COVID-19 and mental health in Indonesia

Evidence is emerging in Indonesia of a serious rise in mental health problems associated with the COVID-19 pandemic, and the crisis has revealed the urgent need for investment in the area, Sudirman Nasir writes.

COVID-19 presents a serious threat to both physical and mental health, but policymakers in Indonesia have so far mostly focused on its impact on physical wellbeing, rather than mental wellbeing. Aside from the clear burden of COVID-19 as a physical disease, the pandemic had produced uncertainty and altered the daily routines of millions of people, triggered psychological issues, created financial pressures, and required extensive social isolation from people.

This is sure to have a lasting effect. Indonesians, as people are the world over, are increasingly, and fairly, worried about getting sick, how long the pandemic will last, and what the future will bring. This is taking a psychological toll. On top of this, information overload and the spread of misinformation contributes even further to a collective feeling of things being out of control.

It is not surprising that, with a significant increase of fear, loneliness, frustration, and sadness – as there has been for many people throughout the COVID-19 pandemic – comes an increase in mental health difficulties such as anxiety and depression.

In turn, these symptoms can contribute to other issues, such as drug and alcohol abuse, self-harm, suicide attempts, or violent behaviour, both during and after the pandemic’s peak. It is also noteworthy that mental health problems often manifest themselves in various physical symptoms too, such as headaches, diarrhea, constipation, or constant fatigue, and that these may weaken immunity and make struggling individuals more susceptible to infection by COVID-19 or to developing other health problems.

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Studies on the mental health impacts of previous disease outbreaks support this too, and have clearly indicated a significant increase in anxiety, depression, and suicide rates among people effected by the disease.

So, what should the government do?

It is noteworthy that a person’s capability or resilience to cope with stress and mental health problems vary, and more resources and attention should be provided to vulnerable groups such as people with existing chronic health conditions, including mental health problems, the elderly, and the disabled, as well as teenagers and children.

In this specific case, policymakers should consider which groups are especially vulnerable due to the systemic impacts of COVID-19, like those people who are recently out of a job due to the economic slowdown, or healthcare workers who have been part of the pandemic response.

Studies have also established links between unemployment and mental health, particularly among men, because of the psychological and cultural significance of employment to male identity in most cultures of the world. These studies also showed that unemployment frequently creates problems outside of a lack of income, and can damage self-esteem and create feelings of a loss of personal dignity.

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Both direct and indirect impacts of unemployment may create new or exacerbate existing mental health problems, and Indonesian policymakers should make particular effort to provide mental health resources to the unemployed, both during and after the crisis.

The COVID-19 pandemic and its socio-economic consequences are providing a fertile ground for various mental health issues among the population, and government agencies, health associations, and non-government organisations in Indonesia must strengthen mental health literacy and care in the country if they want to have any hope of neutralising the negative mental health effects of the crisis.

This could include educating the population on self-care strategies and other skills that can improve mood and psychological wellbeing. It could also mean providing people the knowledge they need to be able to identify signs of danger, both in themselves and in family members or close friends. These might include the changing of sleep and eating patterns, or an increased use of tobacco, alcohol, and drugs. Finally, making sure access to health services providing mental health care are widely available will be crucial.

Fortunately, several organisations in Indonesia, such as the Medical Doctors Association, the Association of Psychiatrists, the Psychologists Association, the Public Health Association, the Association of Nurses, as well as various community health centres, are providing this education and care, but these services should be scaled up and given more resources to do this crucial work.

The participation of religious organisations in Indonesia in strengthening health literacy, both in the COVID-19 crisis and into the future, will be hugely important too. Large Islamic Organisations like the Nahdhatul Ulama (NU) and Muhammadiyah, could play a key role in strengthening mental health care if utilised by policymakers, due to their extensive reach and social capital in many different communities, including in the hard to reach the hinterlands of Indonesia.

NU and Muhammadiyah in particular have millions of members or followers in the archipelago and have strong legitimacy in the eye of the public. Indeed, during the COVID-19 outbreak having these mainstream Islamic Organisations on side – and they have been mostly supportive – has been important for the government.

Christian, Buddhist, Hindu organisations are also, of course, able to help as providers of mental health literacy programs in Indonesia if given support. The use of technology and social media is also going to be crucial to reach and promote mental health literacy among Indonesian young people, and these organisations may be especially well suited for such a task as part of that effort.

No matter what the government chooses to do, COVID-19 is an opportunity for policymakers in Indonesia to understand more closely the intersection between physical and mental health, and how both can be tackled together. If the government takes this chance, it could be the start of an invaluable step towards strengthening the health system in Indonesia.