Understanding Mental Health Problems during the COVID-19
Pandemic through Telecounseling Services in Indonesia
Costrie Ganes Widayanti
1
, Kartika Sari Dewi
2
, Sovranita Oktavian Prihasta
3
and
Devina Ratna Anggita
4
Family Empowerment Centre (PPK), Faculty of Psychology, Universitas Diponegoro,
Jl. Prof. Soedarto, SH, Kampus Undip Tembalang, 50275, Semarang, Indonesia
Keywords: COVID-19, Mental Health, Telecounseling, Indonesia.
Abstract: Since the novel coronavirus has been identified (COVID-19) in China by the end of 2019. The World Health
Organisation (WHO) has released a statement that the COVID-19 has been confirmed as a worldwide
pandemic. As a result, it has become a recent threat for mankind around the globe, including Indonesia.
Indonesia has been struggling to combat this virus for more than one and a half years. The COVID-19 has
resulted in some effects in many areas, such as economy, education, and health. The COVID-19 produces a
significant implication for developing mental health problems. The Indonesian government in collaboration
with HIMPSI (Indonesian Psychological Association) has launched the SEJIWA program. This program is a
telecounseling service aims to provide mental health support due to the COVID-19 pandemic. This study aims
to explain psychological conditions that potentially threaten and support mental health. Data from 16 subjects
was analysed using a thematic analysis. Five themes were found from this study: 1) Fear and anxiety; 2) Risk
factors; 3) Triggers; 4) Dilemmas of support system; and 5) Improve self-help skills through telecounseling.
Fear of infection and anxiety about their personal and familial health condition increased especially for those
who have been vulnerable for experiencing psychological conditions before the pandemic. The lack of
understanding of the COVID-19, continuous media exposure, limited access to health services, and social
restrictions have triggered the presence of psychological symptoms. A telecounseling program has been
helpful in providing psychological self-help skills, as well as supporting mental health during the COVID-19
pandemic.
1 INTRODUCTION
The novel Coronavirus (COVID-19) which was first
identified in Wuhan, China at the end of 2019 has
been declared as a pandemic by the World Health
Organization (WHO). According to WHO (2010b),
pandemic is a large-scale epidemic, affecting humans
in several countries, even throughout the world. In
addition, Coronavirus is relatively easy to transmit
from a person to another and the disease caused by
the virus (COVID-19) is an emerging infectious
disease. Based on these characteristics, the disease
caused by Coronavirus is referred to as a pandemic
(Lederberg et al., 1992; Taylor, 2019). The COVID-
19 pandemic has affected various aspects of human
life, such as economic, education, and health aspects.
Limited working hours, layoffs, burnout work-from-
home employees, study-from-home challenges,
regional conflicts, to the stigma on health workers and
sufferers are among the impacts of the pandemic
(Brahma, 2020; IFRC, 2020). The COVID-19
pandemic has significant implications on individuals
and communities (Pfefferbaum & North, 2020).
Compared to other countries in SouthEast Asia,
Indonesia has recorded the highest death rate
(Tribunpalu.com, 2020). Indonesia also has the
second highest confirmed cases after Singapore. On
May 28, 2020, COVID-19 Task Force recorded
25,216 confirmed COVID-19 cases, 1,520 deaths,
and 6,492 recoveries (COVID-19 Response
Acceleration Task Force, 2020). In Central Java,
there were 311 confirmed COVID-19 cases, with 233
patients in care, 43 deaths, and 45 recoveries
(Detik.news.com, 2020).
The COVID-19 pandemic is usually characterized
by uncertainty, confusion, and sense of urgency. This
312
Widayanti, C., Dewi, K., Prihasta, S. and Anggita, D.
Understanding Mental Health Problems during the COVID-19 Pandemic through Telecounseling Services in Indonesia.
DOI: 10.5220/0010811800003347
In Proceedings of the 2nd International Conference on Psychological Studies (ICPsyche 2021), pages 312-319
ISBN: 978-989-758-580-7
Copyright
c
 2022 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

state of uncertainty relates to the chance of being
infected and the spreading of information related to
disease management as well as questions regarding
the end of the pandemic (Kanadiya & Sallar, 2011).
