 Asalaamu alaikum wa rahmatullah wa barakatuh. I'm Swastiato Dan Salam. Salam sa jatara and good morning, good afternoon and good evening to everyone that's gathering here today to celebrate the World Mental Health Day seminar for the Indonesian Institute. We would like to respectfully acknowledge the traditional owners and custodians of the land on which we gather today and pay respects to their elders past, present and emerging. We would like to extend that respect to other Aboriginal and Torres Strait Islander peoples who are viewing this presentation. In addition, we would like to state that I work here today should in some way, no matter how small, contribute to the journey of reconciliation of cultures that is necessary for sustaining a healthy and diverse world. Now, a little bit about the seminar, the webinar that you're all attending. As you can see, there are some esteemed panelists that are joining me here today and we're going to talk a little bit about mental health in Indonesia. The seminar is going to be broken into two sections. The first section is a series of recorded presentations from all of our panelists and a short film. During that session, we really encourage you to open up the chat box, open up the Q&A and to participate wholly, either in Indonesian or in English. Our panelists are pretty comfortable with either and we invite you to start a discussion about what's happening in terms of some of the issues around mental health. We know that basically there is a number of people who are joining us today with high levels of expertise on mental health. At the same time, we know that there are some people who are new to the area and so we're providing the seminar as a bit of an introduction to some of the issues around mental health in Indonesia. We are going to talk to you about some of the basic issues that are facing mental health systems development in Indonesia. Mental health has to historically dwelt in the shadows of the global health and development agenda and only recently has moved from the margins to become a central priority in research and policy. Mental disorders account for about 30% of worldwide non-fatal disease burden and 10% of the overall disease burden, including death and disability. And the cost to the global economy is estimated to reach as high as USD set $6 trillion by the year 2030. So, you know, it's kind of important. Large and middle and low income countries like Indonesia are struggling with a plurip of challenges in delivering adequate mental health care to, well, 270 million citizens. There is so little funding. And then there's the sheer numbers. Estimations based on the 2016 risk estus, so that's the basic health survey, indicate that 450,000 families in Indonesia have at least one member diagnosed with schizophrenia. We know that number is an underestimate. We also know that a number of these individuals are being subject to human rights abuses that they are being left to languish in situations of possible restraint or confinement called in Indonesia, bustle. And we know from estimations based on the risk estus quoted by Human Rights Watch that as many as 57,000 Indonesians have ever experienced this situation of bustle, including one of our panelists who's speaking to you today. We also know that approximately the population of Australia, so 26 million people are suffering from clinically relevant, so that means symptoms that probably require treatment of anxiety and depression. Think about that. That's a lot of people, 26 million people to, if we're sitting in Australia, directly our northern neighbours. Although there's a shift to community-based out-care models of care, Indonesia has 48 mental hospitals and 269 psychiatric wards in general hospitals. These are still the primary sources of care. There are just over 1,000 registered psychiatrists. Now, these numbers you must take with a grain of salt because they're changing consistently and we don't have great numbers for Indonesia. There are about 2,000 clinical psychologists. They're not all engaged in clinical practice treating patients. 7,000 community mental health nurses. 1,500 mental health trained GPs and 7,000 lay mental health workers or kadir. These are unevenly distributed across the archipelago. Most of them in Java, not in the outer regions. And there are a number of areas that don't have doctors or psychiatrists even within the mental hospitals themselves. Need-outs strip supply, less than half of all primary care centres and only 56% of government district hospitals are equipped to handle mental health cases. Now, fortunately, there are many passionate and committed mental health personnel, government officials, academics, consumer group founders, mental health advocates and others who are working tirelessly to implement the vision embodied by the 2014 mental health law. We've got many of these individuals, well, a small subsection of these individuals gathered here within our panel today who are gonna talk a little bit about their little snippets of what mental health in Indonesia means. So now our first, our first panelist is Dr. Dr. Nova. Nova Riyanti Yusuf, a registered psychiatrist and current head of the Jakatan Psychiatric Association and Secretary-General of the Asian Federation of Psychiatric Associations. Many titles, but Nova, she's a PhD in public health from Ori after studying global health and social medicine in Harvard. She publishes extensively. Global Asia Magazine heralds her as the most influential female legislator for her parliamentarian work. For those who don't know, she was a DEPAEA representative or a House of Representatives representative from 2009 to 2014 and also from 2018 to 19 where she introduced and helped pass the 2014 Indonesian Mental Health Law. This is what she's gonna talk to us about today. Hi, my name is Nova Riyanti Yusuf. I'm from Indonesia. I'm a former member of parliament from the House of Representatives of the Republic of Indonesia. Currently, I'm the Secretary-General for the Asian Federation of Psychiatric Associations, psychiatrist, and I think I feel honored and I think it's a pleasure for me to share with everybody on World Mental Health Day with the Australian National University. So thank you for having me. I am going to elaborate on the progress of the National Mental Health Law in Indonesia. This is going to be a very brief presentation so I hope I can get it in 10 minutes. Okay, yep, so this is the map of Indonesia and apparently I think most of you have visited Indonesia. Indonesia consists of over 17,000 islands and the fourth most populous country with about 270 million people and going and what really ticked me off and why I decided to become a member of parliament was to initiate the mental health bill so I can pass it into law. And one of the triggers was when Indonesia was being highlighted in Time Magazine in 2003 that Indonesia had the lowest rating for the provision of mental health services in Asia. So for instance, in 2003, we only had one psychiatrist for 500,000 population. So as a background, I was a rookie trying to initiate the mental health bill. The argumentation was that 18,000 people with mental disorders being shackled or physically restraints at their homes and shelters and even worse, it was a data in 2007. So in 2013 as the discussion or the writing of the law took place, the basic health research in 2013 came up with a more shocking number that the proportion of household with household members suffering from psychosis and performing shackling or chaining is 14.3% or roughly estimated about 56,000 people with mental disorder or with psychosis. Then I found out that if I entered the parliament, they had this regulation in 2009 and 2014. It's about the procedure to propose a bill. So a bill may be proposed by the House of Representatives or the President or the Regional Representative Council and even better, a bill can be proposed by the member. So that's the opportunity, I think for me. That's why I rent, I was studying psychiatry at the University of Indonesia and suddenly I had this change of heart that, okay, as soon as I graduated, I would run for office and try to initiate a mental health bill with the argumentation that I had been having on my head. So it was on 2009, October 1st, I was sworn in as member of parliament. Yeah, strangely I was in the parliament between 2009, 2014 and also 2018 and 2019. So after five years, the milestone, I guess, was the mental health bill was passed into law in 2014. And it was in effect since August 8th, 2014. And to celebrate that, me along with people with mental disorders or with psychosocial disabilities, we found a dip in the parliamentary compound to celebrate that something that was still very marginalized mental health issue, it could be passed into law. So in 2014, if, well, this is actually a very good coverage, totally different from how we were being portrayed in the Time Magazine because the headlines say, change no more. So Indonesia has a new law and vows to take better care of its 16 million people suffering from mental illness. And at the time, the mental health professionals was 1.07 per 100,000 population. It was, we only had 773 psychiatrists at the time, but now the number is growing. We are at the number of 1,000 psychiatrists for the time being. We had 451 clinical psychologists, 6,500 mental health nurses. However, in 2014, when the bill was just passed into law, the allocation for mental health budget was still 1% of the total health budget, which is still the same until now. So what was being regulated in the mental health law? It was actually a very ambitious law because we try, well, we try to have a foundation of mental health system Indonesia. So it may be the facilities, the service for the provision of mental health professionals, particularly in the general provisions. We try to fight the stigma on how to address people with mental disorder. So we don't call them orangila or lunatics. So we try to introduce the terminologies to the people. So now I am so happy that quite a large number of people now already know how to address people with mental disorder. And the mental health effort here, one of the chapters in the law, we were not just focusing on curative aspect of the mental health effort, but also promotion, prevention, and also rehabilitation. And most importantly, in the concluding provision, the implementing regulation of this law must be enacted by no later than one year following the enactment of this law. And today it's already 2021 and it's the last 100 days if I'm not mistaken. So yep, so what is the progress like with the mental health law now? So after the mental health law was passed in 2014, now in 2021, we are still waiting for the implementing regulations and also other derivative regulations. In 2015, however, there was effort by the Ministry of Health to