COMMUNITY PSYCHIATRY

Prof. Dr. dr. H. Soewadi,MPH.,Sp.KJ (K)

MENTAL HEALTH
WHO (World Health Report 2001) : MH= a state of well-being in which the individual: > realises his/her own abilities > can cope with the normal stresses of life > can work productively & fruitfully > able to make contribution to his/her community Mental Disorders <-------------> Mental Wellbeing (preventing-treating) (fostering-promoting) INDIVIDUAL========> COMMUNITY

IMPACT OF MENTAL HEALTH PROBLEM TO THE COMMUNITY

DECREASE OF PRODUCTIVITY (at work, absenteeism) INCREASE OF MEDICAL COSTS

Premature Death : Suicide, Accident (traffic/domestic), Violence (public/domestic), Drug Abuse, Criminals, etc. DALYs (Disability Adjusted Life Years) Lost : GDB= 11,5 % (rank ke 2 setelah Infectious Dis.) Increase of psychosocial costs (Indirect Costs).

PSYCHIATRY:
THE MEDICAL SPECIALTY CONCERNED WITH THE STUDY, DIAGNOSIS, TREATMENT, AND PREVENTION OF BEHAVIOR DISORDERS OR MENTAL DISORDERS

PSYCHIATRIST IS :
A PHYSICIAN WHO HAS HAD ADVANCED TRAINING IN THE DIAGNOSIS AND TREATMENT OF MENTAL DISORDERS

COMM. PSYCHIATRY
THE BRANCH OF PSYCHIATRY CONCERNED WITH THE PROVISION AND DELIVERY OF A COORDINATED PROGRAM OF MENTAL HEALTH CARE TO A SPECIFIED POPULATION.

COMMUNITY PSYCHIATRIST
COMMUNITY PSYCHIATRIST THEREFORE WILL ACQUIRE INFORMATION FROM THE SOCIAL SCIENCES, PARTICULARLY THE DISCIPLINES OF SOCIOLOGY, ANTHROPOLOGY, AND POLITICAL AND ECONOMIC SCIENCE.

COMMUNITY PSYCHIATRY : DEFINES

THE PRACTICE OF PSYCHIATRIST WHO ARE INTERESTED IN APPLYING ALL MEASURES THAT ARE DIRECTED TO THE PROMOTION OF MENTAL HEALTH AND THE PREVENTION OF ALL MENTAL DISABILITIES TO LARGE POPULATION GROUPS IN ALL THEIR DIVERSITY. THEIR COMMITMENT IS TO CONTINUITY OF CARE AND THE PROVISION OF TREATMENT FOR THE PATIENT AS CLOSE TO HOME AS POSSIBLE AND WITHIN THE CATCHMENT AREA

 SYNONIM
COMMUNITY MENTAL HEALTH COMMUNITY PSYCHIATRY SOCIAL PSYCHIATRY HYGIENE PSYCHIATRY PUBLIC PSYCHIATRY PREVENTIVE PSYCHIATRY

 THE TERM COMM. PSYCH., SOCIAL PSYCHIATRY, AND PREVENTIVE PSYCHIATRY ARE OFTEN USED INTERCHANGEABLE

 COMM. PSYCHIATRY
THE BRANCH OF PSYCHIATRY CONCERNED WITH THE PROVISION AND DELIVERY OF A COORDINATED PROGRAM OF MENTAL HEALTH CARE TO A SPECIFIED POPULATION.

 SOCIAL PSYCHIATRY IS DEFINED AS THE RESEARCH EFFORT TO DISCOVER NEWER METHODS TO DELINEATE AND SUGGEST INFORMATION REQUIRED IN THE PRACTICE OF PSYCHIATRY

 CHANGES ARE SOUGHT IN THE SOCIAL SETTINGS , EITHER IN SMALL OR IN LARGE GROUPS , THAT WOULD SURTAIN MENTAL HEALTH , PREVENT MENTAL DISABILITY OR EXPAND THERAPEUTIC OR SOCIAL REHABILITATIVE INTERVENTION

PSYCHIATRY REVOLUTION
THE FIRST WAS THE AGE OF ENLIGHTENMENT (AFTER THE MIDDLE AGES), WHEN IT WAS DECIDED THAT MENTAL ILLNESS WAS NOT THE RESULT OF WITCHCRAFT. SECOND WAS THE DEVELOPMENT OF PSYCHOANALYSIS BY SIGMUND FREUD THE THIRD IS COMMUNITY PSYCHIATRY

KEY QUESTIONS
IS COMMUNITY PSCHIATRY A MEDICAL SCIENCE OR A SOCIAL MOVEMENT? DOES IT ADDRESS ITSELF TO THE MENTALLY ILL, OR TO THE WHOLE POPULATION , OR TO THE ENTIRE SOCIAL SYSTEM WITHIN WHICH IT EXISTS? HOW FAR SHOULD MENTAL HEALTH SERVICES BE PROVIDED IN COMMUNITY? WHAT SERVICE COMPONENTS ARE NECESSARY ?

