An exploration of the Roles of Lay Mental Health Workers (Cadres) in Community Mental Health Services in Indonesia: A Qualitative Study

Abstract Background: Volunteers trained to support community mental health programs in Indonesia are known as ‘mental health cadres.’ These are lay people trained to provide basic support for people with mental health problems in their local communities. Their contribution has the potential to address the challenges health services currently face in remote, rural, and resource-limited settings. However, little is currently known about the implementation of this form of the lay workforce and the experiences of mental health cadres in Indonesia in particular. This study aimed to explore the role of volunteer cadres in community mental health services in Indonesia from the cadres' perspective. Methods: The study employed a descriptive qualitative design. Purposive sampling was employed to recruit cadres with at least one year of experience across four geographical areas in Java and Sumatra, Indonesia. Data were collected utilising focus groups undertaken between July and November 2020. Due to Covid-19 restrictions, eight focus group sessions for people with mental disorders and families were carried out virtually via zoom and non-virtual, facilitated by local moderators. Data were analysed using thematic analysis. Results: The study involved 71 cadres in four regions: Aceh, Jakarta, West Java and East Java. The majority of participants were looking after their families with a minimum of high school-level qualifications. Four themes were interpreted from the data: (1) Motivation for volunteering, (2) The role of cadres in supporting mental health services, (3) Training and support needs, and (4) Barriers and facilitators to the implementation of cadre roles in local communities. Conclusions: Cadres reported a motivation to help people to improve their mental health and reduce the stigma associated with mental illness. Cadres also contributed to secondary and primary prevention of mental illness with some limitations. This study's results are relevant to those wishing to understand and optimise the implementation of lay workforces in resource-limited settings.