The Role of Startups Expanding the Outreach of Mental Health Services in Indonesia

Mental health is still an issue with a relatively low literacy rate among Indonesians. Often invisible, the essence of mental health is no less important than physical health. Both have involvement with each other. If a person is physically disturbed, it may be mentally or psychologically disturbed, and vice versa.

There are many factors that affect a person's level of mental health, ranging from social, psychological, and biological. Poor mental health is also associated with rapid social change, stressful working conditions, gender discrimination, social exclusion, unhealthy lifestyles, poor physical health, and human rights violations.

This is even more so during a pandemic. Conditions of stress, anxiety, depression, and suicidal ideation appear in response to isolation, an uncertain future, to a declining economic condition. The lack of literacy related to mental health makes many mental problems that can be prevented and overcome early on, in fact, they are found in severe conditions and affect the quality of life of the community.

The UN World Health Organization (WHO) says mental health is one of the most neglected areas of public health. Nearly 1 billion people worldwide have a mental health disorder, 3 million people die each year from harmful alcohol use, and one person dies every 40 seconds from suicide.

The Sample Registration System carried out by the Research and Development Agency in 2016 showed that there were 1.800 suicide reports per year in Indonesia, or the equivalent of five people per day taking their own lives. Of this total, 47,7% of suicide victims are believed to be aged 10-39 years, which is the age of teenagers and productive age.

Apart from that, Basic Health Research (Riskesdas) in 2018 showed that more than 19 million people aged over 15 years experienced mental and emotional problems and more than 12 million people aged over 15 years experienced depression. With a total of more than 30 million people who potentially need mental treatment, Indonesia only has around 2500 registered clinical psychologists and 600-800 psychiatrists.

The collection of facts above raises deep concerns for various parties and encourages innovation to improve the quality of mental health services at all levels. Also, more and more platforms are focusing on reaching vulnerable communities with mental health issues. Slowly but surely, mental health issues are starting to get attention and create business potential.

Counseling services during the pandemic

As the development and use of technology becomes more widespread, innovation begins to appear in the industry mental health. During the pandemic which limits people's movement and social interaction, startups are starting to emerge that focus on offering online counseling services, in-depth seminars with professional practitioners, and other activities that support mental health in general.

Call it KALM. This service, which started operating in 2018, is a counseling application online which provides flexible, private and affordable services with professionals. Apart from online counseling, KALM also offers a journal writing feature with the hope of helping to improve positive thinking patterns, reduce stress levels, and improve sleep.

Karina Negara, Clinical Psychologist & Co-Founder of KALM, said that initially online counseling was considered only as a complement, but nowadays, this concept has become an option for most people. At the end of 2020, according to data from KALM itself, 60% of users admitted that this was their first time using online counseling services.

In line with Karina, Kalbu's Chief Visionary Officer (CVO) Iman Hanggautomo also revealed a significant increase in the number of users of his platform. Based on information from several practitioners who are registered in Kalbu, a psychologist who usually treats 1-2 patients per day, during the pandemic this increased to 8-10 patients. Heart itself offers a variety of services for restoration and maintenance mental health.

In Indonesia, there are already several services that have previously targeted this segment, such as One Percent, talk.id and Riliv which has just received early stage funding from East Ventures.

The presence of these platforms provides validation of the need for mental health services in Indonesia. The funding that has been successfully reaped also shows that investors are starting to attract attention to this segment.

One of the platforms healthtech leading Halodoc also sees the great potential that exists in this segment. Starting in 2020, Halodoc already has a special channel or feature to provide mental health consultation services for its users with the support of 500 psychologists and psychiatrists. Its competitor, Alodokter, also offers this feature and claims to have experienced an increase in the number of mental health consultation sessions during the pandemic.

Potential in the B2B sector

One of the factors that triggers mental health issues is the work environment. The World Health Organization (WHO) in 2019 called mental fatigue a "work-induced phenomenon". The impact of mental health problems in the workplace has serious consequences. Not only for individuals, but also for company productivity.

Realizing the importance of maintaining mental health on employee performance, several companies are starting to look for solutions to overcome this. Karina revealed that since the beginning of 2020, company demand for mental health services has been increasing. This is one of the reasons KALM started running KALMporate, a mental health service for corporations, at the end of the first quarter of 2020.

On the other hand, mental health startups have limited services because they target a narrower market niche than services healthtech in general. It is considered that the potential for mental health services will be more optimally directed at corporate needs. This concept is overrated scalable while also being able to reach a wider market.

"We feel that by providing KALMporate services, business will increase scalable financially. "Of course, while still maintaining the quality of our B2C services," added Karina.

Regarding the potential of B2B schemes for mental health services, Riliv has launched Riliv for Company, while Kalbu is also targeting institutions and communities. In a separate interview, Iman revealed that this B2B concept is also an appropriate effort to increase mental health literacy in institutional and community areas.

"The challenge is in terms of mental health literacy among Indonesian people. Therefore, we are starting to penetrate into several massive schools, as well as large companies in the hope that information can be spread inclusively," said Iman.

Looming challenges

With the presence of various mental health services and their potential, there are still several challenges that still loom in this segment. One of them is the negative stigma that is still strong towards people who experience mental health issues in Indonesia. The limited understanding and knowledge regarding mental health in our country cannot be separated from the values ​​of cultural traditions or community beliefs.

Some people still believe that the causes of mental health issues come from supernatural things or superstition, so they categorize this as a disgrace. Labeling, exclusion and stereotypes of people who experience mental health issues often make them choose to remain silent or refuse to consult experts.

On the other hand, financial issues have emerged again. The costs that must be incurred to undergo counseling practices related to mental health issues are considered disproportionate. This is because the services provided are only considered "confiding" and do not offer special medical procedures at prices that are not much different when consulting a specialist doctor.

Apart from that, unequal access is also a challenge in itself. In Indonesia, there are still many provinces that do not have special agencies and professional resources for this mental health issue. The Indonesian Ministry of Health estimates that at least 90% of people with mental health disorders do not have access to adequate care.

Another challenge comes from the user side. With the various solutions offered by mental health platforms, however, the issues that often trigger a person's mental instability come from a fairly private realm. For this reason, it is not easy for users to immediately decide to share (with other people) personal issues.

One counseling service user who lives in Jakarta acknowledged the positive impact of mental health consultation services on him. Even though he had to go through more than one meeting on several different platforms, he finally found the right and comfortable counselor to share his emotional burdens with.

"People are comfortable differently. I'm grateful if I can find the right one straight away. If not, then I'll have to look again," he said.

Likewise when holding counseling sessions. Like a treatment or treatment, counseling is designed to be ongoing. Karina said, "We will determine each session goal-what and there will be 'homework' to complete."

After all, someone who has experienced life problems for years will not immediately recover in counseling that is targeted to be completed in one hour.

Karina's dream is to position mental health services on a par with health services in general. The stronger the penetration of mental health services in Indonesia, it is hoped that understanding regarding mental health will be deeper and more equitable. In this way, the road to overcoming other challenges will allegedly be smoother.