Approximately 2-3% of Indonesia's population suffers from severe mental disorders. If half of them need hospital treatment and if the population in Indonesia amounted to 120 million people, there are 120 thousand people with severe mental disorders requiring hospital treatment, while all nation-wide hospital capacity is only about 10.000 beds.
From the ancient time, mental disorder has been well-known in Indonesia. For example, the Ramayana and Mahabrata stories narrated “Srikandi Edan” (Crazy Srikandi) and “Gatotkaca Gandrung” (Gatotkaca Crazy For/ Gatotkaca in Love). To date, treatment of mental patients in ancient Indonesia is unknown. If some treatment on the mental patients in modern Indonesia considered as being inherited by our ancestors, we can little imagine the treatment of mental patients in ancient Indonesia, such as put in the stocks, chained or tied up, and placed them at isolated home or in the woods (if the mental disorder is dangerous and severe). If not dangerous, the people with mental disorders are left wandering around the village, looking for food, and become a public spectacle. Even sometimes they treated as sacred, ones having metaphysical power, or a medium (an intermediary between spirits and humans).
1. Colonial Period
Before in Indonesia Psychiatric Hospital available, the people who suffer from mental disorders accommodated in civilian hospitals or military hospitals in Jakarta, Semarang, and Surabaya. Accommodated patients were severe in general. However, mental hospital capacity provided was not enough. In 1862 the Dutch Government held a census of people with mental disorders in Java and Madura; the result was approximately 600 people with mental disorders in Java and Madura, another 200 people in other areas. For the authorities at that time, such circumstances were sufficient reason to build a Mental Asylum. So on July 1st, 1882, the first mental hospital built in Bogor and then Lawang Mental Asylum (June 23rd, 1902), Magelang Asylum (1923) and Sabang Asylum (1927), successively. These hospitals were classified as big hospitals and accommodating people with chronic mental disorders that require long treatment.
Dutch East Indies government recognized 4 types of psychiatric patient care, namely:
1. Mental Asylum (kranzinnigengestichen)
In Bogor, Magelang, Lawang, and Sabang, the asylums kept on full, resulting in a patient waiting in line in interim hospital, police detention, and prisons. Then, it was constructed “annexinrichtingen” at the existing Mental Asylum such as in Semplak (Bogor) in 1931 and Pasuruan (near Lawang) in 1932.
2. Interim Asylum (Doorgangshuizen)
This asylum was an interim shelter for acute psychotic patients. The patients discharged after recovery. Those requiring longer treatment sent to the Mental Asylum which was established in Jakarta, Semarang, Surabaya, Makassar, Palembang, Bali, Padang, Banjarmasin, Manado and Medan.
3. Treatment Home (Veerplegtehuiizen)
Treatment home served as a Mental Asylum, headed by a registered nurse under the supervision of a general practitioner.
4. Colonies
The relocation of psychiatric patients had calmed down. The patients could work in agriculture and stay in the local inhabitant house by paying to the owner, and still be under surveillance.
Such houses were built far from the city and general public. Treatment was isolation and preservation (Custodial care). The basic theory was no longer held):
1. Patients should be out of the house and neighborhood that caused him into mental disorder, and therefore should be treated in a quiet place, so accustomed to the atmosphere of the hospital.
2. Avoiding the stigma
· Today the government has only one type of mental asylum — that is the governmental asylum — to simplify and strengthen the organizational structure as well as to remove discrimination service tendency.
· There is also a tendency to not build a big asylum anymore, but hospital with capacity of 250-300 beds, because more effective and efficient. Hospitals should not be isolated but in the midst of the community so that the activities and relationships will be guaranteed.
· Previous treatment often used isolation and surveillance (Custodial care). Since 1910, too-tight surveillance was left and the next treatment provided patients with greater freedom (no restrain). Later in the year 1930, work therapy began.
