National Institute of Health Research and Development, Jakarta, Indonesia.
Marzoeki Mahdi Hospital, Bogor, Indonesia.
BMC Psychiatry. 2020 Apr 15;20(1):172. doi: 10.1186/s12888-020-02575-3.
Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia.
Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited.
Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings.
Key mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.
印度尼西亚的精神卫生服务正在迅速发展，以响应国家和全球卫生政策，为精神病患者提供支持。这为公民参与提供了一个独特的机会，使患者、照顾者和社区积极参与精神卫生保健，从而塑造新兴服务。缺乏对印度尼西亚精神卫生保健专业人员和其他主要利益攸关方对公民参与的使用的深入探讨，这导致对其在这方面的潜力的理解有限。本研究旨在探讨当代专业人员和其他主要利益攸关方对当前使用公民参与和加强印度尼西亚精神卫生系统的潜力的看法。
采用定性访谈，并使用主题分析进行分析，主题分析以批判现实主义方法为基础。在雅加达和茂物招募了 18 名从事精神卫生保健工作的多学科专业人员和非专业卫生工作者，以及 10 名国家主要利益攸关方。
尽管精神卫生专业人员和决策者对公民参与的认识和支持程度很高，再加上基层运动的兴起，但分析显示，公民参与的机制结构不健全且不足，导致参与活动的随意性和表面性。公民参与被认为需要在现有实践以及组织和社会文化方面进行重大转变。消除污名化是公民参与的一个关键特征，我们的分析强调了在这方面具有地方和文化背景的社会接触方法的相关性。我们的研究结果表明，需要扩大目前侧重于个人赋权的公民参与定义，将其扩大到还包括环境和组织赋权的定义，以优化公民参与在精神卫生环境中的未来使用。
主要的精神卫生利益攸关方已经确定，印度尼西亚文化的核心方面与公民参与的精神非常契合，这有可能促进最近全球卫生政策的实施。然而，如果不进行干预，在精神卫生服务中普遍存在的家长式文化以及对印度尼西亚精神病患者的高度污名化和歧视，可能会阻碍充分实现这一目标。
