The Contribution of Mental Health Cadres to Improving Client and Family Psychosocial Health

. Mental disorders are the conditions of poor functioning of physiological and mental processes that impact changes in thoughts, feelings, and behaviour that interfere with the function of daily life. The method of service was carried out by counselling families and patients with physical illnesses, then continued with mental health gymnastics. Based on the results of this service knowledge before and after education were obtained, there was an increase in knowledge after being given health education, in which the pretest given to 32 elderly people showed that 12 elderly people got a score of 100. In comparison, the post-test results showed that 18 elderly people scored 100. The conclusion of implementing this community service is the importance of mental health cadres' role in mobilising healthy families and the risk of psychosocial problems and mental disorders to attend counselling so that the family's health status has improved. Cadres also play a role in monitoring clients with psychosocial problems and mental disorders.


The Contribution of Mental Health Cadres to Improving Client and Family Psychosocial Health 1. Introduction
Mental health is a condition in which individuals can actualize their potential, cope with the stresses and complexities of daily life, work productively, and contribute well to society.Mentally healthy individuals are happy and enthusiastic and are able to do positive things for themselves and others.Disorders are one of the components of mental health which indicate that an individual has mental health problems.Not only physical illness, mental illness can also have an impact on physical problems and psychological disorders (Mahmud & Syarief, 2022).However, with age and the increasing stressors caused by the pandemic since 2020, a person is more at risk of experiencing mental health problems or mental disorders.
Mental disorders are conditions of malfunctioning physiological and mental processes that result in changes in thoughts, feelings, and behaviours that can interfere with the functioning of daily life.The symptoms vary, ranging from withdrawing from the environment, refusing to relate or talk to others, not wanting to eat, not wanting to do selfcare, to raging for no apparent reason.Mental disorders can impact the maintenance of daily activities, interpersonal relationships, and impaired social functioning (Lestari, Hamid & Mustikasari, 2011).Data from basic health research (Riskesdas) in 2018 recorded a prevalence of mental disorders of 6.1% in the population over 15 years, and more than 12 million people over 15 years experienced depression (Iskandar & Putri, 2021).
The elderly, as individuals over 60 years of age, experience changes due to the aging process that occurs in all body members.This aging occurs continuously in anatomy, physiology, and biochemistry, which ultimately affects the overall function and ability of the body, including the mental and emotional condition of the elderly (Ekasari, Riasmini, & Hartini, 2018).The elderly have a higher risk of experiencing mental problems compared to other age groups.Mental health problems that commonly occur in the elderly are depression, feelings of loneliness, stress, anxiety, and fear of facing death.This condition is influenced by several factors, such as intervention factors, including physical activities that the elderly usually do, spirituality, nutrition, and sociodemographic factors, including gender, education, occupation, and marital status (Rubiyanto, 2022).The existing problems will cause a decrease in the quality of life of the elderly.They can be seen through decreased physical health conditions, psychological health, social relationships, and environmental aspects (Ekasari, Riasmini, & Hartini, 2018).
Efforts to maintain the physical and psychological health of the elderly can be made as promotive and preventive.This effort does not only focus on the elderly but can involve the elderly family or caregiver.The family takes an important position in the life of the elderly.Family social support for the elderly can provide emotional benefits and influence the behaviour of the elderly.The family can provide social support through instrumental support, such as material for the elderly, informational support, emotional support, and appreciation or acceptance support.One form of support that has a psychological impact on the elderly is emotional support.Forms of emotional support can make individuals feel comfortable, confident, cared for, and loved by the source of social support so that the elderly can deal with their stressors well (Nurrohmi, 2022).