Several studies have shown that the COVID-19
pandemic has affected mental health (Ornell et al.,
2020; Otu et al., 2020), resulting in a number of
feelings like isolation, helplessness and negligence,
insecurity, anxiety, and stigma (Mackolil & Mackolil,
2020; Ornell et al., 2020).
One in five Indonesians could suffer from anxiety
during the COVID-19 pandemic. The most at-risk
groups are young women, people with suspected
cases of COVID-19, and those who have
unsatisfactory social support (Anindyajati, 2021).
However, another study (Alnazly, et al, 2021) reveals
that social support does not have a significant
correlation with the emergence of mental health
problems, such as anxiety in individuals during the
COVID-19 pandemic. High levels of anxiety are
characterized by undue anxiety and excessive worry
about one's health, or disproportionate concern for
one's or others' objective health. Therefore,
individuals with high levels of anxiety tend to
develop excessive worry about the emergence of
various types of health threats, exaggerate the
likelihood and seriousness of being sick (Hedman et
al., 2016) and tend to pay attention to minor
symptoms (Tyrer & Tyrer, 2018). Mental health
remains as an essential component for individuals to
manage their ideal life during the COVID-19
pandemic. Therefore, WHO issued protocols to foster
the activities in the field of mental health. This study
aims to identify mental health problems during the
COVID-19 Pandemic through telecounseling
sessions and understand how they deal with them, as
well as associated conditions.
The Indonesian Government through COVID-19
Response Acceleration Task Force has issued various
policies to reduce the number of COVID-19 cases.
The COVID-19 Task Force focuses on three main
protocols, namely protocols to enter Indonesian
territory, protocols in public transportation, and
protocols in the education area (Ifdil et al., 2020). The
steps include large-scale social restrictions (PPKM)
which are implemented in 31 regions and seven
provinces in Indonesia, especially in areas with the
highest number of confirmed cases (KOMPAS,
2021). In addition, 5M policies, namely maintaining
physical distance, wearing masks when conducting
outdoor activities, washing hands with soap/hand
sanitizers and disinfectants, avoiding crowds, and
limiting mobility and interaction, should be
implemented well.
In addition, the government cooperates with
HIMPSI (Indonesian Psychological Association)
providing a telecounseling service. The service is
aimed to provide psychoeducation as well as
psychosocial support for those affected by COVID-
19 (Indonesian Broadcasting Commission, 2020) so
that they are equipped with skills in managing
emotions and remain calm in facing challenges
(IFRC, 2020). Maintaining mental health during the
COVID-19 pandemic is imperative as people need to
be supported to adapt to shocking and stressful
situations so that they can be resilient during the
pandemic. Mental health is vital for individuals who
seek for a better lifestyle.
Many studies have been conducted using a
quantitative survey approach to uncover various
mental health problems during the COVID-19
pandemic. However, there are still few studies that
provide an understanding of how an individual's
mental health condition declines during the COVID-
19 pandemic and what efforts can be made to improve
it.
This study aims to identify and understand types
of mental health problems experienced by community
during the pandemic.
2 METHODS
2.1 Participant Recruitment
This study was qualitative research, which aimed to
understand how a person faces mental health
problems during the COVID-19 pandemic and the
related situations they experience. This research is the
development of community service conducted by the
second author (KSD).
The researchers analyzed the counseling data of
the SEJIWA HIMPSI telecounseling program from
April-June 2020. The program was still running as of
this writing. Data collection in the first three months
was carried out to provide an overview of the initial
conditions of the COVID-19 pandemic in Indonesia
from a psychological perspective. Informed consent
was given to the participants prior to the counseling,
which related to the anonymity and confidentiality of
the data, as well as agreement that the data would be
used for research purposes to improve mental health
services in Indonesia.
Participants in this study were clients of
telecounseling services with the second author as the
counselor. The client contacted the SEJIWA 119
extension 8 operator or the Central Java HIMPSI
operator and was connected to the counselor using
Understanding Mental Health Problems during the COVID-19 Pandemic through Telecounseling Services in Indonesia
313

telephone or social media (WhatsApp) according to a
predetermined schedule. The telecounseling process
lasted approximately 30 minutes for each client.
