Trend and Current Issue in Indonesian Mental Health Nursing

• DEFINITION OF MENTAL HEALTH

The World Health Organization defines health as ‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity’. In 1991 the Australian Health Ministers’ (AHM) Conference provided a definition of mental health that will serve as a starting point for discussion. The definition asserts that mental health is

…the capacity of individuals within the groups and environment to interact with one another in ways that promote subjective well-being, optimal development and use of mental abilities (cognitive, affective and relational) and achievement of individual and collective goals consistent with justice.

In this definition, cognitive refers to all elements and processes involved in thinking, memory and recall; affective refers to emotional responsiveness; and relational to the abilities require to interact with others.

This is a broad definition and one that encompasses key ideas developed throughout this book. To possess good mental health, then, individuals must have several key capabilities that enable them to interact with one another, to use their mental abilities to maximum advantage and to be aware of the wishes and aspirations of others. The AHM Conference also produced a statement entitled Mental Health; statement of rights and responsibilities which point out that :

Good mental health is a resource for everyday life. It is a positive concept which embraces both inner individual experience and interpersonal group experience. To the individual, good mental health means happiness, competence, a sense of power over one’s life, positive feelings of self esteem and the capacities to love, work and play. Good mental health also allows individuals to deal with difficult life events.

This idealized view of mental health is often difficult to achieve. Exactly what constitutes ‘difficult life events’ is likely to vary considerably, depending on an individual’s perspective and societal expectation. For example, in region in which armed conflict is occurring, one’s capacity to enjoy positive self esteem, love, work and play is seriously impaired. Seminary, the transition from childhood through adolescent to adulthood and old age, while normative (common to all) and age related (within the same age cohort), demonstrates the variety of events that can be experienced during these stages. For some people, these transitions are experienced as particularly difficult life events – but not by others. Many of the aspects of these idealized definitions of mental health are challenged by normative, age-related events and are thus difficult to achieve. Some life events are so far beyond the range of the day to day experiences of most people that they overwhelm the capacity to adapt.

Mental health is defined according to commonly held values. The definitions referred to above indicate that individuals are regarded as enjoying positive mental health when the behavior they demonstrate is adaptive (that is, it causes no particular distress to themselves or others), and enables them to fulfill satisfactorily their culturally accepted daily activities including communicating their needs clearly and without impediment. If, for some reason events bring about a deviation from this ideal, and personal discomfort and distressing thoughts and behaviours interfere with everyday living, people are considered to have a mental health problem.

In addition to the ability to take maximum advantage of one’s capacities for self realization, having good mental health confers a degree o flexibility that fosters education. This flexibility enable individuals to tolerate uncertainty and to develop an awareness of their abilities and limitations, thus allowing adjustment to life event. Provided these fluctuation (which may be stressful ) are relatively short-term, people can, and do, adapt satisfactorily. When disruption to everyday life become protracted, good mental health is difficult to maintain. Mental health problems or clinically recognized mental disorders may then develop.

• TREND AND CURRENT ISSUE

Trend and current issue in Indonesian mental health nursing are the commonly problems that always be discussed and important to give attention. The problems can be a threat or challenge which can give a great influence in the mental health nursing in the regional and global area. There are some important trend in mental health nursing :

1. Mental health starts from the conception era

2. Increasing the mental health problems

3. The tendency cause of mental disorder

4. The tendency in globalization situation

5. Globalization and change of health orientation

6. The mental disorder tendency

7. Increasing the post traumatic syndrome

8. Increasing the psychiatric problem

9. Suicide trend in children

10. The AIDS and drugs problems

11. Pattern of parenting in psychiatric

12. Perspective lie span history

13. Abuse

14. Economy and the poor problems

A. Mental health starts from the conception era.

The current research concludes that if we want to talk the mental health status, we have to pay attention at the conception time and maybe we have to give more attention on the pre-wedding time. Many research prove that there is a relationship between the conception time with somebody health in mental or physic in the future. Until now some genetic factors are believed have a big role in the etiology of disease.

B. Increasing the mental health problems

Mental health problems will increase in this globalization era. Most of them can’t manage the stressor and they usually encounter post power syndrome. The hard social living can be the cause of mental health disorder in the community. Neurosis is the mental health problem that will make the sufferer feel anxiety, stress, disturbing in sleeping, and physical problem that the causes don’t clear. The other mental health problem is psychotic disorder. They make some abnormal behavior and something that very dangerous for others.

C. The tendency cause of mental disorder

The war, conflict and economy crisis continuously are some factors which emerge stress, depression, and mental health disorder. 3 causes that make a mental health disorder :

• Physic, biologic, and organic disorder
• Mental, emotional, and psychic disorder
• Social and environment disorder

(Aris Sudiyanto : Guru Besar Psychiatry FK UNS Solo)

D. The tendency in globalization situation 

Science and technology which develop very fast and free trading are the sign of this globalization era, influence in all sectors especially in health. The care provider need to compete because the consumer will chose the care provider which can provide the great services and can guarantee their healing. The psychiatric nurse in this globalization era have to complete themselves with international language, communicating skill, use the communicating technology, and entrepreneurship skill.

E. Globalization and change of health orientation

The mental health focus not only to treat the patient, but also to increase the quality of life. So, the mental health concept not only sick or health, but the optimal condition which have an ideal in behavior and skill of social function. The orientation of mental health effort are promotion and prevention. The treatment move from hospital base become community base.

(Danardi : Psychiatric FK UI)

F. The mental disorder tendency

The new indicator, DALY (Disability Adjusted life Year), tells us that mental health problem will be the global burden of disease (Michard and Chaterina, 1999). This phenomena will be a challenge for “Public Health Policy” which traditionally gives more attention in infection disease.

• Increasing the post traumatic syndrome
• Increasing the psychiatric problem
• Trend in the children suicide
• The AIDS and drugs problems
• Pattern of parenting in psychiatric
• Economy and the poor problems

G. Trend in the mental health care nursing

The treatment changes from hospital base become community base which happen with the deinstitutionalization program. Deinstitutionalization program is the program that release the mental disorder sufferer from health institution (hospital) to the rehabilitation environment in community (Lefley, 1996). How the psychiatric nursing can be integrated in the community mental health? There are three keys in this process : nurse experience and education, role and function of nurse, and relationship between nurse and others profession in community (Leininger, 1973).

H. Current issue in mental health care nursing

• Mental health care services can’t be responded because lack of research for clinical psychiatric nursing.
• The provide psychiatric nursing not ready yet to compete in the free trading because the education still low and no have license for practice which recognize internationally.
• The differentiation education and experience psychiatric nurse not clear yet in position description, job responsibility, and reward system (Stuard Studeen, 1998).
• The nursing students don’t like to be come a psychiatric nurse, they tend to avoid this profession.

I. How the Indonesian psychiatric nurse can deal with this issue?

The efforts that have already done by Indonesian psychiatric nurse are making the standard of practice in the hospital, making professional nursing model (MPKP) in the psychiatric hospital, and training clinical instructor for psychiatric nurse. There are some things that we need to pay attention to deal with this issue in globalization era :

• Focus of the mental health care nursing is community base care, especially on promotion and prevention.
• Make specialization program of psychiatric nursing and increase research about mental health care nursing.
• Provide the license for nurse who works in the care services to maintain the quality of service and protect the consumer.
• We need to filter the concepts of mental health nursing which we get from others country (Estin, 1999).