ANNUAL REPORT 2014 - Health and...Annual Report 2014 National Institute of Mental Health (NIMH) Page...
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ANNUAL REPORT
2014
National Institute of Mental Health
Ministry of Health
Sri Lanka
OUR VISION
The Centre of excellence
For psychiatric care & mental well being
OUR MISSION
Acute, Intermediate, rehabilitative care & specialized Services
underpinned by
Excellent care & Management
Meaningful patient and family involvement
Maximum Independence and activities
Patient’s rights
Clear Operational policies
OUR VALUES
We believe that patients with mental health problems have a right to a
normal life
We try to make a homely atmosphere
We put our patients first
We aim for united team
We value hard work and loyalty
CONNTENT
DIRECTOR’S MESSAGE 01
INTRODUCTION 03
IN- PATIENT SERVICES 05
FORENSIC PSYCHIATRY UNIT 08
PSYCHO-GAERIATRIC UNIT 11
ADOLESCENT PSYCHIATRY UNIT 13
PREGNANCY & PUERPERAL CARE UNIT 13
LEARNING DISABILITY UNIT 14
MEDICAL WARD 15
PHYSIOTHERAPY UNIT 15
PHARMACY 15
DENTAL UNIT 16
INFECTION CONTROL UNIT 17
DIAGNOSTIC SERVICERS 18
OUT PATIENT SERVICES 19
COMMUNITY PSYCHIATRY PROGRAMME 20
COLOMBO OUT – REACH AMBULANCE SERVICE 21
DAY TREATMENT CENTRE 22
DAY ECT UNIT 23
GENDER BASED VIOLENCE PREVENTION UNIT 24
OCCUPATIONAL THERAPY UNIT 26
PSYCHIATRIC SOCIAL WORK UNIT 28
REHABILITATION PROGRAMME 30
TRAINING AND RESEARCH UNIT 32
PRODUCTIVITY, QUALITY AND SAFETY OF PATIENT CARE SERVICES 33
HEALTH INFORMATION UNIT 35
CLINICAL GOVERNANCE UNIT 35
HALFWAY HOME - MULLERIYAWA 36
SCHOOL OF NURSING MULLERIYAWA 39
SPECIAL ACTIVITIES 40
SPECIAL PROJECTS 44
STAFF WELFARE 47
ANNEX 1 48
ANNEX 2 49
ANNEX 3 51
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 1
DIRECTOR’S MESSAGE
The year 2014 is the 7th consecutive year that I write the Director’s message to the
annual report of the National Institute of Mental Health (NIMH). This year’s annual
report too presents the dedicated service rendered by our staff and the well –
wishers to patients, their families and to the community.
During the year 2014 the National Institute of Mental Health worked hard towards
promotion of mental wellbeing, preventing mental disorders, treatment and
rehabilitation of people and their families affected by mental disorders.
As the Director of the NIMH I had the privilege to guide the institution to provide its
services in collaboration with many other local, regional, national and international
agencies. Institution also extended mental health promotional and awareness raising
activities among school children, school teachers, police officers, prison officers,
officers working in the forces and many private institutions.
This report gives a snap shot view of the activities taken place during the year 2014. I
thank and appreciate all my dedicated staff who worked tirelessly for the betterment
of Mental Health services and to make the year 2014 a great success.
Dr. Jayan Mendis
Director
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 2
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 3
INTRODUCTION
The National Institute of Mental Health (NIMH) was established in 1927 and it is one of the
oldest hospitals in South Asia. At present it is the largest tertiary care hospital in Sri Lanka
caring for patients with mental illness. The former Mental Hospital was upgraded to a National
Institute in 2008. The Half Way Home, Mulleriyawa (HWH) and the School of Nursing,
Mulleriyawa are also under the administration of NIMH since 2008.
The NIMH has a total of around 1500 beds and annually over 8000 patients are admitted
seeking treatment for all types of mental illness. NIMH provides acute care, intermediate care
and long term care as well as specialized services. There are about 1000 inward patients
treated at NIMH on any given day. The NIMH is the main training centre in Sri Lanka for
undergraduate and post graduate trainees in psychiatry from medical and allied fields, for basic
and in-service training for health staff as well. All postgraduate trainees in MD psychiatry
undergo a compulsory training for a minimum period of 6 months at the NIMH. The NIMH has
around 1,500 full-time staff. The administration of NIMH comprise of a Director and a Deputy
Director. As at 31stDecember 2014, NIMH had nearly 71 Doctors including 8 Consultant
Psychiatrists, a Consultant Physician, a Consultant Microbiologist, a Consultant Haematologist
and 2 Dental Surgeons. There were also 5 Special Grade Nursing Officers, 445 other grade
Nursing Officers, 14 Psychiatric Social Workers, and 7 Occupational Therapists (Annex 1).
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 4
Preliminary care
24 hr emergency admissions via Psychiatric Intensive Care Unit (PICU)
24 hr outpatient department (OPD)
In-patient care
Treatment facilities for acutely ill patients
Rehabilitation facilities - occupational therapy, horticulture therapy, ward-based
activities
Services for psychiatric social work related issues of patients
Physiotherapy, Laboratory, EEG, ECG and Radiography services
Isolation facility for communicable diseases
Oral health care
Specialized care
Forensic Psychiatry care
Elderly mental health care
Care for adolescents with mental illness
Care for pregnant and post-partum women with mental illness
Care for learning disabilities
Specialized Medical Ward, Dermatology Clinic, Wound Clinic
Out-patient services
Day ECT facility
Day Treatment facility for minor mental illnesses
Day Rehabilitation facility
Alcohol Relapse Prevention Therapy
Gender Based Violence prevention and care
Colombo Outreach Ambulance Service
Community psychiatric care
Continued care at NHSL and outreach clinics
Other Services
Postgraduate and undergraduate trainings in psychiatry
In-service training for the staff
Promotion of ethical research in mental health
Promotion of community mental-wellbeing
Elimination of stigma
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 5
IN-PATIENT SERVICES
OUT-PATIENT DEPARTMENT (OPD) & PSYCHIATRIC INTENSIVE CARE
UNIT (PICU)
The NIMH has a unique system of allocating patients to the Consultant Psychiatrists according
to their area of residence. On admission a joint psychiatric assessment is done by the Medical
Officer and the relevant Nursing Officer at the OPD. Patients can be brought directly by their
families or by police, airport office, and prisons or transferred from other health care
institutions. Sometimes patients may voluntarily seek treatments.
The patients who are not aggressive or violent are directly admitted to the acute care wards or
specialized units. If inward treatment is not needed, patients are referred to the psychiatric
clinics closer to their place of residence. Aggressive or violent patients are admitted to the PICU
for the initial management and thereafter transferred to the relevant acute care wards.
There were 11,723 OPD contacts during the year 2014, of which 9,792 (83%) were admitted.
Among the admissions 2,591 (26%) needed PICU care. Of the admissions 1,341 (13.6%) were
transferred to the NIMH from the other hospitals.
Table 1 distribution of the OPD contact at NIMH, 2014
65
12
89
8
47
87
20
72
49
2
52
11
46
2 3
83
1
51
9
61
2
11
72
3
13
60
86
18
25
91
11
04
To
tal
Co
nta
cts
Cli
nic
Re
ferr
al
Ad
mis
sio
ns
PIC
UA
dm
issi
on
s
Tra
nsf
er
In
Male Female Total
Annual Report 2014 National Institute of Mental Health (NIMH)
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IN-WARD CARE (ACUTE, INTERMEDIATE & LONG TERM CARE)
There are 8 acute care wards (4 males and 4 females) and 8 intermediate care wards (4 males
and 4 females), providing inward care under the 8 Consultant Psychiatrists. The stay in the
acute wards is usually limited to around 30 days. If the treating team decides that the patients
can be managed in the society, he/she will be discharged straight from the acute care ward. If
that patient needs further treatment, they will be transferred to an intermediate care wards.
However if the patient becomes violent and restless again while in an intermediate care ward,
he/she will be transferred back to the acute care ward for further management.
In addition, there are two male wards providing long-term care at NIMH and female long term-
care is provided at the HWH-Mulleriyawa. There are two fee levying long term unit’s (Villas),
(one male and one female) at NIMH where only limited number of patients can be admitted.
Each ward has a multi-disciplinary team (MDT) consisting of a Consultant Psychiatrist, Senior
Registrar, Registrars, Medical Officers, Nursing Officers, Psychiatric Social Workers,
Occupational Therapist and Supportive Staff. Same MDT team treats the patient whether the
patient is in acute care or intermediate care wards.
