JRSSEM 2022, Vol. 01, No. 10, 1621 – 1634

E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494

DOI : 10.36418/jrssem.v1i10.165 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

THE NEED FOR ANTISTIGMA SERVICES AND QUALITY OF

LIFE OF SCHIZOPHRENIA AT THE CARE FOR SOUL HEALTH

CITY IN SEMARANG CITY, INDONESIA

Sri Endang Windiarti

Agus Soewandono

Zahroh Shaluhiyah

Annastasia Ediati

1,2,3,4

University of Diponegoro

e-mail: sriendangwindiarti@ymail.com

,suwandono49@gmail.com

shaluhiyah.zahroh@gmail.com

, ediati.psi@gmail.com

*Correspondence: sriendangwindiarti@ymail.com

Submitted: 29 April 2022, Revised: 09 May 2022, Accepted: 18 May 2022

Abstract. The Semarang City Government's efforts for the mental health village program have not

been programmed intensively. The purpose of this study was to explore an urban care model for

mental health in an effort to reduce stigma and improve the quality of life of people living with

HIV. This research is a qualitative research with an exploratory descriptive approach. Data collection

includes in-depth interviews with program stakeholders and direct observations of the program,

as well as qualitative feedback from program participants. Based on the results of research using

content analysis. The stages are: the text in the transcript, doing the unit of meaning, coding,

categories so that the theme is obtained. Ethics clearance was obtained from the Faculty of Public

Health, Diponegoro University, number: 579/EA/KEPK-FKM/2 Seven in-depth interviews were

conducted representing different mental health programs. The service model in mental health care

villages that is expected by the community is a form of intervention that aims to reduce stigma and

improve the quality of life of Schizophrenia and prevent recurrence.

Keywords: mental health care village; stigma; quality of life for Schizophrenia.

Sri Endang Windiarti, Agus Soewandono, Zahroh Shaluhiyah, Annastasia Ediati
 
                | 1622
 
 
DOI : 10.36418/jrssem.v1i10.165   https://jrssem.publikasiindonesia.id/index.php/jrssem/index 
INTRODUCTION 
 
Indonesia  shows  the  prevalence  of 
Schizophrenia, as much as 1.8 per mile. In 
Central  Java  the  Schizophrenia  is  2.5  per 
mile, while for the city of Semarang severe 
mental disorders are 1.1 per mile (Hardati 
& Ahmad, 2017). The capacity of psychiatric 
care  services in  Central  Java  is  still below 
1,000  beds.  This  condition  causes  not  all 
patients to be served in psychiatric services 
at  mental  hospitals  in  Central  Java 
(McCabe, 2019).  
The city of Semarang with a population 
of  1,668,578  with  an  estimate  of  People 
With Schizophrenia is 1.1 per mile, People 
with  schizophrenia  are  a  classification  of 
severe mental disorders with a progressive 
disease  course,  tend  to  be  chronic 
(chronic),  exacerbating  (frequently 
experience recurrence) (Zhang et al., 2013). 
Recurrence in Schizophrenia is one of the 
conditions that scourges society because it 
has (Jones, 2016)  
confused  thoughts,  strange  behavior, 
laughing  alone,  very  stupid  expressions, 
smiling alone, delusions, hallucinations and 
aloofness,  so  sufferers  are  alienated  and 
belittled (Rus-Calafell et al., 2014).  
The results  of the  research  conducted 
are that there are still many Schizophrenia 
who  experience  discrimination  even 
though  they  are  already  in  community-
based mental health care (Suluh et al., no 
date). The results showed that 69.1% gave 
stereotypes,  52.9%  gave  separation  and 
52.9%  respondents  did  not  discriminate 
against  Schizophrenia.  The  results  of  this 
study are the less stigma that is received, 
the  faster  and  more  sustainable  medical 
treatment is carried out (Charlesworth et al., 
2012). Stigma  against  mental disorders in 
the city of Semarang is still high by looking 
at  the  high  rate  of  recurrence  of 
Schizophrenia in the mental hospital of dr. 
Amino  Gondohutomo  Semarang  (von 
Renteln-Kruse  et  al.,  2015).  Stigma  of 
mental  disorders  is  one  of  the  most 
common  reasons  for  not  seeking  mental 
health care which leads to negative health 
consequences  and  suffering  for  sufferers 
and families (Dardas & Simmons, 2015). 
The  efforts  of  the  Semarang  city 
government to care for mental health in the 
urban  village  program  have  not  been 
programmed intensively, because it has not 
become a priority program. The results of 
in-depth interviews with the Semarang City 
Health Office, socialization of mental health 
care in the city of Semarang has not been 
carried out so that there has never been an 
intensive mental health cadre training. The 
purpose of this study was to find the right 
mental  health  village  model  to  reduce 
stigma  and  improve  the  quality  of  life  of 
Schizophrenia in the community. 
The  results  of  existing  research  to 
improve  Schizophrenia  services,  one  of 
which  is  the  addition  of  skills  through 
professional training in practice in primary 
services  and  supported  by  supervision 
activities  by  professionals  in  the  mental 
health sector on an ongoing basis. 
This  discussion  identifies  the  best 
course of action and strategies, to identify 
key  programs,  and  to  gain  further 
theoretical  insight  into  appropriate  anti 
stigma programs. So that it can create the 
expected  community  mental  health 
services.  The  particular  methodology 
chosen  for  this  research  is  Fundamental 
theory, which is a suitable methodology for 

