Community Psychiatry Gp5

INTRODUCTION
Community health service was concerned mainly with the control of

communicable diseases.
In the course of development, it has become increasingly concerned
with every health aspect of life of individuals in the community.
Psychiatry, has developed as a personal service to the mentally ill
individual,
Psychiatrists have attempted to contribute to preventive aspects of
mental illness.
However, preventive psychiatry remains in its infancy and needs
much community efforts to be well developed.
CAUSES OF MENTAL ILLNESS

The
concept of multiple factors in the causation

of psychogenic disorders has become generally
accepted.
The
factors are considered to involve the

individual, the family and the community.
OBJECTIVES
Promote mental health in the community.

Maintain if possible the mentally ill within the community itself.
Avoid unnecessary admission and restraint in special hospitals.
Provide social therapy.
Care and treatment are being delivered close to home,

Interventions are being given to improve disabilities
treatment and care given are specific to the diagnosis and
needs
Services reflect the priorities of service user
Services are coordinated between mental health professions
and other agencies
Services are mobile rather than static e.g. home treatments
Custodial Care/Institution (past)
Care in Community
(present & future)
Downsizing
the psychiatric Institutions

Reduce referrals to institutions
Mainstream
Out-patient
clinic
acute care (inpatient) state/district hosp.
Hospital
Acute
based community care
home care
Assertive community treatment
Follow-up services for patients with complex needs
All of these services include elements of psycho-education, family-based

intervention, work-based intervention and illness self management skills.
COMMUNITY
PSYCHIATRY
HOSPITALISATION
Acute stay if needed short as possible (early

discharge)
Optimizing treatment
Ensuring continuity of care with other services

in the community
ACUTE TREATMENT
Assessment
with Threshold Assessment Grid (TAG)
Function to assesses the severity of a persons mental health problems
Camberwell Assessment of Needs-Short Schedule (CANSAS):
Function to assess of the needs of people with severe mental health
dimensions to be considered:
Safety,
Acute
care, diagnosis, disability and duration of distress
treatment at home is offered as alternative to hospitalization

Engage family member to assist in patients management
Team building
Example TAG
Example of CANSAS
ACUTE TREATMENT
Develop
alliance with patient and family

Prevent harm by risk assessment & risk management
Control disturbed behavior
Suppress symptoms
Connect family and patients with follow up resources
Psycho education:
What is psychosis? Early signs? Familys role? How to help?
Multidisciplinary
approach
EARLY DISCHARGE PROGRAM
Patient may be admitted due to severe risk or due to logistic

problems (e.g. during weekends or after office hours)
Assessment followed by engagement of family done as soon
as possible
Patient is discharged as soon as possible with a care plan,
acute treatment or assertive treatment will be provided at
home
ASSERTIVE COMMUNITY TREATMENT

(ACT)
Dealing with severe mental illness with complex needs.
Serve outpatients whose symptoms of mental illness
result in serious functioning difficulties in several
major areas of life
Schizophrenia, mood disorder, organic disorder, with
Disability
Unable
to care for self independently

Cannot sustain relationships
Symptoms current or enduring
Recurrent crises and frequent admissions
Significant risk to self and others
MAINTENANCE
Aims
help with stress

provide support
prevent relapse
increase adaptation to live in community
help recovery
Strategies
engagement
adherence to medication
continue education
improve coping skills
family and social support
work
PLANNING, POLICY
NATIONAL MENTAL HEALTH POLICY
Clearly states role

of PRIMARY HEALTH CARE
in providing mental health
services
Integration of Mental Health

Program in the Primary Health
Care
Primary
care
Mental
Health Promotion
Early Detection of Mental IIlness
f/u of stable cases & defaulter tracing of
these patients
Psychosocial Rehabilitation in Community
Empowerment of Family Physician
Mental Health Framework
Promotion
SERVICE
S
Prevention - primary
- secondary
Treatment &
Rehabilitatio
n
Continuing Care
Mental Health Promotion

Healthy Lifestyle Campaign 2000
Public Awareness
Empowerment
- Training On Coping
Skills
Change lifestyle
- Stress Management
- Anger Management
Levels of Care & Intervention
low
high
1
Mental hospital
Frequency
of need
Costs
2
3
5
6
Psychiatric service at
general hospital/clinics
Community mental health services

(outpatient/outreach)
Mental health care
through primary health care services
Informal and formal community care/support
outside the health sector
Self and family care
high
Quantity of services needed
low
5 evidence-based practices in Illness