follow up one of the most important implementing regulations, which is government regulation. And government regulation itself involves at least four ministries with the Ministry of Health as the leading sector. And after the government regulation is issued, it will be followed by other derivative regulations that will be issued by the stakeholder ministries, such as the Ministry of Health and the Ministry of Social Affairs. Why we need the implementing and derivative regulations? There are several crucial reasons. One, we have a regional autonomy system. So somewhat the central government and the local governments need to bridge, to equalize their perceptions and to coordinate mental health services in Indonesia. And the most affected is of course, the mental health services at the grassroots level. For instance, the implementation of free shackling in Indonesia. We need accurate data. We need coordination with the health insurance claim, which Indonesia is already in the universal health coverage system. With the healthcare facilities, case findings and so on and so forth. So between 2015 until 2021, despite there were no implementing and derivative regulations being issued by the stakeholder ministries. But in the past few years, progress also took place in the form of programs. Indicators of mental health are included in the health ministry's regulations, such as SPM or Minimum Service Standard and Indicator Puargasehat or Family Health Indicators. Progresses, however, seems to be taking place also if the minister of health is interested in the mainstreaming of the mental health policy in Indonesia. I believe that the interest of the minister of health will speed up the policy process within the ministry itself for national interest. And I'm very happy actually that this year, despite the pandemic, the government regulation was in discussion between the ministry of health and the stakeholders along with the experts. And I also took place, I also joined this team. And now the draft has reached the bureau of law and organization in the ministry in order to harmonize the draft before further steps. And the minister of health was also surprisingly reaching out to the Indonesian Psychiatric Association to get input about mental health services, priorities and how to be in line with international consensus, such as the suicide prevention target goal in the SDGs, which was not part of the blueprint in Indonesia before. So the inputs have been submitted by the Indonesian Psychiatric Association to the ministry of health. So we are hopeful that there will be some robust improvement in the mainstreaming of mental health sector in Indonesia, other than of course a follow-up itself to the mental health law, but also to the budget allocation in the overall because I have noticed that there has been a specific allocation for mental health during the pandemic, but we need this allocation also in the program that is not only related to the pandemic. I was also involved in the discussion with the ministry of health in preparing prevention guidelines during the pandemic. And I think this is a very good step if the minister of health wants to be in line with the SDGs target goals, particularly the suicide prevention. So I think this is one step forward from the ministry of health and of course the minister of health. And so that's pretty much the progress of the mental health law right now. What I wanted to share, thank you very much again to the Australian National University for having me on this World Mental Health Day. Thank you Mbanova, that was fabulous. I really wanted to hear more in terms of some of the prevention guidelines I think around suicide prevention, but also around generally how Indonesia is handling the mental health crisis during the COVID-19 crisis. But I think we'll have to wait until question and answer time and also maybe some activity in the chat to be able to talk about that in a little bit more detail. I wanna throw it across now to Professor Hans Poles. Professor Hans Poles is a psychiatric historian from the School and History and Philosophy of Science at the University of Sydney and a fellow of the Australian Academy of Humanities. He works on both Australian and Indonesian populations. And he's gonna give us a bit of a potted history on psychiatry in Indonesia. Now, Hans has actually got a new book out at the moment, Traumatic Past in Asia. He has many books actually to his name, one of which I think he's going to plug a little bit at the end of his talk, I have forewarning. Dua Sehat Ngarakua, which is a collaboration for a lot of actors on Indonesian mental health reform and they're looking ahead towards the future of psychiatry in Indonesia. So I'd like to welcome to the screen, Professor Hans Poles, who's going to talk a little bit about the history of psychiatry in Indonesia. I am Hans Poles from the University of Sydney and I will give you a very, very brief history of psychiatry and mental health care in the Dutch East Indies and Indonesia. Renewal in asylum care worldwide started around 1800 with the introduction of moral treatment. Filipinao and San Watuk are the big names. Before that, the mentally ill were considered as violent groups who had to be segregated. Moral treatment saw the mentally ill as confused children in need of fatherly guidance. The best approach to dealing with them is to place them in a beautifully built asylum where there's lots of opportunity for work in the gardens and work in the asylum itself because that gets your mind off things and also would help with rehabilitation later on. One of the origin stories of moral treatment is Filipinao, free Indian saying, during the French Revolution. The story is a little bit embellished, nonetheless, interesting and instructive. These renewals were brought to the Netherlands by Professor Schroeder van der Korke, who led the renewal of asylum care in the Netherlands. It was then brought to the Dutch East Indies to Bauer and Smith, who started the survey of the state of the care of lunatics and mentally ill. The conclusion was it's terrible and that recommended a purpose-built asylum being built. This became the hospital near Batenzorf, or Boeba, which opened in 1881. State of the art mental hospital, a great investment of colonial funds. It had a lot of agricultural colonies, workshops that had no fences and there was no restraint, just isolation. At that time, this mental hospital, today's Marzuke-Madi, was outside Bauer in the countryside. This of course has changed over time. And these images of patients working in the garden and in the workshop are fairly common of mental hospital care at this time, both white. In 1904, Laowang followed pavilion style of care, lots of work for patients, then Magalang Hospital and also Saabbang, which was destroyed during Boeba tour and patients were brought somewhere in Malaysia, which we know is what happened to them, although it's fairly easy to hypothesize. So in colonial times, there were four major mental hospitals and about 12 secular clinics in major urban areas for acute care. If someone needed more care after three months, that would be transferred to mental hospitals. Not a problem, and this is the problem with mental hospital care all over the world at this time, overcrowding from starter, funding was never sufficient, in particular during the Great Depression, the hospitals filled up with people suffering from severe forms of mental illness like dementia and system gets blocked up. Nonetheless, at this time, the Dutchies in these featured the very best mental healthcare system all over Asia. It has the highest number of beds per capita. So it was truly impressive and Dutch physicians advertised this model in Asia as exemplary and as a matter of fact, physicians from other countries in Asia keenly to see how it worked to apply this vision in their own countries. Then of course, Japanese occupation and the war of independence, this was not good for psychiatry, this was not good for mental health care, lots of stuff got destroyed. In 1963, Nathan Klein in the American Psychiatry visits assisted our 32 psychiatrists. The country was not doing well economically, electroshock therapy was given straight out of the electric socket, no machines. It was hardly any psychopharmapology except if private patients could afford it. But nonetheless, a relatively free vision from Poland in terms still prevailed, there were no locked doors. Patients were free to go. Patients would go outdoors, there was lots of occupational therapy in the workshops and in the gardens. This started to diminish when Bobo grew and people in the city felt, what are these people doing in a city we wish as schools to be clean of the 10 restrictions came in? Nathan Klein who had been in Asia sent his student Robert Rubin in 1964 who brought two suitcases with thorazine and an electroshock machine. He also had some, made some rare pictures. This is Suharto Hircham, the city mental hospital in Jakarta which at the time was still not a rural environment. This of course, as we know, is no longer the case, but it looks quite nice. Here we see some of the leading psychiatrists at the time. This is Kusumanto from Lidie Bachtiare, the leading psychoanalyst in Indonesia. This is at the University of Indonesia Medical School and again almost in position Lidie Bachtiare and Kusumanto Satya Nagoro. In the 70s, the fate of Indonesian psychiatry changed quite a bit. Kusumanto had a triple position of being the chair of the Department of Psychiatry at the University of Indonesia, director of the Director of Mental Health in the Ministry of Health and he is considered the Godfather of Indonesian psychiatry. He connected a generation of young psychiatrists. He sent them a broth of further education, placed them really well and gave an enormous boost to psychiatry in Indonesia. This photo is a couple of years ago. This was his private mental hospital, his sanatorium, Dhama Wainzai, where I had the honor to interview him. Now his view, Kusumanto's view on mental health care was a focus on mental hospitals. He felt there should be one in every province in Indonesia. His view was not limited to mental hospitals but he said from the mental hospital we should have public health education, educating general practitioners, provide consultation in general hospitals. So mental health care would radiate from every mental hospital. Mental hospitals would also focus on rehabilitation and open outpatient clinics. At this time, Kusumanto and Indonesian psychiatrists had leading roles in ASEAN, providing how mental health care should be organized in Southeast Asia and the rest of Asia. It was quite prominent. Now, I don't wanna say that since then mental health care has declined but a leader like Kusumanto, we haven't quite had. Mental health care best practice, this is to build Kusumanto's