Interventions: Addressing Schizophrenia
The following interventions and their agencies are being used to address Schizophrenia:
1) Cognitive Behavioral Therapy
2) Combination of therapist and e-therapy
3) The Development of Psychiatry in Indonesia
4) PORT Recommendation
5) Guided Act and Feel Indonesia
6) Art Therapy
7) Psychoeducation
8) School-Based Mental Health Interventions
9) Chain-Free Mental Health
10) Holding an Intervention
Interventions are programs, policies, procedures used to address Schizophrenia in Indonesia or globally.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy was developed in the 1950's as an alternative treatment for things like depression and schizophrenia that didn't include drugs for recovery. "CBT is a highly structured and standardized therapy to help patients with Schizophrenia cope with their psychotic symptoms by examining and reevaluating their thoughts and perceptions of experiences." (Chien, 2013). Although there have been some studies that show a reduction of the positive symptoms of schizophrenia, there have yet to be studies supporting the reduction of the negative symptoms via CBT. "Overall, the research evidence on CBT favors its use among people with schizophrenia, and it is recommended in the United Kingdom and United States that it be included as the main approach to interventions for schizophrenia." (Chien, 2013). A huge part of this therapy is helping the patients to develop coping strategies to help them deal with their psychosis, and other symptoms. One of the few downsides to this intervention is that it requires knowledgeable and skilled practitioners in order to be successful.
Combination of therapist and e-therapy
http://schizophrenia.elsevierresource.com/videos/psychological-intervention-schizophrenia
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This video talks about a new form of "blended" therapy that involves a physical therapist, but also gives "e-therapy" tools for the patient that help them cope on their own as well. "This requires knowledge of how service users ascribe value to different outcomes and treatments as well as which individuals are likely to benefit the most from different treatments to produce a coherent mental health recovery programme." (Wykes, 2016). Different people respond to treatments in unique ways, so it is important to understand how a person with a mental illness best responds to certain things, in order to give them the best treatment possible.
The Development of Psychiatry in Indonesia
In the 1950s, mental health care was largely a matter of custodial work, but in the 70s and 80s in Indonesia, the number of mental hospitals was doubled and new methods of care were introduced. "In 1966, the Directorate of Mental Health adopted the three-fold principles of prevention, treatment, and rehabilitation as the foundation of a comprehensive mental health care system." (Pols, 2006). However, even though they adopted these new systems to cope with mental health, they still gave special attention to their indigenous healers. Even just the doubling of the facilities catering to mental health, can make a huge difference for those in need of treatment.
https://www.slideshare.net/swatiarora73550/management-of-schizophrenia-54387098
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This research team recommends a variety of methods to cope with schizophrenia that are usually combined with drugs, to be most effective. Social skills training has shown to reduce rates of relapse and decrease later hospital visits. Token economy interventions are focused on rewards/"tokens" for positive behavior, so it uses a form of operant conditioning. The goals of a family based intervention include: reduce expressed emotion, increase understanding of disease, create coping skills, and other strategies designed for families. Assertive community treatment is for higher risk level patients and is much more involved. Another intervention they try to use is vocational rehab, because "Employment rates among individuals with schizophrenia and related disorders are substantially lower than in the general population." (Arora, 2015).
PORT Recommendation
Guided Act and Feel Indonesia
This intervention is completely internet based, and that seems to be a very promising idea considering that the internet use in Indonesia is expected to rise from 35% to 50% by 2018. "The Internet is also already used for online support groups of people with mental health problems in Indonesia, such as for mood disorders and schizophrenia. Therefore, based on the evidence of its effectiveness in HICs and given the limited access to mental health professionals along with the increase of Internet usage in Indonesia, Internet-based intervention might be a promising treatment for depression in Indonesia." (Arjadi, 2016). This intervention is found to be most successful when therapist support is available. If this catches on it could be largely successful because it is less expensive, more accessible, and easier to manage.
Art Therapy
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The 2014 guidelines of the National Institute for Health and Clinical Excellence (NICE) recommended the use of art therapy as a treatment for psychosis and schizophrenia. Art can be a way to channel otherwise harmful behaviors into something expressive and beautiful. "Mindfulness-based interventions have been found to be effective in improving outcomes in patients with schizophrenia spectrum disorders" (Yasgur, 2017). This would be another very effective intervention in Indonesia because it requires less money and resources.
Psychoeducation
The aim of a brief psychoeducation for the families in Yogyakarta, Indonesia who had a member afflicted with schizophrenia, was to inform them about the illness in order to help their loved ones more effectively. A brief psychoeducation was given to the intervention group, but the control groups did not receive this counseling. "This study demonstrated that brief psychoeducation with caregivers of patients with early phase psychosis was feasible in our setting, significantly improved caregivers’ knowledge, and resulted in improved regularity of contact with health providers and compliance with pharmacotherapy." (Marchira, 2017). In the end, this intervention did exactly what they had hoped, and that was to increase the knowledge about schizophrenia to the affected families.
School-Based Mental Health Interventions
The study leading to this intervention consisted of "A cluster randomized trial involving 495 children (81.4% inclusion rate) who were a mean (SD) age of 9.9 (1.3) years, were attending randomly selected schools in political violence-affected communities in Poso, Indonesia, and were screened for exposure (> or = 1 events), posttraumatic stress disorder, and anxiety symptoms compared with a wait-listed control group. Nonblinded assessment took place before, 1 week after, and 6 months after treatment between March and December 2006." (Jama, 2008). They measured children's levels of PTSD, and depression, and even their level of hope. It was discovered that a school-based intervention reduced PTSD, but not traumatic stress-related symptoms, depressive or anxiety symptoms, or functional impairment.
Chain-Free Mental Health
Holding an Intervention
As mentioned multiple times earlier, there has been/still is a severe problem in Indonesia regarding those with mental illnesses, such as schizophrenia, being chained up and treated unethically.
http://www.mhinnovation.net/innovations/chain-free-pasung-program?mode=List
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The objective of this intervention is to try to insure that those with mental illnesses are not being held in chains. They chain individuals with schizophrenia because they don't know a better way to deal with them. "Since the program started in 2012,4205 cases of people in pasung have been released. 82%of the reported cases have received treatment and been released." (Grand Challenges Canada, 2017). This seems like a very promising number and I definitely hope that one day there will be zero people left in chains in Indonesia.
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One route that is available is simply an intervention held for the loved one afflicted with schizophrenia. Many patients are resistant to the therapy and/or drugs and they require an intervention from their family members. Many times it is helpful to have a third party, professional interventionist to relieve some of the pressure. An intervention should only be held if the family deems it necessary, and it is a sort of last case scenario. "Choosing the timing of an intervention can be an important part of the process of planning the event," and this should usually occur when they become dangerous or out of control (Intervention Support, 2017). If this last option has to be resorted to, it can still be successful if conducted in an appropriate manner.
