Masalah keperawatan skizofrenia terbanyak adalah risiko perilaku kekerasan, halusinasi, dan harga diri rendah, dengan 55% mengalami kekambuhan karena tidak patuh minum obat. Penelitian ini bertujuan untuk mengetahui pengaruh Acceptance and Commitment Therapy (ACT) dan pendidikan kesehatan kepatuhan minum obat terhadap gejala, kemampuan menerima dan berkomitmen klien skizofrenia. Penelitian ini menggunakan desain quasi eksperimental preposttest with control group, dengan jumlah sampel 90 orang klien skizofrenia yang dibagi menjadi 3 kelompok. Hasil penelitian ini ditemukan penurunan gejala risiko perilaku kekerasan, halusinasi dan harga diri rendah serta peningkatan kemampuan menerima dan berkomitmen pada pengobatan dan kepatuhan klien skizofrenia yang mendapatkan ACT dan pendidikan kesehatan kepatuhan minum obat lebih besar secara bermakna dibandingkan kelompok yang hanya mendapatkan terapi ACT (p< 0,05). Terapi ACT dan pendidikan kesehatan kepatuhan minum obat direkomendasikan sebagai terapi keperawatan klien skizofrenia dengan risiko perilaku kekerasan, halusinasi dan harga diri rendah.

Masalah kesehatan jiwa di Indonesia cenderung terus meningkat, sehingga memerlukan tindak penanggulangan yang menyeluruh dan berkesinambungan. Pelayanan keperawatan kesehatan jiwa merupakan bagian integral dari pelayanan visi kesehatan jiwa mempunyai falsafah, visi dan misi yang mengacu pada paradigm keperawatan tentang fenomena sentral yaitu manusia, lingkungan, kesehatan dan keperawatan. Untuk dapat memberikan keperawatan kesehatan jiwa yang holistis, komprehensif dan berkesinambungan sangat diperlukan perawat dengan pengetahuan dan ketrampilan khusus tentang keperawatan kesehatan jiwa sehingga memungkinkan mereka untuk dapat bekerja pada tiap tatanan pelayanan kesehatan. The mental health problem in Indonesia is increasing which require a comprehensive and continuity of care. The mental health nursing services as an integral part of mental health services has its philosophy, vision and mission based on nursing paradigm of the central phenomena: man, environment, health and nursing intervention. Nurses need to be knowledgeable and skillful on mental health psychiatry nursing to enable them to work at different health settings.

Background Patient and public involvement (PPI) has the potential to strengthen mental health systems in Indonesia and improve care for people living with psychosis. Current evidence from other parts of the world demonstrates the need to understand the contexts in which PPI is to be enacted to ensure optimal implementation. Objective To understand service users’ and carers’ views on the current use and potential applicability of PPI within Indonesian mental health services. Design Qualitative study incorporating focus groups analysed using thematic analysis. Setting and participants Participants included 22 service users and 21 carers recruited from two study sites in Indonesia (Jakarta and Bogor). All participants had experience of psychosis either as a service user or carer. Results Despite the value attributed to PPI in relation to improving services and promoting recovery, current use of such activities in Indonesian mental health services was limited. Participants expressed a desire for greater levels of involvement and more holistic care but felt community organizations were best placed to deliver this because PPI was considered more congruent with the ethos of third‐sector organizations. Additional barriers to PPI included stigma and low levels of mental health literacy in both health services and communities. Discussion and conclusion Participants felt that there was potential value in the use of PPI within Indonesian mental health services with careful consideration of individual contexts. Future aspirations of involvement enactment should ensure a central design and delivery role for third‐sector organizations. Facilitators to global collaborative research in the context of the current study are also discussed.

Introduction: Civic engagement (CE) has the potential to transform mental health services and could be particularly important for low and middle-income countries (LMICs), which are rapidly developing to respond to the burden of poor mental health. Research from high income countries has found many challenges associated with the meaningful implementation of CE in practice, but this has been underexplored in LIMCS and in South East Asia (SEA) in particular. Methods:We completed a realist synthesis and systematic review of peer reviewed publications and grey literature to identify the context and actions which promote successful implementation of CE approaches in SEA. We used a theory-driven approach-realist synthesis-to analyse data and develop context-mechanism-outcome configurations that can be used to explain how civic engagement approaches operate in South East Asian contexts. We worked closely with patient and public representatives to guide the review from the outset.Results: Fifty-seven published and unpublished articles were included, 24 were evaluations of CE, including two Randomized Controlled Trials. The majority of CE interventions featured uptake or adaptation of Western models of care. We identified important cultural differences in the enactment of civic engagement in SEA contexts and four mechanisms which, alongside their contextual barriers and facilitators, can be used to explain how civic engagement produces a range of outcomes for people experiencing mental health problems, their families and communities. Our review illustrates how CE interventions can be successfully implemented in SEA, however Western models should be adapted to fit with local cultures and values to promote successful implementation. Barriers to implementation included distrust of services/outside agencies, stigma, paternalistic cultures, limited resource and infrastructure. Conclusion:Our findings provide guidance for the implementation of CE approaches within SEA contexts and identify areas for further research. Due to the collectivist nature of many SEA cultures, and the impact of shared traumas on community mental health, CE might best be implemented at community level, with a focus on relational decision making. Registration This review is registered on PROSPERO: CRD42018087841.