Table 2 Age distribution of the patients admitted to NIMH, 2014
76
21
29
70
10
94
15
7
65
44
23
14
01
99
2
17
9
40
12
0
44
43
71
20
86
33
6
10
5
<1
1y
12
-16
Y
17
-49
Y
50
-69
Y
70
YA
BO
VE
un
kn
ow
nMale Female Total
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 7
Table 3 Diagnosis of the patients discharged from NIMH, 2014
Figure 1 Distribution of the admission to NIMH by area of residence, 2014
23
8
46
9
26
21
15
35
28
5
33
16
9
4
8
6 1
93
30
14
39
11
67
22
9
36
71
1
2
1
43
1
49
9
40
60
27
02
50
14
69
24
0
5
10
7
Org
an
ic M
en
tal
Dis
ord
ers
su
bst
an
ce a
bu
se
de
lusi
on
al
dis
ord
ers
Mo
od
dis
ord
ers
So
ma
tofo
rm d
iso
rde
rs
dis
ord
ers
of
ad
ult
pe
rso
na
lity
me
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l re
tard
ati
on
ad
ole
nce
nce
be
ha
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ura
l d
iso
rde
rs
dis
ord
ers
of
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cho
log
ica
ld
ev
elo
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en
t
Be
ha
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oti
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dis
ord
ers
ccu
rrin
g i
n c
hil
dh
oo
d…
un
spe
cifi
ed
Male Female Total
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 8
FORENSIC PSYCHIATRY UNIT
Forensic Psychiatry Unit (FPU) is the largest specialized unit of NIMH and it is the only such
facility in Sri Lanka. It consists of two wards (male and female), a rehabilitation unit, a
horticulture area and two clinics held at the Prison Hospital, Welikada and the National
Hospital of Sri Lanka (NHSL). The wards 21 and 25 house male and female patients with bed
strengths of 103 and 24 respectively.
An outreach clinic is held every Wednesday at room 22, NHSL, for out-patients with issues
related to forensic psychiatry. The clinic receives referrals from Judicial Medical Officers
(JMOs), from District Courts, Magistrate Courts, Police, Non-Government Organizations (NGOs)
and the general medical and surgical wards of the NHSL. A psychiatric liaison service is
provided to the Prison Hospital Wellikada Colombo and two out-patient clinics are held every
Monday by the multidisciplinary team. The team conducts assessments, provide treatment and
court reports for prison inmates. Every Wednesday a Registrar in Psychiatry visits the
psychiatry ward of the Prison Hospital.
Court appearances were made by the Consultant Psychiatrist when summoned by the
respective courts to give expert evidence. The Senior Registrar and Registrars were also given
the opportunity to witness the court proceedings as a part of their training.
Under the Community Forensic Psychiatry Initiative regular visits were made to prevent re-
offending and clinical relapses and identified several high risk patients discharged from the
courts in close by areas. During 2014, unit has issued 805 court reports regarding inward
patients, 289 reports through the Prison Hospital and 165 reports through the out patients
clinic at the NHSL. Scene of crime visits and home visits were also conducted. These were done
in order to gather information on alleged crimes, their circumstances, about the offenders and
the victims. During these visits, the team visited relevant places such as the local hospitals and
police stations and interviewed scene of crime officers (SOCO) and villagers in order to gather
further information.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 9
FORENSIC PSYCHIATRY RESOURCE CENTER
Forensic Psychiatry Resource Center was established in 2013 in order to coordinate the
forensic psychiatry service by keeping forensic records, coordinating outreach clinics,
arranging trainings and providing necessary information for the trainees and other health
professionals when necessary. A new email information service was commenced in November
2014 by the Forensic Psychiatry Resource Center of FPU. The aim of introducing the email
address [email protected] was to provide the support and guidance to the
professionals involved in judicial matters regarding forensic psychiatry related issues when
necessary. Any health professionals can contact the Forensic Psychiatry Resources Center
through this email address.
VISITORS’ BOARD
Visitors’ Board is held for mentally ill patients with major criminal charges who were not fit
enough to plea for a long time. The board comprise of representatives of Secretary - Ministry of
Justice, Secretary – Ministry of Health, Commissioner of Prison and a Consultant Psychiatrist.
Visitors’ board meetings were held on 3 occasions in 2014 for which around 23 mentally ill
offenders were produced and 16 were released, counting to 101 since 2010.
FORENSIC PSYCHIATRY REHABILITATION UNIT
Forensic Psychiatry Rehabilitation Unit (FPRU), opened in 2010 is the only such facility in Sri
Lanka. A structured rehabilitation programme is conducted by the unit. FPRU provides its
service for around 50 patients a day. Individual assessments are conducted by the Occupational
Therapist attached to the unit. The FPRU has submitted 130 functional assessment reports
within the year 2014.
OPEN SCHOOL
Open school is one of the major programmes held in the FPRU. It is an educational programme
conducted by National Institute of Education (NIE) in collaboration with NIMH since February
2012. It helps individuals to get formal education through activities and lessons under the
guidance of well-trained school teachers. Open school sessions are held on every Thursday.
Around 40 sessions were held in 2014 and around 40 to 50 people attended each session.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 10
ACTIVITY PROGRAMME
A structured activity programme is conducted by the FPRU and includes creative therapies
such as arts, music, drama and narrative therapy, training on work skills such as making soft
toys and greeting cards, training on Activities of Daily Living (ADL) such as cookery and self-
care activities and indoor/outdoor sports such as volleyball, cricket, carom and darts. A
horticulture therapy programme is also conducted along with the rehabilitation programme.
These activities are conducted by the staff of the FPRU with the help of volunteers.
VOLUNTEERS
FPRU has been supported by many volunteers from the beginning. Ms. Araliya Abeysekara, an
undergraduate, volunteering in the FPRU since 2012, was the selected at the BEST YOUTH
VOLUNTEER OF SRI LANKA in 2014 by the United Nations Development Programme (UNDP).
Mrs. Dilani Ranasinghe, a mental health consumer, volunteering as a trainer of making soft toys
for FPRU since 2012 was appreciated by the WHO country representative to Sri Lanka in 2014.
SPECIAL EVENTS
FPRU celebrates the national events with the inmates of the unit every year as part of their
rehabilitation. The aim of celebrating these events is to connect the inmates to their cultures
instead of being isolated in an institution. Sinahala and Tamil New Year, Vesak, Christmas,
Thaipongal and other cultural events were celebrated in 2014.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 11
PSYCHO-GAERIATRIC UNIT
The Psycho-Geriatric Unit (PGU) was established in 1999 for the specialized care for elderly
patients suffering from dementia. There are 2 separate wards with bed capacity of 20 each for
male and female patients under the care of two Consultant Psychiatrists. In 2014, 119(49%)
male and 121(51%) female patients were admitted.
This unit provides pharmacological as well as non-pharmacological treatments for geriatric
patients through a multi-disciplinary team. Following activities were carried out, aiming
reduced disturbances at home, rehabilitation and reintegration of patients quickly in to the
society.
Rehabilitation activities and cognitive function stimulating activities such as singing,
listening to music, drawing, making crafts to improve the diminishing social skills.
Reminiscence Therapy –help to remember past events and actions over and over to
strengthen the memory.
Activities of Daily Living (ADL) Training - bathing, continence, dressing, feeding, toileting.
The NEUROPSYCHIATRIC OUT-PATIENTS CLINIC is conducted at room 43 NHSL, every
Monday from 2-4.pm for patients with dementia.
DEMENTIA HELP LINE (011-3140844) operates through the unit 24/7
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 12
SPECIAL ACTIVITIES
Two meeting of patients and their care givers were held during 2014 – to educate them on
dementia and offered guidance to overcome the problems they face when looking after such
patients. A two day training programme for caregivers was held with the participation of
Medical Officers and Nursing Officers from NIMH and other hospitals, Occupational Therapists
and Care Givers of Elders’ Homes. A meeting was held with the Director Provincial Social
Service, Western Province to launch a programme to identify inmates with dementia staying at
elder’s homes in the province
Table 4 Admissions to Psycho-Geriatric Unit, 2010-2014
11
1
11
4
12
7 1
52
11
9
98
91
94
12
9
12
1
2010 2011 2012 2013 2014
Male Female
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 13
ADOLESCENT PSYCHIATRY UNIT
Adolescent Psychiatry Unit was opened on 15th December 2014 as the first ever unit
specifically designed for the adolescent patients in Sri Lanka. Patients, both males and females,
below 18 years are admitted to the unit under the care of the eight Consultant Psychiatrists and
the respective teams take the responsibility of the clinical care of the patient. The unit has 6
rooms with inward facilities for 9 patients including library facilities and facilities for engaging
in sports, learning and playing. Both acute management of the disturbed patients and their
rehabilitative aspects are looked after by the respective clinical team.
PREGNANCY & PUERPERAL CARE UNIT
Established in 2007, the Pregnancy & Puerperal Care Unit is the first ever in South East Asia.
The unit provides specialized care for women who develop psychiatric illnesses during
pregnancy or following childbirth where their babies/family members are also allowed to stay
with the patient. The unit has 8 rooms, each room comprising of 3 beds for the patient, the
baby and the care giver.
