BackgroundFor a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care.MethodsIn this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment.All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ‐5D-3L, and resource use and costs evaluated from a health services perspective, at six months.Results153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY.ConclusionGeneral Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap.Trial registrationClinicalTrials.gov NCT02700490

Background: Self-harming behavior (SHB) is an iceberg phenomenon commonly occurred in both normal population and patients with mental illness. This behavior showed an increase in trend and may develop into suicidal behavior if not treated properly. Therefore an effort in screening and prevention of self-harm is necessary to prevent early deaths caused by suicide. Currently Indonesian version of self-harm screening instrument has not been developed yet.Purpose: Conducting validity and reliability test of Indonesian version of self-harm questionnaire.Method: This research was a descriptive analytic study with cross-sectional design. We recruited 110 psychiatric outpatients from Bantul Hospital Yogyakarta (n=110). SHB was measured using Indonesian version of Self Harm Inventory (SHI). Internal validation was tested using Aiken's Validity Index (AVI) and Pearson Product Moment Correlation (PPMC). Reliability was tested using Cronbach Alpha (CA). Statistical significance was defined as p<0,05.Result: The respondents consisted of 57 men (51.8%) and 53 women (48.2%). Twenty four respondents had done more than 5 items of SHB. AVI value ranged from 0.83 to 0.97 which considered good. PPMC obtained 21 valid items with correlation coefficient >0.25 (p <0.05). Item number 22 was excluded because coefficient value was <0.25. Rresult of Keizer Meyers Oklin was 0,686 and Barlett Test of Spherecity 0,000 (p <0,05). CA was 0.831 which means very good.Conclusion: Indonesian version of Self-Harm Inventory is a valid and reliable screening tool against self-harm behavior in clinical setting.

Social support for people with mental disorders in poor areas: a case study in GunungkidulPurposeThe purpose of this study was to describe the role of mental health cadres in the effort of community based mental health service at Wonosari II Health Center Gunungkidul.MethodsQualitative research was done by case study approach. The cadres were chosen purposively with the criteria of: having attended training or socialization of mental health, having at least 2 years work experience related to community mental health service, and still active. Data collection was done through in-depth interviews and document utilization.ResultsCadres play an important role in providing social support. First, the cadre can show empathy to the family of people with mental disorders by building close relationships and facilitating the social acceptance of the community. Secondly, the cadres provide socialization related to mental disorders and mental health services. Third, approaches through home visits, referral assistance to health services, and health insurance and social assistance suggest that cadres facilitate access to care for people with mental disorders.ConclusionThere was a high social awareness of cadres to families with mental disorders in poor neighborhoods. We found that poverty does not limit people to share with others, and social support helps prevent mental illness from getting worse.

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