NIHR Global Health Research Group on sustainable care for anxiety and depression in Indonesia Depression and anxiety are common mental health problems, affecting large numbers of people around the world. Depression and anxiety affect 14 million people in Indonesia, and this country has one of the highest rates of depression in the South-East Asia region. Depression and anxiety can affect how people feel and how communities function. These disorders can worsen physical health conditions and significantly increase healthcare costs. This can challenge sustainable development in low-middle income countries. 
Depression and anxiety are treatable but there is a shortage of trained professionals. Many people in Indonesia, and across the world, are not getting the help they need. Talking treatments can help people with depression and anxiety to recover. These treatments can be delivered by people without a mental health qualification and are recommended by the World Health Organization's for areas where mental health services are limited. Training lay workers to deliver talking treatments is cheaper and more feasible than training a smaller number of highly skilled professionals. It can reduce the stigma of mental health treatment and make treatment more accessible. Similar approaches have been tested in other countries, but the best way to organise and support these services is unknown. This means that we do not know how best to deliver these interventions in Indonesia, how acceptable they will be or what benefits they will have. 

Our group will use information from existing national surveys in Indonesia to identify where rates of depression and anxiety are highest and where talking treatments are needed the most. We will find out which groups of people have the greatest difficulties accessing talking treatments and explore what effects this has. We will work directly with patients and professionals to understand their experiences of, and preferences for, receiving and delivering treatments and the types of challenges they face. 
Once we understand the problem, we will work with patients, lay workers, professionals and policy makers to culturally adapt talking treatments, produce locally relevant delivery plans and provide workforce training. We will explore the impact of our intervention on individuals, communities and health service use. We will talk to patients and professionals about their experiences of our intervention and identify any other needs. 
We will measure the cost of delivering our intervention and identify the geographical areas and patient groups that should be prioritised for treatment roll out. We will compare and contrast findings from different regions within Indonesia to help us understand how best to support treatment availability and uptake in the longer term and deliver new learning to help us enhance the delivery of talking treatments in other global settings. 
We will hold collaborative, faceto-face engagement events to engage individuals, families and communities in our programme and deliver applied health services research training programs to Indonesian health researchers and public representatives to enable further high quality work. We will work with government, academic and public representatives to tell patients, professionals and policy makers what we find.

Where is it being done? Java, Indonesia (South-East Asia)

When is it being done?  August 2022-July 2026

Who is doing it? 
Our research team represents an international partnership between mental health professionals and health researchers at the Universities of Manchester and Manchester Metropolitan University, UK and The University of Indonesia, The Indonesian Research and Innovation Agency within the Ministry of Health and non-governmental organisations in Indonesia. 1. Explore nationally representative and publicly available datasets to assess the distribution, determinants and socio-economic consequences of depression and anxiety for adults in Indonesia, providing a robust evidence base for the development and evaluation of primary care and community mental health services in this country.
2. Understand, through interviews with health professionals and decision makers, the different contexts in which psychological interventions may be used in Indonesia, and culturally-adapt a low intensity psychological intervention (Guided Self-Help) to treat depression and anxiety in Indonesian adults.
3. Work with local community and clinical partners to develop local strategies for intervention implementation, including culturally sensitive workforce training programmes. 
4. Deliver and evaluate, through a mixed method research, the costs, reach and health impacts of our low-intensity psychological intervention. 
5. Combine and disseminate our findings to inform policy and support sustainable service scale-up.
6. Work in partnership with national and local governmental, non-governmental and public stakeholders to engage communities, promote mental health advocacy and stimulate demand for effective, efficient mental healthcare. 
7. Build equitable research partnerships and strengthen research capacity, research management and public and community involvement in mental health research in Indonesia.