Management of mental health disorders in the community

Intended learning outcomes:
a) describe the rationale of providing mental health services in the community
b) identify mental health & psychiatric services at the levels of primary care, general hospital and mental institutions settings
c) describe the role of the different levels & profession of multidisciplinary team members in providing services

1. MANAGEMENT OF MENTAL
HEALTH PROBLEMS AND
DISORDERS IN THE COMMUNITY
Dr. Tuti Iryani Mohd Daud
Head of Community Psychiatry and Psychosocial
Intervention Unit,
Psychiatrist and Senior Lecturer,
Department of Psychiatry
UKM Medical Centre

2. OBJECTIVES
• describe the rationale of providing
mental health services in the community
• identify mental health & psychiatric
services at the levels of primary care,
general hospital and mental institutions
settings
• describe the role of the different levels &
profession of multidisciplinary team
members in providing services

3. WHY DO WE NEED MENTAL
HEALTH SERVICES IN THE
COMMUNITY
SETTING?

4. UNDERSTANDING THE EXTENT
OF THE PROBLEMS

7. Source: http://www.thestar.com.my/news/community/2014/06/14/psychiatrists-in-
seriously-short-supply-at-least-3000-required-to-meet-countrys-rising-cases-of-ment/
Resources
Currently, 300 psychiatrist in Malaysia
Need 3000, to achieve target of 1:10,000
Shortage of other mental health workers

8. Mental health Atlas country profile 2014
Total population (UN official estimate):
a
30,187,900 Burden of mental disorders (WHO official estimates)
WHO Region: WPR Disability-adjusted life years (per 100,000 population)
c
Income group: Upper middle-income Suicide (age-standardized rate per 100,000 population)
d
Total health expenditure per person (US$, 2013)
b
$423
Availability / status of mental health reporting
MENTAL HEALTH SYSTEM GOVERNANCE
Mental health policy Mental health legislation
Stand-alone policy or plan for mental health: Yes Stand-alone law for mental health:
(Year of policy / plan): 2013 (Year of policy / plan):
Implementation status:
Available and partially
implemented
Implementation status:
Policy / plan is in line with human rights covenants 5 Law is in line with human rights covenants
(self-rated 5-point checklist score; 5 = fully in line) (self-rated 5-point checklist score; 5 = fully in line)
Involvement of service users and families (as reported by MoH focal point)
a. INFORMATION gathered / disseminated by MoH Not implemented
b. POLICY on participation developed / published by MoH Not implemented
c. EARLY INVOLVEMENT in mental health policy and law Not implemented
e. RESOURCES available for participation
and reimbursement
RESOURCES FOR MENTAL HEALTH
Mental health financing
Main source of funds for care of severe mental disorders Not reported Psychiatrists
Inpatient / outpatient budget breakdown reported No Other medical doctors
If yes, estimated mental health spending per capita (US$) Not applicable Nurses
Psychologists
Social workers
Human resources for mental health Occupational therapists
Other mental health workers
Total reported staff (mental health inpatient care) 106
Total reported staff (mental health outpatient care) 163
Total mental health workers per 100,000 population 4.9
MENTAL HEALTH SERVICE AVAILABILITY AND UPTAKE
Outpatient care (total facilities) Outpatient care (per 100,000 population)
Mental health outpatient facility 925 Mental health outpatient visits
Mental health day treatment facility 83 Mental health day treatment sessions
Inpatient care (total facilities) Inpatient care (per 100,000 population)
Mental hospitals 4 Mental hospital beds / annual admissions 14.0 /Not reported
Psychiatric units in general hospitals 48 General hospital psychiatric unit beds / annual admissionsNot reported/Not reported
Residential care facilities 27 Residential care beds / annual admissions Not reported/Not reported
Mental hospitals Mental hospitals (length of stay)
Total number of inpatients Not reported Inpatients staying less than 1 year
Admissions that are involuntary Not reported Inpatients staying 1-5 years
Discharged inpatients followed up within one month Not reported Inpatients staying more than 5 years
Treated prevalence (total cases) Treeated prevalence (per 100,000 population)
Treated cases of severe mental disorder 12,531 Treated cases of severe mental disorder
MENTAL HEALTH PROMOTION AND PREVENTION
Existence of at least two functioning programmes Yes Existence of a suicide prevention strategy
Programme examples Category of programme Scope
Mental health awareness/prevention/anti-stigma Unive rsal
Mental health promotion in schools Selective
a
UN World Population Prospects, 2013; http://esa.un.org/unpd/wpp/
b
WHO Global Health Expenditure Database; http://apps.who.int/nha/database
c
WHO Global Health Estimates; http://www.who.int/healthinfo/global_burden_disease/en/
d
WHO, 2013:

