This document provides an overview of community mental health services in Malaysia. It discusses how mental health services have shifted from an asylum-based model to a community-based care model. The goals of community mental health programs in Malaysia are to promote positive mental health, reduce the prevalence of mental disorders through screening and intervention, and facilitate independent functioning for those with mental illness. Services provided at the community level include promotion of mental health, follow-up treatment, early detection and treatment of new cases, and psychosocial rehabilitation. The roles of medical assistants in community mental health include monitoring patients, ensuring medication compliance, and referring cases to specialists as needed.

1. COMMUNITY
MENTAL HEALTH
SERVICES IN
MALAYSIA
Disediakan Oleh : Nassruto

2. COMMUNITY MENTAL HEALTH
(CMH) CARE IN MALAYSIA
1.General Overview of Community
Mental Health Care
• Background
• Preventive Mental Health as the New Public Health
• Why we need CMH care

3. Definition of Mental
Health
Mental Health is the capacity of individuals
within groups and the environment to interact
with one another in ways that promote subjective
well-being, optimal development and use of
mental abilities (cognitive, effective and
relational) and achievement of individual and
collective goals consistent with justice
Canadian, Australia 1991
Malaysia, 1997

4. COMMUNITY MENTAL HEALTH
OVERVIEW
1. Historical
• Asylum and Psychiatric Hospitals
2. Drawback
• Repeated increase in readmission and relapse rate
• Cases lost to follow up
• Lack of family involvement
• Poor clinical outcomes
3. NEGLECTED FAR TO LONG –
WHO 2001-overall wellbeing of individuals &
societies- new understandinfg

5. MENTAL HEALTH AS PUBLIC
HEALTH CONCERN
Epidemiological studies – new understanding that burden from
mental & neurological disorders is a major health concern.
DALY- Depression – no. 4 , no. 2 in 2020
4 other mental disorders – among the 10 leading causes of lived
with disability

6. REASONS FOR ADOPTING
COMMUNITY CARE
1. Humanitarian
2. Moral
• Institutionalism (Barton,1959, Wing & Brown, 1970)
• social breakdown syndrome (Cruenberg et al,1969)
3. Economic
• 70 % Mental Health Budget
4. Scientific
• 19 - 20 studies found that alternative care are more
effective and less costly (Straw, 1982)

7. WHY WE NEED
COMMUNITY MENTAL
HEALTH CARE
• Provide a pathway to overcome widespread fear and the
stigma surrounding mental illness
• Better care for sufferers
Puckett, 1993

8. MENTAL HEALTH SERVICES
IN MALAYSIA
• Started in 1911 – Custodial Care
• Paradigm Shift (1998) – Community
Based Care
• Community Mental Health
Programme (CMHP) – 7th
MP (1996 -
2000)

9. Reasons CMHP being
integrated into General
Health Care System
• Mental Health as an essential component
of overall status in QOL
• Physical disorders mental component
• Industrialisation mental distress and mental
disorders

10. COMMUNITY MENTAL
HEALTH PROGRAM
GOALS
• To promote positive Mental Health through
life style education
• To reduce prevalence of mental disorders
through screening and intervention
• To facilitate independent functioning of
mentally ill
• To provide continuing care in the community

11. MOH HEALTH SERVICE
GOAL
1. Wellness Focus
2. Person Focus
3. Person Empowerment
4. Self Care and Self Help
5. Care closer to the home
6. Seamless, Continuous, Integrated
Care
7. Care tailored to needs of individuals
and groups
8. Affordable, effective and efficient care

12. ADMISSION
Early Discharge Program (EDP)
• assessment
• optimal Treatment
• Family Intervention Program (FIP)
Unstable cases
• f/up weekly at home
with FIP
Partially stable cases
• f/up monthly at
home with FIP
Stable cases
• f/up monthly at health
clinic with FIP
Acute Home Care
With FSG
• Hospital Team
Assertive Community
Treatment with FSG
• Hospital & Health
Psychosocial
Rehabilitation
(PSR) with FSG
• Health & Hospital
Hospital/Mental
Institution
Community
By Whom

