KNOWLEDGE AS IMPORTANT DOMAIN IN REDUCE STIGMA AGAINST PEOPLE WITH MENTAL DISORDERS

The negative stigma of people with mental disorder (ODGJ) has become a social phenomenon that harm sufferers. Discriminatory actions, gossip, the view that ODGJ cannot live normally, is an attitude that still maintains its negative stigma. The purpose of this study is to find a relationship between students 'and nurses' knowledge about mental health with the negative stigma that befalls ODGJ, Correlational design is used in this study. A cross-sectional research approach. Data were collected using a questionnaire, ie respondents' knowledge of ODGJ was measured by the MAKS questionnaire, and the stigma questionnaire for students and nurses (MICA). A total of 115 student and nurse respondents were sampled in this study. The sampling technique used is simple random sampling. Statistical analysis using Spearman Rank correlation test. Correlation value obtained (r) 0.02 (p <0.05). The statistical results interpret the existence of a meaningful relationship between knowledge and the formation of stigma in society. There is a relationship associated with knowledge with the formation of stigma. The knowledge contributes greatly to the formation of a positive mindset of students and nurses about ODGJ (People with Mental Disorders). The role of nurses as educators is needed to block the increasing stigma. Continuity assistance and cross-sector collaboration are needed to succeed in a stigma-free program.


INTRODUCTION
Stigma on people with mental disorders is still a crucial problem in the community and society (Bharadwaj, Pai, & Suziedelyte, 2017)Society views people with mental disorders as a taboo and incurable disease (Niedzwiedz, 2019). Stigma is an attitude or a person's perspective on a phenomenon that tends to be negative (Corrigan & Bink, 2016). It does not stop there, exclusion, exclusion, eviction, rejection, and physical violence are sometimes obtained by people with mental disorders. The acts of intimidation above indicate that poor public stigma makes the problem murkier and there is no contribution to the treatment of healing (Corrigan & Bink, 2016) This is also the view of prospective health workers who are still pursuing nursing education (Valery & Prouteau, 2020). Students also feel scared (Sercu, Ayala, & Bracke, 2015) when meeting with people with mental disorders (Wada et al., 2019). In their minds, mental disorders are people who are always raging or severe mental disorders. Though mental disorders are not only raging. Mental health disorders e-ISSN: 2686-2123 p-ISSN: 2686-0538 according to Keliat (2007) namely the realm of mental health, the realm of risk (stress, anxiety, depression, helplessness, hopelessness, grieving) and the realm of illness (low self-esteem, withdrawal, social isolation, hallucinations, self-care deficits, delusions, violent behavior, risk of suicide).
The data shows that the estimated mental disorder of the global population is 450 million people with the most in India (4.5% of the population, or 56,675,969 cases), and those with low people with mental disorders are in the Maldives (3.7% of the total population or a total of 12,739 cases). As for in Indonesia as many as 9,162,886 cases or 3.7% of the population. (Ayuningtyas, Misnaniarti, & Rayhani, 2018;WHO, 2014). In Indonesia alone, the number of people with symptoms of mental-emotional disorders marked by depression and emotions at the age of> 15 years is around 61% (Depkes RI, 2019).
From the data mentioned mental health problems can not be underestimated. Increased mental disorder patients can become a burden of disease. Public stigma is one of the factors not yet optimal in the treatment of mental disorders in the community (González-Sanguino, Muñoz, Castellanos, Pérez-Santos, & Orihuela-Villameriel, 2019;Wang, Link, Corrigan, Davidson, & Flanagan, 2018). This is due to community indifference and lack of public knowledge about mental health (Schnyder et al., 2018).
Nursing students need to be prepared to face the possibilities in the future when working at the Mental Hospital (Dobransky, 2020). The purpose of this research is to evaluate the knowledge of nursing students about health science and mental nursing which can then be used as a basic foundation in developing learning methods on campus (Morgan, Reavley, Ross, Too, & Jorm, 2018). Students with sufficient knowledge, attitudes, and skills are expected to be ready to be deployed in the community or the mental hospital. Besides, it can be a role model in their area of work to reduce the bad stigma of people with mental disorders. Knowledge plays an important role in shaping one's perspective and behavior (Maulana et al., 2019).

