A day at the mental hospital

"So, how do you feel today?"

"I am fine, Nurse Sal."

"Are you sure?"

"Yes. I am not sick, I am not insane."

"Good. But don't forget to take your medicine, OK?"

The above conversation is the norm for Nurse Salamiah and her patients.

Nurse Sal - as Salamiah is called - has been working at Soeharto Heerdjan Mental Hospital in Grogol, West Jakarta, for years, and she knows how to treat patients with mental disorders.

"We treat many patients here who have many symptoms of mental disorders. Knowing their habits is very important because it will then be easier to help them," Sal told The Jakarta Post recently.

Sal has worked in the rehabilitation ward since last year, preparing patients who are in the process of recovering from mental disorders and preparing them to return to the community.

The nurse works together with 13 staff members, including doctors, psychiatrists, occupational therapists, nurses and social workers. In addition, the ward offers a daily psychiatric day care programme.

Patients joining the programme are those still receiving treatment in the hospital but who are in a better state of health, or those who have been allowed to return home.

The hospital recommends patients who have already returned home to join the day care programme so they can continue to work on their mental health and develop skills to cope in the community.

"Usually it takes from three to six months to help patients become independent and totally healthy," Nurse Sal said.

The schedule for the programme is tight, and Sal is very disciplined. The agenda is written on a blackboard on the wall. Hospital staffers believe the rigid routine is important for patients.

Activities start at 9:30 a.m. with skills classes that can involve cooking, carpeting, cellular repair or gardening. During the classes, patients are accompanied by nurses and volunteers.

For example, Doni (name changed) was in the cellular phone repair class. He has been in the day care programme at the hospital for three months, and hopes he can open his own repair shop in the future.

"I can make money with this skill," he told the Post.

Rona (name changed) chose the cooking class. She was preparing to cook fish in coconut milk when the Post visited.

"She graduated from a chemical engineering department," a nurse told the Post, whispering.

The skills classes finish at 10:30 a.m. and then it is time for therapy for all the patients in the rehabilitation ward.

Sal said they offered several kinds of therapy depending on the patients' needs.

Rona, for instance, said she felt like something was in her head, her stomach or other parts of her body. According to Sal, Rona will have a different therapy than her co-patients, some who suffer from feelings of being haunted or other fears.

Sal said a number of patients refused to recognise that they had mental health problems, while others were aware of their issues.

"If they recognise the mental health condition, the healing process will be easier," Sal said.

The patients (usually five to 12 people) sit in a room to discuss their problems, always accompanied by a therapist.

Medicine and lunch is next on the agenda. Usually at 11:30 a.m. the nurse will give patients their medicine.

"Sometime they refuse because they feel healthy. But we encourage them to always take the medicine," she said.

After noon prayers, patients can participate in various activities like games or discussions to address problems, or there are family visits.

For visitors whose relatives are still patients in the rehabilitation ward, they can meet with doctors or nurses to discuss their loved ones' conditions.

The psychiatric day care at the hospital started three years ago, even though the concept for the programme was introduced in 1977.

"The implementation was quite difficult. So we just started the programme last year," Sal said.

Another problem is that not all patients who have gone home are able to join the programme every day. Financial problems are another factor, for many of the patients are from impoverished backgrounds.

"People need money for their daily needs rather than [having the time] to take a family member to day care at a mental hospital that is far from their place," she said.

No wonder many patients return to in-patient treatment at the hospital when their mental conditions inevitably worsen.

However, Sal is quite happy because in 2012, 12 patients from the rehabilitation ward recovered and have obtained employment thanks to the programme.

Several are working as janitors, couriers and administrative assistants. And to make sure they are OK, social workers from the hospital regularly observe them from a distance.

"The stigma of being a former mental patient is still bad in our society. That is why we tend to observe our patients from a distance," she said.