The prevalence of and perception toward mental illness: a cross-sectional study among Indonesian mental health nurses.

BACKGROUND: The emergence of the Coronavirus disease 2019 (Covid-19) pandemic has affected nurses' mental and psychological health. This study investigates the prevalence of depression, anxiety, and stress among Indonesian mental health nurses and their perception of mental illness. METHODS: A cross-sectional study was conducted shortly before the height of the Covid-19 outbreak in Indonesia. The data were collected using the 21 items of the Depression, Anxiety, and Stress Scale (DASS-21), the questionnaire on perception toward mental illness, and demographic information. RESULTS: Approximately 2.5%, 6.5%, and 1.9% of the nurses had the symptoms of depression, anxiety, and stress, respectively. The vast majority of them perceive that society should treat well people with mental illness (94.8%) and that the government should protect them (94.8%). More than half also believe that they can eat anything but seldom get physically ill (62.1%) and that in Islam, people with mental illness are innocent and are destined for paradise (61.1%). CONCLUSIONS: A considerably low prevalence of mental distress was discovered, which might be attributed to the nurses' implementation of mental health skills and effective coping mechanisms. Further training and awareness-raising campaigns are needed to address their misconceptions about mental illness.

The state of diabetes care and obstacles to better care in Aceh, Indonesia: a mixed-methods study.

BACKGROUND: Cardio-metabolic diseases are a major cause of death worldwide, including in Indonesia, where diabetes is one of the most critical diseases for the health system to manage. METHODS: We describe the characteristics, levels of control, health behavior, and diabetes-related complications of diabetes patients in Aceh, Indonesia. We use baseline data and blood testing from a randomized-controlled trial. We conducted semi-structured interviews with eight health providers from Posbindu and Prolanis programs that target diabetes and other non-communicable diseases (NCDs). We also conducted three focus group discussions with 24 diabetes patients about their experiences of living with diabetes and the existing support programs. RESULTS: The blood tests revealed average HbA1c levels indicative of poor glycemic control in 75.8 percent of patients and only 20.3 percent were free from any symptoms. Our qualitative findings suggest that patients are diagnosed after diabetes-related symptoms manifest, and that they find it hard to comply with treatment recommendations and lifestyle advice. The existing programs related to NCDs are not tailored to their needs. CONCLUSION: We identify the need to improve diabetes screening to enable earlier treatment and achieve better control of the disease. Among diagnosed patients, there are widespread beliefs about diabetes medication and alternative forms of treatment that need to be addressed in a respectful dialogue between healthcare professionals and patients. Current diabetes screening, treatment and management programs should be revised to meet the needs of the affected population and to better respond to the increasing burden of this disease.

Quality of life, depression, and anxiety of patients undergoing hemodialysis: Significant role of acceptance of the illness.

OBJECTIVE: Routine dialysis is stressful. It has the possibility of leading to depression and anxiety and also reducing patients' quality of life. Despite these significant consequences, these comorbidities have been rarely studied among Indonesian patients. This study aims to examine the rate of depression, anxiety, and the role of acceptance of their illness on patients' quality of life. METHOD: A total of 213 patients undergoing hemodialysis in three general hospitals in Aceh, Indonesia, were included in the study. The presence of depression, anxiety, and the quality of life of each patient was assessed using the hospital anxiety and depression scale and WHO quality of life-BREF questionnaires. RESULTS: The prevalence of depression and anxiety was 46% and 30.5%, respectively. Depression was only associated with the presence of anxiety and the duration of hemodialysis. Anxiety was negatively associated with quality of life but positively associated with depression and the prescription of an anxiolytic. Overall quality of life was associated with age, body mass index, the presence of anxiety, and acceptance of the illness. Acceptance of the illness was also independently associated with almost every domain of patients' quality of life. CONCLUSIONS: The rates of depression and anxiety among patients undergoing hemodialysis in the current study setting are relatively similar to the rates in other settings. Patients' acceptance of their illnesses is significantly associated with the occurrence of anxiety and quality of life. Therefore, health practitioners should help patients accept their illnesses and the administration of regular hemodialysis.

