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

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. . .

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

Finally,, i finished my new blog few minutes ago,,
I hope it will be usefull,

Go Nursing!!