The shortage of mental health workers in Indonesia

Because of its size, Indonesia faces a serious shortage of mental health practitioners. The largest economy in South-East Asia, Indonesia has 260 billion inhabitants but only 773 psychiatrists and 451 clinical psychologists.

In 2008, the Indonesian government recognized psychologists as health workers. But the placement of a psychologist in a public health post, or Puskesmasin Indonesia was not considered crucial, unlike the placements of doctors, nurses, midwives, nutritionists and sanitation technicians.

There are sporadic attempts to provide a psychologist in Puskesmas. The city of Yogyakarta, for example, has managed to place a psychologist in all of her 18 Puskesmas since 2010. But no other city or district has a similar policy.

Mental health disorders in Indonesia

Mental health disorders are often hidden. People often think of mental disorders with images of a naked and homeless person on the street. But there is a wide range of these problems.

Mental health issues are stigmatized. Among the general public, this goes from stereotypes and prejudices to discrimination against people with mental illness. People with mental health problems are often considered dangerous, possessed by demons or affected by black magic.

The resulting fears suggest that they should be kept out of the communities. As a result, in 2017, 28.1% of people with mental illness were still stuck or chained in or around their homes. Self-stigma turns the victims against themselves, preventing them and their families from seeking help quickly and preventing them from receiving proper treatment and care.

Victims of disasters are also very vulnerable to mental health problems. As Indonesia is located in an area at high risk of earthquakes, tsunamis and volcanic eruptions, many people have been affected by disasters. They need psychological support to get through the hard times of losing loved ones, their property and fear of future disasters.

Another mental health problem, rarely addressed in Indonesia, is peripartum depression, occurring during pregnancy and after childbirth. The World Health Organization (WHO) reports that in developing countries, 15.6% of pregnant women and 19.8% of breastfeeding women suffer from this disease.

Depression can not only lead to suicides, but it also reduces mothers' ability to take care of their children. Given the country's focus on efforts to reduce stunting, screening for peripartum depression and helping mothers get treatment can help them raise healthy children and intelligent.

Mental health problems occur in people of all ages. Mental disorders are common among young people because it is at this point that people face many different transitions in life. The World Day of Mental Health of WHO 2018 (October 10) recognized this fact by proposing this year's theme "Youth and Mental Health in a Changing World".

But mental problems also affect the middle-aged population. A national survey conducted in 2013 showed that the proportion of mental and emotional problems increased with age. Problems are also common among the poor.

Train health professionals to detect depression in mothers

To help solve mental health problems in mothers, we conducted a project called Kenal Ibu – vaguely translated by knowing mothers – to Banyuwangi and Banda Aceh. The project attempts to help health managers and midwives to detect pregnant and lactating women with depression by using appropriate screening tools.

We have developed training modules and trained 103 health workers in Banyuwangi and Banda Aceh, including health managers, midwives and mental health nurses. After the training, health managers were able to use the tools to detect women in difficulty and refer them to midwives or mental health nurses for further testing and counseling.

Village health officials, the village women, said that they had learned how to use the screening tools and to use them had allowed them to identify problems they were not aware of. in the past.

A midwife mentioned that she had already had a patient, a new mother with behavioral problems, who was not able to feel love for her newborn baby. The midwife did not know how to help. She did not know that her patient was suffering from depression. His job was only to look after the physical health of mothers and children.

But after training and implementation in the field, the midwife can now identify women with potential problems. She is now able to give a name to the disease and know that these women need additional help from professionals.

Role of the government

A recent study published in The lancet Nafsiah Mboi said that the number of years of illness or disability due to noncommunicable diseases, including mental disorders, has increased. The DALY for depressive disorder increased by 37.5% between 1990 and 2006 and continued to increase by 19.8% between 2006 and 2016. This makes the mental disorder the 19th of the leading causes of disability in 2016, up from 29th in 1990.

To raise public awareness of mental health issues, the Ministry of Health has provided online content and an Android-based application. Sehat Jiwa (Healthy Soul) that can be used for self-screening of various mental health issues. The application has more than 1000 users so far.

Screening tools are available to help health practitioners and individuals identify mental health issues. But Indonesia still has to send people diagnosed with mental health problems back to treatment.

It is estimated that between 76% and 85% of people with mental disorders in low- and middle-income countries receive no treatment. Globally, there are only nine mental health workers per 100,000 population. Indonesia would need 7,500 mental health workers to provide adequate psychiatric services to its population.

If Indonesia really wants to ensure that its population of 260 million is healthy and resilient to disasters, the country should start investing in mental health. Ensure that each community health station (Puskesmas) trained staff to detect, treat and treat people with mental disorders.

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