Kesehatan Mental Komunitas

Usmi Karyani
Magister Psikologi Profesi
Universitas Muhammadiyah Surakarta
Mental Health as
a Public Health
Health & Mental Health?

WHO:

Health is a state of complete physical,

mental and social well-being and not merely
the absence of disease or infirmity

Mental health is defined as a state of well-

being in which every individual realizes his
or her own potential, can cope with the
normal stresses of life, can work
productively and fruitfully, and is able to
make a contribution to her or his
community.
Mental Health
Traditional Model/Medical
Perspective
• Absence of mental disorder/mental illness
• Focused on diagnosis, treatment, etiology
• Dichotomies mental health – mental
illness perspectives
Contemporary Public Health Perspective
• A state of well-being, fulfilling functions (personal,
family, community)
• Focused on surveillance of mental health within the
population at large; mental health promotion and
illness prevention; person-environment links; access
to service; and evaluation of service
• Health – illness continuum perspective
Mental Health – Mental Illness - Mental Health Problems

• A state of successful performance functions, resulting in productive activities, fulfilling

Mental Health
relationships with other people, and ability to adapt to change and to cope with adversity.
• Is indispensable to personal wellbeing, family & relationships, and contribution to community or
society

• Is the term that refers collectively to all diagnosable mental disorders (= are conditions that are
Mental Illness characterized by alterations in thinking, mood, or behavior / or combination thereof, associated
with distress and/or impaired functioning

Mental Health • Is the term used for signs and symptoms of insufficient intensity or duration to meet criteria for
any mental disorder

Problems • Almost everyone has experienced mental health problems in which the distress one feels
matches some of the signs and symptoms of mental disorder.
 Example: Mental Health Continuum
Mental Health Problems
Aspect Mental Illness Languishing (poor Moderately Mentaly Complete Mental
mental health) Health Health/Wellbeing/Flo
urishing
Social adjustment Severe impairment Difficult Ups & down Adjusts to social
situations
Coping skill Restricted, Ineffective / Difficult Adapts to environment
dependency, crisis inconsistence
Emotional responses Severe Restricted, extreme, in- Inconsistent Appropriate emotional
disproportionate appropriate responses
Mood control Seriously impairs day- Swings, sad, irritability Fluctuation Controls mood
to-day functioning
Thought patterns Bizarre/illogical Intrusive or obsessions Preoccupations, Thought consistent,
worries, frustrations with goal, intentions
beliefs
Biological patterns Severe disruptions Consistent disruptions Minor disruptions Regular biological
(sleep, eating, etc) patterns
Mental Health Needs: children & adolesence

Psikiatric Disorder (DSM) Social Morbidities

• Health problems resulting from behavioral,
- Anxiety disorder
- Depression & suicidal
- Conduct problem
- ADHD
social, environmental factors related to
lifestyle
• Suicide tendency
• Violance
• Substance abuse (Drugs, alcohol,
tobbaco) and its related unintentional
injuries (motor vehicle injuries)
• Sexual activity ( pregnancy,
birth,abortion,) and sexual transminted
desease (HIV/AIDS, ect)
• Poverty (school difficulties, teenager
pregnancy, unemployment, ect)
• Diet
Public Heath

 Public health is about improving the

health of the population through
preventing disease, prolonging life and
promoting health

 It achieves these aims by working in

partnership with public, private and
voluntary sector organisations and
with communities and individuals
Public Mental Health: why important?

Mental disorder has a range of significant

impacts

Mental disorder results in economic costs (and is

costly to treat)

Levels of mental disorder are projected to

increase

Mental wellbeing has a broad range of impacts

 Public Mental Health: why important?
• Mental disorder is responsible for the largest burden of disease – 23% of the total burden ( compared
to 16% for cancer and 16% for heart disease)
Mental disorder • Mental disorders are very common :
has a range of • 10% of 5 to 16 year-olds have a mental disorder (anxiety, depression, conduct)
significant • 18% of adults have a common mental disorder, 6% alcohol dependence and 3% drug dependence3
impacts • 25% of older adults have depression requiring intervention15
• dementia affects 20% of people aged over 80
• Mental disorders arise early in the life course
• 50% of lifetime mental illness (except dementia) arises by age 14
• 75% of lifetime mental illness arises by the mid-20’s
• 40% of young people experience at least one mental disorder by age 16
• Mental disorders result in broad range of impacts
• poorer educational achievement
• higher risk of homelessness
• higher unemployment
• higher rates of debt problems
• increased suicide and self harm
• increased health risk behaviours, including poor diet, and less exercise (• increased risk of physical illness : of
coronary heart disease and diabetes)
• higher prevalence of smoking, drug and alcohol misuse
Mental disorder
results in economic
costs (and is costly The annual cost of mental disorder is estimated 11% from national budget
to treat)
Public Mental Health: why important?
• Levels of mental disorder are • By 2026: The number of people who experience a mental
projected to increase disorder is projected to increase by 14%

• Improved resilience and ability to cope with adversity

• Reduced emotional and behavioural problems in children and adolescents
• Mental wellbeing has a broad
• Reduced levels of mental disorder in adulthood
range of impacts
• Reduced suicide risk
• Better general health
• Less use of health services and reduced mortality in healthy people and in
those with established illnesses
• Improved educational outcomes
• Healthier lifestyle and reduced health risk behavior, including reduced
smoking and harmful levels of drinking
• Increased productivity at work56,57, reduced absenteeism58,59 and
reduced burnout51 • higher income
• Stronger social relationships
• Increased social/community participation
• Reduced antisocial behaviour, crime and violence
Public mental health involves:

