*population in 2020，GNI and life expectancy are updated based on UN's 2019 data.

*Medical information is based on WHO's report of 2017 Mental Health Atlas-country profile.

I.    Overview

　　Reputed for Country of Ten Thousand islands, Indonesia, comprising of 18,506 islands, is the largest archipelago country in the world, and the fourth most populated country. With a total population exceeding 270 million; however, population distribution is uneven with more than 50% population living in Java island.

　　According to the 2019 data from the World Bank and the WHO, Indonesia' GNI per capita is 4,050 US dollars, and the life expectancy at birth is 71.3 years.

　　Indonesia has enforced national health insurance since 2014, and the coverage rate reached 75% in 2018. Public hospitals are operated by the local governments, the police department, the army and some 　　nonprofit organizations, while the private hospitals are run by the private sectors and some government-owned enterprises. 

　　Medical services are divided into primary care in regional primary care centers and referral services in hospitals. There are 9,655 regional primary care centers in Indonesia, one third of which provide small-scale inpatient services. Each primary care center has a branch office in the village in charge by a nurse. Although each primary care center shall be placed with a physician (and/or the government allowance physician) to work in rural areas, some centers still have no physician due to the shortage and lack of willingness of physicians in rural areas. According to the Ministry of Health, as of 2013, Indonesia has a total of 2,228 hospitals, in which 666 are privately managed and 1,562 are by the public sector. There offer 310,710 hospital beds in total, or 1.17 beds per thousand population.

II.       Mental health policy and system

　　In 1962, Indonesia became the pioneer country in Southeast Asia to have a mental health law. However, in 1992, because of the integration of mental health and general medical treatment, some provisions of the mental health law were partially repealed, which resulted in insufficient legal support for human rights and services. In 2014, the Indonesian government revised and passed the Mental Health Act (MHA) (enforced from the end of 2015), to provide both specific chapters concerning mental health promotion, prevention, treatment, and rehabilitation. In addition, the relevant norms dealing with mental health service system, resources, screening and psychiatric appraisal are also included in order to integrate psychiatric and general medical treatment.

　　Besides, Indonesia has enacted the LAWs in 2009 towards drugs (and related to drugs and narcotic drugs) use disorders, and enforce the medical Rehabilitation and medical services for the Narcotics Addicts. Via these laws, the central BNN-Badan Narkotika Nasional, provincial, and local government have totally established 250 drug and alcohol addiction treatment centers in the country, among which 100 are in in primary care.

　　Most of the hospitals in Indonesia have financial autonomy. The public mental hospitals' revenue comes mainly from social insurance schemes which are managed by central or local governments. Some additional funds can be provided by central or local government with specific purposes, such as infrastructure development or particular high-priority programs. People who are not covered by one or another of the health insurance schemes are required to pay out-of- pocket for mental health services, including hospitalization, professional fees and medicines. The amount of out-of-pocket expenditure varies significantly. In private services, it could reach USD 300 per month only for medications, while it may be as less as USD 10 in government hospitals, which however is still a problem for poor families.

III.   Human Resources

　　The total number of psychiatrists in Indonesia is 1,120. The majority of them is working in Jakarta, while in some provinces there are no psychiatrist. Indonesia has ten psychiatry training programs for the psychiatrists. However, the number of being graduated each year is low, varying between10-60 total per year. Compared to other medical specialists, the people who are interested in training in psychiatry is relatively low.

　　The number of nurses and midwives is around 400,000. Nurses have to complete general nurse training before they undertake specialist training. Following the Tsunami disaster in December 2004 in Aceh Province, there was an initiative for the community nurses (CMHNs) to provide services for mental health. The CMHNs are categorized into three levels - basic, intermediate and advanced. Currently the total number of CMHNs nationally is 6,500, with most at the basic level. Due to the limited number of "formal" mental health nurses, currently the Nurses Professional Organization considers the nurses who have received specific formal education, or the CMHNs training qualification, or the nurses who work in a mental hospital or in the department of psychiatry in a general hospital as the professional mental health nurses. 

　　Other human resources in mental health include clinical psychologist, social workers and occupational therapists, however, there are only a very limited number of them work in mental health programs (2016 ASEAN report, p45); thus, the accessibility and service quality of psychiatric care are still very poor.

　　It takes 4 - 5 years for the medical education at school in Indonesia. The requirements of graduation include minimum two researches, oral presentation of national level case studies at least two times, in addition, a pass of written exam. will be required for every grade increase. It also needs to do presentation cases in the journal, which include internal medicine, neurology, case studies at outside city several times, etc., and take long time case exam. national board exam. and so on. Before entering psychiatric education, it requires to participate in a one-month emergency case study training with all residents from other different fields.

