COMMUNITY

PSYCHIATRY
FATIN NABILAH BINTI SHARIP

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DEFINITION
Psychiatry focusing on detection,
prevention, early treatment and
rehabilitation of patients with
emotional and behavioral
disorders as they develop in a
community.

~ The American Heritage® Medical Dictionary

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1) Hospital Based Community Psychiatry
2) Community Mental Health Centre

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COMMUNITY MENTAL HEALTH CENTRE

a centre for community care treatment which includes the screening,

diagnosis, treatment and rehabilitation of any person suffering from
any mental disorder (MHA 2001)
– Operations
– Objective
– Services

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 COMMUNITY MENTAL
HEALTH CENTRE/MENTARI

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 8am - 5pm (Monday to Friday)

Patients must be referred from psychiatric hospitals/health centers.

OPERATIONS Referrals must be to the medical officer in charge

All CMHCs have a community psychiatry unit that will be multi discipline.

All patients referred for CMHC services would be assessed by

amultidiscipline team headed by a psychiatrist.

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OBJECTIVES

• To provide continuing treatment in an easier and more accessible manner.

• To reduce stigma and discrimination.
• To promote screening of mental illness and ensure early treatment.
• To provide psychosocial interventions including counseling,
psychotherapies, patient and family education.

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SERVICES
1. CONSULTATION CLINIC
a. New cases –clients walk in and need a fairy urgent assessment
b. Follow up

2. PARTIAL HOSPITALISATION
a. Facilitate early discharge and recovery from acute phase of illness.
b. Symptom and illness management, training on use of medication and dealing with
side effects
c. Prevention of relapse
d. Defaulter tracing

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3. PSYCHIATRIC DAY-CARE
a. Help patients to be maintained at home and reduce contact time with families
b. Promote positive interactions with other patients
c. Training in social skills, ADL, grooming, dining etc.

4. CLUBHOUSE APPROACH
a. To promote patient empowerment
b. Help with transitional work
c. Patient run and managed
d. To provide an environment for a low key and drop in approach
e. Help with effective use of leisure time

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5. SUPPORTED AND INDEPENDENT EMPLOYMENT/JOB CLUB
a. Focus on job search and job placement
b. Transitional employment should be an added emphasis for CMHC
c. Job coaching activities

6. OTHERS
A. Counselling services
B. Collaboration with NGOs especially family groups
C. Workshops on Illness management, recovery modules and family support
D. Community access
E. Outreach Support

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SPECIALIST SERVICES FOR ACUTE
PSYCHIATRIC DISORDER
HISHANTINEY SELVAM
BMS 1509 1735

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PATIENTS WHO ARE REFERRED TO SPECIALIST
CARE

• Suicidal patients
• Those who are potentially dangerous to others
• Those with dual diagnoses of mental disorder and substance misuse
or personality disorders.

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Number and type of patients reaching the psychiatric services depends
on :

• Willingness of general practitioners to treat psychiatric disorders

• Treatment skills and resources of the primary care team
• Patients willingness to attend for specialist psychiatric advice
• General practitioners criteria for referral to the psyciatric services
• Psychiatric services criteria for accepting referrals.

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DAY HOSPITALS
• Acute day hospital care
• Acute illness
• Appropriate for those who can be with their families in the
evening and at weekends
• However, they have failed to generalize, needing either a proper
leader or a research programme to sustain them
• Transitional daycare
• Earlier discharge from the hospital

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• Day treatment programme
• More intensive treatment for people who are not
responding to outpatient care

• Daycare centres
• Long-term service users
• An active treatment programme which is specific to each
patients needs so that patients aren’t dependent or stuck.