Preventing suicide; a global imperative; http://www.who.int/mental_health/suicide-prevention
Note: Age-standardised suicide rates - computed using standard categories, definitions and methods - are reported to facilitate comparisons over time and between countries, and may not be the same as official national estimates.
Healthy Mind Programme in School Children
Not reported
Not reported
Not reported
Not reported
Not reported
41.5
Yes
Target group
Mental Health Screening and Intervention Programme All ages
Not reported
Available and partially
implemented
5
d. PARTICIPATION in MoH planning, policy,
service development and evaluation
Partially implemented
Not implemented
0.8
2.3
Not reported
0.9
0.8
0.2
2002
Malaysia
2,942
2.6
Mental health data compiled only for general health statistics
Yes
Mental health workforce (rate per 100,000 population)
Source: http://www.who.int/mental_health/evidence/atlas/profiles-2014/mys.pdf?ua=1

9. Mental health Atlas country profile 2014
Total population (UN official estimate):
a
30,187,900 Burden of mental disorders (WHO official estimates)
WHO Region: WPR Disability-adjusted life years (per 100,000 population)
c
Income group: Upper middle-income Suicide (age-standardized rate per 100,000 population)
d
Total health expenditure per person (US$, 2013)
b
$423
Availability / status of mental health reporting
MENTAL HEALTH SYSTEM GOVERNANCE
Mental health policy Mental health legislation
Stand-alone policy or plan for mental health: Yes Stand-alone law for mental health:
(Year of policy / plan): 2013 (Year of policy / plan):
Implementation status:
Available and partially
implemented
Implementation status:
Policy / plan is in line with human rights covenants 5 Law is in line with human rights covenants
(self-rated 5-point checklist score; 5 = fully in line) (self-rated 5-point checklist score; 5 = fully in line)
Involvement of service users and families (as reported by MoH focal point)
a. INFORMATION gathered / disseminated by MoH Not implemented
b. POLICY on participation developed / published by MoH Not implemented
c. EARLY INVOLVEMENT in mental health policy and law Not implemented
e. RESOURCES available for participation
and reimbursement
RESOURCES FOR MENTAL HEALTH
Mental health financing
Main source of funds for care of severe mental disorders Not reported Psychiatrists
Inpatient / outpatient budget breakdown reported No Other medical doctors
If yes, estimated mental health spending per capita (US$) Not applicable Nurses
Psychologists
Social workers
Human resources for mental health Occupational therapists
Other mental health workers
Total reported staff (mental health inpatient care) 106
Total reported staff (mental health outpatient care) 163
Total mental health workers per 100,000 population 4.9
MENTAL HEALTH SERVICE AVAILABILITY AND UPTAKE
Outpatient care (total facilities) Outpatient care (per 100,000 population)
Mental health outpatient facility 925 Mental health outpatient visits
Mental health day treatment facility 83 Mental health day treatment sessions
Inpatient care (total facilities) Inpatient care (per 100,000 population)
Mental hospitals 4 Mental hospital beds / annual admissions 14.0 /Not reported
Psychiatric units in general hospitals 48 General hospital psychiatric unit beds / annual admissionsNot reported/Not reported
Residential care facilities 27 Residential care beds / annual admissions Not reported/Not reported
Mental hospitals Mental hospitals (length of stay)
Total number of inpatients Not reported Inpatients staying less than 1 year
Admissions that are involuntary Not reported Inpatients staying 1-5 years
Discharged inpatients followed up within one month Not reported Inpatients staying more than 5 years
Treated prevalence (total cases) Treeated prevalence (per 100,000 population)
Treated cases of severe mental disorder 12,531 Treated cases of severe mental disorder
MENTAL HEALTH PROMOTION AND PREVENTION
Existence of at least two functioning programmes Yes Existence of a suicide prevention strategy
Programme examples Category of programme Scope
Mental health awareness/prevention/anti-stigma Unive rsal
Mental health promotion in schools Selective
a
UN World Population Prospects, 2013; http://esa.un.org/unpd/wpp/
b
WHO Global Health Expenditure Database; http://apps.who.int/nha/database
c
WHO Global Health Estimates; http://www.who.int/healthinfo/global_burden_disease/en/
d
WHO, 2013:

