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DESIGNING AN OUT PATIENT MENTAL HEALTH PSYCHOSOCIAL PROGRAM for NATIONAL CENTER for MENTAL HEALTH BASED ON BEST PRACTICES
Maria Rocio Valdes-Cabio,MD, FPPA
Background and Introduction
By encouraging mentally ill out patients to fully realize the amazing possibilities inherent in the mind, we can reintegrate them back to society the soonest possible time, to prevent the “revolving door phenomenon”…that of having a mental patient re-admitted to the hospital within a few weeks from discharged.
We need to lessen the stigma of mental illness.
Chapter 1
Talking about the aims of treatment for mental health services, scholars, advocates and clinicians agree that recovery is the goal,
According to experts this concept includes more than stabilization of health indicators.
Recovery also refers to “ the process in which people are able to live, work, learn, and participate fully in their communities.
For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability.
For others, recovery implies the reduction or complete remission of symptoms.”
...critical aspect of recovery is psychosocial intervention
Statement of the Problem
What are the components of an out patient psychosocial rehabilitation program consistent with best practice for Mental Health
Objective of the studyGeneral objective
To determine what are the components of a design specific psychosocial program (action plan) that would meet the new challenges faced by NCMH-OPD.
Specific objectives:
1.)Impart the knowledge, skills, attitude needed by caregivers/relatives to be able to contribute to best mental health out patient management based on best practices of low income country.
2.)To determine criteria on how to select committed caregivers and patients for best therapeutic care
3.) To match skills and training to job demand in order to create a specific; measurable, attainable; realistic; time bound out patient psychosocial program for NCMH –OPS which can be reproducible and sustainable by itself.
4.) To be able to maintain stress at a minimum for the staff (carers) of NCMH by introducing innovations based on level of stress; comparing it with position and responsibilities
5.)To be able to strengthening the
partnership of NCMH and the community by encouraging relatives to rally for barangay support
Significance of the study
NCMH is the largest mental health institution in Philippines
Patients, relatives and mental health professionals will benefit from the results of this study because it will guide them in making and taking the necessary steps to eliminate obstacles for better out patient mental health service.
Scope and LimitationOut patient service-NCMH
Inside hospitalPolicies are already in placeFinancesBulk of clients versus staff
Definition of terms-Mental health recovery-a concept that includes stabilization of mental health indicators, and the ability to live, work, learn, and participate fully in their communities -Revolving door phenomenon- subpopulation of chronically mentally ill patient who frequently are readmitted to psychiatric units
-Psychosocial rehabilitation (PSR)- a process that facilitates the opportunity for individuals whoare impaired, disabled, or handicapped by a mental disorder to reach their optimal level of independent functioning in the community.
Review of literature
Triangle of Care
Service User
Professional Carer
The impact of mental illness on people
Patients suffering from mental illness face difficulties in their work and home lives attributable to stigma and culture/society
For that reason, treatment approaches should address not only physical care, but also psychosocial issues including relationship, jobs and housing.
The impact on society
The cost of serious mental illness lies both in the direct treatment expenses and in non health cost like productivity and waste of financial, family resources
NCMH must also shift from a therapeutic alliance to a rehabilitation alliance
According to Rehabilitation.com (n.d.), the starting point must be the outcome goals of those actually struggling with recovery, including a job, a decent place to live, and a support network of family and friends.
This will not happen overnight, or even in a six-week trial. It may take years; for some, it may not even be rehabilitation at all, but habilitation.
