Kalmunai Mental Health Association

Project Proposal of Mental Health Rehabilitation Unit in Kalmunai, Sri Lanka

Rehabilitation.

In Mental Health the term rehabilitation denote support and interventions for helping patients to reach and maintain their best level of functioning. This help may be provided in an in patient unit, day hospital or a rehabilitation centre. The procedures used in rehabilitation are medical, psychological, occupational, social, spiritual, income generation and residential.

We only have a 12 bedded (Male & Female) acute cubicle to serve the entire mentally ill population of the Kalmunai District. The Space is not sufficient and the maximum stay is about two weeks, otherwise we can’t help new patients. It is must to establish a Rehabilitation unit inside the hospital premises in order that we can give further support and help to people with mental illness and reduce the re-admission rates to the acute unit.

(The Secretary and the Minister of Health visited our hospital and appreciated our work in mental health. We requested them a rehabilitation unit and the minister asked our Hospital Director. He handed over the new renovated building for the purpose of rehabilitation and day care purposes of mentally ill, Director agreed, but they will provide the building and we want to fulfill other needs through well wishers).

Beneficiaries:

There are two thousand patients with chronic mental illness following clinics in Kalmunai region, Thousand out of two thousand need rehabilitation, they are not on regular medication, many of them affected by the drug side effects, poor social skill and, life skills very poor socio economic background, ( Family members, wife, kids, husband are indirectly affected by their illnesses), kids gave up their education half way through school due to poverty. Both adults and children need basic education and training in skilled work like mason work, carpentry, computer and information technology as well as horticulture.

Direct beneficiaries are thousand patients and indirect beneficiaries are four thousand of the family members.

Family members will attend to the rehabilitation unit in day time and they will be occupied there for vocational training like sewing, computer, horticulture, handicrafts, preparing food materials, as well as providing them more education, information and support on how to help their family member with a mental illness. If families are supported more then this will also reduce re-admission rates to hospital.

The following methods will use in the rehabilitation unit:

1. Medical

Most patients in rehabilitation programme require medication to control symptoms of schizophrenia and chronic affective disorders. Presently the patients in the acute cubical can remain for 2 weeks, there after they are followed up in the community. The main reason for discharge is not that these people are in good mental health but that there is inadequate space in the acute cubicle. Most of the patients are discharged without control their symptoms and no proper training in daily routine life skills, income generation activities.

Known patients’ already on medication admitted with frequent relapses due to the default and many patients has side affects of the medications. Those patients need to adjust the dosage of the drugs and many needs to switch to new drugs.

The patient’s needs minimum of one month in the rehabilitation unit.

2. Psychological

Psychological methods include supportive psychotherapy; self help groups (SHG), behavioral programme, social and life skills trainings, and Family interventions, take place during the rehabilitation.

3. Occupational Rehabilitation

Occupational therapy helps to structure the day learn new skills, increase ability, become more effective in managing essential day to day activities like washing and cooking. Through the development of individual treatment programmes Occupational Therapy can help people to function to the maximum of their ability. Group activities provide an opportunity for interaction and support from other people experiencing the same difficulties. Good results can be a source of self esteem and payment is a further incentive. Occupational therapy can prepare patients for small scale business, industrial work and working in the shops. Unemployment has increased in Sri Lanka around the world and the unskilled jobs has decreased, so that opportunities for employment for people with disabilities have fallen, for this reason rehabilitation programme we decide in horticulture, Gardening, handicrafts, cooking, mason work, carpentry, welding, cycle repair, hair style(these patients will work in appropriate places in the community during the day and night they will stay in the unit). These and other activities can provide a sense of achievement and help unemployment patients use their time constructively. (Currently we send the patients to Mavadivembu in Batticaloa for rehabilitation, family members not involved in the rehabilitation programmes in Mavedivembu, but if we start in Kalmunai the patients and the family involvement will increase)

4. Social rehabilitation

Wherever practical people with disabilities should be encouraged to join social groups attended by the general community. Those who can’t achieve this need special clubs and social centers where they can be with other people who have similar difficulties. In kalmunai we haven’t these facilities in the community. We want to take the initiative to provide those opportunities to the patients with mental disabilities. The rehabilitation unit will address those needs in future.

5. Physical rehabilitation

Most of the patients will chronic mental disorders have deterioration in their functional level to meet the day to day requiments. And the physical fitness also not satisfactory. Now we use the yoga exercises to improve their physical fitness and help to them to improve their quality of life, they can face the challenge of the side effects of the drugs by improving the physical fitness. Part of rehabilitation is through physical rehabilitation as an improvement in physical health can also bring about an improvement in mental health.

6. Alcohol and drug addictions

Following the man made disaster and the tsunami addiction and cannabis consumption increased in Sri Lanka. The government has restrictions in alcohol and smoking and it is hoped that a positive change will occur soon. The age of group 15 -45 has significant addiction, especially those who are dropouts from schools manual workers drivers farmers etc. We plan to accommodate them who need rehabilitation. Others can be occupied in day time in the rehabilitation centre through self help groups or in Alcohol Anonymous(AA).

Direct beneficiaries are 3000 -5000 in 5yrs time but the overall goal is to provide more comprehensive and holistic support to people with mental illness on a permanent basis, not just for 5 years.

MENTAL HEALTH PROMOTION;

Mental health promotion is our another goal in the region. Without proper knowledge and attitude we cannot give a good service to the public. We start slowly the task but it need very speed.

Part of the activity based in mental health promotion, raising awareness and the change the attitudes about the mental illness. We will use the common hall for that purpose in the unit. Where the training programmes will take place. We hope the training and the exposure will reduce the stigma in mental health will make it a positive out come with good awareness in mental health.

Project start:

Project will start on 1^st of January 2010 and continue indefinitely. We have doctors, nurses, social workers, attendants with government employment. There is no Occupational therapist in Kalmunai District, but we hope a permanent occupational therapist will be provided by the health ministry soon after the rehabilitation unit starts to function.

Currently we have three volunteers working in the unit as therapists and they receive a small sum of money to meet their traveling expenses.

The proposed budget estimation:

For staff incentives.

Three therapist wants to give some incentives to meet their needs for three years

3 X 7000.00 X 3 =756,000.00

For rehabilitation unit infra structure development:

Three wheeler for patients transportation	350, 000

Furniture for mental health conferences hall (chairs) 4000 X 100	*400,000*

Computers 10 with acessories (computer training) 40000X10	400,000

Sewing machines (5) 30,000X5	*150, 000*

Photo copier one	*100,000*

Tables, cupboards etc	*150,000*

Horticulture materials	*100,000*

Entertainments materials(TV, Audio sound system, Music instruments)	*100,000*

Total	*1750,000 LKR*