DEVELOPMENT COMMUNICATION MODEL IN THE COASTAL IRAN ISLAMIC

HEALTH BASED ON MENTAL HEALTH / PERSONALITY

Widyawati Sasmita1, Junuda RAF2

1
Doctor's Professional Study Program, Faculty of Medicine, Halu Oleo University
2
Department of Psychiatry, Faculty of Medicine, University of Halu Oleo

Corresponding Author E-mail: widyawatisasmita@gmail.com

ABSTRACT
Background: Coastal communities are various parties (both individuals, groups of institutions, and
legal entities) who live in coastal areas and have their livelihoods from natural resources and coastal
environmental services. Mental disorders are a major public health problem and contribute to 13% of the
global burden of disease measured as years of life adjusted for disability. Iran is a large country located in the
Middle East with a population of over 75 million. Iran is classified as an upper middle-income country with a
per capita GNI of 4,520 US $ in 2009 and ranks 88th in terms of the human development index. Discussion: In
doing psychotherapy, the interview should prioritize the therapeutic aspects, the required data will gradually be
collected with the improvement of the interpersonal relationships that exist between doctors and their patients,
so that the meaning of an interview depends on the nature of the therapist's relationship with the patient.
screening patients compared to control areas. The 15 years of expanding the integration of mental health into
Puskesmas have resulted in major improvements in the delivery of mental health services in rural areas.
Regular monitoring of mental health activities is carried out through routine reporting and statistical analysis
as well as regular field visits by responsible professionals in the province and head office in Tehran. An
independent evaluation was carried out by the World Health Organization's Regional Office for the Eastern
Mediterranean. Conclusion: Iran's experience of mental health reform in the country is multifaceted. The
integration of mental health care in the primary health care system is an impressive achievement. The breadth
of coverage, especially in rural areas means that with the necessary infrastructure and political will, mental
health can be integrated into primary health services.
Keywords: development communications, Iranian coast, mental health

ABSTRAK
Latar Belakang: Masyarakat pesisir adalah berbagai pihak (baik perorangan, kelompok lembaga, maupun
badan hukum) yang bermukim di wilayah pesisir dan memiliki mata pencaharian yang berasal dari
sumberdaya alam dan jasa-jasa lingkungan pesisir. Gangguan mental merupakan masalah kesehatan
masyarakat yang utama dan berkontribusi pada 13% dari beban global penyakit yang diukur sebagai tahun
hidup yang disesuaikan dengan kecacatan. Iran adalah negara besar yang terletak di Timur Tengah dengan
populasi lebih dari 75 juta. Iran diklasifikasikan sebagai negara berpenghasilan menengah ke atas dengan GNI
per kapita sebesar 4.520 US $ pada tahun 2009 dan menempati urutan ke-88 dalam hal indeks pembangunan
manusia. Pembahasan: Dalam melakukan psikoterapi, wawancara harus lebih mengutamakan aspek
terapeutiknya, data yang diperlukan akan berangsur terkumpul dengan kian membaiknya hubungan
interpersonal yang terjalin antara dokter dengan pasiennya, sehingga berartinya suatu wawancara tergantung
dari sifat hubungan terapis dengan pasiennya tersebut Dari 1988 -1990 studi di pusat Republik Islam Iran
menunjukkan peningkatan signifikan pengetahuan petugas kesehatan dan peningkatan keterampilan dalam
skrining pasien dibandingkan dengan area kontrol. 15 tahun perluasan integrasi kesehatan mental dalam
Puskesmas telah menghasilkan perbaikan besar dalam penyediaan layanan kesehatan mental di daerah
pedesaan. Pemantauan rutin kegiatan kesehatan mental dilakukan melalui pengambilan laporan rutin dan
analisis statistik serta kunjungan berkala ke lapangan oleh para profesional yang bertanggung jawab di
provinsi dan kantor pusat di Teheran. Evaluasi independen dilakukan oleh Kantor Wilayah Organisasi
Kesehatan Dunia untuk Mediterania Timur. Kesimpulan: Pengalaman Iran tentang reformasi kesehatan mental
di negara itu memiliki banyak aspek. Integrasi perawatan kesehatan mental dalam sistem perawatan kesehatan
primer merupakan pencapaian yang mengesankan. Luasnya cakupan, terutama di daerah pedesaan
menunjukkan bahwa dengan infrastruktur dan kemauan politik yang diperlukan, kesehatan mental dapat
diintegrasikan ke dalam layanan kesehatan primer.
Kata Kunci: komunikasi pembangunan, pesisir Iran, kesehatan jiwa

