Prevention, treatment and rehabilitationRonny Tri WirastoBlock 22UNTAD2013

MENTAL HEALTHWHO (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 COMMUNITYDECREASE OF PRODUCTIVITY (at work, absenteeism)INCREASE OF MEDICAL COSTSPremature 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).

PREVENTIONTHE 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 PSYCHIATRYPRIMARY 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 PRE-EXISTING STATUS.TERTIARY PREVENTION TO ESTABLISH A MAXIMUM DEGREE OF PERSONALITY FUNCTIONING THAT ARE PERSISTENT , PROGRESSIVELY DETERIORATING , OR BATH

PRIMARY PREVENTIONTHE 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 BYELIMINATING CAUSATIVE AGENTSREDUCING RISK FACTORSENHANCING HOST RESISTANCEINTERFERING WITH DISEASE TRANSMISSION

THE EXAMPLE OF PRIMARY PREVENTIONTO 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 PREVENTIONTHE DEVELOPMENT AND USE OF SOCIAL SUPPORT SYSTEMS TO REDUCE THE EFFECTS OF STRESS ON THOSE AT HIGH RISKS YOUTH PROGRAMSANTICIPATORY GUIDANCE PROGRAMS TO ASSISST PERSONS TO PREPARE FOR EXPECTED STRESSFUL SITUATIONCOUNSELING PEACE CORPS VOLUNTEERSCRISIS INTERVENTION AFTER STRESSFUL LIFE EVENTSBEREAVEMENT, MARITAL SEPARATION, DIVORCE, TRAUMAS, DISASTERS

THE AIM OF PRIMARY PREVENTION PROGRAMERADICATING STRESSFUL AGENTS AND REDUCING STRESSSUCH PROGRAMS INCLUDE PRENATAL AND PERINATAL CARE TO DECREASE THE INCIDENCE OF MENTAL RETARDATION AND COGNITIVE DISORDERS IN CHILDRENADVICE 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 ENCEPHALOPATHYMODIFICATION OF DIVORCEADOPTIONCHILD ABUSE LAWS TO PROVIDE A HEALTHY ENVIRONMENT FOR CHILD DEVELOPMENTENRICHMENT 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 STATUSGENETIC COUNSELING FOR PARENTS AT HIGH RISK FOR CHROMOSOMAL ABNORMALITIES TO PREVENT THE UNWITTING CONCEPTION OF COMPROMISED INFANTSEFFORTS TO REDUCE THE SPREAD OF CERTAIN SEXUALLY TRANSMITTED DISEASES THAT CAN LEAD TO MENTAL DISORDERS ( AIDS AND SYPHILIS)

SECONDARY PREVENTIONIS 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 PREVENTIONCRISIS INTERVENTIONPUBLIC EDUCATIONTO REDUCE STIGMA TO ALLOW PERSONS TO SEEK TREATMENT EARLIER

TERTIARY PREVENTIONTHE GOAL OF TERTIARY PREVENTION ISTO 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 PSYCHIATRYPATIENTS SUFFERING FROM THE MOST SEVERE AND DEBILITATING ILLNESS:SUBSTANCE ABUSE DISORDERSCHIZOPHRENIATHE 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 REHABILITATIONINVOLVES: 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

REHABILITATIONIS 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 HOSPITALIZATIONARE DETERMINED BY FACTORS WITHIN THE INDIVIDUAL PATIENTSEVERITY OF THE ILLNESSLEVEL OF AWARENESS OR INSIGHT REGARDING THE ILLNESSTHE CAPACITY TO CERTAIN IMPULSIVEDESTRUCTIVE BEHAVIORFACTORS IN THE ENVIRONMENT SUCH AS PRESENCE OR ABSENCE OF SUPPORT INTENSITY OF ONGOING STRESSORSIN 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 PSYCHIATRYThe 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 usedto influence the patients mental state, andto assist in his rehabilitation and return to the community

TREATMENT IN PSYCHIATRYThe measures used comprise the following groups:Psychological: psychotherapy (behavior therapy)Physical: pharmacologic agentsOccupational: therapy/industrial therapy

Psychological therapyPsychotherapy/behavior therapy

used to deal with individuals symptoms, illness and personality

Physical therapyPharmacologic agents e.g. sedatives, tranquilizers, antidepressant drugs

used in acute psychoses, depressive illness and maintenance treatment of chronic illness

Occupational/industrial therapyUsed to divert, stimulate, entertain, and encourage the patients 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 psychiatryCertain 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 psychiatryThe 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 psychiatryProviding 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 psychiatryThe 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 surroundingsIt 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 psychiatryAfter 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 psychiatryFuture planning of district psychiatric services in England and 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