1
HEALTH SERVICES DELIVERY
1.4
DISEASE CONTROL PROGRAMME
1.4.1.f
Non-Communicable Diseases control
Mental Health (including substance abuse, suicide &
March 2008)
A Focal Point
B Implementing Agencies
C Target Areas & Beneficiaries
poisoning) (as of
DDG/MS
DDG(MS)I
Director Mental Health Services
Provincial Directors
Deputy Provincial Directors & their staff
Hospital Directors & staff
NGOs
Hospitals
Community
Mentally disabled and community at large
Project Summary:
The present mental health services are predominantly hospital based.
In keeping with
WHO recommendations, and as a long felt need it is necessary to make the services available in the
periphery. Patient care and treatment, rehabilitation, social support should be available in the community.
Many mental disorders are not recognised because of social stigma and due to lack of awareness among the
people. This project aims at addressing these issues by improving quality of care, infrastructure
facilities,
human resources, awareness through proper treatment,
rehabilitating and
promotive activities in the community so that disease burden due to mental diseases are minimised.
1.
Justification:
Mental illness (an estimated prevalence of 10 percent) causes a considerable amount of
health, social and economic hardship. Further the morbidity patterns are changing, with the
increasing prevalence of problems related with long-term illness, substance abuse, special
psychosocial needs of children, adolescents, aged and relationships criminal offenders and
needing new services.
The present mental health services are predominantly mental hospital based
and are confined to Colombo and a few regional centres. The present services
predominantly focus on acute illness in adults with minimal facilities for rehabilitation,
prevention and promotion. Except for a few pilot projects community psychiatric services are
non-existent and numbers / range of mental health professionals are very limited in number.
There is an urgency to develop this inadequate, under funded,
understaffed and the
centralized system of mental health care in Sri Lanka. Ministry of Health should consider MH
as a priority and initiate an urgent development programme.
The recent WHO recommendations for the development of mental health services reproduced
in the World Health report 2001 and the National Mental Health plan prepared on similar lines
by
a WHO consultant which has been accepted by the Ministry in 2001 could be a starting point.
Rehabilitation and continuity of care need to be emphasised.
Drug abuse and suicides including poisoning are an expression of major health
problems in Sri Lanka with over 89,426 admissions and 2440 deaths in hospitals in 2000.
[Source: Medical Statistics Department]
Urgent measures have to be taken to minimise the ever-increasing incidence of suicides due
poisoning and the Health Staff as well as the public have to be educated to combat this national
problem.
The health cost for managing a patient who has ingested poisoning is of a considerable amount
for a third world country like Sri Lanka. Therefore it is essential to minimise the patient
management cost in poisoning and the best possible way to do this is by prevention through the
awareness education. Awareness among the people on poisoning due to various substances is
lacking in Sri Lanka. It is essential to have programs on educating the public on various
problems occurring from careless handling, storing and transportation of poisonous substances.
Reported cases of poisoning due to various substances (Reference - ICD 10 classification) is on
the increase. Therefore, it is very important to educate the public with the intention of
minimising poisoning incidence in future.
Updating the knowledge on latest management procedures and nursing care in poisoning is of
vital importance. Both the senior and junior medical officers as well as the nursing officers will
be benefited by the capacity building of the Health staff. There had been no clinical
updating sessions conducted centrally or provincially during the past few years relevant to
poisoning. This is evidence based and proved by the calls National Poisons Information Centre
received from the other medical institutions.
Pesticide poisoning alone contributes to a large number of deaths and it is the 7th leading cause
of death in Sri Lanka as reported from the hospitals Indoor morbidity and mortality returns.
(Source: Annual Health Bulletin 2000)
2.
Important Assumptions/Risks/Conditions:
New Draft Mental Health Act is approved by the Parliament
Necessary funds are available for
(a). infrastructure development ( material resources
(b). Human resource develop
(c). Developing guidelines and implementation.
including vehicles)
3.
Project Objective:
Objective
Indicators
Reduce
the
disease  No. of patients
burden due
to admitted /Month / District
mental
disorders, to MH Angoda &
substance abuse, suicide Mulleriyawa.
and poisoning
 No: of patients
admitted to Psychiatry
Units per month
 No: of Psychiatry
patients admitted to
medical wards No: of new
patients treated by MOMH
 No: of patients in
the acute and medium stay
units for longer than 6
weeks and long stay units
4.
