In Indonesia has always been known as a mental disorder, such as in “The Mahabharata and Ramayana” recognized the existence of “Heroine Madness”, Billy Gaca Gandrung “. How can the necessary mental patients in ancient times in Indonesia is not known clearly. if some action against people with mental disorders are now regarded as the heritage of our ancestors, we can imagine how little would be at least part of the people with mental disorders were treated in earlier times. As for the action in question is stocks, chains or tied and then placed itself at home or in the woods (if heavy disturbance and endanger his soul). If not dangerous, let loose in the village, seeking food and a public spectacle, there are times when required as a sick man, Mbah a guardian or medium (an intermediary between spirits and humans).
It is estimated that 2-3% of Indonesia’s population suffer from severe mental disorders. if half of them requiring hospital treatment in Indonesia and if the population 120 million people this means that 120 thousand people with severe mental disorders requiring treatment in hospital. available now only 10,000 beds.
1. Colonial period
During the colonial period, mental health care policy in the Dutch East Indies was centred on the mental hospital, which provided custodial care. In 1949, independent Indonesia inherited four very large mental hospitals, about 10 acute-care clinics in the major cities, and an agricultural colony. During the 1950s, mental hospital care remained largely custodial. In 1966, the Directorate of Mental Health adopted the three-fold principles of prevention, treatment, and rehabilitation as the foundation of a comprehensive mental health care system. During the 1970s and 1980s, the number of mental hospitals in Indonesia doubled and a variety of treatment methods were introduced. Special attention was given to the care provided by dukuns, or indigenous healers.
Before in Indonesia Psychiatric Hospital available, the people who suffer from mental disorders accommodated in civilian hospitals or military hospitals in Jakarta, Semarang, and Surabaya. Accommodated patients were severe in general. However, mental hospital capacity provided was not enough. In 1862 the Dutch Government held a census of people with mental disorders in Java and Madura; the result was approximately 600 people with mental disorders in Java and Madura, another 200 people in other areas. For the authorities at that time, such circumstances were sufficient reason to build a Mental Asylum. So on July 1st, 1882, the first mental hospital built in Bogor and then Lawang Mental Hospital (June 23rd, 1902), Magelang Hospital (1923) and Sabang Hospital (1927), successively. These hospitals were classified as big hospitals and accommodating people with chronic mental disorders that require long treatment.
Netherlands Indies government recognize 4 types of psychiatric patient care, namely:
1. Mental Hospital (krazinnigengesticten)
in bogor, Magelang, Lawang, and Sabang, mental hospital is always full, resulting in accumulation of patients in the hospital temporarily, while the police detention and prison. Then constructed “annexinrichtingen” the hospital soul existing as Samplak (Bogor) in 1931 and Pasuruan (near Lawang) in 1932.
2. Temporary hospital (doorgangshuizen)
This hospital was an interim shelter for an acute psychotic patients, sent home after recovery, the need for longer treatment is sent to a mental hospital was established in Jakarta, Semarang, Surabaya, Makassar, Palembang, Bali, Padang, Banjarmasin, Manado and Medan.
3. Home Care (Veerplegtehuiizen)
It functions as a mental hospital, but headed by a registered nurse under the supervision of a general practitioner.
The relocation of psychiatric patients had calmed down, patients can work in agriculture and live in houses, given the host’s rent, and still under supervision
These houses built far from the city and the general public. treatment is the isolation and preservation (Custodial care). The basic theory is now no longer held:
1. Patients should be out of the house and neighborhood that caused him pain, therefore it must be treated somewhere quiet, so accustomed to the hospital atmosphere.
2. avoid the stigma (which is not good seal)
– Present government has only one type of mental hospital that is the government hospital, to simplify and strengthen the organizational structure and remove the tendency to discriminate services.
– There is also a tendency to build a hospital that is not big anymore, but a capacity of 250-300 beds, because more effective and efficient. Hospitals should not be isolated but in the midst of the community so that the activities and relationships will be guaranteed.
