MALAYSIA

MENTAL HEALTH SERVICE

The Framework
for Service Delivery

General Adult Mental Health Services

 Group Members
• Dr Abdul Kadir Abu Bakar
• Dr Sarfraz M. Hussain
• Dr Shariah Idris
• Pn Anil Kalsom
• Dr Mohd. Daud Dalip
• Dr Ahmad Rashidi Saring
 Introduction
• Services for the Mentally Ill
• Ages: 19 – 60 years
• Provide range of services and supports
• Specialist services one component
• Networking with other agencies:
- Welfare, Labour, Local government
- NGOs
 Service Elements
1. Mental Health Promotion and Prevention
2. Early Detection, Treatment and Referral
3. Acute Home Care
4. Acute and Extended Inpatient Care
5. Early Discharge Program
6. Assertive Community Care
7. Long term Stay (LTS) service users
8. Housing and Accomodation Services
9. Family Intervention Programs
10. Follow-up of Stable Cases
11. Specialist Outpatient Care
12. Psychosocial Rehabilitation
13. Individual Placement and Support Programs
14. Liaison Psychiatric Services
15. Forensic Psychiatric Services
16. Services for the Service User with Special Needs
 Objectives
• To identify, assess and treat adults with mental
illness
• Specialist services to focus on assessment and
treatment of complex and difficult SMIs
• To monitor and coordinate provision of services
in ensuring continuity of care
• To deliver a range of community, hospital and
residential care and treatment on a continuous
basis
• To undertake promotion and prevention
activities especially in increasing public
awareness and understanding
 Target Groups
• Adults with mental illness (service users)
including personality disorders and co-
morbid illnesses (substance abuse, medical
illness)
• Age: 19 – 60 years
 Key Service Linkages

• Primary Health Care services

- including GPs private psychiatrists
• Child and Adolescent and Elderly Mental Health
Services
• National Drug Agency
• Social Welfare Services
• Local government
• Housing and Accommodation, domiciliary care, social
support and employment and training services
• Prisons Department
• Non-governmental organisations
 Protocols & Guidelines
• Management of Mental Disorders in
Primary Care
• Available Guidelines:
- Acute Home Care treatment
- Assertive Community Treatment (ACT)
- Psychosocial Rehabilitation (PSR)
- Family Intervention Program (FIP)
- Follow-up of Stable Cases
 Guidelines to be developed
• PSR for severe disabled
• LTS service users
• Housing and accommodation services
• Specialist outpatient care
• Individual Placement and Support Programs
• Services for people with special needs
• Clinical Practice Guidelines

@ each service will provide a defined area

(within a 10 km radius)
 Description of Key Service Elements
• Mental Health Promotion and Prevention
- refer to the group recommendations
• Early Detection, Treatment and Referral
 Primary health care centers, GPs should be able to detect
signs and symptoms of illness, initiate treatment and make
the necessary referrals
 Manual on Diagnosis and Management available
 Screening tools: e.g.
- Edinburgh Postnatal Depression Scale (EPDS)
- Hamilton Depression Rating Scale (HDRS)
- General Hospital Questionnaire (GHQ)
- Anxiety Screening Questionnaire
- Prime MD
 3. Acute Home Care
• Designed to help service users with SMIs who are in
crisis with the intention to prevent hospitalisation
• Delivered by a team:
- doctors, SNs, MAs
- counselors, social workers
• Currently based in hospital setting
• Future: health care setting
- with a population of <100,000
- 10 km radius
 4. Acute and Extended Inpatient Care

• Admission and inpatient care should be considered

along a spectrum of continuity of care
• Strive for a less restrictive environment and
condition of service users regularly reviewed
• Focus to avoid extended stay in hospital
(ie. < 3 months stay)
• For Extended stay: consider transitional placement
close to their homes
• Provision for a Case Manager
• Extended stay determined by BOV
 Acute and Extended Stay
• On discharge: service users be given a treatment plan
explaining the role and responsibility of the service
users, carers and the after care team
• Every hospital with Specialist services:
- should have a Resident Psychiatrist
- adequate inpatient bed capacity
(WHO recommends 3–8 beds/10,000 population)
- staffing should be based on number of core services
provided rather than bed capacity
 WHO Recommendations
• Acute Inpatient Care = 1: 3
• Acute Home Care = 1: 5
• Assertive Community Care = 1 : 12 – 15

Note: Inpatient Care is part of the continuity

spectrum of care which includes
hospitalisation and community care
 Early Discharge Program

• Inpatient stay kept as minimum as possible

• Discharge to home care considered within 2
weeks
• Comprehensive treatment plan given to
service user, carer and homecare team
• Guidelines available
 Assertive Community Care

• To be provided for service users with severe

deficits, living alone with poor support
• Referral to assertive care from acute home
care, early discharge or acute inpatient and
extended inpatient
• Service is continuous, time unlimited and
focus on intensive support
• Limited case load size (1:12-15)
Long Term Stay (LTS) service users

• LTS = stay more than 1 year in institution

• Strong evidence that LTS prefer community care
with good clinical and social outcomes
• Move into community to be carefully planned
• Include provision for accommodation, nursing and
rehabilitation
• Can be provided by NGOs and other agencies
 Housing and Accommodation
Services
• Community residential programs can substitute
long term inpatient care
• Supported housing can serve diverse population
with severe mental illness
• LTS service users show greater emotional well
being and satisfaction when given choice
• Linear Residential Continuum suggest service user
can progress from more restrictive residential
service to least restrictive
• Ultimate aim for service user to live independently
 Family Intervention program

• Objective to involve family members and

carers in mangement to achieve functining
and QOL
• Guideline for implementation is available
• Training being conducted to health center
staff
 Specialist Outpatient Care

• Reserved for service user with complex and

multiple needs and require specialized
interventions
• Service provided in a multidisciplinary
approach
 Follow up of stable cases

• Follow up at health care facilities nearest to

own home
• Care part of continuity spectrum
• Adequate staffing to be provided
• Guidelines and SOPs available
 Psychosocial Rehabilitation
• A process that enable person to achieve
optimal functioning
• Involves active participation of all parties
• Individually tailored and oriented to service
needs
• PSR for moderate disability at health
centers and severe disability at specialist
settings
Individual placement and support
• Significant number of unemployed SMI
• 3 basic aspects of job related services
• Employment preparation
• Employment programs like sheltered workshop
• Individual placement and supported employment
• SMI requires support to maintain employment
• Supported employment shown to be more
successful in placing SMI in full time work
• Guidelines to be developed
 Liaison Psychiatric services
• Provide consultation and treatment in
hospitals
• Include assessment of self harm and the
physically ill.
• 2 levels of service provision I.e. hospitals
with psychiatrist and hospitals with no
psychiatrists
 Forensic Psychiatric services

• Refers to service users involved with

criminal justice system
• Include assessment and treatment and
provision of secure care for high risk cases
 Services for people with special
needs
• Include:
– people with SMI and substance abuse problems
– People with HIV/AIDs
– Homeless
– Women
– Family self help and consumer initiatives