Hans Pols, Pandu Setiawan, Carla R. Marchira, Irmansyah, Eunike Sri Tyas Suci, Mary-Jo DelVecchio Good, Byron J. Good (eds.), Jiwa Sehat, Negara Kuat: Masa Depan Layanan Kesehatan Jiwa di Indonesia. Jakarta: Kompas Press, 2019, xxxiv + 300 (Vol. 1), xv + 384 (Vol. 2) pp. ISBN: 9786024128630 (Vol. 1), 9786024128647 (Vol. 2), price: IDR 99,000.00 (Vol. 1), IDR 105,000.00 (Vol. 2) (paperback).
The title of the book under review, which translates as “Healthy Soul, Strong State”, raises the following questions: What is the connection between a healthy soul and a strong state? Whose healthy soul, that of the state or its citizens? How does the soul of citizens relate to the condition of the state? This two-volumes publication answers these questions and provides ample empirical findings from across the Indonesian archipelago.
The volumes encompass the entire field of mental health services in Indonesia, both as a study and as a development goal. They discuss mental illnesses, the solutions developed by and with the state, and their shortcomings. They engage with the condition of Indonesian mental healthcare and questions about its future. The first chapter of Vol. 1 sets out to answer the questions above, evaluating experiences with community-based mental healthcare. The next two chapters discuss governmental and non-governmental institutions and volunteer movements dealing with various mental illnesses such as schizophrenia, trauma, bipolar disorder, and Alzheimers. Vol. 2 deals with psycho-therapy for depression, drug treatment and rehabilitation, the role of the professionals, and the specific challenges in Indonesia, such as poverty, natural disasters, and the social stigma attached to the political turmoil in 1965.
Combined, the volumes shift the focus to the importance of communities in mental healthcare in Indonesia. The community can provide (early) detection, accompaniment, and support for patients, and can refer them to healthcare institutions. They even remind patients of the time to take their medicines and attend their treatments. The books provide evidence that when communities are involved, relapse cases are lower. The authors therefore remind us that all people are involved in all healthcare systems. In mental healthcare specifically, a structured and communicative approach is needed to support patients from the level of family and community. Such a community-centered approach also reduces the burden for the psychiatric hospitals and asylums.
The different chapters also inform us about the challenges in mental health services in Indonesia. Mental healthcare is still not treated as a mandatory or priority program in the general healthcare system. Compared to other countries, Indonesia is still lagging behind. This is largely because of problems in the bureaucracy. Nevertheless, the authors of Jiwa Sehat, Negara Kuat adopt a positive outlook for the future of mental healthcare in Indonesia. Instead of only relying on psychiatric hospitals or asylums, they suggest that the system should be based on communities. Knowledge of local conditions is also crucial to develop a system that can reach all classes of society.
Reading these two volumes equips us with an understanding of not only mental healthcare in Indonesia, but also the specificity and diversity of attitudes towards mental health in Indonesia, which require different solutions depending on local circumstances. Social stigma and the resultant exclusion from a community is also a big factor in mental illness throughout Indonesia.
In this constellation of mental well-being, (the lack of) support from communities, and the state healthcare system, the authors did not touch upon the role of religion, religious-based institutions, and the communities involved therein. One remaining question, therefore, is what prevented the authors to discuss the issue of religion. Is this due to the rules of professional conduct? Has it been too politically sensitive to incorporate the role of religious-based institutions and communities into the analysis? Or was the omission of religion not a deliberate choice?
Amidst the Covid-19 pandemic and its resultant lockdowns, this publication makes us more aware of some additional challenges we are facing. As reported by WHO and the Indonesian Ministry of Women Empowerment and Child Protection, amongst others, mental-health complaints, particularly anxiety-related ones, are increasing. The function of local communities as the supporters and guardians of mental healthcare in Indonesia, as repeatedly underlined by the authors, is dissolving as a result of social distancing policies. This makes it all the more relevant to include mental health specialists in the task forces responsible for the implementation of Covid-19 protocols. The two volumes Jiwa Sehat, Negara Kuat could not have appeared at a better time. They provide evidence-based practices in developing a mental healthcare system that can be applied during this pandemic, and can serve as a guide in developing mental healthcare systems in general.
