Training Must Always be Productive and Useful

KOMPAS/FAJAR RAMADHAN

Caregiver Yuliansyah Yanim (in yellow jacket) holds schizophrenia patient M. Abdul Fahri to calm him from an earlier rage on Wednesday (2/10/2019) at the Istana KSJ mental health center in Ciarnjur, West Java.

Anggi, 23, as she prefers to be called, was enthusiastic as she followed the instructions of a trainer in a vocational therapy class on hydroponics, held last week at the psychosocial rehabilitation clinic of Marzoeki Mahdi Hospital (RSMM) in Bogor, West Java. She displayed dexterity in her movements.

She also readily helped other patients follow the trainer’s instructions. “Only the long seedlings are to be moved, Pak. The short ones fail, don’t move them,” she told Yudi (not his real name), 45, as they transplanting bok choy seedlings from Rockwool, a hydroponic planting medium, to net pots.

Anggi and Yudi are schizophrenia patients who are being treated at Bogor’s Marzoeki Mahdi Hospital. Anggi, who was diagnosed with schizophrenia seven years ago, is an outpatient, while Yudi receives inpatient care. The vocational training program is part of their therapeutic treatment, designed to help restore their mental health so they can communicate, be self-reliant and develop social skills.

She also practices what she has learned, and has a small hydroponic garden at home.

Anggi had received the same training earlier. She is now knowledgeable about hydroponics, and can nurture plants from seeding to harvesting. She also practices what she has learned, and has a small hydroponic garden at home.

The hydroponics training class is just one of the vocational therapy classes offered at the RSMM. It also has are many other classes in subjects like culinary arts, making salted eggs, pottery, embroidery, organic gardening and computer skills. The hour-long training classes are held regularly in the mornings, from Monday to Wednesday.

Meanwhile, in the culinary arts kitchen, a 20-year-old patient who calls herself Anis was making soy milk, stirring a mixture of soybean powder and sugar with a pinch of salt on the stove. Each cooking class makes a different food, like donuts, cupcakes and puddings.

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Siti Juansyah, 38, cries as she says her goodbyes to her younger sister Maryati (foreground), 22, who has schizophrenia, as the latter departs Thursday (3/10/2019) from their home in Sukasari village, Kadupandak district, Cianjur regency, West Java, for treatment and rehabilitation at the Istana KSJ mental health center.

“So Anis, what foods have you made at home? Are you selling food?” asked Euis, 44, the culinary arts instructor.

Anggi responded promptly and confidently: “I like making pudot, Bu. Puding sedot (pudding drink). Many people like it, especially if it is sold chilled. The returns are pretty good,” she said.

At a glance, there is no visible difference between Anis and Anggi. They are like any girls their age, keen to try new things. They are also responsive when people talk to them. However, they have worked hard and persevered to reach their present condition.

Vocational therapy helps make them independent and productive, and also encourages them to socialize with other people. Fortunately, Anggi does not live far from the hospital, so she has easy access to the program that complements her medicinal treatment.

Recovering and healthy

“The goal of psychotherapy for people with mental disorders like schizophrenia is to recover, heal and be healthy,” said RSMM psychiatrist Lahargo Kembaren.

A patient’s mental recovery is marked by the disappearance of symptoms and resuming daily function, so that they can be independent and productive.

Besides psychosocial rehabilitation, schizophrenia patients also undergo cognitive rehabilitation to restore their memory and develop their ability to concentrate. The therapeutic methods vary from quizzes to cognitive remediation using paper and pen, and to computer-based cognitive remediation.

Other therapeutic methods include social skills training, also called psychoeducation, and vocational training that uses movement, music, literacy and spiritual methods.

Several health centers aside from RSMM also offer psychotherapy services to complement pharmacological therapy for schizophrenia. One of these is Puskesmas Gitik, a community health center in Banyuwangi, East Java, which has a training center to empower people who have mental health conditions.

Nevertheless, it is not easy to provide mental health services, let alone psychosocial rehabilitation, for schizophrenia patients The limited availability of mental health professionals is a constraint on such programs.

The presence of mental health officers makes the public more open and willing to accept people with schizophrenia living together.

This is why Puskesmas East Denpasar in Bali has recruited mosquito larvae monitoring officers to help out as mental health officers. They are trained in managing schizophrenia patients. “The presence of mental health officers makes the public more open and willing to accept people with schizophrenia living together,” said Donna Ervina Saraswaty, who manages Puskesmas East Denpasar’s public mental health program.

Social rehabilitation is also offered by a number of institutions in several cities that the Social Affairs Ministry manages through the Social Rehabilitation Center for Mental Health Patients (BRSPDM). “The BRSPDM receives referrals from social rehabilitation centers in the regions,” said the ministry’s Social Rehabilitation Director General, Edi Suharto.

In addition to government institutions, many private institutions provide psychosocial rehabilitation for schizophrenia sufferers. Rehabilitation therapy is provided because medication alone is insufficient to treat schizophrenia. Skills training helps restore emotional health and self-confidence in schizophrenics, so that they can pursue independent lives in society.

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Maryati, 22, peers out from underneath a cover in her cage in Sukasari village of Kadupandak district, Cianjur regency, West Java. A team from the Istana KSJ arrived on Thursday (3/10/2019) to free the schizophrenia sufferer from confinement to transport her to its mental health center for treatment and rehabilitation.

Another challenge faces schizophrenia patients who finish their treatment and return to society. Many can relapse if they are unprepared to face real life and lack a strong support system. Psychosocial rehabilitation is thus important for empowering people with schizophrenia and enabling them to lead a full life.  (TAN/GER/AYS/SON)