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Communi y-based in e en ions o men al heal h: B idging p ima y ca e and
communi y app oaches
Dian Mus ika ini 1, *, Dyaha i Wahyu ini 2 and Dwi e no Pangas u i 3
1 Medical Doc o , Ama a Medika Clinic, Sleman, Yogyaka a, Indonesia.
2 Clinical Resea ch Uni , D . Cip o Mangunkusumo Na ional Gene al Hospi al, Cen al Jaka a, Indonesia.
3 Depa men o Medical Educa ion, Facul y o Medicine, B awijaya Uni e si y, Malang, Indonesia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4075-4083
Publica ion his o y: Recei ed on 18 Ma ch 2025; e ised on 26 Ap il 2025; accep ed on 29 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1565
Abs ac
Men al heal h is one o he impo an ac o o human well-being and hei p oduc i i y in socie y. Howe e , he
p e alence o men al illness in Indonesia is sligh ly high, due o inc easingly s igma abou men al diso de s and lacking
o men al heal h p o essional. In o de o esol e hese challenges, he ole o gene al p ac i ione s as a communi y
leade in p ima y ca e is needed. This s udy aims o summa ize a ious in e en ions in p ima y le el, hei p ocedu e
and he ou come o men al heal h in communi ies. This s udy used a li e a u e e iew design based on seconda y da a
om elec onic da abase, such as PubMed, Coch ane Lib a y, and ScienceDi ec . The e a e 16 a icles equi ed a e
sc eening by PRISMA 2020 and me he inclusion c i e ia. The esul s o his s udy is communi y-based p og am o
men al heal h could be conduc ed in h ee ways: men al heal h p og ams such as Mind ulness-Based P og am, Family
in e en ion, Emo ional Resilience Skills T aining, and School-based in e en ion; men al heal h ools using cha bo AI;
and he combined o bo h p og ams and ools: SMART Men al Heal h. Some o hese in e en ions p o ed e ec i e o
educe sign and symp oms o men al illness, especially dep ession and anxie y diso de . Fu he esea ch is needed o
analyze men al heal h ou come o each in e en ions and o imp o e he applicabili y o hose p og ams in Indonesia
wi h a ious challenges like cul u al di e si y, s igma and limi ed men al heal h esou ces.
Keywo ds: Communi y-based; Communi y heal h; In e en ion; Men al heal h; P ima y ca e
1. In oduc ion
Men al heal h is c ucial o pe sonal heal h and well-being. Despi e he global bu den o men al diso de s, many p ima y
heal hca e sys ems p edominan ly ocused on physical heal h, igno ing he c i ical need o men al heal h ca e [1, 2]..
Men al diso de s a e widesp ead ac oss na ions and con ibu e signi ican ly o su e ing, educed quali y o li e, and
ele a ed mo ali y a e [2]. Acco ding o Indonesia-Na ional Adolescen Men al Heal h Su ey (I-NAMHS) 2022, 1:20 o
he popula ion expe ienced men al diso de s, wi h 1 in 3 eenage s ha e i [3,9]. The majo i y o indi iduals wi h men al
illness do no seek ea men due o conce ns such as damaging hei amily’s epu a ion, diminishing ma iage
p ospec s, acing disc imina ion, social exclusion, and s igma [3]. The s igma agains men al illness is one o he global
issue ha hu s indi iduals who expe ienced i . This s igma can mani es a a ious le els, including s uc u al, socie al
(in e pe sonal s igma), and indi idual (in e nalized s igma) [4]. Men al heal h s igma is linked o mo e se e e
psychological issues, educed access o men al heal h ca e, poo ea men adhe ence, and ad e se ou comes [4]. While
an i-s igma p og ams in high-income coun ies well-es ablished and ha e shown posi i e esul s, he e is a lack o
comp ehensi e li e a u e om low and middle income coun ies, including Indonesia [4].. One o he wo s o ms o
disc imina ion caused by men al heal h s igma is “pasung”, he physical es ain o indi iduals su e ing om men al
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diso de s [5]. The Na ional Basic Heal h Resea ch documen ed 1,655 cases o pasung agains people wi h men al
diso de in Indonesia [6].
The o he challenges o imp o ed men al heal h among wo ldwide s igma is he lack o men al heal h p o essionals.
