Disediakan Oleh : Nassruto

THE FRAMEWORK FOR SERVICE DELIVERY

 

GENERAL ADULT MENTAL HEALTH SERVICES

Introduction

• Services for the Mentally Ill • Ages: 19 – 60 years• Provide range of services and supports• Specialist services one component • Networking with other agencies:

- Welfare, Labour, Local government- NGOs

Service Elements1. Mental Health Promotion and Prevention2. Early Detection, Treatment and Referral3. Acute Home Care4. Acute and Extended Inpatient Care5. Early Discharge Program6. Assertive Community Care7. Long term Stay (LTS) service users8. Housing and Accomodation Services9. Family Intervention Programs10. Follow-up of Stable Cases11. Specialist Outpatient Care12. Psychosocial Rehabilitation13. Individual Placement and Support Programs14. Liaison Psychiatric Services15. Forensic Psychiatric Services16. Services for the Service User with Special Needs

Objectives• To identify, assess and treat adults with mental

illness• Specialist services to focus on assessment and

treatment of complex and difficult SMIs• To monitor and coordinate provision of services

in ensuring continuity of care• To deliver a range of community, hospital and

residential care and treatment on a continuous basis

• To undertake promotion and prevention activities especially in increasing public awareness and understanding

Target Groups

• Adults with mental illness (service users)including personality disorders and co-morbid illnesses (substance abuse, medical illness)

• Age: 19 – 60 years

Key Service Linkages• Primary Health Care services

- including GPs private psychiatrists• Child and Adolescent and Elderly Mental Health

Services• National Drug Agency• Social Welfare Services• Local government• Housing and Accommodation, domiciliary care, social

support and employment and training services• Prisons Department• Non-governmental organisations

Protocols & Guidelines

• Management of Mental Disorders in Primary Care• Available Guidelines:

- Acute Home Care treatment- Assertive Community Treatment (ACT)- Psychosocial Rehabilitation (PSR)- Family Intervention Program (FIP)- Follow-up of Stable Cases

Guidelines to be developed

• PSR for severe disabled• LTS service users• Housing and accommodation services• Specialist outpatient care• Individual Placement and Support Programs• Services for people with special needs• Clinical Practice Guidelines

@ each service will provide a defined area (within a 10 km radius)

Description of Key Service Elements

• Mental Health Promotion and Prevention- refer to the group recommendations

• Early Detection, Treatment and Referral Primary health care centers, GPs should be able to detect

signs and symptoms of illness, initiate treatment and make the necessary referrals

Manual on Diagnosis and Management availableScreening tools: e.g.

- Edinburgh Postnatal Depression Scale (EPDS)- Hamilton Depression Rating Scale (HDRS)- General Hospital Questionnaire (GHQ)- Anxiety Screening Questionnaire- Prime MD

3. Acute Home Care • Designed to help service users with SMIs who are in

crisis with the intention to prevent hospitalisation• Delivered by a team:

- doctors, SNs, MAs- counselors, social workers

• Currently based in hospital setting• Future: health care setting

- with a population of <100,000 - 10 km radius

4. Acute and Extended Inpatient Care

• Admission and inpatient care should be considered along a spectrum of continuity of care

• Strive for a less restrictive environment and condition of service users regularly reviewed

• Focus to avoid extended stay in hospital (ie. < 3 months stay)

• For Extended stay: consider transitional placement close to their homes

• Provision for a Case Manager• Extended stay determined by BOV

Acute and Extended Stay

• On discharge: service users be given a treatment planexplaining the role and responsibility of the service users, carers and the after care team

• Every hospital with Specialist services:- should have a Resident Psychiatrist- adequate inpatient bed capacity (WHO recommends 3–8 beds/10,000 population)- staffing should be based on number of core services provided rather than bed capacity

WHO Recommendations

• Acute Inpatient Care = 1: 3• Acute Home Care = 1: 5• Assertive Community Care = 1 : 12 – 15

Note: Inpatient Care is part of the continuity spectrum of care which includes hospitalisation and community care

Early Discharge Program

• Inpatient stay kept as minimum as possible• Discharge to home care considered within 2 weeks • Comprehensive treatment plan given to service user, carer

and homecare team• Guidelines available

Assertive Community Care

• To be provided for service users with severe deficits, living alone with poor support

• Referral to assertive care from acute home care, early discharge or acute inpatient and extended inpatient

• Service is continuous, time unlimited and focus on intensive support

• Limited case load size (1:12-15)

Long Term Stay (LTS) service users

• LTS = stay more than 1 year in institution• Strong evidence that LTS prefer community care

with good clinical and social outcomes• Move into community to be carefully planned• Include provision for accommodation, nursing and

rehabilitation• Can be provided by NGOs and other agencies

Housing and Accommodation Services• Community residential programs can substitute

long term inpatient care• Supported housing can serve diverse population

with severe mental illness• LTS service users show greater emotional well

being and satisfaction when given choice• Linear Residential Continuum suggest service user

can progress from more restrictive residential service to least restrictive

• Ultimate aim for service user to live independently

Family Intervention program

• Objective to involve family members and carers in mangement to achieve functining and QOL

• Guideline for implementation is available• Training being conducted to health center staff

Specialist Outpatient Care• Reserved for service user with complex and multiple

needs and require specialized interventions• Service provided in a multidisciplinary approach

Follow up of stable cases• Follow up at health care facilities nearest to own home• Care part of continuity spectrum• Adequate staffing to be provided• Guidelines and SOPs available

Psychosocial Rehabilitation

• A process that enable person to achieve optimal functioning

• Involves active participation of all parties• Individually tailored and oriented to service needs• PSR for moderate disability at health centers and severe

disability at specialist settings

Individual placement and support• Significant number of unemployed SMI• 3 basic aspects of job related services

• Employment preparation • Employment programs like sheltered workshop• Individual placement and supported employment

• SMI requires support to maintain employment• Supported employment shown to be more

successful in placing SMI in full time work• Guidelines to be developed

Liaison Psychiatric services

• Provide consultation and treatment in hospitals• Include assessment of self harm and the physically ill. • 2 levels of service provision I.e. hospitals with

psychiatrist and hospitals with no psychiatrists

Forensic Psychiatric services

• Refers to service users involved with criminal justice system

• Include assessment and treatment and provision of secure care for high risk cases

Services for people with special needs

• Include: • people with SMI and substance abuse problems• People with HIV/AIDs• Homeless• Women• Family self help and consumer initiatives