How to solve Indonesia’s ‘taboo’ mental health crisis

We often consider mental health in the context of a developed society, but the experience of UNSW Sydney PhD student Sandersan ‘Sandy’ Onie in his home country of Indonesia shows it is a public health challenge across cultures and countries.

As recently as 2014 families in rural areas of Indonesia were ‘treating’ loved ones with depression, anxiety or other mental health conditions by locking them in purpose-built metal cages in their homes. In some places, it’s still happening now. While this doesn’t happen as often in bigger cities, it illustrates the rampant underlying stigma and attitude towards mental health in Indonesia.

“Poor mental health is wreaking havoc across the community, but it is still a taboo topic in Indonesia. However, once you bring it to the table, it’s amazing how many people want to engage in the conversation, but we need people brave enough to speak out first,” Sandy said.

“A family friend, a high-ranking public servant, had such crippling panic attacks that he had to take a three-month sabbatical, often not wanting to leave the house. Another prominent businessman had depression and anxiety for more than two decades which unfortunately led to alcoholism.”

Having experienced mental health issues himself, and seeing it both in his family and in the people around him, Sandy knew something had to be done. 

You’re not alone

In coming weeks, Sandy will launch the ‘Things I wish They Knew’ campaign and website, where people from across Indonesia and anywhere else in the world can share their lived experience of mental health. 

The website will allow people to anonymously share their stories, focusing on what they wish the people around them, including family, friends, co-workers etc. did or said. Or conversely, what did they do that wasn’t helpful. Sandy and his collaborators hope to give a voice to those who may be too afraid to speak out.  

In Sandy’s own experience, he says, “I wish people around me knew how much I hated myself during my depressive episode. That I wasn’t spending time with them not because I didn’t like them, but because I felt so lethargic and didn’t want to disappoint them.”

The project will help alleviate stigma and it’s hoped the shared storytelling may support more people with mental health problems to seek treatment or feel less isolated. Furthermore, the stories will be used to help shape mental health programs to equip the general public with the knowledge and skills to care and support someone around them going through similar situations. 

It is a personally significant project for the researcher. Sandy was diagnosed with depression in 2015, but had started developing symptoms in 2009, and has family members spanning three generations with mental health illness. During his Honours year, Sandy was in intensive therapy, combating suicidal thoughts. 

“I’ve seen too many of my family members, too many young people I’ve met working as a youth pastor and too many of my countrymen suffering from mental health issues. I hope that using this data-driven approach, we can shape mental health interventions that people are more likely to respond to and engage with.”

One size does not fit all

A recent report by the Indonesian Psychiatric Association found 19 per cent of youth have had suicidal thoughts and there is evidence suggesting that over decades, the number of interventions has increased; however, the efficacy of our interventions have not increased. 

“You can’t just pick up a treatment tested and found effective in Australia or the UK or the United States, drop it into the Indonesian context and automatically assume it will work the same way and for the same reasons. Because of the lacking research infrastructure and resources, there hasn’t been a single clinical trial for cognitive behavioural therapy, Indonesia’s most widely used therapy," Sandy said.

“Feelings and cultures are so diverse, from one region to another. We need to understand how psychopathology looks in an Indonesian context to better understand how to treat it.”

Sandy is currently overseeing the research component for a project with Personal Growth, a mental health service provider, and the Ministry of Health, investigating how psychopathology manifests in Indonesia. The project aims to see how culture, which varies greatly from one region to another, affects mental health, perceptions on mental health and mental health seeking. He is also currently heading a project to establish a network of mental health researchers in Indonesia, in collaboration with some of the world’s leading researchers. 

"The high rates of mental health issues in Indonesia, along with extremely strong stigma, is problematic in and of itself but even more so due to psychological research being scarce and largely underfunded. There is a concerning lack of experienced researchers - small pockets of work are being done but it's still not enough.”

Advancing Science in Indonesia

Sandy conducts research on the role of cognitive and attentional biases in emotional disorders in the School of Psychology’s Motivated Attention and Perception Lab, as part of a PhD supervised by Dr Steve Most.

He commends Dr Most and colleagues for their interest and support for his multiple projects improving knowledge and outcomes in mental health approaches in Indonesia. 

“There are a lot of amazing researchers at UNSW and I’ve always found them so encouraging. It has been instrumental having the support and advice of the academic staff for everything I’ve done.”

An encounter with Professor Brian Nosek, a guest speaker at UNSW, has sparked Sandy’s latest project, organising and moderating a nation-wide webinar called Advancing Science in Indonesia which can be accessed at webinarsains2019.com and on Zoom. 

The online event is aimed at connecting leading researchers from across the globe with their colleagues in Indonesia from all fields to discuss strategies for developing the research ecosystem in Indonesia. While the main audience is Indonesia, the webinar is open for all to view.

Webinar topics will range from the importance of mastering research basics to the impact of good research practice and creating thriving a research ecosystem. 

Researchers from all areas will be represented and the connections made on the day will deepen into networks of ongoing collaboration and support. Twenty-five universities from all across Indonesia are already signed up for participation on 21 October, and the event will hopefully lead to increased collaborations and a network in building and sharing resources.

“I’m hoping to submit my thesis at the beginning of September, and will immediately head back to Indonesia for a series of speaking engagements about mental health – that is, after a short break. Moving forward, I’m hoping to get more involved in schools to implement early preventive measures for mental health,” Sandy said.