1623 | The Need for Antistigma Services and Quality of Life of Schizophrenia at the Care for

Soul Health City in Semarang City, Indonesia

the question of the process in which the

theory will be developed inductively.

METHODS

The themes of the questions are A.

What are the views of health workers on

stigma and KH Schizophrenia. B. What is the

role of health workers in stigma and quality

of life for Schizophrenia. C. How are the

efforts of health workers against stigma

and KH Schizophrenia. D. How is the need

for a service model in the community in an

effort? prevent stigma and improve the

quality of life for people with HIV. Sources

of data were taken from in depth interviews

(IDI) to health workers, namely the Head of

P2P of the health office, the head of the

puskesmas and the person in charge of the

community mental health program.

Interview preparation, making sure that the

recording device can be used properly. This

research is qualitative research with an

exploratory descriptive approach. This

method is used to explore, understand and

interpret the factors that lead to success in

exploring the need for mental health

services in the community through

community empowerment to reduce

stigma and improve the quality of life of

people with HIV. Data collection began in

December 2019 until May 2020. In depth

interviews with informants were carried out

at the client's family home, the Puskesmas

office, the city health office and the village

office hall. The interview process lasts

between 20-60 minutes.

Data analysis is: all the results of

conversations in interviews are written in

the form of transcripts, sort out meaningful

words or sentences (meaning units), carry

out the coding process that is adjusted to

the independent variables, make categories

of each coding so that it can determine the

theme (L Mitchell & M Jolley, 2010). The

ethical clearance was obtained from the

Faculty of Public Health, Diponegoro

University, number: 579/EA/KEPK-

FKM/2019.

RESULTS AND DISCUSSION

A. Analysis of the Needs of the

Community Mental Health Service

Program according to Health

Workers

Indepth Interview (IDI) conducted

to the Head of the Prevention and

Control of Non-Communicable

Diseases and Surveillance (P2TMS)

Semarang City Health Office, Head of

Public Health Center, Person in Charge

and Implementer of Community Mental

Health Public Health Center and their

families Schizophrenia. In-depth

interviews were conducted at the City

Health Office, Puskesmas and the

homes of Schizophrenia families. The

number of IDI respondents was 7

people. In-depth interviews were

conducted each for 30 minutes to 60

minutes. The topic of the in-depth

interview is the views, roles, efforts and

expectations of mental health

programs in reducing stigma and

improving the quality of life of

Schizophrenia in Semarang City. The

results of in-depth interviews based on

topics are as follows:

1. Health Workers' Views on Stigma

and Quality of Life for

Sri Endang Windiarti, Agus Soewandono, Zahroh Shaluhiyah, Annastasia Ediati

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Schizophrenia

According to the mental health

department in the community, the

public is still not responding well to

mental disorders so that some

people with mental disorders are

still ostracized, and their space is

limited. Stigma still occurs in

families, groups and even health

workers. This is because the mental

health service program at the

Health Service Center (Primary

Heath care) has not been running

well. This means that people find it

difficult to take people with mental

disorders to mental hospitals. So it's

better to just hide it at home by the

family. Basically the stigma of

mental disorders in society still

exists, especially by families and

communities. This is theSemarang

City Health Office as follows:

Statement from the Head of the

"ODGJ is still very isolated if in the

community we meet many cases of

severe ODGJ, we apologize for

severe ODGJ who are not in shackles

but locked in a room, not tied up, but

that is a process that limits their

space for movement. , in terms of

human rights etc.” (Health

Department, M, male).

