Increasing Care for Patients with Mental Disorders Thought Community Empowerment: A Literature Review

Families and people with mental illnesses require community empowerment. When the environment is not empowered, it will have the impact of decreasing productivity levels. To realize mental health and public concern for people with mental disorders, it is necessary to make strategic efforts by developing mental health promotion programs as a preventive effort and increasing community empowerment to support mental health. aims to determine community empowerment in increasing care for patients with mental disorders. The following bibliographical databases were searched to identify potentially relevant documents: Google Scholar, Pubmed, and Proquest publications, 2017 – 2022. Findings from studies were extracted and aggregated, guided by the Joanna Briggs Institute (JBI). Literature review uses the PubMed, ProQuest, and Google Scholar databases. Keywords: "community empowerment"; "community concern"; "community involvement"; "mental disorder." A total of 43,253 articles were obtained. The final results obtained were 12 articles that met the review requirements. The result is that community empowerment in the form of programs or services regarding health in the neighborhood increases public awareness of people with mental disorders. empowerment carried out by the community directly, such as mental health campaigns, discussions, training, and providing facilities and means to support people with mental disorders.


INTRODUCTION
When a person is in good mental health, he or she can grow physically, intellectually, spiritually, and socially. As a result, the person can recognize his or her own strengths, deal with stress, produce results at work, and give back to the community. (Lipson and Eisenberg 2018). According to (McLafferty et al. 2017). Achieving mental health in humans entails creating harmony in the way this same mind functions as well as being able to handle issues, feel content, and start taking care of yourselves.
Worldwide, especially in Indonesia, there is still a serious issue with mental health (Tsai 2019). Approximately 35 million people suffer from depression, 60 million from bipolar illness, 47.5 million from dementia, and million from schizophrenia, according to WHO data from 2016. The number of persons who suffer from mental diseases is continuously rising due to biological, psychological, and societal reasons. The strain on the state and people's capacity to work may be long-term effects of this (Ministry of Health, 2016). According to the WHO World Health Organization (2016), Indonesia is rated fourth in the world with the greatest population and the highest number of individuals suffering from mental disorders, or over 26 million individuals, ranging from mild to severe mental diseases.
Similar to iceberg concerns, the prevalence of mental health issues is growing every year. In the globe today, particularly in Indonesia, mental health is still a serious health issue. Around 35 million people have depression, 60 million experience bipolar disorder, 21 million experience schizophrenia, and 47.5 million experience dementia, according to WHO figures for 2016 (Ministry of Health, 2016). The prevalence of mental diseases is rising in Indonesia due to a variety of biological, psychological, and social causes as well as the country's diverse population, which has an effect on the state's financial burden and the long-term ability of people to work.
According to the 2018 Riskesdas data, mental illnesses are becoming more common in Indonesia. 9.8% of Riskesdas' patients had emotional or mental health difficulties (depression and anxiety). Compared to Riskesdas data from 2013, this implies an increase of 6%. According to the high increase in emotional mental health issues by age group, the age group 65-75 years and older had the highest percentage, up to 28.6%. This was followed by the age group 55-64 years, up to 11%, the age group 45-54 years, and the age group 15-24 years, which had a higher percentage, up to 10%. (Riskesdas, 2018).
Compared to those who suffer from other medical conditions, people with mental problems frequently experience more stigma and discrimination from their community. negatively affecting sufferers as well as family members, including attitudes of exclusion, denial, and being left out. Human rights violations are more likely to occur in people with mental illnesses. (Usraleli et al. 2020) In China, there is a knowledge and experience gap in the field of treating mental health diseases. These health cadres can learn more and develop their skills more quickly. (Yang et al., 2018). In Liberia, there is still a dearth of mental health professionals and a significant stigma associated with having a mental illness. (Gwaikolo et al., 2017). Health professionals in Indonesia, such as cadres, need to be trained and coached so they can manage health services and inform the public about health more effectively. (Nafiah and Kamalah 2021).
The forefront of community health care are the corps. (Susmiatin and Sari 2021). It has been demonstrated through prior research that empowering cadres can improve Community Mental Health Nursing (CMHN) target accomplishment. In Indonesia, the creation and training of mental health cadres is one method of community empowerment in mental health care. Cadres play a crucial role in the community because, via counseling, outreach, and observing the mental health of those around them, they may assist the people there in achieving optimal mental health. (Nafiah and Kamalah 2021).
Efforts to empower the community towards mental health can be achieved with the management of health services, especially community-based mental health services. One form of this community mental health service management approach is the introduction of early detection of mental disorders that can be carried out by the community (cadres) themselves. This can facilitate the handling of mental disorders in the community. One approach to community mental health nursing is to establish Mental Health Alert Villages (DSSJ), which are villages whose residents have the resources and ability to deal with mental health problems on their own. CMHN nurses are health workers who work in the community and with the community, especially community leaders, by training community leaders, religious leaders, and health cadres (Ministry of Health, 2013). The empowerment approach to health services is used with several assumptions, namely that the empowerment approach will have a good impact on patients because their health status is more controlled and patients are able to make the best choice to overcome or improve their health status with the support of health workers.
Based on the discussion above, the researcher is interested in conducting a review on "community empowerment in increasing awareness in patients with mental disorders."