Before the tsunami, there was no systematic training provided for General Practitioners (GPs) and nurses in issues related to mental health and psychosocial support in times of disasters. After the tsunami, the Department of Psychiatry, Faculty of Medicine, University of Indonesia in Jakarta was contracted to organize a special two-week intensive training programme on basic psychiatry for 13 GPs from Banda Aceh Mental Hospital. To improve the nursing practice, a Professional Nursing Practice Model (MPKP) has been piloted in two wards in Banda Aceh Mental Hospital. This is a model of best practice for nursing care and management in an open ward system developed by the School of Nursing group and implemented in several mental hospitals in Indonesia. Basic training of GPs located at the primary healthcare level is being carried out based on the existing Ministry of Health curriculum for GPs. It covers 14 conditions listed in the International Classification of Diseases (ICD) Primary Care classification and has been conducted in 11 tsunami-affected districts. Currently, a total of 169 GPs have been trained. In general, there is an increasing interest among primary care doctors in mental health. Currently, community mental healthcare is provided in 11 districts in Aceh and two districts in North Sumatra by 277 Community Mental Health Nurses (CMHN) who have received basic training. Two thousand six hundred and two cases of serious mental disorders (mostly chronic psychosis) have been detected and treated by the CMHN and the doctors in Primary Health Centres (PHC). CMHN can provide a vital link between patients in the community and doctors in PHC. Two years after the earthquake and tsunami in Aceh, psychosocial intervention should continue and mental healthcare should be made available not only at Banda Aceh Mental Hospital, but also general health services, including PHC services.

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Individualized metacognitive training is an effective therapy for reducing delusion severity and at the same time increasing metacognitive ability. Correlations emerged between delusion severity and metacognitive ability was needed to be established. Current research findings on cognitive biases and their link to schizophrenia/delusions are explained in a comprehensible and non-stigmatizing manner to patients and illustrated by multiple (everyday life) examples. The article is a report of a study conducted to explore the influence of individualized metacognitive therapy (MCT) on delusional severity and metacognitive ability. Delusional beliefs are at the core of schizophrenia. While there is emerging evidence on the usefulness treatment for psychosis of the group training MCT, so far only one study has investigated the effectiveness of individualized metacognitive training. A quasi experimental approach was adopted: The sample consisted of each 26 patients in the intervention group and in the control group. We found that delusion severity as assessed with the Psychosis Rating Scales and metacognitive abilities using the Metacognitive Ability Questionnaire improved significantly in the intervention group. Group differences achieved significance in favour of the MCT for all measures. Correlations that emerged between delusion severity and metacognitive ability were needed to be established. Metacognitive training appears to be effective in decreasing delusion severity and increasing metacognitive ability. We recommend that individualized MCT for a schizophrenic client should become a standard procedure in the treatment of psychosis, which can be administered by a qualified nurse.

BackgroundIndonesia has the highest rate of years of life lost to disability or early death from Schizophrenia than any other country in the world. More than 90% of people with mental illness do not get any treatment and tens of thousands of people with psychosis are illegally detained (‘pasung’) in the family home. Civic engagement, a core part of the recent World Health Organisation global strategy, has the potential to address some of these challenges through the development of person-centered models of care. The aim of the study is to develop a testable systems level, culturally appropriate, civic engagement framework for use in Jakarta and Bogor, Indonesia to strengthen local mental health services.MethodsA mixed methods study underpinned by a realist approach will be undertaken across four phases in two study sites in Indonesia (Jakarta and Bogor). Phase 1 will explore the use of civic engagement across South East Asia by conducting a systematic review of existing evidence. By surveying 300 mental health professionals, phase 2 will identify the stakeholders, the sources of collaboration and the evidence used by professionals in decision making within local mental health systems and identify potential opportunities for civic engagement within the system. In order to explore the potential use of civic engagement within Indonesian mental health services and identify priorities for a culturally appropriate framework, phase 3 will undertake two focus groups with participants with experience of psychosis or caring for someone with psychosis (n = 20–30). Professionals and other key decision makers in a range of roles across the system at a national (n = 5) and local level (n = 10–15/site) will also take part in semi-structured interviews. Phase 4 will co-produce a civic engagement framework for use in Indonesia by synthesising evidence from phases 1–3 collaboratively with key stakeholders.DiscussionCivic engagement is a potential way in which health services in low and middle income countries can address the burden of mental health conditions through the development of person-centred models of care. However, such approaches are underexplored in Indonesia. This study will work with local stakeholders to design a testable civic engagement framework for use in mental health services in Indonesia.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0227-x) contains supplementary material, which is available to authorized users.