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Epidemiology of Mental
Health
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MENTAL HEALTH STATUS OF
MALAYSIANS The 3rd NHMS, which was carried out in 2006,
provided some information on the state of
mental health of adult population in Malaysia
(aged 16 and above).
This is based on a 28 item General Health
Questionnaire (universally used to screen the
state of psychological wellbeing of a person).
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The findings are:
1. Overall prevalence - 11.2% of adult population in
Malaysia has some form of psychiatric morbidity,with the Chinese population experiencing thehighest prevalence at 31.1%.
2. Gender - more females than males have
psychiatric problems, with 55% of them femalesand 45% males.
3. Residence - psychiatric morbidity is higheramong urban population than rural, 12.6% for
urban population versus 8.5% for ruralpopulation.
4. Education level it is higher among those withno education or primary education, 15-16%
versus 10% for those with tertiary education
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5. Education level it is higher among those withno education or primary education, 15-16%
versus 10% for those with tertiary education.6. Marital status it is higher among the
divorcees (13.6%); followed by singles (13.1%)widow/ widower (12.2%) and lastly those who
are married (10.5%)7. Suicidal ideation overall prevalence of acute
suicidal ideas of 6.4% with the highest amongteenagers and young adults, aged 16-24 at
about 11%.8. Insomnia ( inability to sleep) overall acute
insomnia of 14% with those aged 70-74 havingthe highest prevalence of slightly over 20%.
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National Mental Health Registry for
Schizophrenia, 2003
1. Predominance ofmales to females in the ratio
of 1.6 : 1. This could be due to the socio-
economic role of males that make them seek
treatment more readily than females.
2. Patients by ethnic group - Malays ( 54%);
Chinese (28%); Indians (9%) and others (8%).
This is a reflection of the ethnic distribution ofthe population in Malaysia.
3. Marital status 68% were single; 23% married;
5% divorced, 2% widowed and 1% separated.
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4. Education level 6% had no education; 25% hadprimary level education; 61% secondary school
education; 5% with college education and 3%were degree holders.
5. Employment 70% were never employed orunemployed at the time of registration.
6. Duration of untreated psychosis the meanduration was 28 months with a median of 12months. This means that patients took anaverage of 2 years 4 months to seek treatment
from the time of appearance of first symptom ofa disturbed mind but the majority of them tookabout 12 months.
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Treatment Gap
The treatment gap represents the absolute
difference between the true prevalence of a
disorder and the treated proportion of
individuals affected by the disorder.
Alternatively, the treatment gap may be
expressed as the percentage of individuals
who require care but do not receive
treatment.
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The median treatment gap for schizophrenia,
including other non-affective psychosis, was
32.2%.
For other disorders the gap was: depression,
56.3%; dysthymia, 56.0%; bipolar disorder,
50.2%; panic disorder, 55.9%; GAD, 57.5%;and OCD, 57.3%.
Alcohol abuse and dependence had the
widest treatment gap at 78.1%.
Source: Bulletin of the World Health Organization 2004;82:858-
866.
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Ten recommendations to address the
treatment gap made in the 2001
World health report1. Mental health treatment should be
accessible in primary care
2. Psychotropic drugs need to be readilyavailable
3. Care should be shifted away from institutions
and towards community facilities4. The public should be educated about mental
health
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5. Families, communities and consumers should beinvolved in advocacy, policy-making and forming
self-help groups6. National mental health programmes should be
established
7. The training of mental health professionals
should be increased and improved
8. Links with other governmental andnongovernmental institutions should beincreased
9. Mental health systems should be monitoredusing quality indicators
10.More support should be provided for research.
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Factors influencing a persons decision
to seek medical advice
1. Severity and duration of the disorder
2. The persons attitude to psychiatric disorder
3. Attitudes and knowledge of family andfriends
4. The persons knowledge about possible help
5. The persons perception of the doctorsattitude to psychiatric disorder
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Factors influencing a general practitioners
decision to refer to the specialist psychiatric
services Uncertainty of diagnosis
Severity of the condition
Serious suicidal ideas
Need for treatment that is unavailable in
primary care
Willingness of the patient to see a psychiatrist
Accessibility of psychiatrist services, how far
the patient has to travel, and how promptly
patients are seen by the psychiatrist
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Provision of Mental Health Services
They should be:
Accessible to those who require them;
Appropriate to the needs of the wholecommunity;
Effective;
Equitable (fair);
Acceptable to patients;
Efficient and economical.
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Provision of psychiatric services via:
Community mental health teams (CMHTs)
Outpatient clinics
Day services
Inpatient facilities
Rehabilitation resources
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Community Mental Health Team
Mental health problems can be caused by
physical, mental or social conditions - or any
combination of these.
A physical or mental illness, past experiences,
difficult relationships and stresses such as
unemployment and drug or alcohol problems
can all play a part.
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Getting over a mental health problem can also meanthat you may need help with different parts of yourlife:
emotional problems
relationship problems
housing
medicines
money and benefits
work, or something rewarding and useful to do
getting back your self-confidence.
