Trend and Current Issue in Indonesian Mental Health Nursing.Ristina Mirwanti

Trend or current issue in psychiatric nursing is essential problem discussed. These problems can be considered a threat or a challenge that will have a major impact on the psychiatric nursing in both regional and global order. There are several important trends which concern in nursing psychiatric as follows:

* Mental health nursing began in the conception
* The trend increase in mental health problems
* The tendency in the etiology of mental disorders
* Tendency situation in the global era
* Globalization and changes in health orientation
* The tendency of mental illness
* Increased post traumatic syndrome
* Increased psychosocial problems
* The trend of suicide in children
* AIDS and drug problem
* Pattern of parenting
* A life history perspective
* Violence
* Economic and poverty issues.



A. Mental Health Nursing Began in The Conception

In the past, when speaking of mental health problems usually begin at the onset of the occurrence until the client experiencing symptoms. In Indonesia many mental disorders occur starting at the age of 19 years and we rarely see the phenomenon of the problem before the child was born. Concluded that recent developments speaking mental health problems must begin from the time of conception even have to start from the pre marriage. Many researches indicate the relevance of content with the physical and mental health of someone in the future. The following studies show that one's mental health began during conception.


Van de Carr (1979) found that a great musician who was born of a father who cultivate music, patterns have been studied in the womb when unborn babies are exposed to familiar voices regular song composition. Marc Lehrer, an expert from the University of California found that from 3000 infants studied and given early stimulation in the form of sound, music, light, vibration and touch, turned out as adults have a physical, mental and emotional better. Then Craig Ramey, observes that early stimulation, bonding and attachment in the newborn infant can increase intelligence between 15-30%.

Marion Cleves researching on the rats which are pregnant. Some pregnant rats given a low electrical stimulation, light, sound, and the traps show the number of dendrite branching as a prerequisite for intelligence. When compared with the control group had shown a significant difference. Similarly, studies conducted in Bangkok hospital, Thailand , the babies who received good prenatal care and stimulation in the womb. It turned out that the baby is able to speak, communicate, imitating sounds, called the first word and a smile. This finding is supported by Beatriz Manrique (president of the Venezuelan Ministry for The Development of Intelligence) in the study of 600 infants, found stimulation in the womb can increase adaptability, attachment, and language.

Likewise, the link between pregnancy with schizophrenia. Schizophrenia is often regarded as a chronic disease and can not be cured. This assumption is wrong, because with the good treatment that many patients can return to society and to function optimally. One of the constraints in the optimal treatment of schizophrenia is late coming to the clinic patient treatment. The question arises, could this disease be detected early and prevented its development? In 1988, Mednick et al in epidemiological studies reported an interesting discovery, namely the relationship between schizophrenia with a viral infection in the womb. His report was based on the influenza virus epidemic in 1957 in the city is very special Helsinki . This epidemic is very special to remember first, the occurrence in a short period, to commence on 8 October and 5 weeks ended 14 November. Second, the epidemic is really spreading. Nearly two-thirds of the city's population are infected in a variety of levels. This condition allows for evaluation of long-term effects.


Mednick prove that they are at the time of the epidemic is at a second trimester in the womb have a high risk for schizophrenia later in life. This important discovery showed that the external environment that occur at a particular time in the womb can increase the risk of suffering from schizophrenia.

Mednick revive neurocognitive development theory, which states that schizophrenia occurs in the development of neurocognitive abnormalities in the womb. Some neurocognitive disorders such as the ability to maintain lack of attention, distinguishing successive sound stimuli, working memory, and execution functions are often found in people with schizophrenia.

Believed on neurocognitive disorders acquired in the womb and in later life was exacerbated by the environment, for example, heavy pressure in life, brain infections, brain trauma, or affected by substances that affect brain functions such as drugs. Neurocognitive disorders has evolved into the basis of the symptoms of schizophrenia such as hallucinations, confusion, thought processes, suspicion / delusions, bizarre behavior and emotional disorders.

B. The Trend Increase in Mental Health Problems

Mental problems will increase in the era of globalization. For example the number of mentally ill patients in other provinces of Yogyakarta continues to increase. Patients are no longer dominated by lower-class society. Among officials and the public upper middle layer, also touched psychotic and depressive disorders.

The trend is visible from the number of patients who undergo inpatient or outpatient in Grhasia Hospital Yogyakarta and Sardjito Hospital Yogyakarta. In these two hospitals dementia clients continue to grow since the year 2002. In 2003 alone the number reached 7,000 people, was in 2004 rose to 10,610 people. Some of the clients undergoing outpatient,undergoing inpatient reached 678 people in 2003 and increased to 1314 people in 2004. Interestingly, psychotic clients now no longer dominated by the lower classes, but among the students, civil servants, private employees, and among them there are also professionals. Clients of mental disorders upper middle class, largely due to not able to manage stress and there are also cases of people who have experienced post power syndrome due to mutations fired or office.

