Integrating Mental Health in a Planetary Health Intervention in Indonesia

Indonesia and Alam Sehat Lestari (ASRI)

A logger decided to to stop logging and gave his chainsaw to ASRI (Photo courtesy of Stephanie Gee, visitor of ASRI)

An archipelago of more than 17,000 islands between the Indian and Pacific Oceans, Indonesia is a lower-middle income country in Southeast Asia with almost 280 million people. With its tropical geography, Indonesia is facing some of the most pressing environmental threats, including climate change, widespread deforestation, and loss of biodiversity, among others. These environmental problems are affecting not only the livelihood but also the health and wellbeing of the Indonesian people, especially the poor and the marginalized.

One of the organizations that is at the forefront of addressing Indonesia’s serious environmental challenges is Alam Sehat Lestari (ASRI), a planetary health organization based in West Kalimantan, Indonesia. ASRI embodies the vision of a sustainable and healthy future for communities close to natural ecosystems. It stands out for its unique model that seamlessly integrates environmental conservation efforts in Gunung Palung National Park (GPNP) with comprehensive healthcare services. This integration is based on the understanding that environmental issues such as climate change directly impact human health, and conversely, the health of communities can significantly influence their interaction with and treatment of the environment. By providing healthcare services, ASRI addresses immediate health needs while simultaneously engaging communities in activities that promote environmental conservation, such as reforestation. This dual approach not only alleviates the burden of disease but also fosters a sense of stewardship and responsibility towards the natural world.

ASRI’s Current Interventions

Addressing community health needs is at the forefront of ASRI's approach. This involves providing access to medical care and treatment for acute and chronic illnesses and implementing preventive measures to combat the spread of diseases. Some of ASRI’s initiatives include health education campaigns, vaccination programs, and mobile clinics. From 2008 to 2018, ASRI served more than 28,400 unique patients in rural Borneo (1).

In parallel, ASRI is deeply committed to promoting environmental sustainability as a means to bolster community health. ASRI incentivizes community members to engage in reforestation efforts by offering discounted healthcare services. The discounts vary from 30% to 70%, depending on the patient’s community “eco-status,” which includes conservation indicators such as the number of loggers, sawmills, palm oil plantations, etc. and is measured every four months. Moreover, patients at ASRI’s clinic can pay with non-cash payments such as seedlings, manure, husk, and eggshells, which are beneficial for reforestation and sustainable farming programs.

ASRI’s partner communities also engage in other conservation actions, such as reforestation programs, sustainable farming practices, or alternative livelihood programs that reduce reliance on activities harmful to the environment. Moreover, ASRI focuses on community development initiatives aimed at empowering residents through training programs on sustainable farming techniques and support for income-generating activities. ASRI’s organic farming program began in 2009 and trained 10 groups of 15-30 farmers in the small village of Sukadana in West Kalimantan. These efforts help communities diversify their livelihoods to reduce reliance on unsustainable and environmentally harmful livelihoods.

Another program is the Chainsaw Buyback program which effectively addresses deforestation issues by targeting the root cause—illegal logging—and simultaneously providing support and education to local communities. From 2017 to 2019, ASRI purchased 279 chainsaws from former loggers—a success for primary forests (on the average, a logger cuts 274 old-growth trees per year). This is also a win for the families as logging work is dangerous, difficult, and intermittent. Of these former loggers, 76% have already begun loan repayments. Fifty three percent (53%) of the small businesses started by former logging households are still running. So far, the program has saved 42,933 old-growth trees.

ASRI’s combination of healthcare access expansion with conservation, education, and alternative livelihood programs was shown to have a significant impact on reducing illegal logging and achieving nature-based climate mitigation in rural Borneo. A 10-year impact study revealed that 27.4 km2 of deforestation was averted in the national park. The study also found out that the higher the level of engagement of villages in ASRI’s holistic programs, the greater the degree of logging reductions were observed (1).

A patient giving seedling to the ASRI team as payment for medical treatment (Photo courtesy of ASRI)

Future Plans for Integrating Mental Health in ASRI’s Initiatives

Mental Health Screenings

ASRI recognizes the intricate link between mental and environmental health. Environmental degradation and climate hazards can lead to wide-ranging mental health problems in the community. Therefore, ASRI has begun incorporating mental health initiatives into its comprehensive healthcare model. A pivotal aspect of this expansion is the enhanced focus on mental health screenings. ASRI is planning to integrate these screenings more comprehensively into routine health assessments, ensuring early detection and immediate intervention for mental health issues. This proactive approach is aimed at normalizing mental health care and removing barriers to care access. Similar to the existing health programs of ASRI, the new mental health initiatives will emphasize equitable access of interventions that are culturally-appropriate and context-specific. In tandem with this, ASRI is committed to the training of local health workers in mental health support. The objective is to build a robust, community-based mental health system where local health workers are not just the first point of contact for physical health concerns but are also skilled in identifying and addressing basic mental health needs. This training will empower them to provide psychological first aid, and establish referral systems, thereby strengthening the community's overall health resilience. Forest Healing

Inspired by the Japanese practice of shinrin-yoku (forest bathing - see Japan case study), ASRI also plans to introduce the concept of forest healing, which extends beyond mere exposure to nature. Forest healing involves a series of activities and experiences that encourage deep, meaningful interactions with the natural environment. These activities may include guided nature walks and mindfulness meditation sessions in forest settings. Individuals are expected to experience a profound sense of tranquility and rejuvenation by engaging in these activities.

In addition to individual well-being, ASRI recognizes the potential of forest healing programs to foster community cohesion and collective healing. Group activities in natural settings provide opportunities for community members to connect with each other, share experiences, and support one another's healing journeys. This collective aspect of forest healing is particularly valuable in addressing communal traumas and fostering a sense of unity and resilience within the community. Furthermore, ASRI is aware of the reciprocal relationship between the health of the environment and the success of forest healing programs. As such, a significant emphasis is placed on educating participants about environmental conservation and sustainable practices. Participants are encouraged to engage in conservation activities, such as tree planting or habitat restoration, as part of their healing process. This not only enhances the therapeutic experience but also instills a sense of responsibility and stewardship towards the environment, ensuring that the benefits of forest healing extend beyond individual well-being to encompass environmental health and sustainability.

The Way Forward

ASRI's innovative approach, characterized by its commitment to holistic health and environmental conservation, stands as a testament to the organization's understanding of the interplay between human well-being and the health of our planet. Looking ahead, ASRI plans to expand mental health interventions and harness the therapeutic potential of nature through forest healing, embodying a forward-thinking approach that further expands its already-broad framework of environmental stewardship. These initiatives are important next steps toward improving individual psychosocial well-being and fostering a community that is empowered, resilient, and deeply connected to its environment. ASRI’s future plans can also provide lessons for climate change and mental health advocates, researchers, policymakers, and practitioners who may wish to design interventions that reap the co-benefits of mental health and nature conservation. ASRI's vision for the future is one where health interventions are seamlessly woven into the fabric of environmental conservation - a world where the nurturing of the planet and the caring of human health are seen as a single, unified mission.

References

1. Jones IJ, MacDonald AJ, Hopkins SR, Lund AJ, Liu ZY-C, Fawzi NI, et al. Improving rural health care reduces illegal logging and conserves carbon in a tropical forest.Proc Natl Acad Sci U S A. 2020;117:28515–24.

Written by

Laily Lutfiana Dhia and Maria Puspa Kartika