Treating the untreated: applying a community-based, culturally sensitive psychiatric intervention to confined and physically restrained mentally ill individuals in Bali, Indonesia

  • Luh Ketut Suryani
  • Cokorda Bagus Jaya Lesmana
  • Niko TiliopoulosEmail author
Original Paper


This study identified, mapped and treated the clinical features of mentally ill people, who had been isolated and restrained by family and community members as a result of a functional failure of the traditional medical, hospital-based mental health model currently practiced in Indonesia. A 10-month epidemiological population survey was carried out in Karangasem regency of Bali, Indonesia. A total of 404,591 individuals were clinically interviewed, of which 895 individuals with mental health problems were identified, with 23 satisfying criteria of physical restraint and confinement. Of the latter, twenty were males; age range was 19–69 years, all diagnosed by the researchers with schizophrenia-spectrum disorder (ICD-10 diagnostic criteria). Duration of restraint ranged from 3 months to 30 years (mean = 8.1 years, SD = 8.3 years). Through the application of a holistic intervention model, all patients exhibited a remarkable recovery within 19 months of treatment. We conclude that the development of a community-based, culturally sensitive and respectful mental health model can serve as an optimum promoter of positive mental health outcomes.


Community-based psychiatry Cultural psychiatry Biopsycho-spirit-sociocultural approach Schizophrenia 


Conflict of interest

The authors declare that they have no conflict of interest.

This supplement was not sponsored by outside commercial interests. It was funded by the German Association for Psychiatry and Psychotherapy (DGPPN).


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Luh Ketut Suryani
    • 1
  • Cokorda Bagus Jaya Lesmana
    • 2
  • Niko Tiliopoulos
    • 3
    Email author
  1. 1.Suryani Institute for Mental HealthDenpasarIndonesia
  2. 2.Faculty of MedicineUdayana UniversityDenpasarIndonesia
  3. 3.School of PsychologyThe University of SydneySydneyAustralia

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