Community Based Pasung Release on Schizophrenia

Schizophrenia is a severe mental disorder, persistent, chronic, easy to relapse. Schizophrenics at risk of becoming victims of pasung. Confinement is any form of limitation of movement of people with mental illness by families and/or communities. The government has launched the program to end pasung, but the incidence of pasung in the community is still quite high. Liberation of communitybased pasung includes prevention of pasung, handling of pasung and rehabilitation of post-pasung. The method of community-based pasung release at the rehabilitation stage that is widely used is Assertive Community Treatment (ACT) and has been proven to reduce recurrence and hospitalization rates in schizophrenics so as to reduce the incidence of pasung and prevent re-pasung.


INTRODUCTION
World Health Organization (WHO) survey shows that one in 1,000 world population has mental disorders [1]. Based on the 2018 Ministry of Health's Riskesdas data, when compared to the 2013 Riskesdas, the ratio of households with family members suffering from schizophrenia increased from 1.7% to 7%, and the proportion of households with schizophrenic family members who were pasung was relatively the same from 14.3 percent to 14 percent [2]. In the laws and regulations of the Republic of Indonesia No. 19 of 2011, it is a ratification of the convention on the rights of persons with disabilities, which states that holding people with disabilities violates human rights (HAM) [3] [4][5]. The government has launched various mental health promotion programs and stopped pasung, including the "Indonesia Bebas Pasung" program in 2014 and the program was continued in 2019. Lack of understanding and concern for families or communities about mental health and the lack of social services that involve the community causes the practice of pasung to continue takes place [6] [7].
Pasung release is carried out by releasing, treating and empowering people with mental illness from pasung.
Comprehensive handling is needed for people with mental illness and requires optimal effort, high discipline, including the provision of pharmacotherapy treatment, and psychosocial care, in the form of the ability to carry out daily living activities, socialize, rehabilitate and treat families [1][8] [9].
Currently, if there is someone with mental disorders, the family and the surrounding community try to take him to a mental hospital. And conversely, when the family finds it difficult and feels it is a disgrace for the family, the people with mental illness will be separated from the family or even in pasung. Increased accessibility, affordability, and rights-based mental health care may reduce the use of restraint in the community and prevent reintegration of people with serious mental disorders, especially schizophrenia [10].

Community-based pasung release on schizophrenia
Pasung is any form of restriction of people with mental illness movement by family or community so that people with mental illness freedom is limited. These restrictions include the right to health services in recovery efforts [11]. An act by binding or isolating is a form of pasung [12]. The reason for the action of pasung include 1). Family and community ignorance about mental disorders that can lead to wrong approaches, including considering pasung as a form of therapy (binding "avil spirits" within people with mental illness, etc.); 2). Negative and wrong perceptions about mental disorders, both by family and society; 3). Inability to access or reach health services; 4). Feeling that health services are not helping to solve the problems experienced by people with mental illness; 5). Families are not able to care for and help people with mental illness continuously because the family has to work, is elderly, feels tired and bored with people with mental illness conditions, especially if people with mental illness is totally dependent on other people and lasts for years [11].
Mitigation of pasung carried out in phases:

Prevention of pasung
Pasung prevention efforts can be performed optimally by protecting people with mental illness of pasung action, but also efforts to prevent the re-pasung or pasung returned and efforts to improve the quality of health services through:

Socialization and educational
Socialization and education includes the importance of mental health awareness, the benefits of treatment for mental disorders and information about pasung and the impact of pasung on people with mental illness. The existence of stigma against people with mental illness, family and professional stigma as well as low knowledge of mental health in families and communities will hinder the education process [13]. Education can be carried out by all parties, including health cadres for prevention of pasung and post-pasung relapse [14].

Conducting advocacy regarding pasung
Advocacy can be addressed to anyone with an interest in pasung, namely: 1. Health or mental health personnel, to remain committed to serving and empowering sufferers and families.

Team formation
Team formation is carried out after confirming the information during the identification process.  [11].
The implementation of pasung exemption is carried out in the following stages:  6 The doctor informs the family about priority action plans from aspects mental and physical.
The nurse creates a nursing intervention plan. 7 Doctors and nurses ask for written consent (information for consent) to perform medical and nursing actions on families. If the family agrees continue to step 8.

Assertive community treatment (ACT)
ACT is an evidence-based psychiatric rehabilitation practice, with a comprehensive approach to providing services to consumers with severe mental illness [18]. ACT is a program for people with mental illness who experience difficulties in daily living activities, difficulty meeting basic needs, and difficulty fulfilling their life security with a flexible and comprehensive multisectoral team approach in providing services and providing support to the community [19].
The multidisciplinary team consists of 10 -12 staff with experience in the field of psychiatry including case managers, psychiatrists, nurses, social workers, employment counselors, and addiction counselors. Team members will spend more than 80% of their time in the community and team members will provide on call services at any time, 24 hours for 7 days [20].
ACT is characterized by (a) a low client-to-staff ratio; (b) provide services in the community rather than in the office; (c) shared caseloads among team members; (d) 24-hour staff availability, (e) direct provision of all services by the team (rather than referring customers to other agencies); and (f) unlimited service time [18]. Services are carried out to a special people with mental illness group. The care requirements for people with serious mental disorders outside the hospital (community care) are known as "The Seven C's" [21].  overcoming severe mental disorders who live in pasung so that they can return to the community.