PRELIMINARY
Coastal communities are various
parties (both individuals, groups of
institutions, and legal entities) who live in
coastal areas and have their livelihoods
from natural resources and coastal
environmental services. Based on the basis
of residence and livelihood, components of
coastal communities can be mapped,
namely fishermen, fish farmers, owners or
workers in the tourism industry, owners or
workers of the tourism industry, owners or
workers of sea transportation companies,
mining and energy owners and workers,
maritime industry owners and workers.
Shipyard. (Effendy, 2009).
Mental disorders are a major public
health problem and contribute to 13% of
the global burden of disease measured as
years of life adjusted for disability. Low
and middle income countries have a higher
mental burden than economically
developed countries. Mental disorders
have serious negative effects on survival,
and when present with chronic disease as a
concomitant condition, serious mental
disorders can reduce life expectancy by
about 20 years. Mental disorders are
generally not perceived as a health
problem and are not a priority in providing
health services.
Iran is a large country located in the
Middle East with a population of over 75
million. Iranians come from an Indo-
European race and their official language
is Persian. More than 71% of the
population lives in urban areas and around
99% is Muslim. The adult literacy rate is
85%. Iran is classified as an upper middle-
income country with a per capita GNI of
4,520 US $ in 2009 and ranks 88th in
terms of the human development index.
The spring of 2016 showed that the
Iranian economy has recovered from last
year's weak growth, particularly in the
fast-growing oil sector. In the 2012-2013
period, at 6.8 percent and 1.9 percent,
respectively, and rising again in 2014, the
Iranian economy slowed to an estimated
annual growth rate of 0.6 percent in 2015
ahead of the adoption of the Joint
Comprehensive Plan of Action. (JCPOA).
Economic indicators are showing early
signs of economic recovery, with the first
quarter of 1395 (as of April - Jun 2016)
growth of 5.4 percent. This strong
performance was largely due to the
accompanying increase in oil production
and oil exports, with the oil sector
accounting for around 19 percent of GDP
in 2011-2015.
Overall 3% of health care spending
by the government health department is
devoted to mental health. Of all
expenditure spent on mental health, 18%
went to mental hospitals. A mental health
bill has been prepared and will be
submitted to parliament in 2007. There are
33 mental hospitals available in the
country with a total of 7.9 beds per
100,000 population.
In recent years, steps have been
taken to improve access and utilization of
services in urban areas. Mental health
promotion and prevention has been on the
agenda. The coverage in urban areas
through the involvement of health
volunteers has more than doubled so that
development in coastal areas is needed so
that it can overcome the problems that
occur so that people can return to looking
for income through the personality-based
coastal areas that exist in the coastal
communities of Iran.
DISCUSSION
A. Personality Disorders
Personality disorders are
personality traits that are inflexible and
maladaptive that cause meaningful
dysfunction and subjective suffering.
People with personality disorders have
completely rigid responses to personal
situations, relationships with other
people or their surroundings. This
rigidity prevents them from adjusting
to external demands, so that in the end
the pattern is self-defeating.
Personality disorders differ from
personality changes in the timing and
manner in which they occur in that
they are a developmental process,
which occurs during childhood or
adolescence and continues into
adulthood. (Sari, 2016)
At any time, 450 million people
worldwide have the potential to
develop personality disorders due to
mental, nervous, and behavioral
problems. (Sari, 2016)
B. Iranian Coastal Areas
Iran is located in southwest
Asia, covering a vast area of 1,648,000
km2 of the strategic and oil-rich areas
of the Middle East. Iran is connected to
the high seas via the Persian Gulf and
the Strait of Hormoz, which connects it
to the Sea of Oman and the Indian
Ocean. To the north of Iran lies the
world's largest closed waterway, the
Caspian Sea, where Iran's three coastal
provinces are located. While the
weather south of the Caspian Sea is
temperate, humid and usually very
pleasant, the weather on the coast of
the Persian Gulf and the Sea of Oman
is hot, dry, and unfavorable. These
large climatic differences lead to huge
differences in lifestyle, culture and
levels of development. Three provinces
in northern Iran are overpopulated and
considered one of the country's most
attractive regions for tourists,
especially in summer. These provinces C. Development Communication Model
enjoy having good infrastructure and in the Coastal Region and its
can provide relatively good services to Relation to Personality Patterns in
the millions of people who choose the Iranian Territories
north coast for their holidays. On the The communication model is
other hand, the four southern provinces an authentic result of a systematic
of Iran that are connected to the study of various aspects of
Persian Gulf and the Sea of Oman, communication. The communication
except Khuzestan, are undeveloped, model provides a healthy
coastal cities are sparse, income levels understanding of the system or
are low, and the coastline is almost structure by which people can
untouched. understand similar systems or
The southern coastal region of structures.
the Caspian Sea has enormous reserves The interactional model
of groundwater and surface freshwater. illustrates that a person can be both
The people in this area are farmers. sender and receiver in an interaction,
Rice, tea, cotton, olives, and fruits are but cannot be both at once, whereas the
the main products of this area so that transactional model is cooperative,
these three provinces become one of both sender and receiver are equally
the main agricultural pillars of the responsible for the impact and
country. About 30% of this area is effectiveness of the communication
irrigated agricultural land. Forests that occurs. Thus, the transactional
