COMMUNITY MENTAL

HEALTH NURSING (CMHN)

MUHAMMAD ARSYAD SUBU, SKp, MSN

 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 RECOVERY
• Social
• Culture
• Spiritual

• Concept of community mental

health nursing
• Comprehensive nursing Care
CMHN
• Mental health nursing proces 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 Holistic Care

General Hospital

Health Center

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 SECONDARY TERTIARY

Health Early Detection Promote
Promotion of psychosocial Function,
& mental Problems & socialization &
Health Mental Disorders Relapse
Prevention Prevention

Prevent Mental, Reduce the Reduce Disability

Maintain & Promote Occurrence of because of mental
Mental Health Mental Disorders 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
High
6
Psychiatrist,
Mental psychologist, Mental
Requirement Health Nurse
frequency Hospital Expense

5 Unit service of
Psychiatry,
mental health in
Hospital psychologist,
4 CMHN Nurse
Health Service of society

3
Mental Health Service CMHN Nurse
of Basic Health Care
2
Informal & formal support outside

1 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
Traditional
• Partners of CMH
Healer
team
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
Hospitals gangguan jiwa
In Distric/Town
Referral
System
 Mental Health Hospital
Referral Back
Specialist care mental
health that focus at
mental disorder patient
who are not success
cared in the Primary
family/PHC/Hospital.
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
Mental disorders
Conduct mental Disorders
Health care in Included family,.
PHC area Patient & Formal & informal
Family outside health
sectors
 Psychiatrist & Clinical
CMH Team Psychologist
CMHN Nurse

Consultant
Perkeswa Kom
di Puskesmas
Bertanggung jawab
atas keberhasilan
perawatan pasien di Mampu merawat
keluarga 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 Problem solving
abilities

Nursing Care Function

Increases
Nursing
Process
• Management of cases
• Nursing Intervention
Individual & Family
• Collaboration
 Educator
• Develop solving problem
Health abilities
Education • 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
 Community
Tsunami & Disaster characteristics
change

Response:

Healthy/adaptive Psychosocial Mental Disorders

Problems

Community Organization
Community Organization in
CMHN

CMHN
NURSE

Community Community
Nurse
Cooperation
 Identify needs, problems, and
resources in community.

Grouping The Community data

Healthy People
Psychosocial Problems
CMHN Nurse Mental Disorders
Community Nurse
Community 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 patient’s 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

Have Nice Week