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

1. Increased Post Traumatic Syndrome Disorder
When the tsunami in Aceh, many of which premises are exposed to traumatic events, the experience, watching the events a death threat or actual death, and those who are injured and that the threats to the physical integrity of self or others. Response that occurs in the form of a strong fear and helplessness, while for the children what the deal will be expressed with the chaotic behavior.

The victims of the Asian tsunami now face many new dangers and risks. The United Nations estimates that there could be about 150 000 pregnant women in tsunami-hit areas (BBC News, 1 January 2005). At the same time, criminals and opportunists are trying to cash in on the survivors' misfortunes. There are already reports of looting in many of the affected countries, with homes, shops and even dead bodies being targeted. And, in Sri Lanka, some of the disaster victims have allegedly been raped in refugee camps. One of the most disturbing allegations is that criminal gangs are befriending children orphaned by the tsunami, and selling them to sex traffickers (BBC News, 4 January 2005).

This trauma is something catastrophic, which is outside the range of trauma experiences which is experienced by humans in everyday events. Catastrophic experience in various forms, whether the war (it was happening), rape (is suffered many of Aceh some women), as well as natural disasters (earthquake and tsunami), it was horrible. This will make them in a state of prolonged stress and trying to not experience such stress. In clinical criteria arranged in Diagnostic and Statical Manual of Mental Disorders III and IV and the classification guidelines and Mental Disorder Diagnosis III in Indonesia said, the symptoms found in those that describe a place of stress for months, even years. Thus, they become invalid in the human psychological condition with the end result and resultante these patients would be unproductive. And as is known, is in their who repeatedly had the experience catastrophic when the area is ongoing under the Regional Operations Militerdan other events afterwards. The condition is very disabling, it is not only physical, but also conditions of community events in the NAD(Nangroe aceh Darussalam). Later, they became human beings for no good reason to always try to avoid similar incidents, especially the violence that was not going to happen. They are also human beings who always dreamed of scary happens repeatedly. As a result, sleep is supposed to make the restoration of body condition, but the opposite is true. They were tired and like in a state of depression. Maybe they will behave or feel as if the traumatic events that happen again, including the experience, illusions, hallucinations, and flashback episode in the form of dissociative.

They also avoid persistent (permanent), loss of interest in meaningful activities, it’s role in the function, and they always felt alien and apart from the environment and others. Natural range of feelings to be short, is evidenced by the loss of love. And, they did not think again to what they live and without ideals. They also experience difficulty sleeping disorders or to stay asleep, be irritable, difficult berkontrasi, have excessive caution, perhaps even a human being suspicious (paranoid) and the excessive startle response. Post-traumatic stress disorder can take up to 30-years period. Thus, they have very reasonable social support in the present so that the worse the condition can be anticipated. Catastrophic event caused a number of effects, from the worst (death), loss of body and property, and disability both physical and mental. Management will do not only include physical disturbance, but also mental (psychiatric).

According to mental health ambassador in Aceh, nearly 90 percent of the victims of the earthquake and tsunami survivors Aceh experiences mental disorders both heavy and light scale. The easiest and cheapest way to help them is to be a listener and a good friend to talk. According to team leader RSJP field of psychology, physician Donald, patients who they treat most people with severe mental disorders. "Such trauma is trauma includes weight category. As a result, the surface resulted in 40 to 50% will experience a mental disorder. "He also confirmed that the symptoms of trauma resulting from natural disasters always caused a deep psychic wound. One of the recommended treatment is to give Donald a friend to talk and a good listener. Not much different opinions expressed Irmansyah, a psychiatrist from Cipto Mangunkusumo hospital, Jakarta. Five days in Aceh, enough for him to conclude that 90% of residents of Aceh who survived, suffered emotional problems from low until highest level. Mental illnesses they suffered were not only the loss of property and family members in the tsunami. Mental disorders encountered Acehnese Irmansyah also strengthened by the trauma of the past during the conflict and the ongoing war on the porch of Mecca.