　　Currently, there is an active schizophrenia patient and family associations, and several other organizations with a local NGO that focus on some special advocates. Government, through local provincial health offices and mental hospitals, supports these activities. There is a program of the primary mental health level who are to cultivate the volunteers working  at the community level. The number of cadres is still small but the program is promising and have the chance to become a priority in the development of community mental health services. 

IV.  Mental health system and promotion

V.    Major issues, challenge, and opportunities

　　Indonesian national survey in 2013 yielded a prevalence of 6% mental illness among adults, and severe mental disorder like schizophrenia was 1.7%. International Narcotics Control Board (INCB) in 2011 revealed that 2.2% of the Indonesian population aged 15 to 64 years had a history of using illicit drugs at least once in their lifetime. 

　　Prevalence of tobacco use among people more than 10 years was 56.7% (male). Prevalence of alcohol use in the last 12months was 4.6%, while people who continually used alcohol was 3.0%.The addict of tobacco and alcohol is harmful to the health anyhow.

　　A survey at Aceh Province in 2002 showed that high prevalence of mental health issues among patients who visited primary health center, including depression (25%), panic disorder (18.4%), substance abuse disorder (16%), Post Traumatic Disorders (8.8%),  generalize anxiety disorder (7.7%), etc., which overall psychiatric co-morbidity was 51.1%. 

　　Despite the very large number of people with mental disorder presenting in health care services, the reported number of confirmed cases is limited. The lack of mental health resources and knowledge lead to the failure of recognition, diagnoses, treatment and report in time. 

　　The stigma and misperception about mental disorders are the major barriers for people with mental disorder to access health services. Most people think that mental health are psychosocial or spiritual problems, but not a medical problem. The other barrier is the limited resource if it compared to general health services. For example, there are no or limited mental health services at the primary health center because of the lack of facilities or skillful staff to deal with such problems. Mental health specialists are rare and mainly located in the cities in which are difficult to access for the people who live far away. As a result, most people with mental problems have improper or even no treatment, some may end up being restrained for their life time ("Pasung"), or left wandered around, or got lost in the community. 

　　A Survey in 2013 showed that 15.6 % of patients with serious mental illness were being restrained in the community .

　　The Indonesian government has the following important measures to improve mental health:

1.The Ministry of Justice and Human Rights raised some proposals towards the central government to reform the mental health justice, and aimed to improve the human right through the enhancement of mental health care and the inclusive education.

2.The New Mental Health Act was promulgated on 2014, it is a law of requirement and to help to remedy the shortage to the human rights of the mental ill patients.

3. On the World Mental Health Day, 2018, the Ministry of Social Services promoted a theme compaign with the goal of terminating physical restraint and confinement (by handcuffs) for the mental ill people, and to lead to a real change with a vision of solving the problem of Pasung. Under the cooperation between the Ministry of Social Services, Ministry of Health and the Human Rights Watch organization, there are thousands of patients who might have been relieved and got the mental health support. (https://www.hrw.org/news/2018/10/02/indonesia-shackling-reduced-persists)

4. The Work Safety Act, which was enacted by the Ministry of Manpower in 1970, clearly stipulated that employers were obliged to confirm and inspect the mental condition and physical ability of workers, and to introduce mental health cares into the scope of workplace improvement. 

　　The government's full support might result in the re-allocation of national resources, for Indonesia, it is also a moment of turning juncture for the development and improvement in the scope of mental health. We are looking forward to seeing their progress in the near future.

　　There is still a long way to go in Indonesia for the mental patients to have a proper treatment. Many people still think mental illness is a spiritual or religious issue, and tend to seek traditional therapies or religious assistance. Wrong therapies or mistreatments are frequently heard, such as restricted imprisonment, homelessness, disappearance, etc., which are common and need to be improved.

　　The new Mental Health Act brings opportunities for change, various related legal articles and thoughts are being discussed. Since the issue of mental health is not the focus topic in Indonesia so far, there are so many related mental advocacy activities, like how to obtain resources? how to deal with the community stigma? which require more efforts anyway.

IV.   Potential exchange issues

　　Indonesia faces two most common mental health issues, i.e., a severe shortage of mental health professionals , and the sustained stigma against mental illness.

　　Most people in Indonesia do not know psychiatry. There is stigmatic belief and maltreatment against people with mental illness. The results is that people with mental illness is unwilling to ask for help from mental health therapists. Thus, the priority for dealing with Indonesians lie in overcoming the stigma of mental health, to enhance the perception and to promote the basic health education. Other potential issues include the assistance in the development for the medical education, such as the training of physicians, nurses, and recruiting the international students and professionals to Taiwan for the further study. There are also some related fields, like the training for social workers and occupational therapists, developing the community rehabilitation model for the drug and alcohol addicted treatment, etc. Besides, the neuroimaging technology is at the beginning stage in Indonesia, and it can be a future matter for cooperation.

　　The reduction of stigma against mental illness will provide a further opportunity of mutual exchange. Through continuing education and training, the human resources can be therefore cultivated.