METHOD
The research design uses an interpretive approach with the methods needed to answer the problem formulation. A correlational research design was used in this study, with a Cross-Sectional approach. The use of this method aims to find a relationship between the independent variables of knowledge and the dependent variable of stigma in people with mental disorders. There are two variables studied in this study. The independent variable in this study is knowledge and the dependent variable is stigma. The population in this study were all nursing students level 1 to level 4, students in the professional education stage, and nurses. The sample used in this study was n = 115 respondents. The number of samples is calculated with the help of G-Power software (Faul, Erdfelder, Buchner, & Lang, 2009). This software can estimate the number of eligible samples simply by entering data analysis techniques into the programmed options. Then the sample was taken using a simple random sampling technique because it is one of the probability sampling techniques that has the advantage that every sample of nursing students and nursing alumni of the Bhakti Wiyata Kediri Institute of Health Sciences have the same opportunity to be respondents.
The instruments used were sociodemographic, knowledge questionnaires, and stigma questionnaires. Demographic instruments were compiled by researchers to retrieve data in the form of respondent characteristics which contained age, gender, the current level of nursing education, the experience of meeting people with mental disorders, bad experiences when meeting people with mental disorders.

Mental Health Knowledge Schedule
The instrument used in measuring respondents' knowledge was the Knowledge Questionnaire of people with mental disorders. This questionnaire consisted of 2 types, each of which amounted to 6 questions. The first type measures the area of knowledge related to stigma and the second type measures the level of recognition and familiarity with the condition of the soul. Researchers use only the first type because they are most appropriate for this study. A high score indicates good knowledge (Evans-Lacko et al., 2010).

Mental Illness Clinician Attitudes
Stigma on nurse students and nurses was measured using the MICA questionnaire. This questionnaire consists of 16 questions with 6 answer choices ranging from "Strongly agree" to "Strongly Disagree". A high score indicates a strong negative stigma against mental disorders. The questionnaire has passed the test of validity and reliability (Gabbidon et al., 2013).
The process of collecting data in this study uses primary data, which is data taken directly by researchers in the field according to the required criteria. Data collection was carried out for 7 days. Data was collected with the help of a questionnaire using Google form media. The questionnaire was tested for validity and reliability, as well as the backtranslation process. An electronic questionnaire with google form media is chosen by researchers by considering efficiency, effectiveness, and faster and more flexible time. The data obtained in the form of demographic data that contains the characteristics of respondents, respondents' knowledge, and Stigma about people with mental disorder.
The process of managing the collected data is descriptively processed by Univariate analysis (editing, coding, scoring, and tabulating) and Bivariate with the help of software (SPSS ver. 24).

Research Ethics
This research uses ethical principles in its implementation. First, the provision of informed consent to respondents as a form of licensing and approval before conducting research. Second, still pay attention to the principle of ethical confidentiality (Anonymity and Confidentiality), that the respondent's identity will be guaranteed and not circulated or disseminated.

RESULTS
The research has carried out the fund providing results in the form of respondent characteristics, knowledge of student nurses and nurses about mental health, stigma results, and analysis of the relationship of knowledge and stigma.
The first The average age of respondents is 17-25 years because they are still taking nursing education, only 6 respondents who have become nurses. As many as 85% of respondents were female and 14% were male. At the level of education the number of students participating in this study at level 1 there were 28 respondents, level 2 there were 23 respondents, level 3 there were 29 respondents, level 4 there were 13 respondents, professional nurses had 17 respondents, and clinical nurses had 6 respondents. Most of the respondents have met people who have mental disorders, only 7 respondents who have never. Furthermore, respondents who had a bad experience when meetingpeople with mental disorder. totaled 35, and some others did not have a bad experience.    Table 3 explains the number of respondents with a stigma level. Several 94.78% of respondents were in the low stigma category and 5.22% had a high stigma.

