Melbourne School of Population HealthCentre for International Mental Health

International Mental Health Program: Mental Health in Aceh

The CIMH is working with partners in Indonesia to respond to mental health needs in Aceh following the Indian Ocean Tsunami and working on longer term needs for mental health systems development in Aceh and across Indonesia

 
4th International Mental Health Development Conference: Mental Health in Aceh
From left: Dr Wiguna, Dr Irmansyah, Consul General RI Mr. Supriyadi, Dr Keliat & Dr Maramis		    

CIMH work in Aceh

The CIMH has a strong history of collaborative partnerships with leaders in mental health systems development and services in Indonesia, particularly with the University of Indonesia.

CIMH Director, Associate Professor Minas with Dr Benedetto Saraceno of WHO Geneva, assisted the Ministry of Health to develop the Ministry's mental health plan for Aceh.

download WHO Recommendations for Mental Health in Aceh [.pdf | 217kb]

Several of the key leaders for mental health systems and policy development in Indonesia are past graduates of International Mental Health Leadership Program (iMHLP).

Following the Indian Ocean Tsunami, iMHLP Fellows worked together to respond to mental health needs in Aceh. The significant work being conducted by iMHLP alumni and other partners in Indonesia was recently presented at the International Mental Health Systems Development Conference in Indonesia Conference, 14th and 15thAusgust 2008 in Melbourne.

Other links regarding mental health following the Indian Ocean Tsunami:

Community Mental Health System Development in Aceh Indonesia

Nanggroe Aceh Darussalam, better known as Aceh, has experienced long term severe conflict since the colonial era up to the signing of Memorandum of Understanding (MoU) between GoI and Free Aceh Movement (GAM) on August 15th 2005. The three decade long conflict, in addition to the tragedy of the December 26th 2004 tsunami, have resulted not only in the loss of thousands of lives and uncounted property loss, but has also had a significant impact on the emotional wellbeing of survivors and the community as a whole.

Therefore a mental health program has been urgently needed to facilitate the recovery process of the Acehnese community and to provide proper treatment for thousands of people with mental health problems. Through collaboration between the Department of Social Medicine of Harvard Medical School, University of Syiah Kuala Banda Aceh and IOM, the Psychosocial Need Assessment (PNA) study was carried out between December 2005 and February 2006 in Pidie, Bireun and North Aceh. The PNA demonstrated that 65% of the community sample was experiencing depression, 65% suffered anxiety disorders and 34% had Post-Traumatic Stress Disorder PTSD). This study demonstrated that Bireuen is one of the most vulnerable districts in terms of mental and psychological disorders due to the long-term conflict. The number of mentally ill people will undoubtedly increase unless there is a significant effort to address this issue. Based on these facts, there is an urgent need for the development of an affordable, cost-effective and accessible community based mental health program. Such a program would need to be accessible by the whole community because most of population in Aceh lives in rural areas. There is also a need to reduce the burden on the provincial Mental Hospital which provides tertiary care and strengthens the existing health system, eg. Primary Health Centres, Village Health Posts.

The objective of the community mental health program is to improve local capacity to manage the program and to provide the mental health services needed by the population. The mental health system has been developed from the district level to the village level. The system developed covers both program management (including data) and service delivery aspects. The system comprises: District Health Office (DHO) as the program owner managing and supervising community based mental health program implemented in the district under the mental health section; Primary Health Centre which provide basic mental health services such as mental health related information dissemination, counselling and medical treatment provided by GP+ (general practitioners trained in mental health) and CMHN (Community Mental Health Nurse – nurse trained in mental health); and village level where volunteers have been trained to identify people at risk of developing mental illnesses and those who are thought to be mentally ill,  and to provide basic support to mentally ill patients. However, in most districts in Aceh there is still no Psychiatric Acute Care Unit in the District General Hospital as a referral site from primary care. Therefore referral for admission, when it does occur, is to the Provincial Mental Hospital.
 
Bireuen District, where CIMH in collaboration with Aceh Partnerships in Health (APiH) has been working, has the best model of community mental health program in Aceh. Each primary health care centre has 2-3 GP+, 2-3 CMHNs, and 2-3 volunteers per (Mentally Alert Village) village. As well as providing services in the primary health centre, GP+ and CMHN also deliver outreach mental health related services to patients’ home on a regular basis.

To strengthen the Community Based Mental Health Program implemented at the district level, Inter-Sectoral Coordinating Committees (TPKJM) have been established in Bireuen and Pidie Districts. These Committees have members from the key stakeholder groups and play an important role in supporting the policy development and advocacy work. The membership of this team consists of District Health Office, Education Department, Social Welfare, District Planning Bureau, Police, District Parliament, non-government organizations, and community representatives. It is hoped that by having a well functioning TPKJM the sustainability of the community based mental health program in Aceh will be improved.
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