The forms of positive interaction between the elderly and the family certainly need to be facilitated by other resources outside the scope of the elderly and the family itself, one of which is the role of cadres and health workers.According to WHO (1993), health cadres are men or women selected by the community and trained to deal with health problems individually and in the community and to work closely with basic health services.Cadres play a role in helping to improve the health status of the elderly through community mobilization, counselling, monitoring, maintaining nutritional intake, health checks, and exercise (Ningsih, Aisyah, Rohmah, & Sandana, 2022).Mental health cadres can be involved in various government programs, such as Posyandu and community mental health nursing programs, known as Community Mental Health Nursing (CMHN).
CMHN activities provide holistic, comprehensive, and plenary health services focusing on the condition of mentally healthy communities, People with Mental Problems (PMP), and People with Mental Disorders (PMD).The Community Mental Health Nursing (CMHN) approach seeks to realize mental health services with the aim that patients not handled in the community will get better service.One of the activities is to form Mental Health Cadres.One of the CMHN programs is an effort to increase the knowledge and skills provided by health workers by training mental health cadres to help solve mental health problems (Keliat, Akemat & Susanti, 2011).CMHN nurses, as the person in charge of health cadres, facilitate the provision of psychosocial nursing care in the community.Psychosocial nursing care management is carried out to improve the ability of clients and families to fulfil client health needs holistically in healthy communities and risk groups or those experiencing psychosocial problems (Keliat et al., 2019).One of the roles of nurses in handling mental health problems in the community is to provide nursing care to clients and families (Afriyanti et al., 2021).Thus, the role of nurses in providing psychosocial nursing care in the community can improve the ability of families to maintain their health and for families at risk to be healthy and not become mentally ill.
Pedukuhan Kembaran is an area in Tamantirto Village, Kasihan, Bantul, which is the centre of the shell handicraft industry, brick industry, Madukismo sugar factory waste ash, and organic fertilizer making.The population of Tamantirto Village is mostly aged 16-65 years, and it is a densely populated area.The results of research conducted by Yunitasari, Punjastuti, and Maryati (2022) found that 90% of the elderly in the Kembaran Hamlet area did not experience mental disorders/psychiatric problems.However, even with the elderly vulnerable to physical illness, living in a densely populated area with most of their activities being self-employed, does not rule out the possibility that the elderly are at risk of experiencing mental problems.Previous research also conveyed that most of the respondents were still working despite their age.To maintain the health of the elderly, the elderly Posyandu (Integrated Service Post) has been running in Kembaran hamlet.This Posyandu is driven by nine cadres who facilitate the implementation of Posyandu for the elderly with existing services, such as physical examinations (blood pressure, blood sugar checks, and cholesterol, weighing), counselling, and provision of additional food.Based on the results of previous interviews with elderly Posyandu cadres, most of the elderly in this area are very enthusiastic about participating in activities at the Elderly Posyandu, which is held once a month.In addition, the role of the family is seen when the elderly come to Posyandu by being escorted and directed by one of the family members.
The consistent implementation of Posyandu for the elderly, as well as the role of the elderly and families who support the activity program at Posyandu, shows a need for efforts to increase the knowledge of cadres, the elderly, and their families.Appropriate education to the elderly and families directly in the community to increase knowledge in the care and prevention of various physical and psychological health problems.The Kembaran Hamlet mental health cadres that have been formed previously have great potential by being active in health service activities in the community, but those specifically related to mental health need to be further improved.This activity aims to further develop the potential of Kembaran Hamlet partners in improving optimal health status, especially for residents of Kembaran Hamlet who have family members with PMP and PMD.
This mental health care training was previously held on May 26, 2022, at 08.30-12.00WIB.This training was organized under "Kembaran Padukuhan Mental Cadre Training".The target of this training is mental health cadres, while the target of the assessment is the community in the hamlet.The number of cadres who attended the training was 23, with the results of early detection from 8 RCTs and 62 families who had been assessed.Other activities in this community service, by optimizing the role of mental health cadres, will improve the health status of patients and families in Kembaran Hamlet.This activity is a follow-up to implement for clients with psychosocial problems and families with mental disorders.The previous community service only focused on cadres, while this community service focused on clients and families.

