Top

International Journal of Mental Health Systems

Published in:

Open Access 01-12-2018 | Research

The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia

Authors: Endang R. Surjaningrum, Harry Minas, Anthony F. Jorm, Ritsuko Kakuma

Published in: International Journal of Mental Health Systems | Issue 1/2018

Abstract

Background

Indonesian maternal health policies state that community health workers (CHWs) are responsible for detection and referral of pregnant women and postpartum mothers who might suffer from mental health problems (task-sharing). The documents have been published for a while, however reports on the implementation are hardly found which possibly resulted from feasibility issue within the health system.

Aims

To examine the feasibility of task-sharing in integrated mental health care to identify perinatal depression in Surabaya, Indonesia.

Methods

Semi-structured interviews were conducted with 62 participants representing four stakeholder groups in primary health care: program managers from the health office and the community, health workers and CHWs, mental health specialists, and service users. Questions on the feasibility were supported by vignettes about perinatal depression. WHO’s health systems framework was applied to analyse the data using framework analysis.

Results

Findings indicated the policy initiative is feasible to the district health system. A strong basis within the health system for task-sharing in maternal mental health rests on health leadership and governance that open an opportunity for training and supervision, financing, and intersectoral collaboration. The infrastructure and resources in the city provide potential for a continuity of care. Nevertheless, feasibility is challenged by gaps between policy and practices, inadequate support system in technologies and information system, assigning the workforce and strategies to be applied, and the lack of practical guidelines to guide the implementation.

Conclusion

The health system and resources in Surabaya provide opportunities for task-sharing to detect and refer cases of perinatal depression in an integrated mental health care system. Participation of informal workforce might facilitate in closing the gap in the provision of information on perinatal mental health.

Ministry of Health Republic Indonesia. Guidance for integrated antenatal care. Jakarta: Ministry of Health of Republic of Indonesia; 2010.

Ministry of Health Republic Indonesia. Manual book for cadres of Posyandu. Jakarta: Promotion Centre of the Ministry of Health of Republic of Indonesia; 2012.

Ministry of Health Republic Indonesia. Riset Kesehatan Dasar 2013 (basic health survey 2013). Jakarta: Ministry of Health Republic Indonesia; 2013.

Edwards GD, Shinfuku N, Gittelman M, Ghozali EW, Haniman F, et al. Postnatal depression in Surabaya, Indonesia. Int J Ment Health. 2006;35(1):62–74. https://doi.org/10.2753/IMH0020-7411350105.CrossRef

Andajani-Sutjahjo S, Manderson L, Astbury J. Complex emotions, complex problems: understanding the experiences of perinatal depression among new mothers in urban Indonesia. Cult Med Psychiatry. 2007;31(1):101–22. https://doi.org/10.1007/s11013-006-9040-0.CrossRefPubMed

Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90(2):139G–49G. https://doi.org/10.2471/BLT.11.091850.CrossRefPubMed

Segre LS, O’Hara MW, Arndt S, Stuart S. The prevalence of postpartum depression. Soc Psychiatry Psychiatr Epidemiol. 2007;42(4):316–21. https://doi.org/10.1007/s00127-007-0168-1.CrossRefPubMed

Ministry of Health Republic Indonesia. Guideline to provide mental health care in general health service facilities. Jakarta: Directorate of Mental Health Services, Ministry of Health Republic Indonesia; 2010.

Patmisari E. Indonesian mental health reform: a case study of West Java, Indonesia, Flinders University, School of Health Sciences; 2014.

10.

Boothby N, Veatch M, Pentes M. Evaluating treatment of axis I mental health disorders in Aceh, Indonesia. Psychiatrist. 2011;35(7):248–55.CrossRef

11.

Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376:2086–95. https://doi.org/10.1016/S0140-6736(10)61508-5.CrossRefPubMedPubMedCentral

12.

Chatterjee S, Naik S, John S, Dabholkar H, Balaji M, et al. Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial. Lancet. 2014;383(9926):1385–94.CrossRefPubMedPubMedCentral

13.

Murray L, Cooper PJ, Wilson A, Romaniuk H. Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother-child relationship and child outcome. Br J Psychiatry. 2003;182:420–7.CrossRefPubMed

14.

Cooper PJ, Tomlinson M, Swartz L, Landman M, Molteno C, et al. Pico: improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. BMJ. 2009;338(7701):997. https://doi.org/10.2307/20512727.CrossRef

15.

Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902–9. https://doi.org/10.1016/S0140-6736(08)61400-2.CrossRefPubMedPubMedCentral

16.

