Questions/Answers

Number of people with mental disorder (ODGJ) in Central Java Province in 2016 according to Basic Health Research in 2013 were 1.7 per 1000 people of approximately 58,000 people. From the number of ODGJ in Central Java Province there are only Mental Hospital with capacity of 1300 beds. The inconformity of number of bed capacity and the ODGJ in Central Java causes the handling of ODGJ is not optimal according to people's expectations. In 2016 the RSJD Dr.RM.Soedjarwadi of Central Java Province served 1306 inpatient visits for ODGJ. Of the visits 44 were repeated visits with variations of up to 4 (four) visits to the hospital per year and 5 (five) of them were victims of the family's deprivaton. ODGJ in the RSJD Dr.RM.Soedjarwadi, especially inpatients tend to be ostracized and not accepted by the community even by their own families because it becomes a burden economically and socially in the family. To overcome this, RSJD Dr. RM. Soedjarwadi carried out work therapy and training that had been carried out by all mental hospitals in Indonesia and developed mentoring at home through scheduled home visits, then ODGJ was given a stimulant to be able to make a production corner at home as a place producing at his home, the work of ODGJ is marketed through a gallery of rehabilitated works directly or online with the aim of maintaining ODGJ in a health, economic and social manner

Si Terpa Daya Jiwa is in line with the category of Delivering inclusive and equitable services to leave no one behind as the Hospital target is vulnerable groups not only to certain group. This innovation is in line with the criteria of Introducing Innovative Idea, policy, practice and structure because it is the first time done in Indonesia and brings ODGJ closer to hospitals with the same quality of service. Developing Criteria and Supports partnership in service Delivery and Provides access and equity to quality services, developing partnerships in mentoring with Puskesmas and Village Government, for venture capital stimulants partnering with Zakat Collection Units, hospital employee social movements (Gelibu).

Si Terpa Daya Jiwa contributes with the agenda 2030 for sustainable development (SDGs) : 1. Objective 4 : Ensuring the quality of education that is inclusive and equitable and increases lifelong learning opportunities for all. Innovation is related to meeting target 4 : building the resilience of the poor and those in vulnerable conditions, and reducing their vulnerability to economic, social and environmental shocks. 2. Objective 10 : Reducing intra and interstate gaps. Target 2 : Ensuring equal opportunities and reduce disparity in outcomes, including by eliminating discriminatory practices, and promoting appropriate policies and actions related to legislation and policies.

The innovation of Si Terpa Daya which is developed by RSJD Dr.RM.Soedjarwadi of Central Java Province, provides positive impact over ODGJ and families and community environment where ODGJ is domiciled. The regions that have been implemented in this innovation are the ODGJ group in Klaten Regency, Sukoharjo Regency and Boyolali Regency and its surroundings. This innovation provides the benefit of eliminating the stigma of ODGJ from the environment and society because through innovation ODGJ is able to produce and make money from the sale of their works, thereby reducing the financial and social burden for ODGJ and their families. ODGJ's self-esteem increases with the ability to produce works in the form of batik, decorative lights, pottery, which have the effect of reducing the risk of recurrence. This provides a result of increasing patient and family satisfaction with RSJD Dr.RM.Soedjarwadi of Central Java Province. In the following year (2017) data on ODGJ readmissions to hospitals decreased to 36.4% from 44 patients in 2016. From ODGJ who participated in the Psychology 16 patients were able to independently, economically and socially independent : 1. To be productive at home continuously 2. To earn money from the sale of their works directly 3. Stigma of families and community decreases. 4. No one has relapsed and returned to hospital.

The initiative of Si Terpa Daya Jiwa started at the time ODGJ enters a hospital, every time an ODGJ is in mentoring process and humanitarian treatment, after symptoms improve ODGJ gets pro-vocational/vocational therapy according to their abilities. After being allowed to go home, the patient was accompanied and given therapy and work training, assistance involvement by the Puskesmas and the Village Government at ODGJ's home, after which ODGJ was given a stimulus in the form of workshops where the ODGJ was in accordance with skills obtained through work therapy and vocational training. Corner stimulant production funding collaboration between hospitals and the Zakat Collection Unit (UPZ) and the hospital social movement (Gelibu: Movement of five thousand rupiah).

Si Terpa Daya Jiwa which is a model of plenary therapy (humanitarian services in the hospital, free of discrimination and free from violence) and integration of ODGJ services in hospitals and outside hospitals (through full involvement of families, health centers, village governments, UPZ and Gelibu) is an original innovation from mental health services at ODGJ from RSJD Dr.RM.Soedjarwadi as a manifestation of a hospital without walls.

Si Terpa Daya Jiwa is easy to implement by similar hospitals through things that have been done in the Si Terpa Daya Jiwa, which is a Humanistic care process, a therapy model in the family by involving Puskesmas and the village government in adequate environmental advocacy for ODGJ, a production stimulant at the ODGJ house as a place of production by third parties, namely the Zakat and Gelibu Collection Unit, marketing rehabilitated works in a gallery of rehabilitated works directly and online. The innovation of Si Terpa Daya Jiwa continues to be socialized to draw ODGJs interests to participate in this program and similar hospitals to replicate.

