Since the government implemented Large-Scale Social Restrictions (PSBB) in early April, Yohanes Iman (55) has no longer set foot in the Regional General Hospital (RSUD) Bekasi, West Java. As a referral hospital for Covid-19 patients, Bekasi Regional Hospital was forced to close face-to-face counseling services. In fact, this schizophrenia survivor since the age of 20 has to routinely take medication and face-to-face counseling at the hospital. Without it, he will experience hallucinations, delusions and grumble various kinds of words related to religious ideas.
"If you don't take medicine, your neck feels tense. I immediately messed up myself (thought-ed), "said Yohanes Iman when contacted by Jaring.id on Thursday, June 11, 2020.
Iman is one of more than 282 thousand patients with mental disabilities who have had to contend with the Covid-19 pandemic. As of 23 June, the number of Covid-19 cases in Indonesia was 47896, 19241 recovered and 2535 died.
However, during the current pandemic, Iman feels that he doesn't have many options. If he insists on going to the Bekasi Regional Hospital, by mistake, he will be exposed to a virus that attacks the lower respiratory system.
"Now it is very difficult. There is already an anxiety disease (Schizophrenia-ed), then there is a pandemic, ”he added.
Psychologist at Soeprapto Mental Health Hospital, Bengkulu Province, Rudi Rajagukguk, said that counseling services for survivors of mental disabilities are very important in the midst of a pandemic. This is because medical services can suppress the burden of thoughts that often arise in limited conditions like today.
During the pandemic, according to Rudi, there was an increase in the number of counseling. Previously, he admitted that he only served three people a day. However, now the number has increased to 10 people. Rudi also still has to take care of around 300 patients with mental disabilities at the Soeprapto Bengkulu Mental and Drug Addiction Hospital (RSJK). He said, the availability of personal protective equipment (PPE) at RSJK was very minimal and services were carried out with minimal Covid-19 health protocols.
"We have conveyed this to the local government," said Rudi who is also a member of the Bengkulu Indonesian Schizophrenia Care Community (KPSI).
The Chairman of the Association for Healthy Mental Health, Yenny Rosa Damayanti stated the same thing. According to him, survivors of mental disabilities are at risk of contracting Covid-19. The reason is, patients are required to go back and forth to the hospital. In addition, the side effects of the drugs consumed can lead to comorphid diseases such as heart disease and diabetes. On the covid19.go.id site, the two diseases are included in the top five diseases that accompany Covid-19.
"This situation puts them at risk of contracting it," said Yenny when contacted by Jaring.id, Thursday, June 11, 2020.
Realizing this risk, the Association of Healthy Mental Health with the private sector conducted an initial screening through rapid test at the Laras Bina Harapan 2 Cipayung Social Home, East Jakarta on Friday, June 5. Of the 1025 residents and officers, 20 people were declared reactive. Not wanting to make things worse, dozens of people consisting of 15 residents and 5 officers were immediately referred to Duren Sawit Hospital, East Jakarta for further examination.
"I was surprised, fortunately it was quickly discovered so that prevention could be given, if yesterday did not do it rapid test, it can go anywhere (distribution-ed), "said Yenny.
This woman, who has been struggling with mental disability for ten years, explained that in areas with a high distribution of cases such as DKI, East Java, West Java, Central Java and South Sulawesi, there are still many orphanages that have missed the Covid-19 rapid test. According to Yenny, the activity of officers entering and leaving the orphanage is at risk of bringing the SARS-NCOV-2 virus into the institution.
"I'm afraid they are infected," said Yenny.
Head of Panti Laras Bina Harapan Sentosa 2, Tuti Sulistyaningsih stated that the results of lender testing (swab) on 20 patients and health workers at the Laras Bina Harapan 2 Cipayung Social Home were negative for Covid-19. However, they are not allowed to return to the home before undergoing independent isolation for 14 days. Tuti explained that the five officers carried out independent isolation in their respective homes, while the residents of the nursing home were isolated at Duren Sawit Hospital, East Jakarta.
"I want the government to do it regularly rapid test. We don't know the mobility outside, even though we have been equipped with an understanding of the protocol, "said Tuti Sulistyaningsih to Jaring.id, Friday 12 June 2020.
Inhabitants Prone to Infection
The Directorate General of Social Rehabilitation of the Ministry of Social Affairs in 2018 recorded that the number of social institutions in Indonesia reached 8000. This figure includes institutions managed by the central, regional and private governments. However, no more than 10 percent of the institutions carried out the initial Covid-19 screening. In the near future, according to Yenny, his party will conduct rapid tests in four social institutions.
