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
Copyright © 2018 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
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
ICES 2017 - 1st International Conference on Educational Sciences
400
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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