legacy that is to provide mental health care in a variety of settings. In hospitals, in the community, in the Puskas Mas, the new health insurance system in Indonesia wants mental health care to be provided in primary care settings. So in the Puskas Mas, this is a form of community mental health. This is also the policies of the World Health Organization. It is a fantastic idea, but nobody really knows exactly how to go about this in Indonesia, although there are many, many proposals. In addition, recent trends in mental health care worldwide say, let's focus on patient needs rather than diagnosis. Let's focus on recovery, on abilities rather than focusing on mental illness and mutations. Also, let's look for an involvement of other professions such as the community mental health nurse, social workers, and the patient or consumer groups. And in Indonesia, there are many very active groups that do fantastic work. Carpe is in the Indonesia schizophrenia care community by polar care Indonesia into the light because there is such a severe shortage of psychiatrists in Indonesia today, less than a thousand population of around 270 million. I think mental health care would be all assistance it can get. And involving the community groups is a great idea. This is the vision of Dr. Pandu Sitya-1, who was connected to the Ministry of Health for quite a long time. Unfortunately, there's no one with us. And in my own work in Indonesia, we had a project in vision to the future of mental health care and a tool going working out of that on the future of mental health care in Indonesia, more than 50 Indonesian collaborators. And also some of this is also summarized in an online journal called Inside Indonesia where you can check some of these ideas out. To summarize, Dutchies in this and Indonesia have leading mental health care systems in the past. This is no longer the case, but there is a great amount of ideas and initiatives that could be realized and implemented in the very short term. Thank you very much. Thank you, Hans. I love hearing about the legacy of Kusumanto and also Pandu Sitya-1, of course, who is sadly missed. And I do love hearing also about the history of the heyday of Indonesian psychiatry and then from the 1960s up until the 1980s. And I wonder, sort of reflecting on Nova's presentation also what happened between 1980 and now in terms of Indonesia being one of the leaders in terms of mental health care systems reform in Asia and a shining light for the world even. And then maybe, well, obviously things changed. Maybe we can talk a little bit about that later as well. I want to invite to the screen now Mas Anto, SG. Now Mas Anto is, he has many hats. He's a researcher, he's an advocate, he's a survivor and he's a fantastic artist. He's a member, well, should I say in terms of, we might get Hans to stand up here and do a little bit of a twirl actually. In terms of his art, he does art around batik as well as some other areas. And it might have to come closer, Hans, because you're a bit blurry. There we go, we can kind of see your I am batik. This is one of Anto's classic batik works that he does a whole series for but Hans. So other than being an artist, he is also a member of numerous peer support networks. Hans has talked about a few of those in his talk but, well, I think he's already mentioned Kappi SE, which is a Community Care for Schizophrenia Organization that Mas Anto is part of. He's part of also Bipolar Care Indonesia. He received the Human Rights Jim Burley Award in 2016 and an Australian Awards Fellowship and Scholarship also in 2016 to support his Masters in Health Promotion which he has completed now at Deakin University. Mas Anto is going to talk about his personal journey and also a little bit about the consumer groups movement in Indonesia. Hi, everyone. It's been an honor for me to be invited and speaking in this forum. I'm going to explain some of the introduction on my topic which is a personal experience about Pasung and how the survivor group in Indonesia try to begin the ethnicities and the movement in mental health. Let me introduce myself. I'm Anto, Agus Suki Anto. I'm a mental health activist. I experienced a very hard time dealing with the mental health issue at that time and I experienced Pasung, so I'm a Pasung survivor. And I also volunteered in many advocacy and many consumer movement in Indonesia and I become the, now is the Executive Committee of Global Mental Health Peer Network in Indonesia. It's for the full story of my journey, how I experienced the mental health issues and how I end up in chains in the government facilities in the year around 1999. You can see all of my full story in YouTube. It's already released into a documentary movie which is a collaboration, my collaboration with Dr. Eminiakology who invited me to share my story and make it into a documentary movie. So for the full story, we can access this movie through YouTube. A little bit recap on my story. It was started when I had the depression time and I was depressed because I lost my dream when I was unable to make a balance be even working and studying. Then I was trying to be an English teacher but I failed. Then I got dropped out from my campus because I was unable to pay the tuition and I had no support from anywhere because I was by myself. My family couldn't afford to put me in a college or in a campus. So it was all by myself. Then I was blaming myself for had this lost my dream. Then I was entering into a depression time without knowing there was a depression. I should have been a consultation with the psychologists and taken to the right medication but no, at the time we just follow what the suggestion from my neighbor and my family just took me into this facility which is a Gahon facility. It's primary healthcare in another cities but in this primary healthcare, they put all of people with mental illness or the patients into the training practice which is all the patient being changed in the bed, for about one month. I had this experience. I had to take the medication. It was I was given the medication for schizophrenia because they just put my diagnosis with schizophrenia which is no, it is not a proper exam. It was not a proper examination without any consultation or yes, I was mistreated and misdiagnosed and taken the wrong medication. Yeah, it was about my story, how I end up this, for me, and it was the hardest period of time in my life where I experienced the illness and the stigma. Mental illness because I had this depression and wrong medication and wrong diagnosis and the stigma happened after I released, was released from this facility when I tried to come back to my home, my house in the village where everyone tried to avoid me, where everyone start change there, how they interact with me, they avoid me, they just disregard me, they call me crazy and finally it was giving a hard period of in my life when I tried to run away from the feeling because of the shames and the guilt because I was feeling my own self stigma I felt the shame and dishonor because people see me unequal to them. It was a real end of the world for me, so it was a hard. And later that I know, I found that many evidence, many research, many studies mentioned that the stigma does create collateral damage to the patient itself where WHO also mentioned that the stigma is the largest barrier to the treatment, which it's true, it was true. If I was not being stigmatized, I would have already been able to recover more quickly and more, and it was just, it should be not that as hard as that I was experienced. So then the stigma is everywhere in the society, even in ourselves now, in this time, for everyone who's not aware that mental illness and the stigma is really, it does exist because for example, people saw the news, people see people with mental illness is related to the cruelty, related to the lack of faith, related to the bad interaction, negative interaction with the people with schizophrenia, for example. And we saw being brainwashed by the media, by the Hollywood movie that everyone who's become the villain is people with mental illness. So this is the truth. I would like to emphasize that stigma creates negative impacts. As we can see now, the cases of stigmatization does more harm than the mental illness itself because stigmatization leads to the abandonment and ignorance. People are unable to access, don't want to access the medication because of the stigma, end up in chaining and shackling and suicide. So the study explains all about that. My recovery process is a very hard period as well. It was a long journey. When I had my ups and downs, if I can resume that I combine holistically the essential part of recovery and stuff like self-motivations, self-motivation, introspection, acceptance, resilience, medical treatment, support, peer support and community support, community support. I also advocate others to do with the stigma because in Indonesia we have a lot of challenges. There are a lack of surfaces, high cap treatments, a lot of cases of chaining. We still have a number of chaining which is, it mentioned 20,000, 18,000 and some human rights report even mentioned more than that. It's still a massive number. And the passion movement and initiative, I finally joined a lot of patients, consumer groups and peer support because I found and we found and knew that it can promote the recovery process. So it helped me to find a lot of information as well, place where I can be accepted for what we are because there is no stigma among us. This is the Indonesian consumer group that I joined, Indonesian community care for Indonesia, for schizophrenia, bipolar in Indonesia, harmony and diversity. And we have a lot of progress where we have this mental health law which we advocate with Dr. Noriyu. I'm sure she's the one who's also present in this forum. And we finally had this mental health law in Indonesia. And we have a lot of initiative which is the, Into the Light, this suicide prevention, viadol or by borderline personality disorder group, the mother hope Indonesia where we have this group for mother who had depression, post-partum depression group. So there was my introduction. So for more detail, I'm going to share on the event how I survived from Pasung and finally became a mental health activist, raising the awareness and erasing the stigma. People with mental illness is a human who deserve equal respect because we are human. Mental illness is not something to be ashamed of, but we should be a same of this stigma itself. So that's the quote from the Bill Clinton and see you at the event. Thank you so much, Matan, for that introduction. I think we're going to go also to this discussion hour and we'll have an opportunity to talk a little bit more about your own experience. And I also really want to hear more about Kope SE and bipolar care and some details