COMMUNITY MENTAL

HEALTH NURSING (CMHN)

Shanti Wardaningsih
 TUJUAN
• Understand concept of community mental health nursing
• Describe comprehensive nursing care through three levels of
prevention
• Describe mental health nursing process in community mental
health nursing.
 MENTAL ILL HEALTH:
A Large Burden
Maternal conditions Perinatal conditions
Nutritional deficiencies
Respiratory infections
Malaria 6%
7% Other NCDs
Childhood diseases 3% Malignant neoplasms
5%
3% Diabetes
Diarrhoeal diseases 4%

Neuropsychiatric
HIV/AIDS 6% 13%
disorders
Tuberculosis
6% 3%
Other CD causes Sense organ disorders

10%
12% Cardiovascular diseases
Injuries 3%
4%

Congenital abnormalities Respiratory diseases

Digestive diseases
Musculoskeletal diseases Diseases of the genitourinary system
Disease burden measured by Disability Adjusted Life Source: WHR 2002
Years (DALYs)
 PREVALENCE
Hypertension up to 29%

Myocardial Infarction up to 22%

Epilepsy up to 30%

Stroke up to 31%

Diabetes up to 27%

Cancer up to 33%

HIV/AIDS up to 44%

Tuberculosis up to 46%

General up to 10%
[Population WHO, 2003, unpublished document
 OVERVIEW
PROBLEMS:

Physical

Psychological

Social
RECOVERY
Culture

Spiritual

Concept of community mental health nursing

Comprehensive nursing Care

Mental health nursing proces

CMHN
NURSE
 WHR-2001
Recommendations
1. Provide treatment in primary care
2. Make psychotropic drugs available
3. Give care in the community
4. Educate the public
5. Involve communities, families and consumers
6. Establish national policies, programmes and legislation
7. Develop human resources
8. Link with other sectors
9. Monitor community mental health
10. Support more research

©
2001
 SHIFTING PARADYGMS
• From Exclusion to Inclusion
(mentally ill or citizens suffering from mental disorders?)
• From bio medical to bio-psychosocial approach (social dimension as key
component of treatment)
• From bed to setting
• From Hospital to Community
• From Short Term to Long Term Care (rehabilitation)
• From Individual work to Team work
• From Treatment to Service
• From Clinical to Public Health
 SASARAN KINERJA
DEPARTEMEN KESEHATAN RI

VISI
MISI MASYARAKAT
YANG MANDIRI
GRAND STRATEGY MEMBUA
1. Menggerakkan dan T UNTUK HIDUP
memberdayakan masy
RAKYAT
SEHAT
untuk hidup sehat. SEHAT.
2. Meningkatkan akses masy
terhadap YANKES yang
berkualitas.
3. Meningkatkan sistem
surveillance, monitoring dan
infokes.
4. Meningkatkan pembiayaan
kesehatan.
 KESEHATAN JIWA NASIONAL

KEGIATAN
PROGRAM PLAN POLICY

VISI
Menuju Indonesia Sehat 2010 melalui upaya
kesehatan jiwa paripurna

MISI
Memelihara dan meningkatkan derajat keswa individu, keluarga dan masy serta lingkungan
Mengembangkan dan meningkatkan mutu, pemerataan pelayanan dan jangkauan upaya keswa
bersama dengan kesejahteraan /kemanusiaan lainnya
Mendorong kemandirian dan kemitraan masyarakat untuk mewujudkan jiwa yang sehat
Meningkatkan profesionalisme tenaga keswa mel pengembangan IP dan teknologi, keterampilan
dan etika profesi

TUJUAN
Meningkatkan derajat keswa masyarakat
 GAPs DALAM KESEHATAN JIWA
Sebagian besar masyarakat yang mengalami G.jiwa
dihadapkan pada berbagai masalah yang berbeda:
STIGMA & • Antara yang mendapat akses pelayanan dan
HAM tidak
• Menerima dan tidak menerima pelayanan yang
berkualitas
PROMO • Mengalami pelanggaran HAM dan tidak
KUALITAS TIF &
PELAYAN PREVEN
• Terpapar dan tidak terpapar dengan upaya
AN TIF
promotif dan preventif

AKSES Untuk mengatasi gap ini, kebijakan kesehatan jiwa

inivatif dan menjadi bagian SISTEM KESEHATAN.

