COMMUNITY MENTAL HEALTH NURSING (CMHN)

Sulastri, MKep, Sp.Jiwa Program Studi Keperawatan Mitra Lampung

OBJECTIVES
Understand concept of community mental health nursing Describe comprehensive nursing care through three levels of prevention Describe mental health nursing process in community mental health nursing.

OVERVIEW
PROBLEMS: Physical Psychological Social Culture Spiritual RECOVERY

Concept of community mental

health nursing Comprehensive nursing Care Mental health nursing proces
CMHN NURSE

MENTAL HEALTH
Mental health is not merely free of mental disorders, but something that is needed by everyone to perform harmonies and productive in life.

CHARACTHERISTICS OF
HEALTHY MENTAL HEALTH

Be positive for him/her self Be able to grow, develop and achieve self actualization Be able to deal stress/change of himself Be responsible to take action and decision realistic perception Accept of other's feeling & behaviors Adapt to the environment.

PSYCHOSOCIAL PROBLEMS
Anxiety, worry overtly, fear Irritability Difficult to concentrate Doubtful /low self-esteem Disappointed Angriness and aggressive Physical reaction: heart palpitation, muscle spasm Headache.

Definition of Health- illness In Mental Health Nursing

Mental Disorders
Angry without cause Withdrawal Does not recognize the other people Uncontrolled Speaking Speak to himself Unable to perform self-care.

COMMUNITY MENTAL HEALTH NURSING (CMHN)

Comprehensive Complete Ongoing Holistic Focus on Community Healthy Mental Prone to stress Rehabilitation

Comprehensif Nursing Care

Primary Prevention

Secondary Prevention

Tertiary Prevention

HOLISTIC NURSING CARE

Biologics Psychological Social Cultural Spiritual

Comprehensive Nursing Care Complete service of care levels that is from specialist mental health service, integrative mental health care and service of mental health from community resources.

Mental Hospital General Hospital Health Center

Holistic Care

Individual Family Community

Concept of Community Mental Health Nursing

Applied in Nursing Care: Healthy mental of community member People who suffers from mental illness and still in the community. No need to refer to the hospital.

COMPREHENSIVE NURSING CARE

PREVENTION

PRIMARY
Health Promotion & mental Health Prevention

SECONDARY
Early Detection of psychosocial Problems & Mental Disorders

TERTIARY
Promote Function, socialization & Relapse Prevention Reduce Disability because of mental Disorders

Prevent Mental, Maintain & Promote Mental Health

Reduce the Occurrence of Mental Disorders

Primary Prevention
Target:
Community member who doesn't experience disorders according to group old age of children, adolescent, adult and elderly.

Activities:
1. HE program, Growth stimulation, socialization program, stress management, parenting preparation. 2. social support program 3. Drug abuse prevention program 4. Suicide prevention program

Secondary Prevention
Target : Community member who are at risk or shows psychosocial problems & mental disorders. Activities:
1. Early Case Findings
2. Screening & Further Activities 3. Suicide Treatment

4. Modalities Therapy
5. Follow up and referral cases.

Tertiary Prevention
Target:
Community member who experience mental disorders in rehabilitation processes.

Activities:
1. Social support program using sources in community. 2. Rehabilitation program by using the patient & family until independently. 3. Stigma prevention Program

Focus
Individual Family

Community Groups

COMMUNITY MENTAL HEALTH SERVICE PYRAMID

Low
6

High
Mental Hospital
5

Requirement frequency

Expense

Psychiatrist, psychologist, Mental Health Nurse

Psychiatry, psychologist, CMHN Nurse

Unit service of mental health in

Hospital

Health Service of society

Mental Health Service of Basic Health Care Informal & formal support outside

CMHN Nurse

health sector
Self-Support Individual & family

High

Required Service Amount

Low

(Maramis A, 2005; adapted from van Ommeren, 2005)

Self-Care of Individual & Family

Community both individual and family are expected maintain their mental health independently.
At this level, very important the family to include in caring their family member.

