designing an out patient mental health psychosocial program for national center for mental health...

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