13. REFLECTION AND ACHIEVEMENTS
NATIONAL MENTAL HEALTH POLICY
( 1998)
• Covers 9 aspects
• Followed by development of a 5 year
strategic plan of action ( 1997 – 2001)
• NATIONAL MENTAL HEALTH
FRAMEWORK(2002)

14. REFLECTION AND
ACHIEVEMENTS
2) SERVICE SCOPE AND ACTIVITIES
NMHP Policy statement :
“Comprehensive range of mental health care and
services which include promotive, preventive treatment
and rehabilitative activities”

15. SERVICES PROVIDED
(cont)
• Promotion of mental health ( HLSC- 2000, 2001 & 2003)
• Promotion of mental health
• Enhancing emotional stability in Family(
Promotion of healthy Family).
• Handling stress and controlling anger
among students age 10 –12 Years

16. SERVICES PROVIDED
(cont)
• Follow-up treatment of the stable mentally ill
• Early detection and treatment of new cases
• Defaulter tracing
• Home care treatment
• Psychosocial Rehabilitation

17. SERVICES PROVIDED
(cont)
FU Treatment of Stable Mentally Ill @
PHC
• December 2002 – 647 ( 76%)
• 20,894 attendances on F/U since 1998
• 1534 new cases seen by FMS
• Garispanduan perlaksanaan rawatan
susulan di KK( 2001)

18. SERVICES PROVIDED
(cont)
3. Psychosocial Rehabilitation
• Year 2002 – 21 implementing PSR
Success of PSR – study on effectiveness of
PSR( 2002)
- finding Full time job
- Meeting needs of client with treatment
- Lower rate of readmission in treatment group
- higher drop rate with control group
- no adverse events
- lower rate of readmission in treatment group

19. SERVICES PROVIDED
(cont)
3. CHILD & ADOLESCENT MENTAL HEALTH
• Neuroscience research has led to the concept of synaptic
plasticity which indicates that information processing within
the brain circuits through life, genes & environment are
involved in a set of interactions crucial to the development of
the personality of individual.

20. CHILD &
ADOLESCENT
MENTAL HEALTH
• This synaptic plasticity of brain cells allows a person to
change, cope and maintain the balance of the mind and
body with the environment. These studies facilitated the
development of programs that enhance & promote child
& adolescent mental health

21. REFLECTION AND
ACHIEVEMENTS
4) INFRASTRUCTURE AND MANPOWER
Manpower
• In services training and updates
- Development of training manuals
- Developments of guidelines & SOP
• Acquisition of manpower
• Alliance and Partnership
Infrastructure
• PSR Community Mental health centers

22. REFLECTION AND
ACHIEVEMENTS
6. Monitoring and Evaluation
• Process and outcome indicators inbuilt
• Quality control indicators
• Research

23. ROLE OF MEDICAL
ASSISTANTS IN THE
COMMUNITY MENTAL HEALTH
• Refer patients to higher level [hospital for
admission or to the psychiatrist, psychologist and
social workers for complicated cases]
• Ensure patients receive and take their medication
• Carry out home visiting for defaulter tracing of
patients and monitor drug compliance
• Give mental health talks to the public through the
media, seminars and community programmes
• Assist in mental health training to the other co-
workers

24. ROLE OF MEDICAL
ASSISTANTS IN THE
COMMUNITY MENTAL HEALTH
• Refer patients for rehabilitation in Day care
center and sheltered workshop
• Keep a register of patients for rehabilitation in
day care center and sheltered workshop
• Keep a register of patients with mental health
problems and mental disorders at health
center.
• Carry out quality assurance monitoring in
mental health
• Participate in mental health research

25. FUTURE DIRECTION
• Mental Health services for specific target population
• Home Care for Mentally ill
• Development of appropriate services
- supported living programs
• Social Community Rehabilitation Centers
• Inclusion of severely mentally ill as PWD

26. THANK YOU