Family Stigma Correlation with Shackling in Schizophrenia Patients in Psychiatric Hospital of Bali Province

Shackling in Indonesia becomes mental health problem showing that mental disorder patients have not gotten good or full treatment and proper human right yet. Stigma and discrimination for schizophrenia patients often get some treatment in which breaks human right it is caused by that mental disorder patients of do violance and aggresive action. The reason why the family perform Shackling.This study aimed to know the correlation between family stigma and shackling patients with schizophrenia. This study used correlational descriptive design with cross-sectional approach. It was conducted towards 45 respondents selected by sampling concecutive technique. The data was collected by using familys stigma and KKPD questionnaire.The result showed that the familys stigma for schizophrenia patients are mostly in often category as many as 24 respondents (53.3%). The willing of the family for shackling schizophrenia patients is mostly in high category as many as 20 respondents (44.4%). The result of Rank Spearman test showed p-value=0.000<0.05. It could be concluded that Ha was accepted which mean that there was a relationship between familys stigma and shackling for schizophrenia patients. RSJ Bali Province was suggested to give guidance and doing home visit for family that had ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Shackling is a mental health problem in Indonesia which indicates that mental patients have not received good and humane treatment.
Health Department estimates that the number of people having severe mental disorder in Indonesia is 1.7 per mil, Bali is number three with 2.5 per mil.Based on the data, the number of people getting shackling in Indonesia is 14.3%.
The number of people having shackling in rural area is 18.2%.The number is higher compared to the number of people having shackling in Cities, it is 10.7% (1).
Based on data of Psychiatric Hospital in Bali province, the number of people who got shackling The impact of shackling is that patients experience trauma, revenge on their families, feel

MATERIAL AND METHOD
The research plan which was used in this research is cross-sectional emphasising time measurement, or observe independent and dependent variable data only once, there is no follow up (9).This research was done in RSJ Bali province, the research was done in Jun 2017.
The sample in this study were families who had schizophrenic patients and were determined by criteria involving families who were willing to become respondents, the families whose schizophrenia patients who got some treatment in RSJ of Bali province, the patients' family who stayed with the patient and had resposiblity for the patients at their homes.The number of samples were 45 persons, the used technique was consecutive sampling.The independent variable in the research was stigma which was measured by using stigma quistioners from Ariananda (2015) which the validity had been already examined in previous time, Of 20 items about family stigma were found that all of r value was more than r table (r value > 0.36).Therefor the conclusion was that each of family stigma was declared to be valid.The result of reliabilty examination suggeted that value r Alpa be 0,960 > 0,7 so family stigma items were declared to be reliable (9).Dependent variable in the research was the shackling which was measured by using piece of "Kuisioner Keputusan Pasung Daulima" (KKPD) which validity and reability examination had been done in previous time by the reseacher, with value of validity examination 0.176 -0.761 (r table : 0.125) from reability examination 0.935 (10).
The analysis procedure in the reseach was data processing which followed several steps as follow: editing, coding, entering data and cleaning or tabulation.The data analysis in the research used "Rank Spearman" examination.
The hypotheses determination was accepted or refused, when probability value was smaller than signifi cant value (p<0.05)there was relationship between family stigma and the shackling of Schizophrenia patients in mental disorder hospital of Bali province.

RESULT AND DISCUSSION
The characteristics of the research subject The respondents were characterized by age, education and occupation in psychiatric Hospital of Bali Province shown in table 1.This research suggested that the family willing to do shackling for schizophrenia patients be motly in high category at 20 respondents ( The research by Idiani and Raflizar suggested that the data of Riskesdes 2013 was domain factor influencing shackling, it was economy factor, mostly the family with low economy condition did not know that there was health service in village or rural area.They felt that the health service was so far from the place where they lived therefore they did shackling (3).In addition, the reason of shackling was less number of doctors, nurses, counselor and other medical assistants with suffi cient training.
Other causes why shackling was done in Bali was because it was caused by the family tended to perfom traditional treatment and the patient did not get improvement.This matter was caused by the focus of treatment in psychiatric Hospital.In present treatment approach will be better based on cultural approach in community hence the patients will get improvement, their social condition as well (16).Based on the explanation, Table 4