Health center health workers

are not stigmatized, but with limited

facilities and inadequate personnel

capabilities so that patients who

come with complaints of mental

disorders are immediately referred

to a hospital or mental hospital. So

that doctors or nurses at the

Primary Heath care do not meet

with patients because those who

come to the Primary Heath care are

only families to take care of BPJS.

The supply of

psychopharmaceutical drugs at the

Primary Heath care is very limited,

this makes the services for mental

disorders at the Primary Heath care

less complete. The following is the

statement:

“From a health perspective, I

have never stigmatized

schizophrenia, because the services

currently have not been handled

specifically. We are also constrained

by drugs but currently the drugs are

still very limited. The drugs needed

by him (Schizophrenia) have not

been obtained at the Puskesmas, so

they ended up going to the

Puskesmas just to get a referral. His

attitude, service is because we rarely

touch each other, ma'am…because

those who ask for referrals are only

their families. Usually it comes only

once, then, instead of bothering the

family with him, he usually has to

take it to the Puskesmas for the next

time the family asks for a referral.”

(Head of Puskesmas, I, female)

Socialization of new mental

health programs in several ward or

Primary Health care, with Thus

health education about mental

health in the community is still very

lacking, some even have never.

2. The Role of Health Workers,

Cadres, Families, and the

Community

According to a statement from

the health office, the role of the

1625 | The Need for Antistigma Services and Quality of Life of Schizophrenia at the Care for

Soul Health City in Semarang City, Indonesia

family to bring family members with

mental disorders was initially done,

but for the next 1-2 years they still

carry out control, but over time the

symptoms may have decreased, the

family already used to the condition

so control and taking the drug

stopped. So that when mental

illness symptoms appear more

severe, then the family will return to

the health service for a check-up.

Following his statement:

"... the family does not want the

patient to be taken to the hospital

because they are afraid that later on,

it means that there is still insufficient

education in the community so that

education regarding the treatment

of schizophrenia, whether medically,

can be done with regular, continuous

treatment that does not stop the

drug, because taking the medicine is

actually for him not to relapse, it is

said to be cured of his symptoms,

social activities will be good…”

(Health Department, M, L)

The head of the Primary Health

care explained that health workers,

cadres, families and the community

towards Schizophrenia in the

community were still not optimal,

because only services and helping

Schizophrenia had not been

intensively and with good planning.

Health workers who only help

provide referrals and feel they are

not competent to handle mental

illness, cadres feel lack of

knowledge to deal with mental

illness, families lack knowledge and

skills in caring for Schizophrenia

and the community feels lay with

mental disorders, so that their

respective roles are not maximized.

The following is her statement:

"This is temporarily not optimal,

at least we have a health center if it's

not for prevention, ma'am...at least

to give a referral, that's okay.... As for

prevention, there is no innovation for

mental health.... The cadres are just

socializing, it's like there is no

training. If a case is found, it's

reported, and the family can't handle

us PPD, the social service directly, so

he can help bring the patient to the

RSJ ". (Head of Puskesmas, I,P)

The role of cross-sectoral

collaboration in mental illness

services is very much needed in the

community. This is because the

healing takes a long time and needs

the support of the people around

him to become more confident,

more empowered and creative.

3. Efforts made by health workers,

cadres, families, and the

community.

According to the health office,

the efforts made by the health

office on mental health programs

have just begun. This is because the

mental health program is not a

priority program. After collecting

data on non-communicable

diseases in the city of Semarang, it

turned out that the mental illnes

had increased significantly and had

just started the program. However,

it is not in line with the existing

Sri Endang Windiarti, Agus Soewandono, Zahroh Shaluhiyah, Annastasia Ediati

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budget, so the program until now

has not been running well,

especially with the current

pandemic conditions. Several

efforts that have been initiated

include communicating and

coordinating with cross-sectors,

handling Schizophrenia is not only

the responsibility of health workers

but requires complex cross-sectoral

collaboration. The following is his

statement:

“……Alhamdulillah has

communicated by making efforts to

meet with cross-sectors where we

involve the Social Service, TPD

outreach team, urban villages,

Community Health Centers, we start

from places where there are cases of

ODGJ how can we jointly carry out

protection efforts , prevention of

conditions psychologically, socially,

physically, for these severe ODGJ

patients…” (Health Department, M,

L).