The team should have workers from differentprofessions, who understand each other's differentskills and ways of approaching problems.
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Objectives Provide prompt and expert assessment of mental health problems who
have complex needs
Provide effective, evidence-based treatments to reduce and shortendistress and
suffering.
To provide multi-disciplinary team approach to support the users in thecommunity.
Ensure that inappropriate or unnecessary treatments are avoided
Ensure the care is delivered in the least restrictive and disruptive mannerpossible.
Assist patients and carers in accessing support, both to reduce distress but
also to maximise personal development and fulfillment. Provide advice and support to service users, families and carers.
Stabilise and improve social functioning and protect community tenure.
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Who might you meet in a community
mental health team?
General practitioners
Psychiatrist A medical doctor with special training in mental illnesses
and emotional problems.
Community psychiatric nurses (CPNs) They work outside hospitals, usually visiting patients in
their own homes, out-patients departments or familydoctors' surgeries.
Can help people to talk through their problems and givethem practical advice and support.
Nurse therapists - received extra training in particularproblems and treatments, such as eating disorders orbehaviour therapy.
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Clinical psychologists
They will usually meet regularly with you for a
number of sessions to talk through problems and
find ways of solving them.
Occupational therapists
They help people to get back to doing things, andhelp them to regain their self-confidence.
Social workers
They are able to help with money and housing
problems and play an important part in helping
with child-care issues.
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Pharmacists
They offer expert advice to doctors and nurses about
the benefits and side-effects of different medications. Outreach workers
specialised in supporting people with long-termmental health problems. They help them adapt to
ordinary life within the community by developingcoping skills rather than being institutionalised in ahospital or hostel.
Psychotherapists
offer therapy to those who are referred to them (egpsychodynamic psychotherapy (psychoanalysis),cognitive behavioural therapy or interpersonaltherapy).
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How does it works?
The team may have a base, like a clinic, where they cansee clients. They will also work in a whole range ofplaces - out-patient clinics, GP surgeries, day-centres,hostels and people's own homes.
At regular team meetings, staff discuss how best tohelp their clients. They try to make sure that they havea clear picture of your difficulties and strengths. Theycan then plan the right help with you. Staff workclosely together and learn a lot from each other.
One of the team members would usually be your keyworker.
This also means that, if your key worker is away, therewill usually be someone around who knows somethingabout you.
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Specialist CMHTs
Home treatment/ Crisis intervention team
Early intervention for psychosis
First episode psychosis
ABT (assessment and brief treatment)
Continuing care
Rehabilitation
Assertive Outreach
Forensic
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Assertive Outreach Team (AOT)
This service provides home treatment to people sufferingfrom severe and enduring mental health problems whohave a history of disengaging from traditional services andmay have additional co-existing problems like Drug and
Alcohol misuse or forensic issues. Assertive outreach offers a team approach to providing
care and as such each individual will have contact with anumber of the team, including a consultant psychiatrist,social workers, community mental health nurses andsupport workers all available in house. The teams operatein a similar way to the Community Mental HealthTeam(CMHT) but they work with a smaller number ofpeople, each worker has greater flexibility and time andresources to respond to needs of the individual.
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Who is eligible for the service
Individuals who have experienced one or more of the following severemental health problems:-
1. A severe and persistent mental disorder, such as, schizophrenia,persistent psychosis.
2. Major affective disorders associated with a high level of disability.3. A history of high use of inpatient or intensive home based care (for
example, more than 2 admissions or more than 6 months in patient carein the previous 2 years) for individuals recognised as high service user
4. Individuals will also have multiple, complex needs which may include anumber of the following indicators: history of violence or persistent
offending, dual diagnosis of substance misuse and serious mental health5. Detained under the Mental Health Act (1983) for treatment on at least 1occasion in past 2 years.
6. Unstable accommodation or homelessness.
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Crisis intervention/Home Treatment
team
Definition of a service
system for the rapid response and assessment ofmental health crisis in the community with the
possibility of offering comprehensive acutepsychiatric care at home until the crisis is resolved,and usually without hospital admission.
Acute care is delivered by a specialist team so as
to provide an alternative to hospital admission forindividuals with serious mental illness who areexperiencing acute difficulties.
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The aims of treatment are to:
Reduce distress
Help to solve problems
Avoid maladaptive coping strategies, e.g. self-harm Improve problem-solving strategies
It is a short-term intervention, which may requireintensive involvement of the therapist with the
patient, and sometimes also members of theirfamily.
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Early Intervention for Psychosis Team
offering intensive evidence-based interventions toindividuals who are: Experiencing for the first time symptoms of psychosis
Where there is a suspicion they may be developing
psychosis, not just where there is a certainty Who are considered to be at risk of developing psychosis in
the future
typically people referred to the Early InterventionService are likely to be presenting for the first time to
mental health services, will not have yet received anyantipsychotic treatment or will have been treated forless than one year.
