Rehabilitasi Psikososial Untuk Mewujudkan Orang dengan Gangguan Jiwa Bermartabat di Wilayah Kerja Puskesmas Sunggal Medan

ABSTRAKPeningkatan kasus COVID 19 dan penerapan pemberlakuan pembatasan kegiatan masyarakat di Kota Medan mengakibatkan kegiatan pelayanan kesehatan jiwa masyarakat terhenti. Salah satu prioritas masalah di wilayah kerja Puskesmas Sunggal adalah gangguan jiwa. Situasi saat ini banyak penderita yang tidak teratur minum obat, tidak kontrol ke puskesmas atau rumah sakit, mengalami kekambuhan dan tidak mematuhi protokol kesehatan bila keluar rumah serta tidak produktif. Kegiatan ini bertujuan untuk meningkatkan fungsi sosial dan keterampilan orang dengan gangguan jiwa. Target khusus yang ingin dicapai adalah perubahan perilaku dari ODGJ dan keluarga di wilayah kerja Puskesmas Sunggal Medan. Metode yang digunakan adalah ceramah, diskusi dan tanya jawab, home visit, pengembangan bakat dan minat pasien berupa pelatihan dan pendampingan pembuatan sabun cair. Hasil yang diperoleh dari kegiatan ini adalah 12 orang dari 15 ODGJ (80%) dapat mengontrol gejala pskotik, kontrol teratur ke puskesmas sebelum obat habis dan mempunyai keterampilan membuat sabun cair serta mampu mengembangkan keterampilan lainnya sesuai dengan minat dan bakat masing-masing. Rehabilitasi psikosoial memberikan dampak positif bagi peningkatan fungsi kognitif, psikomotor dan afektif orang dengan gangguan jiwa. Keberhasilan program ini membutuhkan partisipasi aktif dari semua pihak. Kata Kunci : Rehabilitasi, psikososial, orang dengan gangguan jiwa, bermartabat ABSTRACTThe increase in cases of COVID 19 and the implementation of restrictions on community activities in the city of Medan resulted in community mental health service activities being stopped. One of the priority problems in the work area of the Sunggal Health Center is mental disorders. The current situation was people with mental illness did not regularly take medication, did not go to the community health center or hospital to see the Doctor, experience relapses and did not comply with health protocols when leaving the house, and was unproductive. The activity aims to improve the social functioning and skills of people with mental disorders. The specific target to be achieved is to change the behavior of ODGJ and their families in the working area of the Sunggal Community Health Center, Medan. The methods used were lectures, discussions and questions and answers, home visits, identifying talents and interests of patients in the form of training and assistance in making liquid soap. The results of the activities were 12 from 15 of people with mental illness (80@) can control psychotic symptoms, regularly visit "the puskesmas" before the drugs run out and have the skills to make liquid soap, and are able to develop other skills according to their respective interests and talents. Psychosocial rehabilitation has a positive impact on improving the cognitive, psychomotor, and affective functions of people with mental disorders. The success of this program requires the active participation of all parties. Keywords: rehabilitation, psychosocial, people with mental illness, dignity

Mental health assistance: identification of nursing diagnoses in a community mental health service

ABSTRACT Objective: to map and identify nursing diagnoses targeted at night care users in a Psychosocial Care Center according to NANDA-I Taxonomy. Method: this is a descriptive-exploratory study, of documentary research type of 319 records in medical records. It was held in a Psychosocial Care Center III in Goiás, from 2014-2018. Nursing diagnoses and records were extracted with non-standardized language. Results: 813 records of nursing diagnoses identified in 53 different titles, in 10 domains, were identified. The most frequent diagnosis was risk for self-extermination. The domain with the highest number of diagnostic records was activity/rest. There was a predominance of diagnoses focused on the problem. Final considerations: mapping contributes to the planning of evidence-based nursing interventions and to the strengthening of professional identity in mental health. It is evident the need for practices that go beyond the symptoms in a preventive perspective, with a view to comprehensiveness.

Continuing health education for qualification of professional practice in Psychosocial Care Centers

ABSTRACT Objective: to describe and analyze a strategy of continuing health education to manage the quality of professionals’ work in Psychosocial Care Centers. Method: this is a research-intervention carried out in Psychosocial Care Centers in the state of Goiás, Brazil, with the participation of 58 professionals. Data were collected in 2016 through seminars and workshops. Thematic content analysis was carried out. Results: professionals associated the Singular Therapeutic Project to the record of performed procedures and described the need to develop skills for correct completion and interpretation of procedures, use of a record software and computerization of processes. The qualification strategy used was considered to be effective in making improvements to the work carried out feasible. Final Considerations: the study presents a qualification strategy for community mental health service teams to guide the care model for territorial care centered on users.

The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations

The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.

An exploration of family dynamics in adults who self-harm

Objectives: The aim of the present study was to explore how adults who self-harm experience family relationships. Methods: A phenomenological design was employed to examine the dynamic relationship between self-harm and family systems. Semi-structured interviews were conducted with six female adults who attend a community mental health service and engage in self-harm. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: Four superordinate themes emerged from the data and two subordinate themes emerged within each superordinate theme: family interactive patterns (subordinate themes: enmeshed patterns and culture of ‘getting on with it’), searching for meaning (subordinate themes: expressing emotional turmoil and engrained worthlessness), relating to others (subordinate themes: guilt and feeling misunderstood) and journey towards life without self-harm (subordinate themes: acceptance and family support). Conclusions: Findings emphasise the role of family systems in understanding self-harm in adults. The study highlights the need for family-based interventions for family members who support adults that self-harm.

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines. Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors. Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated. Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

Staff stress and burnout in a community adult mental health service

Objectives: Burnout has been associated with medical errors and low levels should be considered an indicator of service quality. This study examined the level of personal, work and client-related burnout in medical, other clinical and non-clinical staff in an adult community mental health service. Methods: An anonymous study-specific questionnaire was designed and circulated to all staff with an explanatory document. The Copenhagen Burnout Inventory was used as a validated measure of burnout, with high levels reflecting high rates of stress and burnout. Further questions were added from Maslach Burnout Inventory and effort–reward imbalance index. Information on demographics, job satisfaction, turnover intention, feeling valued and effort/reward balance was gathered and analysed. Results: The overall response rate was 47.4% (63/133), of whom 43 were clinical staff. Overall levels of burnout were low and similar across staff type, with only 30.1% showing moderate levels of burnout, and none in the ‘high-burnout’ category. All staff displayed positive disposition towards patients, with lower client burnout, as compared to personal and work-related burnout. All medical staff felt valued in their work, with lower rates in the other groups (48.7% of non-medical clinicians and 58.3% of non-clinical staff). Conclusions: Relatively low levels of overall burnout were reported among clinical and non-clinical staff working in our adult mental health service. These rates are similar to the levels identified in a national study of burnout in Irish hospital doctors but lower than the levels found among consultants in Irish child and adolescent mental health services.