Means of Verification
 HIS for MH Angoda
 MH Mulleriyawa
 HIS from District
Project Output/Product:
Outputs
Accessible improved to effective quality
treatment for mental disorders, substance
abuse and poisoning and follow up
services
Effective community based rehabilitation
in place for long term care for mentally ill
including those due to substance abuse,
poisoning for self harm dementia and
mentally retarded and childhood mental
health problems
Early detection of mental disorders among:
A) Health Care Seekers
B) Non Seekers
System for promotion of Mental Health
among children, adolescent, adults,
Elderly groups and disaster victims
Effective monitoring mechanism in
place
Effective management organisation
structure in place
Prevention and control of substance abuse,
and suicides, including poising.
Basic infrastructure developed for
Indicators
 No. of patients
admitted to Angoda,
MH
 Mulleriyawa MH
 No: of patients
discharged from
medium stay
rehabilitation units /
one month.
Means of Verification
 Reports and returns
 No: of patient
referred to MOMH
by
1. PHM / Volunteers
2. MO / OPD
3. Ward MOs
 No covered by
promotion programmes
 Reports and returns
 Availability of a
monitoring
mechanism
 Availability of a
management
organisation structure
 Morbidity mortality
statistics
 No of facilities with
 Reports and returns
 Reports and returns
 Reports and returns
 Workshop reports
 Reports and returns
 Reports and returns
community mental health programmes
including transport facilities
Necessary guidelines standards prepared.
developed infrastructure
 Preparation of
guidelines
 No of HCW
deployed
 Workshop reports
 No of HCWs trained
 Workshop reports
Community awareness raised to seek early
and community based treatment and
reduce social stigma
 No of awarene4ss
programmes conducted
 Workshop reports
Improvements to existing Mental
Health Act
and necessary legislation
and enforcement
 Availability of a
revised legislation
 Reports and returns
Adequate psychiatrists, nurses OTs,
psychologists, community mental health
workers, psychiatric social workers. are
deployed
Primary Health Care Workers trained
in community based mental health
programme including substance abuse and
poisoning
 HR data
5. Related Projects:
Project No.
1.1.1
1.1.2
1.1.4
1.1.6
1.1.7
1.2.1
1.2.2
1.3.1
1.3.2
1.3.4
1.3.5
1.5.1
1.5.2
1.5.3
1.5.4
1.5.5
1.5.7
1.7.1
1.7.2
Project Title
Functional Rationalisation by Developing a New Health Services Delivery
Plan.
Facility Development According to the Rationalized Health Services
Delivery Plan.
Strengthening of Laboratory and Diagnostic Services..
Technology Assessment
Medical supplies (including drugs)
Emergency Preparedness & Response
Medical supplies including drug.
Medical equipment
Improved quality of OPD and IPD Services.
Development of emergency service network for injuries Accident ,
poisoning and disasters
Total Quality Control / Management of Hospital Services.
Total quality control / Management of promotive and preventive services.
Estate Health
Elderly Health
Disabled Health
Health of people in conflict attached areas and displaced populations.
Adolescent Health
Health People in Urban Slums
Development of National policy & plan on health promotion as well as
strengthening of coordinating mechanism.
Establishment of implementation mechanisms for Health promotion
programme.
2.1
2.2
Programme for improved community involvement for health development
Programme for the promotion and protection of human rights with Relevance
Health
Programme for the production and Strengthening of human resources for
the Health Sector
Programme for the Rationalization of human resources for the health sector
Programme for improving job performance of Health Personnel
Effective policy development programme
Management Development programme
Health Regulatory Mechanism programme
Strengthening of health information system programme
Health research programme
Inter-sectoral Programme
3.1
3.2
3.3
5.1
5.2
5.3
5.4
5.5
5.6
6.
Relevant Agencies to be Co-ordinated:
Ministry of Health, Ministry of Education, Ministry of Housing, Ministry of Justice,
Ministry of Labourer, Ministry of Social Services, Other agencies, NGOs
7.
Monitoring & Evaluation:
1.Who?
A mental health development
DDG(PH) and DMHS
committee. DGHS,
2. When? To start immediately, annual surveys,
DDG(MS),
periodical or ad-hoc surveys
3. What actions to be taken based on results of monitoring & evaluation?
 Re planning, Strengthening weak area, Human resource, Material
resource, Organisation structure
 To compare morbidity and mortality of poisoning in past and present
 To compare health costs incurred in management of poisoning in a
single
episode past and present.
 Revising the training curriculum and the management of poisoning book
on a need assess
8.