COMMUNITY PSYCHIATRY
ENCOMPASSES ALL MENTAL HEALTH SERVICE SYSTEMS IN THE COMMUNITY THE AREA:
ALL ASPECTS OF CARE FROM HOSPITALIZATION CASE MANAGEMENT CRISIS INTERVENTION DAY TREATMENT SUPPORTIVE LIVING ARRANGEMENTS

COMMITMENT OF COMMUNITY PSYCHIATRY

IS TO CONTINUITY OF CARE AND THE PROVISION OF TREATMENT FOR THE PATIENT AS CLOSE TO HOME AS POSSIBLE AND WITHIN THE CATCHMENT AREA.

THE PRINCIPLES OF COMMUNITY PSYCHIATRY

RESPONSIBILITY TO A POPULATION USUALLY A CATCHMENT AREA DEFINED GEOGRAPHICALLY TREATMENTS CLOSE TO THE PATIENTS HOME MULTI-DISCIPLINARY TEAM APPROACH CONTINUITY OF CARE CONSUMER PARTICIPATION COMPREHENSIVE SERVICES

 COMMUNITY PSYCHIATRY
USES PUBLIC HEALTH METHODS TO ASSESS THE PSYCHIATRIC NEEDS OF ANY SPECIFIED POPULATION, TO IDENTIFY THE VARIOUS ENVIRONMENTAL FACTORS THAT CONTRIBUTE TO OR OTHERWISE MODIFY PSYCHOSOCIAL DISORDER, AND TO EVALUATE THE AFFECTS OF THERAPEUTIC INTERVENTION ON THE IDENTIFIED PATIENT AND SOCIAL UNITS OF WHICH HE IS A PART

COMMUNITY PSYCHIATRY PRACTICE

EMPLOYS PROFESSIONALS IN ALL MENTAL HEALTH DISCIPLINES AS WELL AS INDIGENOUS NONPROFESSIONALS LOCAL CITIZEN PARTIPATION IS ENCOURAGED IN PLANING, ADVISING AND EVALUATING COMM. PSYCHIATRIST WILL AQUIRE & FORMATION FROM :
SOCIAL SCIENCES (SOCIOLOGY) ANTROPHOLOGY POLITICAL SCIENCES ECONOMIC SCIENCES

 A MULTITUDE OF OBSERVATIONS UPON THE EXTENT OF PSYCHIATRIC DISABILITY

ITS ATTENDANT EMOTIONAL STRESS UPON OTHERS ITS SOCIAL AND ECONOMIC CONSEQUENCES ITS MORE FREQUENT ACCOURENCE IN CERTAIN FORUMS AMONG THE MOST DEPRIVED

THE EMPHASIS IN COMM. PSYCH IS :

ON EXTRAPSYCHIC, INTERPERSONAL, ENVIRONMENTAL , AND CULTURAL FORCES THAT ENGENDER, PRECIPITATE, INTENSITY, PROLOG, OR OTHERWISE COMPLICATE, MALADAPTIVE PATTERN AND THEIR RESPONSE TO TREATMENT

SOCIAL PSYCHIATRY IS
DEFINED AS THE RESEARCH EFFORT TO DISCOVER NEWER METHODS TO DELINEATE AND SUGGEST INFORMATION REQUIRED IN THE PRACTICE OF PSYCHIATRY

 CHANGES ARE SOUGHT IN THE SOCIAL SETTINGS , EITHER IN SMALL OR IN LARGE GROUPS , THAT WOULD SURTAIN MENTAL HEALTH , PREVENT MENTAL DISABILITY OR EXPAND THERAPEUTIC OR SOCIAL REHABILITATIVE INTERVENTION

HISTORY OF COM. MENTAL HEALTH

IN 1963 THE CONSTRUCTION OF COMMUNITY MENTAL HEALTH CENTERS EACH CENTER MUST PROVIDE FIVE BASIC PSYCHIATRIC SERVICES:
INPATIENT CARE EMERGENCY SERVICES (ON A 24 HOUR BASIS) COMMUNITY CONSULTATION DAY CARE (INCLUDING PARTIAL HOSPITALIZATION PROGRAMS, HALFWAY HOUSES, AFTER CARE SERVICES, A BROAD RANGE OF OUT PATIENT SERVICES) RESEARCH and EDUCATION

