1.

Would you be able to provide your view on variations in the quality of mental
health care across different geographical regions Indonesia? (I am in particular
interested in the mental health care that was offered in Aceh after 2006, compared to
the state of health care elsewhere in Indonesia, however any thoughts on variations
in care across Indonesia would be appreciated!).

Pemerintah Indonesia menetapkan bahwa layanan kesehatan (termasuk

kesehatan jiwa) menggunakan skema yang sama untuk seluruh Indonesia, yaitu
terbagi menjadi 3 tahapan layanan:

a. Layanan primer – Pusat Kesehatan Masyarakat – jumlahnya lebih dari 9000

tersebar di seluruh wilayah di Indonesia namun hanya 40% di antaranya
yang memberikan layanan kesehatan jiwa. Program kesehatan jiwa tidak
menjadi program prioritas, namun semenjak tahun 2017 dengan berlakunya
standar pelayanan minimal yang menjadi dasar penilaian Kementerian
Dalam Negeri terhadap Kabupaten/Kota dan Program Indonesia Sehat,
keduanya mengangkat topik manajemen pada pasien dengan gangguan
jiwa. Harapan ke depan, Puskesmas semakin mampu menjadi
pelaksana/penyedia layanan kesehatan jiwa yang lebih baik

b. Layanan sekunder – berbasis RS Umum berjumlah 455 dan 60% di

antaranya menyelenggarakan layanan kesehatan jiwa terutama layanan
rawat jalan.

c. Layanan tersier – berbasis RS Umum dengan layanan tersier (rujukan

nasional) atau RSJ. Indonesia saat ini memiliki 49 RSJ yang tersebar di 27
provinsi, sehingga masih ada 8 provinsi yang tidak memiliki RSJ.

Variasi layanan dicoba batasi dengan adanya panduan praktik klinik nasional
untuk layanan primer, sekunder, dan tersier – terutama untuk penyakit terbesar di
Indonesia yaitu delirium, demensia, penyalahgunaan zat, skizofrenia, skizoafektif,
depresi, gangguan afektif bipolar, gangguan panik, gangguan anxietas
menyeluruh, gangguan obsesif kompulsif, gangguan stres pasca trauma, gangguan
pemusatan perhatian/hiperaktif pada anak dan remaja

The Government of Indonesia stipulates that health services (including mental

health services) use the same scheme for all of Indonesia, which is consisted of 3
stages of service:

a. Primary services - Public Health Centers (Pusat Kesehatan

Masyarakat/Puskesmas) - more than 9000 are spread throughout Indonesia,
but only 40% provide mental health services. The mental health program
was not a priority program, but since 2017, with the enactment of minimum
service standards (where the Ministry of Home Affairs bases the District /
Municipal & Healthy Indonesia Programs from), both raise the topic of
psychiatric patients management. Hopefully in the future, Puskesmas will
be able to become better mental health service providers / providers.
 b. Secondary services - Public hospitals - amounted to 455. Only 60% of
public hospitals conducted mental health service (especially outpatient
services).
c. Tertiary services – include General Hospital with national referral service
and Mental Health Hospital (Rumah Sakit Jiwa/RSJ). Indonesia currently
has 49 mental health hospitals located in 27 provinces, so there are still 8
provinces that do not have RSJ.

Variations in services are attempted to be reduced with national clinical practice

guidelines that specialized for each stages (primary, secondary, and tertiary
services) - especially for the most common diseases in Indonesia: delirium,
dementia, substance abuse, schizophrenia, schizoaffective, depression, bipolar
affective disorder, panic disorder, generalized anxiety disorders, obsessive
compulsive disorder, post-traumatic stress disorder, attention / hyperactivity
disorder in children and adolescents.

2. You wrote in your 2014 article in the Conversation about a new parliamentary
bill on mental health that was passed in 2014, which provides a legal
obligation for the government to protect people with mental disorders. Would
you be able to speak to the effectiveness of this law in the last 3 years?