around those consumer movements. So I think we'll have time a little bit later. So I'm now, we're now joined, I can see here, Dr. Aminia Kaluchi is also joined us. And she is going to herself and Dr. Ade Prastani, better known as Baasti. They are a collaborator who've also worked with the Center for Public Mental Health. So we've also got here, you can see Dr. Diana Stiawati in the beautiful purple. She's managed to take her mask off. She's actually currently at Parliament House at Jogchakada at the moment and she's got a private room. So she doesn't have to cover up, which is fantastic. So this fantastic collaboration has been creating some amazing films on mental health. I honestly get goosebumps when I'm actually talking to you about this because some of the experiential stuff, of course they've made a film about Anto's experience, which you can click on in the link that we've provided in the chat system. But some of the newer stuff at the moment is fiddling with the idea of this unhappy marriage between Western psychiatric discourses and the traditional healing world in Indonesia and how that works. So this is a bit of a snippet from their new film, upcoming film, which I'm not sure when it's going to come out. I'm sure that they'll tell us all about it very soon. And we're going to show it live here today. If you do have any problems in terms of buffering, it's a little bit heavier than some of our other recordings. So we are providing a link again in the chat box just in case you want to kind of mute us off and watch it directly on your screen as well, in case it's not coming down the line really well for you. So I'm going to welcome to the screen the beautiful work that has been a combination of huge amounts of time, I'm sure, because making audio-visual stuff I can't even imagine, but takes extraordinary blood, sweat and tears. So I want to welcome them to the stage with this product of their upcoming film. Thank you, Dr. Omenya and Dr. Asti. And also Dr. Diana Stiawati. Thank you. Thank you. If I learn, almost everyone believes we have the spirit. So we can understand people, we don't have to see them, but we can feel the energy. And from here we can see that patients should not always be physically, mentally, but also with this spiritual approach. Actually, we can't imagine that the patients in this community are very close to traditional treatment. Usually, the patients will ask, when we go to therapy sessions, can we not get sick, for example? Usually I motivate people like this, just physically, people with physical illness, get support, spiritual, that will be good. But still, we go to therapy sessions, if the patient needs medicine, they still drink the routine. When we meet with the patient or the doctor, the prayer, the prayer, the prayer, and so on, will definitely strengthen them. Usually, if I have said that there is no one who is against the prayer, and so on, the patient will ask, who is the doctor, among those who may know, who recommended the patient, according to one of my acquaintances, I have been in a dialogue with Brio, so it has become more understandable, because I have had a discussion several times. What are you feeling? What are you feeling? How do you feel right now? I feel better. Yes? I feel better. All the patients with physical illness affect other people, so I pray. I pray to God. It is like listening to the bell. If you can't sleep, you have to look at the bell. The bell. So that you can control it. Usually, the bell will ring right away. Touching is helping. It might be a curse, I also don't know, I can't. But it's a mystery. I feel that God is helping. Touch. I feel you're giving. You're giving to God, you using your hands to pray for them. God, Jesus, you have touched my hand. You have control over my daughter. When I believe that healing from above, can happen, I usually say, okay, you can reach here, but the heavier I am, I will be able to do anything. Amen. We receive a lot from the danger of diseases and all kinds of diseases. Their view is that I will heal by praying and doing spiritual activities. If it is too high, it will be difficult for us to talk about schizophrenia. This medicine can make the patient stable. They don't believe it. There must be a medium between the spiritual and the medical. What we need is this medium for pastors, priests, priests, and religious pastors to come to us together with the patient so that we can have a discussion. According to the understanding of the Shajingan, I have a gene in my body. From there, I was healed. All the priests and priests were walking around. I was in the middle, and they prayed for me so that the gene in my body would disappear. Two weeks of treatment there, but it didn't heal completely. The priests were confused. What kind of disease is this? Finally, the priests asked for help. The special thing that we do here is to help each other. My brother and sister, together with ODGJ. There are no professional doctors here. There are no special doctors in every country. ODGJ is owned by ODGJ. This is a lot of people. I want to try a different approach. It depends on the client, the client center. If he believes it, I try to encourage him, even if it's hard. Especially, I try to help him. But if he doesn't believe it, I'm not surprised. It's actually very simple. I'm not a person. My question is not important. The therapist's trust or understanding is not important. When I met him, I've seen his thoughts and thoughts. What can I do? Communicate with him. Talk to him. There is a psychological burden. It's a ritual process. But it's a language. Hypnotic. So that the mind in the body, the mind that is inside the body, it's empty inside the mind. We can't talk about it without any help. That's why he cleans the mind. He cleans his body, he bathes with water and other things. After that, he sees that the aura, the chakra or the mind is healing. Then he will meet a psychologist. One of them is Dr. Ray. Please take a seat. Please take a seat. Take a seat. Take a seat. Shake, shake, shake. Shake, shake. don't leave me alone please don't leave me alone you can go back home good luck to the Holy Roman people it's their life they are both the worst their lives are in a difficult situation the 8th power that is preventing them I hope the Holy Roman people will be able to destroy that power and the power of the people and free this hampam from the evil and the 8th power God's blessing Hopefully God will help us. Do you want to eat kueh, fried fish, or what? Where's your mom? Mom, here. Mom, thank you for the family in the house. Here's your grandma. Thank you to the parents. They've done a great job. We also thank you for the family we serve. We also work well. Thank you together for mental health. I forgot before to read out some of the accolades of our amazing trio that produced this particular product. So, Dr Aminia Colucci is an associate professor in visual and cultural psychology, Department of Psychology at Middlesex University in the UK and a registered clinical and community psychologist in Italy. Her main expertise is in cultural and global mental health, applied cross-cultural psychology and visual anthropology in low and middle income countries, immigrant and refugee populations. Aminia is passionate about using arts-based visual methods in her research teaching advocacy. And Dr Ade Prastani, I have so much trouble calling you Ade Prastani because I know you so well as Maasti, is a research fellow also for Together for Mental Health. She is currently based in Jakarta. She has been back and forth between Jakarta and Jakarta as COVID has permitted. She is a medical doctor by training from the university of Indonesia in 2010. She completed a postgraduate degree from A&U in culture, health and medicine. Currently she is supporting the World Bank on Indonesia's COVID vaccination program and social action plans. She is a member of the Centre for Public Mental Health, which many of you are already very familiar with as a fantastic organisation that is amazing advocacy work and is connected with a whole host of people throughout the world. Specifically, Diana herself has a PhD from the University of Melbourne. She was supported by the DFAT Australian and has been recognised for outstanding achievements in mental health systems, strengthening advocacy and training. She is going to speak to you from an academic pedestal, which is not a very high pedestal working as the director of Chepemha because you are continually doing Maastiaraka and huge amounts of work at the community level for systems change in mental health. I invite our last speaker to the screen for a little bit over that hour and I want to thank Dr Diana Stiawati for the last presentation. Hello, good morning, good afternoon. My name is Diana Stiawati. I am the director of the Centre for Public Mental Health, Faculty of Psychology, University of Kajamata Indonesia and today I will discuss about how the Centre for Public Mental Health having a role in mental health systems in Indonesia. Basically, they want to contribute to build a comprehensive mental health system in Indonesia. Our vision is the overall well-being of the Indonesian population built upon the nation's strength, potential as well as intersectoral public policies supported by relevant professions based on scientific evidence. We believe the root is actually mental health literacy that leading to stigma, neglect and also partial concern about mental health and that makes our mental health system also having a low resources because it is not become a priority for national development program. We can make the most of the part in Indonesia, maybe only in Java that they have a good mental health service. Not really, not really well established but started to have because we have psychiatrists, psychologists and other mental health professional mostly in Java but in the other part of Indonesia we will see untreated under diagnosis and partial concern. And also people in mental health system in Indonesia think that mental health is only about what to call the managing people with mental illness, not yet about promotion, about prevention to make or to increase the well being of the nation. What the center believe about be the key element of a comprehensive mental health system, we believe that it should be a kind of comprehensive look and comprehensive building of family, school or workplace, community and government policy. So what we do basically we do the strengthening mental health workforce and increase access to mental health care by placing psychologists into primary health care which is currently only in some district in Java that it is happen. And then we also do family strength, we promote through policy and also program and then school based mental health and we also work on community priorities such as suicide, prevention, common mental