PROPOSAL FOR A MODEL MENTAL HEALTH COMMUNITY BASED

SERVICE DELIVERY

Presentation structure

• Current MH care system• Gaps• Expectation for MH service delivery• Proposal• Enabling conditions• Activities• Timeframe plan of model pilot

System of MH care in VN (1)

• Health sector– Mental hospitals: Central, provincial level– Rehabilitation hospital: 36 provinces– Health education Centre– Preventive medicine centre: provincial and district– National target program: community– Community based rehabilitation program: 46

provinces– Mainly provided by public services

System of MH care in VN (2)

• Social affair sector– Social protection Centre– Centre of mental rehabilitation – Department of social affair: provincial, district and

commune level– Centre of social work service: provincial level

Gaps of current system

• No service at district level• Almost no service at community level• Not comprehensive services at where it exits• No participatory of family and community:

informal but sustainable and practical care • No service for prevention and early detection• Weak at MH care for children

Requirement for MH care model

• Community based• Participatory• Comprehensive• Multi sector collaboration• Based on existing system• Suitable and realistic

Objectives

• To provide comprehensive services for people with MH problems, based on community, multi-sector collaboration and integrated in current system

Final goal: to contribute to achievement of target of Program 1215.

Comprehensive: need based approach

Some targets in relation to model pilot

• MH care is provided at different levels: province, district and commune

• 50% clients benefit from services provided at community

• 85% people with risks of MH problem are screened

• 60% of household receive education on prevention from MH problem

Who? What and Where? (1)

• At province level– MH hospital: improve rehabilitation practice,

develop social work service– Social protection centre: improve quality of

diagnosis and chemical therapy, preparations for transfer clients to family

– Social work service centre: participate in screening and counseling, support hospital and SPC to provide social work service to clients and families.

– Establish the mechanism and practice of cooperation between Hospitals and Centers

Who? What and Where? (2)

• At district level– Need to develop services of screening, counseling

and treatment for simple cases, based mainly on health system .

– Promote communication, education and practice of MH prevention

– Provide technical distance – support for commune level through “hotline” when need

– Provide coaching and supervision community during regular field visits

Who? What and Where? (3)

• At community level– Develop service of screening and counseling provided

by commune health staffs: early detection.– Develop comprehensive rehabilitation services to

people with mental illness based on Case management approach: health, education, livelihood, social and empowerment. Coordinated by Social workers with active participation of family members and community actors.

– Develop a model of play -round for people with and without MH can participate and inclusive

– Promote fighting against stigma and discrimination

Who? What and Where? (4)

• Interaction between levels– Develop a regulation and procedure of

cooperation among health and social affair sector at the same level

– Develop a guideline of referral system between low and higher level of a sector as well cross – sector

– Develop appropriate channel of communication and information sharing between community and district and provincial service providers for technical support when need, especially for emergency case and crisis intervention.

Enabling conditions

• Capacity of health and social affair sector, both managerial and technical skills.

• Especially important skills of commune health staffs on screening and counseling

• Availability of social workers at community: at least 2 staffs with training on MH basic understanding and case management.

• Availability of good quality of communication on MH prevention

Roadmap of service provision

Activities (1)

• Capacity building for different levels, especially skills of case management for social workers and screening skills for health staffs at community.

• Workshop to develop referral system and put it in practice with political commitment of involving actors.

• Community awareness raising and behavior change communication on MH prevention

Activities (2) • Design and implementation of events, activities

at community to involve people with mental disability and their families to participate: A “community house” club model for learning, sharing, linking. Exchange, visits to learn from existing practice can help much.

• Monitoring closely and documentation to learn what does and doesn’t so that we can adjust the model.

• Self review and external evaluation on the model and implementation

How to pilot – project site

• Coverage: – 2 provinces: Thanh Hoa, Ben Tre – 2 district in a provinces: Thanh Hoa city and Quang

Xuong dist; Ben Tre city and Giong Trom dist– 3 communes/ each district have community

intervention: case management and community house

– Other interventions will be taken place in all commune of 4 districts/city : capacity building, service of screening and counseling, awareness raising.

How to pilot – Timeframe (1)• First 3 months: forming system and essential

capacity building– Workshop to introduce model– Compose service teams at district and community

level– Workshops to develop guideline and regulation of

referral system as well protocol of cross sector cooperation

– Training on screening for staffs of health, social sectors at provincial level and communes and districts where pilot model

– Training social workers at community and provincial SW center on case management and how to make a personal rehabilitation plan

How to pilot – Timeframe (2)

• Next 3 months:– Need assessment of individual with Mental illness– Resource mobilization and implementation of

support base on rehabilitation plan of each patient

– Participatory workshop to design agenda of “community house”

– Develop IEC products on MH understanding and prevention: clips, posters, leaflets etc

How to pilot – Timeframe (3)• Rest of time (15 months)– Capacity building for staffs at provincial level– Workshop among mental hospital, social protection

centers, social work centers to identify demand and offer of each institute, than make specific plan of cooperation, support each other

– Follow up and implementation of plans of all levels– Focus on advertisement of availability of screening

and counseling unit at district level – Exchange in field visit and outside visit for all levels– Regular monitoring (keep observation and monitoring

support monthly from Molisa, quarterly from local level)