After the establishment of the 4th large psychiatric hospital at Sabang, it became clear that building these expensive hospitals and arranging for more beds did not solve the problem of an ever increasing demand of care for psychiatric patients. The annual discharge percentage was about 6 %, so there could be admitted every year only 420 new patients, while the real need was tenfold. This resulted in a large number of patients who because of their behavior were imprisoned. In order to reorganize the mental health care in the NI, three new types of psychiatric facilities were introduced in the 1920s:

• the psychiatric nursing home (Psychiatrisch verpleegtehuis) for long-stay patients. The health statistics of 1938 mention 6 psychiatric nursing homes (Palembang, Padang, Bandjermasin, Manado, Bangli and Soekolilo). The Koloniaal Verslag 1925 mentions the establishment of a ‘verpleeghuis voor krankzinnigen’ that had been opened in 1925. The management was entrusted to the Government Indian doctor Abdoel Moenir. In March 1924 a modest capacity of 6 patients was planned with a staff of 1 Government Indisch Arts, 2 male mantri-nurses 2nd class, 1 female mantri-nurse 2nd class and 8 so-called ‘oppassers’ . In that year 27 patients were admitted, 20 men and7 women. I Javanese and 1 Chinese patient died in that year.
  In 1930  the capacity was 26 beds. In 1937, this Nursing home at Palembang had a normal capacity of 45 beds, whereas the number of occupied beds per ultimo 1937 was 75. (Mededeelingen DVG XXVIII(1939) 109-110).
• the psychiatric passage home (Psychiatrisch doorgangshuis) for the treatment of acute cases for up to six months.
  The health statistics of 1937 mention 6 ‘doorgangshuizen’ (Batavia (Grogol), Semarang (Tawang), Soerakarta (Mangoendjajan), Soerabaya (Pegirian), Medan (Gloegoer) and Makassar).
• Agricultural communities could take care of long-stay patients who did not need intensive nursing. An example of these ‘Landbouwkolonies’ was the experimental one at Lenteng Agoeng that was set up near the Buitenzorg Hospital for 200 ex-patients. The Salvation Army started a ‘Landbouwkolonie’ at Donggala (Sulawesi).See for a discussion on the organization of psychiatric healthcare in the Netherlands Indies the 1937 editions of the Geneeskundig Tijdschrift voor Nederlandsch-Indie (GTNI). Three authors (P.M. van Wulfften Palthe, J.C. van Andel and W.F. Theunissen) discuss the merites of the chosen system of 4 very large and expensive main hospitals and 12 secondary institutions. Van Wulfften Palthe (speaking as head of a psychiatric department of a central civil government hospital) and the directors of the large psychiatric hospitals have totally different points of view: vWP emphasizes that the present system is far too expensive and leads to continuance of the practice of keeping most psychiatric patients in prisons, as there is no place in the psychiatric institutions themselves.
  vWP argues that the present system ends in shoddy work. Hardly a home is established at Makassar (that in due course is completely crowded) or Bali wants its own institute and Sumatra’s Eastcoast cannot stay behind. “it looks as if we empty the ocean with a tea-spoon.”

See for an overview of the singularities of psychiatry in NI, the article by Hans Pols in the publication “Geneeskundig Tijdschrift voor Nederlandsch-Indie”. This  publication was translated in English: The Medical Journal of the Dutch Indies 1852-1942, A Platform for Medical Research. The article was entitled: ‘Psychiatry and the care of the mentally ill.’

In 1924 the former beri-beri hospital at Loeboek Pakam (Medan) was converted into a so-called ‘ Doorgangshuis voor krankzinnigen’ (Staatsblad no. 51 of 27th February 1924 (Decision of the Governor-General no. 17 of 6 February 1924).

The playlist of the staff (numbers and renumeration) were established in this document:
a. One nurse first class of psychiatric training;
b. Two mantri-nurses with free lodging;
c. Eight ‘oppassers’ with a monthly pay of f 25 (max.) and free lodging