Chief of Medical Staff Functional Psychiatric, Sardjito Hospital in Yogyakarta , Prof.Dr. Suwadi said, in the year 2003 the number of clients of mental disorders as much as 371 hospitalized patients. In 2004 the number increased to 433 patients. Amount, not including clients in the outpatient clinic of the daily average of 25 patients. Similarly, in South Sumatra Province , psychiatric disturbances last two years shows the trend of increased. The burden of life heavier, estimated to be one of the causes of mental disorders increased client. Head Psychiatric Hospital region of South Sumatra Province revealed: this year the number of clients handled by mental disorders in the psychiatric hospital has increased 10-15% compared with the previous year. Tendencies, psychotic cases remains high, then the case of neurosis which tend to increase, the hospital medical records noted South Sumatra, which cared for the number of clients increased from 4101 the number of people (in 2003) to 4384 people (2004). Of the total number of clients treated during 2004, much of which 1872 patients hospitalized in the psychiatric hospital. A total of 1220 people is as old patient had been treated previously. Environmental conditions are getting louder, could be the cause of the increasing number of people who experience mental disorders. Especially for individuals who are vulnerable to environmental conditions with less pressure poverty level.

The cases dealt with psychiatric disorders by psychiatrists and doctors in the hospital showed that mental illness is not known whether the social strata and age. There are rich people who experience great pressure, having lost all their possessions due to fire. Also cases of neurosis in children and adolescents, also showed a tendency to increase. Neurosis is a form of mental disorder that resulted in the sufferer experiencing stress, excessive anxiety, sleep disturbances, and complaints of physical illness is not clear why. Neurosis caused the decline in individual performance. Those who previously worked diligently, diligently studying to be sluggish, and the character becomes emotional. Seeing the trend of mental illness in children and adolescents are mostly cases of physical and nonphysical injury. Non-physical trauma may shape the disaster, loss of parents, or family problems.

Type of mental disorder is more severe, called psychotic disorders. Clients who show symptoms of abnormal behavior are visible. This is a man who often speaks not clear, and do the things that could endanger themselves and others, such as a tantrum.

C. Trend Factors Causing Mental Disorders

Occurrence of war, conflict, winding prolonged economic crisis is one of the triggers that led to stress, depression, and various mental health disorders in humans. According to the data the World Health Organization (WHO), mental health problems throughout the world it has become a very serious problem. WHO (2001) states, at least, there is one of four people in the world have mental problems. The WHO estimates there are about 450 million people in the world who experience mental health problems. Meanwhile, according to Uton Muchtar Rafei, Director of WHO South East Asia, nearly one-third of the population in this region have experienced neuropscyhiatry interference. For proof, we can match and see for yourself from the data Household Health Survey (SKRT); in 1995, in Indonesia is estimated as many as 264 of 1,000 household members suffered from mental health disorders.

In this case, headquarters Azrul Anwar (Director General of Health Department of Public Health) said the figures showed 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, until juvenile schizophrenia.

Other evidence, based on statistical data, the number of mental health disorders patients are worrying. Globally, from about 450 million people who experience mental disorders, about one million people dead due to suicide each year. This figure is quite small compared to the suicide of psychiatric patients who reached 20 million people each year.

The existence of mental health disorders are actually caused by many things. However, according to Aris Sudiyanto, (Professor of Medicine Mental (psychiatric) Eleven University School of Medicine in March (UNS) in Solo, there are three groups causes these mental disorders. First, physical disturbance, biological or organic. The reason, among others come from heredity, abnormalities in the brain, infectious diseases (typhoid, hepatitis, malaria and others), drug and alcohol addiction and others. Second, mental disorders, emotional or psychological. The reason, because of something wrong with the patterns of parenting, Pathological relationship among family members due to frustration, conflict, crisis and stress. Third, the social disruption or environment. The cause may be a psychosocial stressor (marital, parental problems, interpersonal relationships at work or school, the environment, in financial matters, law, development self, family factors, physical illness, etc.).

D. Trend Situation in 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. The development of science and technology is so fast and free trade that is characteristic of this era, have an impact on every sector including the health sector. Current health care providers including mental health should be able to compete, because consumers will choose a more service providers can guarantee the quality of their healing.

Nurse soul as the soul of nursing care to clients is part of the total service in the hospital. Therefore they are also required to be able to provide professional nursing care and can account for upbringing that gave scientifically.

Along with the development of science and technology, always a nurse is required to develop science and technology in the field of nursing which in this case is science and technology in nursing soul. Therefore, research in the field of nursing should be developed primarily soul of nursing research clinic soul. In order for nurses capable of doing the above, in addition they must have knowledge of research methods, they also have to follow the progress of science and trends and issues in mental nursing service both nationally, regionally and globally.