According to the head of the

Puskesmas, the efforts made by

health workers, cadres, families and

the community have not been

maximized. Puskesmas health

workers are still running priority

programs such as HIV, MCH, DHF,

etc. while mental disorders have not

been included in the priority

programs, so the efforts made have

not been maximized. Health

services at the new Puskesmas

provide physical health services,

while mental health services are

referred to a general hospital or

mental hospital. The following is her

statement:

" In my opinion, ODGJ is a new

program, ma'am, if they are larvae

and then their DB, they already

understand that they already know

TB, they already know HIV but if they

are ODGJ they don't really

understand but they are also very

responsive, right, Ms. Santi, if it is to

patients too escorted by the

Puskesmas itself actually wanted to

be able to socialize more about this

disease to the community so that at

least the stigma in the community

was reduced…” (Head of Puskesmas,

R,P)

The mental health program has

only been socialized once this year

and has been accompanied by

other health education programs.

As a result, people feel cloudy with

mental health.

4. Expectations for mental health

programs in the community to

reduce stigma and improve the

quality of life of Schizophrenia

The health department expects

that the Mental Health Alert Village

Program has been planned, but due

to a lack of budget support, it does

not run well. Of the 37 Community

Health Centers, only 1 puskesmas

has a mental health cadre with

assistance from the mental hospital

dr. Amino Gondohutomo

Semarang. It is hoped that every

kelurahan will have an empowered

kelurahan that cares about mental

health so that the community can

maintain, prevent, and deal with

mental disorders independently,

1627 | The Need for Antistigma Services and Quality of Life of Schizophrenia at the Care for

Soul Health City in Semarang City, Indonesia

especially in the city of Semarang,

where there is a regional mental

hospital facility. This will facilitate

the transportation of visits. There

are also many educational

institutions in the city of Semarang

so that cooperation to maintain the

continuation of the program is

actually easier, therefore the village

program cares for mental health, it

is hoped that it can run well. The

following is a statement about what

is expected:

"We will try later at the village

level to have a mental healthy alert

village, our hope is like that. It's just

that it's a bit difficult for us to enter

urban areas, isn't it..." (Health Office,

M, L).

According to the head of the

Harapan Health Center for mental

disorders services in the community

for health workers, cadres, families

and the community all care about

mental disorders so that the stigma

of mental disorders and the quality

of life of Schizophrenia is good. So

that conditions like this are very

concerning, health workers, cadres,

families and the community feel the

need for knowledge about mental

disorders. Increase knowledge

through socialization, health

education, training and approaches,

direct assistance to families. Thus

increasing the competence of

health workers, cadres, families and

communities in dealing with mental

disorders and preventing mental

disorders, the following is the

statement:

“………if we want to provide

information we must have

competence if we do not have

competence how can we provide

socialization or information to the

community or cadres later, when we

meet the community, we have to do

this, automatically we must be given

information about this first so that

we have the competence to manage

mental health like what…” (Head of

Public Health Center, I, P)

Mental health programs should

be primary health care services and

not just programs of choice and

development. This is because

mental health is an integral part of

health and well-being. By becoming

primary, mental health services

become optimal. Moreover, now

more and more medical personnel -

doctors and nurses - public health

centers who can handle mental

disorders.

The results of the IDI to health

workers can be concluded that

there are several things that need to

be done in relation to mental health

services in the community as

follows:

Table 1. Mental Health Services In The Community

Sri Endang Windiarti, Agus Soewandono, Zahroh Shaluhiyah, Annastasia Ediati

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DOI : 10.36418/jrssem.v1i10.165 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

Topic

Of Health Workers

Expectations and

Intervention Plans The

views of health workers,

families, community leaders

and cadres on stigma and

quality of life for

Schizophrenia

● Mental disorders in the

community are still not well

received by the community.

● The mental health service

program at the Health Service

Center has not been running

well).

● The services provided are for

reference only.

● Health education to families

and communities is still very

lacking.