During the telecounseling, the clients could report
psychological complaints that occurred during the
COVID-19 pandemic and received counseling using
a brief counseling technique and Psychological First
Aid (PFA). Of the 23 clients who were willing to be
involved in this study, only data from 16 participants
could be analyzed. The consideration for selecting 16
participants was based on the completeness of the
data provided and the types of problems directly
related to COVID-19. The sociodemographic data
from 16 research participants could be summarized as
follows:
Table 1: Participants’ Sociodemographics.
Initial Sex Age
(years old)
Ya Female 26
An Female 19
En Male 27
Ls Female 19
Aa Female -
C Male 36
Yi Male 34
R Female 26
E Male 26
Tt Male 66
P Female 19
M Female 19
Ib Male 20
Ck Female 12
W Female 18
Bw Male 34
2.2 Data Collection and Analysis
Data were collected using semi-structured interviews
regarding mental health problems during COVID-19.
Atlas.ti 8 version software was applied during the
data analysis. Each author worked on each transcript.
Different codes and themes are discussed among
authors to achieve final agreement.
All data obtained were reported anonymously for
the purposes of this study. Data were analyzed using
thematic analysis (Braun & Clarke, 2006), which
aims to identify, analyze, and report patterns in
qualitative data. Six stages in conducting thematic
analysis are:
1) Familiarize with the data, in this phase, the
authors read and reread the transcripts;
2) Perform initial coding, the researchers started
to code the interesting features across the whole
data set;
3) Categorize the code for the process of
searching for themes, the researchers collected
all data corresponding to each potential theme;
4) Conduct a theme review, the researchers
checked whether the themes aligned with the
coded extracts and the entire data set. A
thematic map was produced;
5) Define and clarify the theme map, the
researchers generated clear definitions and
names for each theme;
6) Make a report, in this phase, the researchers
selected vivid and compelling extracts from the
data, analyzed it, and related back to the
research questions and literature to produce
concise, logical, and interesting account of the
story.
3 RESULTS
There were five main themes revealed in this study.
The five themes consisted of (1) Psychological
symptoms: fear and anxiety, (2) Risk conditions, (3)
Triggering conditions, (4) Support system as a
dilemma, (5) Improved self-help skills through
telecounseling. Themes discovered from data
extraction were described as follows:
Psychological Symptoms: Fear and Anxiety
The result discovered that most of the participants
showed signs of mental health problems, which not
only put them at risk of being infected with the
COVID-19, but also experienced psychosocial
conditions that trigger mental health vulnerabilities.
The result showed that most of the participants were
experiencing fear and anxiety. Some of the subjects
stated that they felt “anxious, worried, and difficult to
sleep” (Subject R) Subject R felt anxious because her
husband and children are considered vulnerable to be
infected with the COVID-19. Similarly, Subject E
also expressed his anxiety because he was 'afraid that
his parents are infected' because, according to Subject
E, they are working in the health sector, which makes
them prone to be infected by the disease. The fear of
being infected with the virus also was expressed by
EN, AA, R, and W, which caused them to be worried
about their health condition, and to feel
uncomfortable in their activities.
In addition, media exposure on the COVID-19
cases was considered by most of the participants as
ICPsyche 2021 - International Conference on Psychological Studies
314

causing distress, as supported by Neria and Sullivan
(2011). Moreover, health threats perceived by the
subject, both to themselves and family members and
changes in daily routine are some of the situations that
might affect the subject's mental health. Although this
study did not measure the participant’s current level
of anxiety, based on the results of interviews to
several participants, it appeared that anxiety referred
to the tendency to be worried about being infected
with the COVID-19.
Most of the participants experienced "shortness of
breath" and "low immunity". According to Taylor,
excessive anxiety resulted in the subject interpreting
somatic symptoms as a sign of infection (Taylor,
2019). In addition, excessive anxiety caused people to
be overly aware of changes in body sensations, was
characterized by paying excessive attention to minor
physical changes (Tyrer & Tyrer, 2018). The
understanding that stressful situations might decrease
immune response can be explained based on the fact
that psychological stress affects the immune system
by interfering with the communication between the
nervous system, hormone system, and immune
system. This interference, according to Prawitasari
(1997), causes the body to become weak and lower
the immunity.
Risk Conditions
The risk conditions experienced by the majority of the
participants consisted of personal conditions in which
caused them prone to experience mental health
problems, such as: overthinking, intense curiosity,
and negative perceptions about COVID-19.
