Exploration of the needs of carers from hospital based-mental health services in Indonesia

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Abstract

One of the major issues of mental health provision in Indonesia is related to services for carers of people with serious mental illnesses. Very basic and limited services have been offered to the carers. Understanding the needs of Indonesian carers is of key importance before developing appropriate interventions for them. The aim of this study was to explore the needs of carers from mental health hospital services in Indonesia from the perspectives of carers, service users and professionals. It consisted of three separate, but, interrelated studies: (1) a review of international literature about carer needs from mental health services and Indonesian policies relating to carers contribution in the services, (2) focus groups with carers and service users, and (3) individual interviews with professionals.In the first stage, 40 studies eliciting the needs of carers from mental health services were reviewed systematically. The results could not provide adequate information of carer needs which were suitable to an Indonesian context. Therefore, reviewing additional literature of 15 policy documents relating to the contribution of carers in mental health services in Indonesia was conducted. The policy review showed that the need of involving carers in the services was acknowledged, but there has not been clear and strong political endorsement ensuring the carers to receive adequate supports based on their own needs and for their own wellbeing. In the second stage, focus groups with carers and service users were undertaken to explore the needs of Indonesian carers and how mental health hospital services could help to meet those needs. In total, 9 focus groups were conducted, seven with carers (n=33) and two with service users (n=13). All carer and service user participants were recruited from two government mental health hospitals in the capital city of Indonesia. The data were analysed by using framework analysis (Ritchie and Spencer 1994), and resulted in four themes: experiences in caregiving, carer needs from mental health hospital services, current support for carers, and recommendations for service improvement.In the third stage, individual qualitative interviews with health professionals were conducted to explore their views of what Indonesian carers need from the mental hospital services, the extent to which the current services have met the needs, and ideas for service improvements. The interviews involved 24 practitioners from a wide range of health professions, recruited from the hospitals where the earlier focus groups were completed. Framework data analysis (Ritchie and Spencer 1994) was adopted and produced five major themes: Professional views of why services should involve carers, professional views of what carers need for ill relatives, professional views of what carers need for own wellbeing, focus of current contact, and perspectives of support provision.The synthesis of the findings sourced from the focus groups and interviews was completed by adopting a thematic approach (Harden and Thomas 2008). This resulted in overall identifications of the needs of carers for own wellbeing as well as for ill persons, current support provision the carers and recommendations for service improvement within an Indonesian context. The synthesis could also identify similarities and differences between the groups of carer, service user and professional participants in viewing the needs of carers. The findings were valuable resources to aid in the design of a need-based and culturally sensitive intervention for carers in the country.

Keyword(s)

Carer need; Framework analysis; Mental health services; Qualitative

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