Identifying sustainable care for depression and anxiety in Indonesia

Depression and anxiety are common mental health problems, affecting millions of people worldwide. In Indonesia, more than 19,000 people (4,800 households) were surveyed in 2023, revealing that over 13% of respondents experienced depression and/or anxiety. Despite this, only one in five people seek help from health services, reflecting both the shortage of trained professionals and the stigma still surrounding mental health.

Researchers at The University of Manchester are collaborating with colleagues from Universitas Indonesia in Indonesia through the STAND-Indonesia programme to improve access to effective mental health care. The project is developing and evaluating sustainable, community-based approaches to delivering treatment - ensuring that support is effective, affordable, and culturally relevant.

Adapting talking treatments for Indonesia

Low-intensity psychological interventions such as problem-solving therapy and behavioural activation are effective for people with depression and anxiety, and can be delivered by trained lay health workers. These interventions, recommended by the World Health Organization, are particularly important in regions where access to mental health professionals is limited.

Professor Penny Bee

Penny is Professor of Applied Mental Health Research in the Division of Nursing, Midwifery and Social Work at Manchester.

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A team led by Professor Penny Bee and Professor Helen Brooks from the Division of Nursing, Midwifery and Social Work, together with Professor Herni Susanti from the Faculty of Nursing, Universitas Indonesia, has worked closely with patients, families, community leaders, traditional healers, and health professionals to adapt these interventions for use in Indonesian communities.

The team conducted qualitative interviews and focus groups with 160 participants which informed subsequent co-design workshops with community stakeholders. These were used to adapt and refine a low-intensity intervention to ensure cultural sensitivity and contextual relevance. The result is a low-intensity psychological intervention (LIPI) that has now been implemented across 12 sites in Indonesia.

Building capacity through training

In 2024, the STAND team launched a large-scale Train-the-Trainers programme, co-designed and delivered with people with lived experience of mental illness.

76 clinicians and health workers (psychiatrists, doctors, nurses, and lead kaders) were trained as master trainers. This training was then cascaded to 150 lay health workers across 12 sites in Java, who are now delivering LIPI in their own communities.

Delivering treatment and engaging communities

Implementation of LIPI is now well underway:

• In 2025, over 1,500 patients have received our intervention, and an evaluation is ongoing. 981 patients have already received treatment across Java, with recruitment surpassing their target of 1,500 patients by 2025.
• Drop-out rates have been extremely low, demonstrating high levels of engagement and acceptability.
• Community outreach has included the SEMESTA Mental Health Festival, a four-day event in Jakarta that brought together over 750 participants for panel sessions, creative workshops, and public discussions about mental health.

Dr Helen Brooks

Helen is a Senior Lecturer and head of the Mental Health Research Group in the Division of Nursing, Midwifery and Social Work at Manchester.

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Alongside this, STAND has delivered 14 research seminars and capacity-building workshops involving more than 1,100 participants, and published resources including a translated patient and lay health worker manual to support national rollout.

Shaping future policy and practice

The Indonesian research team has worked closely with the Ministry of Health to ensure findings inform national policy.

The programme is also evaluating the costs of delivering our co-adapted intervention, providing government with sustainable options for future funding and scale-up.

While grounded in the Indonesian context, the learning generated has wider relevance. Drawing on the results of this programme of activity, the team will work collaboratively to develop recommendations for the effective implementation of culturally adapted mental health interventions in low-resource settings.

Looking ahead

STAND is now considering how to optimally expand its work to additional people within existing sites, and new sites within and beyond Java.

Through this collaboration, STAND is helping to build stronger, more equitable systems for mental health care - creating lasting impact in Indonesia and sharing vital lessons for global mental health research.