Вы находитесь на странице: 1из 43

Epidemiology of Mental Health

MENTAL HEALTH STATUS OF MALAYSIANS


The 3rd NHMS, which was carried out in 2006, provided some information on the state of mental health of adult population in Malaysia (aged 16 and above). This is based on a 28 item General Health Questionnaire (universally used to screen the state of psychological wellbeing of a person).

The findings are:


1. Overall prevalence - 11.2% of adult population in Malaysia has some form of psychiatric morbidity, with the Chinese population experiencing the highest prevalence at 31.1%. 2. Gender - more females than males have psychiatric problems, with 55% of them females and 45% males. 3. Residence - psychiatric morbidity is higher among urban population than rural, 12.6% for urban population versus 8.5% for rural population. 4. Education level it is higher among those with no education or primary education, 15-16% versus 10% for those with tertiary education

5. Education level it is higher among those with no education or primary education, 15-16% versus 10% for those with tertiary education. 6. Marital status it is higher among the divorcees (13.6%); followed by singles (13.1%) widow/ widower (12.2%) and lastly those who are married (10.5%) 7. Suicidal ideation overall prevalence of acute suicidal ideas of 6.4% with the highest among teenagers and young adults, aged 16-24 at about 11%. 8. Insomnia ( inability to sleep) overall acute insomnia of 14% with those aged 70-74 having the highest prevalence of slightly over 20%.

National Mental Health Registry for Schizophrenia, 2003


1. Predominance of males to females in the ratio of 1.6 : 1. This could be due to the socioeconomic role of males that make them seek treatment more readily than females. 2. Patients by ethnic group - Malays ( 54%); Chinese (28%); Indians (9%) and others (8%). This is a reflection of the ethnic distribution of the population in Malaysia. 3. Marital status 68% were single; 23% married; 5% divorced, 2% widowed and 1% separated.

4. Education level 6% had no education; 25% had primary level education; 61% secondary school education; 5% with college education and 3% were degree holders. 5. Employment 70% were never employed or unemployed at the time of registration. 6. Duration of untreated psychosis the mean duration was 28 months with a median of 12 months. This means that patients took an average of 2 years 4 months to seek treatment from the time of appearance of first symptom of a disturbed mind but the majority of them took about 12 months.

Treatment Gap
The treatment gap represents the absolute difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder. Alternatively, the treatment gap may be expressed as the percentage of individuals who require care but do not receive treatment.

The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%.

Source: Bulletin of the World Health Organization 2004;82:858866.

Ten recommendations to address the treatment gap made in the 2001 World health report
1. Mental health treatment should be accessible in primary care 2. Psychotropic drugs need to be readily available 3. Care should be shifted away from institutions and towards community facilities 4. The public should be educated about mental health

5. Families, communities and consumers should be involved in advocacy, policy-making and forming self-help groups 6. National mental health programmes should be established 7. The training of mental health professionals should be increased and improved 8. Links with other governmental and nongovernmental institutions should be increased 9. Mental health systems should be monitored using quality indicators 10.More support should be provided for research.

Factors influencing a person s decision to seek medical advice


1. Severity and duration of the disorder 2. The person s attitude to psychiatric disorder 3. Attitudes and knowledge of family and friends 4. The person s knowledge about possible help 5. The person s perception of the doctor s attitude to psychiatric disorder

Factors influencing a general practitioner s decision to refer to the specialist psychiatric services Uncertainty of diagnosis Severity of the condition Serious suicidal ideas Need for treatment that is unavailable in primary care Willingness of the patient to see a psychiatrist Accessibility of psychiatrist services, how far the patient has to travel, and how promptly patients are seen by the psychiatrist

Provision of Mental Health Services


They should be:
Accessible to those who require them; Appropriate to the needs of the whole community; Effective; Equitable (fair); Acceptable to patients; Efficient and economical.

Provision of psychiatric services via:


Community mental health teams (CMHTs) Outpatient clinics Day services Inpatient facilities Rehabilitation resources

Community Mental Health Team


Mental health problems can be caused by physical, mental or social conditions - or any combination of these. A physical or mental illness, past experiences, difficult relationships and stresses such as unemployment and drug or alcohol problems can all play a part.

Getting over a mental health problem can also mean that you may need help with different parts of your life:
emotional problems relationship problems housing medicines money and benefits work, or something rewarding and useful to do getting back your self-confidence.

The team should have workers from different professions, who understand each other's different skills and ways of approaching problems.

Objectives
Provide prompt and expert assessment of mental health problems who have complex needs Provide effective, evidence-based treatments to reduce and shorten distress and suffering. To provide multi-disciplinary team approach to support the users in the community. Ensure that inappropriate or unnecessary treatments are avoided Ensure the care is delivered in the least restrictive and disruptive manner possible. Assist patients and carers in accessing support, both to reduce distress but also to maximise personal development and fulfillment. Provide advice and support to service users, families and carers. Stabilise and improve social functioning and protect community tenure.