Promosi kesehatan jiwa, Pencegahan G.jiwa, intervensi di

yankes primer dan pemberdayaan masyarakat akan
menjadi komponen penting kebijakan
 AREA KESEHATAN JIWA
 PERAWATAN BERBASIS RS
UNTUK ORANG DG G.JIWA
 G.JIWA YANG BANYAK DI
MASYARAKAT (PREVALENSI
TINGGI) DEPRESI, ANSIETAS
20%  PROMOSI KESWA DAN
TOTAL PENCEGAHAN PENY. ( BUNUH
1- 3%
G.JIWA DIRI, INTERVENSI DINI)
G. JIWA POPULASI KESWA
BERAT
• World Bank tahun 1995 di negara berkembang dan negara maju,
menunjukkan bahwa
• 8,1% dari Global Burden of Disease disebabkan masalah kesehatan jiwa,
• TBC paru (7,2%) ,
• Kanker (5,8%) dan
• Penyakit jantung (4,4%).
• Besaran ini menunjukkan prioritas masalah kesehatan jiwa yang tinggi
dalam masalah kesehatan masyarakat pada umumnya.
 AREA KESEHATAN JIWA
VS
AREA KESWA PELAYANAN
PELAYANAN KESEHATAN JIWA KESWA

POPULASI
KESWA RSJ
PREVALENSI
G.JIWA YANG
BANYAK DI
MASYARAKAT
YANKES
G.
LAIN
JIWA BERAT
 PERPADUAN OPTIMAL PELAYANAN KESEHATAN

TINGGI RENDAH

SELF CARE/ FAMILY CARE

MENTAL HEALTH SERVICES

OUTSIDE HEALTH SECTOR
KEBUTUHAN

MENTAL HEALTH
SERVICES IN PHC

MHS IN THE

BIAYA
MHS IN
COMMUNITY GENERAL
HOSPITAL

MENTAL
HOSPITAL

SPES.SERVICES

RENDAH
TINGGI
Community Mental Health Nursing (CMHN)

Paripurna
Fokus pada masy
 Sehat jiwa
 Rentan stres
 Pemulihan
 HOLISTIC NURSING CARE

Biologics
Psychological
Social
Cultural
Spiritual
 Biologis

Spiritual Psychologis

Cultural Social
 Comprehensive Nursing
Care
Complete service of care levels that
is from specialist mental health
service, integrative mental health
care and service of mental health
from community resources.
Mental Hospital Holistic Care

General Hospital

Health Center

Individual

Family

Community
 Konsep keperawatan
kesehatan jiwa komunitas

Diaplikasikan dalam
pelayanan
keperawatan,
sehingga:
• Anggota masyarakat sehat jiwa
• Masy yang mengalami gangguan jiwa dapat dipertahankan
dilingkungan masyarakat
• Tidak perlu dirujuk segera ke RS.
 COMPREHENSIVE NURSING CARE

PREVENTION

PRIMARY SECONDARY TERTIARY

Health Early Detection Promote
Promotion of psychosocial Function,
& mental Problems & socialization &
Health Mental Disorders Relapse
Prevention Prevention

Prevent Mental, Reduce the Reduce Disability

Maintain & Promote Occurrence of because of mental
Mental Health Mental Disorders Disorders
 SUMBER DAYA MANUSIA
SKILL

RUMAH SAKIT JIWA

(50)

RSU: >1200
PUSKESMAS ( >7600)
FASILITAS KES BERBASIS MASY
ACCESSIBILI
(Posyandu):> 300.000
TY
 RATIO
PSYCHIATRIC NURSES/ 100.000 POPULASI
Negara Ratio
Indonesia 0.9
Thailand 2.7
Singapore 10.4
 Primary Prevention
Target:
Community member who doesn't experience
disorders according to group old age of children,
adolescent, adult and elderly.

Activities:
1. HE program, Growth stimulation, socialization
program, stress management, parenting
preparation.
2. social support program
3. Drug abuse prevention program
4. Suicide prevention program
 Secondary Prevention
Target :
Community member who are at risk or shows
psychosocial problems & mental disorders.
Activities:
1. Early Case Findings
2. Screening & Further Activities
3. Suicide Treatment
4. Modalities Therapy
5. Follow up and referral cases.
 Tertiary Prevention
Target:
Community member who experience mental
disorders in rehabilitation processes.

