Community Mental Health Care

8/6/2019 Community Mental Health Care

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Epidemiology of Mental

Health


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MENTAL HEALTH STATUS OF

MALAYSIANS The 3rd NHMS, which was carried out in 2006,

provided some information on the state of

mental health of adult population in Malaysia

(aged 16 and above).

This is based on a 28 item General Health

Questionnaire (universally used to screen the

state of psychological wellbeing of a person).


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The findings are:

1. Overall prevalence - 11.2% of adult population in

Malaysia has some form of psychiatric morbidity,with the Chinese population experiencing thehighest prevalence at 31.1%.

2. Gender - more females than males have

psychiatric problems, with 55% of them femalesand 45% males.

3. Residence - psychiatric morbidity is higheramong urban population than rural, 12.6% for

urban population versus 8.5% for ruralpopulation.

4. Education level it is higher among those withno education or primary education, 15-16%

versus 10% for those with tertiary education


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5. Education level it is higher among those withno education or primary education, 15-16%

versus 10% for those with tertiary education.6. Marital status it is higher among the

divorcees (13.6%); followed by singles (13.1%)widow/ widower (12.2%) and lastly those who

are married (10.5%)7. Suicidal ideation overall prevalence of acute

suicidal ideas of 6.4% with the highest amongteenagers and young adults, aged 16-24 at

about 11%.8. Insomnia ( inability to sleep) overall acute

insomnia of 14% with those aged 70-74 havingthe highest prevalence of slightly over 20%.


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National Mental Health Registry for

Schizophrenia, 2003

1. Predominance ofmales to females in the ratio

of 1.6 : 1. This could be due to the socio-

economic role of males that make them seek

treatment more readily than females.

2. Patients by ethnic group - Malays ( 54%);

Chinese (28%); Indians (9%) and others (8%).

This is a reflection of the ethnic distribution ofthe population in Malaysia.

3. Marital status 68% were single; 23% married;

5% divorced, 2% widowed and 1% separated.


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4. Education level 6% had no education; 25% hadprimary level education; 61% secondary school

education; 5% with college education and 3%were degree holders.

5. Employment 70% were never employed orunemployed at the time of registration.

6. Duration of untreated psychosis the meanduration was 28 months with a median of 12months. This means that patients took anaverage of 2 years 4 months to seek treatment

from the time of appearance of first symptom ofa disturbed mind but the majority of them tookabout 12 months.


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Treatment Gap

The treatment gap represents the absolute

difference between the true prevalence of a

disorder and the treated proportion of

individuals affected by the disorder.

Alternatively, the treatment gap may be

expressed as the percentage of individuals

who require care but do not receive

treatment.


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The median treatment gap for schizophrenia,

including other non-affective psychosis, was

32.2%.

For other disorders the gap was: depression,

56.3%; dysthymia, 56.0%; bipolar disorder,

50.2%; panic disorder, 55.9%; GAD, 57.5%;and OCD, 57.3%.

Alcohol abuse and dependence had the

widest treatment gap at 78.1%.

Source: Bulletin of the World Health Organization 2004;82:858-

866.


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Ten recommendations to address the

treatment gap made in the 2001

World health report1. Mental health treatment should be

accessible in primary care

2. Psychotropic drugs need to be readilyavailable

3. Care should be shifted away from institutions

and towards community facilities4. The public should be educated about mental

health


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5. Families, communities and consumers should beinvolved in advocacy, policy-making and forming

self-help groups6. National mental health programmes should be

established

7. The training of mental health professionals

should be increased and improved

8. Links with other governmental andnongovernmental institutions should beincreased

9. Mental health systems should be monitoredusing quality indicators

10.More support should be provided for research.


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Factors influencing a persons decision

to seek medical advice

1. Severity and duration of the disorder

2. The persons attitude to psychiatric disorder

3. Attitudes and knowledge of family andfriends

4. The persons knowledge about possible help

5. The persons perception of the doctorsattitude to psychiatric disorder


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Factors influencing a general practitioners

decision to refer to the specialist psychiatric

services Uncertainty of diagnosis

Severity of the condition

Serious suicidal ideas

Need for treatment that is unavailable in

primary care

Willingness of the patient to see a psychiatrist

Accessibility of psychiatrist services, how far

the patient has to travel, and how promptly

patients are seen by the psychiatrist


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Provision of Mental Health Services

They should be:

Accessible to those who require them;

Appropriate to the needs of the wholecommunity;

Effective;

Equitable (fair);

Acceptable to patients;

Efficient and economical.


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Provision of psychiatric services via:

Community mental health teams (CMHTs)

Outpatient clinics

Day services

Inpatient facilities

Rehabilitation resources


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Community Mental Health Team

Mental health problems can be caused by

physical, mental or social conditions - or any

combination of these.

A physical or mental illness, past experiences,

difficult relationships and stresses such as

unemployment and drug or alcohol problems

can all play a part.