In 2014, there were 118 admissions (pregnant and post-partum mothers) and 95 babies, these
admissions included 17 transfers from all over the island
Table 5 Admissions to Pregnancy & Puerperal Care Unit, 2007-2014
3 8
10
12
12
18
12
20
30
68
58
10
3
11
0
14
0
10
1
98
2007 2008 2009 2010 2011 2012 2013 2014
Antinatal Mothers Postnatal Mothers
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 14
LEARNING DISABILITY UNIT
Opened in 2008, the Learning Disability Unit (LDU) aims to rehabilitate clients with learning
disability and associated behavioural problems and to train and educate their parents,
guardians on rehabilitation skills to provide care for patients with special needs. In the unit
there are 6 rooms to accommodate patients individually. The unit encourages a care giver to
stay with the patient. Patients are admitted to the LDU as a direct admission or transferred
from other acute wards. Psychiatric Social Workers help to solve patient’s family problems.
Some patients are referred to the Occupational Therapy Unit for special programme and
volunteers also help patients to do various leisure activities.
In 2014 there were 59 admissions to the LDU. Patients were trained on activities of daily living
according to a time table. e.g. mouth care, bathing, table manners, dressing, toilet training and
improving interpersonal relationships. Entertainment programmes were also conducted. e.g.
listening to radio, playing as a group, singing and playing musical instruments. Cognitive
development programmes conducted included drawing, playing carom, work book activities
and creative activities such as playing with building blocks. Programmes were also conducted
to improve life skills of parents and by standers. e.g. lectures about learning disability
discussions on how children with learning disability should looked after at home. Patients are
under the care of all 8 Consultant Psychiatrists and the medical team.
Table 6 Admissions to Learning Disability Unit, 2008-2014
10
26
36
60
46
45
46
14
26
15
18
12
16
13
2008 2009 2010 2011 2012 2013 2014
Male Female
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 15
MEDICAL WARD
Medical ward was stablished in 2005 under the supervision of a Consultant Physician and 2
Medical Officers. In 2014 there were 3 Medical Officers giving a 24/7 on call coverage. The aim
of the Medical Unit is to provide specialized medical care to the inward psychiatric patients
with co-morbidities. There are separate male and female wards with a total of 20 beds. In
addition a medical clinic is held 6 days per week at the unit to attend to referrals from
Psychiatric Units. During year 2014 there were 856 admissions to the medical ward, out of
them 75 were transferred to other tertiary care hospitals for further management.
PHYSIOTHERAPY UNIT
There are 2 Physiotherapists attached to the unit, who attend to referrals in the unit or in the
respective wards. During the year, around 2200 patients/referrals were seen at the NIMH and
the HWH Mulleriyawa.
PHARMACY
There are 6 pharmacists managing 6 sections: Drug stores, surgical consumable stores, surgical
non-consumable stores, outpatient department, indoor pharmacy, HWH Mulleriyawa including
patients of the community housing project. Out Patient Department functions from 8am to
4pm. In addition, drugs are issued to the community clinics at Modara, Pannipitiya, Kotahena.
Skin ointments and other preparations are made by the Pharmacists for the Wound Care Clinic
and the Dermatology Clinic. Medical Supplies Management Information System (MSMIS)
project was started in 2014 and all pharmaceuticals are issued from MSD through this.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 16
DENTAL UNIT
Dental Unit at NIMH provides its services to all in ward patients of NIMH, HWH-Mulleriyawa
and also to the surrounding community. The main vision of the Dental is Unit to provide state of
the art services towards the challenged patients in the future in a well-equipped friendly
environment that matches the services provided by the developed countries. The treatment
facilitates include routine screening, basic treatments such as fillings, extractions, scaling and
minor oral surgeries. Emergencies such as oral facial trauma, dental alveolar infections
requiring farther treatment are referred to the Dental Institute, Colombo.
In 2014, services were expanded to cover all units of the NIMH (n=2769) which includes the
PPU, LDU, Adolescent Unit, the HWH- Mulleriyawa, the patients who have been under long
term care in ward 22, 27, male villas, female villas etc.
SPECIAL ACTIVITIES
A mega mobile clinic was carried out at the HWH-Mulleriyawa in May 2014 (details are
given under the HWH-Mulleriyawa).
Dental Surgeons of the NIMH supported the age estimation carried out by the Institute of
Legal Medicine and Toxicology, Colombo for the purpose of providing National Identity
Cards for the long term care wards at NIMH (details are given under special projects).
Organized a seminar for the staff of NIMH on oral cancers during the health week 2014 with
the participation of a Dental Surgeon and a Medical Officer from the National Cancer
Control Programme.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 17
INFECTION CONTROL UNIT
The Consultant Microbiologist supervises the work of the infection control Nurses (ICNO). The
ICNO carried out daily ward rounds and supervision in relation to out -breaks, general hygiene,
hand washing practice and waste management. The ICNO coordinates with the Psychiatric
team and the Consultant Microbiologist. Liaisons Nurse meetings were held once a month
giving an opportunity to discuss issues related to infection control. Health education
programmes were carried out for new staff recruits regarding infection control and waste
management.
ISOLATION UNIT
The Isolation Unit consists of 04 separate rooms, constructed according to the National
Infection Guidelines. The activities of the unit are supervised by the Consultant Microbiologist
in coordination with the ICNO and the Psychiatric teams. During the year 2014, 219 patients
were admitted to this unit. A special safety uniform has been provided for all staff members to
prevent the spread of infections among them.
WOUND CARE CLINIC The wound care clinic, started in June 2012, is conducted every Friday morning by the
Consultant Microbiologist. During the year 2014, 85 referrals were received from the wards of
NIMH and the HWH-Mulleriyawa.
Table 7 Admissions to the Isolation Unit, 2014
30
41
8
18
19
15
1
1 2 3
2
1 3
1
MR
SA
Co
nju
nct
ivit
is
TB
Fe
ve
r
Dia
rrh
oe
a
Sca
bie
s
Ch
ick
en
Po
x
He
p B
HIV
Mu
mp
s
Me
asl
es
En
do
the
liti
s
He
rpe
s Z
ost
er
Ra
dio
Act
ive
Io
din
eT
he
rap
y
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 18
HEPATITIS B PROGRAM
This programme was started in 2011 under the guidance of the Consultant Microbiologist. First
the patients in the long term care wards and the hospital staff were vaccinated for Hep-B and
tested for Hep-B antibodies under this programme. Under the second phase of the programme,
patients in the acute and intermediate care wards were vaccinated against Hep-B. In the year
2014, 564 patients were given the first dose; second dose was given to 64 patients. Similarly,
74 newly recruited staff members were vaccinated and 311 staff members were tested for the
Hep-B surface antibody.
DIAGNOSTIC SERVICES
LABORATORY
The Laboratory is supervised by a full time Consultant Haematologist and a visiting Consultant
Microbiologist. There are six MLTs at present. The Laboratory performed a total of 1,076,993
test during the year 2014 which included 25,266 haematological tests, 78,840 bio-chemical
tests, and 3,587 microbiological tests, and 2888 samples were sent to the NHSL and MRI for
other special investigations. Also Internal and External Quality control programmes were
carried out for haematological, biochemical and microbiology Investigations.
EEG, ECG, X-RAY UNITS
EEGs are used to distinguish psychiatric disorders from epileptic disorders. Normal routine
EEG, routine EEG with activation procedure (hyperventilation & photic), Sleep records (Natural
& drug induced) and Sleep deprived EEG are taken at the Unit. A total of 433 EEGs were taken
in 2014.The ECG Unit has two cardiographers and during the year 2014, 8818 ECGs were
done.X-ray Department was started in 1971. There are 02 Radiographers working at present
and around 2000 Patients were referred in 2014. X-ray room was renovated based on the
recommendation by the Atomic Energy Authority to prevent unnecessary radiations to staff
and patients and as a result it was possible to obtain the license after many years. A brand new
“SHIMADZV” RAD speed x-ray machine worth 8 million was installed in 2014. This ceiling
mounted type machine is more suitable to our patients who may not corporate fully to the
procedure.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 19
OUT PATIENT SERVICES
OUT-PATIENT CLINICS
Out-patient clinics are held six days a week in room No 22, NHSL to follow up on patients who
are discharged into the care of families or institutions and to assess new patients. Consultant
Psychiatrists and the respective Medical Staff review the patients at these clinics. The
Psychiatric Social Workers too attended the clinics.
NEUROPSYCHIATRIC CLINIC is held every Monday from 2-4pm in Room No.43 NHSL.
ALCOHOL AND DRUG ABUSE PREVENTION CLINIC is held every Friday at 2 pm at
Room No 22, NHSL.
PRISON CLINIC is held every Monday 2pm at the Welikada Prison.
OUT-REACH CLINICS
There are several outreach clinics conducted by the NIMH (Delgahawattha, Rajamalwattha,
Lunawa and Pannipitiya).The aim of these clinics are to follow-up the discharged patients in
the community. A Consultant Psychiatrist visits and conducts these clinics once a month with
the help of a Medical Officer, Community Psychiatric Nurse, a Pharmacist and a Supportive Staff
member. Around 50 patients are seen per day at these clinics.
