Author: Dato' Dr Suarn Singh a/l Jasmit Singh, Chief Psychiatrist, Ministry of Health, Malaysia
Hospital Bahagia Ulu Kinta (an institutional setting) in Perak, Malaysia demonstrates how a large psychiatric hospital can reorganize its services to incorporate comprehensive community outreach services for a large population.
In 1970s, Community Psychiatric Unit (CPU) was established to provide domiciliary services. Evening psychiatric clinics were operated by staff of HBUK after regular office hours in public places such as a church, community hall or temple. Peripheral psychiatric clinics operating during regular office hours at distances more than 30 km. from HBUK were established to provide psychiatric follow-up care services nearer to patients’ homes. In 1997, follow-up of stable psychiatric patients commenced in primary health care centres in Perak, including assessment and review of patients, provision of medication, psycho-education and support, and defaulter tracing to ensure that patients were compliant with prescribed medication.
Home-care Services
In March 2001, HBUK started home-care services, which aimed to provide continuous and comprehensive services at home, catering for the needs for the patients and carers. The specific objectives are to:
1) Provide treatment and rehabilitation to psychiatric patients
2) Enlist family members in management of patients at home by engaging them in management of patients, via improving communication and problem-solving skills.
3) Reduce relapses and re-hospitalisation to less than 30%.
4) Promote adherence to medication and illness self-management for which the compliance rate should be more than 60%.
5) Provide supported employment (Job search, job match and job coach) for at least 10% of the patients.
Home-care services in HBUK are provided through clearly delineated geographical zones, serving a population of about 800,000 in Kinta district. There are seven zones based on geographical locality. Each zone is headed by a psychiatrist, working together with two to four medical officers, two full-time medical assistants, two full-time staff nurses and two full-time attendants. There are two nursing supervisors for the nursing staff. The home-care team operates during office hours and the case-load for each nursing staff is 1: 15 - 20 patients.
The home-care services in HBUK consist of 5 components:
(a) Acute home care
(b) Early discharge program (EDP)
(c) Assertive community treatment (ACT)
(d) Family intervention programme (FIP)
(e) Follow-up services for stable cases with complex needs
The HBUK home-care service has successfully reduced patients’ relapses and readmission rates within 6 months after discharge, from about 25% before services were started, to 0.56% in 2005 and 0.5% in 2006.
We are also working towards down-sizing our mental institution. Our strategies include reduction of acute admission to our mental institution by setting up small acute units with home-care services (e.g. resident psychiatrist at district hospitals) and development of alternative appropriate residential facilities with varying levels of care- high-level support, low-level support, respite care and group homes. We are also working towards supported education and supported employment. Inter-sectoral collaboration between related agencies (e.g. social welfare, education, labour department), carers, and Non-Governmental Organizations are also strengthened.
There are no comments to display.