Peran Psikolog Di Puskesmas Dalam Penanganan Kolaboratif Gangguan Jiwa Berat

Osi Kusuma Sari, Prof. Drs. Subandi., MA., Ph.D

2024 | Disertasi | S3 Psikologi

Peran psikolog dalam menangani masalah kesehatan jiwa secara umum telah banyak dikaji. Namun peran psikolog dalam menangani gangguan jiwa berat di Puskesmas masih perlu diperjelas, mengingat layanan tersebut juga dilaksanakan oleh profesional kesehatan lain, seperti dokter umum dan perawat/programmer jiwa. Tujuan utama penelitian ini adalah menghasilkan rekomendasi pengembangan layanan psikologis dalam penanganan kolaboratif gangguan jiwa berat di puskesmas. Berdasarkan tujuan utama tersebut, peneliti melakukan (1) kajian konsep penanganan kolaboratif gangguan jiwa berat di puskesmas; (2) eksplorasi tugas dan wewenang Psikolog pada penanganan kolaboratif gangguan jiwa berat di puskesmas; dan (3) Menyusun rekomendasi pengembangan layanan psikologis dalam penanganan kolaboratif gangguan jiwa berat di puskesmas

   Guna mencapai tujuan tersebut, penelitian ini dilaksanakan dalam tiga tahap. Pada tahap pertama, dilakukan scoping review yang bertujuan untuk mengidentifikasi intervensi psikologis yang efektif untuk penanganan gangguan jiwa berat dan komponen dalam penanganan kolaboratif gangguan jiwa berat di layanan primer. Pada tahap kedua, dilakukan FGD kepada 22 orang psikolog dan survei kepada 84 orang non psikolog meliputi konsumen, tenaga kesehatan, dan penyedia layanan non kesehatan. Ini bertujuan untuk memahami persepsi dan kebutuhan layanan psikologi pada gangguan jiwa berat di puskesmas. Pada tahap ketiga dilakukan panel Delphi, guna memperoleh kesepakatan rekomendasi pengembangan layanan psikologi klinisi dalam penanganan kolaboratif gangguan jiwa berat di puskesmas. Dari analisis data, peneliti menemukan enam tema pokok yang dijadikan sebagai komponen utama dalam framework penanganan kolaboratif gangguan jiwa di puskesmas, yaitu:  manajemen berbasis populasi, managemen berbasis pengukuran, penanganan bertahap, kerja mutidisiplin, integrasi penyedia, hubungan dengan masyarakat/layanan sosial. Komponen tersebut selanjutnya dirinci berdasarkan empat upaya penanganan gangguan jiwa secara berkelanjutan, meliputi upaya promotif, preventif, kuratif, dan rehabilitatif.

   Penelitian ini menyimpulkan bahwa dalam penanganan kolaboratif gangguan jiwa berat, peran psikolog di puskesmas sebagai  Behavioral Health Providers (BHP) yang memberikan psikoterapi baik kepada individu, kelompok, maupun komunitas. Dalam penanganan jangka panjang, tugas dan wewenang Psikolog adalah memberikan dukungan psikososial yang efektif bagi orang dengan gangguan jiwa. Penelitian ini menghasilkan komponen kolaboratif yang menjadi dasar rekomendasi dalam mendukung peta jalan pengembangan layanan psikologis sebagai upaya kesehatan jiwa yang memenuhi standar pelayanan kesehatan. Ini memberikan dasar ilmiah dalam memperkuat integrasi psikolog ke dalam tim multidisiplin di puskesmas.

The role of psychologists in treating mental health problems in general has been widely studied. However, the role of psychologists in treating severe mental illness at Community Health Centers still needs to be clarified, considering that other health professionals, such as general practitioners and mental nurses/programmers, also carry out these services. This research aims to produce recommendations for developing psychological services in the collaborative management of severe mental illness in community health centres. Based on this primary objective, researchers conducted (1) a study of the concept of collaborative management of severe mental illness in community health centres and (2) an exploration of the duties and authority of clinical psychologists in the collaborative management of severe mental illness in community health centres; and (3) Develop recommendations for the development of psychological services in the collaborative management of severe mental illness at community health centres.

  In order to achieve this goal, this research was carried out in three stages. In the first stage, a scoping review was carried out, which aimed to identify effective psychological interventions for treating severe mental illness disorders and components in the collaborative treatment of severe mental illness in primary care. In the second stage, FGDs were conducted with 22 psychologists and surveys with 84 non-psychologists, including consumers, health workers, and non-health service providers. This aims to understand the perception and need for psychological services for severe mental disorders in community health centres. In the third stage, a Delphi panel was conducted to obtain agreement on recommendations for developing clinical psychology services in the collaborative treatment of severe mental illness in community health centres. From the data analysis, researchers found six main themes that were used as the main components in the framework for collaborative management of mental disorders in community health centres, namely: population-based management, measurement-based management, staged treatment, multidisciplinary work, provider integration, and relationships with the community/social services. These components are further detailed based on four efforts to deal with mental disorders in a sustainable manner, including promotive, preventive, curative, and rehabilitative efforts.

This research concludes that clinical psychologists are essential as behavioural health providers (BHPs) in providing psychological therapy to individuals and groups. The task and authority of clinical psychologists in the long-term treatment of schizophrenia is to provide adequate psychosocial support. The results of this research provide a road map for developing psychological services to participate in treating severe mental illness in community health centres to strengthen the integration of psychologists into multidisciplinary teams at community health centres.

Kata Kunci : penanganan kolaboratif; peran psikolog; gangguan jiwa berat; puskesmas