Prevention treatment and rehabilitation MENTAL HEALTH WHO World

Prevention, treatment and rehabilitation

MENTAL HEALTH • WHO (World Health Report 2001) : MH= a state of well-being in which the individual: > realises his/her own abilities > can cope with the normal stresses of life > can work productively & fruitfully > able to make contribution to his/her community • Mental Disorders <-------> Mental Wellbeing (preventing-treating) (fostering-promoting) • “INDIVIDUAL”====> ”COMMUNITY”

IMPACT OF MENTAL HEALTH PROBLEM TO THE COMMUNITY • DECREASE OF PRODUCTIVITY (at work, absenteeism) • INCREASE OF MEDICAL COSTS • Premature Death : Suicide, Accident (traffic/domestic), Violence (public/domestic), Drug Abuse, Criminals, etc. • DALYs (Disability Adjusted Life Years) Lost : GDB= 11, 5 % (rank ke 2 setelah Infectious Dis. ) • Increase of psychosocial costs (Indirect Costs).

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.

CONCEPT OF PREVENTIVE PSYCHIATRY – PRIMARY PREVENTION : TO AVOID ENTIRELY THE OCCURRENCE OF A PSYCHIATRIC DISABILITY – SECONDARRY PREVENTION IS TAKING THERAPEUTIC MEASURES TO RESTORE AN INDIVIDUAL SUFFERING FROM A MENTAL OR EMOTIONAL DISABILITY TO IMPROVED HEALTH OR THE PREEXISTING STATUS. – TERTIARY PREVENTION TO ESTABLISH A MAXIMUM DEGREE OF PERSONALITY FUNCTIONING THAT ARE PERSISTENT , PROGRESSIVELY DETERIORATING , OR BATH

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, OTHER ENRICHED DAY-CARE PROGRAMS FOR DISADVANTAGED CHILDREN

THE EXAMPLE OF PRIMARY PREVENTION • THE DEVELOPMENT AND USE OF SOCIAL SUPPORT SYSTEMS TO REDUCE THE EFFECTS OF STRESS ON THOSE AT HIGH RISKS – YOUTH PROGRAMS • ANTICIPATORY GUIDANCE PROGRAMS 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

PRIMARY PREVENTION PROGRAMS (CONT. ) • 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

ADDRESSES OF TERTIARY PREVENTION IN PSYCHIATRY • PATIENTS SUFFERING FROM THE MOST SEVERE AND DEBILITATING ILLNESS: – – SUBSTANCE ABUSE DISORDER 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

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 BY RAPID INTERVENTION AND MAINTAIN SOCIAL SUPPORT SYSTEMS EVEN WHEN PATIENTS ARE ACUTELY ILL

REHABILITATION • IS OFTEN ONGOING DYNAMIC PROCESS CARRIED OUT FOR THE PATIENT’S 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

TREATMENT IN PSYCHIATRY • The term ‘treatment’ is used in a wide sense in psychiatry; specific remedies for illnesses of known etiology are practically unknown, so treatment tends to be empirical and eclectic. • Treatment therefore include any measures used – to influence the patient’s mental state, and – to assist in his rehabilitation and return to the community

TREATMENT IN PSYCHIATRY • The measures used comprise the following groups: – Psychological: psychotherapy (behavior therapy) – Physical : pharmacologic agents – Occupational : therapy/industrial therapy

Psychological therapy • Psychotherapy/behavior therapy – used to deal with individual’s symptoms, illness and personality

Physical therapy • Pharmacologic agents e. g. sedatives, tranquilizers, antidepressant drugs – used in acute psychoses, depressive illness and maintenance treatment of chronic illness

Occupational/industrial therapy • Used to divert, stimulate, entertain, and encourage the patient’s activity and interest plays an important part in rehabilitation by giving the patient the chance to work and earn in a sheltered environment

Therapy in psychiatry • Certain measures may be of most value in the acute illness, e. g. physical treatment ; other may be of most value in rehabilitation, e. g. industrial therapy. Patient should receive help in as many ways as possible.

Therapy in psychiatry • The acute illness may be controlled by tranquillizers which restore the patients contact with reality and enable him to participate more successfully in psychotherapy, and derive some benefit from a therapeutic environment.

Therapy in psychiatry • Providing the environment is permissive and friendly , it is therapeutic rather than antitherapeutic. • Social forces too, are important in coloring illness and adding features which are neither symptoms or sign of illness but merely behaviour patterns imposed by the environment. • Violent behaviour has become less common since this was realized

Therapy in psychiatry • The struggling patient brought into hospital and hurled into a padded room, isolated in total darkness, would be less than normal if he did not react in hostile fashion towards his surroundings • It is important to realize that any hospital admission provokes anxiety mainly because of the uncertainly that the patient experiences and also because he feels his individuality threatened right from the beginning by simple things like having to undress and get into bed.

Therapy in psychiatry • After this , much that goes on in hospital seems to reinforce the feeling of isolation and lack of identity so that if the atmosphere is worsened by heightened uncertainty , tension and suppressed violence – all of which can be commonplace in a badly run psychiatric ward – one soon has all the ingredients for a situation of the sort which Kafka has described in such frightening fashion

Therapy in psychiatry • Future planning of district psychiatric services in England Wales should help considerably towards finally removing the stigma and general unease that surround mental hospital admission. • The psychiatric unit in a general hospital, working in close cooperation with local services , should provide the best way to use hospital admission without damaging the patient

SELESAI