· All asylum and their facilities financed by the Dutch East Indies government, which eventually established krankzinnigenwezen het Dienstvan to take care of this. From private parties on the initiative of Van Wullffen Palthe a colony established in the Great Lenteng receive subsidies from the government. Witte crotch Kolonie was a private effort to accommodate the beggars in the area of Central Java, but also willing to accept the former mental patients who were composed, treated for free.
Post-Independence Period
Bringing a new chapter for the development of mental health efforts, in October 1947, government of Republic of Indonesia formed Mental Disorder Affairs Bureau. Because of physical revolution, the bureau was not able to work well. In 1950 the government of Indonesia carried out assigned important things for holding and promotion of mental health in Indonesia. This bureau was under the Department of Health; in 1958, turned into Affairs Mental Disorder; 1960 became part of Mental Health, and in 1966 became the Directorate of Mental Health who until now headed by the Mental Health Director or Head of Mental Health Directorate.
Mental Health Directorate improved organizational structure to be Affair Office, which turned into Sub-Directorate of Improvement (Promotion), Sub-Directorate of services and Recovery, Sub-Directorate of Rehabilitation, and Sub-Directorate of Program Development.
With the stipulation of Mental Health Law No. 3/ 1966 by the government, it is more open to collect all the potential to gradually carry out modernization of all system hospitals and mental health facilities in Indonesia. Mental Health Directorate held in cooperation with various government agencies and with the faculty of medicine, international agencies, national and Asia regional seminars and work meetings of national and regional, the existence of reporting systems development, establishing PPDGJ I in 1973, and publishing and regrating health services in Puskesmas (Local Governmental Clinic) in 1975.
Private parties were more concerned with mental health problems, especially in big cities. In Jakarta, and in Yogyakarta and Surabaya as well as several other cities established mental health sanitarium. Governmental Public Hospital and military hospitals provide beds for mental patients and established the psychiatry, as well as private hospitals such as St. Carolus Hospital in Jakarta, Mount Mary Hospital (Minahasa). In Jakarta and Surabaya, it have been established Community Mental Health Center.
Method of treatment for the patient with mental disorders has progressed from time to time. This evolution is a reflection of basic changes in philosophy and theory of treatment.
1. Early history
Mental disorders was still considered a disease that was incurable and associated with sin or evil, so that sometimes even the carried-out treatment was a brutal and inhuman (Maramis, 1990).
2. Medieval History
People who experience mental disorders are usually imprisoned / locked up by her family. They even removed and allowed to live on the streets by begging. But after a few religious groups that contribute, the patient began to be distributed to hospital (Stuart Sundeen, 1998).
3. Age of 15th-17th AD
His condition was still worrying. Male and female patients put in one place together. They get clothes and food that was not feasible, often chained, locked, and kept away from the sun (Connolly, 1968; cited by Antai Otong, 1994).
4. Age of 18th AD
French and American Revolution inspired freedom and fair treatment for all.
5. Age of 19th century
The first mental disorder asylum — McLean Asylum — established in Massachusetts providing humane treatment to people with mental disorders (Stuart Sundeen, 1998).
6. Age of 20th AD
This age was called the era of psychiatry, because the medical began digging mental disorder on sciences and clinical basis, such as Adolph Meyer (1866-1950) with the theory psychobiology; Clifford Beers (1876-1943) who wrote an article about the intensive care; Emil Kraepelin (1856-1926) with the classification of disorders soul; Eugen Bleuler (1857-1939) who invented the term schizophrenia; Sigmund Freud (18561939) who developed the theory of psychoanalysis, psychosexual, and neurosis; Carl Gustav Jung (1857-1961), Karen Horney (1885-1952), and Harry Stack Sullivan (1892 -- 1949) who invented interpersonal theory.
Mental health grew rapidly in World War II because of applying approach of public health service method. Consequently, the role of the mental nurse also shifted from a supporting role to an active role in the health care team, to treat people with mental disorders. At present, treatment of mental patients was more focused on community basis. This was in accordance with the National Conference on Mental Nursing I (October, 2004), that the treatment will be more focused in terms of preventive action. Some journals suggest that preventive action was essential.