The a io o psychia is s in Indonesia is 1:200,000 popula ion, ha each one o psychia is mus se e 200,000 people
[7]. This a io is inadequa e based on WHO s anda d ha equi es 1:30,000 o an ideal a io o psychia is s o a
popula ion [1]. Howe e , WHO es ima es ha one in e e y eigh indi iduals wo ldwide is su e ed wi h men al illness
[1]. In his si ua ion, In eg a ing men al heal h in o p ima y heal hca e is mo e signi ican in esol ing he gap be ween
esou ces and needs, o educe s igma and o imp o e be e men al heal h ou comes. P ima y heal hca e no associa ed
wi h any speci ic heal h condi ion, hus he ea o being s igma ized o ma ginalized om he communi y is educed,
making his p ima y le el mo e accep able and accessible o mos pa ien s and hei amilies [2]. Fu he mo e, because
p ima y heal hca e a e in o nea people’s communi ies, many indi ec heal h expendi u es associa ed wi h seeking
ca e u he a ield (e.g. anspo a ion o acili ies loca ed in u ban a eas, loss o p oduc i i y ela ed o he ime spen
in accompanying he pa ien o hospi al, e c) a e a oided, making p ima y heal hca e he mos a o dable op ion bo h
o pa ien s, he communi y and he coun y [2].
As he i s le el o con ac o pa ien s, Gene al p ac i ione s playing an essen ial ole in ea ly p e en ion and
iden i ica ion, he p omp in e en ions, and main ain open communica ion and no malizing men al heal h discussions
e en in someone wi h physical heal h p oblem only [2]. Indeed, gene al p ac i ione in he unique posi ion o p o iding
ca e h oughou people’s li e cycle, om bi h un il elde ly [2]. No only being ca e p o ide s who ea indi iduals
pe sonal heal h, bu also gene al p ac i ione s being a communi y leade , acco ding o he 5-s a doc o s by WHO. In
his case, gene al p ac i ione becomes he decision make o p o ide mo e comp ehensi e and applicable o
communi y-based solu ions o deal wi h he s igma and he limi ed men al heal h p o essionals in Indonesia. The ask-
sha ing app oach om specialis s o p ima y ca e and communi y heal h wo ke s, has been inc easingly implemen ed
in many coun ies o e he pas decade [8]. The e o e, o b idge he gap in he exis ing li e a u e, cu en e iew aims
o highligh he cha ac e is ics o communi y-based p og am o imp o e men al heal h in p ima y ca e se ings and
hei communi ies. Addi ionally, we in end o emphasize c ucial aspec s o each p og ams, including hei p ocedu e
and he mos e ec i e componen s o hose in e en ions based on hei men al heal h ou come.
2. Ma e ial and me hods
The design o his s udy is a li e a u e e iew, included se e al jou nals, a icles, and esea ch indings published in
elec onic da abases such as PubMed, ScienceDi ec , Coch ane Lib a y, and Google Schola . Fi e keywo ds we e
combined in o de o ound ele an li e a u e: “Communi y-based” OR “Communi y heal h” AND “men al heal h” OR
“men al illness” AND “in e en ion”. Da a collec ion was conduc ed on Feb ua y un il Ma ch, 2025. The Li e a u e
il e ed using PRISMA o ma (P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-analyses) and 50 a icles
we e ob ained. Sc eening based on duplica ion o simila i y o a icles, and eligibili y based on he i le, abs ac , and
ee ull ex ; he e a e 30 emaining a icles. Fu he mo e, a icles ha no ha e enough da a and o e ly speci ic o a
mino pa icula popula ion we e excluded. The inclusion c i e ia we e a icles o jou nals ele an o he esea ch
opic, a ailable in ee ull ex , w i en in English, and published wi hin he las i e yea s (2020–2025). A e il e ing
by inclusion and exclusion c i e ia, 16 a icles we e me he equi emen s.
3. Resul s and discussion
Al hough men al heal h se ices con inue o expand, he p e alence o dep ession and anxie y diso de s emains
inc easing [2]. The indings o his e iew a e discussed na a i ely below. Men al heal h and Psychosocial suppo
in e en ion can desc ibed unde h ee ways: 1) Men al Heal h P og am, 2) Men al Heal h Tools, and 3) Combined
In e en ion: P og am and Tools. Besides he p og am, he ools o ins umen can be a suppo ing ac o o clinicians
o imp o e men al heal h h ough a communi y app oach.
