Kalmunai Mental Health Association

Situation on Arrival (December 2009)

Acute unit functioning well, with team of 4 Dr’s and motivated nursing and support staff. Lacking in OT, but willing group of ‘volunteers’ delivering some recreational activities. Support from 2 PSW’s. Family members staying with clients in the unit.

Poor follow up in the community due to lack of staff (CSO’s previously funded by WHO were no longer being employed. There is one CSO for Kalmunai District. All other follow up completed by PSW’s)

Good links with local NGO’s as well as International Donor’s providing funding for activities and service development.

Plans to open rehabilitation centre in the grounds of Base Hospital Kalmunai.

Role of Volunteer

Identify needs of team based on Assessment.

It was identified that the primary focus should be on supporting staff in the opening of the rehabilitation centre. Making sure that appropriate training was given and structures put in place.

Due to primary commitment being in Batticaloa it was agreed that volunteer would attend 1-2 times weekly.

Achievements

Nursing staff and different groups of volunteer staff all participated in 3 month long programme on ‘Rehabilitation Process’. This included how to undertake client assessment, how to complete individual plans, how to provide interventions (activities) for clients based on SMART techniques, how to review clients and what should happen for effective discharge.

Staff worked with vol to develop their own documentation where needed (ie Assessment form)

Staff capacitated to use documentation in ‘VSO Guidelines of Medium Stay Rehabilitation Units’ where appropriate (ie. admission adocumentation)

Staff capacitated to use care planning documentation provided by NIMH Care Planning Volunteer where appropriate.

Staff developed ‘Mission and Vision’ for the Centre

Staff worked as a team to decide on structures and procedures (ie when documentation should be completed by, how often clients should be reviewed, who should be involved in review etc)

Staff able to demonstrate knowledge and ability in understanding holistic and client centred approaches.

‘Vasantham’ rehabilitation centre opened with all clients have their own files with appropriate documentation

Clinical meetings introduced weekly with all members of the MDT and clients taking part (clients able to express their views and wishes). Evidence of working together as a team to problem solve and support the client.

Group activities taking place daily.

Clients able to express their wishes and preferences.

Links made with the PSF to attend a clinical meeting and share the support they can provide.

Meeting held with local police, MDT and clients to discuss how to support homeless clients. Subsequent meeting held with Mother Superior in Home for the Elders, Batticaloa to see what support they could provide. Recommendations also made to Dr on how to follow up on this.

Volunteers took place in joint ‘Introduction to OT’ training, facilitated by OT in next District and vol. This exposed them to different rehabilitation centre (Mavedi Vembu) and experiences of other health professionals, this building capacity and knowledge.

Recommendations for Future

Support and commitment is needed to ensure structures stay in place (clinical meetings, group activities etc)

Staff still need further support in completing some documentation to the best of their ability (ie individual plans)

More one-to-one interventions needed (ie activities based on addressing behavioural and communication issues, rather than just activity based)

Referral and admission criteria need to be adhered to (there is a risk that the Centre will become an ‘overflow’ from the acute unit. Some staff have already voiced concern that this is happening)

Links need to be developed with PSF in order to ensure as many opportunities are available for the clients after discharge.

Maintain links with Batticaloa Team in order that staff can participate in trainings offered by vol there.

Mental Health Services in general would benefit from an increased cardre. There is no OT in Kalmunai, and with re-admission rates high, there is also a need for increased support in the Community. The staff do what they are able to do within the realms of their role, but what is really needed is Psychiatric Social Assistants, as with Batticaloa.

Conclusion

The staff at Kalmunai are incredibly motivated, empathetic and supportive of their clients. Their enthusiasm and care can be evidenced in the behavior of the clients who mostly appear happy and comfortable in their ability to express themselves freely, despite having mental health issues.

The team has worked hard to develop structures and procedures for the Vasantham Rehabilitation Centre and these plans are mostly being carried out. Some further training, or maintenance support would be beneficial in order to make sure that procedures such as Individual Treatment is being carried out to its optimum level. Commitment is needed from the whole team in order to ensure that clinical meetings continue for the benefit of the clients. It is the volunteers belief that, the commitment is there, but continued VSO support would be not only ensure this happens, but seek to capacitate an already motivated team even further.