APSN Banner

More Indonesians seeking online help for mental health issues amid social stigma and shortage of psychologists

Channel News Asia - September 22, 2023

Nivell Rayda, Surabaya, Indonesia – IT engineer Audrey Maximilian Herli was studying at one of Indonesia's top universities in Surabaya in 2015 when he discovered that a close female friend had been struggling silently with a litany of personal problems and traumas.

In a desperate cry for help, Mr Herli's friend turned to social media to vent her frustration, only to be dismissed as an attention seeker and bullied by her peers and random online commenters, sending her further into a state of depression.

To Mr Herli's horror, his friend resorted to harming herself to cope with the flood of emotions she felt.

He thought long and hard about how to help her friend but soon realised that people with mental health problems often faced stigmatisation and discrimination in Indonesia.

Mr Herli said this explained partly why his friend had never sought professional help, adding that she has since got better.

"(People with mental health problems) need to have access to professionals who can direct their problem into something positive without the fear of being preached, judged, mocked or have their secrets revealed," the 30-year-old told CNA.

It is one reason why he co-founded mental health platform Riliv in 2015, which is among nine that have surfaced in Indonesia in recent years, including Bicarakan.id in 2019 and Psikologimu in 2020.

The three companies have given hundreds of thousands of Indonesians, including those living in remote areas where the nearest therapists can be dozens of kilometres away, access to mental health professionals.

The founders of these three platforms, which include apps and websites for users, told CNA that they believed technology could overcome both Indonesia's low mental health awareness and scarcity of mental health professionals, by providing online consultations as well as other mental wellness services.

Riliv is a play on the Indonesian pronunciation of the word "relief", Bicarakan means "talk about it" while Psikologimu means "your psychology".

A personal experience also led Bicarakan.id founder Andreas Handini to set up his platform.

For years, he was struggling to cope with a series of childhood traumas which manifested themselves as nightmares and a sense of bitterness towards the world around him.

But he finally managed to control his emotions after going to therapy for six months in 2019.

"I personally felt the benefit of going to a psychologist and I was bent on rallying others to do the same," Mr Handini, 25 told CNA.

But psychologists are hard to come by in the vast archipelago nation.

The country of 270 million only has 2,800 clinical psychologists and 1,200 psychiatrists, according to data from their respective professional organisations, with most residing in big cities in Indonesia's most populous and developed island, Java.

For comparison, the United States has approximately 106,000 psychologists and 56,536 psychiatrists serving a population of 331 million. Meanwhile, Japan, which has a population of 125.7 million, has 13,000 psychologists and 13,000 psychiatrists.

Psikologimu founder Nova Ariyanto Jono, a human resource consultant with a degree in psychology, experienced first-hand how difficult it was to look for a good psychologist.

"Even I, a psychology graduate, was struggling to find a psychologist. I live in Jakarta and I have to ask around when I want to look for a psychologist," the 37-year-old told CNA.

Breaking barriers

According to a 2018 basic health study conducted by the Indonesian Health Ministry, there were 12 million people over the age of 15 who had suffered from different levels of depression, the first time it was being measured.

The same quinquennial study showed that less than three per cent of that figure sought some form of professional help from psychologists and psychiatrists.

A similar nationwide study is being conducted this year, results of which will be announced in 2024.

Undiagnosed mental health issues can lead to something more serious. Between January and July of this year, the Indonesian national police recorded at least 640 cases of suicides, a 31 per cent increase from the same period in 2022.

But some experts believe that this figure is only the tip of the iceberg with many more deaths by suicide going undocumented.

"Many Indonesians are not familiar with the world of psychology. Many are interested but they are embarrassed, reluctant, afraid of being judged (to go to a psychologist)," said Riliv CEO, Mr Herli, of why the number of treated mental health problems is low in Indonesia.

Technology is breaking these barriers, he continued, allowing clients to get in touch with psychologists from other parts of the country from the comforts and privacy of their own homes.

Psychologist Siti Jessika, 39, who has been treating both physical and online patients over the last three years, said the platforms' presence are also benefiting psychologists by allowing them to expand their clientele.

"I got clients from different places like Papua, where access to psychologists is virtually non-existent," she told CNA, referring to Indonesia's easternmost and least developed province.

"I even had an Indonesian living in Vietnam (as a client) because in Vietnam, only Vietnamese-speaking psychologists are available."

Price is another factor why mental health platforms are becoming popular, particularly among college students and those early in their careers.

In-person consultation can cost up to 700,000 rupiah (US$45) for a one-hour session in Indonesia, while mental health platforms typically charge users 100,000 rupiah for a chat-based consultation and 300,000 rupiah for a video-based session.

