Two ironic and disturbing incidents in the last two months have reinforced a long-held perception among health practitioners in Indonesia.
Ever since studying medicine at university, I've been exposed to the unquestioned assumption that mental healthcare is a deeply marginalized and heavily stigmatized area of healthcare in this country.
The first incident happened last September, two weeks before Idul Fitri. Two suicide cases were reported in the newspapers and both were said to be related to the upcoming Lebaran festivities.
In the first case, a man in Bojonegoro, East Java, killed himself by drinking a glassful of insecticide.
The newspapers quoted several family members who explained that the desperate man decided to end his life because he didn't have enough money to celebrate Lebaran.
The second case happened in Blitar, also in East Java, where a mother and her 8-year-old son committed suicide, reportedly for the same reason.
These cases present a double irony. Idul Fitri is the biggest holiday for Indonesian Muslims, when people are supposed to be grateful for God's grace. It is certainly not the occasion and the reason to end one's life. The second irony is that the suicide acts happened on Sept. 10, which just happens to be World Suicide Prevention Day.
If that is not enough, a month ago - on Oct. 10, which is World Mental Health Day - I experienced one more incident related to the perceptions of mental healthcare that really bothers me.
A friend called me and told me about a mutual friend who had been hospitalized suddenly.
He asked me whether it would be alright to visit the sick colleague. "What should I say?" he asked.
Obviously, he would not have sought my advice had his friend been treated for dengue fever or some other disease. As a matter of fact, his friend was admitted to a mental hospital.
After the two incidents, I realized the bitter fact that mental health is not yet just another health problem. It is still heavily stigmatized, marginalized and widely misunderstood.
From a financial viewpoint, provisions for healthcare are often seen as an investment. Therefore, resources are often poured into health problems which claim the most loss or have the highest mortality rates. Not until the concept of quality of life was invented - where one's productivity is not only related to how long one lives, but also to how healthy one is physically and mentally - was mental health included in discussions about healthcare provisions.
Let us now look at some of the numbers which show us why we need to pay more attention toward mental healthcare. Basic healthcare research conducted by the Indonesian Ministry of Health in 2007 revealed that 11.6 percent of adults in Indonesia suffer from some form of mental or emotional disorder, such as depression and anxiety.
This finding is in line with a study five years earlier, in 2002, by the World Health Organization. WHO found that neuropsychiatric disorders and self-inflicted injuries were the leading cause of a decrease in quality of life in Indonesia. Note that a decrease in quality of life also implies a loss in productivity.
When suicides occur, it is not only the victim who suffers. Another WHO study found that every suicide case impacts deeply on the mental health of at least seven people connected to the victim. The mental health impact usually remains for extended periods, and can often precipitate suicide idealization.
If those numbers and findings are not convincing, let us assess it from the financial perspective. Many researches have suggested that suicides pose huge social and economic consequences for a country, especially one with a growing economy like Indonesia. Most of the victims of suicides are people of a productive working age from 15 to 35 years. More often than not, they are the breadwinners in their families.
So the numbers and impacts are daunting. What should we do? Where do we go from here? I believe mental healthcare should be available in primary healthcare facilities, such as in the Public Health Clinics (Puskesmas).
If a Puskesmas nearby provide mental healthcare, my friend's colleague wouldn't have to go to a mental hospital which is too far and costly, just to bear a heavier stigma. Not only that, those who suffer from depression and other mental health conditions, can be quickly identified, and so given the support and treatment they need.
The next question is why the government seems unwilling to implement such a simple policy? Most governments - at both local and central levels - are often hesitant to supply mental healthcare because of the low demand, despite that the need is so obvious. Why bother to provide it if nobody asks for it?
The writer is a health practitioner who graduated from the Royal Tropical Institute in Amsterdam, Holland.