Meanwhile, the conditional factors that were
considered to increase the risk of mental health
problems during the COVID-19 pandemic were
living apart from family, worrying about vulnerable
family conditions, working or studying online, and
being in uncertain conditions during the pandemic.
For example, participant Ib, who was separated from
his family, felt anxious about their health condition,
as expressed:
“I'm worried about my family because I have
heard that there are some COVID-19 suspects
in my hometown” (Ib, M).
Several subjects also expressed their anxiety
related to various news about the COVID-19. For
example, subject E became "overthinking" and
subject En admitted to be "very paranoid'' and "unable
to think positively" so that the thoughts inhibited
them from doing daily activities. The findings of this
study are in line with the result of the study conducted
by Li et al (2020), which suggested that increasing
anxiety, distress, and depression impacted daily
productivity.
Triggering Conditions
Certain conditions that occurred during the Covid-19
pandemic often provoked psychological problems
and worsened individual mental health conditions.
Most of the participants disclosed that psychological
complaints were starting to feel disturbing. They felt
confused about the situation during the COVID-19
pandemic and what COVID-19 actually was, changes
in social activities that started to be limited and
became increasingly difficult to access health
services. Participant A stated that he experienced
complaints because he could not imagine how long
this condition would last. Participants P and YI felt
more complaints about anxiety and fear when
provoked to follow news about the Covid-19
pandemic in the mass media and on the Internet.
Unlike the others, participants E, En and TT
described that when they thought about and worried
about their family's condition, psychological
complaints appeared more intensely. Negative and
mistaken perceptions of the COVID-19 pandemic had
also influenced their mental health condition.
Support System as a Dilemma
Most of the participants (R, Yi, E, M, AA, C, A, E,
TT, EN, Ib and P) explained that friends and family
were their support systems during the pandemic.
However, some participants who separated from their
source of support due to their conditions (e.g. A
preferred offline lectures and boarding houses
because they felt that their friends understood them
better than their parents; Yi and EN felt they had to
go home to their parents because they felt bored and
anxious in the city where they worked; as well as P
who tried to go home to avoid loneliness) experienced
an increased risk of anxiety and other psychological
conditions such as boredom and loneliness. On the
other hand, the support system became a
psychological burden when they felt their families
were at risk of being infected with the COVID-19 (as
explained by participants TT, E, AA, R, W and Ib)
that increased feelings of guilt when they were sick,
as well as anxiety and worry when family members
were around. They felt that working outside the home
could be at risk of being infected with the COVID-19.
This finding showed that the support system had
two contradictory effects on each other because the
COVID-19 pandemic conditions require the need for
physical distancing, making it difficult for them to
Understanding Mental Health Problems during the COVID-19 Pandemic through Telecounseling Services in Indonesia
315

Figure 1: Theme mapping.
access social support and become worried when
separated. Participants who tried to open up and
proactively seek other sources of support, by seeking
counselors through the telecounseling service,
contacting friends and family online could benefit
from the existing support system, as a source of
emotional support, a source of information, as well as
a source of instrumental support. This explains the
reason why social support does not have a significant
correlation with various psychological problems
experienced by individuals during the COVID-19
pandemic, such as fear, depression, anxiety, and
stress (Alnazly, et al, 2021).
The findings of this study argued that an
individual's social support system could be a
boomerang for their mental health conditions when
they were at risk of being infected with the COVID-
19 or when social support systems were inaccessible.
Interestingly, this study found that the active role of
individuals in choosing and seeking new accessible
sources of social support or seeking to open access to
existing sources of support influenced their mental
health conditions. Individuals who were proactive
about opening up access to a new support system or
seeking to connect with a support system felt calm
and understood what to do.
Associated with being proactive and initiative in
finding solutions to the conditions, all participants in
this study utilized the telecounseling service to gain
an understanding of their psychological conditions
and physical complaints resulting from the COVID-
19 pandemic. The eagerness to tell about their
psychological conditions and their efforts to
overcome psychological conditions made them easier
to accept the suggestions given during telecounseling
sessions.