Preventing suicide; a global imperative; http://www.who.int/mental_health/suicide-prevention
Note: Age-standardised suicide rates - computed using standard categories, definitions and methods - are reported to facilitate comparisons over time and between countries, and may not be the same as official national estimates.
Healthy Mind Programme in School Children
Not reported
Not reported
Not reported
Not reported
Not reported
41.5
Yes
Target group
Mental Health Screening and Intervention Programme All ages
Not reported
Available and partially
implemented
5
d. PARTICIPATION in MoH planning, policy,
service development and evaluation
Partially implemented
Not implemented
0.8
2.3
Not reported
0.9
0.8
0.2
2002
Malaysia
2,942
2.6
Mental health data compiled only for general health statistics
Yes
Mental health workforce (rate per 100,000 population)
Source: http://www.who.int/mental_health/evidence/atlas/
profiles-2014/mys.pdf?ua=1

10. Stigma
Photo source:
https://c1.staticflickr.com/5/4070/4630736058_1aec2423c8_z.jpg

11. THE ROLE OF THE DIFFERENT LEVELS
& PROFESSION OF
MULTIDISCIPLINARY TEAM
MEMBERS IN PROVIDING SERVICES

12. MULTIDISCIPLINARY TEAM

13. Case Management:


“process or method for insuring that the consumer is
provided needed services in a coordinated, effective
an efficient manner.”


(Baker &Intagliata, 1992)

14. Home
Visits

15. Peer Support

17. Family Support Group

18. Supported Employment
A system designed to support people
with disabilities, and
other marginalized groups, who want to
be part of the workforce,
to find and keep a job.

19. “Supported employment is more
effective than pre-vocational training in
helping people with severe mental
health problems to obtain competitive
employment. There is no clear evidence
that pre-vocational training is effective.”

20. Individual Placement & Support:
7 evidence-based* principles
1. Eligibility is based on individual choice
(zero exclusion)
2.  Supported employment is integrated
with clinical treatment
3. Competitive employment is the goal
4. Rapid job search (within 4 weeks)
5. Job finding, and all assistance, is
individualised
6. Follow-along supports are continuous
7. Financial planning is provided
Source: https://www.slideshare.net/CentreforMH/sharing-what-works-evidencebased-supported-employment?
qid=4eb2ee5e-4abd-4b71-882b-884447485801&v=&b=&from_search=3

23. MENTARI

24. References:
• https://www.slideshare.net/nassruto/
community-mental-health-services-in-
malaysia
• http://aamh.edu.au/wp-content/
uploads/2014/01/11_Malaysia_Chin-
Lee_Toh.pdf
• http://www.moh.gov.my/images/gallery/
Polisi/
PSYCHIATRY_OPERATIONAL_POLICY.pdf
• http://www.who.int/mediacentre/news/
notes/2007/np25/en/