● Socialization of anti-

stigma service

program with

outpatients who care

for mental health

● Village administrators

Care for mental health

● Training of cadres and

mental health

administrators

● Family and

Schizophrenia

assistance

The role of health workers,

families, community leaders

and cadres on stigma and

quality of life for

Schizophrenia

● Mental health programs are

not a priority program for

● Health workers and the

community also have not

played a good role in handling

mental illnes families who still

refuse the arrival of health

workers.

● Health workers feel they are

not competent to handle

mental illnes,

● Puskesmas cannot monitor

continuously

The efforts of health

workers, families, community

leaders and cadres to reduce

stigma and improve the

quality of life of

Schizophrenia

● , the efforts made by the

health office on mental health

programs have just begun.

● efforts that have been initiated

include communicating and

coordinating with cross-

sectors.

● The Puskesmas has started to

run a community mental

health program but

temporarily has not been

maximized.

Expectations of health

workers, families, community

● Mental Health Alert Village

Program by empowering

1629 | The Need for Antistigma Services and Quality of Life of Schizophrenia at the Care for

Soul Health City in Semarang City, Indonesia

leaders and cadres in order

to reduce stigma and

improve the quality of life of

Schizophrenia

urban villages that care for

mental health

● Increase competent human

resources, who understand

and are skilled in dealing with

mental disorders.

Each intervention plan will be

described in the following: The results

of the above study need community

empowerment to increase knowledge

about mental disorders at certain levels

so as not to cause stigma to people

with mental disorders that can be

cured.

The discussion in this chapter is the

result of an assessment of community

needs that are felt to be very necessary

to create a form of mental health care

kelurahan services in order to reduce

stigma and improve the quality of life of

people with HIV. Some things that are

needed areis

B. Socialization of the Mental Health

Care Village Model Needed.

Socialization of the

The mental health care village

model is to socialize villages that have

readiness in the health sector, where

villages whose residents have the

resources and ability to deal with health

problems independently (Erwanto &

Kristianto, 2011).

Sendangmulyo Village is the area

with the highest Schizophrenia in the

city of Semarang, so it is natural that it

is very necessary for the community to

pay attention and care about mental

health. The following is a description of

the stigma of society towards patients

with mental disorders, which are related

to susceptibility, benefits, self-efficacy

and barriers (Knaak & Patten, 2016).

People consider mental disorders to

be incurable, patients become unable

to take care of themselves, are

dangerous, some even say that the

cause of mental disorders is the

existence of other factors outside of

medicine, being used for magic, and so

on (Spitzer & Endicott, 2018).

The community with their

awareness of carrying out their duties

and functions as administrators of

mental health working groups and

mental health cadres is very

enthusiastic and moves quickly.

Schizophrenia who drop out of

treatment and have never received

treatment are immediately helped to

get treatment. Cadre assistance for

every Schizophrenia who returns home

from the hospital is always monitored.

Mental health conditions were

found to be more stigmatized (12.9%)

and belittled (14.3%) compared to

physical conditions (8.1 and 6.8%),

respectively. Among mental health

conditions, the most stigmatized

condition was schizophrenia (41%)

while the most underestimated was

obsessive compulsive disorder (33%)

(Robinson et al., 2019).

Sri Endang Windiarti, Agus Soewandono, Zahroh Shaluhiyah, Annastasia Ediati

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Anti-stigma interventions need to

not only inform individuals about the

high prevalence of mental disorders but

also need other interventions to be

effective (Lawson, 2016).

C. It is necessary to establish the

management of the mental health

working group and Mental Health

cadres.

This management consists of

community leaders who are willing to

take the time and thought to help

residents in their area who need

assistance in the form of energy and

thoughts to improve their health,

especially mental health. The

management needs are adjusted to the

needs of the region or area, in this case

the Sendangmulyo village. This model

serves as a tool to help guide the

development and implementation of

anti-stigma programs in the context of

health care. The organizing model for

this service is an anti-stigma health care

provider program as the basis for anti-

stigma activities in health care and to

identify community needs. There are 4

stages that need to be considered,

namely: a. Social process: Health care

program against stigma, b. Set up for

Success, c. Building programs as

needed, d. Creating Networks, e.

Changing Culture (Parker et al., 2016).

This study emphasizes evidence-

based guidelines for reducing stigma.

