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pril 7 marks the founding day of the World Health Organization (WHO), which is celebrated as World Health Day. This year’s theme is “Depression: Let’s talk”, highlighting the importance of mental health by encouraging people with depression across the world to seek and get help.

The WHO states depression is characterized by feelings of sadness or tiredness, loss of interest or pleasure, feelings of guilt or low self-worth, disrupted sleep or appetite, and poor concentration for 14 days or longer — and today it is estimated that more than 300 million people are currently living with depression.

The WHO has found a strong association between depression and other non-communicable disorders and diseases such as diabetes and heart disease, placing depression as the leading cause of ill health and disability worldwide.

Generally, twice as many women as men are prone to suffer from depression. Scholars note that hormonal changes in women during puberty, prior to menstruation, following pregnancy and at perimenopause can be triggers for depression.

Meanwhile in a patriarchal society women come under more stress than men because of the double burden of professional work to earn money and household-based care work including caring for the elderly and the sick.

The first urgent issues to deal with depression are stigma and mental healthcare. People who suffer mental illness inevitably have a fear of stigma, causing them to stay silent and reluctant to access the treatment they need. This has inspired this year’s global campaign so that people with depression can take the first step to talk to a trusted person, as the first step toward treatment and recovery.

Although depression as a mental illness is more intangible compared to other, physical, illnesses, failure to act against it causes a considerable economic and social burden. People with depression struggle to concentrate, making them unable to work. As a result, households can be deprived financially and governments incur higher health and welfare expenditures. Social cohesion is unequivocally at stake when stigma and discrimination against people with depression still exists.
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People with depression struggle to concentrate, making them unable to work.

Investment in mental health boosts economic benefits. Every US$1 invested in scaling-up treatment for depression and anxiety generates a return of $4 in better health and ability to work, the WHO states.

Unfortunately, many countries regardless of income status still provide little support for people with mental health problems where according to the United Nations, on average only 3 percent of government health budgets is invested in mental health.

In Indonesia, according to the Basic Health Research (Riskesdas) 2013, some 14 million people above 15 years old have mental disorders with depression symptoms and anxiety, making up to 6 per cent of the population.

A 2016 study by Human Rights Watch reported that over 57,000 Indonesians with mental health conditions have been subjected to pasung — locked up in confined spaces — and 18,800 were being shackled.

Although a government ban on pasung has been in place since 1977 and the Mental Health Law was passed in 2014, families, traditional healers and staff in institutions continue the practice. Partly due to a lack of understanding and awareness about mental health issues and hurdles for access to treatment that usually involves talking therapy and/or antidepressant medication.

Indeed, in West Sumbawa regency, one of nine targeted locations of nationwide program Pencerah Nusantara, managed by the Center for Indonesia’s Strategic Development Initiatives (CISDI), 35 households were identified as having members with mental disorders, out of 2,931 households, and one household was found to practice pasung.

There was a significant increase of mental health illness from 17 cases in 2014 to 35 cases in 2015 in one sub-district, while only 31.4 percent of people with mental disorders received medication.

To address depression is to break the silence about mental health in the first place. The government, health professionals and mass media have valuable roles in this.

The government cannot wait any longer to strengthen law enforcement on mental health problems and end abuses against people with mental health disorders, including pasung, through rigorous monitoring and policy implementation.

This should be coupled with higher levels of recognition and stronger investment in mental health care that is now integrated with primary healthcare in community health centers (Puskesmas) in compliance with the new Mental Health Law.

Health professionals should be continuously upgraded with the necessary knowledge and skills to meet the concerns and needs of people with mental illnesses. The mass media is expected to provide accurate information in order to confront the existing stigma.

In celebrating World Health Day 2017, let’s be bold in bringing up depression and the importance of mental health in our regular discussions and put the stigma in the past where it belongs.
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The author leads Pencerah Nusantara Program at the Center for Indonesia’s Strategic Development Initiatives (CISDI). The opinions expressed here are her own.