Panic buying: An insight from the content analysis of media reports during COVID-19 pandemic.

BACKGROUND: Panic buying is an emerging phenomenon observed during, but not restricted to, pandemic. AIM: We aimed to evaluate the nature, extent, and impact of panic buying as reported in the media. METHODS: This study was conducted by collecting the information from the English media reports published till 22nd May 2020. A structured format was developed to collect data. Searching was done by using the keyword "panic buying". We have excluded the social media posts discussing the panic buying. RESULTS: The majority of media reporting was from the USA (40.7 %), and about 46 % of reports highlighted the scarce item. Approximately 82 % of the reports presented the causes of panic buying whereas almost 80 % report covered the impact of it. About 25.7 % of reports highlighted the rumor about panic buying and only 9.3 % of reports blamed the government. Only 27.1 % reports described the remedial measures, 30.8 % reports conferred the news on the psychology behind panic buying and 67.3 % news displayed the images of empty shelves. CONCLUSION: A high proportion of reports on panic buying have been found from the developed countries discussing the causes & impact of panic buying on the basis of expert opinion.

Existential Well-Being in Nature: A Cross-Cultural and Descriptive Phenomenological Approach.

Exploring the putative role of nature in human well-being has typically been operationalized and measured within a quantitative paradigm of research. However, such approaches are limited in the extent to which they can capture the full range of how natural experiences support well-being. The aim of the study was to explore personal experiences in nature and consider how they might be important to human health and well-being. Based on a descriptive phenomenological analysis of fifty descriptions of memorable moments in nature from England, Indonesia, and Norway, our findings illustrate a common structure presented under three themes: 1. serenity that gives rise to a growing awareness of how the body is stimulated by the senses; 2. admiration and appreciation for the sensation of beauty; 3. an emerging sense of togetherness and deep emotional bonding. The findings are discussed using the concepts of ecological time and the ecological body, which foreground being in nature as constituted as an interdependent and dynamic human process. We conclude by understanding well-being in terms of human responsiveness to their surroundings and thus as rooted in the human condition.

The community health worker experience and perception toward mental illness: A multi-settings cross-sectional study in Indonesia.

BACKGROUND: The experiences and perceptions of Community Health Workers toward mental illness are vital for tailoring interventions, reducing stigma, improving access to services, and fostering community engagement in mental health initiatives. AIMS: This study investigates the experiences of community health worker and their perception of mental illness. METHODS: A multi-settings cross-sectional study was conducted among 487 Community Health Workers. Their experience and perception toward mental illness were studied with questionnaires, which examined their general perception, religious-related perception, cause, treatment, and expectation for mental treatment. RESULTS: Most participants concurred that serving as a community health worker enhances their communication abilities (90.4%), strengthens connections with community health center staff (84.8%), boosts self-confidence (84.6%), and refines their capacity to identify signs of mental disorders (77%). Most notably, they consider their fellow community health workers essential to their extended family. Furthermore, a notable proportion associates' mental illness with religious elements, with 19.5% believing it can result from a lack of religious worship and a minority attributing it to witchcraft or black magic (3.5%). In terms of treatment, 14.2% think Ruqyah can cure mental illness, 6.4% believe in treatment by religious scholars, and a similar percentage (6.4%) think no medication or treatment is necessary for mental problems. CONCLUSION: Participants overwhelmingly recognize the positive impact of serving as community health workers, citing improvements in communication, relationships with health center staff, self-confidence, and mental disorder identification. The strong bond among community health workers, likened to an extended family, emphasizes their collective importance. Additionally, the majority advocates for compassionate treatment of individuals with mental illness. These findings underscore the complex interplay of professional, communal, and cultural elements in addressing community mental health.

