COMMUNITY PSYCHIATRY

SYNONIMCOMMUNITY PSYCHIATRYPUBLIC PSYCHIATRYSOCIAL PSYCHIATRYPREVENTIVE PSYCHIATRYHYGIENE PSYCHIATRY

COMMUNITY PSYCHIATRYDEFINITIONTHE PRACTICE OF PHYSICIANS OR PSYCHIATRISTS WHO ARE INTERESTED IN APPLYING ALL MEASURES THAT ARE DIRECTED TO THE PROMOTION OF MENTAL HEALTH AND THE PREVENTION OF ALL MENTAL DISABILITIES TO LARGE POPULATION GROUPS IN ALL THEIR DIEVERSITY.

PSYCHIATRY REVOLUTIONTHE FIRST WAS THE AGE OF ENLIGHTENMENT (AFTER THE MIDDLE AGES), WHEN IT WAS DECIDED THAT MENTAL ILLNESS WAS NOT THE RESULT OF WITCHCRAFT.SECOND WAS THE DEVELOPMENT OF PSYCHOANALYSIS BY SIGMUND FREUDTHE THIRD IS COMMUNITY PSYCHIATRY

KEY QUESTIONSIS COMMUNITY PSCHIATRY A MEDICAL SCIENCE OR A SOCIAL MOVEMENT?DOES IT ADDRESS ITSELF TO THE MENTALLY ILL, OR TO THE WHOLE POPULATION , OR TO THE ENTIRE SOCIAL SYSTEM WITHIN WHICH IT EXISTS?HOW FAR SHOULD MENTAL HEALTH SERVICES BE PROVIDED IN COMMUNITY?

COMMITMENT OF COMMUNITY PSYCHIATRYIS TO CONTINUITY OF CARE AND THE PROVISION OF TREATMENT FOR THE PATIENT AS CLOSE TO HOME AS POSSIBLE AND WITHIN THE CATCHMENT AREA.

COMMUNITY PSYCHIATRY PRACTICECOMMUNITY PSYCHIATRIC PRACTICE EMPLOYS PROFFESIONALS IN ALL MENTAL HEALTH DISCIPLINES AS WELL AS INDEGENOUS NONPROFESSIONALS.

LOCAL CITIZEN PARTICIPATION IS ENCOURAGED IN PLANNING, ADVISING, AND EVALUATING.

COMMUNITY PSYCHIATRISTCOMM. PSYCH. THEREFORE WILL ACQUIRE INFORMATION FROM THE SOCIAL SCIENCES, PARTICULARLY THE DISCIPLINES OF SOCIOLOGY, ANTHROPOLOGY, AND POLITICAL AND ECONOMIC SCIENCE.

COMMUNITY PSYCHIATRYENCOMPASSES ALL MENTAL HEALTH SERVICE SYSTEMS IN THE COMMUNITYTHE AREA:ALL ASPECTS OF CARE FROM HOSPITALIZATIONCASE MANAGEMENTCRISIS INTERVENTIONDAY TREATMENTSUPPORTIVE LIVING ARRANGEMENTS

Concept of health and illnessMysticism in Indonesia, perhaps more pronounced in Java and Bali but also found in other islands, plays an important role in the lives of the people.It is the belief that direct knowledge of God, spiritual truth, or ultimate reality can be attained through very subjective experience.

Concept of health and illnessIn the traditional community, health and disease are believed to be linked by mystical forces, just as the social order itself is supposedly based on a balance of good and evil powers.

Beliefs about mental illnessThere are many traditional beliefs about the causes of psychiatric illnesses: An ancestors spirit has been offended or made angryA witch has cast a spellGhostsDisobeying food taboos or practicesThe will of GodFailure to perform certain rituals or ceremoniesThere also many people in the community who believe that there is exists a power which can be used for good or bad purposes.

Traditional healersTraditional healers claim to have this power and use it to cure illnesses or to protect people from becoming sick.It is also widely believed that such power can be used by witches or evil magicians. The power of the healer and witchcraft are especially effective because it frightens those who believe in it.The reason for visiting a traditional healer is due to such beliefs.

Seeking treatmentPeople are seeking treatment with a traditional healer because they believe that only a traditional healer can cure their psychiatric problems. But some of the people sometimes visit a traditional healer just for a try and even without any reason

Seeking treatmentIt should be considered to learn from the indigenous health system acceptable means to the people to improve their health and no exception should be made for mental health care.That means that the existing concepts, and practices of people, hence indigenous health care in psychiatric problems should be recognized.

