Recognizing that the root of psychiatric problems often stems from psychosocial problems, the motto needs to be complemented by "There is no mental health without social health."
By
EUNIKE SRI TYAS SUCI
·9 minutes read
Kompas
Heryunanto
World Mental Health Day (HKJS) which falls on October 10, 2021 takes the theme "Mental Health in an Unequal World," and the Indonesian Ministry of Health added the national sub-theme "Equality in Mental Health for All." That is, equality in mental health for all Indonesians in an unequal world. A noble ideal and worth fighting for, even in reality it is very difficult to achieve, even approaching "mission impossible."
Equality in health in general is still a big homework of the government considering the main indicators of Indonesia\'s health are still of concern compared to ASEAN neighboring countries. Even with Viet Nam that is just recovered from the Viet Nam War of the 1970s, some indicators of Indonesia\'s health are still below Viet Nam\'s. For example, in 2017 Indonesia\'s birth rate was 18.5 per 1000 population, while Viet Nam was able to suppress 14.9 per 1000 population. The infant mortality rate in Indonesia is 25.1 per 1000 live births, and Viet Nam managed to decrease by 14.4 per 1000 live births (ASEAN Statistical Yearbook 2020). Demographic and epidemiological transitions show a shift in the dominance of the burden of diseases, from infectious diseases to non-communicable diseases (Ministry of VAT / Bappenas 2019). Being in transition indicates Indonesia bears a double burden, where the problem of infectious diseases has not been resolved completely, has been followed by the burden of non-communicable diseases. And what about mental health?
Data talks reality
If the calculation of the prevalence rate of Riset Kesehatan Dasar (Riskesdas/Basic Health Research) 2018 is re-weighted to the individual level, then mental health indicators in Indonesia stagnate. The prevalence of severe mental disorders (schizophrenia) in Riskesdas 2013 and 2018 was relatively the same, at 1.7 and 1,675 per 1000 population (Suci, 2021). Reports of an increase in the number of cases occurred due to an increase in the number of population for 5 years. The proportion of “pasung” reported in both data is also not much different, namely 14.3% (2013) and 14% (2018). In fact, the Pasung Free Indonesia movement has been launched since 2010.
Mental health is often narrowly defined as liberating individuals from severe mental disorders such as schizophrenia. Law No. 18/2014 on mental health defines that mental health is "a condition in which an individual can develop physically, mentally, spiritually, and socially so that the individual is aware of his or her own abilities, can cope with stress, can work productively, and is able to contribute to his community." Thus the scope of mental health problems is actually very wide ranging from people with psychological problems (ODMK) to people with mental disorders (ODGJ).
The problem of ODMK is more difficult to estimate because we can not count the number of individuals who experience stress if they do not report and seek help. Riskesdas data shows an increase in the prevalence of emotional mental disorders from 6% (2013) to 9.8% (2018). If ODMK doesn\'t get help, they run the risk of becoming ODGJ.
KOMPAS/AGUS SUSANTO
People with mental disorders (ODGJ) bask in the morning sun at the Jamrud Biru Foundation mental disability rehabilitation center, Mustikasari Village, Mustikajaya District, Bekasi City, West Java, Wednesday (14/4/2021)
Unequal reality
Inequalities in mental health in Indonesia are caused by a variety of factors. First, the geographical and demographic conditions of Indonesia which is the largest archipelago in the world with more than 17 thousand islands where the population is spread across 6000 islands. Of the total 275 million people, 66% live on the island of Java which is not up to 7% of the entire Indonesian mainland. These geographical and demographic conditions complicate equitable mental health efforts.
Second, the ratio and distribution of mental health workers in Indonesia is still far from expectations. Currently it is estimated that there are 987 psychiatrists, 7000 mental nurses and 3,349 clinical psychologists in Indonesia (Suci 2021; ipkindonesia.or.id). Thus, a psychiatrist served 273,154 residents, while a mental nurse served 38,515 residents, and a clinical psychologist served 81,287 residents. The number is far from ideal, especially the distribution is uneven. For example, clinical psychologists, in DKI Jakarta there are 418 clinical psychologists with a ratio of a clinical psychologist serving 25,301 residents. Meanwhile, in NTT there are only 11 clinical psychologists where each clinical psychologist serves 501,218 residents.
Third, stigma and discrimination. Individuals with psychological problems are reluctant to seek help in the health service because they feel unnecessary, distant, or afraid of stigma, bullying and discrimination. Some people, media workers (newspapers, magazines, TV and social media), even health workers remain using the word \'crazy (gila)\' to ODGJ.
Fourth, a limited mental health budget, about 1% of the total health budget (Pols 2020). Mental health is under the Directorate of Prevention and Control of Mental Health and Drug Problems. This means that the budget for mental health is shared with drugs. In districts/cities level, regional autonomy (otonomi daerah) makes the local government authorized to allocate regional budgets in accordance with what is deemed necessary. That is, local governments that do not care about mental health can design a very limited budget.
Mental Health during the Covid-19 Pandemic
The Covid-19 pandemic that lasted almost 20 months changed the plans that had been prepared before. Central and local governments need to reallocate budgets with pandemic management priorities. As a result, the mental health budget is slightly at risk of being reduced. In fact, this prolonged pandemic changed the lifestyle and behavior of the community.