The convenience and affordability offered by mental health platforms are some of the reasons why such online services are attracting first-time clients who have never been to a psychologist before, Bicarakan.id CEO Mr Handani said.

"Not many people know what a psychologist does. Once you experience it then you know, you feel the benefit. Then you become agents of change and tell your friends and family about the benefits of going to a psychologist," he said.

But psychologist, Mdm Jessika, said online consultations do have their limitations.

"Ideally, a consultation should be in-person in a private and cozy room. Online consultations, (therapists and clients) are not even in the same place. Even if it's a video call, we can only see the chest up, not their gestures, hands and feet. Observation is very limited," she said.

"I think (online consultations) is like the first aid in psychology. We need to deal with people with anxiety or suicidal thoughts immediately... That is the strength of online (consultations)."

Pandemic boom

The COVID-19 pandemic and the subsequent activity restrictions and lockdowns have dramatically increased demand for mental health services, particularly those which can be easily accessed from the comforts of their homes.

"The pandemic really stressed people out. They used to be able to move around but suddenly they found themselves deprived of their social support system and struggling to cope with the sudden change in lifestyle," Psikologimu CEO Mr Jono said.

Psikologimu was launched in March 2020, just a few weeks before Indonesia recorded its first COVID-19 cases.

In a matter of days since the pandemic hit, hundreds of people began downloading Psikologimu app despite the absence of a marketing campaign.

"Because we named ourselves 'Psikologimu' our app appeared on top when people searched for the keyword 'psikologi'," Mr Jono said referring to the Indonesian word for psychology.

The platform now has more than 100,000 active users.

Bicarakan.id shared a similar story having grown from a company with just a few thousand clients before the pandemic to one that caters to more than 150,000 users today.

"People today are becoming more aware about mental health than they were before the pandemic," the platform's CEO, Mr Handani said.

Meanwhile, Riliv's growth was even more dramatic. In 2019, the number of people downloading its app stood at a little over 100,000 but today the company is on its way to welcoming its one millionth user.

Mr Herli said during the pandemic, companies were also starting to show interest in forging partnerships with mental health platforms like Riliv to provide counselling as well as workshops, and webinars to raise mental health awareness among their employees.

The Riliv CEO said much of the company's revenue, which he declined to disclose, now comes from these corporate clientele allowing it to be on the path to profitability after years of operating on a shoestring budget.

Much room for growth

Although mental health awareness has been increasing since the pandemic, the three CEOs admitted that their users are still dominated by people under the age of 35 living in some of Indonesia's biggest cities.

"People in this age group are already familiar with technology and they have better understanding of the importance of mental health," Mr Herli said, adding that the exposure to literature on mental health as well as the stress level in big cities are greater than smaller ones.

There are no available data on levels of mental health issues in the rural areas though past reports showed there are between 3,000-6,000 cases of mentally ill people locked up by their family every year.

The low public awareness towards mental health could also be one of the reasons why so few choose to become psychologists or psychiatrists, Mr Jono said.

"On average, psychologists in Indonesia can only have two or three clients a day, sometimes even less. Their occupancy rate is far below their peers in other countries where mental health awareness is high," he said.

Mr Jono believes that as mental health awareness improves, so too will the demand for psychologists and psychiatrists.

The three CEOs said only licensed psychologists are allowed to join their platforms adding that the three are working closely with the Indonesian Psychologists Association (HIMPSI) which regulates the profession.

The Riliv CEO believes that mental health awareness will continue to increase in Indonesia, especially as people in these age groups get older and replace the previous generations who are mostly oblivious to the benefits of mental health services.

While Riliv is focusing on previously untapped markets to expand its business, Bicarakan.id is concentrating on improving the quality of its services to ensure users get the most out of the services provided.

Realising that not all cases can be treated online, the company also provides in-person consultations at two locations in Jakarta.

"You cannot change people's mindset unless you deliver good services so they can share it with their friends. This is what I'm doing now," Mr Handani said.

Mr Jono of Psikologimu has a different approach, believing that the key to improving mental health in Indonesia is to provide help to those in need whenever they need them.

"We are the only mental health platform which provides consultation 24/7," he said, adding that his company is also concerned about what happens to a client after finishing a therapy session.

"A consultation only lasts for 60 minutes. But anything can happen between minute 61 and the next appointment. We want to add value to our users. We will help them throughout their process to get better."

Mr Herli of Riliv said more education is still needed before the idea of seeking professional help to address one's mental health issues becomes mainstream.

"In other countries, going to a psychologist is not something special. We hope one day Indonesia will become such a country," he said. (CNA/ni)

Source: https://www.channelnewsasia.com/asia/indonesia-mental-health-more-seeking-help-psychologists-shortage-378869