Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders

Abstract

Background: Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia. Methods: Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multidisciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited. Results: Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings.

Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis

“…Confinement/pasung and seclusion/seklusi have a negative impact on patients with mental illness, and their use has potential to cause physical harm and further psychological trauma [29]. In addition, many Indonesians adhere to traditional causal beliefs of mental illness, and these beliefs may drive mental health stigma [21,22,26,34,37]. Given that Indonesia is a developing country, it is likely that these traditional beliefs underling mental health stigma are common across rural and urban communities.…”

“…A literature review on mental health in Indonesia conducted in PubMed returned 161 studies published between 1949 and 2020. However, only 15 of these studies discussed stigma either directly or in the context of Indonesian mental health services [18,[30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Among these 15 studies, six discussed stigma in general, consequences of stigma (i.e., "pasung" or confinement), attitudes toward mental health, and perceptions of mental health [18,30,31,[41][42][43].…”

Community engagement strategy for healthy diet in urban community: A phenomenological study

“…Evidence also showed that health promotion intervention that used more than one intervention method and used the environmental change approach would be effective in changing behavior [15,23]. However, health providers should consider the provision of policy framework and the monitoring and evaluation system to ensure community engagement [17,24].…”

“…I mean like 'onthel', make a creative idea. We are more attracted … to the weird content -Female, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]low SES…”

Personal and Perceived Stigmas in Adolescents toward Peers with Mental Disorders in West Sumatra Indonesia

“…Indonesia tend to increase every year [18]. On the other hand, there is an increase in public awareness and strengthening of the mental health system in Indonesia [19]. Based on the phenomenon, there was greater interest in exploring the stigma of mental disorders among adolescents.…”