Pasung: A qualitative study of shackling family members with mental illness in Indonesia.

Use of coercion on people with mental illness is a deeply embedded practice around the world. Not only does the practice raise human rights issues, it also leads to further mental, physical, and emotional harms. In Indonesia, 'pasung' is a common practice of physical restraint, which involves lay people using a variety of illegal methods to tie a person. In this article, we explore the meanings families attach to their actions when using pasung by asking the question: to what extent does the use of pasung by families emerge from socioculturally prescribed norms and conventions? To explore this question, we conducted and analysed eight interviews with family members from Nias Island, Indonesia using Giorgi's descriptive phenomenological method. Our findings reveal that pasung emerges in the disjunction between sociocultural demands and the family's capacity to meet these demands. Struggling to understand the behaviour of a family member with mental illness, the family tries to cope with neighbourhood reactions to ever more visible behavioural signs alongside managing their everyday life. These struggles, in turn, make their social situation increasingly stressful, which initiates a process of depersonalization as a response. Moreover, the prevailing sociocultural values convey a need to act according to expected norms. As such, pasung materializes as a socioculturally accepted practice that allows families to take back control in stressful social situations. In sum, when families feel overwhelming emotional stress and a sense of powerlessness, they try to resolve their situation by using pasung to regain control and thus manage their lives.

Impact of the WHO Safe Childbirth Checklist on safety culture among health workers: A randomized controlled trial in Aceh, Indonesia.

The World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC) to increase the application of essential birth practices to ultimately reduce perinatal and maternal deaths. We study the effects of the SCC on health workers safety culture, in the framework of a cluster-randomized controlled trial (16 treatment facilities/16 control facilities). We introduced the SCC in combination with a medium intensity coaching in health facilities which already offered at minimum basic emergency obstetric and newborn care (BEMonC). We assess the effects of using the SCC on 14 outcome variables measuring self-perceived information access, information transmission, frequency of errors, workload and access to resources at the facility level. We apply Ordinary Least Square regressions to identify an Intention to Treat Effect (ITT) and Instrumental Variable regressions to determine a Complier Average Causal Effect (CACE). The results suggest that the treatment significantly improved self-assessed attitudes regarding the probability of calling attention to problems with patient care (ITT 0.6945 standard deviations) and the frequency of errors in times of excessive workload (ITT -0.6318 standard deviations). Moreover, self-assessed resource access increased (ITT 0.6150 standard deviations). The other eleven outcomes were unaffected. The findings suggest that checklists can contribute to an improvement in some dimensions of safety culture among health workers. However, the complier analysis also highlights that achieving adherence remains a key challenge to make checklists effective.

Antidepressant-like Activity of Patchouli Oil var. Tapak Tuan (Pogostemon cablin Benth) via Elevated Dopamine Level: A Study Using Rat Model.

Essential oils are gaining popularity for their use in treating depression, including that extracted from patchouli leaves and stems (Pogostemon cablin). Herein, we used patchouli oil (PO) containing a high amount of patchouli alcohol derived from P. cablin var. Tapak Tuan. The aim of this study was to investigate the antidepressant potential of PO, with a variety of patchouli alcohol concentrations obtained from a separation process using vacuum distillation with different temperature ranges. The initial patchouli oil (iPO) was traditionally distilled by a local farmer and further distilled using a rotary evaporator at temperature ranges of 115−160 °C (POF-1); 120−160 °C (POF-2), and 125−160 °C (POF-3), resulting in products with different patchouli alcohol concentrations. POF-3, with the highest patchouli alcohol content of 60.66% (based on gas chromatography-mass spectrometry), was used for cooling crystallization, resulting in 100% patchouli alcohol crystal (pPA). A tail suspension test (TST) was performed on a rat model to screen the antidepressant potential of iPO and its derivatives. The TST results revealed that POF-3 had the best antidepressant-like effect and was second only to the fluoxetine-based antidepressant, Kalxetin®, where both groups had significant reductions of immobility time post-treatment (p < 0.0001). Other than patchouli alcohol, POF-3 also contained ledol and trans-geraniol, which have been reported for their antidepressant-related activities. Brain dopamine levels increased significantly in the group treated with POF-3 (p < 0.05 as compared with the control group), suggesting its primary anti-depressant mechanism. These findings suggest the potential of vacuum-distilled patchouli oil in reducing depression via dopamine elevation.