Table 7 Patients seen at NHSL, 2014
63
2
16
0
20
3
13
5
49
14
9
23
9
53
1
13
64
2
ge
n.p
sych
iatr
y fore
nsi
c
sub
sta
nce
ab
use
ge
ria
tric
New Patients Followup Patients
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 20
COMMUNITY PSYCHIATRY PROGRAMME
Established in 2010, Community Psychiatry Unit (CPU) is staffed with 4 Community Psychiatry
Nurses (CPN) at present. The unit maintains a database with all the information on admissions
such as patient’s name, age, address, contact number, date of admission, BHT number, ward
number and the respective Consultant. The place of follow-up is entered once the patients is
discharged from the NIMH.
This programme enables tracing defaulters, ensuring follow up and detecting new patients.
The staffs liaise with the Regional Directors of Health Services, Medical Officers of Health
(MOH), Medical Officers of Mental Health (MO-MH). The treatment defaulters either while on
leave from in–ward care or those who have defaulted clinic visits as well as difficult patients i.e.
those who do not take medication are provided with IM Depot medication, which intern help to
prevent repeated admissions to NIMH.
In addition, new patients referred by the CPN, MOMH, Public Health Midwife or Gramma
Niladari are also visited by them. Depending on the case they are either admitted or provided
community based treatment as advised by the Consultant Psychiatrist. Sometimes the team
visits patients in the community to resolve the legal or social issues of patients.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 21
COLOMBO OUT-REACH AMBULANCE SERVICE
To extend the services given to the patients in the community, the Colombo Outreach
Ambulance Service was started in the year 2013. This ensures prompt assessment and
treatment of patients who are aggressive at home and difficult to be brought to the hospital
using conventional transport. When the request to bring a patient comes from a close relative
of the patient, he/she should produce adequate proof about the relationship to the patient and
valid information about the patient’s health condition e.g. Diagnosis cards, clinic books. Initial
assessment of the patient’s condition and the requirement of in-ward care is decided by the
respective Consultant Psychiatrist based on the information provided by the Medical Officer,
Community Psychiatric Nurse and the Psychiatric Social Worker. The patient is visited by a
team comprise of a Medical Officer, a Nursing Officer/Community Psychiatric Nurse,
Psychiatric Social Worker and a Supportive Staff in an ambulance. If there is a need, help of the
Police, Grama Niladari and Community members are sought. After assessment, if the Medical
Officer decides that the patient needs admission to NIMH, he/she is brought to NIMH in the
same ambulance. The ambulance is sent if the patient’s area of residence is within a 50 km
radius of the NIMH. A fixed administrative fees of Rs 1000 and a refundable deposit of rupees
1000 will be charged from the relative. Ministry of Health has given its approval for this project
and the cost of visiting the patient is reimbursed from the relatives on mileage basis (Rs 50 per
km). In year 2014, 25 patients were brought to the hospital.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 22
DAY TREATMENT CENTRE
Day Treatment Centre (DTC) was started in 2012, as an outpatient’s facility. The aim of the unit
is to provide psychological treatment for wide variety of minor psychiatric or neurotic
disorders. School mental health programmers, community awareness programmers and
alcohol relapse prevention programmers are among other services provided by the unit.
ALCOHOL RELAPSE PREVENTION PROGRAMME
This programme at the DTC was started in 2013 and clinics are held every Tuesday and
Thursday. In January 2014, the Alcohol Anonymous Group was started as an extended step of
the programme. This Group gathers once in two weeks. After detoxification, inward patients
are referred to this relapse prevention programme. In addition, those suffering from Alcohol
Dependency Syndrome from the community too seek care at the DTU. After providing
Psychotherapy, they are followed up at the anonymous group. In addition to this the DTC
conducts awareness programmes on alcohol and substance use especially in schools. Several
programmes were conducted in 2014 during which correct knowledge about addictive
substances and alcohol, risk of using, how to get rid of and where to go for treatment were
discussed openly. The unit developed practical tools to help schools to promote positive mental
health among their students and identify and address those with minor problems at an early
stage and build their resilience. It also provide knowledge on how to identify and direct them to
relevant therapeutic centers without delay. Further, 18 community awareness progrmmes were
conducted in year 2014 at MOH offices and other Government Institutes to raise the mental
health literacy among the public servants on current issues such as substance abuse.
Table 8 Clients registered at Day Treatment Centre, 2012-2014
38
27
7
28
2
38
78
5 9
86
2012 2013 2014
New Registered Clients Sessions done
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 23
DAY ELECTRO CONVULSIVE THERAPY (ECT) UNIT
The ECT unit has made a large contribution to upgrade the overall patient care at NIMH. The
ECT unit consists of a theatre and a 20 bedded ward. In year 2014, 9633 ECTs were given to
total of 1860 patients and the majority were (57%) males.
The day ECT unit was established In October 2014 to minimize unnecessary admissions and
keep patients with their family to enrich their mental health. This service is given free of
charge, from Monday to Saturday including Public Holidays.
Patients can be referred from OPD/Clinics/Day Treatment Centre, etc by a Consultant
Psychiatrist attached to the NIMH who is responsible for the overall management of the
patient. Psychiatrist form any other institutes can refer a patient for day ECT only through a
Consultant Psychiatrist attached to the NIMH.
Referring Consultant Psychiatrist should complete the pre-ECT assessment form and
ensures that the patient is fasting and the necessary investigations are available.
Patients should arrive on or before 7.30 a.m. accompanied by a relative who will be in close
contact with the patient for the next 24 hours and personal transport should be available
for the patient to return home after ECT.
Any patient developing complications during or after ECT will be admitted to the NIMH
under the care of the referring Consultant Psychiatrists.
If a patient does not comply with the next appointment for more than a week, the course is
considered to be over unless the patient or a relative corresponds with the unit.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 24
GENDER BASED VIOLENCE PREVENTION UNIT
Gender based violence (GBV) prevention unit is an evolving addition to NIMH, since 2012. This
was an initiative given the evidence that gender based violence is increasingly identified in the
community as well as among mental health clients in Sri Lanka. Since the inception there has
been increasing requests for intervention by both genders and by couples. Unit’s philosophy
highly respects non-violence, gender equality, and sensitivity to family and cultural norms
among the ethnically diverse client population.
Unit works in collaboration with local mental health services and relevant NGOs. Services
include: reducing violence among partners through education, treatment of mentally unwell
and promoting mental wellbeing. Psychotherapeutic and counselling services are aimed at
curbing violence, flouring harmony among couples and partners and addressing sexual
difficulties.
Unit also collaborate with legal sectors in relevant cases. Unit is supported by Consultant
Psychiatrists, trained Medical Officers and Nursing Officers including Registrars and Senior
Registrars in psychiatry who have training as well as special interest in the context. During the
year 2014, 168 (59%) female and 117 (41%) male clients attended the unit.
Table 9 Type of incidents reported to GBVP Unit, 2014
Se
xu
al
Ha
rass
me
nt
Ph
ysi
cal
Ass
au
lt
Lim
itin
g R
eso
urc
es
Psy
cho
log
ica
l A
bu
se
Ab
use
un
de
rin
flu
en
ce -
Alc
oh
ol
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 25
SPECIAL ACTIVITIES
A GBV prevention workshop was held at Talangama District Hospital in May 2014. Objective
of the workshop was to increase awareness on GBV and educating strategies to prevent it
among, all categories of staff, including Hospital Staff, Staff of Foreign Employment Bureau,
and Police Officers of Talangama Division. Further workshops were held at Nawagamuwa
District Hospital, Monaragala RDHS Office, District Hospital Athurugiriya and District
Hospital Piliyandala.
A hall mark achievement was gained in November 2014 when the unit successfully
launched a 3 day workshop on advanced training on Intimate Partner Violence. More than
30 Medical Officers and 30 Nursing Officers were trained by expert hands through joint
collaboration and sponsorship of WHO Country office in Sri Lanka and NIMH Angoda.
Certified and skilled Medical Officers and Nursing Staff through the course made a network
of joint collaborators in an array of MOMH areas.
On the International Women’s Day 2014, a special talk was held by Prof Chandra
Gunawardena, Emeritus Professor of the Faculty of Education of the Open University of Sri
Lanka to increase awareness of mental health consequences of GBV.
A novel initiative of the unit includes executing a programme to curb the ‘sexual harassment in
workplaces’ based on the Domestic Violence Prevention act No 34. Moreover respecting the
women’s rights, promoting realistic social expectation from women, education on life skills
(Jeevana Kusalatha) and awareness of effective communication among partners are high-up on
the agenda for the unit.
Table 9 Referrals done by GBVP Unit
OCCUPATIONAL THERAPY UNIT
60
2
0 5 1
9
17
9
2 13
10
46
14
19
5
0
35
55
Psy
colo
gy
Se
rvic
e
Po
lice
Wo
me
n I
nN
ee
d
Le
ga
lS
up
po
rt
So
cia
lS
erv
ice
oth
ers
2012 2013 2014
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 26
OCCUPATIONAL THERAPY UNIT
The occupational therapy (OT) service in the NIMH primarily operates for promoting recovery,
health and wellbeing of people with mental health problems through occupation and enables
people to participate in the activities of everyday life. Occupational Therapists achieve this
outcome by working with people and communities to enhance their ability to engage in the
occupations they want to, need to, or are expected to do, or by modifying the occupation or the
environment to better support their occupational engagement. The unit conducted
assessments, group therapy sessions, cultural and religious events, leisure activities, vocational
training, awareness raising programmes and activities to work against stigma. During the year
2014, 780 in-patients and 21 out-patients have received the OT service.
