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INTRODUCTION  Community health service was concerned mainly with the control of communicable diseases.  In

INTRODUCTION

Community health service was concerned mainly with the control of communicable diseases.

In the course of development, it has become increasingly concerned with every health aspect of life of individuals in the community.

Psychiatry, has developed as a personal service to the mentally – ill individual,

Psychiatrists have attempted to contribute to preventive aspects of mental illness.

However, preventive psychiatry remains in its infancy and needs much community efforts to be well developed.

INTRODUCTION  Community health service was concerned mainly with the control of communicable diseases.  In
CAUSES OF MENTAL ILLNESS  The concept of multiple factors in the causation of psychogenic disorders

CAUSES OF MENTAL ILLNESS

The concept of multiple factors in the causation of psychogenic disorders has become generally accepted.

The factors are considered to involve the individual, the family and the community.

CAUSES OF MENTAL ILLNESS  The concept of multiple factors in the causation of psychogenic disorders

       OBJECTIVES Care and treatment are being delivered close to

OBJECTIVES

Care and treatment are being delivered close to home, Interventions are being given to improve disabilities

treatment and care given are specific to the diagnosis and needs

Services reflect the priorities of service user Services are coordinated between mental health professions and other agencies Services are mobile rather than static e.g. home treatments

Promote mental health in the community. Maintain – if possible – the mentally – ill within the community itself. Avoid unnecessary admission and restraint in special hospitals. Provide social therapy.

  
Custodial Care/Institution (past) Care in Community (present & future)  Downsizing the psychiatric Institutions  Reduce
Custodial Care/Institution (past)
Care in Community (present & future)
 Downsizing the psychiatric Institutions
 Reduce referrals to institutions
 Mainstream
 Out-patient clinic
 “acute care” (inpatient)  state/district hosp.
 Hospital based community care
 Acute home care
 Assertive community treatment
 Follow-up services for patients with complex needs
 All of these services include elements of psycho-education, family-based
intervention, work-based intervention and illness self management skills.
COMMUNITY PSYCHIATRY
COMMUNITY PSYCHIATRY
COMMUNITY PSYCHIATRY

COMMUNITY

PSYCHIATRY

COMMUNITY PSYCHIATRY
COMMUNITY PSYCHIATRY
HOSPITALISATION • Acute stay if needed short as possible (early discharge) • Optimizing treatment • Ensuring

HOSPITALISATION

Acute stay if needed short as possible (early discharge)

Optimizing treatment

Ensuring continuity of care with other services in the community

HOSPITALISATION • Acute stay if needed short as possible (early discharge) • Optimizing treatment • Ensuring
ACUTE TREATMENT  Assessment with Threshold Assessment Grid (TAG)  Function to assesses the severity of

ACUTE TREATMENT

Assessment with Threshold Assessment Grid (TAG)

Function to assesses the severity of a person’s mental health problems

Camberwell Assessment of Needs-Short Schedule (CANSAS):

Function to assess of the needs of people with severe mental health

5 dimensions to be considered:

Safety, care, diagnosis, disability and duration of distress

Acute treatment at home is offered as alternative to hospitalization Engage family member to assist in patient’s management Team building

ACUTE TREATMENT  Assessment with Threshold Assessment Grid (TAG)  Function to assesses the severity of
Example TAG
Example TAG
Example of CANSAS
Example of CANSAS
ACUTE TREATMENT  Develop alliance with patient and family  Prevent harm by risk assessment &

ACUTE TREATMENT

Develop alliance with patient and family Prevent harm by risk assessment & risk management Control disturbed behavior Suppress symptoms Connect family and patients with follow up resources Psycho education:

What is psychosis? Early signs? Family’s role? How to help?

Multidisciplinary approach

ACUTE TREATMENT  Develop alliance with patient and family  Prevent harm by risk assessment &
EARLY DISCHARGE PROGRAM  Patient may be admitted due to severe risk or due to logistic

EARLY DISCHARGE PROGRAM

Patient may be admitted due to severe risk or due to logistic problems (e.g. during weekends or after office hours)

Assessment followed by engagement of family done as soon as possible

Patient is discharged as soon as possible with a care plan, acute treatment or assertive treatment will be provided at home

EARLY DISCHARGE PROGRAM  Patient may be admitted due to severe risk or due to logistic
ASSERTIVE COMMUNITY TREATMENT (ACT)  Dealing with severe mental illness with complex needs. Serve outpatients whose

ASSERTIVE COMMUNITY TREATMENT (ACT)

Dealing with severe mental illness with complex needs. Serve outpatients whose symptoms of mental illness result in serious functioning difficulties in several major areas of life

Schizophrenia, mood disorder, organic disorder, with

Disability Unable to care for self independently Cannot sustain relationships Symptoms – current or enduring Recurrent crises and frequent admissions Significant risk to self and others

ASSERTIVE COMMUNITY TREATMENT (ACT)  Dealing with severe mental illness with complex needs. Serve outpatients whose
MAINTENANCE  Aims  help with stress  provide support  prevent relapse  increase adaptation

MAINTENANCE

Aims

help with stress provide support prevent relapse increase adaptation to live in community help recovery

Strategies

engagement adherence to medication continue education improve coping skills family and social support work

