HISTORY OF MENTAL

HEALTH CARE

Ns.BYBA MELDA SUHITA,S.Kep. M.Kes

BAGAIMANA PENDAPAT ANDA TTG GG JIWA ???

GANGGUAN JIWA ???

Bagaimana Masyarakat Memperlakukan ?

SETELAH DIRAWAT

PASIEN DIPASUNG 10 TAHUN

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Rumah pasien pasung

Unsur manusia yg non-materi, tetapi fungsi dan

manifestasinya terkait pada materi

Manifestasi Jiwa: Kesadaran, afek & emosi, psikomotor, proses berpikir, persepsi, & sifat-sifat kepribadian.

JIWA

KEPERAWATAN JIWA

Suatu bidang spesialisasi dari praktik keperawatan, yang menerapkan teori perilaku sebagai ilmunya, dan penggunan diri secara terapeutik sebagai kiatnya

KEPERAWATAN JIWA

Suatu proses interpersonal yang berupaya meningkatkan dan mempertahankan perilaku, yang mengkontribusi pada

fungsi yg terintegrasi

Contents: Introduction Development of mental health care

Early civilization Middle ages 18 & 19th centuries 20th centuries Indonesia

Introduction Mental Health Nursing is the diagnosis

and treatment of human responses to actual or potential mental health problems

Specialized area of nursing practice that uses theories of human behavior as its scientific frame work and requires the purposeful use of self as its art of expression

Its concerned with the promotion of optimum health for society

Comprehensive service focus on prevention of mental illness health maintenance management or referral of mental and physical

health problems diagnosis and treatment of mental disorders and

their sequel and rehabilitation (Haber & Billings, 1993)

Psychiatric nurses must be :

Able to make rapid comprehensive assessment Use effective problem solving skillsAct autonomously as well as collaboratively with other professionalBe sensitive issues as ethical dilemmas, cultural diversityBe comfortable working in decentralized settingsBe sophisticated about the costs and benefits of providing care

(ANA, 1994)

Development of mental health care

Early civilization Middle ages 18 & 19th centuries 20th centuries Indonesia

Early civilization 1770 - 1880 Movements concerning the treatment of persons with

mental illness The ancient Greeks, Romans and Arabs believed

emotional disorders were an organic dysfunction of the brain

They used a variety of treatment approaches, such as :

Sedation Good nutrition Good physical hygiene Music Recreational activities

Hipocrates : Described a variety of personalities or temperaments and proposed that mental illness was disturbance of four body fluids or “humors” heat, cold, dryness and moisture

Aristoteles :The mind was associated with heart

Gallen :The emotional or mental disorders were associated with brain

Early civilization … cont

The Greeks : Used temples as hospitals Provided an environment of fresh air,

sunshine and pure water Riding, walking and listening to the

sounds of waterfall were examples of therapeutic care

Early civilization … cont

Middle AgesAn era of alienation, social exclusion and confinementPersons who displayed abnormal behavior were considered to be lunatics, witches, or demons possessed by evil spiritsSuperstition, mysticism, magic and witchcraft prevailed as patients were starvedBeheading, hanging, and burning at the stake common occurrences

Patients suffering from a mental illnessPhysicians describes symptoms : depression, paranoid, delusions, hysteria and nightmaresThe first mental hospital : Bethlehem Royal Hospital in England

Middle Ages … cont

Bethlehem Royal Hospital

18th and 19th centuriesBenjamin Rush

”The Father of American Psychiatry” Wrote the first American textbook on psychiatry and encouraged more humane treatment of persons with mental illness In 1783 an era of moral treatment, he joined with Pennsylvania Hospital : talk to patients, share in their activities

Philippe Pinel (a French physician ) Began more humane treatment, removing chains

Benjamin Rush

Philippe Pinel

In 1843, Thomas Kirkbridge attempted to establish a training school for attendants at Pennsylvania Hospital to assist physician in the care of mentally ill patients

In 1872, New England Hospital of Philadelphia had established schools of nursing

Dorethea Lynde Dix (a Boston teacher) spent much of her time working for improved conditions for mentally ill persons building state mental hospitals to meet the needs of patients

18th and 19th centuries … cont

The nurse’s role was to oversee the care given and ensure the smooth operation of the ward housekeeping duties, dietary management and laundry care As Hospitals were established to provide long term custodial care In 1882, the first psychiatric training school was established at McLean Hospital in Belmont, Massachusetts

the first formally organized school for nurses in a hospital for mentally ill

18th and 19th centuries … cont

In 1890, trained nurses were employed on nursing staff of state mental hospitals develop their skills to provide therapeutic nursing care

There was a growing appreciation of the therapeutic role of the psychiatric nurseDuties included :1. Assisting the physician2. Administering sedative drugs3. Providing hydrotherapeutic measures

18th and 19th centuries … cont

Martin Charcot penyembuhan Nerosa Histeri dengan hipnosa

18th and 19th centuries … cont

Any Question?

