Indonesia: Building the Capacity of Communities to Address Mental Health

Aceh. Who doesn't remember the graphic images of destruction caused by the December 2004 earthquake and tsunami? The human toll of one of the largest-ever natural disasters left 126,000 dead in Indonesia, and another 500,000 displaced. Roughly 80 percent of the casualties were women and children.

After the tsunami, concerns about the mental health of the Acehnese people ran high. The main psychiatric hospital in Aceh has traditionally been overcrowded, and for many the conditions of this type of institutionalized care are not conducive to psychological recovery. Instead families often turn to traditional healers and religious leaders for support, and in severe cases the mentally ill are restrained near the family home with chains or shackles. International aid organizations knew they had to do more than restore the previous system, and hoped to develop community networks to address mental health, with nurses at the forefront of care.

HSP's support has been most intensive in the district of Aceh Besar, where an external evaluation of the program in July 2007 identified that HSP's assistance had established three new levels of mental health and psychosocial care and support.

At the sub-district level, nurses attend a rigorous and highly structured mental health training program, and then receive focused supervision from senior mental health nurses. There are now two trained mental health nurses per 30,000 Aceh residents.

In the villages, the program developed a community-based approach to empowering women to respond to the psychosocial needs of their peers, with a focus on women and children. Psychosocial volunteers received technical support from a national NGO, PULIH, as well as ongoing assistance from local Acehnese NGOs. These volunteers learn about the mental health issues that plague their communities, have group discussions reflecting on village realities, and conduct field work with the support of mental health professionals. Volunteers also develop systems to document and evaluate the results of their activities. "This is my first experience with learning about mental health," says Rahmi, a volunteer from Lamara village. "I am looking forward to helping the community, as there are many women and children who need extra support."

At the district level, HSP built and equipped a 10-bed acute care psychiatric unit on the campus of the Jantho District Hospital. The facility has state-of-the-art standards for inpatient care facilities, with interactive workstations, tranquil spaces for patients, and safe, secure and (as needed) contained rooms to manage responses to care crises.

The program is already achieving significant results. In a survey of community health nursing patients and their caretakers, 90 percent reported improvements. Says one mother, "I couldn't leave my son alone before due to his mental illness. With support from the nurse and medication, I can now leave him alone for as long as a week. I am so grateful to the program."

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