IN 1975
ADDED THE REQUIREMENTS OF SERVICES
FOR CHILDREN OLDER PERSONS PREHOSPITALIZATION SCREENING FOLLOW UP SERVICES FOR THOSE WHO HAVE BEEN HOSPITALIZED TRANSITIONAL HOUSING ALCOHOLISM AND DRUG ABUSE SERVICES

IN 1980
THE PRACTICE OF PSYCHIATRY IN CENTER

BASIC CONCEPTS IN COMMUNITY MENTAL HEALTH

COMMITMENT SUGGESTS THE PLAN SHOULD IDENTIFY ALL THE MENTAL HEALTH NEEDS OF THE POPULATION INVENTORY THE RESOURCES AVAILABLE TO MEET THESE NEEDS ORGANIZE A SYSTEM OF CARE CITIZENS AND POLITICAL FIGURES SHOULD BE INVOLVED IN THE PLANNING PROCESS PREVENTION IS AT LEAST AS IMPORTANT AS DIRECT TREATMENT ALL THE POPULATION SHOULD RECEIVE CARE (CHILDREN, OLDER PERSONS, MINORITIES, PERSONS WHO ARE CHRONICALLY AND ACUTELY ILL, PERSONS WHO LIVE IN REMOTE AREA)

SERVICES
PUBLIC MENTAL HEALTH IS A TOTAL SYSTEM, NOT A SINGLE SERVICE TO BE EFFECTIVE MUST BE INTEGRATED AND BALANCED THE PUBLIC MENTAL HEALTH TEAM SHOULD INCLUDE:
PSYCHIATRIST CLINICAL PSYCHOLOGISTS PSYCHIATRIC SOCIAL WORKERS PSYCHIATRIC NURSES ADMINISTRATIVE ELECTRICAL STAFF MEMBERS OCCUPATIONAL AND RECREATIONAL THERAPISTS FOR INPATIENT AND PARTIAL HOSPITALIZATION PROGRAMS

LONG-TERM CARE
COMMUNITY MENTAL HEALTH PROGRAMS ENCOURAGE CONTINUITY OF CARE BECAUSE OF CONCERNS ABOUT FRAGMENTATION OF CARE AND THE TENDENCY TO KEEP PATIENTS HOSPITALIZED OR UNNECESSARILY RESTRICTED TO ONE TYPE OF SERVICE.

CONTINUITY OF CARE
CONTINUITY OF CARE ENABLES A SINGLE CLINICIAN TO FOLLOW A PATIENT THROUGH
EMERGENCY SERVICES, HOSPITALIZATION PARTIAL HOSPITALIZATION AS A TRANSITION TO THE COMMUNITY OUTPATIENT TREATMENT AS FOLLOW UP

CONTINUITY OF CARE
CONTINUITY ALSO PROVIDES AN EXCHANGE OF INFORMATION AND TEAM RESPONSIBILITY FOR THE PATIENT WHEN VARIOUS THERAPISTS, FOR REASONS OF CONVENIENCE OR ECONOMY, TREAT THE PATIENT IN SEVERAL SETTINGS. A FREE EXCHANGE OF CLINICAL INFORMATION BETWEEN CENTERS AND A LIAISON BETWEEN AGENCIES ARE ALSO PART OF THE TOTAL SYSTEM OF CARE

CASE MANAGEMENT
INTENSIVE CASE MANAGERS ARE CLINICIANS WHO CAN PROVIDE CONTINUITY OF CARE BY FOLLOWING PATIENTS THROUGH ALL THE PHASES OF TREATMENT WHILE HELPING PATIENTS NEGOTIATE A SYSTEM THAT IS COMPLEX AND FRAGMENTED. INTENSIVE CASE MANAGERS PROVIDE SUPPORT, ADVOCACY, AND SYSTEMS MANAGEMENT.

COMMUNITY PARTICIPATION
THE COMMUNITY SHOULD PARTICIPATE IN DECISIONS ABOUT ITS MENTAL HEALTH CARE NEEDS AND PROGRAMS, INSTEAD OF HAVING THEM DEFINED SOLELY BY PROFESSIONALS. MENTAL HEALTH SERVICES ARE SENSITIVE TO THE NEEDS OF THOSE SERVED IF THE PUBLIC IS ACTIVELY INVOLVED.

CONSULTATION
CONSULTATION RANGES FROM ATTENTION TO OR EVEN TREATMENT OF THE EMOTIONAL PROBLEMS OF AN INDIVIDUAL PATIENT TO USING KNOWLEDGE ABOUT HUMAN BEHAVIOR TO HELP ORGANIZATIONS ACHIEVE THEIR PROFFESIONAL GOALS WITH THE PROGRAM AND THEIR PATIENTS.

