Mental Health in Indonesia; from the point of view of a survivor and psychologist
Mental Health World Day commemorated every 10th of October. It is to remind people of the importance of mental health. Normalize releasing your emotion out rather than holding it by yourself. Cry when you need to cry, tell your friends about how you feel, and also ask your friend about their day.
It is unfortunate that in developing countries, especially Indonesia, mental health does not yet get the appropriate attention. The label ‘crazy’ and ‘shame of the family’ is given to those with mental health disorders. It is such a pity that this stigma still exists in society today. Besides the stigma in society, there is this act of pasung or the act of physical restrains to those who have a mental illness can still be found in the rural village where most people do not know about mental illness and how they should handle it.
The research titled Stigma toward people with mental health problems in Indonesia by Hartini, Fardana, Ariana & Wardana in 2018 reported that,
knowledge about mental health significantly correlated with stigma toward mental health patients. The better knowledge individuals have about mental health, the lower their tendency to have a stigmatic attitude toward people with mental disorders. These findings also support the previous studies that lack of knowledge on mental health or mental health literacy is one of the sources of stigma.
Lack of knowledge of mental health is known to have repercussions both on oneself and on others. For those who do not know about mental health, the effect is being unprepared to correctly decide what to do when one feels symptoms related to a mental health problem, resistance to interacting with mental health patients (Wahl, Susin, Kaplan, Lax, & Zatina, 2011).
Quoted from Merriam-Webster, the definition of mental is relating to the mind. In specific mental is relating to the emotional and intellectual response of an individual to external reality. WHO defined mental-health as a state of well-being in which every individual realizes his or her potential, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to her or his community.
Anastasia Sari Dewi works as the psychologist in her private clinical practice, the Anastasia and Associate. She gives opinion from a psychologist’s point of view through an interview. As a psychologist focusing on Adult Clinical Specialties, she focuses on solving psychological problems of adult individuals, for instance, depression, anxiety, disorders related to psychological conditions, family problems (divorce, custody of children, spouses). To have a better understanding of her profession, Sari then explained that the difference between psychologists and psychiatrists are from the educational background and how they treat the patient.
“The educational background of a psychologist for an undergraduate is called psychology, and for a master’s degree, it is called a profession. That is why psychologists see from the traumatic experiences, parenting styles, psychosocial environment, personality traits, and physically but not as specific as psychiatrists. While a psychiatrist education base on medical and psychiatric, they see physically and medically, such as the presence or absence of neurological disorders, brain injury, hormones, which cause behavior that does not function properly.”
Mental and emotional disorders affect up to 11.6% of the Indonesian population (Ministry of Health Republic of Indonesia, 2013). The capacity of Mental Hospitals in Indonesia is limited, and there is only 1,563 psychological staff throughout Indonesia. It means that one psychiatrist serves about 300–400 thousand people (tirto.id, 2019). This data then raises the question of whether the low interest in becoming a mental health provision caused by a lack of public demand and knowledge, which in turn causes mental health management in Indonesia low? As a psychologist, Sari answered,
“even in hospitals, the slot for practicing psychologists is minimal, the priority is doctors because the demand is bigger. While for psychologist, it is different, psychologist is by-appointment.”
From here we understand that the demand is much lower for a psychologist. Sari argued that this is due to a lack of awareness and a more dominant negative stigma from society. Therefore, very few people come to a psychologist for their mental health or want to recover. To know more about mental health, an interview was held with Grace who chose to seek professional help.
She explained her mental health condition at the beginning of the interview and she said,
“these past days, I feel my anxiety comes back, everything feels not good, I feel sad. In this situation, it is very easy for me to get triggered by people around me.”
However, what Grace feels is a sign that someone might feel there is something wrong with themselves. Sari explained that,
“most of them are feeling the loss of passion or discouragement and overthinking. Another characteristic is whether the daily routine functions running normally or not. For example, in one day you eat three times and it changes to only one time. There are also changes in patterns in daily activities. If it only occurs 1–2 times it is considered normal, but if it happens continuously you could say this is a sign of someone feeling that something is wrong inside themselves.”
We realize that everyone’s way of coping with their mental situation or condition is different, and so is Grace. When asked how to treat her mental health condition so as not to relapse, she answered, “I do hand lettering or drawing, or buying art supply to suppress my stress and emotion. Then I will create something to release the stress and I will throw it away, because I don’t want to see it anymore.” Quoted from sutterhealth.org ’10 Ways to Cope with Stress’, carve out hobby time is one out of ten ways to cope with stress.
What Grace did was her way of releasing stress and emotions she felt. She also realizes that sometimes she is too hard on herself, so she allows herself to release her emotions by crying. Grace also added that she feels comfortable telling stories and venturing out to her boyfriend, who she believes is a support system.
Sari also added that as a support system, the person must do it properly. First, ask if he/she wants to be listened to, needs an opinion, or a solution. Second, listen to him/her. If, for example, your friend asks for an opinion, do not give an opinion as to diagnose him/her because you are not a psychologist or psychiatrist. If we act as if we can provide an assessment or diagnosis, it will be bad for your friend. Last but not least, if you feel you can not help your friend, this is better to accompany him/her to counseling or a professional.
