The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

Abstract In 2014, the Indonesian government passed the Mental Health Act (MHA) to address the country’s complex mental health situation. The implementation of the MHA has been slow, and little is known about how the MHA is perceived by mental healthcare providers within local settings. This study aimed to obtain insight into psychiatrists’ views on the MHA, including on how it affected their clinical practice and on challenges of translating the MHA into practice. The study was conducted in Bali, and 27 psychiatrists (15 men and 12 women) participated in a semi-structured interview. Thematic analysis indicated four overarching themes: raising the profile of mental health, developing a shared understanding of mental illness, integrating psychiatric practice with other services and views on implementation of the MHA into practice. Overall, the psychiatrists viewed the MHA as a step in the right direction to improve mental health services and to create awareness at local and national levels. However, there was consensus that the meaning of the MHA’s concepts of mental problems and disorders were not compatible with psychiatric everyday practice or their patients’ understandings. As a result, many assumed that the MHA was targeted at government and policy officials. Furthermore, there was a perceived lack of clarity on issues relating to collaborating with other services and unequal access to resources among regencies that impacted on their clinical practice in a negative way. Moreover, a few psychiatrists raised concerns that local beliefs and practices were not acknowledged in the MHA. According to the participants, mental health remained a highly political issue and without national support, mental health would remain a low priority. In conclusion, insights into providers’ perspectives contribute to developing an evidence-base that can inform the implementation process of the MHA in Indonesia, and possibly elsewhere, into local level guidelines and regulations.

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Patterns of use of the Mental Health Act 1983, from 2007–2008 to 2016–2017, in two major London secondary mental healthcare providers

BJPsych Open ◽

10.1192/bjo.2019.84 ◽

2019 ◽

Vol 5 (6) ◽

Author(s):

Sian Oram ◽

Craig Colling ◽

Megan Pritchard ◽

Mizanur Khondoker ◽

Daniela Fonseca de Freitas ◽

...

Keyword(s):

Mental Health ◽

Healthcare Providers ◽

Mental Healthcare ◽

Fiscal Year ◽

Historical Cohort ◽

Patient Level ◽

Mental Health Act ◽

Patterns Of Use ◽

Level Data ◽

Active Patients

Summary Trends in detention under the Mental Health Act 1983 in two major London secondary mental healthcare providers were explored using patient-level data in a historical cohort study between 2007–2008 and 2016–2017. An increase in the number of detention episodes initiated per fiscal year was observed at both sites. The rise was accompanied by an increase in the number of active patients; the proportion of active patients detained per year remained relatively stable. Findings suggest that the rise in the number of detentions reflects the rise of the number of people receiving secondary mental healthcare.

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Telehealth mental health services during COVID-19: summary of evidence and clinical practice

Australasian Psychiatry ◽

10.1177/1039856220943032 ◽

2020 ◽

Vol 28 (5) ◽

pp. 514-516 ◽

Cited By ~ 4

Author(s):

Rebecca E Reay ◽

Jeffrey CL Looi ◽

Philip Keightley

Keyword(s):

Public Health ◽

Mental Health ◽

Clinical Practice ◽

Mental Health Services ◽

Health Services ◽

Service Delivery ◽

Mental Healthcare ◽

Evidence Base ◽

Health Measures ◽

Rural Settings

Objective: To provide a rapid clinical update on the evidence for telehealth in mental healthcare in the context of the COVID-19 pandemic public health measures. Conclusions: Telehealth has been rapidly implemented in metropolitan and rural settings and the existing evidence base demonstrates that it represents an effective mode of service delivery.

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The impact on clinical practice of the 2015 reforms to the New South Wales Mental Health Act

Australasian Psychiatry ◽

10.1177/1039856216663738 ◽

2016 ◽

Vol 25 (1) ◽

pp. 43-47 ◽

Cited By ~ 5

Author(s):

Christopher James Ryan ◽

Sascha Callaghan

Keyword(s):

Mental Health ◽

Decision Making ◽

Clinical Practice ◽

Persons With Disabilities ◽

Mental Health Act ◽

Recovery Movement ◽

South Wales ◽

Management Plans ◽

Decision Making Model ◽

The Impact

Objectives: The Mental Health Act 2007 (NSW) ( MHA) was recently reformed in light of the recovery movement and the United Nations Convention on the Rights of Persons with Disabilities. We analyse the changes and describe the impact that these reforms should have upon clinical practice. Conclusions: The principles of care and treatment added to the MHA place a strong onus on clinicians to monitor patients’ decision-making capacity, institute a supported decision-making model and obtain consent to any treatment proposed. Patients competently refusing treatment should only be subject to involuntary treatment in extraordinary circumstances. Even when patients incompetently refuse treatment, clinicians must make every effort reasonably practicable to tailor management plans to take account of any views and preferences expressed by them or made known via friends, family or advance statements.

