem solving, nonverbal communication
• Community functioning – navigating medical appointments, government agencies, local businesses, ceremonies
• Recreation – navigating social outings, playing sport, fishing, riding a motorcycle
• Work – developing vocational skills through supported work settings, including specific trade skills, workplace
• safety, responsibility and accountability, time management, money management
• Housing – independent living, housekeeping, garden maintenance

Such experiences allow patients to practice their abilities in a safe environment with supervision and support from the Solemen team at all times.

Solemen Psychosocial Rehabilitation Centre will also work with the patient’s immediate family to create union. Family therapy includes an assimilation program to overcome the stigma associated with mental health disorders and bring pride in all family members into the family unit. Family programs are facilitated with several families participating in a single activity. Activities are founded in play theory and generate
health competition that exercises social skills such as conflict resolution and cooperation. Kite making and flying is an example of a social family activity, which is relevant outside the Rehabilitation Centre too.

ALLIED SERVICES

Solemen Psychosocial Rehabilitation Centre will engage the services of other professionals to support patients beyond the therapeutic environment of the Centre, including:

• Legal advocates and representatives
• Dentists, physiotherapists, and other health professionals
• Rehabilitation for alcohol, drug, and other addictions

Many of the allied services could be funded through BPJS, with Puskesmas referral, or through corporate social responsibility contributions. Private, non-funded alliances would be a last resort so as not to drain on the Centre’s financial resources.

Where appropriate, Solemen Psychosocial Rehabilitation Centre could also refer discharged patients to non-residential services, such as Rumah Berdaya or Suryani Institute for Mental Health, for additional support. Both services require attendees to have a reasonable level of self-management and the support of their families.

Rumah Berdaya is a zero-cost drop-in centre for patients with managed psychiatric disorders desiring to learn workplace skills. The service facilitates a supported workplace that generates income through screen printing, providing a laundry service, washing motorcycles, and making incense, handbags and tote bags. Art activities such as painting, making masks, making souvenirs or displays made from
old newspapers, painting kites, pottery, and others are also available to attendees. However, as a drop-in centre, Rumah Berdaya is not accessible to patients discharged from Solemen Psychosocial Rehabilitation Centre who do not live in close proximity.

Suryani Institute for Mental Health is focused on the maintenance of psychiatric health. They facilitate community-based workshops and lectures on mental health, mutual family support groups, monthly public dialogues with community and religious leaders, and weekly meditation and relaxation training. The Institute stands for family support and requires financial contribution from the family of the
psychiatric patient and is, therefore, not suitable for all patients discharged from Solemen Psychosocial Rehabilitation Centre.

THE CENTRE

Ideally, Solemen Psychosocial Rehabilitation Centre will be centrally located in the North Kuta, Mengwi or Abiansemal area of Badung. The Centre requires a minimum footprint of 2,000 square metres. The size of the land allows a scheme of areas for different uses:
• a single story, 15-bedroom residential building;
• a therapeutic services building;
• workshops for vocational training and social enterprise;
• pavilions for yoga and similar physical activities;
• a gallery for showcasing and selling patient artwork;
• garden areas for retreat, reflection, relaxation and recreation;

• fruit and vegetable gardens; and,
• parking for staff and patients.
The layout will achieve a feeling of intimacy, resolving important matters such as the control and movement of both the inpatients and the outpatients, of the staff and volunteers and of the visitors. The security of patients, staff, guests and surrounding homes and
businesses is of utmost importance and the Centre will have appropriate perimeter structures with single access.

SPONSORSHIP OPTIONS

Solemen Psychosocial Rehabilitation Centre will cost IDR 1.6 billion (USD 112,000) to set up and IDR 3.7 billion (USD 260,000) per year to operate.


Solemen offers five levels of sponsorship to fund the rehabilitation of SoleBuddies experiencing severe mental health issues. Naming rights are available to donors who sponsor a program, a residential rehab room or the rehab centre vehicle. Donors who sponsor a SoleBuddy or a rehab worker will have a plaque with their name engraved on it on display in the Centre’s reception area.

Sponsorship options

SOLEMEN PSYCHOSOCIAL REHABILITATION CENTRE COSTING

Rehab Costing

HOW TO SPONSOR AND / OR DONATE

Your next step is to contact Solemen’s funding strategy consultant, Robert Epstone to discuss the right sponsorship and donation options for you and your organisation. Robert and his team can look at your social and corporate responsibility plan with you and your team to develop the optimum way to collaborate.

Please contact Robert via email

Office: 0812 3720 6220
Email: info@solemen.org
Your contribution will provide care and support for disadvantaged children and adults all over Bali. Even the smallest amount counts

Other donation options available at solemen.org/donate
PermaBank

Tax deductible donations are available for Solemen supporters from Australia, the United States and New Zealand when made through the Global Development Group (GDG) website. Options include credit card, PayPal, direct deposit and cheque.