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Getting over a mental health problem can also meanthat you may need help with different parts of yourlife:

emotional problems

relationship problems

housing

medicines

money and benefits

work, or something rewarding and useful to do

getting back your self-confidence.

The team should have workers from differentprofessions, who understand each other's differentskills and ways of approaching problems.


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Objectives Provide prompt and expert assessment of mental health problems who

have complex needs

Provide effective, evidence-based treatments to reduce and shortendistress and

suffering.

To provide multi-disciplinary team approach to support the users in thecommunity.

Ensure that inappropriate or unnecessary treatments are avoided

Ensure the care is delivered in the least restrictive and disruptive mannerpossible.

Assist patients and carers in accessing support, both to reduce distress but

also to maximise personal development and fulfillment. Provide advice and support to service users, families and carers.

Stabilise and improve social functioning and protect community tenure.


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Who might you meet in a community

mental health team?

General practitioners

Psychiatrist A medical doctor with special training in mental illnesses

and emotional problems.

Community psychiatric nurses (CPNs) They work outside hospitals, usually visiting patients in

their own homes, out-patients departments or familydoctors' surgeries.

Can help people to talk through their problems and givethem practical advice and support.

Nurse therapists - received extra training in particularproblems and treatments, such as eating disorders orbehaviour therapy.


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Clinical psychologists

They will usually meet regularly with you for a

number of sessions to talk through problems and

find ways of solving them.

Occupational therapists

They help people to get back to doing things, andhelp them to regain their self-confidence.

Social workers

They are able to help with money and housing

problems and play an important part in helping

with child-care issues.


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Pharmacists

They offer expert advice to doctors and nurses about

the benefits and side-effects of different medications. Outreach workers

specialised in supporting people with long-termmental health problems. They help them adapt to

ordinary life within the community by developingcoping skills rather than being institutionalised in ahospital or hostel.

Psychotherapists

offer therapy to those who are referred to them (egpsychodynamic psychotherapy (psychoanalysis),cognitive behavioural therapy or interpersonaltherapy).


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How does it works?

The team may have a base, like a clinic, where they cansee clients. They will also work in a whole range ofplaces - out-patient clinics, GP surgeries, day-centres,hostels and people's own homes.

At regular team meetings, staff discuss how best tohelp their clients. They try to make sure that they havea clear picture of your difficulties and strengths. Theycan then plan the right help with you. Staff workclosely together and learn a lot from each other.

One of the team members would usually be your keyworker.

This also means that, if your key worker is away, therewill usually be someone around who knows somethingabout you.


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Specialist CMHTs

Home treatment/ Crisis intervention team

Early intervention for psychosis

First episode psychosis

ABT (assessment and brief treatment)

Continuing care

Rehabilitation

Assertive Outreach

Forensic


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Assertive Outreach Team (AOT)

This service provides home treatment to people sufferingfrom severe and enduring mental health problems whohave a history of disengaging from traditional services andmay have additional co-existing problems like Drug and

Alcohol misuse or forensic issues. Assertive outreach offers a team approach to providing

care and as such each individual will have contact with anumber of the team, including a consultant psychiatrist,social workers, community mental health nurses andsupport workers all available in house. The teams operatein a similar way to the Community Mental HealthTeam(CMHT) but they work with a smaller number ofpeople, each worker has greater flexibility and time andresources to respond to needs of the individual.


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Who is eligible for the service

Individuals who have experienced one or more of the following severemental health problems:-

1. A severe and persistent mental disorder, such as, schizophrenia,persistent psychosis.

2. Major affective disorders associated with a high level of disability.3. A history of high use of inpatient or intensive home based care (for

example, more than 2 admissions or more than 6 months in patient carein the previous 2 years) for individuals recognised as high service user

4. Individuals will also have multiple, complex needs which may include anumber of the following indicators: history of violence or persistent

offending, dual diagnosis of substance misuse and serious mental health5. Detained under the Mental Health Act (1983) for treatment on at least 1occasion in past 2 years.

6. Unstable accommodation or homelessness.


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Crisis intervention/Home Treatment

team

Definition of a service

system for the rapid response and assessment ofmental health crisis in the community with the

possibility of offering comprehensive acutepsychiatric care at home until the crisis is resolved,and usually without hospital admission.

Acute care is delivered by a specialist team so as

to provide an alternative to hospital admission forindividuals with serious mental illness who areexperiencing acute difficulties.


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The aims of treatment are to:

Reduce distress

Help to solve problems

Avoid maladaptive coping strategies, e.g. self-harm Improve problem-solving strategies

It is a short-term intervention, which may requireintensive involvement of the therapist with the

patient, and sometimes also members of theirfamily.


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Early Intervention for Psychosis Team

offering intensive evidence-based interventions toindividuals who are: Experiencing for the first time symptoms of psychosis

Where there is a suspicion they may be developing

psychosis, not just where there is a certainty Who are considered to be at risk of developing psychosis in

the future

typically people referred to the Early InterventionService are likely to be presenting for the first time to

mental health services, will not have yet received anyantipsychotic treatment or will have been treated forless than one year.