MOTIVATION TO SEEK TREATMENTThe motivation of the community to attend the medical health services seek help or treatment for their illnesses, depends on the awareness of the community.The awareness of the people is very low because of their misconception about health and disease especially for their psychiatric problems or mental illnesses.

MOTIVATION TO SEEK TREATMENTIt appears that belief or misconception about health and disease influences the utilization of health services in primary health care.In most cases the reason of seeking treatment with a traditional healer is the belief that only traditional healer can cure.

How do the traditional healer give psychotherapy?All traditional healer types of psychotherapy reflect local beliefs regarding mans nature and in many cultures the close links between individuals, their ancestors and the spirit world play a prominent role in the treatment.Healing is based on the establishment and maintenance of satisfactory relationships between elements in the present, the past and the spirit world.

How do the traditional healer give psychotherapy?The patient therefore does not consider the illness as something to be cured or controlled but as something to be understood. It is clear that the traditional healer according to the factor of belief is much more acceptable to the community.

Why do many people visit the traditional?Obviously, most of the people visit the traditional healer because they do not expect or get satisfaction from the medical health services for their illness especially for their psychiatric problems.

Why do many people visit the traditional?Traditional healers have an extremely wide social function: their knowledge and incantations often embody a communitys beliefs and values.Traditional healers may be in a position to influence attitudes in many important areas, including health care for illness and psychiatric problems.

Religious groupsWithout designating a particular healer, some religious groups provide care for those illness especially those with mental disorders.Healing Ceremonies, involving the induction of trance and other receptive states, are the main methods used.

Religious groupsClose collaboration between traditional healers and physicians/psychiatrist is probably feasible in a few special situations, but those responsible for health services should be aware of the role `of healer, both therapeutically and influencing attitudes.

STIGMA ABOUT MENTAL ILLNESSSOME CHRONIC SUFFERERS MAY BE STIGMATISED BECAUSE THEY DISPLAY THE OBVIOUS RESIDUAL NEGATIVE SYMPTOMS OF SELF-NEGLECT, LACK OF MOTIVATION, SOCIAL WITHDRAWAL AND ODD OR BIZARE BEHAVIOUR.RIGIDITY OR TREMOR AS SIDE- EFFECTS OF MAJOR TRANQUILIZERS MAY ALSO LEAD TO STIGMATISATION.

STIGMA ABOUT MENTAL ILLNESSTHERE IS STILL OFTEN AN ASSUMPTION THAT FAMILIES MAY HAVE CAUSED MENTAL ILLNESS IN SOME WAY.SOME FAMILIES MAY BELIEVE THAT IF THE OFFSPRING SUFFERS FROM A MAJOR MENTAL ILLNESS THE WHOLE FAMILY HAS FAILED OR LOST FACE.

ABOUT STIGMASOMETIMES FAMILIES TELL ONLY CLOSE RELATIVES OR FRIENDS ABOUT THE ILLNESS. IF PATIENTS HAVE BEEN ADMITTED TO A PSYCHIATRIC HOSPITAL OR PSYCHIATRIC WARD, SOME FAMILIES ENSURE THAT NOBODY OUTSIDE THE FAMILY KNOWS ABOUT IT.

ABOUT STIGMABECAUSE OF THE SENSE OF FAILURE AND FEAR OF NOT BEING ACCEPTED BY OTHERS, FAMILIES OFTEN ISOLATE THEMESELVES. THEY AVOID CONTACT WITH PEOPLE WHO THEY FEAR MIGHT LOOK DOWN ON THEM.

ABOUT STIGMAHEALTHY SIBLINGS IN THE HOUSEHOLD OFTEN DISTANCE THEMSELVES FROM THE FAMILY AS FAR AS POSSIBLE THROUGH SHAME AND EMBARRASEMENT. SOME FAMILIES EVEN GO TO THE EXTREME OF MOVING TO A NEW NEIGHBOURHOOD IN ORDER TO CONCEAL THE FACT THAT THEIR RELATIVE HAD HAD A MAJOR NERVOUS BREAKDOWN

COMMUNITY PSYCHIATRYTHE PRINCIPLES OF COMMUNITY PSYCHIATRY INCLUDERESPONSIBILITY TO APOPULATION, USUALLY A CATCHMENT AREA DEFINED GEOGRAPHICALLYTREATMENTS CLOSE TO THE PATIENTS HOMEMULTI-DISCIPLINARY TEAM APPRPOACH CONTINUITY OF CARECONSUMER PARTICIPATIONCOMPREHENSIVE SERVICES

