Operationalising the construct of Perceptions

Perceptions: Association, Attribution, Reactions

My Questions to Mental Health Professionals:

Attribution: why? - what's the cause?

Treatment: how?

Reaction: 

- mental health landscape (what's good / what's lacking?)

- spiritual treatment (dukun / kiyai) - possibility of partnership?

- stigma?

- Javanese cultural factors that act as protective factors?

- patients reaction to diagnosis?

- caregivers?

- community's reaction?

Association:

First word? 

Associations: Words Used to describe persons with mental illness(es)

Technique to operationalise "Perceptions"

* Association 

* Attribution (meaning)

* Reactions

What people in masyarkat say about PMI  (19/9)

- gila - anyone who enter must be crazy 

- Sinting - gila 

- kenthir - gila 

- gemblung - people who are very stupid

- stress - when one has too much, it affects one's ability to think straight

Results of survey

Kasihan (pity)! My research surfaced kasihan (pity) as the most common word associated with persons with mental illness(es) where more than 40 respondents out of 200 (20%) cited this as the first word that comes to mind when thinking of such persons.

Besides kasihan (pity) other words commonly associated (Chart 1) are gila (crazy) — 12.5% (25 respondents), sakit (sick) — 7.5% (15 respondents), edan (crazy), aneh (weird), kucel (crumpled), berbeda (different), kosong (empty), hilang (lost) and Islamic proclamations: astagfirullah (forgiveness from Allah), innalillahiwainailaihirojiun (surely we belong to Allah and to Him shall we return).  

RSJ Grahsia: Learning from experienced mental health professional Mbak Aspi (19/9)

RSJ Grahsia (observations on environment)

- tenang (peaceful) on Sat

- focus on rehabilitation

- located far from city centre (usually for rehabilitation houses)

- bureaucratic - requires letter from Heads to Heads - shows the importance RSJ Grahsia placed on patients' confidentiality

Interview with Mbak Apsi of KESWAMA revealed:

- menolong - PMI can be helped and more can be done to help them. I want to do what I can to help them.

- there are barriers - due to bureaucracy - challenging to go directly to people - the stratified hierarchy suggest that there are levels to go - this might incur inefficiencies - as evidenced by the result of DSSJ being spread to 6 villages in 5 years

- DSSJ (Desa Siaga Sakit Jiwa) - Village Readiness for Mental Illness - is a Programme targets at 5 regencies in D.I.Y.

- patients that come to Grahsia from the desa (village) are usually those who have gone to the dukun for 5 to 10 times with no results

- the families usually have huge debts and lost many savings at this point in time (bcoz the demands of ube rampe from a dukun can be extremely challenging to attain) - desperate to help their kids 

- Grahsia is usually seen as the last choice to go to - the last resort

- not really possible to work with dukun because 

(1) medical practitioners see them as being of lower status (dislike to associate) - no evidence / non-scientific

(2) agama - musyrik is not good - everything is planned by God - nrimo better

(3) because of stigma, dukun many times don't identify themselves as dukun - they call themselves kiyai, religious leaders who are experts on paranormal phenomenon

- Going Forward: How can we achieve better mental wellness?

* research

* sosialisasi (psychoeducation promotion and training)

* bebas (free) pasung movement - and treat them medically and with dignity

* reduce stigma through education

* build connections between sectors 

Remark by Anita, S2 senior

(it is better to be possessed than to be mentally ill)

Ojek Pak Yanto's experiences with PMI (19/9)

When I shared with Pak Yanto that I will be visiting RSJ Grahsia today, he shared with me his experiences.

The Area

He passed by that area frequently to visit his Friend and send people to a park near there. He said there are many "orang gila" in there. Outside, there are a few. Sometimes, they are thrown out because they do not have money to pay since their family had abandoned them after some time.

Experiences with PMI @ Security Post - what they asked for

When he was working as a security guard, he recounted that there was this man who always come to where he work. He will ask for food (Nasi goreng). After which, ask for drink (Es Teh). After which, ask for cigarettes. Pak Yanto said he will buy them and give it to him. He said the man seldom talk to others, even though he's gila. But according to Pak Yanto, he seem to trust Pak, so Pak Yanto, will help him when he ask. Pak said the man used to be a mahasiswa until stress proved too much to take.