Methodology
The community service activities took place from November 2022 to January 2023 in Kembaran Hamlet, Tirtonirmolo Village, Kasihan, Bantul, Yogyakarta.This community service was a collaborative initiative of the UMY nursing study program with Jenderal A. Yani University.This activity was carried out in several sessions, with the target being the elderly, who are members of the elderly Posyandu and the families accompanying them.The activity was carried out at one of the residents' houses in Kembaran Hamlet.Overview of activities:

A. Session I:
Session I contained mass education activities for the elderly and families with physical illnesses.This activity began at 08.00, which included health checks, namely checking body weight and blood pressure.After the health check, the next activity provided educational material about a healthy soul supporting a strong physique.Before and after the activity, the elderly and families were asked to fill out a knowledge questionnaire about physical health and mental health for the elderly.

B. Session II:
Session II was filled with demonstrations of mentally healthy exercises demonstrated first by students and the service team accompanied by cadres.Furthermore, gymnastics were carried out together with the elderly and family companions.Before and after the exercise, the team evaluated and validated the feelings and physical condition of the elderly and their families.In addition, the team also facilitated discussions about physical health that can affect the mental health of the elderly.
This activity also measures the knowledge of the elderly and their families before and after being given mass education.Ten questions must be answered, and then the answers were scored to see the changes occurring before and after the education.The service team expected that this education can provide changes in the knowledge and attitudes of the elderly and their families about physical health and mental health.

Results and Target Achievement
The results of observations during the implementation of community service activities for the elderly in Kembaran Hamlet found that all elderly people and families were very enthusiastic about participating in the activity from the beginning until the end.Enthusiasm can be seen from the many questions submitted by the audience during education and some elderly people who can answer questions directly correctly.Then, the results of the assessment of the knowledge questionnaire before and after education were obtained; there was an increase in knowledge after being given health education, whereas when the pretest was carried out on 32 elderly people, it was found that 12 elderly people scored 100.In comparison, the post-test results showed that 18 elderly people scored 100.From these results, this mass education activity has a major impact on increasing knowledge in the Kembaran hamlet community.
As health workers in the community, nurses have a very strategic role in providing health education related to problems faced by the community and family (Safitri, 2020).The role of nurses as educators is important because it is part of facilitating families and communities to be independent in overcoming their health problems.Through health education or counselling, it is hoped that there will be an increase in family and community knowledge so that they can have the right behaviour towards people with mental disorders such as schizophrenia so that they can provide positive support and prevent treatment in the form of stigma that persists in society (Erlando, 2019).After completing the session I activity, the activity continued with mental health gymnastics.The gymnastics was attended by the elderly, elderly families, cadres, and the service team.Gymnastics participants looked enthusiastic and happy and established interaction communication between members or other gymnastics participants.Mental health gymnastics is a sports activity that combines rhythms and movements that can improve physical and psychological fitness.Gymnastics can help improve the work and function of the heart, lungs, and blood vessels, increase muscle strength, and produce endorphin hormones that can reduce stress and pain and increase the body's immune response.Mental health exercises can be done 150 minutes a week or 30 minutes a day.The benefits of mental health exercises are stress and anxiety relieving, suppressing the hormone cortisol's onset.This exercise aims to improve mental health in the elderly with physical health problems.With the holding of this mentally healthy gymnastics activity, the elderly are expected to have physical and mental health to carry out their daily tasks in excellent conditions.Therefore, it is hoped that with the implementation of this activity, the elderly can do gymnastics to improve their physical and mental health status.Mental health gymnastics is one of the physical activities as a good preventive activity for maintaining mental and physical health (Rosdiana et al., 2022).
Gymnastics session with the elderly and PMP families

Conclusion
The conclusion of implementing this community service is the importance of mental health cadres' role in mobilising healthy families and the risk of psychosocial problems and mental disorders to attend counselling.The degree of family health has increased, seen by an increase in knowledge of clients and families with psychosocial problems as caregivers who accompany patients at home.In addition, there is also an increase in family knowledge of mentally ill clients, and they can manage the burden of caring for and preventing client relapse.

Figure 1 :
Figure 1: Session I activities: Mass education (a) and questionnaire filling (b)