Twentieth centuryThe mental health movement was strongly

Publication of a book written by Clifford Beers “A Mind That Found Itself”(1908) Influence to organize the National Association for Mental Health public awareness

Large state mental hospitals were built in rural areas

“A Mind That Found Itself”

by Clifford Beers

In 1915 Linda Richards (the first graduate nurse in US The First American Psychiatric Nurse) :

Mentally ill patients receive the same quality care as physically ill patients

The average students : Caring for mental ill Clinical experience in mental hospital

With ANA promoted study of mental ill & publishing journal articles

Twentieth century … cont

Linda Richards

Emil Kraepelin Psikosa manik-depresif VS Dementia Praecox

Kretschmer and Sheldon Typical body VS personality, temperament and emotional disorders

Sigmund Freud Teori libido, struktur kepribadian, topografi jiwa

Carl Gustav Jung Teori alam bawah sadar kolektif, individualisasi, introversi dan extroversi

Alfred Adler Motivasi manusia pada kekuasaan, perfeksi dan totalitas

Eugen Bleuler Skizofrenia

Adolf Meyer Teori psikobiologi

Harry Stack Sullivan and Erich Fromm Penerapan konsep psikoanalisa ke masalah sosiobudaya

Twentieth century … cont

Sigmund Freud

Textbooks focusing on psychiatric nursing practice

The National League for Nursing educational objectives included :- Relationship between physical and mental illness- The application of nursing principles to MHN- Assessment behaviors of patients – recognize early

signs or symptoms- Relationship of environmental conditions and mental disorders- To be resourceful, versatile and adaptable

(Smoyak, 1982)

Twentieth century … cont

Students were given the opportunity to care for patients with varying degrees of mental disorders

Experiences Focused :- physical- hydrotherapy- occupational- recreational- diversion therapy- patients education

Twentieth century … cont

Nursing interventions : Emphasizing Cleanliness Proper elimination Adequate nutrition Supervising continuous bath to promote

relaxation

Twentieth century … cont

In 1963, The Community Mental Act : establish community health centers to provide:1. Emergency mental health care 2. Inpatient care /hospitalization3. Partial hospitalization4. After care 5. Consultation services

Twentieth century … cont

The deinstitutionalization of patients from hospitals to community

At the present psychiatric nursing began to evolve as clinical specialize

Nurse involved as managers and coordinators of activities that provided therapeutic care

Advanced study and clinical practice experienced in a master’s program in psychiatric nursing, clinical specialists to gain expert knowledge in care and prevention of mental disorders

Twentieth century … cont

Indonesia

Jaman Kolonial Sebelum ada RSJ ditampung di RSU Sipil

atau RS Militer di Jakarta, Semarang dan Surabaya

1862 Pemerintah Hindia Belanda Sensus Banyak yang gangguan jiwa dibangun RSJ: RSJ Bogor (1 Juli 1882) RSJ Lawang (23 Juni 1902) RSJ Magelang (1923) RSJ Sabang (1927)

Pembagian tempat penderita psikiatrik: Rumah Sakit Jiwa

Bogor, Magelang, Lawang, Sabang Rumah Sakit Sementara

Tempat penampugan pertama pasien psikotik akut Bisa pulang atau dikirim ke RSJ Jakarta, Semarang, Surabaya, Ujung Pandang,

Palembang, Bangli (Bali), Padang, Lubuk Pakam (Padang), Banjarmasin, Manado, Glugur (Medan)

Rumah Perawatan Fungsi sama dgn rumah sakit sementara, tetapi

dikepalai oleh perawat berijazah dan di bawah pengawasan dokter umum

Koloni Penampungan pasien yang sudah tenang, bekerja di

bidang pertanian, tinggal di rumah penduduk, masih di bawah pengawasan

Jaman Kolonial … cont

Pengobatan: Isolasi dan penjagaan “dibungkus” Suntikan obat penenang Terapi mandi Jemur di panas matahari Terapi kerja

1910 gerakan “No Restraint”

Jaman Kolonial … cont

Perang dunia ke-2 dan pendudukan Jepang Tidak dapat berkembang RSJ Sabang hancur karena bom

Kemerdekaan Oktober 1947 terbentuk Jawatan Urusan

Penyakit Jiwa (di bawah Departemen Kesehatan) penyelenggaraan dan pembinaan kesehatan jiwa di Indonesia

1958 dirubah menjadi Urusan Penyakit Jiwa

1959 dirubah menjadi Bagian Penyakit Jiwa

1960 dirubah menjadi Bagian Kesehatan Jiwa

1966 – sekarang Direktorat Kesehatan Jiwa

Selesai …