Association between Suicide Rate and Human Development Index, Income, and the Political System in 46 Muslim-Majority Countries: An Ecological Study.

Very little has been researched assessing the relationship between the suicide rate and the ecological perspectives of the country, especially in the Muslim majority countries. We aimed to determine the association between suicide rate and the ecological parameters of 46 Muslim majority countries. We extracted the Muslim majority countries and their suicide rate, income distribution, distribution of the WHO region and continents, and Human Development Index (HDI). We assessed the correlation of the proportion of Muslim populations, the total population of the countries, number of suicides, continent, income group, political system, and HDI score with the suicide rate. The median suicide rate was 5.45 (IQR = 4.8); 2.9 (IQR = 4) in females and 7.45 (IQR = 8.2) in males per 100,000 population. The males had a significantly higher rate and the highest suicide rate was found in Africa. There are inverse associations between the total suicide rate, the rate in males, and females with HDI, and the income of the country. Furthermore, the suicide rate was significantly higher in countries with democratic systems compared to non-democratic countries. The findings suggest that ecological parameters may have an etiological role on suicides in Muslim countries where HDI and income are inversely associated with suicide rates.

Knowledge, Attitude, and Practice of Nurses Toward COVID-19: A Cross-Sectional Study in a Referral Hospital of Indonesia.

BACKGROUND: Limited study has been conducted on the Indonesian nurses' knowledge, attitude, and behavior toward Coronavirus disease 2019. We investigated the Knowledge, Attitude, Practice (KAP) of nurses working in the referral hospital toward the COVID-19 disease. MATERIALS AND METHODS: Using a questionnaire on KAP toward COVID-19, a cross-sectional online data collection was conducted in the mid of 2020 to examine the nurses' KAP, perception, and experience toward COVID-19. RESULTS: The correct rate of knowledge was 85.60%. No significant difference of all KAP items between the COVID-19 and regular nurses was observed (P>0.05). They had positive attitudes regarding the pandemic and good practices for virus transmission prevention. Most nurses were worried that they will be infected by COVID-19 (91.53%). CONCLUSIONS: The Indonesian nurses have good knowledge, a positive attitude, and good practices regarding the virus, transmission, and prevention. The fact that the majority of nurses feel worried demands further investigations.

Physiological Predictors of Mental Disorders Among Police Officers in Indonesia.

Police officers may be at a higher risk of suffering from mental disorders (MDs) compared with other occupations. This study aimed to examine the physiological predictors of MDs among police officers in Indonesia. The mental health status of each participant was examined using a standardized Minnesota Multiphasic Personality Inventory (MMPI) tool and underwent several laboratory examinations including hematology, urine, serology, and electrocardiogram tests. A logistic regression was performed to calculate the odds ratio. Of the 4590 participants, 2.14% were diagnosed with MDs. The study found 19 physiological variables are potential predictors of MDs. In multivariate analysis adjusted for body mass index, sex, and age, the concentration of ketones, protein, and specific gravity in urine and the amount of lymphocyte in the blood are among important predictors of MDs. This suggests that carefully examining the results of urinalysis and hematology tests can help us detect early cases of MDs among police officers.

Effects of the World Health Organization Safe Childbirth Checklist on Quality of Care and Birth Outcomes in Aceh, Indonesia: A Cluster-Randomized Clinical Trial.