within 5
years 2008-2013 reached more than 300 persons.The number was spread to 57 districts in Bali.The number of people shackled by the family in 2014 reached 30 persons.In 2015 it increased to be 55 persons including several persons who got shackling but they were not given treatment in hospital because the families minded to bring the patients with various reasons.Meanwhile, only did 14 persons become outpatients and did homecare (2).Shackling was family or commonity action for persons with mental disorder (mostly schizophrenia) done to limit the mental disorder person's activities.The way how to shackle was performed specially by wood (kayu apit) for both the mental disorder person's feet hence the person could not walk.Mental disorder person could not do the basic life activities such as caring themselves, peeing, defecating.The high desires in shackling in order to prevent it after patient had been discharged from the psyciatric hospital.penderita gangguan mental secara paksa di sebuah ruangan atau area.(4).The shackling of severe mental disorder persons such as schizophrenia was done because of social reaction such as rejection, e x c o m m u n i c a t i o n a n d d i s c r i m i n a t i o n .Economically, the effect could be loss of effective day for income for either the patients or the families obligating the patients, high cost must be spent by the families, stigma of schizophrenia patients (5).According to Idaiani and Rafl izar, the treatment for mental disorder person was still limited because of stigma and economy inability for treatment.Stigma is negative characteristic embeded in person and becomes bad label for somebody because of enviroment factor which is infl uenced by misunderstanding of family or community.A such label will damage or worsen one's condition with a such mental disorder (6).The forms of stigma and discrimination in schizophrenia person are as they often get some treatment in which against the human right, keep distance among patients because they often do agrresive action.Because of those reasons, the patients always get shackling (7).
This research was supported by the result done by Rohmadoni and Mudzakir analized factors infl uencing family to do shackling for the family member having mental disorder in mental disorder hospital of Jawa Menur Surabaya.This research suggested that mostly at 14 families (70%) want to do shackling for schizophrenia patients, mostly belonged to be high category (17).The research argued that the family willing to do shackling for schizophrenia patients was mostly high category, it was caused by limitation of knowledge about mental disorder.In addition, the poor facility of mental disorder treatment in community triggered the community to do shackling.Besides, the decision to shackling was also to keep the schizophrenia family member from endangering the community.The patient with chronical schizophrenia always tended to do something endangering other people and enviroment such as striking, breaking public facility, and raging.Those deeds could stimulate others getting the effect of what the patient's aggresive actions to revenge.
According to Daulima, families had willing to do shackling action because the family could overpowered from community pressure who felt threatened because of the patients' deed.The principle was the family did not want to shackle the patients because of love for the family members.However, the physical pressure came from external factors, the community had antipathy to the patients and the families were forced to do shackle the patients.The condition created big conflict for the family before the shackling was done.The conflict happened The research was supported by Rohmadoni analized factors influencing the family to do shackling for the patients in mental disorder hospital of Menur Surabaya.The result suggested that the recovery factor and stigma had signifi cant impact for the shackling for the patients with schizophrenia in psychiatric hospital of Menur Surabaya (p-value=0,000<0,05)(20) .The researcher thought that the families gave high contribution in retreatment for the patients with schizophrenia.The families need to understand how to treat the patients at home.The ability improvement of families' patients can be done by giving guidance when the families come to the hospital or by performing home visite whe the patients are at home.Home visite will be very useful for the families in treating the patients and also give correct information to community about schizophrenia.CONCLUSION AND SUGGESTIONThe family's stigma for the patients with schizophrenia was mostly in often category at 24 respondents (53.3%).The family desires to do shackling for the patients with schizophrenia was mostly in high category at 20 respondents (44.4%).The examination Rank Spearmen result suggested p-value <0.05.The conclusion was Ha accepted meant the family stigma had relationship with shackling for the patients in psychiatric hospital of Bali province in 2017.Psychiatric hospital of Bali province is expected to increase guidance activities or home visits for families who have a high desire in shackling to prevent it after patients return to their homes.Families are expected to actively take part in programs related to increasing knowledge about treatment for patients at home such as following guidance conducted by public health or psychiatric hospital.For futher researches are expected to be able to exam other factors infl uencing the family need to do shackling such as social economy, family load and support from community.