Skip to main content Skip to main navigation menu Skip to site footer

Barriers to mental health services at public health centers: Providers’ perspectives


Background and purpose: The disparity between the increasing prevalence of mental health (MH) illness and the availability of treatment in Indonesia remains high, despite the campaign to provide MH services at public health centers (PHCs) initiated by the government in 2014. This study explored barriers to provide MH services at PHCs in Denpasar, Bali, Indonesia in order to identify priorities to improve the services.

Methods: This qualitative study was conducted from March to December 2015 and employed in-depth interviews and focus group discussions (FGDs). In-depth interviews were conducted with the Head of Denpasar City Health Office to explore the barriers of MH services provision at PHCs in the scope of policy and services management. Interviews with general practitioners (GPs) from 4 PHCs in Denpasar were conducted in order to explore the experiences and barriers of MH services in the PHC clinics. To explore further the MH services implementation in the community, two FGDs were conducted with the MH program managers and community health workers (CHWs). The interviews and FGDs were recorded, and the verbatim transcripts were analyzed using a thematic framework analyses.

Results: Barriers to MH service provision identified in our study are poor dissemination of the national policy to the local government and PHCs; low prioritization of MH issues; organization workforce issues; funding concerns; poor coordination and supervision; poor management and recording system; scarcity of ancillary facilities and other resources such as psychotropic medicines.

Conclusion: The findings of this study highlight the importance of national policy dissemination and collaboration between local government, health providers and CHWs to overcome the barriers in providing MH services at PHC level.


  1. Whiteford H A, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet [Internet]. 2013 Nov 9 [cited 2014 Jul 13];382(9904):1575–86. Available from:
  2. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: A systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43(2):476–93.
  3. Ministry Of Health Republic of Indonesia. Basic Health Survey Statistics. Jakarta; 2013.
  4. Minas H, Diatri H. Pasung: Physical restraint and confinement of the mentally ill in the community. Int J Ment Health Syst [Internet]. 2008 Jan [cited 2016 Jan 26];2(1):8. Available from:
  5. Kurihara T, Kato M, Reverger R. Pathway to psychiatric care in Bali. 2005;(August):204–10.
  6. MH Act. Undang-undang Republic Indonesia, No. 18 Tahun 2014 Tentang Kesehatan Jiwa (MH Act, Number 18, 2014). Indonesia; 2014.
  7. Saraceno B, Ommeren M Van, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Global MH 5 Barriers to improvement of MH services in low-income and middle-income countries. 2007;
  8. Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unützer J. Grand challenges: integrating MH services into priority health care platforms. PLoS Med [Internet]. 2013 Jan [cited 2014 Jun 3];10(5):e1001448. Available from:
  9. Humphreys JS, Wakerman J, Wells R, Kuipers P, Jones JA, Entwistle P. “Beyond workforceâ€: a systemic solution for health service provision in small rural and remote communities. Med J Aust. 2008;188(8 Suppl):77–80.
  10. Hailemariam M, Fekadu A, Selamu M, Alem A, Medhin G, Giorgis TW, et al. Developing a MH care plan in a low resource setting : the theory of change approach. BMC Health Serv Res [Internet]. 2015;1–11. Available from:
  11. WHO and Wonca. Integrating MH into primary care: A global perspective. Funk M, Ivbijaro G, editors. Singapore: WHO and Wonca; 2008.
  12. Balaji M, Chatterjee S, Koschorke M, Rangaswamy T, Chavan A, Dabholkar H, et al. The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India. BMC Health Serv Res [Internet]. 2012;12(1):42. Available from:
  13. Ngo VK, Rubinstein A, Ganju V, Kanellis P, Loza N, Rabadan-Diehl C, et al. Grand challenges: Integrating MH care into the non-communicable disease agenda. PLoS Med [Internet]. 2013 Jan [cited 2014 Jun 2];10(5):e1001443. Available from:
  14. Ross LE, Vigod S, Wishart J, Waese M, Spence JD, Oliver J, et al. Barriers and facilitators to primary care for people with MH and / or substance use issues : a qualitative study. BMC Fam Pract [Internet]. 2015;1–13. Available from:
  15. Makhashvili N, Voren R Van. Balancing Community and Hospital Care : A Case Study of Reforming MH Services in Georgia. 2013;10(1).
  16. Petersen I, Baillie K, Bhana A. Understanding the benefits and challenges of community engagement in the development of community MH services for common mental disorders: lessons from a case study in a rural South African subdistrict site. Transcult Psychiatry [Internet]. 2012 Jul [cited 2016 Jan 26];49(3–4):418–37. Available from:
  17. Chisholm D, Flisher A, Lund C, Patel V, Saxena S, Thornicroft G, et al. Scale up services for mental disorders: a call for action. Lancet. 2007;370(9594):1241–52.
  18. WHO. mhGAP Intervention Guide. Dua T, Clark N, Faydi E, Fleischmann A, Poznyak V, Ommeren M van, et al., editors. Geneva, Switzerland: WHO; 2010.
  19. De silva MJ, Lee L, Fuhr DC, Rathod S, Chisholm D, Schellenberg J, et al. Estimating the coverage of MH programmes: A systematic review. Int J Epidemiol. 2014;43(2):341–53.

How to Cite

Aryani, P., Januraga, P. P., Sari, K. A. K., Gerstel, L., & Scholte, W. F. (2019). Barriers to mental health services at public health centers: Providers’ perspectives. Public Health and Preventive Medicine Archive, 7(1), 66–72.


90 249


Search Panel