1. An assessment of the risk factors for Key words:

mental disorder, the protective factors
for wellbeing, and the levels of mental
disorder and wellbeing in the local
population Risk Factors – Protective
2. The delivery of appropriate interventions Factors
to promote wellbeing, prevent mental
disorder, and treat mental disorder early
3. Ensuring that people at ‘higher risk’ of
mental disorder and poor wellbeing are Promotion - Prevention
proportionately prioritised in assessment
and intervention delivery
Implications of Public Mental Health Perspective
a. Comprehensive service provision
(continuum of services, from Key words:
promotioan - prevention to
treatment)
b. An ecological model (takes into account Promotion – prevention – treatment
of social, cultural, and physical
environmental factors) Ecological model
c. Provision to service that easily to
accessed by general population (eg:
through public facilities: schools; public Public facilities
health care center, ect)
d. Science base approach to practice that Ongoing evaluation
includes ongoing evaluation
Risk & Protective
Factors
Determinants of mental health and well-being (WHO)

• Individual : Relate to a person's innate

Individual (biological, emotional, social factors)
attributes
• Social & economical :
• Relate to immediate social surroundings
(including their opportunity to engage
positively with family members, friends or
colleagues, and earn a living for themselves
Mental and their families) and
Health & • opportunities to gain an education and
income
Wellbeing
Social & • Environment : The wider sociocultural and
Environment
s Factors
economical
circumstance
geopolitical environment in which people live
s can also affect
• access to basic commodities and services
• discrimination, social or gender inequality
and conflict
Risk and Protective Factors

• a characteristic at the biological, psychological,

Risk family, community, or cultural level that precedes

and is associated with a higher likelihood of

factors
problem outcomes.
• A condition that increase the probability of a
disorder

• a characteristic at the biological, psychological,

Protective
family, or community (including peers and culture)
level that is associated with a lower likelihood of
problem outcomes or that reduces the negative

Factors impact of a risk factor on problem outcomes

• A condition that inhibits, reduce, or buffers the
probability os a disorder
Level Risk factors Protective factors

Individual • Low self esteem • Self esteem, confidence

• Cognitive/emotional immaturity • Ability to solve the problems and
• Medical illness, substance use manage stress
• Physical health, fitness

Social • Loneliness • Social support of family & friends

• Neglect, family conflict • Good parenting/family interaction
• Low income & poverty • Economic security
• Work stress, unemployment • Satisfaction, success at work

Environmental • Injustice and discrimination • Social justice, tolerance, integration

• Exposure to disaster • Physical security & safety
Risk & Protective Factors: Children & Adolescence Mental Health
Promotion – Prevention - Treatment

• As efforts to enhance health/mental health but to optimize it, and it

Promotion does so not just to prevent health problems but to enhance overall life
quality, as well as social and economic productivity
• Focus on well-being rather than prevention of illness and disorder

Prevention
• As efforts that prevent the initial onset of a mental disorder,
emotional/behavioral problem, or a co-morbid disorder
• Universal, selected, targeted

Treatment • As efforts to alleviate the distress and suffering mental health problem
and support the return to healthy development and behavior
Promotion - Prevention
Promotion
• Driven by a focus on the enhancement of
health and well-being
• The goal of promotion is to optimize
health in order to improve quality of life
and maximum productivity
• Does not require a specific problem be
identified
Prevention
• Operates from an illness model based on
reducing problems, disorders, and risk
• The goal of prevention is to minimize the
development of health problems
• Dependent on the identification of a
problem
Prevention - Treatment
Purpose of
intervention
Prevent future cases of
disorder
Prevent future cases of
disorder
Prevent future cases of
disorder
Reduce symptom, cure
disorder, limit diasability
Show progression of
disorder and minimiz
complications
Population of Focus for Traditional IOM Categories
the Intervention Intervention category
Whole population Primary Prevention Universal Prevention
Sub population with Primary Prevention Selective Prevention
elevated risk
Sub population showing Primary Prevention Indicated Prevention
some symptom but not
diagnosable disorder
Subpopulation with Secondary prevention Treatment
disorder, but often
undetected and with
mild manifestations
Population with full- Tertiary prevention Treatment
blown disorder
Community Based Intervention

1. Ecological perspective
2. Bottom up approach -
Participatory methods
3. Social justice etic
Ecological
Perspective
Russian Doll Urie Bronfenbrenner
 Ecological Perspective
• the system closest to the person and the one in which they have direct contact.
Some examples would be home, school, daycare, or work.
• typically includes family, peers, or caregivers. Relationships in a microsystem are
Micro bi-directional

• consists of the interactions between the different parts of a person's

microsystem. The mesosystem is where a person's individual microsystems do
not function independently, but are interconnected and assert influence upon
Meso one another

• refers to a setting that does not involve the person as an active participant, but
still affects them. This includes decisions that have bearing on the person, but in
Exo which they have no participation in the decision-making process

• Encompasses the cultural environment in which the person lives and all other
systems that affet them
Macro • Could include the economy, cultural values, and political systems
Terimakasih