CONSULTANT
THE CONSULTANT OFFERS ASSISTANCE TO THE MENTAL HEALTH PROFESSIONAL WHO WORKS IN AN OUTPATIENT CENTER OR AGENCY. THE CONSULTANT MAY ALSO PROVIDE DIRECT EDUCATIONAL ACTIVITIES, LIAISON WITH CONSUMER AND ADVOCACY GROUPS, AND ADMINISTRATIVE SERVICES.

PREVENTION
THE DISABILITIES ASSOCIATED WITH CHRONIC MENTAL DISORDER ARE MAJOR SOCIAL, ECONOMIC AND PUBLIC HEALTH PROBLEMS THEY ARE COSTLY AND CREATE SUFFERING FOR THEIR FAMILY AND SOCIETY THE GOAL OF PREVENTION IS TO DECREASE THE ONSET (INCIDENCE), DURATION (PREVALENCE), AND RESIDUAL DISABILITY OF MENTAL DISORDERS.

CONCEPT OF PREVENTIVE PSYCHIATRY

PRIMARY PREVENTION : TO AVOID ENTIRELY THE OCCURRENCE OF A PSYCHIATRIC DISABILITY SECONDARRY PREVENTION IS TAKING THERAPEUTIC MEASURES TO RESTORE AN INDIVIDUAL SUFFERING FROM A MENTAL OR EMOTIONAL DISABILITY TO IMPROVED HEALTH OR THE PRE-EXISTING STATUS. TERTIARY PREVENTION TO ESTABLISH A MAXIMUM DEGREE OF PERSONALITY FUNCTIONING THAT ARE PERSISTENT , PROGRESSIVELY DETERIORATING , OR BATH

PRIMARY PREVENTION
THE GOAL OF PRIMARY PREVENTION IS TO PREVENT THE ONSET OF A DISEASE OR DISORDER AND THEREBY REDUCE ITS INCIDENCE (THE RATIO OF NEW CASES TO THE POPULATION IN A SPECIFIC PERIOD)

TO REACH THE GOAL OF PRIMARY PREVENTION

THE GOAL IS REACHED BY ELIMINATING CAUSATIVE AGENTS REDUCING RISK FACTORS ENHANCING HOST RESISTANCE INTERFERING WITH DISEASE TRANSMISSION

THE EXAMPLE OF PRIMARY PREVENTION

TO HELP PERSONS COPE WITH LIFE INCLUDE MENTAL HEALTH EDUCATION PROGRAMS
PARENT TRAINING IN CHILD DEVELOPMENT AND ALCOHOL AND DRUG EDUCATION PROGRAMS

EFFORTS AT COMPETENCE BUILDING

OUTWARD BOUND, HEAD START, OTHER ENRICHED DAY-CARE PROGRAMS FOR DISADVANTAGED CHILDREN

THE EXAMPLE OF PRIMARY PREVENTION

THE DEVELOPMENT AND USE OF SOCIAL SUPPORT SYSTEMS TO REDUCE THE EFFECTS OF STRESS ON NTHOSE AT HIGH RISKS WIDOW - TO - WIDOW PROGRAMS ANTICIPATORY GUIDANCE PROGRAS TO ASSISST PERSONS TO PREPARE FOR EXPECTED STRESSFUL SITUATION COUNSELING PEACE CORPS VOLUNTEERS CRISIS INTERVENTION AFTER STRESSFUL LIFE EVENTS BEREAVEMENT, MARITAL SEPARATION, DIVORCE, TRAUMAS, DISASTERS

THE AIM OF PRIMARY PREVENTION PROGRAM

ERADICATING STRESSFUL AGENTS AND REDUCING STRESS SUCH PROGRAMS INCLUDE PRENATAL AND PERINATAL CARE TO DECREASE THE INCIDENCE OF MENTAL RETARDATION AND COGNITIVE DISORDERS IN CHILDREN
ADVICE ABOUT IMPROVED NUTRITION AND ABSTINENCE FROM ALCOHOL AND OTHER SUBSTANCES DURING PREGNANCY, IMPROVED OBSTETRICAL SERVICES.

PRIMARY PREVENTION PROGRAMS (CONT.)

STRICT LEAD-ELIMINATION LAWS TO REDUCE THE INCIDENCE OF LEAD ENCEPHALOPATHY MODIFICATION OF DIVORCE ADOPTION CHILD ABUSE LAWS TO PROVIDE A HEALTHY ENVIRONMENT FOR CHILD DEVELOPMENT ENRICHMENT OR REPLACEMENT OF INSTITUTIONAL SETTINGS FOR INFANTS, CHILDREN AND OTHER PERSONS

PRIMARY PREVENTION PROGRAMS (CONT.)

