Depresi di masa

pandemi COVID-19:
tatalaksana di tingkat
komunitas
Dr. Hervita Diatri, Sp,KJ, Subsp. Kom(K), FISQUA
Staf Pengajar Divisi Psikiatri Komunitas, Trauma, dan
Rehabilitasi Psikososial
Departemen Psikiatri FKUI/RSCM
Perbandingan Data Dunia vs Indonesia
Data Gangguan Jiwa Secara Umum

Pandemi
+ 25 – 27%

Treatment gaps 91%

WMHR, 2022; Riskesdas, 2018; PDSKJI, 2022; MoH, 2023

Beban akibat gangguan jiwa

16

WMHR, 2022; Amani, 2023; IHME, Global Burden of Disease, 2017 dan 2020
Disrupsi Layanan di Masa Pandemi

The D, 2022; Ransing, 2020

Apa yang perlu dilakukan?
 Arahan Internasional…

WMHR, 2022
 Arahan Internasional…

WMHR, 2022
 Arahan Internasional…
People Needing Mental Health Support

2% Hospital
8%

Community
Mental Health
Centres
33% Primary Care
57%

Community and
Family

WMHR, 2022, Goldberg and Huxley, 1980

 Arahan Internasional…

WMHR, 2022; Kestel, 2023

 Arahan Internasional…bentuknya???

PSYCHIATRIC ACUTE
DAY CENTRES
INPATIENT WARDS
PEER SUPPORT AND CRISIS SUPPORT
CENTRES

COMMUNITY
MENTAL HEALTH
CENTRE
PRIMARY CARE

SUPORTED LIVING
INCLUDING HALF-WAY
HOMES

Suzzana, 2023; WMHR, 2022

STRUCTURES PURPOSE

PEOPLE
 People dedicated to co-ordinating the full range of mental
health support for people living in a local community

A place where people

can go during the day for
An appropriate place in the
support, treatment,
local community for
activities and company
admission of people requiring
immediate treatment for
acute mental health problems Provision of support for
people at an early stage
of their recovery from
acute mental ill health
Community
A range of different
mental health options for
service PURPOSE accommodation
Support from people with various levels
or FUNCTIONS who have of support
experienced mental
health problems
Suzzana, 2023; WMHR, 2022
Core components of a community-based mental health systems
Every administrative district should have a network of community-based mental health services.
• Offer outpatient department mental health support including outreach clinics.
Community Mental • Support primary health care through technical support, medication supply, capacity building,
Health Centres supportive supervision, referral and back-referral.
• Work with the wider network of support in local communities, including families and caregivers.
Psychiatric Acute • Treatment of people in acute phases who cannot be managed at home.
Inpatient Wards and • Short stay admissions.
Crisis Support Centres • Treatment and care to relieve acute episodes.
• Provide psychosocial rehabilitation.
Rehabilitation or • Improving functioning (self-care) and participation
Intermediate Care • Participating in daily living skills
Centres
• Skills training
Independent and • Independent group homes
supported living, • Possible permanent home for patients discharged from Institutions.
including half-way • Very sheltered nursing home for patients with few living skills and poor self-care
homes. • Possible secure environment for patients presenting risks to themselves or others.
• Daily support, supervision, and monitoring of patients.
• Non-restrictive, friendly, low pressure therapeutic environment. Meaningful contact.
Day Care • Offer support and advice on practical problems.
• Daily meals, social events (groups and clubs), recreation, occupational and vocational skills
training.
Peer Support (recovered • People with lived experience and other lay workers to provide practical and emotional support.
patients, non- • Based in and liaise with community mental health centre staff. Follow up.
professional staff, • Run support groups for people with similar problems.
volunteers) • Support families
 Arahan Regional…
Paro Declaration • Strengthening capacity of PHC → UHC
Paro, September 2022 • Establishing community mental health networks & plan
the process of deinstitutionalization
• Expand specialized and nonspecialized MH workforce
(multidisciplinary teams)
• Strengthen prevention and promotion programmes
• Ensure allocation of resources
• Strengthen data
• Lead multisectoral MH response

Mental Health Summit

Rome, October 2022
Deinstitutionalization

Regional Meeting - Development of the Recommendation to establish National Mental Health

WHO SEAR Mental Health Action Plan Action Plan in line with Regional Mental Health Action
Krung Thep Maha Nakhon, April 2023 Plan 2023-2030 and Paro Declaration

Regional Meeting - Expanding Community Recommendation to establish National Mental Health

Mental Health Services
Colombo, June 2023 Action Plan
Kemenkes, 2023 16
Arahan Nasional
Sosok yang dipilih oleh komunitas…
Follow up
•Follow up post discharge
•Dukungan piutang
•Outreach
Follow up
Promosi Keswa
•Aktivitas promosi
•Kelompok pemberdayaan – pasien
dan pelaku rawat
•Prevensi penyalahgunaan zat
Deteksi kasus depresi
Deteksi •Membantu identifikasi gejala awal dan
Kasus kekambuhan
•Kunjungan rumah dan asesmen psikososial
•Edukasi awal tentang depresi
•Berkomunikasi dengan keluarga/orang terdekat
•Berkontribusi dalam penilaian kebutuhan
Manajemen
kasus dan
rujukan
Manajemen kasus dan rujukan
•Rujukan ke layanan kesehatan dan lainnya
- termasuk LSM
•Konseling dan dukungan untuk pelaku
Promosi rawat
Keswa •Membantu untuk akses ke sumber daya
•Pola hidup sehat → bantuan psikososial
dasar Kemenkes India, & Sri Lanka, 2023
Kunci Pengembangan Kesehatan Jiwa Masyarakat untuk Manajemen Depresi
• Mengapa komunitas → respect, dignity, kindness, humanity and
hope → pemulihan lebih memungkinkan
• Keluarga membutuhkan bantuan → edukasi untuk pemberdayaan.
• Semua orang ingin mendapatkan bantuan → di mana mereka
berada
• Semua orang tidak ingin diambil “kebebasannya” tanpa proses
konsultasi yang memadai. Negosiasi dan pemberdayaan →
hubungan terapeutik.
• Tujuan pengembangan sistem → membangun perilaku dan
memberikan keterampilan
• Kebutuhan ada di berbagai settings – semua sektor memiliki
peran.
• Menyediakan layanan yang meningkatkan pengalaman pasien dan
keluarga
hervita94@yahoo.com
08567942962