AT THE entrance of the main building of the Yayasan Galuh rehabilitation centre for the mentally ill, the first thing that hits you is the overwhelming stench. An open sewer borders the structure on three sides and the odour is especially rank in the midday heat. But the fetid smell only hints at the utter wretchedness that awaits inside.
On a dirty white-tiled floor, dissected by two more open sewers, are the patients. Some 50 of them are chained like animals to the supporting beams of the expansive shed, each a portrait of deprivation and misery. A naked man rocks back and forth, picking faeces from the drain, inspecting it and flicking it away. A few metres away, two others squabble over the remnants of a cigarette. Some fidget and fret, contorting their emaciated bodies as much as the shackles will allow. Others lie comatose, their faces dolefully empty.
It is lunch time, so many are eating boiled rice and there is not much chatter. The silence is punctured only by bursts of wailing from a young boy. His name is Santo. He is 12 and the chain that tethers him is twisted tightly around his leg.
Santo was brought in two days earlier by police who found him wandering the streets of Bekasi, a satellite city outside Jakarta. Speaking in Javanese, he was unable to tell the authorities his address or why he was alone, explains the director of the centre, Suhartono.
''Yes, we chain them here,'' he confirms. ''But we always bless the chain before we do it. And, by chaining them, we will find out what treatment will apply.''
The ''treatment'' at the Yayasan Galuh centre - a free facility for people with conditions ranging from Down syndrome to methamphetamine psychosis and schizophrenia - does not involve modern psychiatric techniques, or even regular visits from a doctor or nurse.
Rather, care consists of prayer, massage, ''ancient wisdom'' and the prescription of a secret herbal elixir by the centre's founder, 98-year-old Gendu Mulatip, administered orally, on the skin or as eye drops. ''It's common to find people who are possessed or under the influence of magic. For those patients that are possessed, we give them the ancient wisdom,'' Suhartono says.
For ''uncontrollable'' patients, staff at the centre bring out a large four-metre python for a kind of shock therapy. ''We show them the big snake. It scares them and they become quiet,'' he says.
As deeply disturbing as the conditions are at Yayasan Galuh, they are by no means uncommon in Indonesia, say mental health experts and activists. These are ''orang di pasung'', literally people in stocks. The vast majority of Indonesia's 725,000 severely mentally ill receive no treatment at all.
''It's everywhere, in every province. We are talking about many thousands of people,'' says Pandu Setiawan, a former director of mental health at Indonesia's Health Ministry who now chairs Indonesian Mental Health Networks, a group of NGOs and activists. ''The biggest problem for [Indonesians] is collective denial. They don't want to see the reality.''
Incredibly, Yayasan Galuh is not the worst place a person like Santo could find himself. At least he gets some treatment, of a sort. The chaining , insists Suhartono, is only temporary. There are thousands of mentally ill people shackled for years, even decades, by poor Indonesian families who believe they have no alternative.
Indonesia's head of mental health, Dr Irmansyah, says there could be more than 30,000 people kept in this state. ''It's terrible. It's a situation that should not happen, not only in terms of psychiatric diseases but in terms of humanity," he says.
Suharto, 31, has spent the past 18 years in solitary confinement, the past seven of them in a tiny, raised goat pen at the back of a shack in Banten in western Java. After so long in confinement, his legs have withered and muscles atrophied, his feet are deformed and skewed. He cannot walk but twists and shakes constantly in his putrid two-metre by 1.5-metre pen, where he eats, bathes and defecates. He sings children's songs, recites lines from the Koran and swears a lot.
''I put him there because he was always angry and he attacked me. It happened ever since his father died,'' says his mother, Darwinah, who is 73, between rasping coughs. ''I once took him to hospital but I'm a poor mother. I can't afford to keep him there. What can I do? I can't do anything.''
Local spiritual healers - known as dukuns - were more affordable but their remedies of bathing him in sacred water, or drinking the blessed liquid, ''made no difference''. Darwinah was advised by the dukuns that Suharto was suffering from a curse passed on from his dead father, who scandalised the village by marrying 21 times and selling off family land holdings to finance his active love life.
Mental illness is poorly understood by much of the Indonesian population, and it remains a low priority for the national government. Just 1 per cent of the country's health budget is devoted to mental health.
While there are some decent state-run psychiatric hospitals in Indonesia, particularly in Java and Aceh, many are no better than badly run prisons. Shelters and rehabilitation centres are usually worse. Jakarta's four shelters for the mentally ill, for example, had 182 deaths in the seven months to May last year due to acute diarrhoea, malnutrition and anaemia.
