Global & National

Mental Health and Psychosocioal

Problems
2020
 Learning objective:

• After learning this lecture it is

expected that the students will
understand
mental health (MH) &
psychosocial problems 
plan prompt intervention

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Psychosocial Problem
 Introduction:

 Understanding MH & psychosocial

problems is important for establishing
mental health intervention
 Health providers - who have western
perspective – and work in non western
community have to understand the
perspective of the people to whom they
work with before understand their
problems
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Psychosocial Problem
 Factors that have contribution to
M H and psychosocial problems
 Population:
Indonsia Global
Population > 267,7 m (World
Bank,2018)
> 7,792 b (United
Nation, 2019)

Population 1,05 % (United Nation,

2017)
1,09 % (United
Nation, 2017)
Growth Rate
Maternal 177/ World Bank, 211 / World Bank,
2018
mortality ratio 100,000 lb 2018
100.000 lb

Life Overall 71,5 UNDP, 2018

expectancy F: 73,7
M: 69,4
Living in
poverty:

< USD3,2 / d 24,2 %

World Bank,
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< USD 5,5 / d 56 % < 2018 Mental Health &
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Psychosocial Problem
  AKI: 305/100.000 kelahiran hidup (Supas, 2015)
 Birth rate 4,5 million / y  44 mother die / d
 Number of children rate 2.6  number of
orphaned increase 110/day
 Urban population: 53,7% (WHO,2017)
 Prevalence first marriage 15-19 y: 41,9%,
10 – 14 y : 4,2 %
 Prevalence first have girl/boy friend (15-19 y)
< 15 y  boy 34,5% girl 33,3% (Kemenkes RI, 2016)
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  Divorce rate 10-30% (212.000 cases/y) (Kemenkes
RI,2016)

 Elderly: 9,99% (2020) (Kemenkes 2019)

 Unemployement : 5,0 % (Afriyadi & Dwi, 2019)

 Total dependency ratio: 47,5%

 Number pregnant mother & child with under
nutrition and exposed to pollution increase
 Prevalence of handycaped people 15% (WHO, 2018)

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  Number of groups too many  too various
languages & concept of thingking  conflict
 man made disasters
 Social relation sosial pressure/suport
 Geographic
 Number of provinces: 34
 Number of occupied islands > 6.000 (from > 18.000
islands)
 Disaster prone areas  natural disasters
 Lack of coordination (interprofessions,
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interministry)
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8
 MH Services Problems
 Limited (human) resources
 Underqualified services, focus on hospital setting
 Treatment gap 83-90%
 Cases need long life & inter sectoral interventions:
 Survivors of disasters  psychosocial problems
 Specific mental problem in community  panti
 Limited state mental hospitals:
 Long life patients  need rehabilitation center
 Not all puskesmas has mental health service
 Lack of coordination

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 Suicide rate increase, most of people who
commited suicide met doctor in primary
service but not obtained intervention
 Highest case between 15 – 24 tahun,
 comite suicide: male 4 X female
 attemp suicide female 4 X male
 South East Asia 13,4 / 100.000 pop
 Indonesia: 3,7 / 100.00 population (WHO,2016)

 Jakarta  1,2 / 100.000 population

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 http://nasional.vivanews.com/news/read/110420-kasus_bunuh_diri_di_indonesia
Psychosocial Problem
Problems  poor mental health service
in primary health service

 Mental health service is not priority

program explicitly
 Limitation of resources:
 Man power
 Psychotropic
 Room
 Time etc

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The ecology of medical care

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Mental Health:
 Healthy mental person:
 Have constructive adaptation
 Obtained the satisfaction of his
effort
 Provide contribution
 Free from tension, anxious and
sadness
 Mutual relationship.
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Psychosocial Problem
 Mental Health & Psychosocial
Problems in Indonesia

 life time prevalence of mental &

behavior disorders among general
population ( 25% ),

 Global point prevalence of mental &

behavior disorders among adult is 10%
(WHO report, 2001)

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 WHO report 2001

 24% of patient who seek treatment to

primary health doctors  mental disorders
 69% of them come with physical complaints
& no evidence of any physical disease.
  40% out of them was misdiagnosed 
spend money for un-necessary test & tx
(Target of coverage of mental health
problem in Puskesmas: 15 % of patient)
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 Effect of transformation & transition
 new problem  additional burden:
 Alteration in life style, attitude, & life
value pattern
 In health sector: epidemiological
transition of infectious disease to non
infectious disease and behavior
related disease and mental
disorders.