Activities:
1. Social support program using sources in
community.
2. Rehabilitation program by using the patient &
family until independently.
3. Stigma prevention Program
 Focus
Individual

Family

Community
Groups
 Self-Care of Individual & Family

• Community both individual and family are expected maintain their

mental health independently.

• At this level, very important the family to include in caring their

family member.
Formal & informal Services / Supports
outside Health Sectors
• Public figures, formal and informal groups outside health
sector is target of mental health care.

Public Figures
• Target of Care
Traditional
• Partners of CMH
Healer
team
Mental Health Service of Basic Health
Care
• Every health caregivers in the community: private
practice doctor /midwife/nurse/psychologist.
• Every health care institution (e.g. PHC, Clinics)

Partners of Mental Health Team.

 Mental Health Care Unit
in General Hospital
pelayanan rawat
jalan dan rawat
inap bagi pasien
Hospitals
gangguan jiwa
In Distric/Town

Referral
System
 Mental Health Hospital
Referral Back
Specialist care mental health that
focus at mental disorder patient
who are not success cared in the
family/PHC/Hospital.

Primary
Health Care

Continuum care at
the family
HEALTH CARE
ORGANIZATION
Caregivers in Community Mental
Health Services

• Psychiatrists
• Clinical Psychologist
• CMHN Nurse
 CMHN NURSE
In PHC

Psychosocial
Problems &
Mental
Mental disorders
Conduct mental Disorders
Health care in Included family,.
PHC area Patient & Formal & informal
Family outside health
sectors
 Psychiatrist & Clinical
CMH Team Psychologist
CMHN Nurse

Consultant
Perkeswa Kom
di Puskesmas
Bertanggung jawab
atas keberhasilan
perawatan pasien di Mampu merawat
keluarga pasien sehingga dapat
berfungsi dalam
kehidupan sehari-hari
 Hospital District/Town

(Psychiatrist, Clinical Psychologist, CMHN Nurse)

Nurses who work in Mental hospitalization

Unit:
• Treat the patient in the acute phase
• Help the patient, family and community to solve the
problems.
• Working in team.
• Nurse in hospital in direct contact with the nurse in
PHC in order to continuum care.
Role and Function of
CMHN Nurses
Direct Nursing Care (Practitioner)

Nurse Patient Problem solving

abilities

Nursing Care Function

Increases
Nursing
Process
• Management of cases
• Nursing Intervention
Individual & Family
• Collaboration
 Educator
• Develop solving problem
Health abilities
Education • Conduct 5 tasks of the
family health.

• Recognize the problem

• Make decision
• Care the family member
• Environment modification
• Using health care institutions.
 Coordinator
Activities
Coordination:

CASE FINDINGS

Referral System
 COMMUNITY
ORGANIZATION
 Community
Tsunami & Disaster characteristics
change

Response:

Healthy/adaptive Psychosocial Mental Disorders

Problems

Community Organization
Community Organization in
CMHN
CMHN
NURSE

Community Community
Nurse
Cooperation
Identify needs, problems, and resources
which are exists in the community
• The ways to get the data :
• Information from the community such as teachers, community
members who suffer from mental disorders
• Information from community nurse
• Case finding by direct assessment of individual, family and
groups.
• By formal & informal meetings.
 Grouping the Data

• If found healthy community member

needed prevention and promotion program to
prevent psychosocial problems and mental
disorders.
• If found healthy community member suffers
from psychosocial needed intervention
program for immediate recovery.
• If found mental disorder case needed
immediate recovery intervention and
rehabilitation
Planning and Nursing Intervention to
the Cases

• CMHN nurse makes schedule to provide intervention

to the case by using module of nursing care, include:

• Daily activities schedule according to daily activities.

• Visiting schedule for the case to treat according to the
rehabilitation program.
 Evaluation and Follow Up

Record the patient progress and the family's ability in

caring the patient

• If condition be better continue with care plan until

the patient independent the family continue the care
to prevent relapse and increase the patient’s quality of
life.