RSJD Dr.RM.Soedjarwadi has a Bed capacity of 199 with a Daycare capacity for provocational and vocational therapy an average of 30 patients per day. The rehabilitan companion consisting of Psychiatrists, General Practitioners, Psychologists, Nurses, Occupational Therapists, Social Workers and Skill Trainers with an average daily ability to assist 7 patients per health worker. The program is financed from the BLUD budget allocation which was rolled out at 275 million rupiah and the regional budget in the form of promotions of 100 million in 2018. The rehabilitated gallery is visited by the guests of RSJD Dr.RM.Soedjarwadi and the general public through online sales on the web. hospital, in shopee and open stalls with an average of 20 people per day.

RSJD Dr.RM.Soedjarwadi guarantees that Si Terpa Daya Jiwa is sustainable and develop by carrying out mental health service to ODGJ which always increase in quality and quantity. Through the policy of allocating BLUD budgets for therapy in hospitals and collaboration across programs and sectors. The involvement of third parties in stimulating the production of production corners at ODGJ homes began to be increased by looking for foster care in the marketing of ODGJ's work. With the enactment of the Si Terpa Daya Jiwa as a public policy in Central Java, it will have an impact on the sustainability of this innovation with the support of other programs that already exist across regional organizations so that the empowerment of ODGJ is socially, economically and environmentally stronger and ODGJ social status will grow in a community without stigma, with ODGJ activities in its measured and structured production corner, ODGJ's independence in economic aspects is expected to increase. In terms of health aspect, the risk of recurrence and readmission in ODGJ can be reduced. The service process of Si Terpa Daya Jiwa will be standardized with a digitization system so that it can be accessed by everyone in various regions.

Yes

Si Terpa Daya Jiwa has been periodically internally evaluated through clinical monitoring by supervising recurrence and readmission of ODGJ to the hospital and the independence of ODGJ seen from the improvement of social function and ability to work at ODGJ. Another internal evaluation was through increasing the number of participants with Si Terpa Daya Jiwa and the number of products produced by ODGJ who had production corners at home.

The success indicators of Si Terpa Daya Jiwa are: 1. Clinical Indicators a. Recurrence and readmissions rates of ODGJ. b. Improvement of social function and ability to work which is measured using the Global Assessment of Functioning (GAF) and Comprehensive Occupational therapy evaluation (COTE) instruments have 16 ODGJ that are independently healthier, economically and socially with activities in the production corner. 2. Quantity a. Participants of Si Terpa Daya Jiwa b. Production work of ODGJ.

1. Here was an increase in social and occupational functions and a decrease in recurrence and readmission in ODGJ who participated in the Mental Disability at 36.4%. 2. The number of Participants in the Si Terpa Daya Jiwa who rose to the vocational therapy category from provocational therapy increased by 32.1% from 1306 ODGJ. 3. The production result in 2018 increased by 124.5 %. 4. ODGJ is able to have saving, able to carry out social activities

The parties play roles in this ODGJ empowerment are: 1. Internal Hospital a. Hospital Board of Directors and management play role in technical standardization of services and funding policies in the development of ODGJ Business and management of rehabilitated Works Gallery. b. Psychosocial Rehabilitation Installation which is a downstream service unit of the mental health service process in hospitals where indicators of the success of mental care not only eliminate symptoms but are able to produce. c. Community Mental Health Installation which encourages the implementation of mental health programs in the community ranging from the family to the wider community and the establishment of a network system with the community and other relevant agencies. 2. External: a. ODGJ plays role as as the perpetrator subject and his family as a companion at home; b. The Klaten Regency Government through the MSME Trade Service by giving attention to the work of ODGJ will increase public confidence in the product so that the consumption of ODGJ products increases. c. The Village Government in the Klaten Regency supports in creating the comfort of the environment around ODGJ's house . d. Gelibu(Gerakan Lima Ribu) and UPZ RSJD Dr.RM.Soedjarawadi. e. Health Agency through Puskesmas participates in supervising ODGJ during the stay at home. f. The community and the surrounding environment as consumers of ODGJ products that are marketed directly by ODGJ and their families as well as through the Rehabilitation Gallery of RSJD Dr.RM.Soedjarwadi. g. Government of Central Java Province through budget for Promotion.

The implementation of this empowerment program adds to the experience and ability of staff in problem solving efforts because of the dropout of participants, this requires a strong commitment both leaders and other stake holders in supporting the implementation of activities in the main field facilitating obstacles that arise for the sustainability of the program. Therapy will be effective when providing awareness for ODGJ and the family is the subject / actor of empowerment. So that the effective step for the implementing team is to become ODGJ mentors and assistants and families in an effort to achieve a common goal of improving health status and optimizing the social functions of ODGJ and their families. The success of networking strengthening therapy with stake holders of government officials across sectors and programs from the district level to the village level.