HISTORY OF COM. MENTAL HEALTHIN 1963 THE CONSTRUCTION OF COMMUNITY MENTAL HEALTH CENTERSEACH CENTER MUST PROVIDE FIVE BASIC PSYCHIATRIC SERVICES:INPATIENT CAREEMERGENCY SERVICES (ON A 24 HOUR BASIS)COMMUNITY CONSULTATIONDAY CARE (INCLUDING PARTIAL HOSPITALIZATION PROGRAMS, HALFWAY HOUSES, AFTER CARE SERVICES, A BROAD RANGE OF OUT PATIENT SERVICES)RESEARCH & EDUCATION

IN 1975ADDED THE REQUIREMENTS OF SERVICESFOR CHILDRENOLDER PERSONSPREHOSPITALIZATIONSCREENINGFOLLOW UP SERVICES FOR THOSE WHO HAVE BEEN HOSPITALIZEDTRANSITIONAL HOUSINGALCOHOLISM AND DRUG ABUSE SERVICESIN 1980THE PRACTICE OF PSYCHIATRY IN CENTER

BASIC CONCEPTS IN COMMUNITY MENTAL HEALTHCOMMITMENT SUGGESTSTHE PLAN SHOULD IDENTIFY ALL THE MENTAL HEALTH NEEDS OF THE POPULATIONINVENTORY THE RESOURCES AVAILABLE TO MEET THESE NEEDSORGANIZE A SYSTEM OF CARECITIZENS AND POLITICAL FIGURES SHOULD BE INVOLVED IN THE PLANNING PROCESSPREVENTION IS AT LEAST AS IMPORTANT AS DIRECT TREATMENTALL THE POPULATION SHOULD RECEIVE CARE (CHILDREN, OLDER PERSONS, MINORITIES, PERSONS WHO ARE CHRONICALLY AND ACUTELY ILL, PERSONS WHO LIVE IN REMOTE AREA)

SERVICESPUBLIC MENTAL HEALTH IS A TOTAL SYSTEM, NOT A SINGLE SERVICETO BE EFFECTIVE MUST BE INTEGRATED AND BALANCEDTHE PUBLIC MENTAL HEALTH TEAM SHOULD INCLUDE:PSYCHIATRISTCLINICAL PSYCHOLOGISTSPSYCHIATRIC SOCIAL WORKERSPSYCHIATRIC NURSESADMINISTRATIVEELECTRICAL STAFF MEMBERSOCCUPATIONAL AND RECREATIONAL THERAPISTS FOR INPATIENT AND PARTIAL HOSPITALIZATION PROGRAMS

LONG-TERM CARECOMMUNITY MENTAL HEALTH PROGRAMS ENCOURAGE CONTINUITY OF CARE BECAUSE OF CONCERNS ABOUT FRAGMENTATION OF CARE AND THE TENDENCY TO KEEP PATIENTS HOSPITALIZED OR UNNECESSARILY RESTRICTED TO ONE TYPE OF SERVICE.

CONTINUITY OF CARECONTINUITY OF CARE ENABLES A SINGLE CLINICIAN TO FOLLOW A PATIENT THROUGHEMERGENCY SERVICES,HOSPITALIZATIONPARTIAL HOSPITALIZATION AS A TRANSITION TO THE COMMUNITYOUTPATIENT TREATMENT AS FOLLOW UP

CONTINUITY OF CARECONTINUITY ALSO PROVIDES AN EXCHANGE OF INFORMATION AND TEAM RESPONSIBILITY FOR THE PATIENT WHEN VARIOUS THERAPISTS, FOR REASONS OF CONVENIENCE OR ECONOMY, TREAT THE PATIENT IN SEVERAL SETTINGS.A FREE EXCHANGE OF CLINICAL INFORMATION BETWEEN CENTERS AND A LIAISON BETWEEN AGENCIES ARE ALSO PART OF THE TOTAL SYSTEM OF CARE

CASE MANAGEMENTINTENSIVE CASE MANAGERS ARE CLINICIANS WHO CAN PROVIDE CONTINUITY OF CARE BY FOLLOWING PATIENTS THROUGH ALL THE PHASES OF TREATMENT WHILE HELPING PATIENTS NEGOTIATE A SYSTEM THAT IS COMPLEX AND FRAGMENTED. INTENSIVE CASE MANAGERS PROVIDE SUPPORT, ADVOCACY, AND SYSTEMS MANAGEMENT.