Childhood maltreatment (physical abuse, sexual abuse, exposure to abuse) obtained in the childhood turned out to make an impact and cause of vulnerability toward a mental disorder. Of 8.000 respondents, 14% claimed to have experienced one of the three types, and 34% said having more than one of those (American Journal of Psychiatry, Volume 160, August 2003). Women who experienced depression at age 18-21 years old, have a tendency obese compared with not experiencing. But in general, those depressed at age 11-15 years has higher tendency to have obesity in adult life (Archives of Pediatrics and Adolescent Medicine, Volume 157, August 2003).
Of all respondents 26-years-aged, more than half have mental health problems predicted equal with mental disorders that may be suffered when he was 15 years (Archives of General Psychiatry, Volume 60, July 2003).
Pharmacological therapy and psychotherapy given simultaneously in low-income women with depression can actually lower levels of depression. It was reported that those who only received only pharmacological therapy showed decreased levels of depression and also increased work-home. While those who only received psychotherapy, also experienced a decline in levels of depression but did not experience an increase in the work-home activity (Journal of the American Medical Association, Volume 290, July 2003). A child with parents who have mental disorders has a tendency to experience a mental disorder at his Adolescent (Pediatrics, Volume 112, August 2003).
Mental Health Efforts in Indonesia
Treatment on mental patients in the past in the Indonesia was unknown in certain. However, mental patients were housed in the hospital, civil hospital, or the military during the Dutch colonial era. The number of people with mental disorders was increasingly pushing the government at that time to establish the first mental asylum in Bogor on July 1, 1982 (now asylum Marzoeki Mahdi). Next asylum established in Lawang (June 23, 1902), RSJ Magelang (1923), and asylum Sabang (1927).
In the Dutch colonial period known 4 kinds of treatment place for mental patients:
1. Mental Asylum (Kranzinnigengestichen)
2. Interim RS (Doorgangshuizen)
3. Temporary shelters for people with acute psychotic and return to home after recovery. For those who require long treatment, sent to a psychiatric hospital.
4. Care homes (Veerplegtehuiizen)
Serves as a psychiatric hospital but was headed by a nurse under registered supervision.
The colony was a shelter for people with mental disorders calmed down. Patients could work in agriculture and live within community. House owner (host) was given living costs and the patients were still under-surveillance. Such these houses built far from the city and the general public. Unfortunately, after the Japanese occupied Indonesia, mental health development could setbacks, and even psychiatric hospital located in Sabang destroyed.
During the year 1940 – 1990, the various movements of mental health changes occurred, including:
1. 1946: launching the Law of Mental Health
Changes occurred: establishment of a national pharmaceutical institute of mental health that supports research on intervention, psychiatric diagnosis, and prevention and treatment of mental disorders.
2. 1961: Commission President's health and mental disorders.
Changes that occur: legislative support for education for mental health professional staff including nurses, social workers, psychiatrists, and psychologists.
3. 1963: Launching the Law on the mental community health center.
Changes occurred: Deinstitutionalizing clients with chronic mental disorder moved from the institution (asylum) to the community rehabilitation center.
4. 1970-1980: emergence of interest in aspects of biology and neurobiology of mental disorders and treatment.
Changes occurred: The emergence of third-generation psychotropic drugs increased the popularity of biological therapy.
5. 1990s: brain decade.
Changes occurred: Neurobiology and technology increasingly grew; identification of diagnostic studies, especially for innovative schizophrenia and mood disorders.
6. Year 1990s-early 20th century: the change in the economic and social reform of health services.
changes occured :
· Increasing of the number of homeless
· lack of legislative funding for primary prevention, secondary, and tertiary
· global epidemic of AIDS
· The need for provision of health services systematically
· Development of a high risk of mental disorders in pregnant women
· Violence on women children, parents, and users of prohibited drugs.
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Kozier, Barbara. 1979. Fundamental of Nursing.
California: Wesley Publishing Company.
Varcarolis, M.Elizabeth. 1994. Foundations of Psychiatric: Mental Health Nursing.
Philadelphia: W.B Sounders Company.
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