3.1. Men al Heal h P og am
Men al Heal h and Psychosocial Suppo (MHPSS) encompasses a comp ehensi e ange o s a egies and in e en ions
aimed no only a ea ing men al diso de s bu also a p e en ing he de elopmen o poo men al heal h (e.g., by
s eng hening coping mechanisms and social suppo ) and p omo ing o e all psychological and social well-being (e.g.,
h ough amily suppo , communi y engagemen , and ec ea ional ac i i ies) o indi iduals, amilies, and communi ies
[10]. The mos e ec i e MHPSS s a egies include as and lexible communi y-based in e en ions, psychosocial
suppo in eg a ed wi h o he heal h esponse sys ems, in ol emen o ulne able g oups and he use o li ed
expe iences, communi y-based app oaches such as healing dialogues and pee suppo o inc ease social cohesion and
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educe s igma, and echnology-based in e en ions (e.g., ho lines, online counseling) [11]. They we e e y e ec i e bu
had limi a ions in a eas wi h low access o echnology.
MHPSS bes p ac ices a e no solely abou deli e ing men al heal h in e en ions; hey also in ol e b oade app oaches
o how we connec wi h and assis people acing c isis. MHPSS should be sys ema ically in eg a ed in o clinical se ices,
public heal h ini ia i es, and social wel a e esponses, including p og ams ha p omo e inancial secu i y [12,13].
Besides in no mal s a e, MHPSS should be ins i u ionalized as a c i ical clinical and on line capaci y wi hin epidemic
p epa edness amewo ks oo. E en hough epidemics a e uncommon occu ences, some aspec s o hem can be
p edic ed. The necessi y o unde s anding men al heal h, psychological i s aid, be ea emen counseling, and social
suppo should no come as a su p ise o physicians, nu ses, clinicians, public heal h specialis s, and communi y heal h
wo ke s. In ac , hese opics should ideally be inco po a ed in o he majo i y o public heal h models [14]. The COVID-
19 pandemic 5 yea s ago, along wi h o he public heal h eme gencies, demons a ed he c ucial ole o s ong
in e pe sonal and communi y ne wo ks in ensu ing e ec i e esponses [15]. T ained pee s om a ec ed popula ions
can build us and diminish s igma by p o iding cul u ally sensi i e men al heal h suppo [11,33]. In addi ion, he
digi al ools mus be add essed o ensu e echnology-based se ices a e widely accessible, e en in emo e a eas [11].
Besides he p og ams ha ocused on pa ien wi h men al diso de , he in e en ion should be a ge ed o clinician,
o he heal h wo ke s a he communi y le el and all le el o s akeholde s. I can be aining o wo kshop o inc ease he
capaci y o hem o p o ide psychosocial suppo oge he du ing no mal condi ion, heal h eme gencies and p epa e
o unexpec ed disease ou b eaks in he u u e. Some o in e en ion p og ams o imp o ed men al heal h ou come a e
desc ibed below:
3.1.1. Mind ulness-Based P og am
Mind ulness-Based P og ams (MBPs) ha e become a popula me hod o men al heal h p e en ion and used in a ious
ins i u ions such as wo kplaces and schools [16]. This led o he de elopmen o h ee Mind ulness-Based P og ams,
each aimed a alle ia ing dep ession, anxie y, o psychological dis ess wi hin a ge ed popula ions. These app oaches
ha e been widely adop ed in bo h physical heal h and men al heal h con ex s. A no able example is Mind ulness-Based
S ess Reduc ion (MBSR), an in ensi e eigh -week p og am ocused on mind ulness medi a ion aining. MBSR was
c ea ed in 1979 o help educe s ess, emo ional dis ess like anxie y and dep ession, and he pain ha o en comes wi h
ch onic illnesses [17,18]. De i ed om MBSR, Mind ulness-Based Cogni i e The apy (MBCT) is an eigh -week,
e idence-based p og am ha in eg a es Cogni i e Beha io al The apy (CBT) echniques o ea ing dep ession wi h
mind ulness medi a ion p ac ices. O iginally, MBCT de eloped o p e en ecu en dep ession, bu i has been adap ed
o a ious ange o o he men al diso de s oo [18-20]. Mind ulness-Based Relapse P e en ion (MBRP) is a p og am
ha blends mind ulness medi a ion wi h echniques om cogni i e beha io al he apy o help p e en elapse. I 's
designed o help indi iduals manage nega i e emo ions, c a ings, and p e en subs ance use elapse [18,21].