DISCUSSION
This study aims to analyze the relationship between students 'and nurses' knowledge about mental health with the occurrence of negative stigma affecting people with mental disorders. Based on statistical analysis with the Spearman rank test showed a correlation or a relationship because of the value of p <0.042 (<0.05). The direction of the relationship between knowledge and stigma variables is an inverse relationship (negative correlation coefficient of -0.190) which means that the higher the score of knowledge about mental health in students and nurses, the stigma score will go down or low.
As many as 90.43 respondents know about good mental health. Only 9.57% are lacking knowledge. When seen from the results of the survey most of those who lack knowledge are at level 1. They are still unfamiliar with people with mental disorders. Even the data says there have never met people with mental disorders and some others have had a bad experience.
Several related studies of knowledge in nursing students on stigma have been conducted. As a study conducted by Bingham & Brien (2017) that education about mental health in nursing students can make a good contribution in shaping knowledge about mental health. Knowledge plays an important role in reducing stigma. Facts show that respondents with good knowledge result in low stigma scores. This is also evidenced by a variety of literature that mentions results that are not much different.
Knowledge about mental health is an important basis for nursing students especially and other prospective health workers (Lanfredi et al., 2019). In this case, knowledge includes knowledge about behavior seeking mental health assistance, recognition, forms of support, employment, care, and recovery of people with mental disorders (Evans-Lacko et al., 2010). Researchers observe and observe directly some things affect students' knowledge so that they have good knowledge. Their knowledge comes from direct education or lectures in class with the application of the 7th KKNI curriculum on mental nursing (İnan, Günüşen, Duman, & Ertem, 2019;Sherwood, 2019). Also, outdoor education (by visiting) the land/soul posyandu, the existence of field learning practices (PBK), clinical supervision in the field as well as the existence of audio-visual education about people with mental disorders (Bilge & Palabiyik, 2016). Equally important is the question and answer from the facilitator both in formal education and outside formal education (Bingham & Brien, 2017).
The results showed that 94.78% of respondents had a low stigma against people with mental disorders. The experience of meeting with people with mental disorders also influences the perceptions of (Moses, 2014). The forms of stigma in the form of neglect, prejudice, and neglect are only found in 5.22 respondents. Educational background as student nurses who have received mental health information can be a major factor why the results of stigma scores are low (Maunder & White, 2019). There is a relationship between knowledge, attitudes, and habits. It is expected that increased knowledge (Evans-Lacko et al., 2010;Gabbidon et al., 2013) can influence attitudes and habits (Gabbidon et al., 2013).
Good knowledge for health workers, especially nursing has good implications for the community is the role model of learners, the existence of facilitators as media help-seeking, as well as the habit of being non-stigma, and stigma reduction (Blais & Renshaw, 2013). Students need to have experience meeting people with mental disorders in nursing education related to knowledge and stigma formation (Vidourek & Burbage, 2019). Preparations to make nurse students become professionals must be prepared early on. Learning knowledge about mental health is expected to further broaden the perspective of nursing students (Schnyder et al., 2018). This can slowly affect changes in student behavior and attitudes when meeting people with mental disorders patients in both community and clinical (Fox, Smith, & Vogt, 2018). Besides, it also affects the rate of handling mental cases if found in the community (Dockery et al., 2015).

CONCLUSIONS
Found a relationship with the direction of an inverse / negative relationship between knowledge about mental health with the stigma of people with a soul. The higher the knowledge score, the lower the stigma score. This can be used as a basis for reducing the stigma of people with mental disorders in the community that is still high. This result is an important provision for student nurses and nurses when deployed and working in the community. They can become role models (educators, advocates, collaborators) in the community so that knowledge about mental health in the community increases and stigma decreases. There is a need for an ongoing program on mental health education by involving various cross-sectors to promote mental health.