Right now in the world, was hit by major changes in various aspects, whether economic, political, and healthcare industries. These changes caused by technological developments very quickly, especially in the field of information technology. Consequently, there arose what is called the era of free market where competition is very tight in the market seized (Kompas, August 8, 2001). To be able to compete in this era, professionalism and expertise becomes key, because the competition is no longer local, but international. The exchange of nurses across the country resulting in high opportunity for mental nurses to work abroad. On the other hand overseas nurses will go to Indonesia . mental nurse in the global era must equip themselves with the international language, communication skills and the use of communications technology, high skill, and soul Enterpreneurship.

E. Globalization and Changes in Health Orientation

Era of globalization or free trade or not have been aware of impact on health services. Two main things bepengaruh to the development of health services including nursing, is the availability of alternative service and competitive organization of services to attract users services. In essence it is a competition of competition quality. This means that health workers, including nursing personnel soul, must have a global standard in providing health services if they do not want to miss (Suahemi, 1997)

There is an interesting phenomenon related with mental health problems, namely mental health indicators in the future no longer a clinical problem as the prevalence of mental disorders, but oriented to social context. Therefore, efforts to ensure the mental health matters is no longer just a psychiatrist, but also involves other professions. This statement was made Danardi, from the Section of Psychiatry Faculty of Medicine University of Indonesia. The focus of mental health, Danardi papa, no longer only dealing with the sick, but rather on improving the 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 should say if it could work, able to socialize, and enjoy leisure. This means that, although a person suffering from schizophrenia and had had the possibility of relapse, if it is achieved tigal it can be said that he was in optimal health status. Working definition in this case not only worked in the office, but also if you are able to do everyday jobs such as washing dishes, help cook, not just be passive, without doing anything.

According to WHO, if 10% of the population experiencing mental health problems receive the attention it should because it included sensitive mental health. In line with the proclaimed health paradigm Department of Health which emphasizes proactive efforts to prevent than to wait at the hospital, now more soul-oriented efforts at prevention (preventive) and promotion. Effort involving many professions, in addition to psychiatrists / doctors also nurses, psychologists, sociologists, anthropologists, teachers, scholars, journalists and others. Handling of mental health hospital shifted from base to base community.

To achieve a healthy society, must be started from individuals who are healthy too, both physically and mentally. In this case, Erich Fromm (1995) expresses a mental healthy person is a productive person and not alienated, the person who connects himself with the world is full of love, and the use of reason budinya to capture an objective reality. Also the feeling itself as a unique individual entity and at the same time was one with each other, which is not subject to irrational authority and sincerely accept the rational authority of conscience and the mind, someone who is experiencing the rebirth of a lifetime, and consider the gift of life is a very valuable opportunity.

As a solution, at least, there are four characteristics of the structure forming a healthy society. First, a healthy society is a society in which no human being is being manipulated by others, but always the goal itself. Therefore, there should be no one who manipulated / manipulate themselves, in which man became the center and all the political and economic activity is derived in the human self development goals. Second, a healthy society encourages productive activity every citizen in his work to stimulate the development of mind and furthermore, he was able to make people to express their inner needs of the arts and the collective normative behavior. Third, a healthy society is a society that escaped from the properties of greedy, exploitative, excessive ownership, narcissism, does not have the opportunity to use the material without profit to limit or prestige merely someone. Fourth, a healthy society is a condition of society that allows a person to act in the dimensions that can be directed and observed. Although he became an active and responsible participants in community life, other than as a master of his own life. Finally, to create a healthy social structure like that, then no other keys are all we have to do to improve the quality of life that can guarantee the creation of the actual health condition. Independent and not dependent on others is an orientation of the mental health paradigm that is very important. The principle is that if we are not able to help or alleviate someone else, then save, help yourself!

F. Disease Tendencion

According to the ICN (1997), quoted by Suhaemi (1997) that in the year 2020 throughout the world will shift the disease. Infectious diseases will be controlled, AIDS will continue to be a major problem.

Mental health problems will be the Global Burden of Disease (Mirchard & Chaterina, 1999). This will be a challenge for Public Health Policy which traditionally give more attention on infectious diseases. Standard measurements for global health needs of traditionally is the number of deaths from the disease. This has caused mental disorders as if not a problem. With the new indicator, namely Daly (Disability Adjusted Life Year), known that mental disorders are major health problems internationally.

Social change is very rapid economic and social situation of political uncertainties caused higher unemployment, poverty, and crime, this situation can increase the incidence of crises and mental disorders in human life (Otong Antai, 1994)

To answer this challenge required health personnel such as psychiatrists, psychologists, social workers and psychiatric nurses are adequate both in terms of quantity and quality, such as: psychiatrists, psychologists, social workers and psychiatric nurses are adequate both in terms of quantity and quality.

to be continued. . .

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