– treatment methods are used frequently are used in isolation and hospital care (Custodial care), since 1910 too-tight surveillance was left and the next treatment provided patients with greater freedom (no restrain). Later in the year 1930, try to work therapy.
– all hospital and government facilities funded by the Dutch East Indies Indies government, which eventually established krankzinnigenwezen het Dienstvan to take care of this. Care of private parties on behalf of the initiative Van Wullffen Palthe Kolonia Founded in Lenteng great pemerintah.witte receive subsidies from crotch kolonie a private effort to accommodate pemengis in central Java, but also willing to accept those former patients who had ganguan quiet spirit, the care for free.
2. Era after independence
Brought a new chapter for the development of mental health efforts, the government of Republic of Indonesia formed Mental Disorder Affairs Bureau. Because of physical revolution, the bureau was not able to work well. In 1950 the government of Indonesia carried out assigned important things for holding and promotion of mental health in Indonesia. This bureau was under the Department of Health; in 1958, turned into Affairs Mental Disorder; 1960 became part of Mental Health, and in 1966 became the Directorate of Mental Health who until now headed by the Mental Health Director or Head of Mental Health Directorate.
Mental Health Directorate improved organizational structure to be Affair Office, which turned into Sub-Directorate of Improvement (Promotion), Sub-Directorate of services and Recovery, Sub-Directorate of Rehabilitation, and Sub-Directorate of Program Development.
With the stipulation of Mental Health Law (UU)No. 3/ 1966 by the government, it is more open to collect all the potential to gradually carry out modernization of all system hospitals and mental health facilities in Indonesia. Mental Health Directorate held in cooperation with various government agencies and with the faculty of medicine, international agencies, national and Asia regional seminars and work meetings of national and regional, the existence of reporting systems development, establishing PPDGJ I in 1973, and publishing and regrating health services in Puskesmas (Local Governmental Clinic) in 1975.
Private parties were more concerned with mental health problems, especially in big cities. In Jakarta, and in Yogyakarta and Surabaya as well as several other cities established mental health sanitarium. Governmental Public Hospital and military hospitals provide beds for mental patients and established the psychiatry, as well as private hospitals such as St. Carolus Hospital in Jakarta, Mount Mary Hospital (Minahasa). In Jakarta and Surabaya, it have been established Community Mental Health Center.
Method of treatment the patient has many mental disorders has progressed from age to age. Evolution is a reflection of changes in filisofi basics and theory of treatment.
– Early history
mental disorders is still considered a disease that is incurable and associated with sin or evil, so that sometimes even the treatment is carried out brutal and inhuman.
people who experience mental disorders are usually imprisoned / locked up by her family. They even removed and allowed to live on the streets by begging. But after a few religious groups that contribute, the patient began to be distributed to hospitals, hospital (stuart Sundeen, 1998).
– 15-17th century
His condition is still worrying. Male patients and female together. They get clothes and food that is not feasible, often chained, locked, and kept away from the sun (Connolly, 1968: quoted by Otong Antai, 1994).
– 18th Century
French Revolution and the American who inspire the public for freedom and fair treatment for all.
– 19th century
Established the first psychiatric hospital, McLean Asylum in Massachusetts that provide humane treatment to people with mental disorders (Stuart Sundeen, 1998).
– 20th Century
Called the era of psychiatry, because the medical start digging in a mental basis and clinical sciences, such as Adolph Meyer (1866-1950) with the theory psikobiologi; Clifford Beers (1876-1943) who wrote an article about the neonatal intensive care; Emil Kraepelin (1856-1926) classification problems with his soul; Eugen Bleuler (1857-1939) who invented the term schizophrenia; Sigmund Freud (1856-1939) who developed the theory of psychoanalysis, psychosexual, and neurosis; Carl Gustav Jung (1857-1961), Karen Horney (1885-1952) , and Harry Stack Sullivan (1892-1949) with the interpersonal theory.
Mental health flourished during World War II because of their approach to public health service method service. Consequently, the role of the nurse soul also changed from a supporting role to an active role in the health care team, to treat people with mental disorders. At present, treatment of mental patients is more focused on community basis. This is in agreement with the National Conference on Mental Nursing I (October, 2004), that the treatment will be more focused in terms of preventive action. Some journals suggest that preventive action is essential.
