Author: Hans Pols
Professor Hans Pols is associated with the School of History and Philosophy of Science at the University of Sydney. His research focus on the history of colonial and postcolonial medicine in Southeast Asia. He can be reached at hans.pols@sydney.edu.au
A quick glance at the state of Indonesia’s mental health care system indicates that there is much room for improvement. There are approximately 1,000 psychiatrists for over 270 million people. The number of clinical psychologists (around 2,000, mostly in private practice), community mental health nurses (around 7,000), and other mental health personnel is limited—clearly insufficient to meet the mental health needs of the country. In 2013, the Indonesian Ministry of Health has estimated that roughly 90% of individuals with severe mental illness have never received any medical attention of any kind. Today, that number is much lower, as continuous care for individuals with severe mental illness is now mandated of all community health centres (puskesmas).
The international media regularly focuses on the still common practice of pasung—the chaining or placing of individuals with severe and persistent mental illness in wooden blocks. Family members often resort to this practice out of sheer desperation to prevent violence or damage to property. Ten years ago, the Ministry of Health initiated the “Indonesia Free from Pasung” (Indonesia bebas Pasung) program, which has had some success. From 2016 to 2018, for example, the number of individuals in pasung dropped from approximately 19,000 to 12,000. Documenting the use of pasung and the state of many informal and official care institutions, the 2016 Human Rights Watch report on individuals with psychosocial disabilities in Indonesia was named Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia.
There is, however, much more to be said about mental health care in Indonesia.
In several locations, innovative and successful initiatives are undertaken to provide treatment for individuals with severe mental illness. In Lombok, for example, psychiatrist Elly Wijaya has set up an effective system to free people from pasung and to keep them out of pasung. Local community health centres (puskesmas) provide follow-up care, and there is a place where former patients can go to during the day and where they are all employed in some way or another. In Yogyakarta, clinical psychologists are associated with community health centres and provide much needed mental health services. After the Boxing Day tsunami, many community mental health nurses were trained to provide basic mental health services, and to identify individuals in need of mental health care within the community.
World Bipolar Day 2017. From left to right, Panca Atis (MC), Hans Pols (author of this blog post), Igi Oktamiasih (one of the founders of BCI and, in 2017, chairperson), Paramitha Rusady (Indonesian TV personality), Agus Sugianto (mental health advocate), Hervita Diatri (psychiatrist), Ade Binarko (MC). (Credit photo: Hans Pols)
In 2014, I started, with Byron Good and Mary-Jo DelVecchio Good from Harvard University, an ARC-funded research project discussing the future of mental health care in Indonesia with Indonesian psychiatrists, psychologists, nurses, social workers, caregivers, individuals with lived experience of mental illness, and mental health advocates. We interviewed hundreds of people, visited many sites, and held several workshops. It became evident to us that most people involved in mental health care are very dedicated and determined to develop and implement new programs and initiatives. The results of our work were recently published in a two-volume edited book Jiwa Sehat, Negara Kuat, to which more than 50 Indonesians have contributed. We are currently preparing an English version.
I recently edited a special issue of the online magazine Inside Indonesia, with 18 short articles on mental health in Indonesia. It provides a good overview of the current state of affairs and the type of initiatives that are currently undertaken.
What I found most striking and encouraging during the several years I visited Indonesia for 2 to 3 months every year was the presence of several consumer and carer groups. They meet a clear need in Indonesia. Access to mental health care services is not always easy and mental health professionals are very, very busy. Individuals with lived experience and their caregivers mutually support each other in how to live with a mental disorder or a psychosocial disability. Physicians can prescribe medication; other mental health professionals can provide support. But managing everyday life with a mental illness is something individuals with a lived experience of mental illness know best.
Among the first associations founded are the Indonesian Mental Health Association (Perimpunan Jiwa Sehat) and the Indonesian Schizophrenia Support Community (Komunitas Peduli Skizofrenia Indonesia). This group was founded by Bagus Utomo in 2001. For years, Bagus and his family had been struggling to care for his brother who has schizophrenia. One day, while browsing the web, he found information about schizophrenia, its symptoms, and treatment options. He translated this information into Indonesian and placed it on the web. Today, KPSI has chapters in many cities, which organise activities for individuals with schizophrenia and provide information to them and their caregivers.
In 2013, Igi Oktamiasih and Vindy Ariela founded Bipolar Care Indonesia (BCI). This group organises activities to support individuals with bipolar disorder and makes information about this condition available. The most important event takes place every year on 30 March, World Bipolar Day. This day is the birthday of Vincent van Gogh, the well-known Dutch artist who suffered from bipolar disorder. BCI has several chapters across the country. In the beginning, Bipolar Care Indonesia was a support group for people with Bipolar Disorder and their caregivers. Later, BCI became a platform to organise campaigns about mental health in general, such as fighting the stigma associated with mental health issues.
There are currently many mental health communities. Unfortunately, most of them are mostly active on the internet only. BCI has stuck to its initial goal—it is still an actual mental health community. Members arrange programs and activities in real life, including mental health seminars, group therapy, and art therapy. According to the people at BCI, real-life activities provide a better opportunity for establishing strong relationships between people with bipolar disorder and their caregivers.
Into the Light Indonesia (ITLI) is a group focusing on suicide prevention. It focuses on conducting research, organising public education sessions, and doing cross-sectoral advocacy for suicide prevention. Benny Prawira founded this group in 2013 after he found that there was hardly any reliable information in Indonesian on suicide and suicide prevention. He also noted the generally negative media coverage of suicide. At that time, there were no services available for individuals with suicidal thoughts. Meanwhile, the stigma around suicide was very strong. Into the Light Indonesia has organised a comprehensive training program for volunteers to learn about suicide, risk groups, mental health system advocacy, program development, and suicide crisis interventions. Graduates are called “Lightbringers”.
One of the most important activities of all these volunteer groups is fighting stigma. The stigma against mental illness and suicide prevents people from seeking the help they need. It causes unnecessary suffering.
Providing accurate and up-to-date information is also central to the mission of these groups.
Unlike some patient advocacy movements in the United States, the mental health support groups in Indonesia work closely with psychiatrists, psychologists, and other mental health professionals. Because of the severe shortage of mental health personnel and mental health services, these voluntary groups play an essential role for individuals with mental illness and those who are contemplating suicide. In addition to receiving adequate mental health care and, where appropriate, medication, individuals with mental illness benefit greatly from participating in these groups. It is individuals with similar conditions who can provide proper support because they know what it is like to live with those conditions.
There are several other mental health associations in Indonesia:
- MotherHope Indonesia (MHI) makes information available about post-natal depression and supports mothers who are affected by it.
- Alzheimer Indonesia (ALZI) supports people who care for individuals who suffer from Alzheimer’s disease.
- Komunitas Jiwa Sehat: their best-known activity is the annual Mental Health Festival.
- Get Happy Yuk Indonesia.
- Bounce Back Indonesia, a community that goes to orphanages and boarding schools, and strives to reach other children at risk to teach them about resilience.
- Alpas Indonesia, which provides psychoeducational sessions and online counselling.
- Depression Warrior Indonesia.
- Ubah Stigma organises interesting campaigns that encourage people to talk about mental health and to practice arts that promote mental health.
- Komunitas Sehat Jiwa dan Bahagia (Sejiwa) uses a positive psychology approach to mental health.
- Teman Peduli promotes mental health awareness through music and other arts:
- Petualangan Menuju Sesuatu is not a mental health community, but its members use storytelling and comics to raise mental health awareness.