Around 480,000 Indonesians with schizophrenia were recorded in 2018, and an estimated seven out of 1,000 households have family members with schizophrenia.
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JAKARTA, KOMPAS – Schizophrenia is treatable and curable. However, strong social stigmas, misconceptions, limited mental health services and the politicization of mental health have left scores of schizophrenia sufferers without prompt treatment, increasing the burden on their families as well as the state.
Bagus Utomo, chairman of the Indonesian Community for Schizophrenia Care (KPSI), said in Jakarta on Tuesday (8/10/2019) that the state was not yet present for schizophrenia patients. The state’s lack of attention for such patients had left schizophrenia sufferers with untapped potential amid the nation’s efforts in taking advantage of the demographic bonus.
Around 480,000 Indonesians with schizophrenia were recorded in 2018, and an estimated seven out of 1,000 households have family members with schizophrenia. An estimated 18,800 to 57,000 schizophrenia sufferers live in confinement. Others are homeless, are neglected by their families or do not received proper care.
A majority of people with schizophrenia is in the productive age range from 15 to 30 years. In 2004, Indonesia had the highest rate of productivity lost to schizophrenia in the world.
“The mental health budget is around 1 percent of the total health budget,” said Bagus. The Healthcare and Social Security Agency (BPJS Kesehatan) spent Rp 720 billion (US$50.77 million) on mental health services in 2016, much less than for any other illness.
Minimal budget
The minimal central and regional budgets for mental health services indicate a lack of attention to mental health issues. Strong social stigmas persist against people with mental illnesses, and Indonesia found it difficult to meet its 2014 and 2019 target to release mental illness sufferers from confinement.
“Eradicating forced confinement is not just a health issue. Various sectors must be involved,” said Fidiansyah, the Health Ministry’s mental health and addiction prevention and management director.
The government must pay serious attention to schizophrenia as a mental health issue. Other than the demographic factor, schizophrenia has a unique and wide-ranging impact on families and society.
“Even if just one person has schizophrenia, it will have a wide-ranging impact on other family members, be it socially, economically or in terms of welfare,” said Bagus. In many cases, increased stress, conflict and divorce are common in the families of people with schizophrenia.
Schizophrenia sufferers generally require long-term treatment. If they are not disciplined in taking their medication, they can remain unproductive for life.
Limited mental health services remain a huge problem. The data shows that Indonesia had only 48 mental hospitals in 2017, and eight provinces did not have any mental hospitals. Only 2 percent of hospitals and 14 percent of puskesmas (community health centers) in the nation have a psychiatric ward. These figures indicate an increased risk of medication discontinuation.
In addition, Indonesia has a limited number of mental health professionals. In 2019, the country had 987 psychiatrists who serve a population of 267 million, and 77 percent of its psychiatrists practice in Java and Bali.
“To resolve this, primary healthcare services at puskesmas and general practitioners must be strengthened,” said Indonesian Psychiatric Association (PDSKJI) secretary Agung Frijanto.
Aside from psychiatrists, Indonesia has around 1,100 clinical psychologists. It also has a limited number of workers in mental health treatment and rehabilitation, including mental health nurses, social workers and occupational therapists.
Providing a full range of healthcare services for people with mental disorders is critical.
Providing a full range of healthcare services for people with mental disorders is critical. However, a shift in paradigm is needed, from prioritizing therapeutic mental health treatment, which requires large funding, to prioritizing public campaigns and prevention, including early diagnosis.
“Public awareness must be developed to support early diagnosis of mental health conditions,” said Bagus. This was a major challenge due to the strong stigma against schizophrenia, which stemmed from a belief that the sufferer lacked religious piety or that it was caused by witchcraft. The stigma also made it difficult to eradicate institutions that used faith-based approaches to rehabilitation.
As a result, mental health was often politicized, especially ahead of an election.
Despite the importance of providing adequate mental health services, Hervita Diatri, a psychiatrist with the University of Indonesia-Cipto Mangunkusumo General Hospital medical program, said that medication alone was not enough to help schizophrenia sufferers. Family and community support were also important.
More rehabilitation centers must be established to help empower people with schizophrenia.
Social rehabilitation director general Edi Suharto of the Social Affairs Ministry pointed out that Indonesia’s social and psychiatric rehabilitation system lacked integration, and therefore, more rehabilitation centers must be established. The ministry currently has only four mental rehabilitation centers.