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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%.
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%.
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 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
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
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.
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).
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
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.
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.
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.
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
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
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.