“The longer the psychological wound is left untreated, the longer it will take to heal.”
Grace also shared that she experienced unfavorable treatment from the people around her when she learned of her mental health condition. This unpleasant treatment came from Grace’s family members. Grace said they didn’t know why she went to a psychologist and psychiatrist. Grace stated that this could have happened because of vast age differences and different era conditions, which caused her family members to also not know about mental health.
The unfavorable treatment could happen by several factors, such as communication patterns in the family. Zarkashy argued that (2005, p.65 in Hiasinta, 2016, p.22) communication can take place by involving three components, namely communicators, communicants, and messages. In this discussion interpreted that communicators are the children, communicants are parents, and the message is about mental health. Communication in the family is defined as the readiness to talk about everything openly, both pleasant and unpleasant, as well as having the readiness to solve problems in the family with talks that are carried out in patience and honesty and openness (Friendly in Hiasinta, 2016, p. 23 ).
Based on the definition above, it can be understood that if parents as the communicant who receive messages from their children, they must have the readiness to communicate and have the desire to understand the message. Therefore, the parent can learn and understand the child’s mental health condition. Quoted from dr. Meva Nareza from alodokter.com, if parents want to maintain children’s mental health, parents can build children’s trust, build good relationships with children, increase children’s self-confidence, teach children how to relieve stress, and familiarize children with a healthy lifestyle (alodokter.com, 2020).
Mental disorders are disorders of thoughts, feelings, or behavior that cause suffering and disruption of the functions of daily life. Meanwhile, mental illness is more dominant and leads to serious mental disorders that require special treatment and care as well (Lubis, Krisnani, & Fedryansyah 2014). This statement then leads to the question, do you think the statement that stated ‘mental health is difficult/ untreatable, and people who have mental health problems need special treatment’ is correct? This is how Grace answered,
Mental health is not something that could be rated whether it is treatable or not. There are specific criteria as the signs of a mental illness. Then it can be determined how it should be treated. Seeing the number of people especially teenagers and adolescents who use social media and claiming that they have a mental illness, Sari responded to this trend.
“Those who proclaimed have a mental illness or just joining the trend probably self-diagnosing. Self-diagnosis is seeing what is in front of you then feel it matched with how you feel about yourself. Then think that you are like what is in front of you. Even though it is not that simple, it needs a lot of consideration and examination.”
Sari also added, it would be better to do counseling with a psychologist or psychiatrist because there are criteria that need further examination, then a person can be diagnosed with something. If you feel there is something wrong with you, contact your primary care provider for a diagnosis and treatment options (betterhelp.com, 2020).
These situations also lead to the question of whether it is hard or not to find the right psychologist? Because the demand from the community is also lower. As we know, Grace already chooses to seek help from professionals. She did counseling to psychologists and psychiatrists. Grace responded,
“the first time I went to a psychologist it was useless and because I had trust issues. Then I went to the psychiatrist, and it was useless too. But do not generalize. In my case, the psychiatrist always asks how do I feel, wrote it down, and give me medication. However, the treatment did not suit me. She did give me advice, but it is about how people should be, not how I should solve my problem.”
According to the statement above, I had asked Sari, is it hard to find the right psychologist or psychiatrist? How do you think about this? Sari then responded,
“counseling with professionals must be in accordance with how they treat the patient. Take a look when you need to go to a general practitioner. You want to be sure about your health condition, that is why you go to two different doctors. You will compare by the way they convey the diagnosis, how they treat patients, and if the drug prescription is giving effects or not.”
Finding the right psychologist is important, which is true because they are the one that will help you and understand what happened to you. “That is why some patients are comfortable with a senior psychologist whose treatment is more advising. While some others are more comfortable with relaxing treatments where they feel talking to a friend,” added Sari.
Sari explained that psychologists have formulated their approach, according to client needs, and not prioritizing religiosity. However, some psychologists use a religious approach, and some patients do not fit this way. Believe it or not, this situation still often happens in Indonesia. As a country with many types of beliefs and religions, it is not uncommon that many things are associated with religion. That is why most Indonesian still do not believe in mental health, and the negative stigma is still going on.
The community has started to mention the above statement nowadays. As reported by VOA Indonesia, Benny Prawira, coordinator of the suicide prevention community — Into The Lights — stated that the stigma of mental disorders disturbs people to seek help, leaving the person isolated, and feeling hopeless (voaindonesia.com, 2019).
To anyone battling and still in the process to heal their mental health, keep positive, and keep your spirit up. To those whose family members having mental health issues, support them, and let them know they are loved.
At every stage of our lives, there must be problems and difficulties for each. Recognize your emotions and have a support system that can help. If not, immediately seek help from an expert. Do not leave psychological wounds without treatment because it is the same as allowing the wound to get bigger and yourself so you can’t function properly. Don’t be afraid and don’t think that asking for help is embarrassing, it is normal. If not, of course, you will lose time and energy.
-Anastasia Sari Dewi
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