Indonesia's Mental Health Landscape

• Locally, the treatment gap for Indonesia for psychosis is the highest at 96.5% among developing countries. 
• According to Indonesia’s 2007 Demography and Health Survey, 11.6 percent of people, 15 years old and above, experienced minor mental health problems such as anxiety and depression while 0.46 percent of the total population of the country experienced serious depression, such as manic depression or schizophrenia (The Jakarta Post, 2011). 
• An estimated 1.1 million Indonesians suffers from serious and chronic mental health issues. Yet only 0.023% of the 2011 Indonesian budget is spent on mental health, given that the health budget accounted for only 2.3% of the total national budget (Suarez, 2011). 
• It is no wonder that there is a severe shortage of mental health services. In a country of almost 240 million people, there are only about 800 psychiatrists out of the recommended 8,000 (if the ratio of 1 psychiatrist : 100,000 population is kept), implying a shortage of 90% (WHO, 2011; The Jakarta Post, 2011)! 
• There are 48 mental hospitals with more than half of these psychiatric hospitals located in four out of 34 provinces. Eight provinces does not have psychiatric hospitals to date. 
• The unequal distribution of mental health services, with concentration in big cities like Jakarta and Surabaya, meant that there is an inherent structural difficulty in access for persons with mental illness(es). Most do not get the services they require and families resort to restraining their children as a result. 
• The phenomenon of pasung has gained the attention of Human Rights Watch and is considered a severe violation of human rights. In 2014, the Mental Health Law was passed, emphasising that “treatments for mentally ill people should ‘provide protection and guarantee services’ and ensure no human rights violations in the process (Jakarta Globe, 2014).” 
• It may still be a long process before most persons with mental illness(es) get treated in Indonesia but the law has created momentum for “Bebas Pasung” the freeing of persons with mental illness(es) who are chained. This is a good sign.

  

Comparison of Mental Health Capacity of Southeast Asian Nations

Regionally, mental health has been a low priority. In most of the Southeast Asian countries, “mental health spending is no more than 2% of the health budget, with 80 - 90% going to mental hospitals.” Poor mental health has also been linked to slower development. “The direct consequences of neglect are many, including avoidable disability, impoverishment, and widespread human-rights abuses (in the region).” A comparison of the mental health capacity across Southeast Asian nations can be found in the Table above (Maramis, Van Tuan & Minas, 2011). 

Perceived Barriers to Help-Seeking: Perceived Stigma, Poor Mental Health Literacy and Lack of awareness on places to seek help

What are the perceived barriers towards help-seeking in Yogyakarta among youths?

According to the youths surveyed, the top five barriers towards help-seeking are (1) lack of awareness of mental illness (61.8% - 131 respondents), (2) lack of knowledge on places to seek help (52.8% - 112 respondents), (3) perceived social judgement by peers (48.6% - 103 respondents), (4) fear of others knowing that they are seeking help (40.1% - 85 respondents) and the (5) lack of support from parents (32.1% - 68 respondents). 

Perceived barriers -- across cultures 

	Comparisons across culture
		WESTERN	SINGAPORE	YOGYAKARTA
1	Barriers to help-seeking	Lack of a perceived need for help	Fear of Peer Stigma	Lack of awareness
2		Lack of awareness of services or insurance coverage	Lack of information on where to seek help	Lack of knowledge on were to seek help
3		Scepticism — perceived ineffectiveness of treatment programme	Lack of time	Perceived social judgement by peers — fear of peer stigma
4		Religious prohibition and discouragement	Parents do not encourage help-seeking	Fear of others knowing
5			Fear that conditions will not be kept confidential by schools	Lack of support from parents

• A comparison across three cultural contexts of Western, Singapore4 and Yogyakarta, revealed that the factors of perceived stigma, poor mental health literacy and lack of awareness on places to seek help, consistently surfaced as key barriers towards help-seeking. 
• This finding has implications on the prioritisation of mental health promotion, prevention and engagement efforts, when tackling barriers. 
• Strategies for improving help-seeking for youths should focus on reducing perceived stigma by debunking myths and abating concerns that others will judge, improving mental health literacy and in raising awareness of the public on places offering mental health services. 

Let's build a mentally healthy generation (7/11)

[7 NOV 2015] SEMINAR SOSIALIASI KESEHATAN JIWA “MENYIAPKAN GENERASI SEHAT JIWA SEJAK DINI” @ RSJ GRHASIA DIY

Observation

• lack of appreciation shown via a lack of clapping at seminars
• leaving things behind for others to clear
• need to have an official opening
• Only 12 out of 80 in attendance are males
• It is interesting to see what psychologist Dr. Adiyanti classify as problems and strengths of youths
• Spirituality is a major component of mental health in Indonesia
• Definition of “what does it mean to have a mentally healthy generation?”
• Creating a generation that is not free from all problems but one that can solve their own problems
• Dr. Ida: Attribution of causes to B.P.S., when do we need to bring the kid to the professional?