University students' stress in kota pelajar?

A Friend who died

Pak Yanto said he had a Friend who had problems with his thinking. Especially when the weather gets hot. He will show signs of distress and become angry easily. He will often ask food, drinks and cigarettes from Pak. He didn't used to be like that. Passed away recently.

Pak's attributions of expressions of anger as a mark of PMI 

On the way x4

Pak Yanto pointed out to me 4 times on my 15 minutes journey from my rumah kos to UGM's library, people on the streets who he claims are orang gila.

There was a man who looks decently dressed but was hunched over sitting along the pavement with his head buried, under the hot sun.

There was a "mahasiswa" (young) according to Pak, along the street talking to himself. 

There was a woman (presumably in her 50s) who was dressed in clothes that were a little tattered and torn. She was toying with garbage and had a bicycle beside her loaded at the sides with plastic bags full of "garbage".

Appearance - untidy

Signs - talking to self

Abnormal - sitting under the sun

Living around PMI 

I asked Pak if there were orang gila in his community. He said yes! But the guy was often in his house, and does not disturb others. He said there are people in the community that doesn't like him. He's okay with him.

Peaceful co-existence? An uneasy peace? - rukun 

Why did people not like him? 

Peer Aulia: Religious fanaticism and ODGJ (14/9)

Aulia's sharing:

Religious fanaticism - phenomenon in Central Java 

- fanaticism - prejudice - group polarisation 

- Same Allah but different religious practices - clash in Central Java 

On ODGJ

- first word: gangguan

- dukun for orang Desa (uneducated)

- people approach kyai too (but after consultation, just drink water, not psychiatric medicine) - opportunity for collaboration?

- she don't believe in dukun or kyai

- will recommend friend to seek psychological help should he/she exhibit symptoms 

- perspective towards medicine?

[CPMH] What happens when you bring teachers, students and parents together?

What happens when you bring teachers, students and parents together?

• The affirmation-exchange activity was profound!
• Parents teared! Fathers and mothers alike.
• Teachers smiled heartwarmingly.

This initiative, School of Wellbeing Training is a psycho-education workshop for the above stakeholders initiated by CPMH, MOE & MOH.

• The students are taught techniques to gain success via goal-setting and having dreams. They are also made to write affirmation notes for their parents and teachers.
• Teachers are taught to communicate with empathy to their students (techniques of empathic communication). They are also taught basic techniques of counselling and ways to spot problems among youths.
• Parents are taught communication techniques and the use of affirmations to nurture their children.

Guru

Siswa-siswi 

Meeting KPSI Yogyakarta's Founder Dr. TIKA (23/8): Nongkrong (hangout) with caregivers

Meet Dr Tika :)

She spends her Sunday morning today, cooking for and facilitating the sharing for Komunitas Peduli Skizofrenia Indonesia Jogja's caregivers and consumers together with her team. 

I am so glad to finally meet Dr. Tika in person! 

Via the practice of nongkrong - Dr. Tika is able to nurture a culture of support among caregivers, persons with mental illness(es) and professionals like herself.

Anthropologist Margaret Mead once said, "Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has." Social change can happen with combined efforts. To feel supported, to be understood and to realise one is not alone, are human needs that while simple, is profound especially for persons struggling with mental health issues.

I look forward to learning more from her. Striving together towards a world where there's mental wellness for all :) 

#6 - Ojek knows PMIs (10/9)

Encounter with PMI (10/9)

It was 8 am and I was exiting from my rumah kos to take my Ojek (motorcycle taxi) to school. There was a man (in his late 50s) loitering outside my rumah kos, he looks lost. Just as I was boarding my Ojek, he asked me if I had seen his son from Jakarta inside my house. I replied no, and that I am sorry before boarding my Ojek. My usually talkative Ojek Pak Yanto was unusually quiet throughout this episode. As my Ojek moved, I close the main gate behind the man.

(Why did I do that? - was it out of fear?)

As we moved on, Pak Yanto said: "Dia orang gila!" 

I asked, "Bagaimana Pak tahu?"

Pak Yanto: "Kelihatanya dia hilang. Pakaian kotor sekali ya."

Note to self

#Terms Of Address for PMI: Orang Gila

#Judging PMIs based on appearance - an appearance conscious Javanese

I asked "Ada banyak di Jogja?"