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Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns

Indian Journal of Medical Ethics ◽

10.20529/ijme.2022.004 ◽

2022 ◽

Vol 07 (01) ◽

pp. 37-41

Author(s):

Ramdas Ransing ◽

Sujita Kumar Kar ◽

Vikas Menon

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Alternative Medicine ◽

Mental Healthcare ◽

Evidence Base ◽

Evidence Based ◽

Insufficient Evidence ◽

Indian Government ◽

Evidence Based Care

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

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Mental health law in Ghana

BJPsych International ◽

10.1192/s2056474000001768 ◽

2017 ◽

Vol 14 (2) ◽

pp. 38-39 ◽

Cited By ~ 7

Author(s):

George Hudson Walker ◽

Akwasi Osei

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Health System ◽

Mental Health System ◽

Mental Healthcare ◽

Health Law ◽

Community Based ◽

Mental Health Law ◽

Mental Health Act ◽

New System

In 2012 Ghana passed a new Mental Health Act, which aimed to create a new system of mental healthcare in Ghana. The Act includes provisions for the creation of a modern, community-based mental health system and for the protection of the rights of persons with mental disorders. This article discusses the implications of the Act and the progress which has been made towards its implementation.

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Supporting people in mental health crisis in 21st-century Britain

BJPsych Bulletin ◽

10.1192/bjb.2019.93 ◽

2020 ◽

Vol 44 (6) ◽

pp. 231-232 ◽

Cited By ~ 1

Author(s):

Andrew Molodynski ◽

Stephen Puntis ◽

Em Mcallister ◽

Hannah Wheeler ◽

Keith Cooper

Keyword(s):

Mental Health ◽

Law Enforcement ◽

21St Century ◽

Current System ◽

Mental Healthcare ◽

Evidence Base ◽

Health Needs ◽

Mental Health Crisis ◽

Mental Health Needs ◽

Health Crisis

Recent years have seen a surge in interest in mental healthcare and some reduction in stigma. Partly as a result of this, alongside a growing population and higher levels of societal distress, many more people are presenting with mental health needs, often in crisis. Systems that date back to the beginning of the National Health Service still form the basis for much care, and the current system is complex, hard to navigate and often fails people. Law enforcement services are increasingly being drawn into providing mental healthcare in the community, which most believe is inappropriate. We propose that it is now time for a fundamental root and branch review of mental health emergency care, taking into account the views of patients and the international evidence base, to ‘reset’ the balance and commission services that are humane and responsive – services that are fit for the 21st century.

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Preserving Control: Understanding People's Experiences Before, During and After Detention Under the Irish Mental Health Act 2001

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1769 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S483-S483

Author(s):

D. McGuinness ◽

A. Higgins ◽

B. Hallahan ◽

E. Bainbridge ◽

C. McDonald ◽

...

Keyword(s):

Mental Health ◽

Subjective Experience ◽

Structured Interview ◽

Legal Framework ◽

Theoretical Understanding ◽

Mental Health Act ◽

Loss Of Autonomy ◽

Psychiatric Units ◽

The Face ◽

Competing Interest

IntroductionThe Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.ObjectiveTo develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.MethodsFifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.ResultsThe theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.ConclusionsWhilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Use of Section 5(2) in clinical practice

Psychiatric Bulletin ◽

10.1192/s0955603600106506 ◽

1992 ◽

Vol 16 (01) ◽

pp. 14-16 ◽

Cited By ~ 11

Author(s):

Christina Pourgourides ◽

V. P. Prasher ◽

Femi Oyebode

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Psychiatric Hospitals ◽

Annual Basis ◽

Mental Health Act

The Mental Health Act (1983) came into being eight years ago but few studies into its use have been reported (West, 1987; Sackett, 1987). The Act provided for the setting up of the Mental Health Act Commission to safeguard the interests of detained patients and to monitor the use of the Act. The Commission visits ordinary psychiatric hospitals on an annual basis and writes a report of the visit. The Commission also submits a Biennial Report to Parliament. These reports address important issues but do not provide detailed information on the use of the various sections of the Act in differing hospitals.

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Implementation of treatment guidelines for specialist mental health care

Advances in Psychiatric Treatment ◽

10.1192/apt.20.2.82 ◽

2014 ◽

Vol 20 (2) ◽

pp. 82-82

Author(s):

C. Barbui ◽

F. Girlanda ◽

E. Ay ◽

A. Cipriani ◽

T. Becker ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Clinical Practice ◽

Mental Health Care ◽

Patient Outcomes ◽

Psychotic Disorders ◽

Treatment Guidelines ◽

Evidence Base ◽

Provider Performance

A huge gap exists between the production of evidence and its take-up in clinical practice settings. To fill this gap, treatment guidelines, based on explicit assessments of the evidence base, are commonly employed in several fields of medicine, including schizophrenia and related psychotic disorders. It remains unclear, however, whether treatment guidelines have any impact on provider performance and patient outcomes, and how implementation should be conducted to maximise benefit.

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A human right to be detained? Mental healthcare after ‘Savage’ and ‘Rabone'

The Psychiatrist ◽

10.1192/pb.bp.112.040980 ◽

2013 ◽

Vol 37 (9) ◽

pp. 294-296 ◽

Cited By ~ 1

Author(s):

Mohammad Shaiyan Rahman ◽

Nadya Wolferstan

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Service Providers ◽

Healthcare Providers ◽

Mental Healthcare ◽

Case Law ◽

Human Right ◽

Health Service Providers ◽

The Uk ◽

Suicidal Patients

SummaryThe UK courts have recently considered the management of suicidal patients in the cases of Savage and Rabone. As a result of these judgments, the case law has extended significantly the responsibilities of mental healthcare providers. In this article we discuss the repercussions of these landmark decisions which are likely to have significant consequences for mental health service providers in the UK.

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