Action-based assessment, needs

assessment based on conditions, and

using examples of successful Desa

standby models. Other studies have

reported similar findings. Kelurahan

caring for mental health is a form of

suitable condition for the

implementation of the solutions

proposed by the community. So the

research is able to explore perspectives

on stigma reduction strategies used by

different stakeholders, patients and

their families. Some intervention

strategies are more focused on the

community. Emphasis on education for

attitude and cultural change emerged

as a fundamental factor for reducing

stigma (Taghva et al., 2017).

Despite increased mental health

promotion and advocacy, stigma

persists and poses a significant threat

to healthy functioning at macro- and

micro-sociological levels (Holder et al.,

2019). Stigma gradually expanded with

the incorporation of a wider social

context in micro and macro level where

individuals, institutions, and

construction of a larger culture shaping

and influencing the perception of what

is different about the stigma, and

therefore need a different approach.

D. Mental health cadre training is

needed.

The increasing number of people

with disorders is a burden for

individuals, families and communities.

This situation causes people with

mental disorders to really need

appropriate treatment so that people

with mental disorders can be accepted

back into the community. One of the

efforts that can be done is to empower

the community, namely the existence of

mental health cadres.

The training materials include the

Village/Kelurahan program for health

care, early detection of families, family

1631 | The Need for Antistigma Services and Quality of Life of Schizophrenia at the Care for

Soul Health City in Semarang City, Indonesia

characteristics, health, risk and

disturbance, home visits, case referrals.

The training is carried out for 3-4 days,

with the time agreed upon by the

cadres and administrators. The media

used are modules, booklets, and

leaflets.

New knowledge on the applicability

and effectiveness of evidence-based

psychological and collective

empowerment interventions (ACT, CEE,

and ACT+CEE) in overcoming mental

illness stigma and mobilizing

community leadership (Gurugea et al.,

2018). In the study, three simultaneous

interventions for people with mental

disorders in reducing stigma provided

new knowledge on how to get effective

strategies to seek new services in the

community.

E. Family and Schizophrenia Assistance

Required

Implement and practice mentoring

for families in order to find out how to

care for Schizophrenia. The most

important element for people with

mental disorders mental illnes is family.

The importance of family participation

in clients with mental disorders can be

viewed from various aspects. First, the

family is a place where individuals start

interpersonal relationships with their

environment. The family is the main

educational institution" for individuals

to learn and develop values, beliefs,

attitudes and behaviors. Individuals test

their behavior in the family, and family

feedback influences individuals to

adopt certain behaviors. All of these are

preparations for individuals to play a

role in society (Tristiana et al., 2018).

Family psychoeducation programs

have shown a reduction in post-

intervention stigma (Morgan et al.,

2018), it is more effective in reducing

stigma given directly to caregivers who

want to take good care of

Schizophrenia.

Orientation to overcome stigma

varies widely according to context,

individuals often choose to hide

problems, to anticipate discrimination

and lack of confidence to face stigma

(Isaksson et al., 2018).

Mentoring interventions and

educational interventions have a direct

effect of up to 50% on stigma. More

research is needed to find out how to

sustain benefits in the long term, and to

find out how effective these

interventions are more positively, to

reduce social distance and increase

knowledge related to stigma

(knowledge that refutes stereotypes)

(Henderson, C. and Gronholm, I. and PC

(2018) 2018).

Anti-stigma interventions in

Indonesia should consider related

sociodemographic factors and use a

psychosocial approach to improve

literacy and contact with mental health

patients (Hartini et al., 2019). Mental

Health Interventions require broader

innovations that are translated into

public interventions. Exploration of

community needs in accordance with

the times, to improve mental health

services (Bishop et al., 2018).

CONCLUSIONS

Sri Endang Windiarti, Agus Soewandono, Zahroh Shaluhiyah, Annastasia Ediati
 
                | 1632
 
 
The service model through the mental 
health care village is highly expected by the 
community,  the  service  model  in  the 
mental health care village in question is a 
form  of  intervention  that  aims  to  reduce 
stigma  and  improve  the  quality  of  life  of 
Schizophrenia  and  prevent  recurrence  by 
conducting  socialization  of  mental  health 
programs to families, community leaders , 
cadres and health workers, forming health 
working  group  administrators,  forming 
mental  health  cadres,  training  mental 
health  cadres  and  mentoring  and 
education  on  family  health  and 
Schizophrenia. The culture of all members 
of  the  organization  becomes  very 
important in  making services more  useful 
and effective. 
 
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