Unveiling Shadows: Challenges Encountered by Mental Health Nurses and Health Cadres in the Delivery of Care to Persons With Mental Illness in Indonesia.

Sri Warsini, Martina Sinta Kristanti, I Made Moh Yanuar Saifudin, Rizki Fitryasari, Marthoenis Marthoenis, Kim Usher
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Abstract

Mental health nurses and health cadres in Indonesia who provide care to persons with mental illness (PWMI) report encountering several challenges and obstacles to the delivery of quality care. At present, there is a paucity of research on this topic. The objective of this study was to examine the challenges encountered by mental health nurses and health cadres in their interactions with the families of PWMI in the community. This descriptive qualitative study employed focus group discussions, conducted in three Indonesian cities: Banda Aceh, Surabaya and Yogyakarta. Thematic analysis was utilised to analyse the data. The study revealed that the theme of this research is nurses and health cadres experienced challenging family behaviours toward a PWMI. The initial subtheme of family behaviour is 'concealing the PWMI.' This subtheme encompasses instances where families attempted to hide the mental health condition of the PWMI. The second subtheme is 'unsupportive families'. This subtheme is characterised by reluctance to engage in treatment or outright rejection of hospital care. This is often due to factors such as familial busyness. The third subtheme is 'poor parenting styles'. This subtheme highlights how inadequate parenting practices, domestic violence and lack of family support contribute to stress and exacerbation of mental disorders in PWMI. The fourth subtheme is 'hidden motive related to wills and testaments', which reveals how families may attempt to manipulate treatment to remove the inheritance rights of PWMI. The fifth subtheme is 'abandonment by family', which describes scenarios where families completely neglect PWMI, leading to inadequate care and medication adherence. The final subtheme, 'removal of PWMI from family units', describes instances where families sent PWMI to mental health facilities for permanent separation, sometimes even relocating to another city. To address these issues, a comprehensive approach is required that considers both the affected individuals and their families. An understanding of the motivations behind these behaviours is essential for the development of targeted interventions that promote family support, reduce stigma and improve the overall mental health environment in communities.

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揭开阴影:印度尼西亚心理健康护士和卫生干部在为精神病患者提供护理时遇到的挑战》。
印度尼西亚为精神病患者(PWMI)提供护理服务的精神卫生护士和卫生干部表示,他们在提供优质护理服务时遇到了一些挑战和障碍。目前,这方面的研究还很少。本研究旨在探讨精神卫生护士和卫生干部在与社区中的精神病患者家庭互动时所遇到的挑战。这项描述性定性研究采用焦点小组讨论的形式,在印度尼西亚的三个城市进行:班达亚齐、泗水和日惹。数据分析采用了主题分析法。研究结果表明,本研究的主题是护士和卫生干部经历过的家庭对残疾人的挑战行为。家庭行为的第一个次主题是 "隐瞒残疾人"。这个次主题包括家庭试图隐瞒残疾人的精神健康状况。第二个次主题是 "不支持的家庭"。这个次主题的特点是不愿意接受治疗或完全拒绝医院护理。这通常是由于家庭事务繁忙等因素造成的。第三个次主题是 "不良的养育方式"。这一分主题强调了不恰当的养育方式、家庭暴力和缺乏家庭支持是如何导致压力和精神障碍加剧的。第四个次主题是 "与遗嘱和遗言有关的隐藏动机",揭示了家庭如何试图操纵治疗,以取消残疾人的继承权。第五个次主题是 "被家人遗弃",描述了家人完全忽视精神病患者,导致护理和用药不足的情况。最后一个次主题是 "将残疾人从家庭单位中带走",描述了家庭将残疾人送往精神健康机构进行永久性隔离的情况,有时甚至搬迁到另一个城市。为了解决这些问题,需要采取一种全面的方法,同时考虑到受影响的个人及其家庭。了解这些行为背后的动机,对于制定有针对性的干预措施,促进家庭支持、减少污名化和改善社区的整体心理健康环境至关重要。
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Unveiling Shadows: Challenges Encountered by Mental Health Nurses and Health Cadres in the Delivery of Care to Persons With Mental Illness in Indonesia. 2nd International Conference on Mental Health and Behavioral Medicine (MHBM2024), 13 - 15 September 2024, Kuala Lumpur, Malaysia. Mental Health Experiences Among Undergraduate Nursing Students in a New Zealand Tertiary Institution: A Time for Change. Why Are We Not Asking About Suicidal Mental Imagery? The Impact of Clinical Supervision on the Mental Health Nursing Workforce: A Scoping Review.
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