Mental health model of care programmes after the tsunami in Aceh, Indonesia
Before the tsunami, there was no systematic training provided for General Practitioners (GPs) and nurses in issues related to mental health and psychosocial support in times of disasters. After the tsunami, the Department of Psychiatry, Faculty of Medicine, University of Indonesia in Jakarta was contracted to organize a special two-week intensive training programme on basic psychiatry for 13 GPs from Banda Aceh Mental Hospital. To improve the nursing practice, a Professional Nursing Practice Model (MPKP) has been piloted in two wards in Banda Aceh Mental Hospital. This is a model of best practice for nursing care and management in an open ward system developed by the School of Nursing group and implemented in several mental hospitals in Indonesia. Basic training of GPs located at the primary healthcare level is being carried out based on the existing Ministry of Health curriculum for GPs. It covers 14 conditions listed in the International Classification of Diseases (ICD) Primary Care classification and has been conducted in 11 tsunami-affected districts. Currently, a total of 169 GPs have been trained. In general, there is an increasing interest among primary care doctors in mental health. Currently, community mental healthcare is provided in 11 districts in Aceh and two districts in North Sumatra by 277 Community Mental Health Nurses (CMHN) who have received basic training. Two thousand six hundred and two cases of serious mental disorders (mostly chronic psychosis) have been detected and treated by the CMHN and the doctors in Primary Health Centres (PHC). CMHN can provide a vital link between patients in the community and doctors in PHC. Two years after the earthquake and tsunami in Aceh, psychosocial intervention should continue and mental healthcare should be made available not only at Banda Aceh Mental Hospital, but also general health services, including PHC services.


Recent research on the study of trauma (trauma studies) began to understand that trauma is not merely the symptoms of the individual psyche. Trauma emerged as a result of the interplay of social and personal memories about the events that shook the existence of mental. In the context of the tsunami disaster, Aceh and other major disasters in Indonesia, social and cultural complexity is very important to remember that the public has witnessed megalami and variety of violence since the ongoing security operations in this area. Therefore, the understanding of trauma as a process of social and psychological processes as well as personal necessity to find a way out of the circle of traumatic memories experienced by clients who experience disasters across Indonesia. Interestingly, Sigmund Feud has suggested that trauma is a repressed memory. And, because the repressed trauma that the trauma is often unknowingly take place in a period long enough. Psychological shocks caused by the terrible memory of the tsunami waves, the bodies scattered, and about the loss of many family members as well as the potential to form a traumatic memory.

Nurse residents in the future is important to pursue the study of trauma, also underlined that the study prooses psychology is often referred to as transference. This term refers to the "transfer" a traumatic experience that occurred from people who directly experienced physical terrible events to others who do not directly experience it. Freud gives an example that the psychoanalyst is also able to experience transference when he unconsciously identify with the victims of such trauma. Loub Dori, a psychiatrist who was involved in the making of Shoah, said that the transference could occur when pschycoanalist or anyone else who does interviews with victims' "see" the terrible events through narratives told by the victim.

Humanitarian volunteers who jumped into Aceh and saw the bodies, or participate directly handled the victims who survived are also vulnerable to trauma. It is rather unfortunate that the humanitarian volunteers in Indonesia rarely or almost never, saw a special training to deal with a very traumatic situation. Their involvement mostly driven by a deep sense of humanity, but without realizing that a direct collision with the terrible events can also impact on their psychological situation. These volunteers are at risk of transference, and if not anticipated or handled properly, will become part of a traumatized society.

2. Increased 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 (Psichiatri), an outline of mental health problems are classified into:
- problems of harmonious human development and improved quality of life of psychiatric problems associated with the meaning and value of human life such as:
a. mental health problems associated with the lifecycle of human life from premarital preparation, the child in the womb, infants, children, adolescents, adults, and old age.
b. The impact of chronic disease that causes disability.
c. Healthy settlement.
d. Relocation tingga place.
- psychosocial problems of mental or psychological problems that arise as a result of social changes, such as:
a. Psychotic bum (someone who wandered in the general tempay estimated psychotic mental disorder and is considered disturbing the peace / security linhkungan).
b. Shackling mental patients.
c. Problem of street children.
d. Adolescent problems engage in a gang fight, delinquency).
e. Abuse of narcotics and psychotropics.
f. Sexual problems (sexual deviations, sexual harassment, etc.).
g. Social violence (poverty, neglect is not given a living, victims of violence on children and others).
h. Post-traumatic stress (anxiety, emotional disorders, repeatedly felt the back of a traumatic experience, natural disasters, explosions, violence, assault / physical abuse or sexual abuse, including rape, terrorism, etc.)
i. Refugee / immigration (mental or psychological problems that arise as a result of a social change, such as anxiety, depression, post-traumatic stress, and others.
j. Problems elderly terisolasir (neglect, physical abuse, psychological disorders, adjustment disorders to changes, interest changes, sleep disturbance, anxiety, depression, memory disorders, etc.).
k. Labor health problems at work (mental health workers, decreased productivity, stress in the workplace, etc.).

3. Trend of suicide in children and adolescents
According Iyus Yosep (2009), lately I have observed a week, 5 days in between the People's Mind presents news to us about the suicide that happened to adults and children. In fact there are 3 news about suicide in a single publication. Without prejudice to my love for this country, could emerge a new phenomenon in our nation but have the highest ranks in the corruption, tuberculosis, debt, abortion, and the destruction of the environment, will add its achievement in suicide rates?
According Prayitno, collecting data on suicide cases in Indonesia is still ugly. From the data taken at morgue of The Hospital Cipto Mangunkusumo, for example, there are 1119 cases of suicide from 2004-2005. Of these, 41 percent of suicide by hanging himself and 23 percent use insect venom, rest again for an overdose.

