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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.

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.

OBJECTIVES

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.

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

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
Acute

based community care

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

HOSPITALISATION

Acute stay if needed short as possible (early


discharge)

Optimizing treatment

Ensuring continuity of care with other services


in the community

ACUTE TREATMENT
Assessment

with Threshold Assessment Grid (TAG)

Function to assesses the severity of a persons mental health problems

Camberwell Assessment of Needs-Short Schedule (CANSAS):

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

dimensions to be considered:
Safety,

Acute

care, diagnosis, disability and duration of distress

treatment at home is offered as alternative to hospitalization


Engage family member to assist in patients management
Team building

Example TAG

Example of CANSAS

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? Familys role? How to help?

Multidisciplinary

approach

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

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

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

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

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

SERVICE
S

Prevention - primary
- secondary
Treatment &
Rehabilitatio
n
Continuing Care

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
3

5
6

Psychiatric service at
general hospital/clinics

Community mental health services


(outpatient/outreach)
Mental health care
through primary health care services
Informal and formal community care/support
outside the health sector
Self and family care

high
Quantity of services needed

low

5 evidence-based practices in Illness


Self Management and Recovery (IMR):
1. Psychoeducation
2. Behavioural tailoring
3. Relapse prevention
training
4. Coping skills training
5. Social skills training
Illness managment

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

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 natural reminders
(such

as putting ones tooth brush by ones 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 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 helping
them identify and practice coping strategies
Hence,

decrease distress and


severity of symptoms.

Illness management

Modul
Kemahiran
Kesihatan
Mental

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

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)

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

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

20% have comorbidities,


with substance abuse being
the commonest (80%).

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

Responding together :)

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