Pak Yanto: "Banyak! Terutama di Grhasia. Mau pergi ke sana? Kira-kira 15 menit."

I replied, "ya! Mungkin suatu hari ya."

Pak Yanto went on to share with me how they are followed by spirits (diikuti makhluk halus) and are possessed. Some are dangerous and have to be "tangkap." "Mungkin dia yang lalu, jahat."

I asked, can they recover (bisa sembuh?), according to him?

He said maybe.

I asked have he heard of terms like psychosis, schizophrenia and "gangguan jiwa". He said no.

Key Reflections

This encounter is revealing of perceptions of laymen in the community towards persons with mental illness(es). The labels and terms heaped upon them "orang gila" appears to be sweeping but telling of attitudes. The perception that " diikuti makhluk halus" suggests that mental illness(es) are still very much linked towards spiritual notions of possession and karma (Mungkin dia yang lalu, jahat). His silence at the start when the (lost) man was around, suggests a sense of avoidance and discomfort, yet his silence indicated that he wanted to maintain "rukun" (harmony) and not even engage, much less confront the man.

#5 Youths in Jogja: Dissonance, Adjustment and Illness?

Conversations with Mbak Wenty, internship supervisor on the state of youths in Jogja

What's Good about youths

More well-informed: access to more sources of information. More resources

As an educator, this is good as "discussions (among students and teachers) become richer."

- Mbak Wenty

What are some issues of concern?

Students might feel overwhelmed by the wealth of information.

This information can be used for good and bad. Exposure to media - advertisements inspire wants and consumption. Lifestyle choices like pornography and free sex may be influenced.

There are concerns with emotional well-being of students. Tensions between the desire for pre-marital sex and religious fundamentalism (a return to more religious piety). Some lead double lives. Mental stress and guilt may occur as a result.

Adjustment issues. This is compounded and complemented with the fact that in Kota Pelajar, many students are away from home and realise their newfound independence endows them with power to make decisions independently and choose what lifestyle they want. 

These decisions can go a long way in influencing their future and outlook. 

Dating culture

Pre-dating is usually done via social media and LINE rather than in person. Dating is before and after getting into a relationship in Singapore. But in Indonesia, dating is done after the guy ask the lady to be his pacar, with the preparation/intention to get married.

According to Luthfi, Undergraduate (Law), these are the youths problems of the day:

- free sex

- drugs

- ethics (cheating, plagiarism, corruption - bribing)

These "sins" and lifestyle choices can lead to the development of "ill" mental health.

#4 Medicalising / Diagnosing Mental Illness(es) via DSM-IV

The dominance of the medical model (9/9)

Mbak Ariana teaches her masters' students (S2) on identification of "gejala" (symptoms) and making a diagnosis using the five aksis (axes) of DSM-IV.

#3 - PMI: How can I get help?

Conversations with Supervisor Mbak Ariana, M.Sci Social Work - Week 2

How does the community mental health landscape look like?

This is a map of the "defences" in the system.

For those in the community / the poor without private insurance, they have to go to PUSKEMAS first. If they need specialist treatment, they must get a referral. Similar to the Polyclinic system in Singapore.

#1 - Primary Health Care - PUSKEMAS

(for those with General Insurance Coverage)

#2 - Secondary Health Care - hospitals

(For those with private health care insurance)

Reminder: learn about the city structure 

Key reflections:

Mbak Ariana related those who sought the help of dukun as those who are less educated and those who have less access to services.

How can we improve the mental health services?

Mbak Ariana wishes that more districts have psychologists. The alternative is to have more GPs and nurses trained in mental health. The current issue is there is a limited supply of psychiatrists and psychologists.

Eg. Community Mental Health Nurse (CMHN) programme - to train and certify nurses

Eg. GP+ programme - qualify GPs to do assessments and prescribe anti-depressants as well as anti-psychotics 

Eg. Targeting the community to support PUSKEMAS

CPMH has a new initiative to train volunteers in mental health - mental health cadre. They will help to conduct initial screening for PMIs, deliver psychoeducation but NOT interventions.

Referred me to Mbak Nurul, who's heading the initiative. Will get involved in the planning for the training which will happen in 2 weeks time.