Many s udies ha e shown ha MBPs can educe s ess and anxie y, bu he e is a signi ican a ia ion in hei
e ec i eness. The s udy o Galan e e al [16] desc ibed he e ec s o MBPs and i s indi idual ac o s such as baseline
s ess le el, gende , age, and educa ion in luence he e ec i eness o MBPs in non-clinical se ings. The analysis used a
andom-e ec s, wo-s age IPD me a-analysis app oach wi h a p ima y ocus on he impac o MBPs on psychological
dis ess wi hin 1 o 6 mon hs a e he in e en ion. The s udy showed ha MBPs educed psychological dis ess wi h
mino o mode a e e ec s. No e idence was ound ha such a iables as gende , age, educa ion le el, o le el o
disposi ional mind ulness modi y he e ec s o MBPs on psychological dis ess. MBPs did no demons a e signi ican
supe io i y o e o he ac i e in e en ions such as physical exe cise o s ess managemen p og ams. MBPs pe sis ed
up o 6 mon hs a e he in e en ion, bu he e was insu icien da a o assess long- e m impac beyond 6 mon hs.
The e o e, mo e esea ch is needed o unde s and he ac o s ha in luence he e ec i eness o MBPs a he indi idual
le el and explo e ways o inc ease hei impac in ac ual p ac ice [16].
Fu he mo e, one o mind ulness-based p og am is mind ulness-based S ess Reduc ion (MBSR). Acco ding o he
indings o he Se cekman, 2024 s udy [22], MBSR p og ams seem o be mos success ul a lowe ing s ess le els soon
a e hey a e inished. Pa icipan s epo ed immedia e bene i s in s ess educ ion and inc eased consciousness. They
desc ibed an inc eased elaxa ion and enhanced capaci y o handle wi h he s esso s hey ace on daily basis. The
p og am has equipped hem wi h e ec i e s ess managemen ools and s a egies, esul ing in an o e all imp o ed
men al wellbeing. These MBSR p og ams we e esea ched by 8 key hemes on ei he medi a ion o yoga ou ini y. A
yea a e comple ing he p og am, pa icipan s con inued o expe ience posi i e e ec s on hei inne calm, coping
mechanisms, and in e pe sonal ela ionships. Th ee yea s la e , he long- e m impac was e iden in he adop ion o a
mind ul li es yle, enhanced compassion, and sus ained pe sonal de elopmen [22].
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3.1.2. Family-Based In e en ion
Child en o men ally ill pa en s ha e a h ee o se en imes highe isk o de eloping men al diso de s compa ed o he
gene al popula ion. The child en’s men al heal h p oblems along wi h he isk and p o ec i e ac o s associa ed wi h
he pa en al diso de can be desc ibed on mul iple le els, such as he child, pa en al, amily, and socie y le el [23]. Risk
ac o s on he pa en al le el a e he speci ic psychia ic diagnosis, inapp op ia e coping s a egies and poo emo ional
a ailabili y. Family- ela ed isk ac o s include iolence, he lack o communica ions, and social isola ion. A he child
le el, isk ac o s include he child’s empe amen , cogni i e and social abili ies, and he phenomenon o pa en i ica ion.
F om a psychosocial pe spec i e, insu icien social suppo and he absence o a achmen igu es ou side he amily
a e also signi ican isks o he child’s de elopmen . Con e sely, a ange o p o ec i e ac o s ha e been iden i ied,
including posi i e ela ionships bo h wi hin and ou side he amily, e ec i e indi idual and amily coping s a egies,
and suppo i e amily dynamics [23, 24].
