NIHR Global Health Research Group on sustainable care for anxiety and depression in Indonesia.

Background: The total proportion of people living with common mental health disorders is rising. These disorders impact significantly on patient and population health and challenge sustainable development in low-to-middle-income countries (LMICs). Fourteen million people live with depression and anxiety in Indonesia, placing it in the top two countries for prevalence in the WHO’s South-East Asia region. Effective psychological interventions are available for depression and anxiety but robust evidence to maximise their scalability and sustainability is lacking. Aim: Our group aims to improve health and productivity in Indonesia by increasing the availability and accessibility of evidence-based treatments for adults living with anxiety and depression. Methods: Our 4-year programme comprises 5 work-packages (WPs) and 2 cross-cutting themes (CCTs). WP1 (Month 0-28) will pilot a new household survey to understand the distribution, determinants and socio-economic consequences of depression and anxiety in Indonesia and area-level influences on service supply. WP2 (Months 4-15) will qualitatively explore the different contexts into which psychological interventions may be introduced in Indonesia and culturally-adapt, with Community Engagement and Involvement (CEI) representatives, a low intensity psychological intervention for Indonesian use. WP3 (Month 16-22) will work in partnership with professional and community stakeholders to co-develop local implementation strategies to increase access to depression and anxiety treatments in Indonesia, and deliver and evaluate sustainable training to increase workforce capacity. WP4 (Month 23-46) will use implementation science methodologies to evaluate the delivery, reach and impacts of a culturally-adapted, low-intensity psychological intervention for depression and anxiety in Indonesia and identify any outstanding barriers to its uptake, access and use. WP5 (Month 34-46) will take a health economic perspective to identify priority regions for treatment roll-out and deliver a sustainability toolkit to support national scale-up. Two cross cutting themes, community engagement and partnership working (CCT1) and leadership and capacity building (CCT2) span our programme, establishing intersectoral networks and upskilling clinical, academic and public collaborators to undertake high quality service development and mental health research. Anticipated impact & dissemination: Our proposal builds on strong partnerships between the Universities of Manchester and Indonesia developed over 3 years. It directly addresses two research priorities identified through collaboration with local Indonesian community groups. It is supported by the Indonesia Workforce Council at the Ministry of Health, and the Directors of Mental Health and Primary Care in Indonesia. We will adopt an inclusive, proactive approach to dissemination with high stakeholder participation. At programme end, we will deliver manualised protocols to support high quality service delivery, sustainable workforce capacity building and treatment resources. We will have quantified costs and completed a budget impact analysis to optimise scalability and sustainability. We will have strengthened mental health advocacy in Indonesia, established a vanguard health services research training hub, developed culturally-acceptable CEI guidelines and produced a new evidence-based framework to optimise knowledge mobilisation.