Unveiling Shadows: Challenges Encountered by Mental Health Nurses and Health Cadres in the Delivery of Care to Persons With Mental Illness in Indonesia.

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.