The sys ema ic e iew om Bosque e al., 2023 [25] desc ibed ha 43 o he 64 amily o pa en ing in e en ions had
posi i e and e ec i e esul s o he men al heal h o child en and adolescen s 0-24 yea s. Some success ul s a egies
in ol e non-specialis acili a o s (an e ec i e and sus ainable s a egy, especially in a coun y wi h limi ed men al
heal h p o essionals), in ol ing a he s in he p og am, and an in eg a ed o mul i-sec o se ice app oach. Mos
in e en ions use CBT, amily sys ems heo y, and social-ecological app oaches o in luence pa en -child ela ionships
and he amily en i onmen . In eg a ing men al heal h in e en ions wi h gene al heal h and social se ices is he key
o sus ainabili y and e ec i eness [25]. Fo amily-based in e en ion, Clinicians and psychologis s mus conside
amily backg ound in diagnosis and in e en ion. Pa en 's men al heal h needs o be e alua ed o e e y child wi h signs
and symp oms o men al diso de s [26].
Pa en s who expe ience Ad e se Childhood Expe iences (ACEs) ha e a highe isk o ha ing child en wi h men al heal h
p oblems. Ad e se Childhood Expe iences a e nega i e expe iences in childhood, such as domes ic iolence, abuse, o
amily dys unc ion, ha can hu a pe son's men al and physical heal h well in o adul hood. A c oss-sec ional
quan i a i e s udy by Buchanan G.J.R. e al., 2023 [26] assessed he pa en al ACEs, pa en al men al heal h (Kessle -6,
GAD-7, and B ie Resilience Scale, pa en ing s yle (Au ho i a ian, au ho i a i e, and pe missi e), and child men al heal h
(wi h he S eng hs and Di icul ies Ques ionnai e / SDQ). The s udy concluded ha pa en al ACEs ha e a di ec impac
on child en's men al heal h p oblems (β = 0.189, p < 0.001). The highe he pa en 's ACEs, he wo se he child's men al
heal h. Howe e , his impac is en i ely media ed by pa en al men al heal h and pa en ing pa e ns. Pa en s' ACEs also
hu hei men al heal h. Poo pa en al men al heal h leads o poo pa en ing pa e ns, which hu s child en's men al
heal h. I he pa en s ha e good men al heal h and posi i e pa en ing s yles, he impac o ACEs on child en can be
signi ican ly educed. This can s op he cycle o in e gene a ional ansmission o ACEs. One o he ac o s ha can
educe he nega i e impac o ACEs on child en is he s able men al heal h o pa en s, he eby o ming child en's
psychological esilience. Posi i e pa en ing ha is lo ing and suppo i e can also educe ACEs. Pa en ing pa e ns can
be ained wi h a Pa en ing educa ion p og am ha s eng hens pa en ing skills. The inal suppo ing ac o is social
and communi y suppo , such as pa en suppo g oups, amily he apy se ices, and men al heal h educa ion in schools
[26].
3.1.3. Emo ional Resilience Skills T aining
Public Sa e y Pe sonnel (PSP)
Public Sa e y Pe sonnel (PSP) such as police, i e igh e s, pa amedics, and communica ions s a o en exposed o
psychologically auma ic e en s, which can lead o pos - auma ic s ess diso de (PTSD) and pos - auma ic s ess
inju y (PTSI). Ca le on’s esea ch [27] has e alua ed he e ec i eness o Emo ional Resilience Skills T aining (ERST) in
educing symp oms o men al heal h diso de s among PSPs. ERST is designed o inc ease emo ional awa eness and
emo ional egula ion skills o educe he impac o PTSI. The s udy design was a 16-mon h longi udinal s udy wi h 119
PSPs. Pa icipan s wi h ac i e psychosis, high isk o suicide, o se e e alcohol/d ug dependence we e excluded. The
in e en ion was conduc ed as Uni ied P o ocol-based ERST aining in 13 weeks h ough g oup sessions las ing 1
hou /week. The p ocess was assessed a h ee s ages: (p e- aining), (pos - aining), and (1-yea ollow-up).
Measu emen wi h alida ed ques ionnai es such as he PTSD Checklis o DSM-5 (PCL-5), GAD-7, (PHQ-9), and o he s.
