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Barriers to accessing mental health treatment have meant many patients go untreated in Indonesia. Modern technological solutions could help fill the treatment vacuum and disrupt the faith-based approaches that have germinated in the mental health space.

Editorial

In 2015, Carika, a 29-year-old Indonesian woman suffering from a psychosocial disability sold rice and tempeh from her stall in Central Java. Carika may look like any other roadside vendor, but between 2006 and 2010, Carika spent four years locked in a goat shed where she could barely stand or move.

Her family could not cope with Carika’s mental health needs and like 57,000 others in Indonesia, they simply locked her away.

Carika’s case is not unique in Indonesia. Intense social stigma and lack of mental health funding gave rise to inhumane and discriminatory practices. However, there are indications that the stigma is receding. Thanks in part to technological advances, the next generation will not be subject to the same barbarism of the last.

There is widespread stigma attached to mental health issues in Indonesia

In Indonesian communities, those suffering from symptoms of mental health issues are frequently assumed to be manifesting symptoms of a demonic possession or experiencing the malign spiritual repercussions of engaging in sinful behaviour.

This leads to an intense social stigma surrounding mental health concerns. Rather than treating the mental health problem, many families choose to lock the patient up rather than let it be known that a family member is suffering from a mental health disorder.

When the family does acknowledge the need for treatment, the belief that mental health issues are the result of a moral or spiritual digression or the result of a demonic possession leads many to consult spiritual healers rather than medical professionals.

Despite high rates of mental illness, treatment and research are underfunded

Those that do acknowledge the need for medical assistance find a myriad of barriers to accessing treatment. Indonesia suffers from a shortage of trained psychiatrists and psychiatric beds. Those that can get help have to pay for expensive treatment sessions out of pocket as there are severe limitations on the treatment available through the state healthcare insurance.

Mental health research has been scarce and underfunded, which has led to a shortage of experienced researchers conducting fieldwork in the areas of psychology and psychiatry.

While there are voluntary groups operating in pockets of the country, Indonesians do not have the benefit of a coordinated local effort dedicated to mental health research. Provincial and district health departments do not have a specific mental health subsection. In most cases, mental health issues fall under the scope of the family office or the office for non-communicable diseases.

In 2014, Indonesia enacted a new Mental Health Law, outlining specific plans of action for the promotion, prevention, treatment and rehabilitation of mental health disorders. However, this has not materialised in the form of increased numbers of psychiatric beds or a more comprehensive mental health infrastructure.

This lack of mental health literacy has allowed religious healers to fill the vacuum

Given a dearth of options for mental health patients and the spiritual stigma surrounding mental health episodes, spiritual healers, priests and clerics have filled the treatment vacuum with cheaper, faith-based approaches.

Literally meaning ‘incantation’, ruqyah, for example, is a form of spiritual treatment that uses prayer to cure mental illness. Adi Supriadi, an Islamic preacher who practices ruqyah in his native West Java, told ASEAN Today, “various mental health problems can be cured with ruqyah.” “By reciting the verses of the Qur’an or hadith by not changing the sentence structure and believing,” he said, “a Muslim can build a health mentality.”

For Adi, ruqyah is a valuable supplement to modern medicine. When the patient and their family are in between doctor’s visits, Adi believes ruqyah can be a valuable addition to their treatment plan. As patients pay as much or as little as they are willing for ruqyah, the financial barriers present in other forms of treatment are not present in faith-based approaches.

However, not everyone agrees. Someone with personal experience of ruqyah spoke to ASEAN Today on the condition of anonymity. “Based on experience, it did more harm than good,” they said. “If they [are] solely connecting mental health issues with religious matters, then [it’s] not really helpful.”

Technology can replace religion in the mental health sphere

There are signs that young people are beginning to shed the stigma behind mental health and are more willing to seek out medical assistance for mental health problems. Livia Iskandar, a psychologist in South Jakarta revealed that most patients she sees are in their teens and early twenties. 2AM club, a magazine targeting young people and raising awareness about mental health issues, is also challenging the stigma surrounding mental health disorders.

This indicates that Indonesia’s youth are beginning to turn to modern medical solutions. As internet adoption rates rise, new technology in the field of mental health can help address Indonesia’s mental health crisis.

In 2011, the situation in China mirrored that in Indonesia today. 91.8% of Chinese citizens suffering from mental illnesses went untreated. Severe social stigmas and a lack of access to mental health treatment (at the time, China had just 1.2 psychiatrists per 100,000 people) meant most had few avenues for assistance.

Access to online counselling is making significant inroads in the Chinese mental health sector. As online therapy takes place in patients’ homes behind closed doors, it is not as intimidating as travelling to a public clinic and patients do not have to fear being seen going in or out by people they may know. Several start-ups now offer online treatment in China. They report that up to 70% of their users are first-time therapy users, suggesting that the technology is making inroads in communities that have traditionally shunned therapy.

In China, the start-ups are working with clinics. The online psychiatrists can refer patients to brick and mortar establishments if the patient poses a risk to themselves or requires prescription medication as part of their treatment.

Internet-delivered therapy would provide teens and young adults, who are likely more mental health literate than their parents, with an avenue for treatment. It would bypass many of the hurdles that prevent Indonesians from accessing modern treatment methods and reduce their reliance on unproven faith-based methods.

While there will likely still be financial barriers, the reduced overhead costs involved in online therapy compared to brick and mortar clinics will allow them to slash treatment prices and reach a larger segment of the population. It also takes the issue of funding out of governmental hands and opens the market up to private investors.

Online therapy will not solve Indonesia’s mental health crisis. The lower economic classes will still require accessible community-based support and government-funded mental health services. There will be no substitute for this, and it is a responsibility the government has to shoulder. However, any avenue which can bypass older members of the community and avoid stigmatisation is a welcome step to addressing Indonesia’s urgent mental health needs.