Tidak mudah menilai efektivitas dari adanya UU Kesehatan Jiwa. Tidak ada ukurannya yang formal.
Namun bila dikaitkan dengan pemanfaatan dalam proses advokasi, UU Kesehatan Jiwa telah secara
luas dipergunakan dan hal ini terlihat dari berbagai produk pedoman maupun panduan yang berlaku
dalam sistem layanan kesehatan jiwa. Namun dapat dikatakan bahwa pemahaman atau pemanfaatan
undang-undang ini masih dalam scope yang kecil, yaitu hanya di lingkungan kesehatan dan social
saja (terutama pasca terbitnya UU disabilitas tahun 2016).

Masih terbatas pemanfaatan UU kesehatan jiwa untuk sektor lain yang juga berhubungan dan
tersebut dalam UU tersebut yaitu sektor pendidikan, pekerjaan, masyarakat, lembaga keagamaan,
lembaga pemasyarakatan/tahanan, dan media massa.

Hingga saat ini juga masih ditunggu produk peraturan pemerintah yang menjamin peraturan
perundang-undangan yang ada dapat lebih dioperasionalkan

It is not easy to assess the effectiveness of the Mental Health Act (UU Kesehatan Jiwa), since there is
no formal standard for assessment. In relation with advocacy process, the Act has been widely used,
evident from the various guideline products that are being used in the mental health services system.
But it can be said that yet, the understanding or utilization of this law is still in a small scope, which is
in health and social sector (especially after the publication of Disability Act of 2016).

There is still limited utilization of the mental health law for other sectors that are also related and
mentioned in the law, namely the education sector, employment, community, religious institutions,
prisons / detention, and mass media.

Until now, government regulation which can guarantee that the existing laws can be applicable to
larger extent is still much awaited.

3. You mention in your 2016 article in the Conversation that travel distances and
the cost of transportation are what hinder people from seeking proper mental
health treatment. What kind of steps need to be taken to improve this?

Hingga saat ini sistem pembiayaan yang ada baru menjamin pembiayaan terkait
pelayanan kesehatan – obat, tindakan, dan jasa tenaga kesehatan. Biaya
transportasi diupayakan dikurangi dengan beberapa program:
a. homevisit and homecare
b. rujukan ke layanan kesehatan yang lebih dekat – rujuk balik

Ke depan, Kementerian Sosial merencanakan akan memberikan kartu bagi orang

dengan disabilitas yang dapat digunakan juga untuk mengurangi beban biaya
transportasi.

Until now, the new financing system only ensures financing related to health
services - drugs, action, and healthcare services. Transportation costs are
reduced by several programs:
a. homevisit and homecare
b. referral to closer health services – and referral back

In the future, the Ministry of Social Affairs plans to provide cards for people with
disabilities that can be used also to reduce the burden of transportation costs.

4. One of the points made in the HRW report ‘Living in Hell” is the disunity
between different regulations on rights for people with disabilities. You
have written about the importance of harmonising these frameworks — what
action has been taken to achieve that in recent years, and has it been effective?

Hingga saat ini belum dilakukan upaya bersama untuk melakukan sinkronisasi antar berbagai produk
regulasi dan kebijakan yang ada. Tahapan yang saat ini banyak dilakukan lebih berhubungan dengan
memperbanyak kolaborasi antara berbagai sektor terkait dalam penyusunan kebijakan dan rencana
kerja. Salah satu contoh yang dapat diangkat adalah upaya kolaboratif Gerakan Stop Pemasungan.
Gerakan ini diinisiasi oleh Kementerian Sosial, sebagai penanggung jawab pelaksanaan perlindungan
hak asasi manusia pada orang dengan disabilitas termasuk disabilitas mental. Gerakan ini merupakan
kolaborasi antara Kementerian Sosial dengan Kementerian Kesehatan, Kementerian Dalam Negeri,
BPJS, dan Kepolisian.

There has been no concerted effort yet to synchronize the various regulatory products with existing
policies. The stages that are currently being done are increasing the internal collaboration between
various sectors in the making of policies and work plans. One example is the collaborative effort of
Pemasungan (fetter/physical restriction at home) Stop Movement. This movement is initiated by the
Ministry of Social Affairs (who is responsible for the implementation of human rights protection for
people with disabilities including mental disability), and is a collaboration with the Ministry of Health,
Ministry of Home Affairs, BPJS/National Health Insurance, and the Police.