F om his s udy, he e was a signi ican educ ion in symp oms o PTSD, dep ession (MDD), anxie y (GAD), and social
anxie y diso de (SAD) om be o e o a e aining. This educ ion emained isible a ollow-up 1 yea a e
in e en ion. O ganiza ional suppo in luences he success a e o in e en ions, wi h sec o s ha de o e paid ime o
aining showing be e esul s. Fu he esea ch needs o explo e mode a ing ac o s such as o ganiza ional cul u e
and indi idual in luence on ERST e ec i eness. [27]
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P ospec i e Uni e si y S uden s
S uden s in mode n highe educa ion ace high academic and emo ional bu dens, including complex cu iculum
demands, long s udy hou s, and p essu e o succeed. This equi es s ong emo ional esilience o adap , comple e hei
s udies well, and main ain hei men al heal h. The s udy by Mo oz, 2021 [28] analyzed he impac o emo ional
o e load wi h a s udy o how s uden s imp o e emo ional esilience. Emo ional esilience helps s uden s o emain
calm when acing di icul ies, abso b ma e ial e icien ly, deal wi h c i icism cons uc i ely, and make sel -co ec ions
in a imely manne . The main componen s o emo ional esilience include: posi i e esponse o c i icism, abili y o adap
o exam p essu e, abili y o ind and apply in o ma ion, abili y o de elop lea ning s a egies and deal wi h ailu e, social
skills, including communica ion and building ela ionships. S uden s wi h high emo ional esilience a e mo e esis an
o men al a igue and bu nou , and a e be e able o de elop in insic mo i a ion and ocus on academic and
p o essional success. Inhibi ing ac o s include he lack o psychological se ices in highe educa ion ins i u ions,
minimal a en ion o s uden s' psychosocial needs, and une en in e pe sonal compe ence. The s udy concluded ha
Emo ional esilience is an impo an elemen in main aining s uden s' men al heal h and academic success [28].
3.1.4. SME-ZTEs p og am
Sun Y e al, 2024 [29] p o ided o he e ec i e in e en ions o men al well-being using he Sha ing, Mind, Enjoymen
(SME) and Ze o- ime Exe cises (ZTEx) app oach. The esea ch discussed an in e en ion in p ima y ca e o imp o e
physical ac i i y and men al well-being in Hong Kong. This in e en ion used a Sha ing me hod (Encou age he
in ol emen o amily and iends in physical ac i i y, Mind (Emphasizing posi i e emo ions and mind ulness du ing
ac i i ies), and Enjoymen (Assess engagemen and enjoymen in ac i i ies), as well as ZTEx (Ligh exe cises ha can
be done a any ime wi hou equipmen , such as simple s e ches while wa ching TV o wai ing o anspo a ion). The
in e en ion consis ed o wo sessions o 2 hou s each. The con ol g oup ecei ed social ac i i ies un ela ed o SME o
AF, such as able games and ga den ou s. [29]
The main esul s desc ibed signi ican imp o emen s a 3 mon hs pos -in e en ion in he g oup o SME engagemen
compa ed o he con ol g oup. The huge impac also occu ed in pe cei ed pe sonal heal h a 1 mon h. Abou he
accep ance and sa is ac ion, 97% o pa icipan s disposed o sha e hei ZTEx expe ience wi h o he s. Many pa icipan s
epo ed imp o ed amily ela ionships and dec eased s ess h ough pa icipa ion in ac i i ies. Some pa icipan s
sugges ed ex ending he du a ion o he p og am and adding ollow-up sessions o main ain posi i e e ec s. Communi y
collabo a o s sugges ed wide dis ibu ion a o he se ice cen e s. [29]
3.1.5. School-based men al heal h li e acy o child and adolescen
Adolescen is one o he mos ulne able men al heal h popula ions, wi h he main obs acle is low le els o men al heal h
li e acy among educa o s, pa en s, and eenage s hemsel es. The p og am "Go-To Educa o " was de eloped o inc ease
he capaci y o eaching s a in Ea ly iden i ica ion o adolescen s a isk o men al heal h diso de s, acili a e mo e
e ec i e e e als sys em and Reducing he s igma a school en i onmen . The in e en ion was a "Go-To Educa o "
p og am in he o m o 6 hou s o in ensi e aining o school s a ( eache s, counselo s, and suppo s a ) [30].