COMMUNITY PARTICIPATIONTHE COMMUNITY SHOULD PARTICIPATE IN DECISIONS ABOUT ITS MENTAL HEALTH CARE NEEDS AND PROGRAMS, INSTEAD OF HAVING THEM DEFINED SOLELY BY PROFESSIONALS.MENTAL HEALTH SERVICES ARE SENSITIVE TO THE NEEDS OF THOSE SERVED IF THE PUBLIC IS ACTIVELY INVOLVED.

CONSULTATIONCONSULTATION RANGES FROM ATTENTION TO OR EVEN TREATMENT OF THE EMOTIONAL PROBLEMS OF AN INDIVIDUAL PATIENT TO USING KNOWLEDGE ABOUT HUMAN BEHAVIOR TO HELP ORGANIZATIONS ACHIEVE THEIR PROFFESIONAL GOALS WITH THE PROGRAM AND THEIR PATIENTS.

CONSULTANTTHE CONSULTANT OFFERS ASSISTANCE TO THE MENTAL HEALTH PROFESSIONAL WHO WORKS IN AN OUTPATIENT CENTER OR AGENCY.THE CONSULTANT MAY ALSO PROVIDE DIRECT EDUCATIONAL ACTIVITIES, LIAISON WITH CONSUMER AND ADVOCACY GROUPS, AND ADMINISTRATIVE SERVICES.

PREVENTIONTHE DISABILITIES ASSOCIATED WITH CHRONIC MENTAL DISORDER ARE MAJOR SOCIAL, ECONOMIC AND PUBLIC HEALTH PROBLEMS - THEY ARE COSTLY AND CREATE SUFFERING FOR THEIR FAMILY AND SOCIETY

THE GOAL OF PREVENTION IS TO DECREASE THE ONSET (INCIDENCE), DURATION (PREVALENCE), AND RESIDUAL DISABILITY OF MENTAL DISORDERS.

PRIMARY PREVENTIONTHE GOAL OF PRIMARY PREVENTION IS TO PREVENT THE ONSET OF A DISEASE OR DISORDER AND THEREBY REDUCE ITS INCIDENCE (THE RATIO OF NEW CASES TO THE POPULATION IN A SPECIFIC PERIOD)

TO REACH THE GOAL OF PRIMARY PREVENTION THE GOAL IS REACHED BYELIMINATING CAUSATIVE AGENTSREDUCING RISK FACTORSENHANCING HOST RESISTANCEINTERFERING WITH DISEASE TRANSMISSION

THE EXAMPLE OF PRIMARY PREVENTIONTO HELP PERSONS COPE WITH LIFE INCLUDE MENTAL HEALTH EDUCATION PROGRAMS PARENT TRAINING IN CHILD DEVELOPMENT AND ALCOHOL AND DRUG EDUCATION PROGRAMSEFFORTS AT COMPETENCE BUILDING OUTWARD BOUND, HEAD START, OTHER ENRICHED DAY-CARE PROGRAMS FOR DISADVANTAGED CHILDRENTHE DEVELOPMENT AND USE OF SOCIAL SUPPORT SYSTEMS TO REDUCE THE EFFECTS OF STRESS ON NTHOSE AT HIGH RISKS WIDOW - TO - WIDOW PROGRAMSANTICIPATORY GUIDANCE PROGRAS TO ASSISST PERSONS TO PREPARE FOR EXPECTED STRESSFUL SITUATIONCOUNSELING PEACE CORPS VOLUNTEERSCRISIS INTERVENTION AFTER STRESSFUL LIFE EVENTSBEREAVEMENT, MARITAL SEPARATION, DIVORCE, TRAUMAS, DISASTERS

THE AIM OF PRIMARY PREVENTION PROGRAMERADICATING STRESSFUL AGENTS AND REDUCING STRESSSUCH PROGRAMS INCLUDE PRENATAL AND PERINATAL CARE TO DECREASE THE INCIDENCE OF MENTAL RETARDATION AND COGNITIVE DISORDERS IN CHILDRENADVICE ABOUT IMPROVED NUTRITION AND ABSTINENCE FROM ALCOHOL AND OTHER SUBSTANCES DURING PREGNANCY, IMPROVED OBSTETRICAL SERVICES.

