health outcomes. However, this study demonstrates that with the same budget currently invested in the program, the changes proposed will result in improvements on the current low uptake and poor coverage, thus yielding cost savings for the government and a possibility to reallocate resources to the country's priority health concerns, consequently leading to better health outcomes.

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Background: Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia. Methods: Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multidisciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited. Results: Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings.

Abstrak Sistem kesehatan jiwa yang baik akan menghasilkan masyarakat Indonesia yang sehat jiwa dengan ketersediaan pelayanan kesehatan jiwa yang bermutu, merata, tanggap, efisien dan terjangkau. Tulisan ini bertujuan untuk memberikan tinjauan sistem kesehatan jiwa di Indonesia beserta tantangannya. Studi ini merupakan kajian di bidang kesehatan jiwa. Informasi diperoleh melalui telaah kepustakaan, dokumen, curah pendapat, kunjungan ke lapangan dan wawancara terhadap pelaksana program jiwa. Hasil kajian memperlihatkan masih minimnya sumber daya kesehatan, pengeluaran biaya kesehatan yang masih rendah di Indonesia dibandingkan negara-negara tetangga. Sistem informasi kesehatan juga belum memadai. Kelebihan yang dimiliki Indonesia adalah adanya obat psikotropika yang cukup variatif dalam daftar obat esensial, memiliki Undang-Undang Kesehatan Jiwa, dan beberapa Peraturan Menteri Kesehatan yang menyangkut kesehatan jiwa. Meskipun memiliki Undang-Undang Kesehatan Jiwa, namun belum tersedia perangkat hukum dibawahnya untuk melaksanakan Undang-Undang. Peran serta sektor lain serta upaya promotif dan preventif belum dirasakan. Kata kunci: sistem kesehatan jiwa, undang-undang kesehatan jiwa, sumber daya, sistem informasi, Indonesia Abstract A good mental health system will produce a healthy mental Indonesian community with the availability of good quality, equitable, responsive, efficient and affordable mental health services. This paper aims to provide a review of the mental health system in Indonesia and it challenges. This study is a review of mental health. Information is obtained through literatures and documents review, brainstorming, field visits and interviews with the implementers of the mental health program. The result shows that human resources, health expenditure are still minimal than neighbour countries. Health information system has not yet been adequate. The advantages of Indonesia are this country have adequate list of essential medicines, have a Mental Health Law and some Ministerial decree related to mental health. Although Indonesia has a Mental Health Law, but there has no legal devices available under the law to implement it. Other sector role’s and promotive, prevention program have not been felt. Keywords: mental health system, mental health law, resources, information system, Indonesia

Abstrak Psikosis adalah gangguan jiwa yang memiliki prevalensi kecil dibandingkan gangguan jiwa lainnya tetapi mempunyai beban penyakit yang cukup tinggi. Tujuan analisis ini adalah untuk memperoleh prevalensi psikosis pada penduduk Indonesia secara nasional, per provinsi dan melihat sebaran psikosis antara perkotaan, perdesaan berdasarkan Riset Kesehatan Dasar (Riskesdas) 2018. Analisis ini merupakan analisis lanjut Riskesdas dilaksanakan di 34 provinsi, 514 kabupaten/kota pada bulan Juli 2018. Jumlah blok sensus 29.824 dengan respon rate 99,41%, jumlah rumah tangga dikunjungi dan diwawancara 282.654 dengan respon rate 95,58%. Enumerator bertanya kepada kepala keluarga atau yang mewakilinya mengenai adakah anggota rumah tangga (ART) di rumah tersebut yang pernah atau sedang mengalami gangguan jiwa psikosis dan berapa banyak jumlahnya. Analisis dilakukan dengan perangkat statistik SPSS versi 22 dengan metode complex sample. Berdasarkan Riskesdas 2018, didapatkan estimasi prevalensi orang yang pernah menderita psikosis di Indonesia sebesar 1,8 per 1000 penduduk. Prevalensi antar provinsi berkisar 0.9 sampai 3.5 per 1000 penduduk. Prevalensi psikosis lebih tinggi di perdesaan dibandingkan di perkotaan (p=0,099). Kata kunci: Riskesdas 2018, psikosis, prevalensi Abstract Psychosis is a mental disorder that has a small prevalence compared to other mental disorders but it has a fairly high burden of disease. The purpose of this analysis is to obtain the national, provincial prevalence of psychosis and to compare the prevalence between urban and rural regions in Indonesia based on Basic Health Research (Riskesdas) 2018. This is an advance analysis. Riskesdas was implemented in July 2018 in 34 provinces and 514 regencies/cities. A total of 29,824 census blocks with a response rate of 99.41%, as many as 282.654 households visited and interviewed with a response rate of 95.58%. The enumerator interviewed the head of the family or his representative regarding the existence of household members (ART) in the house who had or were experiencing psychosis and how many of them. The analysis was carried out with SPSS version 22 using the complex sample method. Based on Riskesdas 2018, an estimated prevalence of people who have suffered psychosis in Indonesia is 1.8 per 1000 population. The prevalence between provinces ranges from 0.9 to 3.5 per 1000 population. The prevalence is higher in rural than urban area (p=0.099). Keywords: Riskesdas 2018, psychosis, prevalence

Background Depression among elderly individuals is related to physical illness, functional status, prolonged treatment and other factors. Depression is not effectively treated with medication but can be alleviated by treating the physical illness and improving functional status. Therefore, this study aims to determine the relationship between functional status and depression in elderly individuals in Indonesia. Methods The data used were obtained from a national survey dataset, namely, the Basic Health Research and Socio-Economic Survey in 2018, which was carried out in 34 provinces and 514 districts or cities. The total number of respondents was 93,829, aged ≥60 years. Functional status and depression were assessed using the Barthel index and MINI (Mini International Neuropsychiatric Interview), respectively. Furthermore, data processing was carried out with the Statistical Package for Social Sciences (SPSS) version 26 program and analyzed using the chi-square test and multiple logistic regression with the complex sample method. Results Elderly individuals with severe dependence were at the greatest risk of becoming depressed compared to those without functional impairment or with independence after considering sociodemographic factors and disease history have 5.730 (95% CI = 4.302-7.632) the adj odds. Furthermore, this figure was higher than that of individuals with total dependence have 4.147 (95% CI = 3.231-5.231) the adj odds. The physical illness experienced also played a role in the risk for depression, which was higher among elderly individuals with stroke and a history of injury. The sociodemographic factors involved include low education and economic levels. In contrast, the area of residence and marital status had no statistically significant effect on the relationship between functional disorders and depression. Conclusions Elderly individuals with decreased functional status are prone to depression. The highest probability for depression was observed among those with severe dependence compared to those with total dependence. Consequently, interventions that involve various sectors, including social and family support, are needed.