Community Based Care

in Mental Health  

     

Community based care is said to hold the key to responsive mental health services, those that are more suited to the wishes of the individual.

 lnstitutionalised care (such as living in a hospital for the duration of one’s life) and rehabilitation programmes do not serve the chronic mentally ill person well as they foster dependency and compliance rather than autonomy. The medical model of fix and cure is not enough for those who have the combined challenges of illness and social unfriendliness.

Community based care provides an opportunity for collaboration with other services already serving the people. Therefore, services can be adapted and developed to meet the needs according to each locality (such as rural locations, remote and isolated areas and semi urban. Even urban city life). There is no set pattern but a flexible approach based on negotiation with other health care providers.

 There is a growing awareness in Sri Lanka that adults who have spent most of their lives in an institution (Mental hospital, Orphanages, Home for the Mentally Handicapped, etc) have suffered from a loss of personal identity, a loss of dignity, impaired social and personal care skills, and also a deterioration in their physical and mental wellbeing (this is by no means an exhaustive list of the dependency effects of institutionalization).

 Community based care allows people to regain control over their own pathways of recovery.

 The move away from large psychiatric institutions to a single ward for the relief of acute episodes which need a short period of inpatient care in a district general hospital, and the training of Psychiatric Medical Officers has enabled people to stay closer to home and remain in contact with their own communities. This is a great move forward and must continue.

 Nest can then figure highly in the range of options open to the individual sufferer. Without that form of additional support community based services as an alternative to institutionalisation will not necessarily meet the need.

 In the west this movement out of institutions led to the setting up of community based services and facilities, mental health multidisciplinary teams whose members became the case managers for up to 30 individuals at a time. Facilities such as drop-ins or more structured day services, half way housing schemes and supported lodgings were essential if a move into community based care-giving was to succeed. Now there is an awareness that day centres could in fact lead to the same damaging effects on the individual as an inpatient service by excluding the people who attend them from mainstream community resources. This has led to new ways of supporting people to access mainstream services.

 Attitudes also have to change if community based care is to supersede the current system of institutionalised care. This involves a move away from prescriptive services to negotiating with the individual the service that meets their own agenda. Ultimately this could give rise to user and carer led groups influencing how community based care and service development should operate.

 Nest Work

 This small introduction gives a good illustration of what Nest has been initiating and encouraging in visiting families and institutions, and here we give some suggestions for community based care:  
       - Improve quality of life which also means a happy and satisfying life - doing what one wants to do.
       - Promote independence - social inclusion which is supporting the individual to engage in ordinary activities – that is having ordinary people in ‘ordinary’ places. 
        - Support individuals to discover their own potential and move away from the notion that mental health difficulties are what only professionals can sort out. This could unfortunately, build a career of ‘listening’ to individuals but not doing anything with what one hears.
        - Increase possibilities for social contact. For instance, living one’s life out in a remote area and never visiting another village and community can restrict education and progress in every possible way. Many of us find ourselves excluded from the community we live in because of an aspect in our being which labels us as ‘different’. Often this exclusion is based on poverty, race, geographic location, perceived sexual habits, class structure and circles (such as not speaking English fluently), mental difficulties, social issues, appearance, education, religion, economics (such as doing demeaning jobs) and politics. What is left? Surely you will agree, not much! We care about others and we accept each other. We are glad to be together.
 
One stirring change we can be part of, however,  is bad behaviour as this inadvertently destroys ourselves and those around us. Finally, we are happy that we never excluded anyone with say HIV and AIDS  and we were able to include her/him in the family and community and encourage for her/him support, love, care and equal rights. Same with a mental illness and mental disturbance.

 Institutionalisation is harmful

 Systems and services are changing in Sri Lanka but there is still a long way to go to synchronise community living and getting the message across that to live at home freely and accepted by family and friends is the best way.

 What are we doing at the Occupational Therapy Centre at Unit 2 of Mulleriyawa Mental Hospital (Colombo District)?

 We are helping women to take control of their own lives.

 The situation           

Unit 2 Mulleriyawa Psychiatric Hospital is currently “Home” to approximately 556 women. Ages vary, as do the geographical areas of Sri Lanka. However, this is where the variables end. Each woman is a “patient”. Instltutionalisation has stripped these women of many of the skills they once had.

 Life Skills           

Institutionalisation be it in a psychiatric hospital, a prison or a care home means that the important skills that enable people to function in their daily lives; skills that help people to perform family and community activities  become lost and forgotten. Social Skills help us to communicate effectively and allow us to understand the subtle rules of body language. Skills such as knowing how to dress, and what to wear for different occasions, being aware of when to cut your hair, nails and how to make sure that you are clean, being able to cope with managing your home, paying the bills, cooking a meal and doing the shopping, and having the confidence and self-esteem to meet new people or just to walk outside of the hospital grounds are good examples.

                        The Nest Occupational Therapy Centre team work hard 5 days of the week and sometimes at the weekend, since September 2005. They are qualified Community Health Workers, traveling from home and Kåre House. 

The Occupational Therapy Centre at Unit 2 Mulleriyawa Mental Hospital run by Nest

 

Thanks go out to the Norwegian Women and Family Association and the Scheiblers Legat whose wonderful financial and human supports have made the OTC the success it is. Also, we cannot forget the support and kindness of the Ministry of Health to initiate the MOU between Nest and the MOH to redesign an old ward and subsequently work in it. 

 

The Occupational Therapy centre is designed to be a safe and inviting environment.  It is an area that is awash with natural light and has many trees and garden outside to grow vegetables and flowering plants.  It has areas for the development of personal hygiene skills, domestic and home management skills, a library, indoor table tennis, indoor badminton, creative arts, dining room, handicrafts, use of the computer, toilets, showers, washing machine for clothes, group drama, musical activities and a kitchen. “Liv” room (called after the Deputy Chairman of Scheiblers Legat when she visited Sri Lanka) has a Television, plenty of magazines and newspapers, radio and space to relax. Other services: a retail shop, restaurant, free telephone service, and garden chairs and umbrellas.