Importance: To address major causes of perinatal and maternal mortality, the World Health Organization developed the Safe Childbirth Checklist (SCC), which to our knowledge has been rigorously evaluated only in combination with high-intensity coaching. Objective: To evaluate the effect of the SCC with medium-intensity coaching on health care workers' performance of essential birth practices. Design, Setting, and Participants: This cluster randomized clinical trial without blinding included 32 hospitals and community health centers in the province of Aceh, Indonesia (a medium-resource setting) that met the criterion of providing at least basic emergency obstetric and newborn care. Baseline data were collected from August to October 2016, and outcomes were measured from March to April 2017. Data were analyzed from January 2020 to October 2021. Interventions: After applying an optimization method, facilities were randomly assigned to the treatment or control group (16 facilities each). The SCC with 11 coaching visits was implemented during a 6-month period. Main Outcomes and Measures: For the primary outcome, clinical observers documented whether 36 essential birth practices were applied at treatment and control facilities at 1 or more of 4 pause points during the birthing process (admission to the hospital, just before pushing or cesarean delivery, soon after birth, and before hospital discharge). Probability models for binary outcome measures were estimated using ordinary least-squares regressions, complemented by Firth logit and complier average causal effect estimations. Results: Among the 32 facilities that participated in the trial, a significant increase of up to 41 percentage points was observed in the application of 5 of 36 essential birth practices in the 16 treatment facilities compared with the 16 control facilities, including communication of danger signs at admission (treatment: 136 of 155 births [88%]; control: 79 of 107 births [74%]), measurement of neonatal temperature (treatment: 9 of 31 births [29%]; control: 1 of 20 births [5%]), newborn feeding checks (treatment: 22 of 34 births [65%]; control: 5 of 21 births [24%]), and the rate of communication of danger signs to mothers and birth companions verbally (treatment: 30 of 36 births [83%]; control: 14 of 22 births [64%]) and in a written format (treatment: 3 of 24 births [13%]; control: 0 of 16 births [0%]). Conclusions and Relevance: In this cluster randomized clinical trial, health facilities that implemented the SCC with medium-intensity coaching had an increased rate of application for 5 of 36 essential birth practices compared with the control facilities. Medium-intensity coaching may not be sufficient to increase uptake of the SCC to a satisfying extent, but it may be worthwhile to assess a redesigned coaching approach prompting long-term behavioral change and, therefore, effectiveness. Trial Registration: isrctn.org Identifier: ISRCTN11041580.

Is there any link between celebrity suicide and further suicidal behaviour in India?

BACKGROUND: Little is known about the factors that determine vulnerability to subsequent suicide in the community following a celebrity suicide. Our objective was to investigate the link between an alleged celebrity suicide and further suicidal behaviour in the community in India. METHODS: Relevant news articles that reported suicidal behaviour in the population were retrieved from online news portals of regional and English language newspapers in the immediate month following the actor's death. A deductive analysis of the retrieved suicide news articles was carried out using a pre-designed data extraction form. RESULTS: A total of 1160 relevant news articles were identified from the local language (n = 985) and English (n = 175) newspapers. For a sizeable percentage of these reports (n = 65, 5.6%), the media reported links with celebrity suicide. Odds of subsequent suicide among young (Odds Ratios [OR] - 9.24), female (OR - 1.94), unemployed (OR - 7.26), those without precipitating life events (OR - 2.94) or mental illness (OR - 1.69) were higher among those with link to celebrity suicide; likewise, odds of death by hanging (OR - 49.84) and leaving a suicide note (OR - 2.03) were higher among those linked to celebrity suicide. English newspapers (OR - 4.23) were more likely to report events linked to celebrity suicide than local language newspapers. CONCLUSION: Persons who died by suicide by hanging after a celebrity suicide are more likely to be young, female, unemployed, have a mental disorder or precipitating life events. Suicide prevention efforts must focus on this group and prevent the same method of suicide like that of the celebrity.

Indonesian online newspaper reporting of suicidal behavior: Compliance with World Health Organization media guidelines.