PRIMARY PREVENTION PROGRAMS (CONT.)STRICT LEAD-ELIMINATION LAWS TO REDUCE THE INCIDENCE OF LEAD ENCEPHALOPATHYMODIFICATION OF DIVORCEADOPTIONCHILD ABUSE LAWS TO PROVIDE A HEALTHY ENVIRONMENT FOR CHILD DEVELOPMENTENRICHMENT OR REPLACEMENT OF INSTITUTIONAL SETTINGS FOR INFANTS, CHILDREN AND OTHER PERSONSMODIFICATION OF CERTAIN RISK FACTORS FOR MENTAL DISORDER THAT APPEAR TO BE ASSOCIATED WITH LOW SOCIOECONOMIC STATUSGENETIC COUNSELING FOR PARENTS AT HIGH RISK FOR CHROMOSOMAL ABNORMALITIES TO PREVENT THE UNWITTING CONCEPTION OF COMPROMISED INFANTSEFFORTS TO REDUCE THE SPREAD OF CERTAIN SEXUALLY TRANSMITTED DISEASES THAT CAN LEAD TO MENTAL DISORDERS ( AIDS AND SYPHILIS)

SECONDARY PREVENTIONIS DEFINED AS THE EARLY IDENTIFICATION AND PROMPT TREATMENT OF AN ILLNESS OR DISORDER, WITH THE GOAL OF REDUCING THE PREVALENCE (THE PROPORTION OF EXISTING CASES IN THE POPULATION AT RISK AT A SPECIFIED TIME) OF THE CONDITION BY SHORTENING ITS DURATION

COMPONENTS OF SECONDARY PREVENTIONCRISIS INTERVENTIONPUBLIC EDUCATIONTO REDUCE STIGMA TO ALLOW PERSONS TO SEEK TREATMENT EARLIER

TERTIARY PREVENTIONTHE GOAL OF TERTIARY PREVENTION ISTO REDUCE THE PREVALENCE OF RESIDUAL DEFECTS AND DISABILITIES CAUSED BY AN ILLNESS OR A DISORDER

IN THE CASE OF MENTAL DISORDERS, TERTIARY PREVENTION ENABLES THOSE WITH CHRONIC MENTAL ILLNESS TO REACH THE HIGHEST FEASIBLE LEVEL OF FUNCTIONING

PSYCHIATRIC REHABILITATIONINVOLVES: A COMPLEX PROCESS IN WHICH THE PROFESSIONAL ATTEMPTS TO ADDRESS THE PSYCHOLOGICAL, SOCIAL, AND OFTEN THE MEDICAL NEEDS OF THE PATIENT SIMULTANEOUSLY

MODERN PUBLIC PSYCHIATRY ATTEMPTS TO LIMIT THE LENGTHS OF HOSPITALIZATION NBY RAPID INTERVENTION AND MAINTAIN SOCIAL SUPPORT SYSTEMS EVEN WHEN PATIENTS ARE ACUTELY ILL

REHABILITATIONIS OFTEN ONGOING DYNAMIC PROCESS CARRIED OUT FOR THE PATIENTS LIFETIME BECAUSE OF THE CHRONIC RELAPSING NATURE OF MANY TYPES OF MENTAL ILLNESS, ESPECIALLY SCHIZOPHRENIA

INDICATIONS FOR HOSPITALIZATIONARE DETERMINED BY FACTORS WITHIN THE INDIVIDUAL PATIENTSEVERITY OF THE ILLNESSLEVEL OF AWARENESS OR INSIGHT REGARDING THE ILLNESSTHE CAPACITY TO CERTAIN IMPULSIVEDESTRUCTIVE BEHAVIORFACTORS IN THE ENVIRONMENT SUCH AS PRESENCE OR ABSENCE OF SUPPORT INTENSITY OF ONGOING STRESSORSIN GENERAL HOSPITAL TREATMENT IS INDICATED WHEN PATIENTS ARE SO SEVERELY DISTURBED THAT SOMEONE ELSE MUST STEP IN AND PROTECT THEM FROM HARMING SELF OR OTHERS AND THEIR ENVIRONMENT CANNOT PROVIDE THIS PROTECTION

ADDRESSES OF TERTIARY PREVENTION IN PSYCHIATRYPATIENTS SUFFERING FROM THE MOST SEVERE AND DEBILITATING ILLNESS:SCHIZOPHRENIATHE MOST SEVERE AFFECTIVE DISORDERS THE MOST DISABLING PERSONALITY DISORDERS

RESIDUALS IN MANY CASES THE PERSONS CAN HAVE A WIDE RANGE OF PSYCHOLOGICAL DEFICITS THAT IMPAIR THEIR ABILITY TO INTERACT WITH OTHERS, HANDLE THE USUAL STRESSES OF DAILY LIFE, AND ACHIEVE THEIR POTENTIAL

TERIMA KASIHRonny3w@yahoo.comPsikiaterJogja

Prof. Dr. dr. Soewadi, MPH., Sp.KJCommunity Mental Healtlh ProblemsBlock V, April 26, 2005, Week 5 (International Programme)*