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INPATIENT UNITS
• The number of bed required for acute psychiatric disorder is
difficult to determine exactly
• Severe bed shortage is a factor in increase of mental illness as it
depends on :
• Level of morbidity, including substance abuse in the population
served by the unit
• Willingness and ability of families to care for acutely ill relatives
which in turn depends on the quality of accommodation and the
availability of other family members
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• The extent and availability of crisis services
• Facilities for treatment of acute psychiatric disorder outside hospital
such as a well staffed hospital
• Facilities for early discharge of patients from hospital after the acute
phase of the disorder, it is generally easier to discharge early than to
avoid admission

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DESIGN OF INPATIENT UNITS
• Should have a balance between patients needs for privacy and the
staffs requirement to observe them
• Must be large enough to ensure adequate staffing for emergencies
yet avoid the institutional feel.
• Minimize the possibility of suicide by hanging or jumping.
• Secure areas for the most disturbed patients, areas where patients can
be alone and where they can interact amongst themselves.
• Space for occupational therapy, practice of domestic skills and
recreation
• Outdoor is desirable
• Single sex accommodation is mandatory.

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Siting of acute inpatient units
• Part of a general hospital complex
• Reduces stigma and provides easy access to general medical
services when required
• Low threshold for disruptive behaviour and inadequate space
for occupational and recreational activities suitable for
psychiatric care.
• Issues are avoidable when psychiatry unit occupies a
separate building withing the general hospital complex.

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Community Psychiatric Services For Long term
care or Patients with chronic mental disorder

BY HTOO AUNG

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• With the exception of elderly , most pyschiatric patients who
require long term care have schizophrenia, chronic affective
disorders or personality disorder associated with substance
abuse or aggressive behaviour.
• Patient who need care in hospital more than 1 year , other
than forensic patients , are referred as ‘ new long- stay’.

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• To treat the patients in the community, they need
all the elements of care previously provided by
hospital. The following provisions are required:

1. Suitable and well supported carers

2. Appropriate accommodation
3. Suitable occupation
4. Arrangement that enlist the patient’s
collaboration with treatment
5. Regular assessment of physical health
6. Effective collaboration among carers
7. Continuity of Care and rapid response to crisis
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 1. Carers
1. Friends and Family are main carers for people with severe mental
illness at home. They may encourage the patients to get up in
morning, maintain personal hygiene, eat regular meals , occupy
himself or herself constructively and also encourage collaboration
with treatments
2. Volunteers _ Trained volunteers can give help and support to
patients and families.
3. Community psychiatric nurses _ the backbone of community care
by evaluating patients, supervising drug therapy and encouraging
social interaction.
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 Accommodation
• Many patients who are discharged from hospital live with families, and
some care for themselves in rented accommodation. Those require
extensive help can be provided in three ways.
(i) In lodgings _ Some families take in patients as lodgers and to provide
them with extra care
(ii) In group home _ Patients live in group homes of four or five patients .
The houses are owned by social or health services or by charity
(iii) In hostels _ hostels are half way houses from which patients move on to
more independent living. Hostels have permanent staffing. Levels of
supervision vary and overnight staff may sleep in.

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 Occupation
• There are several approach to increase work and employment of patients with severe
psychiatry disorder
(i) Vocational Rehabilitation_ extensive training based on assessment of disabilities and
following structured programme to develop skills and confidence.
(ii) The Club House Model _ a specialized form of vocational rehabilitation that is based
around the building which is jointly administered and maintained by people with mental
illness
(iii) Sheltered Work _ it allows people to work productively but more slowly than would be
acceptable elsewhere. Schemes include horticulture projects and craft workshops.
(iv) Occupational therapy _ provided in day care or day hospital.
(v) Supported Employment _ individuals are placed in competitive work without any
extended preparation but with support on job.

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 Reassessment
• Patients metal state and collaboration with treatment are
assessed by a key worker, community nurse.
• Physical health review is essential because patient often
neglect physical illness or may not accept offered help
• Regular assessment of patient’s risk to harm himself or others
people involves (1) static factors, such as past behaviours (2)
dynamic factors such as the current level of substance misuse
or psychosocial stressors.

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 Continuity of Care
• Community care staff need to gain confidence from their
patients and to know them well. Neither can be achieved if
there are frequent changes in staff.
• Staff should be extra vigilant when care passes between
workers

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 Response to crisis
• A crisis plan agreed in advance with the patient and carers is
helpful.
• Staff need to respond quickly to crisis and readmission to
hospital may be avoided by prompt action.

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 Rehabilitation
• Rehabilitation denotes procedures for helping patients to
reach and maintain their best level of functioning. It is based
on a careful assessment of disabilities and relies on a
structured gradual training which include medical,
pyschological , occupational , social and residential.
• The aim is to return to ordinary work. Those who cannot
achieved this is trained for activities such as gardening, crafts
and cooks. These provide a sense of achievement , self esteem
and a shape t o the day.

