Trend and Current Issue of Mental Health in Indonesia
Trend and Current issue in mental health nursing is the current problems of mental health nursing. These problems can be considered a threat or a challenge that will have a major impact on the mental health nursing in both regional and global order. Several trends of interest in mental health nursing is the following problem:
- Mental Health Begins Early Conception
Some studies indicate a connection in the womb with the mental and physical health of one's future and at the same time prove that the mental health begins at the time of conception. Van De Carr (1979) study of the birth of a great musician from a father who was a musician, his research indicates that the baby had been recognized musical patterns in the womb. Marc Lehrer research about babies who are given early stimulation in the form of sound, music, light, vibration, and touch, was once an adult has a physical, mental, and emotional better .
Subsequent research conducted by Marion Cleves in mice that were pregnant given the low electrical stimulation, light, sound, and the traps show the number of dendritic branching as a prerequisite for intelligence. Similarly, research conducted in one hospital in Bangkok Thailand, in babies with good prenatal care and stimulation in the womb. Another study conducted by Mednick et al (1988), the study found a relationship between schizophrenia with a viral infection in the womb. His report was based on the influenza virus epidemic in 1957 in Helsinki. Mednick prove that they are at the time of the epidemic is at a second trimester in utero have a higher risk for schizophrenia later in life.
- Increasing Trend of Mental Health Problems
Along with the times that happens, it can not be denied that mental health problems increased. Now people with mental disorders do not only come from lower-class society, but also from the middle layer to the top even from the officials. Head of Psychiatry Hasan Sadikin Hospital Bandung, dr. Teddy Hidayat said that mental patients in West Java continues to increase each year. It is seen from the increasing number of patients who come to the psychiatrist. According to the 2007 Basic Health Research, West Java to occupy the highest levels of psychiatric disorders compared with other regions in Indonesia. Until this year, the number of psychiatric patients in West Java was never dropped, instead it increased. In 2007, the percentage of people with mental disorders by 20 percent for ages 15 years and over. If the population of 40 million people in West Java, 9 million of them have mental disorders. Indications of an increase in the number of people with mental disorders in West Java seemingly from many patients who come to the psychiatrist because of the pressures of life are increasingly heavy. Improvement is happening is expected because the economic situation in Indonesia is not stable.
Improving patients with mental disorder is also shown by the inability Hospital Marzuki Mahdi (RSMM) to accommodate more new patients. Head of Legal and Public Relations Organization RSMM, Abdul Farid Patuti said, in RSMM all beds available for patients with psychiatric disorders is full. 420 beds available is fully charged. Most of them are people with chronic mental disorders (Scizophrenia). A total of 70 patients experiencing mental RSMM due to drug use. Patuti said, counting from mid-2008, there are an increasing number of patients treated in mental RSMM. Another factor that could be a trigger (stressor) a person experiencing mental disorders or stress. Partly because of social factors, heredity, biology, hormonal. The data recorded in RSMM, in the year 2006 and RSMM receiving psychiatric care for patients and approximately 15,534 people. Meanwhile, in the year 2007 was recorded from January to July, RSMM treat 10,655 patients. For the year 2008 the amount exceeded the previous year figures. The situation is very supportive of mental disorders is a state of the economy, especially those who are vulnerable to environmental conditions with high poverty levels.
Some clients of mental disorders among the middle to top large mostly caused inability to manage stress and there are also cases that had post power syndrome due to mutations fired or office.
- The trend factor Mental Disorders
WHO (2001) states, at least, there is one of four people in the world have mental problems. Meanwhile, according to Uton Muchtar Rafei, Director of WHO South-East Asia Region, almost one-third of the population in this region have experienced neuropsikiatri interference. Headquarters Azrul Anwar (Director of Community Health, Ministry of Health) said the number of people with mental health disorders at a very high society, which is one of four Indonesian population suffers from mental anxiety, depression, stress, drug abuse, juvenile delinquency to schizophrenia. According to Aris Sudiyanto (Professor of Medicine Faculty of Medicine Mental UNS Solo), there are three classes causes of mental disorders. First, physical disturbance, biological or organic. Causes include heredity comes from, abnormalities in the brain, infectious diseases, drug and alcohol addiction, and others. Second, mental disorders, emotional or psychological. The reason, because of the pattern of pathological parenting relationships among family members due to frustration, conflict, and the pressure of the crisis. Third, social or environmental disruption. The cause may be a psychosocial stressor (marital, parent problems, interpersonal relationships at work or school, the environment, the financial problems, legal, self development, family factors, physical illness, etc.)