Establish a detailed understanding of all local resources relevant to support of individuals with mental health problems and promote effective interagency working. Gain a detailed understanding of the local population, its mental health needs and priorities, and provide a service that is sensitive to this and religious and gender needs. Provide support and advice to primary care through collaboration. Reduce the stigma associated with mental health care Establish effective liaison with local Primary Care Team members, Acute Care, Assertive Outreach, Early Intervention teams and other referring agents to shape referrals in order to mange complex cases

Who might you meet in a community mental health team?


General practitioners Psychiatrist
   

A medical doctor with special training in mental illnesses and emotional problems. They work outside hospitals, usually visiting patients in their own homes, out-patients departments or family doctors' surgeries. Can help people to talk through their problems and give them practical advice and support. Nurse therapists - received extra training in particular problems and treatments, such as eating disorders or behaviour therapy.

Community psychiatric nurses (CPNs)

Clinical psychologists
 They will usually meet regularly with you for a number of sessions to talk through problems and find ways of solving them.

Occupational therapists
 They help people to get back to doing things, and help them to regain their self-confidence.

Social workers
 They are able to help with money and housing problems and play an important part in helping with child-care issues.

Pharmacists
 They offer expert advice to doctors and nurses about the benefits and side-effects of different medications.

Outreach workers
 specialised in supporting people with long-term mental health problems. They help them adapt to ordinary life within the community by developing coping skills rather than being institutionalised in a hospital or hostel.

Psychotherapists
 offer therapy to those who are referred to them (eg psychodynamic psychotherapy (psychoanalysis), cognitive behavioural therapy or interpersonal therapy).

How does it works?


The team may have a base, like a clinic, where they can see clients. They will also work in a whole range of places - out-patient clinics, GP surgeries, day-centres, hostels and people's own homes. At regular team meetings, staff discuss how best to help their clients. They try to make sure that they have a clear picture of your difficulties and strengths. They can then plan the right help with you. Staff work closely together and learn a lot from each other. One of the team members would usually be your key worker. This also means that, if your key worker is away, there will usually be someone around who knows something about you.

Specialist CMHTs
Home treatment/ Crisis intervention team Early intervention for psychosis First episode psychosis ABT (assessment and brief treatment) Continuing care Rehabilitation Assertive Outreach Forensic

Assertive Outreach Team (AOT)


This service provides home treatment to people suffering from severe and enduring mental health problems who have a history of disengaging from traditional services and may have additional co-existing problems like Drug and Alcohol misuse or forensic issues. Assertive outreach offers a team approach to providing care and as such each individual will have contact with a number of the team, including a consultant psychiatrist, social workers, community mental health nurses and support workers all available in house . The teams operate in a similar way to the Community Mental Health Team(CMHT) but they work with a smaller number of people, each worker has greater flexibility and time and resources to respond to needs of the individual.

Who is eligible for the service  Individuals who have experienced one or more of the following severe mental health problems:1. A severe and persistent mental disorder, such as, schizophrenia, persistent psychosis. 2. Major affective disorders associated with a high level of disability. 3. A history of high use of inpatient or intensive home based care (for example, more than 2 admissions or more than 6 months in patient care in the previous 2 years) for individuals recognised as high service user 4. Individuals will also have multiple, complex needs which may include a number of the following indicators: history of violence or persistent offending, dual diagnosis of substance misuse and serious mental health 5. Detained under the Mental Health Act (1983) for treatment on at least 1 occasion in past 2 years. 6. Unstable accommodation or homelessness.

Crisis intervention/Home Treatment team


Definition of a service
system for the rapid response and assessment of mental health crisis in the community with the possibility of offering comprehensive acute psychiatric care at home until the crisis is resolved, and usually without hospital admission. Acute care is delivered by a specialist team so as to provide an alternative to hospital admission for individuals with serious mental illness who are experiencing acute difficulties.

The aims of treatment are to:


Reduce distress Help to solve problems Avoid maladaptive coping strategies, e.g. self-harm Improve problem-solving strategies

It is a short-term intervention, which may require intensive involvement of the therapist with the patient, and sometimes also members of their family.

Early Intervention for Psychosis Team


offering intensive evidence-based interventions to individuals who are:
Experiencing for the first time symptoms of psychosis Where there is a suspicion they may be developing psychosis, not just where there is a certainty Who are considered to be at risk of developing psychosis in the future

typically people referred to the Early Intervention Service are likely to be presenting for the first time to mental health services, will not have yet received any antipsychotic treatment or will have been treated for less than one year.

1. 2.

Service interventions which could be provided include: Medication Where Appropriate Low dose of atypical anti-psychotics Side effect monitoring Use of antidepressants, mood stabilizers etc where appropriate Psychological Therapies Provide psychological assessment, formulation and intervention where appropriate Use of CBT as appropriate Psycho-education

3. Family/Carer/Significant Other Involvement and Support Provision of psycho-education, family interventions and support 4. Activities of Daily Living Assessment of financial circumstances and care plan to address income needs. Early reliance on disability allowance to be avoided where possible and focus on working towards valued occupation. 5. Providing Pathway To Valued Education and Occupation Access to specialist assessment of vocational/educational needs. Maintaining the person in their chosen setting. Assisting a rapid return to education/work when these have broken down.