The most successful task of the OT Unit during the year was launching of the “MINDFUL
CREATIONS – LOVING HEARTS CAN CHANGE MINDS”, project in October 2014, along with
World Mental Health Day Celebrations, which aimed to promote the art and crafts of the clients
and creating awareness for the need for sustainable avenues of income generation. It also helps
to enhance their self-confidence through giving sense of value, opportunities and hope. A
special exhibition and a sale was organized at the OT unit with the products made by persons
recovering from mental illnesses and the event also focused on getting media attention to
deliver positive messages to the public against stigma and discrimination.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 27
A special vocational training on leather work and shoe making was initiated in collaboration
with the Industrial Development Board (IDB). As a result 15 trainees including mental health
consumers and health supportive staff were given a 03 month basic training followed by on-
the-job training in private sector.
“Feelings 2014” the art exhibition was organized for the 4th successful year with creations
made by clients of NIMH and Half-Way Home Mulleriyawa.
The weekly cookery training programme was introduced with the support of a volunteer
cookery instructor. The computer training unit was refurbished with new equipment to
provide various computer based facilities for the staff and public at a concessional rate.
Number of picnics and a day trip were organized to Colombo city, Kandy, Peradeniya and
Pinnawala to facilitate long hospital stay clients to enhance their leisure and social skills
and to promote community participation. The event was sponsored by Pastor Lakdas Perera
and Peoples’ church, Narahenpita. Thaipongal, Sinhala and Hindu New Year, Vesak and
Christmas festivals were celebrated with clients which gave an excellent opportunities for
them to exhibit their talents and skills. A special musical show and a dinner party was
organized for 400 patients with the financial support of Mr. Udeepa Peiris.
Clinical training and orientation programmes were organized for Medical Students, BSc
Occupational Therapy Students and Nursing Students. The OT department also supported
workshops organized by the Consumer Action Network in Mental Health (CANMH) and the
Forensic Rehabilitation Centre of the Forensic Psychiatry Unit, NIMH.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 28
PSYCHIATRIC SOCIAL WORK UNIT
The psychiatric social work unit (PSW) consists of 4 PSW’s and 10 Development Assistants –
(Mental Health) at present. After 32 years of service 4 senior PSW’s retired and they will be
remembered by the PSW unit due to their great and unique contribution for the Mental Health
Service in Sri Lanka.
During the year, 2162 family visits were done for 685 male patients and 710 of female patients.
Court appearances were done for 25 clients, 3 patients were handed over to the Probation and
Child Care Services Colombo, 2 Clients were granted their pension and W&OP, 6 clients were
given letters for financial aid (Samurdhi /living allowances). With the recommendation of the
PSW, 1 female and 1 male received houses from the Housing Authority, 3 clients were granted
legal aid by the Legal Aid Commission. A women of 75 years who was a resident at HWH for
nearly 40 years was returned to her relatives in 2014. This gives evidence for the sincere
collaboration developed with other government and non-governmental authorities to support
persons with mental illness.
During the year, 23 clients presented with a variety of social problems such as private medical
reports, property problems, placements, court cases, counselling and welfare benefits. Among
them were 7 significant. One was a school girl of 16 years referred by a village priest, had been
sexually abused by a family member. After assessing the information given by mother and
neighbours, the girl was referred to the DTC for management who was later found to be
completely cured.
During 2014, 25 bank accounts were opened at the National Savings Bank, Kirulapana and Rs.
5,800,000 were deposited. The PSW unit led the project of getting NIC and voting rights to long
stay patients at HWH-Mulleriyawa & NIMH (details are given under special projects).
The PSYCHIATRIC SOCIAL WORK TRAINING PROGRAMME was conducted in May 2014
specifically designed for 22 Development Officers, with the help of Mental Health Training
Division of NIMH. These Development Officers were from General, District, Base or Rural
Hospitals and M.O.H Offices. The main purpose of this training programme was to train them on
the role of the PSW in the multi-disciplinary team to support people with mental disorders.
During the first three months they were taught basics in psychiatry and psychiatric social work
coupled by 3 months of practical training. A five day training programmes was also coordinated
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 29
for counselling students from the National Institute of Social Development and University of
Colombo.
The PSW Unit contributed to celebrate World Mental Health Day 2014 by organizing a street
drama. Chief Guest was Dr. F.R. Mehta W.H.O Country Representative. The message was to raise
awareness to deal with expressed emotions, identify relapses and to challenge against stigma.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 30
REHABILITATION PROGRAMME
WARD BASED REHABILITATION - INTERMEDIATE CARE WARDS
Patients in intermediate care wards are taught and trained to develop their self-care: brushing
teeth, having showers, bathing, washing their clothes etc. The four female intermediate-care
wards have ward based kitchens where the patients are trained to develop skill of cooking. In
the male intermediate-care wards, patients spend their time on vocational rehabilitation e.g.
making joysticks, painting, cultivating plants, making candles, etc. The rehabilitation
committee, chaired by the Director, NIMH comprises of almost all the major staff categories.
Sinhala and Tamil New Year Festival is organized annually by the rehabilitation committee
since 2012 at the T. B. Illangarathne grounds. In year 2014 the New Year Festival was organized
with the participation of around 400 in-ward patients and staff.
WARD BASED REHABILITATION - LONG TERM CARE WARDS
In ward 27 there are 39 patients who are under the care of the eight Consultant Psychiatrists in
NIMH. Of them 25 Patients engage in rehabilitation activities. Other patients are either having
severe mental retardation or are bed ridden. As part of their main rehabilitation programme
patients usually work from 8.00am to 12 noon at the cultivation of vegetable farms which span
2 acres, with the support of the Nursing Officers and Supportive Staff. The harvest is collected
daily and sent to the ‘Shakti’ Sales Center. Patients engage in leisure activities in the afternoon
e.g. singing songs, watching television and reading newspaper.
Table 10 Income from the Horticulture Project, 2011-2014
Rs150,984.00
Rs462,899.00
Rs354,495.00
Rs183,912.00
Rs10,715.00 Rs64,428.00
Rs11,500.00
Rs32,969.00
2011 2012 2013 2014
INCOME FROM THE HORTICULTURE PROJECT Annual Income Amount Deposited
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 31
Total income from the cultivation during the year was Rs.120, 000 and Rs.12,000 was deposited
in the savings accounts of the patients. Rs. 25,200 was spent for their food and beverages. The
rest was used to purchase raw materials needed for the cultivation. In 2014, a ground water
well was constructed within the ward premises for watering plants, saving the water bill
substantially. In Ward 22 there are 68 patients of which 20 patients have been allocated to
horticulture therapy on daily basis, 20 patients have been referred to vocational training, 6
patients were employed by the cleaning service of the NIMH and were allocated to the HWH-
Mulleriyawa. Other patients help in carrying out the daily activities of the ward such as
bringing food from the kitchen to the unit, helping to serve food among patients, washing and
drying clothes, bathing patients. Oversees voluntary groups have been supporting the unit on
Thursdays by engaging with patients for recreational activities.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 32
TRAINING AND RESEARCH UNITS
The Training Unit of NIMH conducted many national as well as international training programs
over the year 2014 (Annex 2). Research unit of the NIMH completed its second year during year
2014. The unit promotes high quality of research in mental health through the Ethics Review
Committee (ERC) established in 2012. The ERC is in the process of developing Terms of
Reference (TOR), Standard Operating Procedures (SOPs) and necessary forms in accordance
with the national and international guidelines. The committee has the membership of the
Federation of Ethics Review Committees, Sri Lanka (FERCSL) and is working towards applying
for international accreditation.
Titles of research proposals submitted during 2014
1. A psychological study regarding the manner in which the cured mental patients are socialize
2. Socio-demographic and clinical variables of patients requiring ECT cycles
3. Development of mental health first aid guidelines for helping a suicidal person in Sri Lanka: Delphi Study
4. Re-thinking mental health
5. Personality traits in teenage pregnant mothers in Moratuwa & Dehiwala MOH areas
6. A study on the stage of surviving domestic violence in male &female domestic violence survivors at NIMH
7. A Study on the attitudes of the health staff to wards mentally ill persons at NIMH
8. A sociological study of social isolation due to mental illness
9. Common life events and their associations with relapse of disease among patients with Schizophrenia
10. Violence against women in Sri Lanka
11. Naturalistic study of patients with acute mania: outcome at two weeks
12. Psychiatric disorders in Sri Lankan female offenders in a Forensic Psychiatry setting
13. Analysis in to reporting of suicide in Sri Lankan newspapers
14. Oral health status and associated factors in hospitalized psychiatric in Colombo district
15. A Study on the psycho social problems faced by the family members of Dementia patient
16. The effectiveness of family psycho-education program for Schizophrenic patient's family members - A study at Kolonnawa Divisional Secretariat
17. Co-morbidities and other associated factors among patients with schizophrenia admitted to NIMH
18. Satisfaction of the services provided among patients admitted to the NIMH
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 33
PRODUCTIVITY, QUALITY AND SAFETY OF PATIENT CARE SERVICES
During the year 2014, improvements of the quality of the patient care service were carried out
according to the guidelines given by Directorate of Healthcare Quality and Safety. The NIMH
monitors 10 main activities to strengthen the quality of the service. The 5 indicators selected
for 2013 were provision of safe water, sanitation facilities, diet services, nursing care and
clinical care (Annual Report 2013).