METHODS
This literature review uses a systematic approach and selection process. Library sources were searched from national and international databases, including: PudMed, Proquest, and Google Scholar. The search technique uses certain keywords from the research question. The keywords/phrases to be used in the search are Community Empowerment and Community Concern and Community Involvement and Mental Disorders. The search is restricted to publications published between 2017 -2022. Language restrictions are also used to limit searches for published articles only in English and Indonesian, and judging by the inclusion criteria that have been determined, the inclusion criteria used to determine an article that is eligible to be included in this review are articles related to community empowerment in improving care for patients with mental disorders, articles published in the last 5 years (2017-2022), articles in English and full text, articles in English and full text, articles in English and full text, articles in English and full text, articles in English and full text, articles in English and The article selection process complies with the Preferred Reporting Systematic Review (PRISMA) guidelines. (Moher et al. 2009). A total of 43,253 articles were found in the first search of the three databases, indicating that they were highly relevant to the topics reviewed between 2017 and 2022. After publishing duplicate articles and screening titles and summaries, 92 articles took the next step in full-text review and eligibility by criteria. Specified inclusions. Next, the quality of the 2 qualifying studies was examined and summarized in the final report of this literature review.

RESULT AND DISCUSSION
After the researcher selects and extracts the data for each article obtained, a detailed description regarding the name of the researcher, title, research design, characteristics of the respondents, objectives, interventions and results, this research is summarized in the To find out the form of social support for residents with mental disorders The family provides social support, such as instrumental support. The support provided by the community is group support. And social support from the government, namely information support (Susanti, et al.,2021) The The results of the literature review show that people with mental disorders can be helped by empowering people with mental disorders. Empowerment of people with mental disorders in the community has a role in improving the quality of their daily lives and also providing preventive measures. with the existence of empowerment in the community so that it helps both improve capabilities and help access health services in a monitored manner.

Community Mental Health Campaign
The mental health movement emphasizes efforts to help and improve the quality of human life in the broad realm of prevention in certain communities. This effort is not only carried out by health workers but also by community empowerment through activities to provide understanding, raise public awareness, and foster concern for mental health problems in the community. (Adella and Purnamasari 2022).
In social communication, mental health campaigns also serve a communication function. Campaigns are run to educate or inform the public so that they can change their behavior in a positive direction. This is the role of instrumental communication. According (Widjaya, Erna, and Wardaningsih 2020). Instrumental communication is communication that has the aim of informing, teaching, encouraging, changing attitudes, moving actions, and entertaining. The communication process can meet personal and work needs, such as expressing empathy, giving a test, or making a good impression. Like the research conducted by Adella in 2022, where the mental health campaign media uses posters as instrumental in educating the public about mental disorders, the community responds well to the posters and the public before and after being given mental health campaign education, which shows that there is an increased participant understanding of medium to high categories.

Community Social Support for People with Mental Disorders
In accordance with Law Number 18 of 2014 concerning Mental Health, which is aimed at ensuring that everyone can achieve a good quality of life and provide health services in an integrated, comprehensive, and sustainable manner through promotional, preventive, curative, and rehabilitative efforts, Broadly speaking, the law contains one of them, namely the need for community participation in protecting and empowering ODGJ (people with mental disorders) in the form of assistance, which can be in the form of personnel, funds, facilities, treatment for people with mental disorders (ODGJ), and protection against acts of violence, creating a conducive environment, and providing skills training.
Social support is generally interpreted as the existence of other people who can be trusted, people who can make someone feel cared for, valued, and loved. Social support provided by the community for people with mental disorders comes from social interaction. The social interaction occurs with sufferers and with sufferers' families. Social support is the availability and concern of someone who can be relied upon (Karangora, 2012).
According to research (Kumalasari, Wardana, and Martiana 2020), when there is emotional support from the community for families and people with mental disorders who provide empathy to bring them to health services, it shows community social support for families and people with mental disorders. Appreciative support is given by the community, which gives praise to people with mental disorders in carrying out worship or daily activities. As well as caring for people with mental disorders, the community provides support so they can continue to work. instrumental support, in which society provides opportunities for people with mental disorders to work productively. Social support that is obtained by individuals from their surrounding environment, both from their family and the surrounding community, will affect the way they deal with stress and anxiety in their daily lives. Individuals who receive social support from other individuals will feel loved, valued, and like they are part of their social environment. (Syarifah et al.,2021). In research (Syarifah et al., 2021), which has an overview of community social support for people with mental disorders by people in the living environment, be it neighbors, community groups, or community leaders, to increase individual coping resources and assist in psychological adjustment to a problem or illness to prevent stress. According to Maulana (2021), which has an overview of community social support for people with mental disorders by people in the living environment, be it neighbors, community groups, or community leaders, to increase individual coping resources and assist in psychological adjustment to a problem or illness to prevent stress. According to Maulana (2016), social support is needed for the recovery of mental disorders by providing psychological support. People with mental disorders feel inferior when they return to live in society after being treated in a mental hospital.