Bax e ’s esea ch [30] concluded ha School-based men al heal h li e acy aining imp o es he equency, quali y, and
e ec i eness o e e als o men al heal h se ices. The s uden s' age is younge , indica ing ha he p oblem was
iden i ied ea ly. Mo e s uden s om single-pa en amilies ecei ed e e als, indica ing inc eased sensi i i y o socio-
economic ac o s. Dec eased e e als due o suicide isk sugges ha in e en ion is p o ided ea ly be o e he condi ion
wo sens. S uden s e e ed om schools who ha e been ained ha e a highe le el o case se e i y, including mo e
como bid diagnoses. Upon discha ge om men al heal h se ices, s uden s who ecei e ea men signi ican ly imp o e
hei condi ion. Educa o s ha e an essen ial ole in he ea ly de ec ion o men al diso de s. This p og am s eng hens
he link be ween schools and men al heal h se ices, ensu ing ha s uden s who need help. This collabo a ion is
u gen ly needed o imp o e o e all adolescen men al heal h. [30]
3.2. Men al Heal h Tools: Cha bo AI
Nowadays, AI-based cha bo used inc easingly in men al heal h in e en ions. The sys ema ic e iew om Ha is e al.,
2023 [31] e alua ed exis ing e idence o cha bo AI based on he 31 a icles ha we e eligible o analysis, published
be ween 2010-2023 in pee - e iewed jou nals. I desc ibed he inc easing ac o s o cha bo engagemen such as
au oma ic eminde s and sho e session imes. The a e age in e ac ion a ies om a ew minu es o weeks. I
explained mo e equen in e ac ions a e associa ed wi h be e psychological ou comes, especially o anxie y and
mild-mode a e dep ession. Technical issues and lack o pe sonaliza ion o con en we e he main easons o low
engagemen in se e al s udies. Mos use s ha e a posi i e a i ude owa ds cha bo s due o he na u e o cha bo s ha
a e easy o access, esponsi e, and able o p o ide non-judgmen al emo ional suppo . The main ac o s in luencing i
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4075-4083
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a e he cha bo 's empa he ic pe sonali y, ease o access, and lexibili y o use. Howe e , cha bo s also ha e limi a ions,
speci ically in unde s anding complex con e sa ions, epe i i e esponses, and echnical discom o . Age and le el o
digi al li e acy also in luence pe cep ions o cha bo s, wi h olde people end o be mo e skep ical. [31]
Cogni i e Beha io al The apy (CBT)-based cha bo s a e e ec i e in educing dep essi e symp oms, especially in non-
clinical and mild clinical popula ions. Some s udies showed signi ican educ ions in anxie y diso de s, while o he s
showed minimal imp o emen s o no di e ences compa ed o con ol g oups. Cha bo s ha e also shown posi i e
esul s on insomnia, ea ing diso de s, and ADHD symp oms, al hough he e ec s a y depending on he cha bo design
and a ge popula ion. The e ec i eness o cha bo s a ies depending on ac o s such as he ype o in e en ion,
echnological ea u es, and use demog aphics. La ge s udies a e needed o u he alida ion and de elopmen . In
he u u e, cha bo s a e expec ed o be able o in eg a e wi h con en ional men al heal h se ices. [31]
3.3. Combined in e en ion: men al heal h p og am and assessmen ools
The esea ch by Mukhe jee A. e al. 2022 [32] s udied on SMART Men al Heal h, a combined in e en ion o a
communi y-based s igma educ ion campaign and a echnology-based app oach wi h an Elec onic Decision Suppo
Sys em (EDSS) o p ima y heal h wo ke s. The s udy used mixed me hods (quan i a i e & quali a i e) o e alua e 144
p ima y heal h cen e s (PHC), six in e en ion g oups and wo con ol g oup. The i s in e en ion is An i-S igma
Campaign, which is communi y-based, wi h audio isual and p in ed ma e ials o aise awa eness abou men al heal h
and educe s igma. In he nex s ep, Communi y heal h wo ke s (ASHAs - Acc edi ed Social Heal h Ac i is s) a e ained
o use EDSS. EDSS helped in sc eening, diagnosis, e e al, and managemen o CMDs. This in e en ion also used a Task-
Sha ing app oach ha a e ini ial digi al sc eening (wi h PHQ-9 o dep ession, GAD-7 o anxie y), High- isk pa ien s
will be e e ed o a doc o a he p ima y heal h cen e . The ou h componen is he eminde and P io i y Sys em.