- Tendency situation in the Globalization Era
Globalization era is an era where there is no longer a barrier between the countries, especially in the field of information, economic, and political. These developments have an impact on all sectors including health. Care providers including mental health should be able to compete, because consumers will choose providers a higher quality service.
The development of this era requires nurses to continually develop science and technology in the field of nursing which in this case is science and technology in mental health nursing. With the free market in this era of globalization, the nurse must be able to compete to win the market. Professionalism and expertise becomes key, because the competition is no longer local, but international.
- Globalization and Change Orientation Healthy
Mental health indicators in the future no longer a clinical problem are like the prevalence of mental disorders, but oriented to social context. Danardi (Section of Psychiatry Faculty of Medicine University of Indonesia) said that the focus of mental health is no longer just dealing with sick people, but on improving quality of life. Thus, the concept of mental health is no longer healthy or sick, but the optimal conditions are ideal in behavior and social functioning abilities. Someone said if you are able to work well, able to socialize, and enjoy leisure. This means that, although a person suffering from schizophrenia and had had the possibility of relapse, if three things were achieved then it could be said that he was in optimal health status.
- Kecenderungan Penyakit Tendency Disease
The times are going to make mental health a major health problem and need treatment by medical personnel adequate in quality and quantity.
- Increased Post Traumatic Syndrome Disorder
Some time round a lot of disasters in the world especially in Indonesia. The disaster caused psychological trauma to all those who experience it. Symptoms of trauma can be felt immediately, a few days, until a few months after the disaster. Post-disaster psychological effects experienced by disaster victims can be: a show of weak victims, panic, depression, aggression, irritability / high temperament.
Post Traumatic Syndrome Disorder (PTSD) or Post-Trauma Stress Disorder is a psychological reaction that can occur as a result of a traumatic experience or life threatening situations that are extreme stress that is generally characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of the event. (Merriam- Webster's Medical Dictionary). All people can experience PTSD, men, women, children, young and old. However, PTSD can be cured with medicine. At first thought that PTSD is only limited to the direct victim of a traumatic event. We have known that people who witnessed the occurrence of traumatic events to others can suffer PTSD (Flanery, 1999). Not all people who experience a traumatic event will suffer from PTSD. Differences in reacting to something depends on one's ability to cope with these traumatic events. As a consequence of this, each person will differ in overcoming traumatic events. Some people will look not affected by the traumatic event or not visible the impact of the event while others will appear a variety of symptoms of PTSD. Many of the victims showed symptoms of PTSD immediately after the disaster, while others are newly developed PTSD symptoms several months or several years later. In the small number of people, PTSD can become a chronic psychiatric disorder and settled a few decades even a lifetime.
Some risk factors of post-disaster PTSD can be divided into several categories. The first category are factors prior to the disaster, among others: gender, age, previous disaster experience, culture, race, socioeconomic status (education, occupation, income), marital status, status in the family (father, mother, children), personality and mental health history prior to the disaster. The second category are factors existing among other disasters which grief over the disaster, seeing himself or family injury, felt a threat to his life, a sense of panic during the disaster happened, fears are very, very, separated from family members, losing members family, loss of property, moved from the home or place of origin. Management of post-disaster mental health can be divided into 2 stages. The first stage is the stage of acute emergency that in principle is to manage urgent psychiatric complaints (eg: to overcome the dangerous situations the patient or others, to overcome psychosis, severe depression, mania) at the health post. The second stage is the stage rekonsolidasi (performed after 4 weeks post-disaster). Activities that can be done on this second stage can be arrange and conduct a psychological educational activities in communities in the disaster area, trained volunteers or community leaders about the important things in the psychological treatment of how to give psychological support, first aid on psychological disorders, signs and symptoms of psychiatric disorders. (Technical Guiline for Health Crisis Response on Disaster).
- In Psychosocial Problems
Scope of mental health problems, very large and complex, too interconnected with all aspects of human life. Referring to the law No. 23 of 1992 on Health and Medical Science Soul, an outline of mental health problems are classified into:
- Problems harmonious human development and improved quality of life of psychiatric problems associated with the meaning and values of human life.
