Bridging Formal Law and Local Wisdom: A Systematic Literature Review on Legal Empowerment for Persons with Mental Disorders through Community Mental Health Cadres

Abstract

Despite increasingly rights-based mental health and disability laws, people with mental disorders (PWMDs) in Indonesia and other low- and middle-income settings continue to experience exclusion, coercion, and practices such as pasung (restraint and confinement). This paper reviews how community mental health cadres can bridge formal legal mandates and local wisdom to advance legal empowerment and rights protection. A systematic literature review was conducted following PRISMA 2020. Searches were performed in Google Scholar, PubMed, ScienceDirect, and DOAJ for peer-reviewed articles published in 2020–2025 using keywords combining mental disorders, cadres/community health workers, legal empowerment/rights, and local wisdom/culture. After screening 72 records, 9 studies met the inclusion criteria and were synthesized thematically. The review identified three main findings: (1) a persistent implementation gap between national prohibitions of coercion and local practices, shaped by stigma, family burden, limited services, and culturally embedded explanatory models of illness; (2) cadres act as cultural brokers who translate biomedical services and legal norms into locally acceptable support, facilitate referrals, and mediate with families and community leaders; and (3) legal empowerment is strengthened when cadre activities are coupled with rights literacy, multi-sector referral pathways (health–social–legal aid), and community accountability mechanisms. This study proposes an integrative conceptual model positioning cadres at the interface of primary health care and village governance to operationalize SDG 3 (health) and SDG 16 (justice and strong institutions) through culturally grounded, rights-based mental health care.