Mental Health Case Management Services


provide service to individuals living in the community with a severe and persistent mental illness or concurrent mental illness and substance abuse which has had a major impact on aspects of their lives, such as housing, employment, social supports, finances, daily living skills. The teams operate under the Principles of Psychosocial Rehabilitation which emphasize hope, recovery, empowerment, and effective rehabilitation founded on a partnership between the person receiving services and the practitioner. The goal of the teams is to support individuals in achieving the best quality of life possible and to support individuals in their recovery and growth beyond illness.

CMHT provided by HMBP

Background
o Started on 19.01.1996 ( 15 years ago ). o Due to there are no observation towards patient after discharge, patient lack of compliance or poor family support that cause relapse and re-admission to hospital.

Objectives
To increase public awareness towards prevention of mental illness to avoid relapse. To encourage family acceptance. To ease patient to get following check-up at home To encourage family involvement in psychosocial treatment To reduce public stigmatization To reduce readmission and to shorten the period of admission To give continuous treatment after patient being discharge.

Vision To give effective and continuous treatment to patient to achieve patients satisfaction Mission Provide effective and efficient services to help patient and family living in high quality of life.

Services provided:
Mobile clinic Home visit Patient discharge

Mobile clinic
Patient which unable to come to clinic for followup due to lack of family support Patient which unable to come to clinic due to financial problem High risk of admission Giving depot injection to patient which is poor compliance Patient which is physically handicap.

Mobile clinic coverage area (25 km radius from HMBP) (divided into 4 zones)
ZON 1 (KAWASAN PENAMPANG). Kg. Kibabaig Kg. Tampasak Kg. Timpango Kg. Babagon Kg. Pogunon Kg. Nabangkung Kg. Kibonong Kg. Kimolohing Inobong Kg. Ketiau Kg. Maang Kg. Nambazan Kg. Kolopis Kg. Hungab Kg. Babah Kg. Sugud
Kg. Navahu Kg. Ulu Seberang Kg. Kobusak Kg. Kibambangan Kg. Tagad Kg. Tomposik Kg. Koidupan Kg. Mogoputi Kg. Sindanan Tmn. Penampang Tmn. Oriental Park Tmn Summer Set

Jumlah Pesakit: 27 Orang

ZON 2 (KAWASAN KOTA KINABALU)


Tmn. Beautry Garden Tmn. Luyang Phs 1 Tmn Luyang Phs 2 Tmn. Seri Gaya Tmn. Teck Guan Tmn. Cempaka Tmn. Mandrin Park Tmn. Kinanti Luyang Rumah murah Kepayan Tmn. Lintas Court Kg. Kopungit Kg. Sembulan lama Kg. Sembulan Tengah Kg. Ganang Kg. Tg Aru Baru Kepayan Ridge Padang Bandaran Jln. Lintas Kg. Air

JUMLAH PESAKIT : 45 ORANG

ZON 3 (KAWASAN LIKAS, INANAM, MENGGATAL & TELIPOK ) :


Kg. Likas Kg. Cenderamata Kg. Warisan Inanam Kg. Gudon Menggatal Kg. Unggun Kg. Kalansanan Tmn. Jaya Diri Menggatal Kg. Karambunai Baru Kg. Tebobon Kg. Nongkulud Telipok Pekan Menggatal Kg. Keliangau Kg.Kokol Kg. Nountun Inanam Kg. Kionsom

Tmn. BDC Kg. Bambamgan Inanam Kg. Tampulan Telipok Kg. Poring-Poring Inanam Kg. Madsiang Kg. Pulutan Kg. Bandulan Sepanggar Kg. Suang Prai Kg. Inanam Laut Kg. Rampayan Laut Kg. Pomotodon Old Folks Home Calvary Likas

JUMLAH PESAKIT: 45 ORANG

ZON 4 (KAWASAN PETAGAS


Kg. Petagas lama Kg. Pasir Putih Putatan JKR QRTS Putatan Kg. Contoh Petagas Kg. Ketiau Putatan Kg. Duvanson Putatan Kg. Kepayan 2 Putatan Kg. Tampasak Kinarut Kg. Kerilip Kinarut
Kg. Somboi Kinarut Tmn. Kinarut Kg. Sabuk Laut Kinarut Kg. Beringgis Kg. Gusi Kinarut Kg. Pituru Lok Kawi Tmn. Bersatu Putatan

JUMLAH PESAKIT : 17 ORANG

Home visit
25km radius from HMBP Patient which failure to come back from HTL To trace family member To trace defaulter To observe patient condition/ family members/ home environment Psychoeducation to patient and family

Discharge
Sending patient home when family members are unable to take. Patients are send by group This service include all towns in Sabah.

Вам также может понравиться