Self Management and Recovery (IMR):
1. Psychoeducation
2. Behavioural tailoring
3. Relapse prevention
training
4. Coping skills training
5. Social skills training
Illness managment
1. Psychoeducation
Is
teaching information about mental illness

and its treatment, which improves consumers
understanding of their disorder and their
capacity for informed treatment decision-making.
Illness management
In
Malaysia, a psychoeducational package is available

in 5 training modules covering:
Illness management
2. Behavioural tailoring
Is
helping consumers fit taking medication into daily

routines by building in natural reminders
(such
as putting ones tooth brush by ones medication

dispenser), which improve medication adherence and can
prevent relapses and rehospitalization.
Illness management
3. Relapse prevention training

Teaching
consumers how to recognize situations

that trigger relapses and the warning signs of a
relapse
Developing a plan for responding to those signs
Illness management
4. Coping skills training

Improve
consumers ability to cope,

Deal with persistent symptoms by helping
them identify and practice coping strategies
Hence,
decrease distress and

severity of symptoms.
Illness management
Modul
Kemahiran
Kesihatan
Mental
5. Social skills training

Helps
consumers strengthen their social

supports and and bonds with others by
practicing interpersonal skills in role plays
and real life situations,
resulting
in more rewarding relationships and

better illness management
Illness management
A) Supported employment:
Individual Placement & Support
Rapid job search (Job search)

Attention to patient preferences (Job match)
Ongoing support and on going training for the job
without a time limit (Job coach)
B) Supported education
is
the process of helping people with a diagnosis of

mental illness return to education.
Involve:
Target to get into school

Campus support
Family intervention
Families with high Expressed

emotions (high levels of
criticism, hostility, or over
involvement) were associated
with more relapses in people
with schizophrenia
(Brown and Leff,1972).
Family intervention
Family Intervention
program:
Engagement
Enlist family members in active management of

patients,
Build on the strength available in the family
Communication Training
Education
Problem solving
Family intervention
20% have comorbidities,

with substance abuse being
the commonest (80%).
Functions of support groups
Emotional support
Share
experiences and decrease negative emotions

Form friendships and Reestablish network
Decrease isolation
Establish hope and focus on positive roles
Information provision
Help
increase knowledge on illness and services,

demystify illness, enhance coping and problem solving
Advocacy
Potential
for power and influence
Education psychoeducation
focus
on patients outcomes& improving family

outcomes
Responding together :)

Community Psychiatry Gp5

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INTRODUCTION

Community health service was concerned mainly with the control of

CAUSES OF MENTAL ILLNESS

concept of multiple factors in the causation

factors are considered to involve the

Promote mental health in the community.

Provide social therapy.

Care and treatment are being delivered close to home,

Custodial Care/Institution (past)

(present & future)

the psychiatric Institutions

based community care

All of these services include elements of psycho-education, family-based

Acute stay if needed short as possible (early

Ensuring continuity of care with other services

with Threshold Assessment Grid (TAG)

Function to assesses the severity of a persons mental health problems

Camberwell Assessment of Needs-Short Schedule (CANSAS):

Function to assess of the needs of people with severe mental health

care, diagnosis, disability and duration of distress

treatment at home is offered as alternative to hospitalization

alliance with patient and family

What is psychosis? Early signs? Familys role? How to help?

EARLY DISCHARGE PROGRAM

Patient may be admitted due to severe risk or due to logistic

ASSERTIVE COMMUNITY TREATMENT

to care for self independently

help with stress

Clearly states role

Integration of Mental Health

Empowerment of Family Physician

Mental Health Framework

Mental Health Promotion

Levels of Care & Intervention

Community mental health services

5 evidence-based practices in Illness

teaching information about mental illness

Malaysia, a psychoeducational package is available

helping consumers fit taking medication into daily

as putting ones tooth brush by ones medication

3. Relapse prevention training

consumers how to recognize situations

4. Coping skills training

consumers ability to cope,

decrease distress and

5. Social skills training

consumers strengthen their social

in more rewarding relationships and

Rapid job search (Job search)

the process of helping people with a diagnosis of

Target to get into school

Families with high Expressed

Enlist family members in active management of

20% have comorbidities,

Functions of support groups

experiences and decrease negative emotions

increase knowledge on illness and services,

for power and influence

on patients outcomes& improving family