Activities:
Activities
3
Process Indicators
Develop a mental health policy
National mental health
policy developed
Identify policy group
Develop the policy
Establish Health Department
Psychiatry units according to the
national norm with paediatric and
geriatric psychiatry for medium stay
and long stay
Establish out reach clinics in smaller
hospitals
Train relevant staff for early detection,
Health Department
Psychiatry units
developed according
to the national norm
Develop plans and
proposals
Out reach services
strengthened
Mental disorders,
Develop plans and
proposals
Identify training needs
1
2
Expected Results
4
5
quality treatment of mental disorders,
substance abuse and poisoning
Conduct community awareness
programmes/ family members / care
givers
Improve Forensic Psychiatry Services
6
8
Improve quality of care for special
services at the mental hospitals
Introduce a patient family education
programme
9
Develop mechanism for community
organisation for rehabilitation
7
10 Establish rehabilitation facilities in
acute wards and clinics
11 Establish Day Care Centre per district
and community based day services
specially for elderly
12 Develop a system to provide social
support to long term mentally ill
patients and for the care givers
13 Develop a system to addressing issues
related to child protection/child abuse
14 Train HCW in mental health and
related areas
15 Conduct a awareness raising
programme regarding Psychosocial
needs of children, adolescents, aged,
disaster Victims
16 Develop a programme to promote
Bioethics specially in relation to
management of mental health and
mental health research
17 Profession liaison with
international bodies such as S.A.
forum for MH, UK Royal college of
psychiatrists etc.
18 Develop a Effective Mental Health
Information System
substance abuse and
poisoning detected
early
Community
awareness increased
Forensic Psychiatry
Services improved
Improved quality of
care
Patient/ family
education
programme
established
Community
rehabilitation
strengthened
Rehabilitation
facilities established
in acute
wards and clinics
Day Care Centres
established
Design training
programmes
Identify training needs
Design training
programmes
Develop plans and
proposals
Develop plans and
proposals
Identify training needs
Design training
programmes
Nominate a work group
Identify the
methodology
Develop plans and
proposals
Develop plans and
proposals
Social support
extended to long
term mentally ill
patients and for
the care givers
Effects of child
abuse minimized
HCW trained in
mental health and
related areas
Awareness raised
in Psychosocial
needs of children,
adolescents, aged
and disaster Victims
Bioethics programme
developed
Develop plans and
proposals
Collaboration with
international bodies
maximized
Identify needs
Design methodology
Effective monitoring
system developed
Identify information need
Design the information
base pilot test
Develop plans and
proposals
Identify training needs
Design training
programmes
Identify awareness needs
Design training
programmes
Identify training needs
Design training
programmes
19 Conduct research in
Mental Health
20 Formulation of provincial / District
Mental Health plan
21 Set up NIMH
22 Appoint MOMH Province/District
23 Set up Development Committee at
national level / Provincial level /
District level
24 Develop a programme to combat
substance use
25 Conduct a general awareness
programme aiming at the community
based organization (CBO) level
26 Develop data bases with INTOX latest
version and MICROMEDEX
27 Build Psychiatry units in the districts
with secure units
28 Build secure units to existing
psychiatry units
29 Provide transport facilities for
MOMH for out reach clinics,
Community work
30 Develop a training course for
Psychiatric Nursing
31 Develop a Psychologist service
Strategies to improve
mental health
services.
Mental health plans
developed
NIMH established
Well-managed
mental health
services at provincial
& district level
Development
committees
established
Reduction of
substance use
Awareness among
public on effects of
poisoning due to
various substance
Data based
developed
Effective treatment
of acute cases in
the periphery
Secure units built
Identify work group
Develop plans
Identify the need
Identify components
Design methodology
Identify awareness needs
Design training
programmes
Identify information need
Design the information
base pilot test
Develop plans and
proposals
Develop plans and
proposals
Develop plans and
proposals
Effective community
mental health
services in Districts
Effective nursing
Identify training needs
care to mentally ill  Design training
programmes
Quality care in
Identify the needs
treatment improved
Design training
programmes
Community support
Identify advocacy needs
enhanced
Design programmes
32 Develop advocacy programmes and
media programmes for mental health
33 Develop a training programme for primary Primary school teaches
school teaches on mental health
Identify research
priorities
Identify researchers
Identify work group
Develop plans
Identify work group
Setup NIMH
Identify the need
Train the MOMH
trained on mental
health
Identify training needs
Develop programme