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span class="inline inline-left">Chained: Fifteen-year old Jamil, who suffers from mental illness, sits in his room shackled to the wall. There are an estimated 20,000 people with severe mental illness shackled in their homes by their families. JP/Wendra AjistyatamaAn estimated 19 million people suffer from mental illness in Indonesia, yet because of a lack of services and basic public awareness, most people don’t get treatment.

As with many other illnesses, early detection and treatment of mental illness is widely regarded as the best way to prevent symptoms from developing into a far more serious condition.

There are an estimated 20,000 people with severe mental illness shackled in their homes by their families. For some, early detection may have prevented their health from deteriorating to this point.

Clinical psychologist Sherly Saragih Turnip from the University of Indonesia said many people don’t know what to do when faced with either their own or a family member’s mental illness.

“I think the biggest problem we have right now is the low awareness about what mental health is, and then what people can do with mental health,” she said.

Mental health problems range from severe conditions like schizophrenia to more common disorders such as depression and anxiety, all of which can lead to suicide if left untreated.

Most patients shackled in their homes suffer from psychotic disorders, which always require professional help. Current research shows early intervention can help reduce the severity of the illness.

However, only 20 percent of the country’s community health centers (known locally as puskesmas) can handle psychotic patients.

More generally, Indonesia suffers from a shortage of hospital beds, and is home to one of the world’s lowest psychiatrist-to-patient ratios.

Sherly said because of a lack of awareness family members usually bought their relatives to get help when their symptoms were full-blown and were totally detached from reality.

Health Ministry mental health director Irmansyah said people often believed mental illness caused by a number of superstitious factors of has roots in a patient’s personality.

“We not only have to provide more services for the community, but we also should educate the community that this a medical situation that can be handled by the nearest medical service,” he said.

If someone is displaying psychotic behavior, such as talking to themselves, behaving strangely or acting paranoid they need to get help right away, said Sherly.

Although not all doctors at community health centers are trained to deal with mental health patients, they should be the first port of call and might refer the patient to hospital, said Irmansyah.

Continuity of treatment for mental health patients is imperative and some people need to take medication for the rest of their lives.

Emotional disorders can be triggered by daily stresses, such as traffic jams, financial pressure, a lack of personal space or insufficient family or leisure time.

Many Indonesians felt uncomfortable seeking professional help for their emotional disorders, as they often worried what people might think of them and were reluctant to get help from strangers, said Sherly.

With a lack of services, getting into treatment wasn’t always affordable or possible either.

Although Sherly stressed the importance of seeking professional help when emotional disorders are in an advanced stage, she said there were steps people could take to look after their mental health in the early stages of mental illness or when treatment wasn’t possible.

These steps could also prevent mental illness from developing in the first place.