Conceptual Framework Independent variables (causes or challenges)
Families’ lack of knowledge, skill and attitude about mental health (education)
Individual patient’s ability (skills training)
Commitment of carer (time and desire to help)
No support from community (opportunity)
High cost of medication and treatment
( access, infrastructure ) Poor documentation (no basis
for resource allotment) No mental health bill
(legislation) for unified help (policy)
Dependent variables (outcomes or effects)
Poor compliance to medications and treatment
Poor family support leading to revolving door phenomenon
No opportunity to go back to being independent
Decreased individual responsibility to ones mental health
Burden to society (lower GNP) Prevailing “Mental Stigma” /
no Culture change No prioritizing prevention in
homes; schools ;work place
Chapter 2
Operational Frameworkmethodology
input•Mental health Lectures•Group discussions•Family psycho education•Seminars•Flyers, IEC
process•Level 1• (basic self empowerment)•Level 2• (match skills training to demands)•Level 3 (allocate community resources)
output•Lesser revolving door phenomenon•Maintaining good mental health•Faster reintergration
Research design: descriptive cross sectionalLocal of study: NCMHData collection: FGD Implementation Evaluation
Method of data analysisStrength (What are being done right)Initial Psycho education started (In patient)Daily open lectures at Public Health UnitWeekly lectures at nearby barangay centersInclusion to philhealth (some Diagnosis)MAP (medical access program) started
Weakness (What are being done wrong)Lack of empowerment (mental workers) Personality screening not done(caregivers)Poor documentation of progress/poor ff-upPoor mobilization of resources (efficiency?)No country census for mental illness (% allocation)
Opportunities(What are the possibilities)A change in culture of society (how they view and accept mental illness)Window of job opportunities (networking)Match skills/training to service demandsNo discrimination policy (equal opportunity)Decrease revolving door phenomenonBetter stress reduction in occupational areas
Threats (What are the threats)Lack of government support for financial, legal, work and housing issuesInternal family discord (personal dynamics)Life events (level of stress and coping style)Disasters/calamities (existential issues)High cost of treatment (safety and quality)No mental health bill
Summary of findings…
Chapter 3
patients Relatives/carers Mental Professional
knowledge Right and latest information about mental health
Right and latest information about mental health
Information on how to identify, manage, treat patients (acute/chronic stage)
skills Basic home choresSkills for possible occupationSocial interaction skills
Recognition of signs and symptoms of relapse of illness and side effects of prolonged medicationsIdentification of stress levels and own personalityKnowing where and when to ask for help
Re-orientation on management (in-patient and out patient) since staff usually rotateIdentification of work stressLatest techniques on managing mental health issues
attitudes Acceptance of illness and side effectsAcceptance of chronicity of disease and medication intakeBe part of own management
Give equal treatment to relative with illnessUnderstanding that environment plays a part in prognosis and that they are part of milieu
Respecting people suffering from mental illnessHaving rehabilitation in mind when managing patient’s daily activity
The COMPONENTS for an ideal out patient psycho social rehabilitation program include not only helping out patients get their specific affordable yet high quality medicines (resource allotment) and making sure they understand how to take them (access to information, infrastructure)
Empowering patient to make them responsible
for their own mental health. Ownership influence outcome, because it influence behavioural change. The people around them should be psycho-educated as well to lessen the stigma. There must be changes in Filipino society’s behaviour towards mental health for real improvement in overall management to happen.
Chapter 4
Personality and stress levels of caregivers (mental health personnel included) should be periodically evaluated (conducive, stress free working environment)
Job opportunities should be open to them, with equal opportunity employers like the government doing its part for recovering out patients to be a lesser burden to the economy. Programs of government should be for long term coordinated support with terms for carer respite.
Legal help, financial advice, housing (e.g. relocation for drug abusers), and the
opportunity to match training based on their level of skills and personality are vital components.
Conclusion
A new outlook at what out patient service can do is inevitable
Mental health personnel of NCMH should not be contented on just tolerating the symptoms of mental illness but be part in the initiative to the road to full re-integration, back to a level of functioning that will not be a burden to relatives and society.
A proactive approach to care with use of networking for significant improvement of life for the people suffering from mental illness is warranted
Holistic psycho-rehabilitation is the
key to unlock the mysteries of how people suffering from mental illness can cope and go back to mainstream society.
RecommendationThe National Center for Mental Health with its
core values of integrity, excellence, compassion, accountability in public service, dedication, commitment, and responsiveness to culture and gender sensitivity,
should be the lead mental health facility in the Philippines to start opening “doors of possibilities”.
We can start by implementing a design specific mental health out patient psycho social rehabilitation program with the vital components in placed.
Action Plan
Education (empowerment)
Time frame
Short termLong term
Indicators
InputProcessOutput
Resources sources
Expenditure items
Treatment
Work issues
Legal Issues
Residential Issues
Infrastructure
Financial Issues
Skills training and demand
Thank you for the opportunity