5 indicators (2014)- patients waiting time in OPD, patient’s safety, notification of
communicable disease, monitoring of quality improvement programme, in service
training
Routine recording of all patients’ waiting time in the OPD (time from arrival to OPD to the time
taken to be reviewed by the Medical Officer on-call) is carried out. Random cross checks are
carried out to ensure the accuracy of this information. To ensure patient safety, data collection
on the incidents such as those more common at a mental health institute (absconding, assaults
on other patients, assaults on staff, damage on property, suicide or attempt to suicide, self-
harm) as well as those seen in other hospital settings (needle prick Injury, cat/dog related
bites) is carried out on daily basis and a discussion in the form of a monthly clinical governance
meeting is held to arrive at new guide lines and protocols if necessary.
Certificate of commendation for productivity 2013/ 2014 by the National Productivity
Secretariat
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 34
Notifiable diseases are identified at the ward level and notified to Infection Control Nursing
Officer (ICNO) and the relevant Medical Officer of Health (MOH) of the area of residence or the
Kolonnawa MOH if detected among long stay patients. A survey is planned to be carried out to
ensure the coverage, quality and timeliness of the notifications. Monitoring of the quality
improvement programme is carried out by the number of the Working Improvement Team
(WIT) circles conducted monthly by the ward staff. According to the needs of the institution
training need are identified for each staff category and a schedule was prepared for the in-
service training.
FOOD COMMITTEE
The Nutrition Unit of the NIMH was established in December 2014, after the recruitment of two
Nutritionists with the aim of improvement of the nutritional status of in-patients. The
Nutritionists actively participate in planning special diets for patients, follow up and nutrition
counselling. The Nutrition Unit also provides necessary guidance to the Diet Stewards on food
safety and food quality while giving technical assistance to the staff involved in the diet supply
chain. In addition, the unit is in the process of establishing of guidelines on food hygiene
practices, good processing practices and practices for minimizing nutritional losses. The food
committee meeting chaired by the Director is being coordinated by the Unit.
PUBLIC ADDRESSING SYSTEM
A new public addressing system consisting of 97 speakers were installed in all units in the
hospital, saving time and the resources used earlier to broadcast messages related to
administration , and welfare activities.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 35
HEALTH INFORMATION UNIT
The routine Information Systems: Admission Record Information System, Gender Based
Violence Information System and “Health Net”- the web based information system to collect
performance and facility information were continued to function well. The information
gathered from these systems were used both at local and central level for decision making and
planning. During the year 2014 the Unit contributed to the NIMH cost accounting project,
compiling the annual report and clinical governance data.
Electronic Indoor Mobility and Motility Record (EIMMR) Information System continued to
function well during the year 2014. According to the recommendation of the Department of
National Achieves new racks were installed to store the records with the recommended spacing
between racks.
CLINICAL GOVERNANCE UNIT
This Unit was established in 2010 with the aim of improving patient care and clinical services.
In the year 2014, six clinical governance meetings were held with the participation of all staff
categories where there were opportunities to create awareness, identify the short comings and
root causes. Corrective actions have been implemented to prevent future recurrences.
Table 2 11 Incidents reported at NIMH, 2014
57
8
57
2
26
3
10
3
62
25
41
50
36
22
8
Ab
sco
nd
ing
Acc
ide
nt
Ass
au
lt o
n p
ati
en
t
Ass
au
lt o
n s
taff
Da
ma
ge
to
pro
pe
rty
De
ath
Se
lf I
nfl
icte
d I
nju
ry
An
ima
l re
late
d I
nju
ry
Tri
ed
to
ab
sco
nd
Att
em
pt
to s
uic
ide
clin
ica
l in
cid
en
t
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 36
HALFWAY HOME –MULLERIYAWA
Half-Way Home (HWH) Mulleriyawa, has 483 female residents with chronic mental illness and
different functional capacities originating from all over the country. Almost one third of them
are fit to be discharged and would be able to live and work outside the HWH if given the right
environment and opportunities. The information given below highlights the events that have
occurred at the Half-Way Home in 2014.
EXTENSION TO THE WARDS
To make the living environment more spacious and patient friendly, the front section of the 7
wards was made in to a veranda with a ward based kitchen.
RELOCATING DOGS
In 2014 there were 74 dog – bites in the institution (from January to August). As a measure to
reduce the dog population, NEST – HWH-Mulleriyawa branch organized a two day program to
shift some ferocious dogs known to bite the inmates frequently to other location. With the help
of a veterinary team, 55 dogs were shifted from premises to a similar close by environment
where their needs are fulfilled. After that there was a marked reduction of dog bites
(September to December).
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 37
COMMUNITY HOMES
Upstairs of the existing community home was renovated and a new community house started
in February 2014. It consist with 3 bed rooms, a living room, a dining room, a kitchen and a
bathroom. The fully furnished house handed over to residents. The monthly rental, electricity
and water bills are covered through donations
HANDING OVER NON-CLINICAL WASTE TO “PRADESHIYA SABAWA”
Non-clinical solid waste was discarded within the premises which led to environmental
pollution and producing breeding places for mosquitos and flies. This was discussed with
relevant authorities of Kotikawaththa Mulleriyawa- Pradeshiya Saba and they agreed to take
over the non-clinical solid waste. A waste collection center was built to store the segregated
waste till it is collected by the Pradeshiya Saba, twice a week.
HORTICULTURE PROJECT
About 1 ½ acres land is allocated for the horticulture project and several kinds of vegetables
and fruits are cultivated. In 2014 new “Katuanoda” (soursop/ custard apple) cultivation was
started over about ¼ acres area. About 15 residents are attached to the project. In 2014 total
income was Rs. 122 182.25 and net profit was Rs. 115,492.25. Half of the profit is divided
among the residents attached to the project and rest of it was deposited to an account.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 38
CELEBRATIONS
New Year Festival 2014 was sponsored by UNESCO club of Royal College – Colombo. Chief gust
was Mr. Upali Gunaskara, Principal – Royal College. A “Wesak Bhakthi geetha” program was
organized by the Occupational Therapy Unit with the sponsorship from several volunteers. The
annual “Wesak Dharmadesanawa”, “Wesak” decorations and “Wesak” lantern competitions was
sponsored by the Royal College Colombo.
SPECIAL EYE CLINIC
Eye problems are common among the residents due to their old age, or due to the medical
problems such as diabetes or hypertension or as a side effect of some of psychiatric
medications. Most of these eye diseases may go undetected either because they cannot explain
their eye problems due to the psychiatric conditions or to the associated poor cognitive
functions. Considering this Dr. M. L. Dharmarathne, Consultant Eye Surgeon at National Eye
Hospital, Colombo organized a screening program for eye diseases with help of the Vision Care
Optical Services (Pvt.) Ltd. This was held in November and about 400 residents were screened.
Out of them 41 residents were found to have refractive errors and they were donated
spectacles by the Vision Care Optical Services (Pvt.) Ltd. Another 61 were found to have
cataract and 24 of them underwent cataract surgery by the end of 2014. They were given lenses
free of charge.
SPECIAL DENTAL CLINIC
In the absence of a Dental Unit at HWH-Mulleriyawa residents were sent to the Dental Unit
NIMH. Residents with physical disabilities or with uncooperative behavior may have
undetected dental problems as it is difficult to send them to NIMH. In overcoming this problem
a special Dental Clinic was held at HWH-Mulleriyawa in May 2014, organized with the
participation of about 15 Dental Surgeons of the mobile units of the offices of the RDHS area
Colombo, the Dental Institute, Colombo and the mobile units of the Sri Lanka Dental
Association. About 400 residents were assessed and necessary treatments were done. Some of
them were followed up at the Dental Unit, NIMH. A special Dental Record was introduced for
each residents.
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 39
SCHOOL OF NURSING MULLERIYAWA
The School of Nursing Mulleriyawa is the only institution in Sri Lanka which conducts mental
health and psychiatric nursing courses for registered nurses and student nurses. The academic
staff consists of the principal, two special grade nursing tutors, four grade 1 nursing tutors and
one clinical instructor. All the academics are qualified in BSc nursing. Hostel facilities are
available for 150 students. The trainees obtain clinical experience at HWH-Mulleriyawa.