Even so, there is a small but passionate group of people trying to highlight the dire state of mental healthcare in Indonesia, including the Victorian-based NGO Mind and a consortium of mental health practitioners from the University of Melbourne and the Nossal Institute for Global Health.
They have been providing rehabilitation services and training in community mental health to Indonesian psychiatrists and nurses, as well as supporting academics at the University of Indonesia who want to know why the problem is so widespread.
According to the University of Indonesia's Novi Helena, who is conducting research into pasung, many families are pushed into physically restraining or locking up their kin by the local community. ''If the patient is someone who can become violent and disruptive, the community can become angry. So for the families, they use pasung because they are afraid the community will brutalise the patient,'' she says.
She relays one extreme case where a mentally ill patient - as a result of pressure from local villagers - was kept in a wooden 2.5-metre by one-metre box only half a metre high with no light.
''They said it was because the patient was so strong. If they don't do this, he will be violent,'' says Novi. ''They also didn't give the patient food three times a day. They wouldn't feed him properly, to stop the patient from becoming too strong.''
Dr Harry Minas, who spent time working with pasung people on Samosir Island in Sumatra, now heads the Centre for International Mental Health at the University of Melbourne. ''It's an atrocious abuse of a person, an incredible assault on their human dignity,'' Minas says. ''But in many of these places, there are not even basic services. It may seem hard to believe, but families and communities are usually doing it with the best intentions.''
Indonesia's minuscule mental health budget is devoted mostly to about 30 mental hospitals and rehabilitation centres of vastly varying quality and effectiveness. Given the scale of the problem and the lack of resources, Indonesian specialists say the approach needs to be overhauled, with mental healthcare being handled instead by Indonesia's vast network of community health clinics, or puskesmas. They would not only provide medical help but educate communities about their options.
''Many pasung [people] simply don't need to be locked up,'' says Dr Budi Anna Keliat, a senior lecturer in nursing at the University of Indonesia. Her program includes counselling families, and those in pasung themselves, about how to deal with mental illness and recognise the early signs of problems.
One treatment model gaining interest is the work of Dr Luh Ketut Suryani, a remarkable Balinese psychiatrist who has used spiritualism and meditation, as well as anti-psychotic drugs, to achieve amazing results with those in pasung. ''Most important of all is the acceptance back to the family, the community,'' she says. ''One pasung patient we cared for was in [confinement] for over 40 years. It took us three months, three injections and some therapy. The last time we visited him, he was doing well. Back with his family and communicating with others in the village.''
It was in the aftermath of the 2004 tsunami in Aceh, as international and local authorities surveyed the area, that the extent of pasung in Indonesia, and the country's dysfunctional mental health system, was first recognised.
Aceh governor Irwandi Yusuf has promised to make the province free of pasung by this year. But it is slow work, as illustrated by Radhiah and Badrun Kaman, both immobilised by their families in the same village of Mali Lamkuta.
Badrun Kaman, 28, has had his left leg hooked inside a wooden stock for nine years. His home is a bare brick room, its floor scattered with ash to make it easier for the family to clean up his excretions.
It is a desolate scene. There are no pictures on the wall, no books, cards or other amusements. Just Badrun in a dirty sarong that covers his lap, sitting up on a wooden plank with his chin resting in his right hand, as if he is waiting patiently for someone, or something to happen.
A quiet boy who ''changed'' after hitting his head on an asphalt road in a motorcycle accident, Badrun began wandering into the forest for days, or around the village, throwing stones at neighbours' houses. So he was put in stocks.
Radhiah, a striking young woman with penetrating eyes, is 22 and lives a few hundred metres away. She has been chained up by an ankle for four years in an old bamboo house next to her family's newer home. She became sick when she was 16 and began wandering and setting fire to things, her older brother Juliadi says. ''We think she became ill because of the stress in the family. We are very poor. Radhiah's mother has been mentally disturbed for some time.
Her father lost a leg to diabetes. As the only daughter, Radhiah had to do all the household chores from a young age. Her body is covered in welts and sores and the blanket she sleeps under is rancid. Like Badrun, Radhiah is clearly damaged, not least from the torture of being chained up for so long. But she is also sentient. With the right treatment and support, she could no doubt have a much different life.
''I get very bored sitting here. I want to see the world,'' she says quietly.
Does she know why she is chained up?
''I don't know,'' she says, before adding, ''sometimes I remember my friends. I liked going to Banda Aceh because I had a friend there. I want to be with my friends.''
A collection of images that may be distressing to some, so keep that in mind