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Indications for Patient Referral
to Community Psychiatry
Gan Tze Yang
BMS15091382

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Indications for Hospital Based Community
Psychiatry
• Severe mental illness (schizophrenia, mood disorders, dementias).
• History of non adherence to treatment and non engagement to
services.
• Frequent crises.
• Frequent readmissions.
• Prolonged psychotic episode.
• Co morbid substance use.

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Indication for Assertive Community Team
• Psychotic disorder: schizophrenia and mood disorder.
• History of no adherence to treatment.
• Frequent crisis, admissions and prolonged psychotic episode.
• Co morbid substance abuse.

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Indications for Acute Home Care Services
• Patient with mental disorder who are in crisis.
• Low risk of suicide or aggression.
• Good family support.
• Consent from the patient or relatives.

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Indications for Follow Up Services
• Patient with severe mental illness who has a history of frequent
defaulting due to logistic reasons.
• Good psychosocial support.
• Consent from the patient or relatives.

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Organizations involved in
community psychiatry
DASHINI SOUNTHARARAJAN
BMS15091441

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• The care and treatment offered under public psychiatry are delivered behind a

variety of associations under inpatient and community-based services

• These includes government agencies like:

-departments of mental health

-substance use treatment services

-children, youth, and family services

-public health, social services,

-education, adult corrections, and juvenile justice agencies 38

• Non government organization includes: not-for-profit community
mental health, substance use treatment, child guidance, or health
care organizations

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MENTARI (COMMUNITY MENTAL HEALTH
CENTRE)
• MENTARI is a new approach initiated by the Ministry of Health Malaysia (MOH) to
improve outreach and re-integration of people with mental health problems.

• There is at least one MENTARI in each state in the country, and they are managed
by the Department of Psychiatry and Mental Health in the nearest hospital.

1. To provide continuing treatment in an easier and more accessible manner

2. To provide psycosocial interventions including counselling, psychotherapies,

and psychoeducation
OBJECTIVES
3. To promote screening of mental illness and promote early treatment

4. To reduce stigma and discrimination 40

Perak Society for the promotion of mental health
• Works to inform, advocate and enable access to quality behavioural health
services for all Malaysians

• Formed with the main objective to device programmes to break down public
prejudiced that is being held against mentally cured patient

• Aftercare and rehabilitation could be made available in cooperation with the

Government Psychiatric Service

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Malaysian Mental Health Association
• It is a community based NGO operating solely on public donations and a small annual
grant from the Department of social welfare
• Aims:
1. dynamic advocate for positive attitude towards mental health
2. To plan and execute mental health programmes
3. Provide rehabilitation services
• Runs a Day Care Centre, charity shop project, organise public form on mental health
issues, provide support for carers of the mentally ill, family to family edication group,
depression support group and advocated for the rights of the mentally ill 42
Mental Illness Awarness and Support
Association (MIASA)
• Mental health NGO based in Selangor (patient initiated)
• Objectives
1. Promote awareness on the importance of good mental health and
mental health issues
2. Provide support for patients and carers through various programs
3. To promote mental illness literacy
4. To support other bodies in all areas to promote mental health
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 BEFRIENDERS
• Befrienders is a not-for-profit organisation providing emotional support 24 hours
a day, 7 days a week, to people who are lonely, in distress, in despair, and having
suicidal thoughts

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REFERENCES
• Kaplan and Sadock’s Synopsis of Psychiatry

• Malaysian Healthcare Performance Unit, Malaysian Mental Healthcare Performance:Technical report 2016,
Ministry of Health Malaysia: Putrajaya. p. 1-67.

• Perak Society For the Promotion of Mental Health. https://www.hati.my/perak-society-for-the-promotion-

of-mental-health/

• Malaysian Mental Health Asscociation. https://www.hati.my/malaysian-mental-health-association/

• Mental Illness Awarness and Support Association. https://www.hati.my/mental-illness-awareness-support-

association-miasa/

• Befrienders. https://www.befrienders.org.my/

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