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The role of mental health system in suicide prevention in Bali, barriers and possibilities

Document type: mthesis
Download file(s): 192377 (511 KB)
Abstract: BACKGROUND: Neuropsychiatry disorders and self inflicted injury are the leading cause of Disability Adjusted Life Years (DALY) lost in Indonesia (13,9%). Suicide is a fatal outcome of serious psychiatric problems. Bali province has the highest suicide rate in Indonesia. Despite the fact that population based studies on suicide in Asia reveals that 63%-81% of suicide victims had diagnosable psychiatric disorders; the response of Bali’s mental health system is inadequate. There is a need to better understand why suicide prevention is not a priority for Bali health system and analyze the underlying causes (technical and structural factors). OBJECTIVE: This study aims to outline the potential role of the mental health system in reducing suicide in Bali and ways to address the barriers to prioritization. The thesis will then hopefully help to improve advocacy, research, planning and implementation of suicide prevention programs in Bali. METHOD: Literature review and document analysis. RESULT: Technical factors assessment on suicide in Bali (epidemiology, feasible intervention, cost effectiveness, accessibility and compatibility to cultural value) support prioritization of suicide prevention in Bali. Structural factors assessment (policy framework and key implementers structure and function) result in two fold. Analysis of the general health law and mental health policy support provision of integrated mental health care thus inline with strategy for suicide prevention being offered. Analysis on key implementers structure and function shows many functional support are absent in implementation level such as: 1) Mental health care is no longer integrated within the public primary health care, 2) Mental health section is absent within many district health authority which supposed to conduct stewardship, resource generation and financing function, 3) The function of community mental health team has been reduced from strategic planner and coordinator of general community mental health program, into coordinator for rehabilitation of the mentally ill to society. These structural barriers partly explained the inadequate respond of mental health system toward suicide prevention. CONCLUSIONS: 1) In Bali setting, mental health system has to play the role both as service provider and demand creator through primary care doctors training, awareness and education campaign and development of community based support group. 2) These role can be played optimally if the structure and function of the mental health system are changed to meet the need; since radical structural change may not be easy this problem has to be acknowledged and creative ways to deal with the structural barriers such as partnership and outsourcing is encouraged.
Authors: Octaria, Y.C.
Country: Indonesia
Category: Research
Department: Development Policy & Practice
Institute: KIT (Royal Tropical Institute)
Keywords: mental health , health services
Language: eng
Organization: KIT - Royal Tropical Institute
PAGE: viii, 46, xii
Year: 2008
Region: Southeast Asia
Right: © 2008 Octaria
Subject: Health and Nutrition
Title: The role of mental health system in suicide prevention in Bali, barriers and possibilities
Training: Master of Public Health / International Course in Health Development (ICHD)