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Psychosocial Problem
 Prevalence of emotional mental
disorders:
 5-14 y: 104/1000
 > 15 y: 140/1000
(Household survey of mental health problem:Central Statistic Bureau, MoHealth, 1995):

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 Household survey in Indonesia
(2018):
 Prevalence of house hold with member with
mental disorder 7/1000 (3-11/1000) (2018)
 Prevalence of mental emotional disorder 9,8
(3,6 – 19,8) %
 Disabilty adult 22 (13,8-40,6) / 1000
 Household with:
 history of pasung (14%)
 History of pasung during last 3 mo (31.5%)
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 Point prevalence of mental disorders among
patients who seek treatment for the first
time in 20 PHC of 10 regencies / municipality
in NAD (conflict area) in 2002 was 51,10%.
(in West Java in 2002 was 36%) (2002; unpublished).

 In 2020 decade there is a prediction that a

big increasing of life burden and depression
with risk of suicide.

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 Status of community mental health of
Indonesia (from social welfare and quality
of life of the community perspective):
Community mental health status viewed by using
Human Development Index (HDI) of United
Nation Development Program (UNDP):
 in 1999, Indonesia was in rank of 105 out
of 180 countries in the world
 in 2000 was in 108 and
 in 2002 was in 112.
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Spesific problem of mental health cases:

 Major mental disorders:

 reqognized by the family after 1 y,
 seek treatment to healers first and
 go to mental hospitals after + 4-5 y (chronic)
 Many neglected chronic psychotic ill people
 Psychotic patient in chained (pasung) due to:
 Difficult to access mental health services
 Family collapse (economic and affective)
especially after the 3rd hospitalization

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 lived in pasung for 20 y (Jember, Rabu, 27 April 2011)

Estimation in Indonesia 200.000 in pasung

Impact of failure of mental health service
back ground problem should be found
 qualitative research  in depth interview
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(Impact of failure of mental health service)

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 (http://jateng.tribunnews.com/2017/10/13/40-tahun-mbah-marsiyo-telaten-
merawat-orang-orang-gila-yang-datang-ke-rumah diunduh pada hari minggu, 17
Maret 2019 pk 1231 wib)

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 Burden of life due to mental disorders
measured with DALY (disability-
adjusted life years) in Indonesia in
2000 about 12,3%,
 higher than burden of life due to
ischemic heart disease, CVD, and
tuberculosis
(WHO & World Bank 1996)
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 M H problems  social impact:

 violence,  substance
 criminality, abuse,
 suicide, homicide  HIV/AIDS,
 child abuse,  gambling,
 divorce,  jobless etc.
 youth
delinquencies,

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 Understanding of the community:

- Psychotic  stigmatized.
- Non psychotic shows more as physical
complaints
 tend unrecognized as MH problems
 doctors concentrate to physical diseases
 do some unnecessary test and provides
medication for physical complaints
 do not consider mental problems as
background  in-effective treatment
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So far mental health services have
not reached all community due to:

- Lack of understanding of MH
- Stigma  mentally ill people  healer
- Those who live in area where there is no
mental hospital have to spend much time
and cost to reach the nearest mental
health services.
- Decentralization policy  influences quality
of MH services
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Daftar Masalah Kesehatan

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 Mental health system in Low –
Income/Resourced - Countries

WHO recommendation:
 Due to these reasons WHO encourage to:
 integrate M H services in general health
services:
 started from primary health care
 including public empowerment ( volunteer)
and
 have to reach remote areas and
 develop referral system
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 Primary care for M H services
promotes respect of human rights:
 minimizes stigma and discrimination.
 minimizes the risk of human rights
violations that often occur in mental
hospitals.

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National Health Insurance

 Jaminan Kesehatan NasionaL

 Primary care  Secondary Care 
Tertiary Care
 Primary health facilities as gate keepers
 competence of medical doctor very
important
 Competence of medical doctor in primary
care include: promotion, prevention,
curation and rehabilitation
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Progression of mental disorders

Risk factors--Prodromal phase - aktive phase- remisision-aktive phase -residual &

depression phase

  Medical doctor in primary care should be

competence in case finding and holding in
prodromale & residual phases (can be lasted
for years before active phase)
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 Research challenge
 MH research should answer the problems
 Coordination between related ministries

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Coordination challenge
 Mental health problem should be
solved by SOLID MENTAL HEALTH
TEAM
 Mental health team must be a
coordinated team and consist of those
who work in mental health service and
other professions work in
humanitarian fields
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 Q A ?

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