Five weeks mental health and psychiatric nursing training was conducted for the nursing
students who are attached to government nursing school island wide as a part of their three
year nursing diploma. Total of 1753 nursing students were trained during the year 2014
from schools of nursing Kurunegala, Hambantota, Kandy, Anuradhapura, Colombo,
Kaluthara, Rathnapura, Sri jayawrdanapura, Ampara, Badulla, Galle, Kandana, Matara,
Jaffna, Batticaloa, Vavuniya and Military School of Nursing Anuradhapura.
In addition concerts for clients in HWH-Mulleriyawa were arranged by Nursing Students at
the end of their five week mental health and psychiatric nursing training. Sinhala and Hindu
New Year, Vesak and Christmas festivals, were celebrated by Nursing Students with clients
in HWH-Mulleriyawa.
Twelve rooms not used due to various reasons were completely renovated and put in to use.
In addition roof of the new quarters’ complex was repaired along with the gutters and the
drainage system around the building from the World Bank funds
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 40
SPECIAL ACTIVITIES
MENTAL HEALTH DAY CELEBRATIONS
An Island wide inter-school quiz competition was organized with the approval of the Ministry
of Education among schools representing various parts of the country. Questions were
prepared on general knowledge for the first rounds, i.e. related to general health, art, sports etc
in the local as well as global settings and subsequent rounds included questions related to
mental health. The Final round was held on 13th October 2014 at NIMH with the participation
of the Director/National Operation, Ministry of Education as the Chief Guest. The quiz
Competition gave an opportunity to the school children, teachers as well as family members to
enrich their knowledge regarding mental illness. The final round of the quiz competition was
held between the Ananda College, Colombo 10 and the Ghanodaya Vidyalaya, Kaluthara. The
Annada College became the winner.
Annual Report 2014 National Institute of Mental Health (NIMH)
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The “Mental Health Day Walk” was held on the 10th of October 2014 with the participation of
around 1000 patients, special guests, well-wishers and employees. The Director General of
Health Services Dr. Palitha Maheepala, Director/Mental Health, Dr. Rasanjalee Hettiarachchi,
representatives from WHO and the Rotary Club Battaramulla were among the special guests.
Nearly 20 Inmates who were bed ridden for years at the HWH-Mulleriyawa joined the walk in
wheel chairs with the help of the Supportive Staff. The Walk started from the Diyatha Uyana,
Battaramulla, alone Sri Jayawardanapura Mawata, up to the end of the Japanese Sri Lanka
Friendship Road.
Annual Report 2014 National Institute of Mental Health (NIMH)
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The “Open Day” and the “Art and Craft Exhibition” was held on 11th and 12th of October 2014 at
NIMH. Around 100 arts under the theme of “Feelings 2014-Art Against Stigma” and Craft
produced by inmates of NIMH and the HWH-Mulleriyawa were displayed and sold at the
exhibition. The “Open Day” at NIMH -opened doors to the public to get an idea of the services
provided by NIMH including rehabilitation & occupational therapies. In addition CANMH Sri
Lanka-the consumer activity network- displayed and sold their products of their clients to the
visitors to the open day. The event was ceremonially opened by the First Lady, Madam Shiranthi
Rajapajsha and also visited by the Minister of Parliamentary Affairs, Hon. Ms Sumedha P
Jayasena.
Annual Report 2014 National Institute of Mental Health (NIMH)
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The handcrafts produced by the inmates and the day clients of the Occupational Therapy
Department were launched under the trade name “MINDFUL CREATIONS”. The products
included stitched and woven clothes, handy crafts, greeting cards, jewelry made of paper pulp,
leather work produced under the guidance of the Industrial Development Board, and were
displayed for the public. An exhibition photographs taken by Dr. Jeewarnaga Gunasekara
Medical Officer (Mental Health) working at NIMH, titled “LIVING WITH SCIZOPHRENIA”
depicting the theme of the World Mental Health Day 2014 was also held during these days.
A ‘street drama’ was staged during the ‘open day’ of the NIMH relating to the theme of the
World Mental Health Day 2014 ‘LIVING WITH SCIZOPHRENIA’. The actors represented different
categories (nursing officers, social workers, supportive staff) of staff at NIMH
Annual Report 2014 National Institute of Mental Health (NIMH)
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SPECIAL PROJECTS
NATIONAL IDENTITY CARDS & VOTING RIGHT
Under the process of social re-integration of the long stay residents of the HWH-Mulleriyawa
and the NIMH two important activities were initiated during the year 2014: obtaining National
Identity Cards for 400 females at the HWH-Mulleriyawa and 125 males at the NIMH and
establishing their voting rights. More than 95% of the long-stay residents do not have a
National Identity Card because they do not have the necessary documents such as the Birth
Certificate or any proof of their age, details such as their date of birth or a permanent address,
to apply for it. The project was supported by the Institute of Legal Medicine & Toxicology,
Colombo (Chief Judicial Medical Officer, Odentologists and the Staff), Commissioner General of
Registration of Persons, Commissioner General of Elections, Divisional Secretariat Kolannawa,
Grama Niladharis of Malpura and Rajasingha Gama-Mulleriyawa New Town. As the first step
residents with satisfactory mental state were selected after an assessment. Approximate age of
the patients was assessed by a team led by the chief JMO. A team consisting of Judicial Medical
Officers and Odentologists visited the HWM and NIMH and carried out the clinical evaluation
with the support of the Dental Surgeons at NIMH. Residents were given permanent addresses
in the DS division Kolonnawa as advices by the former Divisional Secretariat Mr. U. W.
Senarathne. Inmates of HWM and NIMH were registered at the Grama Niladari Divisions of
Rajasinghe Gama and Malpura respectively. The NIC were issued to about 600 inmates in 2014
and alone with the registration in the voters list they obtained their voting rights. The issuing
of NIC also helped the clients to obtain employment and to open savings accounts. The above
achievements carried out as part of their psychosocial rehabilitation have paved the pathway
for their independent living in the society.
Annual Report 2014 National Institute of Mental Health (NIMH)
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WASTE MANAGEMENT PROJECT
During year 2014, World Bank funds (10 Million) was allocated by Ministry of Health for the
above project. Existing sewerage system was old and damaged causing water to leak out and
damage to the surrounding environment.
To store the segregated waste temporary, two buildings, consisting of 4 rooms were
constructed at NIMH and HWH-Mulleriyawa. In addition, staff quarters, more than 180 in
number were grouped into 3 zones for the purpose of waste disposal and 3 buildings with 3
separate waste disposal rooms in each were constructed for the 3 zones.
Waste water form HWH Mulleriyawa was drained to the adjacent paddy fields in the past
and many complaints were received from the neighbours. With the guidance form the
Central Environmental Authority and Environmental and Occupational Health Unit,
Ministry of Health, a waste water recycling system was constructed and the treated water is
planned to be used for the pineapple plantation of the horticulture project of HWH. This
project was planned as an Eco-productivity project. The damaged waste water drainage
system at HWH Mulleriyawa was also renovated.
Sewerage treatment plant of NIMH was built in 1981 and was not functioning for many
years. The sewerage plant was repaired with the technical assistance form the Building
Department, at a cost of 9 million rupees. A new toilet complex was built to serve the needs
of the visitors to the NIMH and HWH-Mulleriyawa.
The old drainage system was renovated at the cost of Rs. 3,284,400.00 with the addition of
new pipelines and gully pits.
Annual Report 2014 National Institute of Mental Health (NIMH)
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HEALTH CARE COST ACCOUNTING PROJECT
Health Care Cost Accounting Project was started in 2014 according to the guidelines given by
the Ministry of Health with the aim of managing the scarce resources affectively while
minimizing the cost. Under the supervision of the Director, a Development Officer was
appointed for the task. The system of costing followed was Step-down Cost Accounting and
only recurrent cost was considered.
As the first step all the cost centres were identified and categorized in to overhead,
intermediate and final cost centres (Annex 3). While final cost centres are directly involved
in managing patients, intermediate cost centres are not directly involved in patient
management but support their management, whereas overhead cost centres are
responsible of running intermediate and final cost centres.
All the direct costs, which can clearly be allocated to a particular cost centre, were allocated
to previously identified overhead, intermediate and final cost centres.
As the second step the total cost for the overhead cost centres were calculated. The total
overhead cost was stepped down to the intermediate and final cost centres according to the
total number of staff and the patients in each intermediate and final cost centre. The
calculated total cost of the intermediate cost centres were stepped down to the final cost
centres again according to the total number of staff and the patients in each of the final cost
centres yielding the total cost of each final cost centre.
Total cost of the individual final cost centre was divided by total inpatient days for the given
centre yielding per patient per day cost of individual final cost centres (Annex 3)
Annual Report 2014 National Institute of Mental Health (NIMH)
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STAFF WELFARE
2014 saw a renaissance in the Hospital Welfare Association. The Association elected a new
Council and an Executive Committee in the early part of the year. The Constitution of the
Association was amended to bring in few major changes to the association to better stream line
its function. Staff welfare was the expected mission. The benefits offered at death of loved ones,
child births and other major life events were increased dramatically. The Association also
organized a Blood Donation Day at the hospital premises which had a very successful outcome
with around 100 donating blood.
