Perceived causes of mental illness and views on appropriate care pathways among Indonesians

Sabrina Gabrielle Anjara,Tine Van Bortel,Carol Brayne

doi:10.1186/s13033-021-00497-5

Sabrina Gabrielle Anjara, Tine Van Bortel + Show 1 more

Open Access

https://doi.org/10.1186/s13033-021-00497-5

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Abstract

BackgroundThe mental health system in Indonesia comprises attempts to modernise a colonial relic. There is still a disconnect between available services and help-seeking behaviours at the grassroots level. This study aims to explore the perceptions of Javanese people on the aetiology of mental illness and their ideas on how to deal with individuals who may have mental illness.MethodsThis qualitative study involves semi-structured interviews, embedded in a cluster randomised trial examining the clinical and cost-effectiveness of primary mental health services. Interviews were conducted with Indonesian and Javanese. The recruitment procedure was aligned to the trial. Participants were primary care patients recruited from 21 sites across Yogyakarta province. Interviews were recorded, transcribed, and translated into English. Thematic analysis was used to analyse the interview transcripts.Results75 participants took part in the study: 51 women (68%) and 24 men (32%). Key themes emerged around perceived causes of mental health problems (including ‘extrinsic factors’; ‘intrinsic factors’; and ‘spiritual factors’), and perceived appropriate pathways of care (‘modern medical science’; ‘social support and activities’; and ‘religious or spiritual interventions’). Gender potentially influenced some of the responses.ConclusionsThemes indicate the variety of preconceptions towards mental health problems and assumptions regarding the best management pathways. Some of these preconceptions and assumptions support the utility of modern medical care, while the rest promote spiritual or religious healers. Participants’ ideas of the appropriate care pathways largely correspond to their perception of what the symptoms are caused by. Despite hints to some understanding of the bio-psycho-social model of mental illness, most participants did not capture the complexity of mental health and illness, indicating the importance of contextual (especially culturally and religiously-aligned) public education around mental health, illness and care.

Highlights

The mental health system in Indonesia comprises attempts to modernise a colonial relic
We identified three themes that describe Javanese people’s perceptions of the causes of mental health problems: extrinsic factors, intrinsic factors, and spiritual factors
In contrast with older literature which indicates that people with mental health problems are usually taken to traditional healers [10], our findings show that only a small percentage of respondents had gone to see a traditional healer before seeking modern medical treatment

Summary

Introduction

The mental health system in Indonesia comprises attempts to modernise a colonial relic. Indonesia is a South-East Asian archipelago of over 17,000 islands inhabited by around 270 million people who belong to more than 300 ethnic groups and speak more than 500 languages. Over half of Indonesia’s population live on the island of Java, while those with Javanese ethnicity amount to around 40% of Anjara et al Int J Ment Health Syst (2021) 15:74 the total population. In 1868, Bauer and Smit surveyed mental health care in the Netherlands East Indies and concluded that in comparison to the situation in Europe, colonial psychiatric care was inhumane and unscientific, lacking proper psychiatric facilities [2]. Bauer and Smit persuaded the Dutch government to restructure the ‘treatment of the insane’ in the Netherlands East Indies according to modern European principles, leading to the establishment of several transit houses, agricultural colonies and a stand-alone mental asylum in Java [3]

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