"Everything is still in the DKI Jakarta area," said the Chairman of the Association for Healthy Spirits, Yenny Rosa Damayanti.
According to Yenny, Covid-19 screening at the nursing home is urgent. He admitted that he could not wait for the government-initiated testing. Especially since the first case was announced by President Joko Widodo on March 2, his institution has written twice to the Ministry of Social Affairs. Finally, Yenny exclaimed in a web-seminar through the Zoom application with the Ministry of Social Affairs. However, the government's response is no more than the distribution of social assistance (Bansos).
"What we want is to ensure the prevention of infection in the home. It can't be resolved with social assistance, ”said Yenny, somewhat annoyed.
The Director of Social Rehabilitation for Persons with Disabilities at the Ministry of Social Affairs, Eva Rahmi Kasim, stated that his party had tried to prevent Covid-19 at homes and rehabilitation centers. The effort that Eva meant by issuing letter Number B 106 / Kemensos / 4 / KS.03 / 3/2020 concerning Instruction related to the Protection of Persons with Disabilities during the Corona Virus 19 (COVID-19) Pandemic. The letter mainly contains restrictions on the number of visits and procedures for applying physical distancing, such as rearranging the layout of the bed and dining room.
"There are instructions," said Eva Fahmi when contacted by Jaring.id, Friday, June 12, 2020.
However, in practice the circular has not been implemented in rehabilitation centers or centers. Referring to the findings of the Healthy Mental Association, Panti Bina Laras Harapan Sentosa 2, East Jakarta and the Galuh Bekasi Foundation, they have not implemented health protocols. Provision of a proper sanitation system, maintaining a safe distance (physical distancing), and arrange the layout of the bedroom has not been done. According to Yenny, the bedrooms in both homes are still occupied by 20-30 people.
"There is discrimination they face in the orphanage. They are not required as citizens, "said Yenny.
Yenny admitted that he had reported the findings to the Presidential Staff Office (KSP) Deputy V for the study of the management of strategic political, legal, defense, security and Human Rights issues in mid-May. Jaleswari Pramodhawardani Deputy V of the KSP when confirmed regarding the report of the Association for Mental Health had not yet provided a response. Jaring.id has also attempted to land phone calls and WhatsApp messages, but there was no response until this article was published.
Meanwhile, the Ministry of Social Affairs' Disability Director, Eva Rahmi, did not deny the findings of the Association for Mental Health. According to him, efforts to carry out initial Covid-19 screening collided with the authority of the Ministry of Health. The Ministry of Social Affairs cannot act alone before coordinating with the Ministry of Health.
"It's a health matter, we don't have that authority," Eva told Jaring.id, Friday, June 12, 2020.
However, Eva appreciated the steps of the Healthy Mental Association and the private sector that carried out the Covid-19 rapid test. This step is useful for early detection of cases of infectious infections in nursing homes and rehabilitation centers.
"I actually welcome any efforts to do this rapid test, "He said.
According to the Ministry of Health's Director of Mental Health and Drug Prevention and Control, Fidiansjah, the provisions for conducting a rapid test have been regulated in the guidelines for handling Covid-19. In this guideline, Puskesmas and hospitals are given the role of conducting mass testing.
"Meanwhile, counseling can still be done online on line/ online, ”said doctor Fidianjah via a WhatsApp message on Friday, June 19, 2020.
The risk of exposure to Covid-19 for homes, rehabilitation centers and Mental Hospitals (RSJ) was revealed by the Association of Indonesian Psychiatric Specialists (PDSKJI). Doctor Zulvia Oktanida Syarif from the Partnership and Foreign Relations Division of PDSKJI said that the layout of closed or limited orphanages, centers and RSJs for medicinal purposes and the rehabilitation process allowed the spread of the virus to spread rapidly.
"It must be guarded, so that no viruses enter because it is very risky," said Zulvia to Jaring.id, Thursday, June 11, 2020.
The woman who is now on duty at Tarakan Hospital, Jakarta, explained that handling Covid-19 for people with mental health disorders is much more difficult. This is because the mental condition of each mental disability is different. Paranoid attitudes and high anxiety will make handling mental disabilities infected with Covid-19 must be extra.
"There are those who are afraid to see complete PPE, they can even bring up suicidal thoughts. The challenge is there, ”said doctor Zulvia. (Abdus Somad)
This article is the first of two articles about the conditions of people with mental disabilities during the Covid-19 pandemic.