health of course the post disaster mental health is also important and the root is the mental health literacy. The ongoing research that we are using collaborative methods to understand the experience of mental health is question and question in Ghana and Indonesia. Basically we try to see or cover to see the case studies in Indonesia where actually most of the Indonesian going or seeking help if they have mental health problem and spiritual healer is one of the key element and we try to capture how spiritual healer can collaborate with the mental health professional so if they happen spiritual healer become an asset to strengthen mental health system. The other research that we are conducting now is the impact of COVID-19 on people with psychosocial disabilities especially people with severe mental illness that's the ongoing research and we are also doing a research about strong families surviving the pandemic. How family strength or how strong family can survive in this kind of difficult situation. We are currently also working with Ministry of Health mapping of Indonesian mental health system. What is potential protective and risk factor in the people too in Indonesia. So we do hope that after this research we can have good threat about mental health system in Indonesia and can have good recommendation for national strategic strengthening mental health. What we do is we doing the systematic review focus group discussion interview with the whole Indonesian district health office and then we do survey to the population and also analyzing the Indonesian family life survey data. This among the publication that we have related to primary health care in the primary health care. Yes, still a unit cost of primary health care psychology and then this our publication with Aliza about evaluating the Indonesian ripasong in Kebumen and then it is related to school based mental health and we also produce guidelines such as Kampus Secahtera Sekolah Secahtera also provide prevention and we do the ongoing advocacy of strengthening family as school based mental health and comprehensive mental health system through Chukchakarta Kebumen and also national level and I think this is the network that we have all the friends and colleagues support us with expert knowledge and this our activities roughly we do training seminar but mostly we do advocacy through research and training as well and we do lots of discussion with the government and currently we are having many projects with government we can say that we become a partner in various things such as from making a low local low or mapping mental health system and also doing independent research to produce guidelines and documentation for the government I think that's all thank you very much for your attention I hope this can illustrate what the centre for public mental health is. Thank you very much and see you soon. Thank you so much Burdiana there's a smorgasbord of activities that Chabemha are obviously involved in and I'm sure that there might be some questions around that as well. We've only got a couple of questions at the moment in the Q&A box and I invite everyone at the moment to talk about some questions or feel free also to raise your hand and we'll sort of take groups of three for the questions. I know there's been some talk a little bit of talk in the chat box around some first of all we were talking a little bit about for those who weren't following we were talking a little bit about the transition from the 1980s into the current modern mental health system in Indonesia and some of the challenges around that and then the discussion turned a little bit more to issues around LGBTQIA plus I'm not sure where we're at with that I'm not an expert in the area by any means but I'm wondering maybe while we're waiting for some more questions and hands to raise if there's anyone else who might have some comments from the panel around some of these this is a very tricky issue it's a very sensitive issue and I don't I invite people to speak only if you're comfortable to speak about this issue but it is something that needs to be touched on and talked about in terms of issues around people's subjectivity and mental health in Indonesia would anyone from the panel like to add anything to open the discussion a little bit more sorry I was temporarily distracted what would you like me to address happy to do so we were just talking a little bit about about the LGBTQIA plus community in Indonesia and I think we had a GP who was talking about some of the concerns around that area and wondering what are some of the issues that need to be considered and maybe some different approaches from different organizational perspectives around the issue this is a very difficult and sensitive issue in Indonesia especially since in 2018 some politicians launched a war against LGBT some general said that what is it a nuclear bomb is preferable over lesbian and gay people because they do more damage now politicians worldwide like to saw the vision like to foster stigma and like to create this types of enemies to put our own advantage and this is the probable worldwide we know the very severe effects that stigma has on people with a variety of mental illnesses stigma social exclusion I think it's a cancer it makes things so much worse we should aspire all of us Australia Indonesia everywhere to have an inclusive society that is accepting and we should have a moral fortitude to say throwing division stigmatizing people we should abolish not for an over can say maybe a bit about the Indonesian psychiatric association it is debating thinking of falling out with the international standards being lesbian gay whatever is not a mental diagnosis it's not a psychiatric diagnosis there's no evidence for this I think Indonesian psychiatry should just openly acknowledge this the political climate is difficult I know this but I think we should address this in a way that this in the Indonesian context will be affected now how exactly to do that I'm an outsider I don't quite know and I know that lots of people are concerned about these issues but there is a fear to speak out very regrettable but in the current political atmosphere there is a fear to call to speak I think Wudiana you might want to say something a little bit about this issue maybe not specific about this issue but the stigma the root of all of this thing is mental health literacy is I think the big the root of everything yeah and also since currently working with the Ministry of Health for mapping the mental health system in Indonesia I really like said to hear that all around Indonesia actually the unequality like exists you can imagine in some in Sleiman for example the one where Kacahmata University is there we have 25 clinical psychologist 35 clinical psychologist working in 25 Puskas mas primary healthcare with all the program from promotion prevention and everything family, school babies everything and when we talk to people in Sleiman they are politicians not really politicians but they are officers not only in health sector we do really I can feel that their mental health literacy is like very high compared to their counterpart from other places like for example where they only have 11 Puskas mas so a person need to go there to the Puskas mas like 6 hours to get access and then among the 11 primary healthcare only one GP ever heard about mental health gap being trained and what they do what they will do if there is a mental health problem they will wait for a chance to refer this person from Puskas mas to Rumahsakejewa to mental hospital which is in Pontiana means like 10 hours then our car and the Dinsos only have 4 times a year to for the budget for referring people from the district to that Kota, Pontiana so things like that like really actually the root of all the problem where the stigma exists everything we really suffering unequality everywhere yeah, thank you I think we might throw it open to the audience for now before we go to I think Dr Aminia also has a bit of a request of Matt Nova to talk a little bit more about the suicide prevention guidelines but before I do that I might just let's just go to the Q&A box and I'm wondering if we live in the background there can we possibly unmute Payasthiti Ghafani sorry about my pronunciation so we've got a question I'll read out this question this is Dr Fani from Bali thank you very much for this question to Dr Nova in Indonesia there's a gap between mental health care services and private sector patients can't have enough time to do consultations with doctors if they are using the national health insurance the Jamanan Kesahapan National Bebetia S is there a strategy to solve this problem okay thank you for the question Dr Fani from Bali the gap is of course convenience private mental health service is convenient but expensive for the expenses but however benefits are durations of consultation and range of treatment options so not only medicines but forms of psychotherapy however the governmental mental health service if you are registered to the JKN or our social health insurance system for as far as I know in Jakarta does offer a different form of convenience that is you don't pay out of pocket yet you feel the benefit from the instalment that you pay regularly as participant of JKN so despite I was in the parliament more in the past 10 years than in practice I did my practice in the mental hospital in Jakarta Suarto Herjan for 2 years so I know the limited time to give to the outpatients with so many daily patients and massive paperwork and also having to do input to the computer information system hence the hospital also provides services of clinical psychologists usually the psychiatrist will refer to a clinical psychologist should there be an indication and also there is a maximum limit for dispensing medicines if you use JKN however there are setbacks it is very possible there are 2 opposite regulations for instance between the ministry of health and regional office of social health insurance administration body one of them experience in western Jakarta where I practice was to decide indication for rehabilitative program being covered by the social health insurance psychiatrist I think according to the ministry of health regulation is are able to decide instead of being restricted by the regional JKN regulation and during the world mental health day just few days ago I was panelist with Hans Pauls and also official from the ministry of health and he shared that 7 out of 10 people do not know JKN can cover the cost of accessing and also treating mental health services and 3 of 3 out of 10 people do not know if there are mental health services in their domicile area so I think that's pretty much it Aliza I'm wondering if there's anyone else who's got anything to add to that from the panel yeah actually I would like to respond about