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Service interventions which could be provided include:

1. Medication Where Appropriate

Low dose of atypical anti-psychotics

Side effect monitoring

Use of antidepressants, mood stabilizers etc whereappropriate

2. Psychological Therapies

Provide psychological assessment, formulation andintervention where appropriate

Use of CBT as appropriate

Psycho-education


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3. Family/Carer/Significant Other Involvement and Support

Provision of psycho-education, family interventions and support

4. Activities of Daily Living Assessment of financial circumstances and care plan to address

income needs. Early reliance on disability allowance to be avoided where possible

and focus on working towards valued occupation.

5. Providing Pathway To Valued Education and Occupation Access to specialist assessment of vocational/educational needs.

Maintaining the person in their chosen setting. Assisting a rapid return to education/work when these have broken

down.


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Mental Health Case Management

Services provide service to individuals living in the community with

a severe and persistent mental illness or concurrent mentalillness and substance abuse which has had a major impacton aspects of their lives, such as housing, employment,social supports, finances, daily living skills.

The teams operate under the Principles of PsychosocialRehabilitation which emphasize hope, recovery,empowerment, and effective rehabilitation founded on apartnership between the person receiving services and thepractitioner. The goal of the teams is to support individuals

in achieving the best quality of life possible and to supportindividuals in their recovery and growth beyond illness.


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Background

o Started on 19.01.1996 ( 15 years ago ).

o Due to there are no observation towards

patient after discharge, patient lack ofcompliance or poor family support that cause

relapse and re-admission to hospital.


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Objectives

To increase public awareness towards prevention ofmental illness to avoid relapse.

To encourage family acceptance.

To ease patient to get following check-up at home

To encourage family involvement in psychosocialtreatment

To reduce public stigmatization

To reduce readmission and to shorten the period of

admission To give continuous treatment after patient being

discharge.


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Vision

To give effective and continuous

treatment to patient to achievepatients satisfaction

Mission

Provide effective and efficient

services to help patient andfamily living in high quality of

life.


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Services provided:

Mobile clinic

Home visit

Patient discharge


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Mobile clinic

Patient which unable to come to clinic for follow-

up due to lack of family support

Patient which unable to come to clinic due to

financial problem

High risk of admission

Giving depot injection to patient which is poor

compliance Patient which is physically handicap.


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Mobile clinic coverage area (25 km radius from HMBP)Mobile clinic coverage area (25 km radius from HMBP)

(divided into 4 zones)(divided into 4 zones)

ZON 1 (KAWASAN PENAMPANG).

Kg. Kibabaig

Kg. Tampasak

Kg. Timpango

Kg. Babagon

Kg. PogunonKg. Nabangkung

Kg. Kibonong

Kg. Kimolohing Inobong

Kg. Ketiau

Kg. Maang

Kg. Nambazan

Kg. Kolopis

Kg. Hungab

Kg. Babah

Kg. Sugud

Kg. NavahuKg. Ulu Seberang

Kg. Kobusak

Kg. Kibambangan

Kg. Tagad

Kg. Tomposik

Kg. KoidupanKg. Mogoputi

Kg. Sindanan

Tmn. Penampang

Tmn. Oriental Park

Tmn Summer Set

Jumlah Pesakit: 27 Orang


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ZON 2 (KAWASAN KOTA KINABALU)ZON 2 (KAWASAN KOTA KINABALU) Tmn. Beautry Garden

Tmn. Luyang Phs 1

Tmn Luyang Phs 2

Tmn. Seri Gaya

Tmn. Teck Guan

Tmn. Cempaka

Tmn. Mandrin Park

Tmn. Kinanti Luyang

Rumah murah Kepayan

Tmn. Lintas Court

Kg. Kopungit

Kg. Sembulan lama

Kg. Sembulan Tengah

Kg. Ganang

Kg. Tg Aru Baru

Kepayan Ridge

Padang Bandaran Jln. Lintas

Kg. Air

JUMLAH PESAKIT : 45 ORANG


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ZON 4 (KAWASAN PETAGAS

Kg. Petagas lama

Kg. Pasir Putih Putatan

JKR QRTS Putatan

Kg. Contoh Petagas

Kg. Ketiau Putatan

Kg. Duvanson Putatan

Kg. Kepayan 2 Putatan

Kg. Tampasak Kinarut

Kg. Kerilip Kinarut

Kg. Somboi Kinarut

Tmn. Kinarut

Kg. Sabuk Laut Kinarut

Kg. Beringgis

Kg. Gusi Kinarut

Kg. Pituru Lok

KawiTmn. Bersatu Putatan

JUMLAH PESAKIT : 17 ORANG


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Home visit

25km radius from HMBP

Patient which failure to come back from HTL

To trace family member To trace defaulter

To observe patient condition/ family

members/ home environment Psychoeducation to patient and family


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Discharge

Sending patient home when family members are

unable to take.

Patients are send by group

This service include all towns in Sabah.

Community Mental Health Care

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