YOGYAKARTA, Indonesia — The National Alliance on Mental Illness has designated May as Mental Health Month. The month is devoted to raising awareness about the importance of mental wellness and reducing the stigma against mental illness. Many developed nations have the means to provide adequate psychiatric counseling; however, some developing nations are forced to cope with hostile conditions and limited resources. Here are some ways that people are combating mental illness in Indonesia.
The Prevalence of Mental Illness in Indonesia
Indonesia, a country in Asia that is home to 264 million people, is facing a mental health crisis of its own. In October 2018, it was reported that the prevalence rate of individuals with extreme mental health disorders was 1.7 percent and as high as 2.2 percent in some rural communities. Specifically, 3.7 percent of the population, or nine million out of more than 250 million people, suffer from depression. Additionally, 6 percent of people ages 15 and older display symptoms of suffering from an emotional mental disorder, such as anxiety. That equates to 14 million people throughout the country.
Two of the most common explanations for mental illness issues in Indonesia are the persistent stigma surrounding it and the lack of psychiatric professionals available. Fortunately, the continuing effort of institutions like the Human Rights Watch and the Ministry of Health has been making progress. Living conditions for those with psychiatric illnesses still have a long way to go but the potential for continued improvement.
The Stigma Around Mental Illness
Stigma is the negative labeling or disapproval of a person based upon social characteristics. Those with psychiatric disorders often fall victim to societal stigma, exacerbating the challenges they face. Individuals with mental illness in Indonesia often face discrimination and isolation. There is a very limited understanding of mental disorders in the nation, and the lack of exposure has created a climate that is hostile and resistant towards people who behave unusually.
One of the results of the stigma is a gruesome practice known as pasung, the practice of confining and restraining the mentally ill. In 2016, the Human Rights Watch reported that 18,000 Indonesians demonstrating signs of a mental health problem were locked in institutions or living in shackles with more abuse offered than treatment.
The practice of pasung was outlawed in the nation in 1977, but due to the persistent stigma and lack of treatment facilities, it has remained widespread. Often, pasung is carried out in an effort to enforce safety and protection in rural communities where mental illness is largely misunderstood and many people view those behaving erratically as a danger to society.
Shortage of Mental Health Professionals
Despite the high prevalence rates of mental illness in Indonesia, the nation currently only has around 800 psychiatrists, 450 clinical psychologists and 48 mental health facilities among a population of more than 250 million people. Of the 48 facilities, more than half are spread throughout only four of the 34 provinces, making mental healthcare inaccessible for the majority of the population.
In 2008, the Indonesian government recognized psychologists as health workers among doctors, nurses, nutritionists and midwives. Despite this, psychologists and clinical mental health workers have not been given priority in comparison to other medical professionals. The city of Yogyakarta is the only city that was able to successfully place a psychologist in all of its 18 public health posts.
The Human Rights Watch
The Human Rights Watch is an international NGO that carries out research regarding human rights issues around the world and advocates for policy change. In 2016, the organization exposed the brutal treatment of those with mental illness in Indonesia, sharing personal stories and revealing the startling statistic that 18,000 people with psychosocial disabilities were living in shackles. Since 2016, 5,200 individuals have been released following persistent advocacy and community outreach to more than 16.2 million households in the region.
Human Rights Watch has visited Indonesia five times over the last three years to keep tabs on the number of people being released and to conduct interviews with family members of the imprisoned. However, they feel that progress has been limited and are still advocating for improved living conditions in Indonesia. The organization has created the hashtag “#BreakTheChains,” to put a stop to shackling and confinement, and it encourages the community to take to social media, specifically the Social Affairs Ministers page.
The Healthy Indonesian Program with a Family Approach
In January 2017, the Healthy Indonesian Program with a Family Approach was launched. This is a comprehensive program that covers 12 facets of family health, including mental health. This is a significant step forward in the integration of mental and physical wellness. The program sends health workers directly into communities where they gather data in addition to raising awareness about health issues and providing available services.
As of September 2018, the program had reached 16.2 million Indonesian households, which is around 25 percent of the population. The government is aiming to achieve full coverage by the end of 2019, reaching around 65 million households. Mental health is being considered as equally important as all of the other sectors, which include child nutrition, access to clean water and immunization.
The program’s success rests upon the house visits, a highly-regulated process that involves identifying which indicator needs the most assistance, providing counseling and offering a free national health insurance card. When community outreach workers come across an individual with psychosocial disabilities, they offer the opportunity to visit the community health center for counseling or suggest peer support groups via WhatsApp. The program is still in the data-collection phase, so there are limited statistics regarding its overall impact.
Although mental illness in Indonesia and the practice of pasung still remain extremely problematic, there is positive work being done to affect real change. With the collaboration of the Social Affairs Ministry, the Health Ministry and advocacy from organizations like the Human Rights Watch, there is potential for the thousands of people suffering to receive support and treatment.