Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders

Article


Irmansyah, I., Susanti, H., James, K., Lovell, K., Idaiani, S., Imah, S., Hargiana, G., Keliat, B., Utomo, B., Colucci, E. and Brooks, H. 2020. Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders. BMC Psychiatry. 20 (1), pp. 1-15. https://doi.org/10.1186/s12888-020-02575-3
TypeArticle
TitleCivic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders
AuthorsIrmansyah, I., Susanti, H., James, K., Lovell, K., Idaiani, S., Imah, S., Hargiana, G., Keliat, B., Utomo, B., Colucci, E. and Brooks, H.
Abstract

Background: Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals’ and other key stakeholders’ perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia.
Methods: Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited.
Results: Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings.
Conclusions: Key mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.

KeywordsSocial psychiatry; therapy and provision of mental health care; Civic engagement; Implementation; Indonesia; Low- and middle-income countries; Mental health; Patient and public involvement
LanguageEnglish
PublisherBioMed Central
JournalBMC Psychiatry
ISSN
Electronic1471-244X
Publication dates
Online15 Apr 2020
Print31 Dec 2020
Publication process dates
Deposited08 Jun 2020
Submitted29 Nov 2019
Accepted30 Mar 2020
Output statusPublished
Publisher's version
Copyright Statement

© The Author(s) 2020. Open Access
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Digital Object Identifier (DOI)https://doi.org/10.1186/s12888-020-02575-3
Web of Science identifierWOS:000528948800007
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