Empowerment of Cadres in the Early Detection of Mental Health
The importance of cadre training on early detection of mental disorders is so that cadres can recognize and be able to treat mental disorders early based on the signs and symptoms that appear, in addition to providing conducive conditions for patients. Early detection also functions to improve and maintain the mental health of patients and their families and is a source of problems regarding family psychiatric problems. in research (Susanti et al., 2021), where cadre empowerment is carried out through training in order to increase cadre knowledge in carrying out early detection of mental disorders.
Training for cadres is given by small group discussion (lecture and question and answer), using a module on the detection of mental disorders. The training was given in 2 meetings, with a duration of 2 hours for each meeting. From the research results, it is illustrated that the cadres' knowledge of early detection has increased significantly after being given training through health education using modules on early detection and has had a significant influence. With the presence of mental health cadres, it is hoped that they can become the spearhead for promotive, preventive, curative, and rehabilitative mental patients and their families in the community. This can increase the productivity of patients with mental disorders and improve mental health in the community. In research (Grant et al. 2021) empowerment uses the Community Mental Health Education and Detection Tool (CMED), which shows the need for tools such as CMED to help promote mental health to the community, which is carried out regularly, and this tool conducts screenings of mental health conditions. The use of this tool provides benefits to society. First, the CMED tool is a health promotion tool that can increase local community knowledge and health by looking at the mental condition of the family. Second, it becomes a media referral channel that identifies whether the referral pathway is appropriate for mental health disorders. Third, provide understanding to people with mental disorders who are being monitored, as well as guidance in using CMED tools to improve the health of people with mental disorders and their families.
The need for supportive supervision and mentoring for the public health team cannot be ignored, given the strong relationship with CHW program performance Likewise with Mueller (2020), where research develops community-based health care that has a good effect on empowering the community by using media with a new approach to community-based integrated mental health care called Gemein Depsychiatrische Basisversorgung (GBV). Includes an initial needs assessment and an individually tailored mental health treatment plan as core elements of an integrated mental health care process.
According to research (Halimah 2021) the role of community cadres in the Aji Mumpung program is in a communicative strategy in which they make observations on early detection activities in the community such as providing information on early detection schedules and conducting consultations with.The role of cadres in the community and family is to gather as much information as possible for further action. An informative communication strategy is a communication strategy where the message consists of information that is conveyed as it is according to the facts. That the Aji Mumpung program has two red lines, namely examination and treatment, as well as community education, both of which are part of the ODGJ empowerment process. These two red lines were then implemented into four activities, namely: early detection, home visits, and counseling. Efri Widianti and Imas Rafiyah (2017 also stated that by empowering the community to carry out early detection of mental health problems, cadres' knowledge of community mental health problems has increased and they can carry out early detection of mental health problems.
In dealing with the persistence of cases of mental disorders in their area, mental health cadres can take several actions, including mobilizing cadres who have attended mental disorder detection cadre training to conduct health education about mental disorders directly to the community, either in formal or informal activities. For example, in monthly posyandu and posbindu activities. The cadres can pass on the knowledge gained to other cadres who have not attended the training or to the wider community.