BACKGROUND: Despite the lack of attention, suicide is a major public and mental health problem in Indonesia. Research on how Indonesian newspapers portray suicide case has been lacking. AIM: To assess the quality of Indonesian online newspaper reporting suicide news and its compliance with the World Health Organization (WHO) mass media reporting guidelines. METHODS: The content of suicide news reported in online newspapers was searched and scrutinized against the WHO suicide reporting guidelines. RESULTS: Within the duration of 6 months, there were 548 suicide news reported. This consisted of 16.8% attempted suicide and 83.2% completed suicide. Approximately 90.3% reported age, 97.3% reported gender and 64.3% reported the marital status of the victims. Furthermore, 68% reported the methods of suicide in headline or title, 40.5% shown the picture of the victims and 56.6% shown illustration only, and 67.2% reported life event related to suicide act. CONCLUSION: The vast majority of online newspapers in Indonesia exaggerate suicide news. They rarely inform the readers that there is hope and help available. The majority also do not conform to the WHO media guidelines.

Prevalence and determinants of posttraumatic stress in adolescents following an earthquake.

CONTEXT: The 2016 Aceh earthquake causes a significant mental health impact in adolescents. However, the prevalence and determinants have never been reported. AIMS: The study aimed to estimate the prevalence rate and determinants of posttraumatic stress symptoms in adolescents following an earthquake. SETTINGS AND DESIGN: This cross-sectional study was conducted in Pidie Jaya district approximately 6 months following the earthquake. MATERIALS AND METHODS: The Trauma Screening Questionnaire (TSQ) was distributed to adolescents living around the earthquake-affected area. STATISTICAL ANALYSIS: The Chi-square test and binomial logistic regression were performed using GNU PSPP statistical software. RESULTS: The prevalence of posttraumatic stress disorder (PTSD) was 47%, and the mean score of TSQ was 5.11 (standard deviation = 2.3). The presence of PTSD was associated with gender and age (P = 0.001). Logistic regression analysis confirmed that gender, being injured, witnessing someone injured, feeling stressed after the earthquake, and feeling scared of staying inside a building following the earthquake were independently and significantly associated with PTSD (P = 0.001). CONCLUSION: The prevalence of PTSD at 6 months following an earthquake is relatively high, and many factors are associated with the presence of PTSD.

Prevalence, comorbidity and predictors of post-traumatic stress disorder, depression, and anxiety in adolescents following an earthquake.

BACKGROUND: This study sought to assess prevalence rate, comorbidity and predictors of Post-Traumatic Stress Disorder (PTSD), depression and anxiety among adolescents affected by the 2016 Aceh Earthquake. METHODS: A cross-sectional study was conducted six months after the earthquake. The multi-stage random sampling method was applied to a selection of respondents from district schools. A total of 321 students participated in the study. In addition to generating demographic data, a brief PTSD inventory, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorder (GAD-7) questionnaire and the Disaster Impact Questionnaire (DIQ) were administered. RESULTS: Approximately 58.3%, 16.8% and 32.1% of adolescents reported the clinical symptoms of PTSD, depression and anxiety, respectively. The associations and comorbidity between PTSD, depression, and anxiety were statistically significant (p = 0.001). Gender, depression, having directly seen someone injured or trapped, the injury or hospitalization of a member of the nuclear family and being afraid to stay inside a building since the earthquake were demonstrated to be the significant predictors for PTSD. The injury and hospitalization of a member of the nuclear family and feeling stressed after the earthquake were significant predictors for depression. Having been injured, having one's house destroyed; being afraid to stay inside a building and gender were significant predictors for generalized anxiety disorder. CONCLUSIONS: The prevalence of PTSD in the current study population is relatively high and the fact that a significant number of adolescents were afraid to stay inside a building following the earthquake calls for further investigation and treatments.

Healthcare providers' perception of the referral system in maternal care facilities in Aceh, Indonesia: a cross-sectional study.

