Challenges and Opportunity of Psychiatric Care in Indonesia

印度尼西亞精神照護的挑戰與機會

Andi J. Tanra；Ireine S. C. Roosdy

Indonesia ； mental health services ； psychiatry ； mental rehabilitation ； 印度尼西亞 ； 心理衛生照護 ； 精神醫學 ； 精神疾病復健

台灣精神醫學

31卷3期（2017 / 09 / 01）

183 - 194+ii

英文

Indonesia holds an important position among nations, geographically and social- politically. As an archipelago of over 17,000 islands that lies between two large continents and two great oceans, Indonesia is an ethnically and linguistically diverse country, with around 300 distinct native ethnic groups, and 742 different languages and dialects. Government expenditure on healthcare in Indonesia is about 3.1% of its total gross domestic product. Many psychiatric problems were to be expected could raise from such a diverse cultural population, but as a nation, Indonesia has struggled to thrive to a mentally healthy nation by striving to develop its own personalized psychiatric care. Psychiatry arrived in Southeast Asia in the late nineteenth century. Dutch colonialism brought psychiatry and psychology to the Dutch East Indies (Indonesia’s name during Dutch colonialism). Mental health care policy of the colonial Dutch government in the Dutch East Indies was centered on the mental hospital, for custodial function. In the early 1950s, the new government of Indonesia took over full responsibility for mental health and mental health institutions, part of a larger policy of nationalization and centralization, with the director of mental health of the Ministry of Health in Jakarta functioning as the central agency for planning mental health services. In 2000s, there were new growing interest in modern psychiatry. This emerging interest has come to uprise since the growing cases of narcotics and psychotropic abuse among Indonesian youngsters. A renewed Mental Health Act was published in 2012. President Joko Widodo in 2017 declares a national alert and fight over drug problems, taking mental problem as a serious matter for the nation. In national strategic plan of Health Planning Guidelines for 2015-2019, there are seven aspects of Healthcare Development Program, including the Development of Mental Health Services. The target of this services is to increase the quality and access of mental health service and drug problems. We gave an example of Dr. Soeharto Heerdjan Mental Hospital, to describe rehabilitation programs for its psychiatric patients and drug abusers.

印度尼西亞在地理、社會及政治上都佔有重要地位。印尼是由位於兩大陸與兩大洋間超過17,000 座島嶼所組成，在種族及語言上都極具多樣性，有約300 個原生獨特族群及742 種不同語言或方言。政府用於衛生照護的支出約佔國內生產毛額的3.1%。由於人口組成的文化如此多元，可以預期將產生許多精神問題，而印尼也努力地藉由發展獨特的個人化精神照護以成為一個心理健康國家。精神醫學在十九世紀末期進入東南亞。作為帝國的一部分，荷蘭殖民政權將歐洲醫療發展中的精神醫學及心理學帶到了時稱荷屬東印度的印尼，而當時的心理衛生照護政策主要著重在有監護功能的療養院。1950 年代初期，在國家化及集權化的大政策下，新政府全權負責心理衛生及其相關機構，位於雅加達的衛生部心理衛生主事者即為策畫全國心理衛生服務的中央機關。進入21 世紀，由於印尼青少年成癮藥物及精神藥物濫用的增加，精神醫學受到了新的重視。新版的精神衛生法在2012 年公布。Joko Widodo 總統在2017 年宣示國家對心理衛生的重視及對藥物問題的警覺與對抗。2015-2019 年健康計畫指引的國家戰略中有七項健康照護發展方案，其中之一即是發展心理衛生服務，目標為提高心理衛生服務及藥物的品質及可近性。社會心理復健提供了精神疾病人者在社會適切地發揮功能的機會。最後作者以Dr. Soeharto Heerdjan 精神專科醫院的模式，及其針對藥物濫用者的復健方案，加於說明介紹。

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