Community Empowerment in Building Community Mental Health
Families and communities are involved in handling cases of mental disorders, starting from early detection, treatment options, and treatment to individual needs-oriented rehabilitation. Psychiatric rehabilitation is an effort to overcome obstacles and limitations in a person as a result of mental disorders, especially severe mental disorders, so that they are able to play an active role in normal social life. What is the government's role in empowering people with mental disorders, such as providing comprehensive facilities and facilities both in the leech sector and in the health service, mental hospital, and village apparatus, according to research (Asih, 2017), where roles involve various sectors to have a good impact on families or people with mental disorders? Where the village head plays an important role, where the village head demonstrates concern by providing vehicles for residents, alert villages, and motivation to the community in an effort to build community mental health by attempting to provide a budget focused on providing medicine and a budget for human resource development through training from doctors and nurses who provide mental health knowledge in the community.
In research (Asih, 2017), it was revealed that where efforts are made by a community that cares about mental health and wants to continue to improve the quality of life of sufferers, As a result, improving the quality of life for people with mental disorders requires the entire community and the environment to pay attention and care.It is hoped that through community empowerment activities, patients with mental disorders will not only be a concern for each of their families, but also a concern for the quality of life of sufferers in the local environment.
Therefore, in order to maintain the stability of the patient's soul, it is necessary to develop or train the ability of existing human resources in the surrounding community to deal with patients who relapse unexpectedly. The community is one of the supporting environments that can be empowered in accordance with the opinion put forward by George R. Terry, as well as several figures such as Gary Dessler, Peter Sheal, and Armstrong, as well as Stephen Robbins, who stated that the community is a human resource that can be developed and will be an investment in human capital that can be developed. The price is expensive in accordance with the concept of human capital (Armstrong, 2014). Communities that will be empowered to increase their dignity in accordance with their needs to develop community mental health must be developed according to their needs.

Community Participation in Caring for People with Mental Disorders
Empowerment is an appropriate treatment goal for psychosis (Berry, Allott, Emsley, Ennion, & Barrowclough, 2014;Tolman & Kurtz, 2012). What's more, people with mental disorders themselves identify empowerment as a key factor in the treatment process. In research (Yotsidi and Kounenou 2018), empowerment has a relationship role with other people (namely, family, peers, the therapy team, and sensitive people in society). Personal relationships include volunteer and neighbor contributions, initiatives by various local agencies (e.g., cultural associations, churches), and the role of community medical support services in establishing contact and participation in patients with mental disorders.
Yotsidi revealed that participants had training programs according to their interests, for example, cooking, computer courses, and handicrafts. where it is needed so that it is productive and does not depend on other people. In addition, recreation is provided, such as painting and sports, which can be organized by local institutions. And supporting mental, social, and employment health is a supporting factor for improving treatment services for people with mental disorders. The mental health community can be a bridge between people with mental disorders broadly, both holding group discussions and increasing the abilities of people with mental disorders with various activities, establishing social relationships, and preparing people with mental disorders to work in social institutions. counseling patients to provide individual understanding and ways of managing problems in community-based services to prevent stigma among people with mental disorders. Mental Health Service User Experience on Integration. (Rise, Westerlund, Bjrgen, & Steinsbekk, 2014).
In his research, Yotsidi emphasized the importance of community health services being able to adapt to their needs by providing support to people with mental disorders and implementing focus group discussions between communities in order to provide participation for people with mental disorders.

Empowerment Training on the Use of Health Services in Strengthening Mental Health
Empowerment is the most appropriate solution to address the complexity of mental disorders. Empowerment is basically an effort to restore the productivity of people with mental disorders with a series of structured plans (Suprajitno & Liani, 2016). Empowerment of people with mental disorders can be carried out by health services that are oriented towards mental health recovery and education with integrated programs and services (Livana, 2018).
In research (Abayneh et al. 2017), it was revealed that empowerment training in health services provided benefits. In a qualitative study, respondents stated that training provided interesting and useful topics, and training that used interesting words provided a good focus on the community. Whereas in a quantitative study, participants experienced an increase in understanding after attending training, and respondents expressed that they had new skills that could be used.
In Abayneh's research, it shows a positive value in increasing knowledge and mental health recovery. This research is closer to the Photo Voice media, which supports participants to play an active role in conveying complex mental disorders. as well as the active involvement of participants in the photovoice process so as to provide new skills such as photography and group work. which has a positive impact, such as increased self-confidence and selfesteem.as well as health services reveal the adoption of healthier lifestyles such as reduced alcohol consumption, effective drug use, better social interaction, and presence in health services. And the training process provides social benefits such as building relationships, learning together, and sharing experiences.

STUDY LIMITATIONS
This article is only limited to searching the twelve databases that were analyzed due to the lack of research discussing this matter, and all literature sources obtained in this study are articles in English and Indonesian.

CONCLUSIONS AND SUGGESTIONS
Conclusions and recommendations. This article has presented several reviews of research results related to community empowerment programs related to caring for patients with mental disorders. After reviewing the 12 articles, it can be concluded that with the empowerment carried out in the community, various programs in health services are available in the community environment. The results from the literature show a positive impact on increasing the productivity of people with mental disorders as well as providing community care for families and people with mental disorders, preventing discrimination and stigma, and providing opportunities for people with mental disorders to socialize. Community mental health services play a role in preventive or curative programs. With the availability of mental health services in the community, access will be easier and the progress of the treatment can be better monitored.