Art Therapy Group as Efforts of Psychiatric Emergency Prevention

Received: September, 12, 2021 Revised: September, 30, 2021 Available online: September 2021 World Health Organization (WHO) works hard for facing this covid-19 pandemic. The whole world applied WHO suggestions in public health actions, such as social distancing to reduce the spread of COVID-19. However, these protocols lead societies to feel isolated and lonely that increase stress and anxiety. Community service activities are one of the efforts that can be taken to empower family members to carry out simple therapy in reducing anxiety. This community service will focus on the mother who has a big influence on managing family. This community service aimed to educate the mother’s group to help their family in improving knowledge and skill of emergency psychiatric prevention. This activity was divided into two main parts, a seminar about health education about Psychiatric Emergency and ran a workshop in the art therapy group. This community service results showed that health education can improve knowledge related to emergency psychiatrics, and mothers could implement art drawing therapy as an effort of psychiatric emergency prevention. In conclusion, Art group therapy is recommended for mother and her family for prevent the emergency psychiatric condition.


INTRODUCTION
Public health emergencies might affect the health, safety, and well-being of both individuals (causing, for example, insecurity, confusion, emotional isolation, and stigma) and communities (owing to economic loss, work and school closures, inadequate resources for medical response, and deficient distribution of necessities). These effects may transform into various emotional reactions (such as distress or psychiatric conditions), unhealthy behaviors (such as excessive substance use), and non-compliance with public health directives (such as home confinement and vaccination) in people who acquired the disease and in the general population. Extensive research in mental health disaster has established that emotional distress is ubiquitous in affected populationsa finding certain to be echoed in populations affected by the Covid-19 pandemic.
Some groups could be more vulnerable towards psychosocial effects of pandemics than others. In particular, people who at high risk acquired the disease (including the elderly, people with compromised immune function, and those living or receiving care in congregate settings), and people with pre-existing medical, psychiatric, or substance use problems are at increased risk for adverse psychosocial outcomes (Plant & White, 2013 In Indonesia Covid-19 still exist in bug number; the latest data was noted more than 6000 mortalities. This number was decreasing compare to the number of the covid-19 patients in the early year of 2020 (Ghani, 2020). The Coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented hazards to mental health globally. While psychological support is being provided to patients and healthcare workers, the general public's mental health requires significant attention as well. Systematic research conducted on PubMed, Embase, Medline, Web of Science, and Scopus from inception to 17 May 2020 following the PRISMA guidelines, which was taken the data in China, Spain, Italy, Iran, the US, Turkey, Nepal, and Denmark, was found that symptoms of anxiety (6.33% to 50.9%) relatively high, depression (14.6% to 48.3%), post-traumatic stress disorder (7% to 53.8%), psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) (Xiong et al., n.d.) World health organization (WHO) works hard to deal with the covid-19 pandemic, the whole world practiced WHO suggestions in public health actions, such as social distancing to reduce the spread of COVID-19. However, the protocol lead society to feel isolated and lonely that can increase stress and anxiety (CDC, 2021). In a survey conducted by American Psychiatric Association (APA) concluded that in 1000 adult Americans, there were 48 % with the anxiety of infected by covid-19, 40% worried about after disease and complication after the Covid-19, and 62 were anxious about their family member regarding to be infected bycovid-19 (Zhou et al., 2020) Psychiatric emergencies could develop as psychomotor symptoms such as agitation or suicidality which mostly happened in non-psychiatric settings such as public hospitals, primary emergency services, or community setting (Mavrogiorgou et al., 2011). Once the psychiatric emergency arises in a community setting, society should have prevention action like what society needs in first aids physical emergency prevention skill. Nowadays Psychological First Aid (PFA) is in an effort of developing and formulating.
As disaster management is to prevent and to manage disaster effectively, society also the same acts in a psychiatric emergency situations (Math et al., 2015) Anxiety disorders are disorders with an 'abnormal' experience of fear, which gives rise to sustained distress and/ or obstacles in social functioning (Abbing et al., 2019). Anxiety should treat well to avoid emergency of psychiatry conditions, such as panic. It is good for society can avoid the stage of anxiety reach the panic stage, regarding this condition need emergency treatment. Society especially mothers should learn and have enough knowledge and skills about emergency psychiatry to implement it in the family. The family is the smallest unit in a society where the mother has an important role to influence the family members about health management. Art therapy is one of modality therapy believed can reduce anxiety and can improve mental health status (Kartina, 2019). One of effort to decrease anxiety is Art Drawing Therapy. Art therapy, which can use in children and also adult, it has a positive impact (Beebe et al., n.d.).
Irna Kartina -Art Therapy Group as Efforts of Psychiatric Emergency Prevention Art therapy also can use for assessment tools and health promotion media. This community service program will use Art drawing therapy as tool for improving the knowledge of mothers regarding the emergency of psychiatry and how to prevent it in the family. As the smallest part of a community, family is the area where health education and treatment can be started. This program focus on mother as the main subject regarding mother has an important role in influencing family member in health behavior. In terms of effectiveness, Art therapy is more effective in small groups than big groups, the small group defines 5-7 members and big group defines more than 6 people. These considerations lead the author to apply the art therapy group that will be started in a family with focus subject mother. Art therapy is also believed in terms of helping people explore their feeling by creative process that's follow body, mind and soul concepts (Case & Dalley, 2014). This community service is expected that the mother's group will help their family in knowledge and skill of emergency psychiatric prevention.