– Childhood maltreatment (physical abuse, sexual abuse, exposure to abuse) are obtained when the little one turned out to make an impact and cause of vulnerability experienced a mental disorder. Of 8000 respondents, 14% claimed to have experienced one of the three types, and 34% said having more than one type of (American Journal of Psychiatry, Volume 160, August 2003).
– Women who experience depression at age 18-21 years old, have a tendency obese compared with not experiencing. But in general, they bail men and women who were depressed at age 11-15 epidemic, it has a tendency to obesity is higher in the period of his adult (Archives of Pediatrics and Adilescent Medicine, Volume 157, August 2003).
– All of the respondents aged 26 years, more than half have mental health problems predicted with mental disorders that may be suffered when he was 15 years (Archives of General Psychiatry, Volume 60, July 2003).
– Pharmacological therapy and psychotherapy are given simultaneously in low-income women suffering from depression, it can lower levels of depression. Reported that they are only just getting terpai pharmacology, showed decreased levels of depression and also increase the work activity or work house. While those who only received psychotherapy alone, also experienced a decrease in depression levels but did not experience an increase in the home or work activities (Journal of the American Medical Association, Volume 290, July 2003).
– A child with parents who have mental disorders is also on her period Adolescent (Pediatrics, Volume 112, August 2003).
Mental Health Efforts in Indonesia
Treatment on mental patients in the past in the Indonesia was unknown in certain. However, mental patients were housed in the hospital, civil hospital, or the military during the Dutch colonial era. The number of people with mental disorders was increasingly pushing the government at that time to establish the first mental asylum in Bogor on July 1, 1982 (now asylum Marzoeki Mahdi). Next asylum established in Lawang (June 23, 1902), RSJ Magelang (1923), and asylum Sabang (1927).
In the Dutch colonial period known 4 kinds of treatment place for mental patients:
1. Mental Asylum (Kranzinnigengestichen)
2. Interim RS (Doorgangshuizen)
3. Temporary shelters for people with acute psychotic and return to home after recovery. For those who require long treatment, sent to a psychiatric hospital.
4. Care homes (Veerplegtehuiizen)
Serves as a psychiatric hospital but was headed by a nurse under registered supervision.
The colony was a shelter for people with mental disorders calmed down. Patients could work in agriculture and live within community. House owner (host) was given living costs and the patients were still under-surveillance. Such these houses built far from the city and the general public. Unfortunately, after the Japanese occupied Indonesia, mental health development could setbacks, and even psychiatric hospital located in Sabang destroyed.
During the year 1940 – 1990, the various movements of mental health changes occurred, including:
1. 1946: launching the Law of Mental Health
Changes occurred: establishment of a national pharmaceutical institute of mental health that supports research on intervention, psychiatric diagnosis, and prevention and treatment of mental disorders.
2. 1961: Commission President’s health and mental disorders.
Changes that occur: legislative support for education for mental health professional staff including nurses, social workers, psychiatrists, and psychologists.
3. 1963: Launching the Law on the mental community health center.
Changes occurred: Deinstitutionalizing clients with chronic mental disorder moved from the institution (asylum) to the community rehabilitation center.
4. 1970-1980: emergence of interest in aspects of biology and neurobiology of mental disorders and treatment.
Changes occurred: The emergence of third-generation psychotropic drugs increased the popularity of biological therapy.
5. 1990s: brain decade.
Changes occurred: Neurobiology and technology increasingly grew; identification of diagnostic studies, especially for innovative schizophrenia and mood disorders.
6. Year 1990s-early 20th century: the change in the economic and social reform of health services.
changes occured :
· Increasing of the number of homeless
· lack of legislative funding for primary prevention, secondary, and tertiary
· global epidemic of AIDS
· The need for provision of health services systematically
· Development of a high risk of mental disorders in pregnant women
· Violence on women children, parents, and users of prohibited drugs.
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