MODIFICATION OF CERTAIN RISK FACTORS FOR MENTAL DISORDER THAT APPEAR TO BE ASSOCIATED WITH LOW SOCIOECONOMIC STATUS GENETIC COUNSELING FOR PARENTS AT HIGH RISK FOR CHROMOSOMAL ABNORMALITIES TO PREVENT THE UNWITTING CONCEPTION OF COMPROMISED INFANTS EFFORTS TO REDUCE THE SPREAD OF CERTAIN SEXUALLY TRANSMITTED DISEASES THAT CAN LEAD TO MENTAL DISORDERS ( AIDS AND SYPHILIS)

SECONDARY PREVENTION
IS DEFINED AS THE EARLY IDENTIFICATION AND PROMPT TREATMENT OF AN ILLNESS OR DISORDER, WITH THE GOAL OF REDUCING THE PREVALENCE (THE PROPORTION OF EXISTING CASES IN THE POPULATION AT RISK AT A SPECIFIED TIME) OF THE CONDITION BY SHORTENING ITS DURATION

COMPONENTS OF SECONDARY PREVENTION

CRISIS INTERVENTION PUBLIC EDUCATION TO REDUCE STIGMA TO ALLOW PERSONS TO SEEK TREATMENT EARLIER

TERTIARY PREVENTION
THE GOAL OF TERTIARY PREVENTION IS
TO REDUCE THE PREVALENCE OF RESIDUAL DEFECTS AND DISABILITIES CAUSED BY AN ILLNESS OR A DISORDER

IN THE CASE OF MENTAL DISORDERS, TERTIARY PREVENTION ENABLES THOSE WITH CHRONIC MENTAL ILLNESS TO REACH THE HIGHEST FEASIBLE LEVEL OF FUNCTIONING

ADDRESSES OF TERTIARY PREVENTION IN PSYCHIATRY

PATIENTS SUFFERING FROM THE MOST SEVERE AND DEBILITATING ILLNESS:
SCHIZOPHRENIA THE MOST SEVERE AFFECTIVE DISORDERS THE MOST DISABLING PERSONALITY DISORDERS RESIDUALS IN MANY CASES
THE PERSONS CAN HAVE A WIDE RANGE OF PSYCHOLOGICAL DEFICITS THAT IMPAIR THEIR ABILITY TO INTERACT WITH OTHERS, HANDLE THE USUAL STRESSES OF DAILY LIFE, AND ACHIEVE THEIR POTENTIAL

PSYCHIATRIC REHABILITATION
INVOLVES:
A COMPLEX PROCESS IN WHICH THE PROFESSIONAL ATTEMPTS TO ADDRESS THE PSYCHOLOGICAL, SOCIAL, AND OFTEN THE MEDICAL NEEDS OF THE PATIENT SIMULTANEOUSLY

MODERN PUBLIC PSYCHIATRY ATTEMPTS TO LIMIT THE LENGTHS OF HOSPITALIZATION NBY RAPID INTERVENTION AND MAINTAIN SOCIAL SUPPORT SYSTEMS EVEN WHEN PATIENTS ARE ACUTELY ILL

REHABILITATION
IS OFTEN ONGOING DYNAMIC PROCESS CARRIED OUT FOR THE PATIENTS LIFETIME BECAUSE OF THE CHRONIC RELAPSING NATURE OF MANY TYPES OF MENTAL ILLNESS, ESPECIALLY SCHIZOPHRENIA

INDICATIONS FOR HOSPITALIZATION

ARE DETERMINED BY FACTORS WITHIN THE INDIVIDUAL PATIENT
SEVERITY OF THE ILLNESS LEVEL OF AWARENESS OR INSIGHT REGARDING THE ILLNESS THE CAPACITY TO CERTAIN IMPULSIVE DESTRUCTIVE BEHAVIOR FACTORS IN THE ENVIRONMENT SUCH AS PRESENCE OR ABSENCE OF SUPPORT INTENSITY OF ONGOING STRESSORS

INDICATIONS FOR HOSPITALIZATION

IN GENERAL HOSPITAL TREATMENT IS INDICATED WHEN PATIENTS ARE SO SEVERELY DISTURBED THAT SOMEONE ELSE MUST STEP IN AND PROTECT THEM FROM HARMING SELF OR OTHERS AND THEIR ENVIRONMENT CANNOT PROVIDE THIS PROTECTION

THANK YOU