The Indonesian Association of Psychiatrists (PDSKJI) provides online swaperiksa (self check) services related to anxiety, depression, and trauma on its main webpage. There are 2364 service users spread across 34 provinces. A total of 69% admitted to psychological problems, 68% anxiety, 67% depression, and 77% psychological trauma. 49% of those who were depressed thought of death (http://pdskji.org/home).
Not only people who experience psychological or psychiatric problems, but health workers as well. The Indonesian Health Psychology Association (APKI, 2020) conducted an online survey of 213 health workers and found that 27.3% needed family support and 25.6% needed support from fellow professions. The need for professional counseling or psychologists only ranges from 11-13%. The stigma of being a client of a counselor or psychologist may be a consideration.
Kompas
Doctor Ratna Dewi (right) serves patients at the Curhat Clinic, Krian Health Center (Puskesmas), Thursday (1/10/2020). Mental health checks and counseling are part of the services provided by the Krian Puskesmas.
Community-Based Mental Health
The World Health Organization (WHO) has updated the Mental Health Action Plan 2013-2020 to the Comprehensive Mental Health Action Plan 2013-2030. The four main objectives remain unchanged indicating that the four goals have not been achieved so they need to be extended until 2030, namely: (1) strengthening leadership and governance; (2) comprehensive, integrated and responsive community-based social welfare and social services; (3) implementation of promotion and invention; and (4) strengthening information systems, evidence and research. The implementation of the action plan needs to uphold six basic principles including universal health coverage, human rights, lifelong approaches, and cross-sector engagement.
In Indonesia, the implementation of the Action Plan for health and social welfare services involves the ministry of health and the ministry of social affairs. With regional autonomy, the implementation of health and social services needs to involve local governments. The strengthening of leadership and governance becomes absolute so that mental health and social services for people with mental disabilities get comprehensive treatment. In this case, strengthening information systems and coordination between local governments, health services, and social services is needed.
The involvement of community components, both religious leaders, community leaders, activists of mental health, and local & social media has tremendous leverage in evoking local governments to improve mental health services. Internet access and social media during pandemics became more intense as people were expected to stay home and do daily activities (work, school, college, shopping, etc.) online.
Mental health problems are not only about severe mental disorders such as schizophrenia, but also those living in societies that experience psychological. Because their social function can still be done, the number of cases of people reported experiencing psychiatric problems is like the peak phenomenon of the iceberg because the actual number is difficult to know and may be much larger. Action plan no (4), namely the implementation of promotion and invention into an inevitability. Severe mental disorders do not occur suddenly, they are the product of unresolved individual psychosocial problems. Genetic and biological factors (e.g. brain injury) are also contributing to cases of severe mental disorders, but the number is smaller.
If severe mental disorders require professional help (psychiatrists, clinical psychologists, mental health nurses), promotional efforts and inventions for the management of psychosocial problems need to involve social experts (scholars in psychology, psychologists, anthropologists, sociologists, lawyers, social workers, etc.), as well as all components of society (cadres, NGOs, religious leaders, and public figure). In the WHO\'s Optimal Mental Health Services Pyramid, it is evident that the needs of this second group are at the bottom two stages of the pyramid, where the number of informal mental health services needed is huge and low-cost. Self-care becomes sokoguru (integral) because it becomes a basic effort of invention and passes on all mental health services both formal and informal. Conversely, formal health services in the setting of Health Centers, Hospitals, and Mental Hospitals are needed for those with mental disorders. The need is lower, but the cost is higher. Thus the efforts of invention and promotion that can be done by all components of society and mental health activists are the spearhead of complete mental health services.
Hope is there.
There is no mental health without social health
The mental health services pyramid that integrates community components can be expected to be able to close the shortage of mental health professionals in a relatively shorter time, consider waiting for students to complete their education. The involvement of community components also gives space to mental health professionals to be with family and friends to maintain their own mental health. Teresa Hoeft et al (2017) call it task-sharing or task-shifting.
The book "Healthy Soul, Strong State: The Future of Mental Health Services in Indonesia" (Pols et al 2019) clearly explains how task-sharing was successfully implemented in Aceh at the time of the tsunami that had devastated the province. The success of this "Aceh Model" is expected to be applied by other provinces certainly by considering local demographic and cultural conditions.
DOKUMENTASI PRIBADI
EUNIKE SRI TYAS SUCI
Mental health deserves greater attention both by the central and local governments, as well as by community components. Considering the definition of health that cover the physical, mental, and social aspects, then the health of the individual is not separated from his mental health. "There is no health without mental health",said Prince et al. (2007). Recognizing that the root of psychiatric problems often stems from psychosocial problems, the motto needs to be complemented by "There is no mental health without social health."
Eunike Sri Tyas Suci, Chairman of the Indonesian Health Psychology Association / Unika Atma Jaya Lecturer
/https%3A%2F%2Fkompas.id%2Fwp-content%2Fuploads%2F2021%2F04%2F4b2d52c4-03cc-4544-a758-1a6978e2bc57_jpg.jpg){kind=logo}