#aib = #stigma 

#attributionofcauses 

#discipliningofunreasonbyreason

Dr. Maria Adiyanti	What will you prioritise as the issues to resolve for children and youths?
Dr. Astriana Praharani, Sp.A, Child Specialist Dr. Ida Rochmawati M.Sc. Sp. KJ (K) RSUD Wonosari Gunung Kidul	What do people in the community usually attribute as the causes of mental illnesses? Aib (stigma / dishonor / disgrace)

KESWAMAS

• focus on promotion and prevention

Mbak Tyas’s speech:

• over social media, we have seen cases of cyber-bullying
• this world we are living in, has many influences 
• challenges for raising and educating kids

Audience

• Dinas Kesehatan Kabupaten — healthcare policymakers
• TK (kindergarten) teachers
• Healthcare Professionals

Head, RSJ Grhasia

• “We need to go close to the community, the mental health hospital cannot just stay in the institution. We need to have efforts that focus on promotion and prevention. That’s why KESWAMAS was started.” 

dr. Astriana Praharani, Sp.A, Child Specialist

• growth stages of children

MENCIPTAKAN GENERASI SEHAT JIWA (CREATING A MENTALLY HEALTHY GENERATION)

Dr. MG. Adiyanti

Just like cooking “nasi goreng,” the taste cooked by different people always come out different. Even though, the ingredients added and climate might be similar. Nurturing kids and youths are not that much different. 

Some problems

• hooked on to phones
• depression by loneliness / neglect / bullying
• child abuse
• cyber bullying
• bullying in school
• lack of aspirations
• free sex
• pre-martial sex and closeness
• heavy smoking
• glue sniffing (even for kids) and drugs
• abortions

Some strengths

• people dedicated to the promotion and participation of arts and culture
• participation in competititons, bringing glory
• participation in KKN
• working to provide for family
• participation in discussions for academic improvements

The double-lives of youths

• religiousity — pray 5 times a day
• but take drugs 5 times a day too
• and say as long as he don’t get caught, he will continue

What does it mean to have a mentally health generation?

• A generation that is not only physically healthy, but also psychologically and spiritually 
• sebagai generasi yang sehat baik fisik, psikis maupun rohani
• Generation
• not a generation that is free from all problems
• but a generation that can solve their own problems by their own means
• people who can be accepted by their neighbourhood
• people who do not causes harm to others
• people who do not hurt themselves

Contribution

• organic
• supervision
• by teachers and parents
• interpersonal
• intrapersonal 
• socioeconomic status

The conditions are different

• technologically savvy
• connected generation
• information-bombarded generation

“It takes a village to raise a child.” — African Proverb, popularised by Hillary Clinton

The village in Yogyakarta, Indonesia consists of:

• Playgroup (TK)
• Sessions for kids to read the koran
• Plays for learn-n-play
• Scouts
• Pendidikan Anak Usia Dini - early childhood education programmes
• Summer camp adventure club

Strategies

• give kids money to shop but give rules — learn skills of financial planning, budgeting

Kid get bullied but dare not say out of threats.

• How will parents / teachers resolve this problem?
• Kids solved their own problem:
• teacher ask what can you all do?
• the kids thought and said we can accompany each other
• safety in company 

Thinking out of the box

Mengenal dan Mengelola Kesehtan Jiwa pada anak dan remaja

Dr. Ida Rochmawati M.Sc. Sp. KJ (K) RSUD Wonosari Gunung Kidul

Problems

• what does it mean to be “naughty” for kids?
• could it be attention-deficit disorder? or ADHD instead?
• Social training — whose role is it? — a prevalent perception of females below males?

Why is it important for us to talk about mental health in Yogyakarta?

• Berdasarkan hasil Riset Kesehatan Dasar (RISKEDAS) 2007 prosentase gangguan mental emosional mencapai, 11.6% dari sekitar 19 juta penduduk yang berusia 15 tahun ke atas
• Based on the results of Basic Health Research in 2007 the percentage of mental disorders emotional reach, 11.6% of the approximately 19 million people aged 15 years and over

What are the common mental health conditions?

• Cemas pada anak (anxiety)
• usually expressed through physical reactions (inability to relax, always falling sick, headache)
• affective disturbance — depression
• gangguan perilaku (disturbed behaviour)
• eating disorders
• PICA
• Anorexia
• Bulimia
• elimination disorders
• Enueresis
• psychosis

• Autism
• Mental retardation

Insomnia (types)

• broken insomnia — usually depression
• insomnia alone — usually anxiety
• insomnia — can sleep but wake up early and can’t return to sleep

Apa penyebab dari gangguan jiwa? (What causes mental disorders?)

• Biological
• Psychological
• Social

Stigma

• erroneous perceptions from the community
• it delays help-seeking behaviour
• because of erroneous attribution of problems — not to BPS

Peer Haritz: Gila, Identification by Appearance & Perpetuation of Stigma (19/10)

Lecturer Pak Koentjoro: "Mental health is harmony!" (15/10)

Interview with Pak Koentjoro on mental health community development(15/10)

Perceptions towards ODS & Integration (How) (9/10)

Perceptions towards ODS & Integration (How)

What is it shaped by?

- exposure to media

TV (electronic)

Print (newspaper and magazines)

- family's reactions 

According to Pak Harry

- some call them "gila"

- some see them as "lucu" - a laughing joke

- others make fun of them and see them as source of amusement

Stigma exists among neighbours and friends.

How can we achieve integration?

Systemic (Mbak Aspi)

Devotion of more Economic resources

As an individual, shift in mindset

- we can learn more

- we need to stop seeing them as not normal - and other-ing them

- it's true that they are sick (illness)

- we can and must see their assets and appreciate their ability to do small tasks

For caregivers

- help them care for ODS

- enable them to educate others - share their story with others

- support others