The Hospital Welfare Association also continues to support and work together with the
Hospital Sports Club and Hospital Buddhist Association to promote sports and religious
activities amongst the staff and clients. Annual Pirith Ceremony and Alms Giving was
organized by the Buddhist Association.
Sports Society of the NIMH alone with the all the hospitals and the health institutions in the
country organized an island wide inter institution six a side cricket tournament. It was held at
T. B Iilangarathne Grounds with the participation of 33 teams. Director General of Health
Services Dr. Palitha Maheepala was the chief guest for the occasion
Annual Report 2014 National Institute of Mental Health (NIMH)
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ANNEX 1
NIMH NIMH
Director 01 EEG Recordists 02
Deputy Director 01 Radiographer 02
Consultants 10 Pharmacist 08
Medical officer 37 Dispensers 01
Dental Surgeon 03 ICT Assistant 01
Accountants 01 Medical Record Assistants 01
Administration Officer 01 Ward clerk 10
Matron 04 Lab orderly 01
Nurses 372 Diet Stewards 02
Ward Sisters 07 House Warden 04
Technical Officer 01 Drivers 09
Medical Laboratory Technologist 06 Cooks 11
Public Management Assistant 28 PHI 01
Psychiatric Social Workers 04 Telephone Operator 01
Development Assistants 11 Seamstress 02
Development Officer 10 Nutritional 02
Occupational Therapist 07 Overseers 05
Physiotherapist 02 Attendants 130
ECG Recordist 02 Supportive Staff 368
Half-Way Home, Mullariyawa Nurses Training School
Medical Officers 04 Principle 01
Nurses 73 Special grade nursing Tutors 02
Matron 01 Nursing tutors Grade 1 04
Public Management Assistant 01 Clinical Instructor 01
Occupational Therapist 02 Cooks 02
Diet Stewards 01 House Warden 02
Cooks 03 Attendants 00
Overseers 01 Drivers 01
Attendants 31 Supportive Staff 10
Supportive Staff 46
Annual Report 2014 National Institute of Mental Health (NIMH)
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ANNEX 2
Programme Participants No. Resource Personnel
International
workshops
and trainings
Mental Health Training Program -
Bangladesh Doctors (5 days)
19 Mental Health Training Unit
The Psychiatry of Development
Intellectual Disorder Workshop - Medical
officers (5 days)
35 Dr. Sherva Cooray (Consultant
Psychiatrist-UK)
Conference of Psychiatry update - Medical
Officers (01 day)
100 World Psychiatric Association,
Asian Federation of Psychiatric
Associations
Role of Psychologist in Mental Health
Services - All Trainees Doctors (01 day)
40 Dr.Verity Wilkinson & Dr. Jennie
Robertson from UK
Local
training
programs
2 batches of Medical Officers Mental
Health (6wks)
35
Mental Health Training Unit
Psychiatric Social Workers / Development
officers(90days)
35
Mental Health Training Unit
Nursing Officers from District Hospital
Higurakgoda(14days)
06
Mental Health Training Unit
Mental health training for staff of Meth
Sevana
50
Mental Health Training Unit
Trainee teachers from Teachers training
school – Maharagama (2 days)
280 Mental Health Training Unit
Development Officers in North & East -
Program for counselling support for the
war affected
40 Mental Health Training Unit
Mental health training for Nursing staff
from Asiri Hospitals (pvt)(4 days)
160
Mental Health Training Unit
Mental health training for Nursing
Students from Lanka Hospital(14 days)
40
Mental Health Training Unit
Forensic Psychiatry Rehabilitation &
Occupational Therapy for Nurses (6days)
20 Mental Health Training Unit
Gender base Violence training for doctors
& nurses
35 Mental Health Training Unit
Violence management program 28 Mental Health Training Unit
Training for
undergradua
te students
Mental health training for Nursing
Students from Eastern University &
Ruhuna University (01 month)
114 Mental Health Training Unit
Clinical Training– University of Sri
Jayawardanapura
20 Mental Health Training Unit
Staff Training Induction program for Newly appointed
nurses (10 days) 2 programs
185 Mental Health Training Unit
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 50
General Principals of Psychiatric Nursing
for nurses
50 Rebecca Rollo – Registered Mental
Health Nurse UK
Team Building & Personality Development
for all staff
100 Mr. Prasanthalal De Alwis –
President’s Counsel Lions Club of
Sri Jayawardanapura Kotte
Staff Training Child Mental Health 100 Dr. Jayan Mendis – Director, NIMH
Kidney disease, Cancer, Non
Communicable Disease
100 Dr. Vindya Kumarapeli – Deputy
Director, NIMH
Good Parenting 100 Dr. Swarna Wijethunga Consultant
Child Psychiatrist
Orientation
programs
Nursing Students – All island NTS (01
day)
1539 Mental Health Training Unit
Training &
Practical
Exams
Health Service Assistants 33 Ministry of Health
Education
tour
Diploma in Public Health Inspectors –
North Western Province
70
Mental Health Training Unit
Attendant training students of National
Hospital Sri Lanka
36 Mental Health Training Unit
Undergraduate Students in Psychology –
University of Peradeniya
29 Mental Health Training Unit
Diploma in Counselling (Tamil students) -
National Institute of Social Development
50 Mental Health Training Unit
Diploma in Counselling (Sinhala students)
-Damrivi Foundation
30 Mental Health Training Unit
Certificate in counselling – Buddhist &
Pali University of Sri Lanka
93 Mental Health Training Unit
Medical students of Indigenous Medicine–
University of Colombo
45 Mental Health Training Unit
Diploma in Counselling students –
National Institute of Social Development
50 Mental Health Training Unit
Volunteers from District Hospital -
Akuressa
30 Mental Health Training Unit
Medical Assistant Qualifying course - Sri
Lanka Navy
54 Mental Health Training Unit
Undergraduate Students in External
degree program – University of Kelaniya
300 Mental Health Training Unit
Counselling Training Students Maldivian
30 Mental Health Training Unit
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 51
ANNEX 3
Cost for the month of December - 2014
OVERHEAD
cost centre
INTERMEDIATE
cost centre
FINAL
cost centre
COST - PER PATIENTS
PER DAY (Rs)
Administrative
Section OPD Ward 1 2,232.45
Training Unit Laboratory Ward 2 2,349.11
Research Unit PICU Ward 3 1,892.19
Clinical
Governance Unit ECT Ward 4 2,274.99
Health
Information Unit Ward 18 ( Medical Ward) Ward 5 2,536.74
Quality Unit ECG Ward 6 2,612.58
Maintenance
unit EEG Ward 7 2,679.01
Medical Record
Room X RAY Ward 8 2,758.87
Telephone
Exchange Physiotherapy unit Ward 9 2,399.87
Security Services Kitchen Ward 10 2,417.08
Cleaning
Services CSSD /PICU & Isolation unit Ward 11 3,060.84
Consumable
Stores
Psychiatry Social Work
(PSW) unit Ward 12 3,009.44
General Stores Occupational Therapy Unit Ward 13 2,084.39
Transport
Section
Forensic Psychiatry
Rehabilitation Unit Ward 14 1,886.69
Library Horticulture Unit Ward 15 2,431.37
Mortuary Community Psychiatry Unit Ward 16 2,320.22
Doctor's
Quarters Dental Unit Ward 17 2,444.98
Matron Quarters Indoor Pharmacy Ward 20 2,840.63
Nurses Quarters Outdoor Pharmacy Forensic Male 21 1,516.30
PMA Quarters Drug Stores Forensic Female 25 3,823.07
Supportive Staff
Quarters Surgical Stores PPU 3,084.75
LDU 1,864.81
Long term care Ward 22 4,064.88
Long term care Ward 27 1,443.99
Male Villas 1,878.85
Female Villas 3,730.74
Day Treatment Center 1,295.60
GBV Unit 2,082.48
Annual Report 2014 National Institute of Mental Health (NIMH)
Page 52
Sincere gratitude to:
Director and all the Consultants for their guidance and advice.
Dr. Arosha Wijewickrama, Dr. Dilini Wijesuriya, Dr Janaka Weeragalla, Dr. M.R.
Galappaththi, Dr. T.D.N.S Hemapala, Dr. Priyasha Wijenayake, Dr. Chamila
Abeywickrama, Mr. S. L. Ajith Kumara, Ms. Shamika Rathnayake, Mrs. Punya Perera, Ms.
K L A P Liyanage, Mr. Ashoka Sanjeewa, Mr. Pradeep Gunarathne, Ms. Jayamini
Subeshika, Mrs Shashika Wickramarachchi for their write-ups.
Principle NTS, Special Grade Nursing Officers and Officers in-charge of Wards/Units for
providing necessary information for this report.
Administrative Officer, the Accountant, the staff from the Administration Brach and the
Finance Branch for providing the necessary information and support.
Ms. H.M.K.D Herath, Medical Record Officer for collection and compilation of data
Dr. A.M.A. Kanchana Kumara, Medical Officer (Health Informatics) for his untiring
support in compiling this report.
Edited by
Dr. Vindya Kumarapeli
Deputy Director
National Institute of Mental Health