Actual Challenges of Mental Health in Indonesia: Urgency, UHC, Humanity, and Government Commitment

Presenter: Aisyah Putri Rahvy
Author: Aisyah Putri Rahvy, Ilham Akhsanu Ridlo
For poster presentation session on 16th World Congress on Public Health 2020

WHO’s statement “there is no health without mental health” is indeed a fact. Mental issues have become another haunt in public health. Years ago, most developing countries including Indonesia mainly focus on infectious and non-infectious diseases, often labelled as physical health issue. But lately mental issues are being in the spotlight after number of mental health cases were increasing, indicating the need of policy and attention from government and also society. This article will elaborate data as reasons why mental health policy should be reformed.

In Indonesia, mental health or kesehatan jiwa is primarily ruled by UU No.18 Tahun 2014 tentang Kesehatan Jiwa. Another related policy found is Permenkes No. 54 tahun 2017 tentang Penanggulangan Pemasungan pada ODGJ, which describes the procedures to prevent confinement to people with mental illness. After analyzing current situation and policy implemented, researchers may conclude that current policy is not enough. Riskesdas (2018), national health survey conducted by Indonesian government showed that 14% of families did confinement, with 31.5% did it in the last 3 months. Moreover, 15,1% patients who were suffered from schizophrenia did not take medication while 61,1% of those who received it did not maintain their medication.

Riskesdas also showed the increase of emotional issue in all provinces in Indonesia, compared to 5 years ago based on Riskesdas 2013. And from 6,1% prevalence of depression among people above 15 years old, only 9% received treatments. These data proved that current mental health policy implementation is challenged by a lot of problems. First one, WHO report in 2017 noted some problems related to human resources in mental health field. Indonesia only reached psychiatrist rate 0.31, mental health nurses rate 2.52, and social workers rate 0.17 (all per 100.000 population), confirming the lack of mental health resources in Indonesia. Study from Idiani and Riyadi (2018) made it clear that some health services in provinces in Indonesia were lacked of mental health services. From 685 public hospital owned by government, only 32,5% of them had psychiatry services with just 8% had inpatient services. These researches and surveys prove the problem of Universal Health Coverage in mental health field in Indonesia.

Furthermore, mental health is also supposed to be provided in primary health care. Another issue found about this is health workers are still dealing with stigma about mental health patients in society. This condition leads to confinement, a much greater issue of humanity in mental health cases. On the other hand, confinement phenomena also proves the family’s lack of trust to health workers or health facilities which cause the reluctant of family to bring patients to proper mental health facilities. Primary health care also experienced problems related to unclear data management when health workers wanted to report some mental health issues like dementia, but there was no such option in the report (Idaiani and Riyadi, 2018). This is in line with Ridlo and Zein (2018) who mentioned that Indonesia was lacking of mental health data because the only related data found in national level was Riskesdas.

Mental health is an important part of the complete state of health. Mental health issue may lead to loss of productivity and other physical health issues. If government still relies only on current policy implementation, the prevalence of mental health disease and its economic loss will increase rapidly. In Indonesia, DALYs reached 2,463.29 per 100.000 population and suicide mortality rate 3.4 with no strategy related to suicide prevention found (WHO, 2017). Just like Australia and other countries, Indonesia also needs to make national calculation about mental health’s economic loss in order to push the urgency of this issue and reform policy.

Meanwhile, this pandemic era also worsens mental health issues, as data showed that general population prevalence of PTSD has been ranging from 4% to 41%; while prevalence of major depression increased by 7% after the outbreak. Health workers have greater exposure to mental health issues since they experience over workload, lack of rest and attention, risk of infection, and many more. Moreover, pandemic may affect confinement cases as well. Family with schizophrenia patients for example, will be affected both in subjective and objective care so that patients’ quality of care will be impacted as a whole.

Government should integrate mental health services into community-based services as a way to ensure universal coverage of mental health services. Putri et al. (2013) had described the potential of Desa Siaga Sehat Jiwa (DSSJ), which proposed the concept of community mental health nurse. Their study showed the effectivity of this program to reduce stigma in society. Integrating mental health services into community-based services will be a bottom-up empowerment, and it will solve problems of resources and stigma that obstruct the success of mental health program in Indonesia. This also supports family as caretaker of patients and reduce the possibility of relapse.

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