Formal & informal Services / Supports outside Health Sectors

Public figures, formal and informal groups outside health sector is target of mental health care.

Public Figures

Target of Care
Partners of CMH team

Traditional Healer

Mental Health Service of Basic Health Care

Every health caregivers in the community: private practice doctor /midwife/nurse/psychologist. Every health care institution (e.g. PHC, Clinics)

Partners of Mental Health Team.

Mental Health Care Unit in General Hospital

pelayanan rawat jalan dan rawat inap bagi pasien gangguan jiwa

Hospitals In Distric/Town

Referral
System

Mental Health Hospital

Specialist care mental health that focus at mental disorder patient who are not success cared in the family/PHC/Hospital.
Referral Back

Primary Health Care

Continuum care at the family

HEALTH CARE ORGANIZATION

Caregivers in Community Mental Health Services

Psychiatrists Clinical

Psychologist CMHN Nurse

CMHN NURSE

In PHC
Psychosocial Problems & Mental disorders
Included family,. Formal & informal outside health sectors

Conduct mental Health care in PHC area

Mental Disorders
Patient & Family

CMH Team

Psychiatrist & Clinical Psychologist

CMHN Nurse Consultant Perkeswa Kom di Puskesmas Bertanggung jawab atas keberhasilan perawatan pasien di keluarga

Mampu merawat pasien sehingga dapat berfungsi dalam kehidupan sehari-hari

Hospital District/Town
(Psychiatrist, Clinical Psychologist, CMHN Nurse)

Nurses who work in Mental hospitalization Unit: Treat the patient in the acute phase Help the patient, family and community to solve the problems. Working in team. Nurse in hospital in direct contact with the nurse in PHC in order to continuum care.

Role and Function of CMHN Nurses

Direct Nursing Care (Practitioner)

Nurse Patient
Nursing Care

Problem solving abilities

Function Increases

Nursing Process
Management of cases Nursing Intervention Individual & Family Collaboration

Educator
Health Education

Develop solving problem abilities Conduct 5 tasks of the family health.

Recognize the problem Make decision Care the family member Environment modification Using health care institutions.

Coordinator
Activities Coordination: CASE FINDINGS

Referral System

COMMUNITY ORGANIZATION

Tsunami & Disaster

Community characteristics change

Response:

Healthy/adaptive Psychosocial Problems

Mental Disorders

Community Organization

Community Organization in CMHN

CMHN NURSE

Community Nurse

Community

Cooperation

Identify needs, problems, and resources in community.

CMHN Nurse Community Nurse Community

Grouping The Community data Healthy People Psychosocial Problems Mental Disorders Planning and intervention of the cases: Daily activities Schedule Home visit Schedule Evaluation and Follow up

Refer Case or Not

Identify needs, problems, and resources which are exists in the community
The

ways to get the data :

Information

from the community such as teachers, community members who suffer from mental disorders Information from community nurse Case finding by direct assessment of individual, family and groups. By formal & informal meetings.

Grouping the Data

If found healthy community member needed prevention and promotion program to prevent psychosocial problems and mental disorders. If found healthy community member suffers from psychosocial needed intervention program for immediate recovery. If found mental disorder case needed immediate recovery intervention and rehabilitation

Planning and Nursing Intervention to the Cases

CMHN nurse makes schedule to provide intervention to the case by using module of nursing care, include:

Daily activities schedule according to daily activities. Visiting schedule for the case to treat according to the rehabilitation program.

Evaluation and Follow Up

Record the patient progress and the family's ability in caring the patient

If condition be better continue with care plan until the patient independent the family continue the care to prevent relapse and increase the patients quality of life.

If found signs and symptoms that need treatment CMHN nurse can give medicine according to standard delegation medication program monitor medication. If with caring and medication are not successful (condition become worse) the patient is referred to the PHC/Hospital/Mental Hospitals.

Thank You

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