Stigma, Discrimination upon People with Mental Disorder and

Mental Health Literacy in Indonesia

Rika Damayanti, Ahmad Hufad and Mustofa Kamil

Universitas Pendidikan Indonesia, Bandung, Indonesia

r1k4.damayanti@student.upi.edu

Keywords: Stigma, Discrimination, Mental Health Literacy.

Abstract: There has been an increase in the mentally retarded people number in Indonesia. The high rate of stigma and

discrimination upon them is apparently one of the influential causes of the problem. The lack of honesty and

openness of the family to admit the family member’s mental problem and to seek proper treatment on it still

occurs. Some may assume their mentally retarded family are suffering caused by genie disturbance or black

magical practices and that cause them treated inhumanly, like being locked on their legs between two pieces

of wood, got their legs chained or being isolated. Thus, there should be promote and curative efforts to prevent

the increase and curative and rehabilitative efforts to fasten the healing process. This research is aimed at

analyzing mental health literacy program – one of the promote programs in preventing stigma and

discrimination regarding the mental health problem. The research method employed was literature review of

the issue from various countries. The findings reveal that the mental health literacy program in the form of

courses or trainings is very helpful to make the society aware of the issue and allow people with mental

disorder may get immediate professional treatment and immediately cured.

1 INTRODUCTION

Mental health is the state of an individual which

allows him to develop physically, mentally,

spiritually and socially, to realize his own capacity, to

overcome pressure, to work productively and to

contribute positively to his surroundings as well (UU

Kesehatan Jiwa, 2014). Someone is claimed to have a

healthy mental if he performs good mental functions,

shows productive activities, has comfortable social

relations, adapts to changes and manages problems

(Mohr, 2006). To sum up, concept of mental health

is not related to a state of healthy or unhealthy, but

rather an optimal condition which is ideal in thinking,

behaving and performing social functions.

Someone with good mental health owns a descent

quality of life for having the ability to play both the

individual and social role suitably within the society

in this global era. In fact, possessing this kind of

ability is highly needed since nowadays people are

getting more interconnected and interdependent to

fulfill their needs. Otherwise, they will find it hard to

carry their lives.

Stuart states that mental health is within a range

of responses starting from adaptive to maladaptive

response, from mentally healthy, psychosocially

disturbed to mentally disturbed (Stuart, 2009).

Psychosocially disturbed people or in Laws of Mental

Health called People with Mental Emotional Problem

(PwMEP) are those who have physical, mental,

social, growth and development, and/or life quality

problems which further lead them to suffer from

mental disorder. Meanwhile, People with Mental

Disorder (PwMD) are those who undergo

disturbances of thought, behavior and senses

manifested in a collection of symptoms or eloquent

change of behaviors which may cause griefs and

hindrances to act out the humanity function as human

beings (UU Kesehatan Jiwa, 2014).

Research findings issued by World Health

Organization reveal that in general approximately

154 million people get depression, 25 million people

get schizophrenia, 15 million people abuse the drugs,

50 million people suffer epilepsy, and 887,000 people

commit suicide annually (WHO, 2001). This figure is

estimated to keep increasing from year to year

considering the complexity of problems faced.

In Indonesia, findings of Basic Health Research

(Riskesdas) in 2013 displayed the augmenting

prevalence of severe mental problem

(psychosis/schizophrenia) amounting 1.7 per mile of

population or equal to 400,000 sufferers, whereas in

398

Damayanti, R., Hufad, A. and Kamil, M.

Stigma, Discrimination upon People with Mental Disorder and Mental Health Literacy in Indonesia.

In Proceedings of the 1st International Conference on Educational Sciences (ICES 2017) - Volume 1, pages 398-401

ISBN: 978-989-758-314-8

2007 there were only 0.46 per mile. The highest

prevalence of severe mental health problems occurred

in Jakarta (20.3 per mile) (Riskesdas, 2013). This

figure tends to keep increasing considering the rising

complexity of social problems faced by Indonesian

citizens such as poverty, unemployment, crimes,

disasters, and political instability as well.

Based on the result of interviews with PwMD and

the family of PwMD, it was found out that the decline

of productivity and quality of life is worsened by

stigma and discrimination experienced by the PwMD

and the family. PwMD are very liable to encounter

varied stigmatizations and discriminations from

society members. These may include being dropped

out of school, fired from the office, divorced by the

spouse, ignored by the family, locked the legs with

woods or chain and also defrauded (Depkes, 2014)

A research finding carried out in Australia

discloses that the major factor to improve the life of

mentally retarded people is to reduce stigma. It was

exposed in a national interview by SANE Australia

during the Mental Health Week in October 2000. The

survey reveals that the misunderstanding of mental

health problems and discrimination greatly influences

all aspects of human life including the treatment

provided by mental health service agency (Carr and

Halpin, 2002).