Data from the world health body (WHO) in 2003 revealed that one million people commit suicide every year, or occurs in every 40 seconds. Suicide also includes one of the three main causes of death at the age of 15-34 years, other than an accident factor.

According to the Nadsiyah http://www.indomedia.com, Saturday, March 12, 2005, in the last three months of the end of December 2004 until February 2005 recorded 12 cases of suicide, three were successfully rescued. Last 19-year-old girl trying to end life with menyilet wrist, but soon learned the family and still be saved. Interestingly, the perpetrators included age group immediately, between 14 to 65 years. Background is very diverse, from about romance, work, check-cok household economy, to being in debt due maly. Suicide as an act of his own to take a life deliberately, there must be causes that drive people to do the shortcut that condemned the Lord.

4. Drug problems and HIV / AIDS
Addictive substance use disorders are highly correlated and the impact of technological development and from an increasingly negaras forward. The most important thing that supports the spread of drug in our country is a weak legal tool sometimes even actors are often law enforcement agencies backing, coupled with doubts determining penalties for dealers and users, so that the impact of human resources in Indonesia defeated Malaysia a more assertive action against dealers and users drug. This condition will increase for the future, especially in the era of globalization. In the era of globalization there is a huge movement which is called by the term "Kafirisasi Movement". If a few decades ago we knew the term Zionism, the current line with globalization we are dealing with ideology kafirisasi called Neozionisme, an ideology which wants to create a global world order of secular and completely independent of religious doctrine they consider to be false, poison , and the dogmatic fundamentalists.

Everywhere they will make a shock, anxiety, and sense of doubt in the hearts of the religious community through the movement termed Tasmara Toto (1999), with a 10 F, which is destroying the financial strength (financial) Muslims in particular, damage to your diet (food) , spread of opium and other addictive substances (flight), creating solutions and match sheep among religious people (friction), spread way of thinking freely outside the religious frame (free thought), spreading the ideology that frees people from religious thinking procedures (freedom of religion), control of public opinion, mass media, newspapers, private TV, movies (film), to grow and tempting people to be civilized and to follow their milla (fashion / life style), making some of mysticism to destroy a religion (faith, ocultism sect), creates a sense of disappointment and frustration among the people and the younger generation (Frustasion).

All of us, especially the health team should feel compelled to save the future generation from the clutches of drug (drugs, alcohol, psychotropic and other addictive substances). Nurses are the largest component of the entire health team, the efforts of prevention and management of nursing becomes very important because nurses are always on the client side in a long span of time than any other health care team. Through this forum, presentation of nursing orientation if we try to explain a topic with the theme of Nursing at the Orphanage drug users.
5. Pattern of parenting in nursing soul
Given the large number of suicide and depression in children, the current parenting families back into the spotlight. Good parenting is parenting where parents applying high heat coupled with high control. Warmth is how parents become friends vent, playmate, a wonderful companion for children, especially during recreation, learning, and communicate. Sometimes the warmth expressed by hugging, kissing, holding or invite children to explore nature while learning. Warmth is the efforts made to parents by children and dare to talk to their parents when children have problems. So that children become healthy soul.

High control is how children are trained and familiar with self-discipline at home. This independence becomes very important in mental health. Children used to solve the problem independently, he will have enough self confidence. Example controls are applied to parents when children have to get up early, when learning, when children practice their own socks, feed themselves, dress independently. Parents are also responsible for training child chores at home such as washing, watering the flowers, and so on.

6. Economic problems and poverty
Unemployment is more than 40 million people has caused people worse off Indonesia. Weak purchasing power, low education, poor environment, lack of nutrition, easily agitated, decreased immunity, and the infrastructure that is still causing many people of Indonesia who have a mental disorder. Economic problems is a problem which initiated the poll dominant dementia in Indonesia. This can be proved that when there is an increase in fuel is always accompanied by an increase in double digits a mental disorder. This is compounded by the expensive school fees, medical expenses not afford, and evictions that often occur.

-the end-

References :
Yosep, Iyus.2009.Keperawatan Jiwa.Bandung : Refika Aditama.
http://www.cimh.unimelb.edu.au/__data/assets/pdf_file/0010/33949/maramis.pdf
http://www.contemporarynurse.com/archives/vol/18/issue/3/article/2092/tsunami-waves-of-mental-trauma
http://www.ijmhs.com/content/2/1/8
http://www.informaworld.com/smpp/content~content=a767874772&db=all
http://www.ncbi.nlm.nih.gov/pubmed/17162697