ASHAs use a colo -based algo i hm ( ed-yellow-g een) o iden i y p io i y pa ien s who equi e immedia e ollow-up.
[32]
Success is measu ed by adop ing he Medical Resea ch Council (MRC) F amewo k and he RE-AIM F amewo k, which
includes i e componen s. Fi s , Reach, namely how wide he co e age o campaigns and se ices is. Second,
E ec i eness: Do in e en ions inc ease access and educe men al heal h bu den. Then, abou Adop ion: The ex en o
which ASHAs and doc o s accep and use his echnology. Implemen a ion: Ba ie s and suppo ing ac o s in
implemen a ion. The inal componen , Main enance, is he po en ial o pos - ial sus ainabili y o he in e en ion. The
implemen a ion ba ie s include echnological in as uc u e, such as p oblems wi h in e ne connec i i y and
elec ici y, which hinde he op imal use o EDSS. Besides ha , he excessi e wo kload o ASHAs lead o hei needs o
mo i a ion in luenced by inancial incen i es and communi y suppo . Men al heal h s igma is also an obs acle, whe e
he e is communi y esis ance o men al heal h se ices. I was ound ha men a e mo e eluc an o seek ca e han
women. Despi e acing a ious challenges, he e s ill suppo ing ac o s such as in ol emen o illage and eligious
leade s, o inc ease communi y accep ance. Communi y-based educa ional sessions inc ease communi y pa icipa ion,
and mHeal h helps educe he long ime and dis ances ha pa ien s needed o each heal h acili ies. Communi y-based
sc eening also allows ea ly de ec ion o men al diso de s. [32]
4. Conclusion
These e iew concluded ha communi y-based app oach in p ima y ca e and hei communi ies can be a p agma ic
solu ion and p ac ical app oach o p e en and ea he men al diso de s, also o imp o e access men al heal h se ices
in Low-Middle Income Coun ies, including Indonesia. Communi y-based in e en ion o men al heal h could be
implemen ed in h ee ways: p og ams, ools, and he combina ion bo h o hem. P og am in e en ions included MHPSS,
MBP, amily in e en ions, school based aining, and emo ional esilience aining. Fo he suppo ing ac o s o men al
heal h ca e, he ools o cha bo AI is one o choice. Bo h o p og ams and ools could be combined o make be e men al
heal h ou come, such as SMART Men al Heal h p og am.
Mul i-modal in e en ion and mul i-sec o al coo dina ion a e needed o inc ease he quali y and quan i y o
communi y-based men al heal h p og am, ei he in p ima y ca e o ad ance heal h acili ies, o make hese p og ams
widely implemen ed on any le el o age, om bi h, adolescen , pa en s and elde ly wi h o wi hou physical como bid
disease. While communi y-based sc eening is e ec i e, s igma and s uc u al ba ie s emain signi ican challenges in
implemen ing men al heal h se ices. Communi y-based s a egies o educe s igma should be s eng hened o inc ease
help-seeking people wi h men al heal h diso de s. These in e en ions should be suppo ed by adequa e aining o
p ima y and public heal h wo ke s, a s ong supe ision sys em by each le el o s akeholde s, and he de elopmen o
policies ha in eg a e ad anced men al heal h se ices wi h p ima y heal h se ices. Al hough some o hose
in e en ions ha e been implemen ed in Indonesia, esea ch abou he ou comes, he cul u al adjus men o inc easing
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4075-4083
4081
hei applicabili y, and he s a egies o esol e speci ic men al heal h challenges is equi ed in he u u e. Hope ully he
e ec i e p og am can be sus ainable and well-es ablished o accomplish p oblem o s igma, high p e alence men al
illness and limi ed men al heal h p o essionals in Indonesia
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o e hical app o al
The Au ho s exp ess g a i ude o he online da abases PubMed, ScienceDi ec , Coch ane Lib a y and Google Schola o
p o iding aluable esou ces. This esea ch ecei ed no speci ic g an om any unding agency in he public,
comme cial o no - o -p o i sec o .
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