The Low Prevalence Disorders Study (LPDS)

pointed out that 15.3% people with psychotic disorder

(17.2% male and 12.4% female) did not feel secured

in their own place. Besides, 17.6% reported that they

had gotten physical violence, been tortured and

bullied within the last twelve months, and 13.2%

indicated that they were expecting to have assistance

from police or others, yet to no avail (Carr and Halpin,

2002).

Social isolation widely spread among the

sufferers of psychotic disorder. LPDS also indicated

that 63.5% of the single participants, 31.3% lived

alone and did not actively participate in the family

programs. Almost 40% reported that they did not

have any one to whom they could share their burden,

and 44.9% thought that they needed a close friend.

Then, there were only few participants of LPDS

reporting satisfactory sexual intercourse (Carr and

Halpin, 2002).

2 REVIEW OF LITERATURE

Mental disorder is a maladaptive response upon

internal and external stressors indicated by improper

thought, feeling and behavior against the norms and

disturbing social relations, job as well as physical

functions (Stuart, 2009). In addition, Videbeck (2006)

affirms that mental disorder is a sort of syndrome or

someone’s psychological pattern or behavior

clinically related to the presence of distress and

disability or the death risk. In conclusion, mental

disorder is the presence of maladaptive responses

indicated by cognitive, affective, physiological,

behavioral and social individual judgment.

The causes of mental disorder are very complex,

multi-causalities, not only related to social problem

as previously suggested. It can also be caused by

biological, psychological, socio-cultural and spiritual

factors.

The greatest hindrance in handling this problem is

stigma or the response of society upon the mental

disorder itself. The term ‘stigma’ here means sign,

sign of disgrace or to discredit; and ‘to stigmatize’

means to label someone socially unacceptable or

shameful. The consequences of being stigmatized

include shame, humiliation, isolation and desperate.

The burden is even worsened by the unfairness of

treatment. This case is not only about the attitude of

society and the efforts to change it but also related to

human rights. Likewise, discrimination, prejudiced-

based treatments, is also related to human rights and

is not tolerable to occur within the society upholding

the commitment of justice for all (Carr and Halpin,

2002).

The main focus of treating the symptoms of

PwMD is aimed at improving the quality of life.

Unfortunately, personal experience of being

stigmatized which surely affects the quality of life is

not becoming the priority of treatment given by either

the society or the mental health professionals. As a

matter of fact, Reports of National Investigation on

the Human Rights of People with Mental Disorder

recorded that PwMD experienced the awful stigma

and discrimination almost in every aspect of their

lives (Carr and Halpin, 2002).

Furthermore, stigma tends to intensify and

strengthen the practice of social isolation, limit the

equal chance for job and recreation (Markowitz,

1998), hamper the search for assistance activity

(Sartorius 1998), create, affirm and nurture the

mythology of pseudo-mental, often internalized by

people with mental disorders which may cause a lot

of pains (Markowitz, 1998). Even though PwMD are

able to describe their personal experiences of being

stigmatized, health mental nurses and professionals

are often hard to prove that the experience took place

as the direct impact of negative attitude or

discriminative actions (Carr and Halpin, 2002).

Sartorius (1998) further asserts: “... stigma and

discrimination are the most significant obstacles in

Stigma, Discrimination upon People with Mental Disorder and Mental Health Literacy in Indonesia

399

developing mental health treatment and ensuring

quality life for the people with mental disorders ...

actually there is sufficient fund to help people with

mental disorder, but it is not available due to negative

attitude of most of the decision makers as well as the

society towards them (Carr and Halpin 2002).

Mass media also plays an important role in the

practice of stigma and discrimination upon PwMD.

Mass media is often blamed to wide spread the stigma

upon PwMD, and it is true that the picture of people

with schizophrenia looking harmful and unexpected

is voraciously consumed by many people. It is not

rare to find in some popular press in England such

expressions as ‘maniac’, ‘shizos’, ‘psycho pat’, and

‘crazy’. Prejudiced attitude and easily to define

problems are likely to be the stereotype of ‘media’.

Moreover, traditional media in England like

Broadsheets is considered to bear more responsibility

because they tend to describe people with mental

disorder having the potency to harm others in their

both fictitious and non-fictitious representation (Carr

and Halpin, 2002).

To deal with the mental health problem in

Indonesia, the government has implemented the

following efforts: 1) Utilizing comprehensive,

integrated and continuous mental health service

system; 2) Providing the necessary facilities and

resources needed to assure the optimum mental health

service including medicines, equipment, and medical

and well-trained non-medical staff around Indonesia;

3) Steering the society to perform preventive and

promote efforts, early detection of mental disorder,

and rehabilitation and reintegration of PwMD to the

community. Another urgent action is to do

empowerment of PwMD with the purpose to enable

them live independently, productively and

confidently in the community free of stigma and

discrimination and without feeling fear, ashamed and

hesitant. This effort, of course, wily work well with

the concern and active participation of the family and

community members including the prominent figures

of religion, custom and society, social organizations,

organizations of profession, business sector and also

private sector. Stigmatization as well as

discrimination upon anyone must be eliminated since

it is against the human rights and may further ignite

social, economic and security problems (Depkes,

2014).