METHOD
This activity was approached by quantitative design; one group of mothers was grouping virtually. The group passed two main sections, in every section mother group was given pre and post-test regarding psychiatric emergency knowledge and understanding. This community service program invited 60 mothers, however only 37 mothers who complete all the section until the end. The mothers were from two different countries, Taiwan and Indonesia. The mothers who were originally Indonesian brides, stayed in countries with covid-19 experience. Taiwan represented by mothers who were admitting in Muslimah Sisterhood (SALIMAH) overseas branch, Taiwan and Indonesia presented by SALIMAH member in Surakarta. The mothers were given health education regarding emergency psychiatry and art therapy, the activity was divided into two sections. The classes were applied online for Indonesian brides in Taiwan (Salimah Taiwan member) and offline for Indonesian mothers which were attended Universitas Kusuma Husada Surakarta, Indonesia.
The mothers were recruited by voluntary form via announcement in each online application group that they used as coordinating forum then in the actual day of activity the mothers followed some stages.

c. Implementation of Program
The implementation program will be included team members and students, will be arranged in seminar and zoom discussion class, and also 3 meetings offline.
Irna Kartina -Art Therapy Group as Efforts of Psychiatric Emergency Prevention d. Monitoring and evaluation Monitoring was 2 weeks after implementation of the program, took time in May-June 2021. Primary outcomes that were measured for each group of subjects about the implementation of community engagement was knowledge related to psychiatric emergency and skill of doing art therapy.

RESULT AND DISCUSSION
The result obtained by the author during the community service program was represented in two tables, description regarding participant's characteristic and average percentage of knowledge improvement and narrative observation of author to the ability of mothers for using art therapy as expressive feeling ways a prevention of severe condition psychiatric emergency. training mode also shows that can improve the understanding and skills of mental nurses related to psychiatric emergency management in patients with panic anxiety attacks (Astuti, 2017). The author tried to look deep into questioner's questions we used, approximately mothers understood about definition and sign and symptom of emergency psychiatry, but in question-related to how to react in community, several mothers did not consistency about the role of security to help in emergency psychiatry. The future programs should focus on more teaching how to react properly in emergency psychiatric cases in the community.
The articles journal about management emergency psychiatric were rare to find in society. Most of the references describe efforts in the hospital setting such as how to improve learning media for emergency psychiatric (Mukarromah, 2018) and description of Family Knowledge about emergency psychiatry: violence behavior (Novitasari, 2018) Based on a survey in video and the result of art drawing therapy, mothers who followed the 1-2 section can express their feeling via drawing which showed in drawing that can express and explain in the drawing therapy section (section 2). From 37 mothers who participated in this program, 22 mothers who joined all the section could finish drawing their feeling on the paper as the instruction.
Art therapy was believed to one of therapy to promote mental health and reduce mental illness (Haeyen et al., n.d.). It is also can offer complementary in terms of releasing trauma events and increasing feeling expression (Uttley et al., 2015). Art therapy was also one of modality therapy believed could reduce anxiety and improve mental health status (Kartina, 2019), as one of effort to decrease anxiety is art drawing therapy. As this narration of art therapy benefits, it is reasonable to suggest as one of Irna Kartina -Art Therapy Group as Efforts of Psychiatric Emergency Prevention complementary therapy for assisting the family with psychosocial disorder even healthy people for prevention of emergency psychiatry.

CONCLUSION
This community engagement program could give benefit for society or community and contribution theoretic in terms of emergency psychiatric knowledge. Recommendations from this community service are: a. Assisting family especially mothers in health education can improve mother knowledge b. An art therapy groups can give skills to mothers in implementation as prevention of emergency psychiatric.
This community service has some impacts that can be expected: a. Improving knowledge of mother regarding psychiatric emergency in the community b. Improving mothers' skill in art drawing for preventing psychiatric emergency situation In short, this activity is suggested for continuing as a routine activity in every family, or community health service. The more members who joined the activity, the more impacts spread in the community.

UNKNOWLEDGEMENTS
Acknowledgements on this manuscript deliver to Universitas Kusuma Husada Surakarta for supporting funds and facilities, women organization Salimah Taiwan and Salimah Solo City for contribution and active participation in whole community services.