cover 55.5%, grasslands cover 13%, model makes communication more
and the rest are mostly gardens and effective.
fruit yards. Surface water resources The interactional model does
vary from 4000 million m3 in the west not run dynamically so feedback that is
to 1,235 million m3 in the east. The indirect, occurs delays and takes a long
same trend also occurs in groundwater, time and feedback does not occur
which is estimated to be around 2000 simultaneously, while the transactional
million m3 in the west to 1200 million model with dynamic communication
m3 in the east. All water is consumed and face-to-face communication means
by the agricultural and industrial that verbal and nonverbal responses
sectors. can be known directly. .
 For psychotherapy itself, it is patients compared to the control area.
done by means of conversation or The 15 years of expanding the
interview (interview). In an interview, integration of mental health into
there is no separation between Puskesmas have resulted in major
therapeutic properties and diagnosis. improvements in the delivery of mental
Usually, the questions posed contain health services in rural areas.
both aspects, namely to optimize the There is a simple information
interpersonal relationship with the system for mental disorders like
patient (therapeutic properties), and to psychosis, depression, epilepsy, mental
complement the data in an effort to retardation, etc. There are also mental
make a diagnosis. In conducting health reporting systems in the health
psychotherapy, interviews should network. Regular monitoring of mental
prioritize the therapeutic aspects, the health activities is carried out through
required data will gradually be routine reporting and statistical
collected as the interpersonal analysis as well as regular field visits
relationships that exist between doctors by responsible professionals in the
and patients are improving, so that the province and head office in Tehran. An
meaning of an interview depends on independent evaluation was carried out
the nature of the therapist's relationship by the World Health Organization
with the patient. Regional Office for the Eastern
Mental health policies and Mediterranean in 1995. The study
programs were originally formulated in included field surveys and data
1986. Its main components are collection from 266 multipurpose
advocacy, promotion, prevention, health workers (behvarz) and health
treatment and rehabilitation. The main homes, 91 general practitioners and
strategy is to integrate mental health rural health centers, and 737 families
programs into the Primary Health Care living in the rural environment where
system. From 1988 to 1990 successful mental health programs are run.
pilot studies were implemented in Iran's experience of mental
Shahr-e-Kord and Shahreza in the health reform in the country is
center of the Islamic Republic of Iran, multifaceted. The integration of mental
which showed a significant increase in health care in the primary health care
the knowledge of healthcare workers system is an impressive achievement.
and increased skills in screening The breadth of coverage, especially in
rural areas suggests that with the
necessary infrastructure and political
will, mental health can be integrated
into primary health care. Public health
workers are capable of providing basic
mental health care, provided they are
trained and supervised and supported
by an appropriate referral system.
After the system was created, mental
health professionals worked closely
with it. The success of this integration
program is highly dependent on the
existence of a well-structured health
system.
Empathy plays an important
role in creating a therapeutic
relationship. Empathy is defined as the
ability to understand the patient's
condition and transfer these
perceptions to the client so that the
client realizes love (caregiver).
Other researchers stated that
the ability of empathy helps nurses and
patients build trust and connect with
each other in two-way interpersonal
communication. Implementing
strategies such as showing kindness,
using therapeutic touch, maintaining
boundaries, and respecting patient
privacy are the principles of cultivating
trust in patients while providing
professional care. In addition, nursing
training must have flexible behavior in
front of the patient, who experiences
the physical and psychological effects
of the disease as well as the emotional
and financial burden of hospitalization.
This point is especially important
during communication with patients
who have been hospitalized for a long
time and have recurrent chronic
illnesses.
Iranian nursing students
tolerate moody and emotional
outbursts of patients and try to
maintain their composure during
interactions. They do not reply to the
patient's unwanted words and behavior
with angry tones and harsh words as
this can lead to worse arguments. They
use strategies such as keeping quiet
and expressing casual phrases to calm
angry patients, especially in psychiatric
wards. Also, in another Iranian study,
it was reported that Iranian nurses used
the same strategy and they did not
report inappropriate patient behavior to
higher authorities even in cases of
verbal and physical abuse.
CONCLUSION
Iran's experience of mental health
reform in the country is multifaceted. The
integration of mental health care in the
primary health care system is an
impressive achievement. The breadth of
coverage, especially in rural areas means
that with the necessary infrastructure and
political will, mental health can be Johar A, Hartuti P, Palupi DD. 2011.
integrated into primary health services. Implementasi Metode Frame untuk
Mendiagnosa Gangguan
SUGGESTION Kepribadian Dramatik
As for the suggestions that can be Menggunakan Sistem Pakar. Jurnal
given, the Iranian government in this case Rekursif. 2(2): 1 – 5.
needs to pay full attention to the coastal
Marty, A. M., Segal, D.L. 2015. DSM-5:
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Diagnostic and Statistical Manual
questions regarding the development that
of Mental Disorders. The
will be carried out, express their opinions
Encyclopedia of Clinical
regarding the development that will be
Psychology. 1 – 7.
carried out.
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