3 RESEARCH METHODS

At this writing, the method used is descriptive

qualitative approach, it is expected that this approach

can strengthen and sharpen the qualitative discussion.

While the literature study and comparative study is

used to search data from books, literature, records and

reports that have to do with mental health literacy.

4 DISCUSSION

Laws of Mental Health Number 18 2014 Article 2

elaborates the efforts to promote mental health on the

basis of: fairness, humanity, usefulness,

transparency, accountability, comprehensiveness,

protection and non-discrimination. Article 3

elucidates that the effort of mental health is aimed at,

among others, assuring that everyone is capable of

acquiring a quality life; possessing a healthy mental

life, free of fear, stress and other disturbances which

may lead to mental health problem; ensuring

everyone to develop owned-intellectual potency;

providing protection and mental health service for

PwMEP and PwMD on the basis of human rights;

providing health service with integrated,

comprehensive and continuous way through promote,

preventive, curative and rehabilitative efforts for

PwMEP and PwMD; make certain the availability

and within reach resources in the efforts of mental

health; improving the quality of efforts of mental

health in accordance with the development of science

and technology; and providing equal chance to all

PwMEP and PwMD to attain their rights as

Indonesian citizen.

The availability of mental health service in a

certain country depends very much on its

understanding of the mental health issues which is

then called Mental Health Literacy. It is defined by

Jorm et al. (1997) as "knowledge and belief of mental

disorder which may help to manage the problem.

Health literacy includes the ability to recognize

certain disorders; the knowledge to search for

information of mental health; the knowledge about

such factors as risks and causes, self-treatment, and

the available professional assistance; and the attitude

promoting openness and quick response to get

assistance." (Jorm et al., 1997) However, this

definition fails to state overtly that mental health

literacy is knowledge based on proofs of mental

disorder and its treatment.

The concept of mental health literacy is derived

from health literacy aimed to augment the knowledge

of PwMD about physical health, disease and

treatment (Jorm et al., 1997).

There are three major components of mental

health literacy: admittance, knowledge and attitude.

A conceptual framework of mental health literacy

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describes the relationship among the components, and

each component is conceptualized as the area of

target to measure and intervene (Jorm et al., 1997;

Jorm, 2000; O'Connor et al., 2014). Some researchers

are only focusing on a particular component, while

some others are trying to see the relation between

components. Take for an example, a researcher is

researching the increase in admittance solely through

a certain educational program, whereas another

researcher may integrate the three components in one

program.

The literature review reveals that the knowledge

of the society about mental disorder as a clinical

situation and the strategy of treatment in the

developing countries in general is less than sufficient.

It is also noted that there is a high need to improve the

mental health literacy among the primary mental

health treatment professionals themselves. Lack of

literacy may affect the treatment given to those who

need it, especially to those from the middle class

people or lower in the countries where mental health

service is rare to find. To better the situation, there

should be comprehensive and innovative strategies by

making good use of the strengths and dealing with the

challenges properly.

This phenomenon indicates the urgency of mental

health literacy program for the society, particularly in

the developing countries to prevent stigma and

discrimination. Mental health literacy program has

been carried out in the developed countries like

Australia and some other developed and developing

countries. The program is in the form of training

starting from knowledge of mental disorder

(recognition of mental disorder, knowledge and

beliefs about causes, about self-help, professional

help, attitudes recognition and help seeking,

knowledge of how to seek mental health information,

cognitive organisation of mental health literacy and

improving mental health literacy) (Jorm, 2000). that

facilitate up to first aid to the sufferer of mental

disorder. The training is given to some groups of

teenagers and adult people organized by certain

organizations having concern about the prevention of

stigma and discrimination upon people with mental

disorder.

5 CONCLUSIONS

People with mental disorder are very likely to

experience stigma and discrimination in their

community. It is indeed an awful situation and surely

against the human rights. It also violates the Laws of

Mental Health. It may happen due to lack of

understanding about mental disorder. Besides,

misunderstanding of it may become the cause like the

perception that it has nothing to do with medical

matters, but more related to intervention of genies or

ghosts.

Considering the trend of instant increasing

number of PwMD, it is high time for Indonesia to set

up mental health literacy programs to be carried out

by either government institution closest to the society

such as Center for Community Health Service

(Puskesmas) or Non-Governmental Organizations.

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Depkes, 2014. Stop Stigma dan Diskriminasi pada Orang

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