Warsini Sri, Kristanti Martina Sinta, Saifudin I Made Moh Yanuar, Fitryasari Rizki, Marthoenis Marthoenis, Usher Kim
Department of Mental Health and Community Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Basic Nursing and Emergency, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Int J Ment Health Nurs. 2025 Feb;34(1):e13471. doi: 10.1111/inm.13471. Epub 2024 Nov 4.
Mental health nurses and health cadres in Indonesia who provide care to persons with mental illness (PWMI) report encountering several challenges and obstacles to the delivery of quality care. At present, there is a paucity of research on this topic. The objective of this study was to examine the challenges encountered by mental health nurses and health cadres in their interactions with the families of PWMI in the community. This descriptive qualitative study employed focus group discussions, conducted in three Indonesian cities: Banda Aceh, Surabaya and Yogyakarta. Thematic analysis was utilised to analyse the data. The study revealed that the theme of this research is nurses and health cadres experienced challenging family behaviours toward a PWMI. The initial subtheme of family behaviour is 'concealing the PWMI.' This subtheme encompasses instances where families attempted to hide the mental health condition of the PWMI. The second subtheme is 'unsupportive families'. This subtheme is characterised by reluctance to engage in treatment or outright rejection of hospital care. This is often due to factors such as familial busyness. The third subtheme is 'poor parenting styles'. This subtheme highlights how inadequate parenting practices, domestic violence and lack of family support contribute to stress and exacerbation of mental disorders in PWMI. The fourth subtheme is 'hidden motive related to wills and testaments', which reveals how families may attempt to manipulate treatment to remove the inheritance rights of PWMI. The fifth subtheme is 'abandonment by family', which describes scenarios where families completely neglect PWMI, leading to inadequate care and medication adherence. The final subtheme, 'removal of PWMI from family units', describes instances where families sent PWMI to mental health facilities for permanent separation, sometimes even relocating to another city. To address these issues, a comprehensive approach is required that considers both the affected individuals and their families. An understanding of the motivations behind these behaviours is essential for the development of targeted interventions that promote family support, reduce stigma and improve the overall mental health environment in communities.
在印度尼西亚，为精神疾病患者（PWMI）提供护理的心理健康护士和卫生干部报告称，在提供高质量护理方面遇到了一些挑战和障碍。目前，关于这一主题的研究很少。本研究的目的是调查心理健康护士和卫生干部在社区中与PWMI的家属互动时所遇到的挑战。这项描述性定性研究采用了焦点小组讨论的方法，在印度尼西亚的三个城市进行：班达亚齐、泗水和日惹。采用主题分析法对数据进行分析。研究发现，本研究的主题是护士和卫生干部在面对PWMI家属时经历了具有挑战性的家庭行为。家庭行为的初始子主题是“隐瞒PWMI”。这个子主题包括家庭试图隐瞒PWMI心理健康状况的情况。第二个子主题是“不支持的家庭”。这个子主题的特点是不愿意接受治疗或直接拒绝住院治疗。这通常是由于家庭忙碌等因素造成的。第三个子主题是“不良的养育方式”。这个子主题强调了养育方式不足、家庭暴力和缺乏家庭支持如何导致PWMI的压力和精神障碍加剧。第四个子主题是“与遗嘱和遗产相关的隐藏动机”，它揭示了家庭可能如何试图操纵治疗以剥夺PWMI的继承权。第五个子主题是“被家庭遗弃”，它描述了家庭完全忽视PWMI的情况，导致护理不足和药物依从性差。最后一个子主题“将PWMI从家庭单位中移除”，描述了家庭将PWMI送往心理健康机构进行永久分离的情况，有时甚至搬到另一个城市。为了解决这些问题，需要一种综合方法，既要考虑受影响的个人，也要考虑他们的家庭。了解这些行为背后的动机对于制定有针对性的干预措施至关重要，这些措施可以促进家庭支持、减少耻辱感并改善社区的整体心理健康环境。
