COMMUNITY

PSYCHIATRY

SYNONIM

COMMUNITY PSYCHIATRY
PUBLIC PSYCHIATRY
SOCIAL PSYCHIATRY
PREVENTIVE PSYCHIATRY
HYGIENE PSYCHIATRY

COMMUNITY PSYCHIATRY
DEFINITION
THE PRACTICE OF PHYSICIANS OR
PSYCHIATRISTS 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
DIEVERSITY.

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?

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.

COMMUNITY PSYCHIATRY
PRACTICE
COMMUNITY PSYCHIATRIC
PRACTICE EMPLOYS
PROFFESIONALS IN ALL MENTAL
HEALTH DISCIPLINES AS WELL AS
INDEGENOUS NONPROFESSIONALS.
LOCAL CITIZEN PARTICIPATION IS
ENCOURAGED IN PLANNING,
ADVISING, AND EVALUATING.

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

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

Concept of health and

illness
Mysticism in Indonesia, perhaps
more pronounced in Java and Bali
but also found in other islands,
plays an important role in the lives
of the people.
It is the belief that direct knowledge
of God, spiritual truth, or ultimate
reality can be attained through very
subjective experience.

Concept of health and

illness
In the traditional community,
health and disease are
believed to be linked by
mystical forces, just as the
social order itself is
supposedly based on a
balance of good and evil
powers.

Beliefs about mental

illness
There are many traditional beliefs about the causes
of psychiatric illnesses:
An ancestors spirit has been offended or made
angry
A witch has cast a spell
Ghosts
Disobeying food taboos or practices
The will of God
Failure to perform certain rituals or ceremonies

There also many people in the community

who believe that there is exists a power
which can be used for good or bad purposes.

Traditional healers
Traditional healers claim to have this power
and use it to cure illnesses or to protect
people from becoming sick.
It is also widely believed that such power
can be used by witches or evil magicians.
The power of the healer and witchcraft are
especially effective because it frightens
those who believe in it.
The reason for visiting a traditional healer
is due to such beliefs.

Seeking treatment
People are seeking treatment
with a traditional healer because
they believe that only a
traditional healer can cure their
psychiatric problems.
But some of the people
sometimes visit a traditional
healer just for a try and even
without any reason

Seeking treatment
It should be considered to learn from
the indigenous health system
acceptable means to the people to
improve their health and no
exception should be made for mental
health care.
That means that the existing
concepts, and practices of people,
hence indigenous health care in
psychiatric problems should be
recognized.

MOTIVATION TO SEEK
TREATMENT
The motivation of the community to
attend the medical health services
seek help or treatment for their
illnesses, depends on the
awareness of the community.
The awareness of the people is very
low because of their misconception
about health and disease especially
for their psychiatric problems or
mental illnesses.

MOTIVATION TO SEEK
TREATMENT
It appears that belief or
misconception about health and
disease influences the utilization
of health services in primary
health care.
In most cases the reason of
seeking treatment with a
traditional healer is the belief that
only traditional healer can cure.

How do the traditional

healer give
psychotherapy?
All traditional healer types of
psychotherapy reflect local beliefs
regarding mans nature and in many
cultures the close links between
individuals, their ancestors and the spirit
world play a prominent role in the
treatment.
Healing is based on the establishment
and maintenance of satisfactory
relationships between elements in the
present, the past and the spirit world.

How do the traditional

healer give psychotherapy?
The patient therefore does not
consider the illness as something
to be cured or controlled but as
something to be understood.
It is clear that the traditional
healer according to the factor of
belief is much more acceptable
to the community.

Why do many people

visit
the
traditional?
Obviously, most of the people
visit the traditional healer
because they do not expect or
get satisfaction from the
medical health services for
their illness especially for
their psychiatric problems.

Why do many people

visit
the
traditional?
Traditional healers have an extremely
wide social function: their knowledge
and incantations often embody a
communitys beliefs and values.
Traditional healers may be in a
position to influence attitudes in
many important areas, including
health care for illness and psychiatric
problems.

Religious groups
Without designating a particular
healer, some religious groups
provide care for those illness
especially those with mental
disorders.
Healing Ceremonies, involving
the induction of trance and other
receptive states, are the main
methods used.

Religious groups
Close collaboration between
traditional healers and
physicians/psychiatrist is
probably feasible in a few special
situations, but those responsible
for health services should be
aware of the role `of healer, both
therapeutically and influencing
attitudes.

STIGMA ABOUT
MENTAL ILLNESS
SOME CHRONIC SUFFERERS MAY BE
STIGMATISED BECAUSE THEY
DISPLAY THE OBVIOUS RESIDUAL
NEGATIVE SYMPTOMS OF SELFNEGLECT, LACK OF MOTIVATION,
SOCIAL WITHDRAWAL AND ODD OR
BIZARE BEHAVIOUR.
RIGIDITY OR TREMOR AS SIDEEFFECTS OF MAJOR TRANQUILIZERS
MAY ALSO LEAD TO
STIGMATISATION.

STIGMA ABOUT MENTAL

ILLNESS
THERE IS STILL OFTEN AN
ASSUMPTION THAT FAMILIES MAY
HAVE CAUSED MENTAL ILLNESS
IN SOME WAY.
SOME FAMILIES MAY BELIEVE
THAT IF THE OFFSPRING SUFFERS
FROM A MAJOR MENTAL ILLNESS
THE WHOLE FAMILY HAS FAILED
OR LOST FACE.

ABOUT STIGMA
SOMETIMES FAMILIES TELL
ONLY CLOSE RELATIVES OR
FRIENDS ABOUT THE ILLNESS.
IF PATIENTS HAVE BEEN
ADMITTED TO A PSYCHIATRIC
HOSPITAL OR PSYCHIATRIC
WARD, SOME FAMILIES ENSURE
THAT NOBODY OUTSIDE THE
FAMILY KNOWS ABOUT IT.

ABOUT STIGMA
BECAUSE OF THE SENSE OF
FAILURE AND FEAR OF NOT
BEING ACCEPTED BY OTHERS,
FAMILIES OFTEN ISOLATE
THEMESELVES. THEY AVOID
CONTACT WITH PEOPLE WHO
THEY FEAR MIGHT LOOK DOWN
ON THEM.

ABOUT STIGMA
HEALTHY SIBLINGS IN THE
HOUSEHOLD OFTEN DISTANCE
THEMSELVES FROM THE FAMILY AS
FAR AS POSSIBLE THROUGH SHAME
AND EMBARRASEMENT.
SOME FAMILIES EVEN GO TO THE
EXTREME OF MOVING TO A NEW
NEIGHBOURHOOD IN ORDER TO
CONCEAL THE FACT THAT THEIR
RELATIVE HAD HAD A MAJOR
NERVOUS BREAKDOWN

COMMUNITY
PSYCHIATRY
THE PRINCIPLES OF COMMUNITY
PSYCHIATRY INCLUDE
RESPONSIBILITY TO APOPULATION,
USUALLY A CATCHMENT AREA
DEFINED GEOGRAPHICALLY
TREATMENTS CLOSE TO THE
PATIENTS HOME
MULTI-DISCIPLINARY TEAM
APPRPOACH
CONTINUITY OF CARE
CONSUMER PARTICIPATION
COMPREHENSIVE SERVICES

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 & 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.

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 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
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

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

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

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

TERIMA KASIH

Ronny3w@yahoo.com
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