Community PSychiatry, Essays (university) of Medicine

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COMMUNITY PSYCHIATRI

CHAPTER I

INTRODUCTION

Health is a state of well-being, physical, mental and social, and not merely freedom from disability and death. This healthy definition applies to both individuals and residents (community). The degree of public health is influenced by four interacting factors, namely environment, behavior, heredity and health services. The degree of community mental health can be seen from the incidence of mental disorders and disabilities. Mental disorders and diseases including burden disease. The World Health Organization states that 12% of the global burden of disease is caused by mental health problems.^1 Community psychiatry emerged soon after the 2nd world war in both western and third world countries. Under community psychiatry, the proportion of people being treated for emotional problems has increased dramatically, patients with chronic mental illness have been treated and there have been improvements in techniques and programs for the treatment of non-psychotic mental disorders. The care and treatment offered in community psychiatry is delivered in a variety of inpatient and community-based services that are more integrated into networks sponsored by public agencies.2– Community psychiatry emerged as an effort to provide humane care for people with severe mental disabilities who lack the resources to protect against stigma. Community psychiatry developed in response to societal concerns that psychiatric treatment is a form of marginalization and oppression, or inhumane exile and

CHAPTER II

LITERATURE REVIEW

A. Definition The term "community" has different meanings, based on the context in which it is intended. Overall, the community is all the people who live in a certain area or country. Or it could also be about the context of a group of people with the same religion, race or occupation. In the context of “Community Psychiatry”, community can be visualized as a geographic area outside the hospital or mental institution. Community psychiatry can be defined in many ways, within a holistic approach it can be thought of as “any activity related to mental health that takes place outside the premise of a mental hospital”.^7 Community psychiatry provides community health services to people and families with mental illness in the community using community resources. Psychiatry focuses on the detection, prevention, early management and rehabilitation of emotional and behavioral disorders as they develop in the community.8, While in the Decree of the Minister of Health of the Republic of Indonesia number 406/Menkes/SK/VI/2009, community psychiatry is defined as the provision of mental health services for the local community which includes principles and practical implementation needs which include 1) providing therapy and care based on the basic needs of the community , 2)

providing a service network system from various sources that is sufficient and affordable, and 3) providing evidence-based services for all people with mental disorders.^1 B. Principles of Community Psychiatric Services Community Psychiatry consists of the principles of services needed to provide mental health services to the local population, namely: (1) determining population-based needs for treatment and care; (2) provide a service system that connects various resources with adequate capacity, operates in an accessible location and; (3) provide evidence-based care to people with mental disorders. The principles of community psychiatry proposed by Caplan have also been shown to be useful and valid to varying degrees in defining the subject:5,

1. Responsibilities for a population, usually geographically defined area
2. Treatment close to where the patient lives
3. Multidisciplinary team approach
4. Continuous care
5. Patient participation
6. Comprehensive service In Indonesia in the Decree of the Minister of Health of the Republic of Indonesia number 406/Menkes/SK/VI/2009, the principles used in the implementation of community mental health services are as follows:^1

7. Division of service areas. For the development and operation of community mental health services, regional division is carried out, namely mental health services are linked to certain geographic areas.
8. Obligation. Community mental health services are responsible for the mental health conditions of the entire population in their working area. C. Scope The scope of community mental health service activities includes:11,
9. Prevention and promotion of mental health
10. Efforts for early detection and prompt treatment
11. Referral efforts and follow-up care
12. Rehabilitation and resocialization efforts This mental health service effort is carried out by an integrated multidisciplinary team, including: psychiatrists, psychologists, social workers, general practitioners, mental nurses, and occupational therapists. D. Components of Community Psychiatric Services The diverse community psychiatric sector must work together with the goal of providing effective and coordinated mental health services. The World Health Organization provides recommendations for community psychiatric services:^7