the why the mental health issue is hard to advocate I think based on my own experience and the community support group that I joined we are finding that the stigma is what become the challenge of all that's what make it so hard to advocate because government see that the issue is not as a priority because I've been involved in the advocacy in Pantan because we the budgeting department we call it PAPEDA and we are trying to advocate and as far as I know that not much can be done and there is not much result on that so the stigma there and the lack of support from the government is also the problem and the second is about the gap services that what can be done on our health the patient can get the more information I think this is where the role of the peer support group can be involved and be empowered because as far as I know the group like Rumah Berdaya for example in Bali as it's been pictured in the in the movie they and in this community we get a lot of information and if we want to ask about the condition there are psychiatrists some psychologists and we can have a lot of access on that and yeah I think I can add that so we can do something about the community support group and peer support group involvement and also in empowerment of people living experience for the benefit of us thank you I'm wondering if anyone else has got something to add in terms about the issues around advocacy that touches everyone in the panel and probably most of the people in the audience from the list of names I'm wondering if maybe we'll go to the panelists first and if you can speak a little bit about some of the challenges in advocacy for mental health maybe specifically in Indonesia but maybe more broadly and then maybe if there's any of the audience that wants to share anything as well we do invite you to either if you're not comfortable to raise your hand and participate by please participate in the chat box and get involved and let us know and we'll read out some of those things that we're talking about if we get a discussion going so is there anyone from the panel who wants to add anything about advocacy at the moment Emi please thank you Elisa thank you for organizing this event and it's lovely to see some of my friends here today and also in the chat I think I guess some of the challenges are also some of the things we can do more positive notes I think also through my work in other countries beyond Indonesia one of the main issues here on stigma and advocacy for mental health in general is also which kind of discourse we promote so what I notice a lot is when there are campaigns that's a stigma the kind of message given is a mental illness it's like any other illness very much promoting a strong biomedical approach to mental health which I think is also very dangerous because it's a very only directional and it is also potentially assuming that having schizophrenia, depression or the diagnosis is like having diabetes or a heart issue and I think there's a lot of danger in this kind of promotion so the balance is I guess how can we promote obviously the discrimination towards people with mental illness without pushing so much for a biomedical approach which is as pitiful as we can discuss later some other way to go about it I think very important to be aware of is that the researcher tells us that exposure to people who have experience with mental health issues for example Anthos and his work in another organization in Indonesia which are very active in terms of speaking about their experience also what has happened what has been unhelpful it's actually very important in terms of helping people from the with actually what a person with a mental health diagnosis my mental illness diagnosis might actually look like what it might be like and diminishing potentially the misconception about it so I think more opportunity for the public to actually be exposed is fundamental and we recommend on the work that Anthos is doing and others in Indonesia but actually the country is leading this kind of lived experience advocacy very much for the rest of Asia and that was for the rest of many other low income countries low income countries yeah from our experience in advocacy if we come to the government and we are talking directly about mental health the only thing about mental illness sometimes and sometimes the resistance coming like oh we only have a small number of people with mental illness in our area something like that but we learn that we start to talk about advocacy from the angle of family for example or school that will be more they will accept the resistance like not there anymore and they will come with all of this issue and how we can use this as a door for further advocacy something like that Alisa is there anything else that any of the panels want to add? it is if no no no you go first sorry jump in on the excellent description by all the panelists about the challenges in advocacy and I think there is also the sensitive questions about gender identity and the collective groups of marginalized communities that one of the lessons that we have on the field is especially what we see in passing advocacy as well as well so if it is not talked about and counted it is an issue that is not addressed so if we keep a group of populations their humanities and the complexity of their lives hidden it is not addressed and I think that is one of the big issues in advocacy for the marginalized and secondly also after advocating we need to know how to move forward with actions that are actionable programs it refers also to the public system of programs and institutions having roles so if it is not counted so there is no representation and it is not detailed in the budget items and programs it is not actionable so I think those two representation and also budgeting and governance those are the big issues in advocacy including in mental health but also in other issues that are still not addressed in Indonesia maybe that is what I can add for now. I think we might change tack for a moment I think we have got a live question from the audience but Trisa Shinta would you like to unmute your microphone now and ask your question to Mas Anto? Thank you all panelists I want to ask Mr. Anto I have heard about your amazing story and it is not easy to break the stigma and then as I know you make a beautiful batik could you please tell me how did you start working by batik but also using batik as a campaign media against stigma in mental health thank you Thank you Should I directly answer this? First of all I would like to also like to declare it's never been easy to be a mental health activist based on live experience especially exposing yourself to your story that you've been in chain or passing so it's never been easy until at this moment but I I feel like this is my duty to speak because if nobody wants to speak who's going to speak about this although my pasong is not the same pasong that experienced by people who've in the remote island that been cast away into near the forest and it put in the hill but at least I know what it felt to be in chain so that's why I committed myself to this advocacy so yes the advocacy is about relentlessly action and not just about the advocacy but also the action that's why I use to do the advocacy to use the advocacy my artwork my skills it began when I actually I have some talent in art I design I do painting so my mother is a pathic making so she do the handmade pathic so I at first I sketch some pathic just to make an art so as a media to campaign that's at the end of the my and the journey of the advocacy when I asked to speak in one of the conference in like a psychiatric conference in Indonesia in one of even so they asked me do you have anything to show like us that you have some art then I bring my path and yeah some of them are being auctioned to be sold and to be donated to the agency that's how it was started then finally I think I'm more comfortable with the designing this pathic because I designed and I empower my neighbor actually it's not just my one who's doing it but actually I approach my neighbor which part of them they also part of them who's being who's stigmatize me but I approach them to you know this is mean as a media to campaign as a media at least I can do this so my neighbor help me so it's it a bit by bit it erasing the stigma between me and my neighbor who's now is like my co-worker so actually I empower some of part of my society so that's until going now say that I'm hoping to be able to make a more pathic in the future maybe we can do something about the pathic and because again we can make some action too because KPSI now we lost our office of like secretary secretary office we usually come there people usually come here to to ask about anything in Jakarta you have to close the office because we don't have any funds so I'm planning to someday we could do some exhibition to make an auction maybe we can donate all of the the pathic or our artwork that we can do thank you thank you for the question Dr. Thank you for joining okay thank you my response thank you thank you Masanto also I would like to invite a number of our audience now we've got three questions Dimas Mohammed I think you're here and would you unmute your microphone and ask your question to the panelists please yes thank you Aliza okay my name is Dimas I'm a GP I am the one who asked about the LGBT community but yeah that's for another time I think but my question is especially question to Dr. Diana Dr. Nova and Dr. Adi who practice mental health services every day as we all know that the Ministry of Health is very very committed into technological empowerment in health services in general but how does this help the psychiatrist the psychologist to provide mental health services because they are the fields that cannot lose the human touch the human connection a few psychiatrists told me that they do not prefer telemedicine for their services so what is the potential of technology in psychiatry or a matter of other mental health services based on your professions thank you Dimas can I also invite Professor Johanna to unmute her microphone and to ask her question please Aliza usually I just call Diana Diana you are you are having the Centre for Public Mental Health I wonder you are collaborating with the community using so that working together with the psychologists at Puskas Mas they can use not only for the children but also the older people but also you can give some psychoeducation to prevent the what you call it the community mental health issues I'm not so sure whether you have done that before thank you and I think we have one further question we've now got Dr Rati I think you're here and would you like to ask your question to the panellists as well please thank you for the time Aliza my name is Dr Rati I'm from Jakarta my question for the panellists