Towards a community oriented programme

1

• Towards a community oriented programme

2
Map of Malaysia
Mental hospitals in Malaysia
(250)
(2200)
(1600)
(330)
3

PSYCHIATRIC FACILITIES IN SARAWAK
Psychiatric units in GH
(32)
Mental hospital
(32)
SARATOK
(330)
(10)
(16)
KALIMANTAN
4
Context of Mental Health in Malaysia

• Population 25 million
• Higher Middle Income country
• Literacy rate 96.7 and 92.7
• Life expectancy 70.6 and 74.9 yrs
• Proportion of health budget to GDP 2.4
• Mental Health expenditure
• 2 of public healths budget
• 3 of medical division budget
• 77 of budget to the 4 mental hospitals

5
Mental Health Facilities

• Total Psychiatric Beds
• 4200 in mental hospitals 900 in general
  hospitals
  
• 82 of beds in mental hospitals
• Psychiatrists/100,000 pop 0.3
• Psych Nurses/100,000 pop 0.5 (plus 295 MA)
• SW / 100,000 pop 0.2 (plus 148 OT)

6
Malaysia Mental Health Care Facts

• Majority of patients (89) treated in public
  hospitals 25 General Hospitals 4 Mental
  hospitals
  
• 150 qualified psychiatrists
• From 1998, some aspects of care available in
  primary health centers
  
• 778 Health centers providing medication follow
  up
  
• Mental health promotion
• Psychosocial rehabilitation in 27 health centers
• Mental health unit in Public health division

7
Case for change in Sarawak

• High rate of readmissions
• Overcrowding of the acute wards
• Custodial care
• No proper follow up after discharge OGK follow
  up

8
The change

• Creating of a more conducive acute ward
  environment providing private and individual
  rooms
  
• Assertive care at 2 levels Level 1 for those
  requiring more intense follow up and level 2 for
  less complex cases
  
• Early discharge
• Patient led rehabilitation activities self help
  groups, sundry shops, cooperatives, education of
  families and public
  
• Job placement

9
The result

• Reduce readmissions by 60
• No overcrowding in acute wards (BOR 40, ALOS 12
  days)
  
• Level 1 243 patients (5 readmission rate)
• Level 2 335 patients, non adherence rate of
  2.6, readmission rate of 3)
  
• Increase of Assertive staff from 3 to 21
• Job placement from 0 to 60 staying in full time
  jobs for 3 years
  
• 10 on Transitional Employment
• 900 families trained in family education and run
  their own program
  
• 30 long stay persons living on their own in group
  homes in community (budget by hospital)
  
• 20 long stay living in a group home run by an
  NGO
  
• Plan for a community-based residential facility
  in pipeline

10
(No Transcript)