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Service interventions which could be provided include:
1. Medication Where Appropriate
Low dose of atypical anti-psychotics
Side effect monitoring
Use of antidepressants, mood stabilizers etc whereappropriate
2. Psychological Therapies
Provide psychological assessment, formulation andintervention where appropriate
Use of CBT as appropriate
Psycho-education
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3. Family/Carer/Significant Other Involvement and Support
Provision of psycho-education, family interventions and support
4. Activities of Daily Living Assessment of financial circumstances and care plan to address
income needs. Early reliance on disability allowance to be avoided where possible
and focus on working towards valued occupation.
5. Providing Pathway To Valued Education and Occupation Access to specialist assessment of vocational/educational needs.
Maintaining the person in their chosen setting. Assisting a rapid return to education/work when these have broken
down.
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Mental Health Case Management
Services provide service to individuals living in the community with
a severe and persistent mental illness or concurrent mentalillness and substance abuse which has had a major impacton aspects of their lives, such as housing, employment,social supports, finances, daily living skills.
The teams operate under the Principles of PsychosocialRehabilitation which emphasize hope, recovery,empowerment, and effective rehabilitation founded on apartnership between the person receiving services and thepractitioner. The goal of the teams is to support individuals
in achieving the best quality of life possible and to supportindividuals in their recovery and growth beyond illness.
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Background
o Started on 19.01.1996 ( 15 years ago ).
o Due to there are no observation towards
patient after discharge, patient lack ofcompliance or poor family support that cause
relapse and re-admission to hospital.
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Objectives
To increase public awareness towards prevention ofmental illness to avoid relapse.
To encourage family acceptance.
To ease patient to get following check-up at home
To encourage family involvement in psychosocialtreatment
To reduce public stigmatization
To reduce readmission and to shorten the period of
admission To give continuous treatment after patient being
discharge.
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Vision
To give effective and continuous
treatment to patient to achievepatients satisfaction
Mission
Provide effective and efficient
services to help patient andfamily living in high quality of
life.
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Services provided:
Mobile clinic
Home visit
Patient discharge
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Mobile clinic
Patient which unable to come to clinic for follow-
up due to lack of family support
Patient which unable to come to clinic due to
financial problem
High risk of admission
Giving depot injection to patient which is poor
compliance Patient which is physically handicap.
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Mobile clinic coverage area (25 km radius from HMBP)Mobile clinic coverage area (25 km radius from HMBP)
(divided into 4 zones)(divided into 4 zones)
ZON 1 (KAWASAN PENAMPANG).
Kg. Kibabaig
Kg. Tampasak
Kg. Timpango
Kg. Babagon
Kg. PogunonKg. Nabangkung
Kg. Kibonong
Kg. Kimolohing Inobong
Kg. Ketiau
Kg. Maang
Kg. Nambazan
Kg. Kolopis
Kg. Hungab
Kg. Babah
Kg. Sugud
Kg. NavahuKg. Ulu Seberang
Kg. Kobusak
Kg. Kibambangan
Kg. Tagad
Kg. Tomposik
Kg. KoidupanKg. Mogoputi
Kg. Sindanan
Tmn. Penampang
Tmn. Oriental Park
Tmn Summer Set
Jumlah Pesakit: 27 Orang
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ZON 2 (KAWASAN KOTA KINABALU)ZON 2 (KAWASAN KOTA KINABALU) Tmn. Beautry Garden
Tmn. Luyang Phs 1
Tmn Luyang Phs 2
Tmn. Seri Gaya
Tmn. Teck Guan
Tmn. Cempaka
Tmn. Mandrin Park
Tmn. Kinanti Luyang
Rumah murah Kepayan
Tmn. Lintas Court
Kg. Kopungit
Kg. Sembulan lama
Kg. Sembulan Tengah
Kg. Ganang
Kg. Tg Aru Baru
Kepayan Ridge
Padang Bandaran Jln. Lintas
Kg. Air
JUMLAH PESAKIT : 45 ORANG
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ZON 4 (KAWASAN PETAGAS
Kg. Petagas lama
Kg. Pasir Putih Putatan
JKR QRTS Putatan
Kg. Contoh Petagas
Kg. Ketiau Putatan
Kg. Duvanson Putatan
Kg. Kepayan 2 Putatan
Kg. Tampasak Kinarut
Kg. Kerilip Kinarut
Kg. Somboi Kinarut
Tmn. Kinarut
Kg. Sabuk Laut Kinarut
Kg. Beringgis
Kg. Gusi Kinarut
Kg. Pituru Lok
KawiTmn. Bersatu Putatan
JUMLAH PESAKIT : 17 ORANG
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Home visit
25km radius from HMBP
Patient which failure to come back from HTL
To trace family member To trace defaulter
To observe patient condition/ family
members/ home environment Psychoeducation to patient and family
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Discharge
Sending patient home when family members are
unable to take.
Patients are send by group
This service include all towns in Sabah.
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