especially to Dr Nofa is suicide is a very sensitive issue for us Indonesian but we all know it's a big problem but not always seen I am a GP working for the community mental health so what do you think I can do to help the public to educate the public about suicide and what kind of approach do I need to do thank you so much for your time and thank you for answering my question I might throw this over to Dr Nofa to start off with to talk a little bit more about the suicide issues and also we did haven't forgotten you Amy you were asking a little bit more about suicide prevention guidelines from very early in the morning at the moment in Italy so we want to thank Amy for getting out very early in the morning for the rest of it it's a reasonable hour but for her a little bit early so I want to just throw it over to Nofa if you can talk a little bit more about the suicide the issues around suicide and particularly the suicide prevention guidelines to respond specifically to one of our questions here around suicide please okay Aliza and also afterwards I will address a little from Dimas regarding telemedicine so thank you Dr Ati but I did a very long presentation about this particularly for GPs just last Sunday it's on Alamedica I presented about suicide prevention but I want to focus more here on what Armenia asked in the chat box I hope some way it can relate to one another so this is the thing I also I was asked by the Ministry of Health and WHO to develop instrument which was an early detection of risk factors for suicidal ideation among teenagers as vulnerable group even I had to ensure that this work is also being utilized in the draft of guidelines for suicide prevention and treatment because the personnel in the directorate of mental health have been rolled to different directorates so sometimes there is an information gap and I feel like I can also convey the information about the work that you have done regarding the suicide first aid guidelines for Indonesia I think they have not really completed the draft so far it consists of identifying risk factors and protective factors what kind of mental health promotion that can be done for suicide prevention that can be done and early detection of suicide and also handling of risk factors and suicide action and they are trying to develop also programs, surveillance and information systems so probably the national suicide registry system so I think your work on suicide first aid guidelines it can somewhat be introduced that the director has just been changed so I hope he is still doing the same work with the previous director I will check on that one, Armenia thank you so much for this initiative as in for Dr. Rati you should first educate yourself more about suicide prevention from terminology to identify risk factors and how to utilize early detection instrument you have to be fully equipped you need to understand what people with suicidal ideation need that way you can educate because even doctors can give a very wrong response in emergency room for instance they can give someone who just tried suicidal attempt so I think that's it and you should follow more well webinar or whatever workshop on suicide prevention just last Sunday we did it with Alamedica and please try to maybe follow Alamedica because they do this real webinar particularly on suicide as well on telemedicine also Aliza I continue with the suicide guidelines for a moment I might throw it over to Deanna who has been working on these as well and you might talk a little bit about that issue and maybe also Deanna you might want to comment at the same time on Professor Johanna's fantastic idea about looking at specifically around mental health issues and wondering whether that's something that has been considered at any level of the discussion okay thank you doctorate for your amazing question if only all the GP thing like the way you think it is very good because most of the suicidal person have ever been in health system before and with Dr. Elminia Colucci we actually already made a guideline yeah Elminia was in the chat that's the English version the Indonesian version will be in that link as well so what we can do is we need to train people to do the suicide prevention and that guideline provides type by type guideline we do hope that we can roll the training after this with Dr. Elminia Colucci soon and regarding the telemedicine is it? not yet about Prof. Johanna Prof. Johanna is actually the pioneer of the psychologist Puskasmas she is initiating that long maybe in 1980 something when faculty of psychology working with Puskasmas in Jogjakarta and what the center for public mental health in regard with psychologist Puskasmas is we have become their partner the Dinkes partner to advancing their knowledge their skill in specific area including about mental health literacy, psychoeducation how to utilize how to do the brief CBT for example and then about also lifespan development program developing lifespan development program in Puskasmas and we also helped them produce the SOP SOP is what to call SOP is standard procedure like something like in Sleiman for example the first visit of pregnant woman they need to see psychologist for those who will get married like someone here want to get married soon they need to go to they need to go to the psychologist so that's what actually they do in the Puskasmas but the innovation between Puskasmas are different each other like it's very depend on how Puskasmas arranging their budget so some some of them yeah having innovation with posyandus but some of them with Pekaka for family strengthening some of them have innovation with for example mental health day in the Puskasmas something like that prof so this I think a very good idea how to make posyandu reach out to the community because most of the people engaging with psychologist Puskasmas are mostly women through Pekaka so that's very good idea and I will throw this to the Puskasmas in psychologist in Puskasmas yeah Aliza thanks Deanna I'm wondering also if we can shuffle it across to Masanto who might want to talk a little bit about the impact of telemedicine initiatives on the consumer group movement and maybe Hans has also got some comments around that about telemedicines as far as Pekaka and the community we are not really into that telemedicine actually not much of us really using the method the technology actually in the community we prefer to just chat with the groups then if someone needs to be assist then the psychiatrist or psychologist in the group will approach the our members who need support I think that's what I can respond but it's still a positive way to engage with this service although telemedicine is with a lot of obstacles and everything because not all of people are comfortable with the method thank you I think Emmy was just saying how much she missed the call to prayer I had to read that out because I think for us I'm in Australia so is Hans and I think some of the others who are joining us today from the Indonesian Institute and Ali I think we are very involved in traveling to and from Indonesia in terms of research and obviously this is something that hasn't happened for a long period of time so it's always nice to get those contextual cues maybe Hans do you want to comment a little bit more about medicine before we throw it back to no far to talk a little bit more about that and probably Deanna as well I think she had something to add something medicine in general telemedicine wondering about telemedicine and the saying Massanto was talking about the consumer groups really interacting with telemedicine in a huge way and I'm wondering if you can about how that might be utilized to sort of and may grow for the consumer group movement but let me address a few things that come up from the discussion the consumer groups are mostly volunteer and they receive a little bit of money here and there this is a problem because they're very idealistic very motivated but you know they don't pay your rent as well I think in all countries but specifically in Indonesia I think there should be a third sector beyond government and industry or commercial world the voluntary sector NGOs moving that sphere I think there should be funding for these voluntary movements like KAPE and SE to do their activities because they do them really really well there are some initiatives like telehealth closer to these consumer movements we should be very careful that telehealth specifically mental health apps could be an easy cop out from providing the real care now my university promotes all kind of apps that help you meditate help you fall asleep this is all terrific but this is not mental health interventions that can be good for the mental health of people who are mentally healthy but if you have a psychotic break then listening to meditation tips is just not going to do anything so it's really important if there are apps available that could really help with tyranny of distance in Indonesia because especially in the east with all its islands people need to travel sometimes days before to see a doctor and especially a psychiatrist but these apps should not relate on their own there should be a human support staff that can jump in if the app in itself is not sufficient to organize referrals for consultations these consultations could also be done by smart phone or zoom or whatever and there is really something to explore further that could make a real difference this also means of course that infrastructure in the east needs to be improved but there is a lot of opportunity there and I think it is a golden idea to think to involve the consumer groups in the light in Indonesia to develop apps that they think will be useful for their members so to bring that expertise on building these apps together with the people who know from experience what can help these conditions we might go briefly back to Nova do you want to talk a little bit about the telemedicine you were very keen there has been an increase of awareness among Indonesians about mental health ever since the pandemic this increase seems to appear together with the growth of digital mental health psychological first aids through online services have been highly in demand so apps such as Sehat Jiwa provided by the Ministry of Health was relaunched last year on World Mental Health Day 2020 but there is always a limited number of services being provided the consultation is free to the users but somebody's got to pay for their professional services and remote consultations such as telepsychiatry it provides services according to regulations these are relatively new regulations being distributed to the psychiatrists during the pandemic the reluctance I think somewhat is related to the limited services we can provide to the patients in regard to the strict rules and regulations and also the fear of prescribing