1. Primary mental healthcare (primary mental health eligibility). Most people with mental disorders come to primary health facilities with or without physical symptoms. The average prevalence of psychiatric disorders attending primary health facilities worldwide is 24% and is associated with a burden on society. Primary mental health services with the help of specialists is a model where specialists are involved to train, carry out consultations and examinations of inpatients in complex cases, and management of cases that cannot be handled at primary health facilities.7,
2. Outpatient/ ambulatory clinics (outpatient clinic). The clinic can be seen as a service in primary care center settings, public hospitals and community mental health centres, where trained mental health workers offer examination and treatment, including pharmacological, psychological and social interventions.
3. Community mental health care teams (community mental health service team). Considered the basis of community mental health health services in most highly resourced countries. Evidence from the UK shows that community-based mental health care teams are a cost- effective and feasible approach.7,
4. Specialized community mental health care teams (specialized community mental health service team). It is the most studied component of balanced care, and randomized controlled trials have reported the effectiveness of this approach. There are two additional

variety of supported employment models. These models center on fast placement in competitive jobs and the support of employment specialists. According to the Decree of the Minister of Health of the Republic of Indonesia number 406/Menkes/SK/VI/2009, the components of community psychiatric services are as follows:^1

1. Primary level health service facilities can provide the following services: a. Counseling b. Early detection c. Psychiatric emergency services d. Outpatient service e. Referral service f. Home visit service
2. Health service facilities provided for mental health services at the referral level are as follows: a. Psychiatric emergency services b. Outpatient services (children, adults, elderly) c. Day-care service d. Inpatient service e. Supporting examination services (laboratory, radiological, psychometric) f. Psychological examination

g. Consultation-liaison psychiatry services h. Occupational therapy services i. Group activity therapy services j. Psychiatric rehabilitation services k. Assistance services for primary level health workers l. Home visit service

3. Whereas in non-health facilities it can be in the form of: a. Outpatient service b. Inpatient service c. Referral service d. Home visit service e. Job training services (occupational therapy) E. The Role of the General Practitioner in Community Psychiatry Considering that most cases of mental disorders in the community come to primary health facilities, general practitioners are the spearhead of community mental health services. Primary services must be able to provide basic mental health services, including early detection of mental health problems, treatment of common mental disorders, counseling and psychoeducation, and referral of specialist cases. Primary services can form a Mental Health Team consisting of trained general practitioners, mental health nurses, and field workers. This team is expected to be able to provide services:
4. Crisis assessment and treatment (crisis assessment and treatment)

to prevent mental disorders, maintain and improve the ability of individuals and families to maintain mental health.

3. Community Mental Health Service Program at the Soeharto Heerdjam Psychiatric Hospital DKI Jakarta. This program is a tertiary-level community mental health service model that serves urban, densely populated and multi-cultural communities. Soeharto Heerdjan Mental Hospital as a vertical special hospital of the Ministry of Health of the Republic of Indonesia which is responsible for mental health programs, especially issues related to mental health in urban areas. This model aims to provide quality and accountable mental health services and care for urban communities, and contribute to eliminating the stigmatization of mental disorders in society.

CHAPTER III

CONCLUSION

Health is a state of well-being, physical, mental and social, and not merely freedom from disability and death. This healthy definition applies to both individuals and residents (community). Community psychiatry emerged as an effort to provide humane care for people with severe mental disabilities who lack the resources to protect against stigma. In Indonesia the implementation of community psychiatry is regulated in the Decree of the Minister of Health of the Republic of Indonesia number 406/Menkes/SK/VI/2009 which includes definitions, principles and efforts, components and service mechanisms. Considering that most cases of mental disorders in the community come to primary health facilities, general practitioners are the spearhead of community mental health services. Primary services must be able to provide basic mental health services, including early detection of mental health problems, treatment of common mental disorders, counseling and psychoeducation, as well as conducting specialist case referrals. In Indonesia, there are several models of community psychiatry currently underway, namely Community Mental Health Nursing in Nanggroe Aceh Darussalam, the Community Mental Health Service Program at the Sleman District Health Center in the Special Region of Yogyakarta and the Community Mental Health Service Program at the Soeharto Heerdjam Mental Hospital DKI Jakarta.

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11. Surya, Vita. Community Psychiatry. 2016.
12. Compton MT. Public Health, Prevention, and Community Psychiatry. In: Handbook of Community Psychiatry. 2012.p. 37–44.
13. Burns T. Community-Based Mental Health Care in Britain. Consort Psychiatr [Internet]. 2020;1(2):14–20. Available from: http://dx.doi.org/10.17650/2712- 7672-2020-1-2-14-
14. Alvin Becker M, N. MIchael Murphy M, Milton Greenblatt M. Recent Advances in Community Psychiatry. N Engl J Med. 1989;321(19):1306–11.