MAINTENANCE  Aims  help with stress  provide support  prevent relapse  increase adaptation
PLANNING, POLICY NATIONAL MENTAL HEALTH POLICY Clearly states role of PRIMARY HEALTH CARE in providing mental
PLANNING, POLICY
NATIONAL MENTAL HEALTH POLICY
Clearly states role
of PRIMARY HEALTH CARE
in providing mental health
services
Integration of Mental Health Program in the Primary Health Care  Primary care –  Mental
Integration of Mental Health
Program in the Primary Health
Care
 Primary care –
 Mental Health Promotion
 Early Detection of Mental IIlness
 f/u of stable cases & defaulter tracing of
these patients
 Psychosocial Rehabilitation in Community
• Empowerment of Family Physician
Mental Health Framework Promotion Prevention - primary - secondary SERVICE S Treatment & Rehabilitatio n Continuing
Mental Health Framework
Promotion
Prevention - primary
- secondary
SERVICE
S
Treatment &
Rehabilitatio
n
Continuing Care
Mental Health Promotion Healthy Lifestyle Campaign 2000 • Public Awareness • Empowerment - Training On Coping
Mental Health Promotion
Healthy Lifestyle Campaign 2000
• Public Awareness
• Empowerment
- Training On Coping
Skills
• Change lifestyle
- Stress Management
- Anger Management
Levels of Care & Intervention low high 1 Mental hospital Frequency of need Costs 2 Psychiatric
Levels of Care & Intervention
low
high
1
Mental hospital
Frequency
of need
Costs
2
Psychiatric service at
general hospital/clinics
3
Community mental health services
(outpatient/outreach)
4
Mental health care
through primary health care services
5
Informal and formal community care/support
outside the health sector
6
Self and family care
high
low
Quantity of services needed
5 evidence-based practices in Illness Self Management and Recovery (IMR): 1. 1. Psychoeducation Psychoeducation 2. 2.
5 evidence-based practices in Illness
Self Management and Recovery (IMR):
1.
1.
Psychoeducation
Psychoeducation
2.
2.
Behavioural Behavioural tailoring tailoring
3.
3.
Relapse prevention
Relapse prevention
training
training
4.
4.
Coping Coping skills skills training training
5.
5.
Social Social skills skills training training
Illness managment
1. Psychoeducation  Is teaching information about mental illness and its treatment, which improves consumers’ understanding
1. Psychoeducation
 Is teaching information about mental illness
and its treatment, which improves consumers’
understanding of their disorder and their
capacity for informed treatment decision-making.
Illness management
1. Psychoeducation  Is teaching information about mental illness and its treatment, which improves consumers’ understanding
1. Psychoeducation  Is teaching information about mental illness and its treatment, which improves consumers’ understanding
1. Psychoeducation  Is teaching information about mental illness and its treatment, which improves consumers’ understanding
 In Malaysia, a psychoeducational package is available in 5 training modules covering: Illness management
 In Malaysia, a psychoeducational package is available
in 5 training modules covering:
Illness management
2. Behavioural tailoring  Is helping consumers fit taking medication into daily routines by building in
2. Behavioural tailoring
 Is helping consumers fit taking medication into daily
routines by building in natural reminders
 (such as putting one’s tooth brush by one’s medication
dispenser), which improve medication adherence and can
prevent relapses and rehospitalization.
Illness management
3. Relapse prevention training  Teaching consumers how to recognize situations that trigger relapses and the
3. Relapse prevention training
 Teaching consumers how to recognize situations
that trigger relapses and the warning signs of a
relapse
 Developing a plan for responding to those signs
Illness management
4. Coping skills training  Improve consumers’ ability to cope,  Deal with persistent symptoms by
4. Coping skills training
 Improve consumers’ ability to cope,
 Deal with persistent symptoms by  helping
them identify and practice coping strategies
 Hence, decrease distress and
severity of symptoms.
Illness management
Modul Kemahiran Kesihatan Mental
Modul
Kemahiran
Kesihatan
Mental
5. Social skills training  Helps consumers strengthen their social supports and and bonds with others

5. Social skills training

Helps consumers strengthen their social supports and and bonds with others by

practicing interpersonal skills in role plays and real life situations,

resulting in more rewarding relationships and better illness management

Illness management

5. Social skills training  Helps consumers strengthen their social supports and and bonds with others
A) Supported employment: Individual Placement & Support  Rapid job search (Job search)  Attention to

A) Supported employment:

Individual Placement & Support

Rapid job search (Job search) Attention to patient preferences (Job match)

Ongoing support and on going training for the job without a time limit (Job coach)

A) Supported employment: Individual Placement & Support  Rapid job search (Job search)  Attention to
B) Supported education  is the process of helping people with a diagnosis of mental illness

B) Supported education

is the process of helping people with a diagnosis of mental illness return to education.

Involve:

Target to get into school Campus support

B) Supported education  is the process of helping people with a diagnosis of mental illness
Family intervention  Families with high “Expressed emotions” (high levels of criticism, hostility, or over involvement)
Family intervention
Families with high “Expressed
emotions” (high levels of
criticism, hostility, or over
involvement) were associated
with more relapses in people
with schizophrenia
(Brown and Leff,1972).
Family intervention

Family Intervention program:

Engagement

Enlist family members in active management of patients, Build on the strength available in the family

Communication Training Education Problem solving

Family intervention

Family Intervention program:  Engagement  Enlist family members in active management of patients,  Build
20% have comorbidities, with substance abuse being the commonest (80%).
20% have comorbidities,
with substance abuse being
the commonest (80%).
Functions of support groups  Emotional support  Share experiences and decrease negative emotions  Form

Functions of support groups

Emotional support

Share experiences and decrease negative emotions Form friendships and Reestablish network Decrease isolation Establish hope and focus on positive roles

Information provision

Help increase knowledge on illness and services, demystify illness, enhance coping and problem solving

Advocacy

Potential for power and influence

Education – psychoeducation

focus on patients’ outcomes& improving family outcomes

Functions of support groups  Emotional support  Share experiences and decrease negative emotions  Form
Responding together :)
Responding together :)