certain medications such as anti-anxiety medicines such as benzodiazepine benzodiazepine which can be against the law in Indonesia so I think that's the pros and cons of utilizing the telepsychiatry or telemedicine I think we've also got another question from an audience member here I think if I'm not mistaken would you like the mic is all yours thank you Aliza so I actually previously am actively into the light Indonesia before I left organization last year after resuming scholarship so I think my question to Dr. Adey is about the issue of the geographic pickup in Indonesia and you previously mentioned that the budgeting is really small and it has been also shown in Dr. Nofa's slides about the budgeting issue in Indonesia what do you think we can do with this kind of limitation and actually the second one is just I wanted to share my experience so I think just few years ago a neighbor of mine recently died by a suicide and then one of our neighbors was I think a researcher related with University of Indonesia's pharmacy department so I mean he has I think some sort of name recognition because his office affiliation and then I think he dealt with the police department of Indonesia and he managed to change I think the death certificate of that individual that neighbor and then he changed it into he died by some sort of accident or something like that I think it's very it makes it very difficult for the national registry suicide based on my experience in Indonesia it makes it very difficult for us to track the specific number of death by suicide in Indonesia I think maybe you can comment on that thank you very much all right thank you very much Aliza and Pa Verdi for the question about the geographical challenges and the budgeting I have to put a disclaimer that I'm no longer a practicing medical doctor mostly my vantage point is a former doctor Kasmas and a medical anthropologist looking at it from a grass root especially in the rural area so I I am a witness also of the difficulty to reach you know populations that are hard to reach and are in need of mental health care be it in severe mental illness condition or even less I think with regards to budgeting we have to acknowledge that first we have a overreliance of a particular type of service where there is a program from the health offices local health offices for health workers either in the local health offices mental health program and in collaboration with health workers at the Puskas Mas to go and do these outreach what is it programs which are not always happening on a regular basis to all places so this overreliance of this model of care is what we need to untangle and deconstruct and see whether we can introduce a more progressive and perhaps out of the box kind of skill mix care at the primary and community health level and this is also where we look at where together for mental health tries to look at actual allies resources that are already in place that the community are seeking help for mental health care but are under recognized in the system what we need to create is an alliance with them and so that is first of all looking down and looking at what resources we already have in the communities and trying to then combine that with the potential of telemedicine because we look at in Flores for instance there are only two psychiatrists one is full time and one is part time flying back and forth from Kupang to Ende and rather than having them in places that they can geographically reach we can provide a system where this skill mix at the primary level can have a consultation system for instance and that is for the medical side of treatment and then as Hans also pointed out we cannot just look at this as a capture of like technology will solve this but also we have to expand our view of not this being a gap but also a care gap so we have to look into resources or budgets from other sectors not only in medical healthcare and then we also have to understand that Dr. Noffa previously mentioned about the fear to prescribe medications because it is not if the medications are not there not well distributed then the physicians nurses they are not confident I can't even talk about the competency because we are not measuring it properly so they are not even confident about using the medication so we have to also provide training and mentoring programs for health workers at the community level so that they can improve their confidence in providing these mental healthcare and then lastly with regards to budgeting we also have to understand that the structural support needs to be there indicators for minimum service has to include things that are beyond just severe mental illness which is what is existing now I might be wrong perhaps Dr. Noffa and Ibudian and Masanto and Hansken can talk more perhaps these are changing but the current system is only recognizing severe mental illness as the indicators for minimum care so I think those things need to be addressed when we talk about budgeting thank you. I think we have got a number of other questions flooding in also and we are basically to time we might on Maaf but basically extend the webinar just a few minutes maybe five minutes more I can see that individuals are sort of talking about consistently we are getting things coming up around the lack of resources and particularly in rural divide and we have talked a little bit about the telemedicine and some resources that are being used to try and access those populations I know that together for mental health the attempt to marry the traditional with the modern hasn't really spoken much about in terms of that particular project and I am wondering if I give you three minutes could you give us a little bit more information about that project when the screening is going to happen for instance. Thank you Elisa and of course Asti being the the research director of the project and Diana the Indonesia Comissi Gato please chip in at any point I just gave a link because I think is a good to know there is a place where people interested can go and read more about the project but also find a lot of links which are always going to be progressing as we are releasing more materials but as the excerpt showed was only 12 minutes or I think Asti 92 minutes the film is up now of harmony but always shows basically what we have been doing with this research project which was based in Indonesia and in Ghana so it's a comparative study using photography, documentary and participatory video so it's completely visual methodology based was around looking at collaboration between a faith based and traditional healers and mental health professionals so what we have been doing with Asti and Diana as well has been around looking for Indonesia about their good practices is there something we can see about how these collaborations possible and when they work what they look like what are some of the facilitators that actually allow collaboration you will be looking for bi-directional collaboration where there was a will a will from both sides to be helping each other because often when people talk about collaboration it's about mental health professionals going to healers and telling them about this is the way and obviously this is a lot of reaction from their side but also assumes that there is some form of knowledge which is superior simply because it's a scientific base when mental health and mental illness is much more complex and there is a lot of dimension to it so in some way our project as Dato says together from mental health is to use an inclusive approach about to mental health and mental illness and healing but also looking about going back to the Pasung issue that Nova mentioned which has been my first film I made in Indonesia breaking the chains and then connected to breaking the chains and to story it's also about seeing does this collaboration actually eradicate or at least decrease human rights abusive practices such as Pasung and so I think it's been a very important exploration for us in the field and I can say with confidence we had a lot of hours of footage we also done some short videos we are still editing now more films we are hoping to do more coming out but capturing some very good examples in three different locations in Indonesia so we are now going to festivals starting actually where you are now in Canberra so our first film festival this has been last weekend of October in Canberra this is my brave festival now it's going to other festivals in the next few months the film is going to festivals but then we will organize another online screening at some point maybe beginning next year and then eventually the film after it's gone to festival will be publicly released on our website so if you want to watch Armonie as well as Kebom which is the Ghana film which is about to be released as well please do go to the website you can follow so then you receive some updates on when things are released and when epismic should be used as much as we as you can and I want to thank everybody here so Asti the such fellow Diana as my faithful companion in many adventures including these answers supporting this project has been until August was part of our steering committee and all of these people we are part of the same journey it's so beautiful also with you and Lisa to be part of all of this together so as the word says together for mental health thank you so much Amy I really appreciate that we're actually we're totally out of time and I can see there's a fantastic discussion that has opened up in terms of issues around social psychological rehabilitation and the time that these sorts of things take and what sort of interventions are sort of available for those sorts of things directing to some of the panelists particularly Dr Novo but we're going to have to draw the seminar to a close we are really hopeful that we continue to offer more in-depth discussions around mental health in Indonesia to a broader audience including those Indonesian who are based in Australia and we would invite you to check out the Indonesia Institute website where we're going to upload the recording of these proceedings also to just save the date for the Human Rights Day in December that the Indonesian Institute is going to have an event around gender and sexuality you might want to check that out also I just want to virtually join with you in a round of applause for all of our panelists here today they've done a fantastic job they've produced some amazing introductory videos about mental health in Indonesia and I hope that you've learned a little bit more about some of the questions and some of the things that you want to learn about around health systems development in Indonesia and I hope we can continue to continue to build a stronger, better system for Indonesia in mental health care thank you very much, salam sejahtera and sampai ketemu lagi