Pelayanan Psikolog di Puskesmas (psychological service at Puskesmas). http://kesehatan.jogjakota.go.id/?exec=viewberita&id=55 (2010). Accessed 21 Sept 2014.

17.

Dinkes tambah jumlah psikolog di puskesmas (health office of Surabaya increases the number pf psychologists in PHC centres), in Jawa Pos: Surabaya; 2015.

18.

Isfandari S, Rahmawati T, Siahaan S, Roosihermiatie B, Abbas I, et al. Evaluation the presence of psychologist for mental health service at primary health cares in Sleman District, Yogyakarta, Indonesia, 2011. Bull Health Syst Res. 2012;15(4):355–9.

19.

Maramis A. After the tsunami, building back for better mental health in Aceh. ASEAN J Psychiatry. 2006;7:45–8.

20.

Chatterjee S, Chowdhary N, Pednekar S, Cohen A, Andrew G, et al. Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India. World Psychiatry. 2008;7:45–53.CrossRef

21.

Health Department of Surabaya. Annual report of health department of Surabaya 2012. Surabaya: Health Department of Surabaya; 2012.

22.

Health Department of Surabaya. Health Profile 2015. Surabaya: Health Department of Surabaya; 2015.

23.

Health Department of Surabaya. Annual report of health department of Surabaya 2013. Surabaya: Health Department of Surabaya; 2013.

24.

Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, Prawira J. The Republic of Indonesia health system review, vol. 7, no. 1. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017.

25.

Hunter C. The national health system and discourses of power in Indonesia. Asian Stud Rev. 1996;20(1):20.CrossRef

26.

Health Department of East Java. East Java health profile 2012. Dinas Kesehatan Propinsi Jawa Timur: Surabaya; 2012.

27.

Ministry of Home Affairs. Ministry of home affairs regulation no 54 year 2007 about guideline to establish operational working group of integrated health service posts; 2007.

28.

Okamoto A. Maternal and child health in Indonesia. Acta Paediatrica Japonica. 1993;35(6):559–66.CrossRefPubMed

29.

Andriani H, Liao CY, Kuo HW. Association of maternal and child health center (Posyandu) availability with child weight status in Indonesia: a national study. Int J Environ Res Public Health. 2016. https://doi.org/10.3390/ijerph13030293.PubMedPubMedCentralCrossRef

30.

Ministry of Health Republic Indonesia. Guideline for the management of Posyandu. Jakarta: Ministry of Health Republic Indonesia; 2011.

31.

Ministry of Health Republic Indonesia and Pokjanal Posyandu Pusat. Kurikulum dan Modul Pelatihan Kader Posyandu (training curriculum and module for health cadres at Posyandu). Jakarta: Ministry of Health Republic Indonesia; 2012.

32.

Ministry of Home Affairs. Decree of ministry of home affairs number 19 year 2011 about guideline for integrated social services in integrated service post; 2011.

33.

Statistics Indonesia, National Population and Family Planning Board, Ministry of Health, and ICF International. Indonesia demographic and health survey 2012. Jakarta, Indonesia: Statistics Indonesia, National Population and Family Planning Board, Ministry of Health, and ICF International; 2013.

34.

Ritchie J, Lewis J, Nicholls CM, Ormston R. Qualitative research practice: a guide for social science students and researchers. 2nd ed. London: Sage Publications Ltd.; 2014.

35.

Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. J Adm Gov. 2009;4(2):72–9.

36.

World Health Organization. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: WHO; 2007.

37.

Setiawan GP, Viora E. Disaster mental health preparedness plan in Indonesia. Int Rev Psychiatry. 2006;18(6):563–6. https://doi.org/10.1080/09540260601037920.CrossRefPubMed

38.

Puteh I, Marthoenis M, Minas H. Aceh Free Pasung: releasing the mentally ill from physical restraint. Int J Ment Health Syst. 2011;5(1):10–4. https://doi.org/10.1186/1752-4458-5-10.CrossRefPubMedPubMedCentral

39.

Human Rights Watch. Living in hell, abuses against people with psychosocial disabilities in Indonesia. 2016. https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia. Accessed 25 Aug 2017.

40.

Ramawati Y. Nurses and community health workers’ training on community-based Pasung-free initiatives in East Java. J Health Res “FORIKES VOICE”. 2017;8(2):64–8.

41.

World Health Organization. Improving health systems and services for mental health. Geneva: World Health Organization; 2009.

42.

Bledsoe SE, Rizo CF, Wike TL, Killian-Farrell C, Wessel J, et al. Original research—qualitative: pregnant adolescent women’s perceptions of depression and psychiatric services in the United States. Women Birth. 2017. https://doi.org/10.1016/j.wombi.2017.02.006.PubMedCrossRefPubMedCentral

43.

Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Women’s Ment Health. 2015;18(6):745–59. https://doi.org/10.1007/s00737-015-0548-6.CrossRef

44.

Mann R, Adamson J, Gilbody SM. Diagnostic accuracy of case-finding questions to identify perinatal depression. Can Med Assoc J. 2012;184(8):E424–30.CrossRef

45.

Bauer A, Knapp M, Parsonage M. Lifetime costs of perinatal anxiety and depression. J Affect Disord. 2016. https://doi.org/10.1016/j.jad.2015.12.005.CrossRefPubMedPubMedCentral

46.

Price S, Masho S. What does it mean when we screen? A closer examination of perinatal depression and psychosocial risk screening within one MCH home visiting program. Matern Child Health J. 2014;18(4):765–71. https://doi.org/10.1007/s10995-013-1317-7.CrossRefPubMedPubMedCentral

47.

Tsai AC, Scott JA, Hung KJ, Zhu JQ, Matthews LT, et al. Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis. PLoS ONE. 2013;8(12):e82521. https://doi.org/10.1371/journal.pone.0082521.CrossRefPubMedPubMedCentral

48.

Tabb KM, Choi S, Pineros-Leano M, Meline B, McDonald HG, et al. Perinatal depression screening in a women, infants, and children (WIC) program: perception of feasibility and acceptability among a multidisciplinary staff. Gen Hosp Psychiatry. 2015;37:305–9. https://doi.org/10.1016/j.genhosppsych.2015.03.008.CrossRefPubMed

49.

Ismail I. Stress before and during pregnancy increased risk antepartum depression. Med J Indones. 2003;12:81–6.CrossRef

50.

Brintnell ES, Sommer RW, Kuncoro B, Setiawan GP, Bailey P. The expression of depression among Javanese patients with major depressive disorder: a concept mapping study. Transcult Psychiatry. 2013;50(4):579–98. https://doi.org/10.1177/1363461513501709.CrossRefPubMed

51.

Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82–6. https://doi.org/10.1016/j.socscimed.2013.08.004.CrossRefPubMed

52.

Mendenhall E, De Silva MJ, Hanlon C, Petersen I, Shidhaye R, et al. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Soc Sci Med. 2014;118:33–42. https://doi.org/10.1016/j.socscimed.2014.07.057.CrossRefPubMedPubMedCentral

53.

Ministry of Home Affairs. The ministry of home affairs regulation number 28 year 2011 about guideline for FWM in assisting demographic administration; 2011.

54.

Chowdhary N, Sikander S, Atif N, Singh N, Ahmad I, et al. The content and delivery of psychological interventions for perinatal depression by non-specialist health workers in low and middle income countries: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):113–33. https://doi.org/10.1016/j.bpobgyn.2013.08.013.CrossRefPubMedPubMedCentral

55.

Health Department of Republic Indonesia. Training module of mental health counselling for psychiatrists, psychologists, and mental health program managers at provincial health office. Jakarta: Health Department; 2007.

56.

Buist A, O’Mahen H, Rooney R. Acceptability, attitudes, and overcoming stigma. In: Milgrom J, Gemmill AW, editors. Identifying perinatal depression and anxiety: evidence-based practice in screening, psychosocial assessment, and management. 1st ed. Wiley: Chichester; 2015. p. 51–62.

57.

Burke L, Suswardany DL, Michener K, Mazurki S, Adair T, et al. Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia. BMC Pregnancy Childbirth. 2011;11(1):20–7. https://doi.org/10.1186/1471-2393-11-20.CrossRefPubMedPubMedCentral

Title: The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia
Authors: Endang R. Surjaningrum
Harry Minas
Anthony F. Jorm
Ritsuko Kakuma
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: International Journal of Mental Health Systems / Issue 1/2018
Electronic ISSN: 1752-4458
DOI: https://doi.org/10.1186/s13033-018-0208-0

ACC 2024 Congress

Springer Medicine

The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia

Abstract

Background

Aims

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Relationship of peer specialists to mental health outcomes in South Florida

Assessment of patients’ satisfaction and associated factors among outpatients received mental health services at public hospitals of Mekelle Town, northern Ethiopia

Prevalence and correlates of post-traumatic stress disorder among survivors of road traffic accidents in Ethiopia

Correction to: Risk factors for relapse in patients with first-episode schizophrenia: analysis of the Health Insurance Review and Assessment Service data from 2011 to 2015

Living with obsessive-compulsive disorder (OCD): a South African narrative

Risk factors for relapse in patients with first-episode schizophrenia: Analysis of the Health Insurance Review and Assessment Service data from 2011 to 2015