OBJECTIVES: Our study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia. DESIGN: With a cross-sectional approach, two sets of surveys were administered during September to October 2016 in 32 sampling units of our study. We also collected referral data in the form of the frequency of ingoing and outgoing referral cases per facility. SETTING: In three districts, Aceh Besar, Banda Aceh and Bireuen, a total of 32 facilities including hospitals, community health centres, and private midwife clinics that met the criteria of providing at least basic emergency obstetric and neonatal care (BEonC) were covered. PARTICIPANTS: Across the 32 healthcare centres, 149 members of staff (mainly midwives) agreed to participate in our surveys. PRIMARY AND SECONDARY OUTCOME MEASURES: The first survey consisted of 65 items focusing on organisational measures as well as case numbers for example, patient counts, mortality rate and complications. The second survey with 68 items asked healthcare providers about a range of factors including attitudes towards the referral process in their facility and potential barriers to a well-functioning system in their district. RESULTS: Overall, mothers'/families' consent as well as the complex administration process were found to be the main barriers (36% and 12%, respectively). Healthcare providers noted that information about other facilities has the biggest room for improvement (37%) rather than transport, timely referral of mothers and babies, or the availability of referral facilities. CONCLUSIONS: The largest barrier perceived by healthcare providers in our study was noted to be family consent and administrative burden. Moreover, lack of information about the referral system itself and other facilities seemed to be affecting healthcare providers and mothers/families alike and improvements perhaps through a shared information system is needed.

Patterns and Determinants of Treatment Seeking among Previously Untreated Psychotic Patients in Aceh Province, Indonesia: A Qualitative Study.

Immediate treatment of first-episode psychosis is essential in order to achieve a positive outcome. However, Indonesian psychiatric patients often delay accessing health services, the reason for which is not yet fully understood. The current study aimed to understand patterns of treatment seeking and to reveal determinants of the delay in accessing psychiatric care among first-time user psychotic patients. Qualitative interviews were conducted with sixteen family members who accompanied the patients to a psychiatric hospital. Many families expressed beliefs that mental illness appertains to village sickness and not hospital sickness; therefore, they usually take the patients to traditional or religious healers before taking them to a health professional. They also identified various factors that potentially delay accessing psychiatric treatment: low literacy and beliefs about the cause of the illness, stigmatisation, the role of extended family, financial problems, and long distance to the psychiatric hospital. On the other hand, the family mentioned various factors related to timely help seeking, including being a well-educated family, living closer to health facilities, previous experience of successful psychotic therapy, and having more positive symptoms of psychosis. The findings call for mental health awareness campaigns in the community.

Mental health in Aceh--Indonesia: A decade after the devastating tsunami 2004.

The province of Aceh has suffered enormously from the perennial armed conflict and the devastating Tsunami in 2004. Despite the waves of external aid and national concern geared toward improving healthcare services as part of the reconstruction and rehabilitation efforts after the Tsunami, mental health services still require much attention. This paper aims to understand the mental healthcare system in Aceh Province, Indonesia; its main focus is on the burden, on the healthcare system, its development, service delivery and cultural issues from the devastating Tsunami in 2004 until the present. We reviewed those published and unpublished reports from the local and national government, from international instances (UN bodies, NGOs) and from the academic literature pertaining to mental health related programs conducted in Aceh. To some extent, mental health services in Aceh have been improved compared to their condition before the Tsunami. The development programs have focused on procurement of policy, improvement of human resources, and enhancing service delivery. Culture and religious beliefs shape the pathways by which people seek mental health treatment. The political system also determines the development of the mental health service in the province. The case of Aceh is a unique example where conflict and disaster serve as the catalysts toward the development of a mental healthcare system. Several factors contribute to the improvement of the mental health system, but security is a must. Whilst the Acehnese enjoy the improvements, some issues such as stigma, access to care and political fluctuations remain challenging.