Improved Self-help Skills through Telecounseling
All clients chose to utilise the telecounseling to
overcome their anxieties and fears. At the beginning,
not a few of them complained of physical symptoms,
such as shortness of breath, difficulty sleeping,
palpitations, and sore throats, however, as the
ICPsyche 2021 - International Conference on Psychological Studies
316

counseling went on, they admitted that they felt
uncontrollable anxiety. The telecounseling was able
to help them improve their psychological self-help
skills in addition to educating them about the
COVID-19 pandemic. Through telecounseling they
knew how to manage excessive anxiety and looked
for alternative coping for the conditions they were
experiencing.
The findings in this study supported a previous
study regarding effective efforts to overcome mental
health disorders during the COVID-19 pandemic,
namely by focusing on cognitive emotion regulations
by reducing negative and maladaptive thoughts that
have the potential to cause excessive fear (Zsido et al.
in Coelho et al., 2020). The forms of cognitive
emotion regulations include physical exercise,
relaxation, acceptance, and professional help (Wu et
al., 2020 in Coelho et al., 2020).
4 DISCUSSION
The mental health conditions during the COVID-19
pandemic of the 16 participants were dominated by
two psychological symptoms, namely anxiety and
fear during the COVID-19 pandemic. Complaints of
anxiety had an impact on decreasing their
productivity and mental health conditions.
Meanwhile, fear comprised the fear of being infected,
the fear of leaving the house, or the fear of the family
being infected or transmitting the virus. The anxiety
and fear that arose was triggered by a lack of
understanding about the COVID-19 pandemic, the
confusion of news in the media, their difficulty in
accessing health services, and social restrictions on
the support system. These conditions had a more
negative impact on participants because they already
had vulnerable personal characteristics that were
characterized by overthinking and a view that the
COVID-19 pandemic was terrible, had a high
curiosity without being selective with media, and had
a previous psychiatric history, such as being on
medication for depressive mood disorders.
Psychological complaints get worse when they
have already developed a risky condition, both
personally and conditionally that they experienced
during the pandemic. For individuals who have
characteristics of overthinking, high curiosity level,
and a history of psychiatric disorders, the COVID-19
creates an inadequate sense of agency due to their
inability to control the situation. In addition, working
or studying from home cause difficult adjustments
due to heightened feelings of burden and pressure.
12 out of 16 participants stated the role of the
support system although they also felt that their
support systems were not optimal due to social
restrictions that occurred due to the COVID-19
pandemic and even became a problem that potentially
increased the risk for causing mental health problems.
This finding supports a previous study that during the
COVID-19 pandemic, there is a potential for
misinformation, uncertainty, and fear of being
infected with COVID-19 that increases stress and
anxiety, which lead to mass panic. Mental health
education and psychological supports are efforts to
reduce the risk of experiencing mental health
problems (Kaligis et al., 2020).
5 CONCLUSION
This result of the study shows that mental health
problems during the COVID-19 pandemic are found
in the community. The presence of feelings, such as
anxiety, fear, and worry, is manifested in the form of
somatic disorders and an assessment of the risk of
contracting the COVID-19 to oneself and others.
The risk conditions of the subjects affect subjects'
response to deal with the COVID-19 pandemic.
During the COVID-19 pandemic people cannot rely
on their support system because the pandemic
condition requires physical distancing with others to
maintain their health. Dilemmatic conditions within
the support system during the COVID-19 pandemic
can be minimised by being proactive and searching
for alternative tools or resources. Their willingness to
use the telecounseling service is one of the efforts to
identify and overcome psychological complaints that
can affect their mental health and psychological well-
being in order to be able to adapt during the
pandemic.
This study has limitations. The majority of
participants took part in at least one counseling
session within a limited time, therefore, deeper
information about the participants’ situations were
difficult to attain. Further study can be recommended
to follow the participants’ mental health conditions
after participating in the telecounseling service to
ensure how this service can be utilized as a tool to
support mental health during the pandemic era.
ACKNOWLEDGMENTS
The authors would like to extend their gratitude to
Indonesian Psychological Association (HIMPSI) –
Understanding Mental Health Problems during the COVID-19 Pandemic through Telecounseling Services in Indonesia
317

Central Java that made the research possible by
providing access to the subjects and authorizing the
researches to access telecounseling data. In addition,
we would like to acknowledge LPPM Universitas
Diponegoro for providing research grant through the
scheme of Development and Application Research
(Riset Pengembangan & Penerapan/RPP) legalized
by Letter of Assignment No. 185-
31/UN7.6.1/PP/2021.
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