- Psychosocial problems of mental or psychological problems that arise as a result of social change
- Trend Suicide
The death rate due to suicide in Indonesia later tended to increase. The case that caused many of these factors, tend to be open places. In the last five years, according to data released forensic FKUI / RSCM 2004 there were 771 male suicides and 348 female suicide. Of these, 41 percent committed suicide by hanging himself, by using insecticides 23 percent, and the OD reached 356 people.
In 2005, the suicide rate in Indonesia is still considered high enough. Based on data from the World Health Organization (WHO) in 2005, Indonesia at least 50,000 people commit suicide each year. Thus, Indonesia is estimated 1,500 people commit suicide per day. While for the year 2007, there were 12 victims killed themselves because of economic problems jammed, eight other cases of illness due to not go away because no money for treatment, and two cases due to the moral issues of one person due to breakup, and a result of depression. Then in 2008, based on data from the beginning of April 2008 to the existing 11 suicides that occurred in Banyumas or an average per month for nearly three cases.
The psychological factors that encourage people to commit suicide is less social support, had lost their jobs, poverty, psychology riot, severe conflict of refugees and so on. Reports in Jakarta says about 1.2 per 100,000 population and the incidence of suicide is highest in Indonesia, Gunung Kidul, Yogyakarta reach 9 cases per 100,000 population.
The highest incidence of suicide in the age group of teenagers and young adults (15 - 24 years), for sex, men commit suicide (suicide Comite) four times more than women. However, women make suicide attempts (attemp suicide) four times more than men. Indonesia's position itself close to the countries of suicide, such as Japan, the suicide rate reached more than 30,000 people per year and China which reached 250,000 per year.
- Drug problems and HIV / AIDS
Addictive substance use disorders are highly correlated and the impact of development and technology from a country that increasingly advanced. Other problems arise as with the proliferation of drug usage. AIDS cases increased from waku to time. This all is a threat loss of life and the collapse of civilization.
- Pattern of Parenting in Nursing Life
With the discovery of many suicide cases in children, the current family upbringing into the spotlight. Good parenting is parenting in which parents apply high heat coupled with high control. Warmth is how parents become friends. Warmth is the efforts of parents to children near and dare to talk to their parents when children have problems. High control is how children are trained and familiar with self-discipline at home. This independence becomes very important in mental health.
Warmth)
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Control
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High
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Low
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High
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Autoritative
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Authoritarian
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Low
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Permissive
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Neglected
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- Economic Problems and Poverty
Economic problems are the most dominant issue initiated a mental disorder in Indonesia. Increased unemployment and economic conditions of an unstable place with an increased incidence as a mental disorder.
- Trend in Psychiatric Mental Nursing Services
Psychiatric mental nursing as a profession emerged in the early 19th century. Around 1960 there deinstitusionalisasi program which is a client acquisition program with chronic mental illness from hospital institutions and return them to the environmental rehabilitation in the community (Lefley, 1996). Changes hospital based care to community-based care is the most significant trends in the treatment of mental disorders (Leininger, 1973). Reforms in health services has been demanding nurses to redefine their role.
- Issue Concerning Mental Psychiatric Nursing Services
- Mental Health Nursing research is still lacking, so that the nursing service is less accountable.
- Psychiatric nurse who was not yet ready to face the free market.
- Distinctions based mental nurse role piye and experience is often not clear
- Being a psychiatric nurse not attract students.
Some things to note in the face of trends and offering nursing services are:
- The focus of mental health nursing is based on the community emphasis on preventive and promotive.
- Increasing nursing research on the mental health nursing and to develop and conduct educational programs in nursing specialization mental health to answer an increase in science and technology.
- In order to maintain the quality of services provided and to protect consumers, it's time there is a "license" for nurses who work in the service
- Differences in cultural background of Indonesia with the literature sources as a nurse requires us to be able to filter out the concepts from the outside and adjust with the culture in Indonesia.
Reference:
Yosep, Iyus. Keperawatan Jiwa. 2009. Bandung: Refika Aditama
Penderita Gangguan Jiwa di Bogor Meningkat. 2009. downloaded from metro.vivanews.com. Penderita Gangguan Jiwa di Jabar Terus Meningkat. 2009. downloaded from www.detik.com
Penelitian Post Traumatic Stress Disorder di Jawa Tengah. 2008. downloaded from www.balitbangjateng.go.id
