Annual Report 2017
National Institute of Mental Health Ministry of Health - Sri Lanka
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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Annual Report 2017 Š National Institute of Mental Health, Ministry of Health, Sri Lanka National Insitute of Mental Health Mulleriyawa New Town Tel: 0112 578 234 - 7, Fax: 0112 578 238 Email: info@nimh.health.gov.lk Web: http://nimh.health.gov.lk Facebook: https://www.facebook.com/pg/NIMH.Angoda/ Printed on 100% recycled paper by Printec Establishment (Pvt) Ltd - 0112 815 816 2
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Our Vision To Lead the Nation in Mental Health Care
Our Mission To provide comprehensive and evidence based Mental Health Services appropriate to the Local Context through state of the art approaches to patient care, capacity building, advocacy, community engagement, multi-sector collaboration and research delivered by competent and reliable staff
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Contents 1. Director’s Message 1 2. Introduction 2 3. Services Offered at NIMH 3 4. Out Patient Services 4 4.1. Out Patient Department & Psychiatric Intensive Care Unit 4 4.2. Out Patient Services 5 4.2.1. Out-Patient Clinics 5 4.2.2. Dental Unit 5 4.2.3. Community Psychiatry Programme 7 4.2.4. Colombo Outreach Ambulance Service 8 4.3. Day Rehabilitation Centre 9 4.4. Day Treatment Centre (Navodaya) 11 4.5. Day ECT Centre 13 4.6. Gender Based Violence Prevention Unit 14 5. In Patient Services 16 5.1. In-Ward Care 16 5.1.1. Acute & Intermediate Care 16 5.1.2. Long Term Care 17 5.1.3. Isolation Unit 21 5.2. ECT Unit 22 5.3. Forensic Psychiatry Unit 23 5.4. Psycho-Geriatric Unit 26 5.5. Adolescent Psychiatry Unit 27 5.6. Perinatal Psychiatry Unit 28 5.7. Learning Disability Unit 29 5.8. Medical Ward 30 5.9. Nutrition Unit 31 5.10. Halfway Home - Mulleriyawa 32 6. Ancillary Services 34 6.1. Planning & Development Unit 34 6.1.1. Planning Section 34 6.1.2. Quality Management Section 34 6.1.3. Public Health Section 34 6.1.4. Disaster Management Section 35 6.1.5. Health Informatics Section 35 6.2. Infection Control 36 6.2.1. Wound Care Clinic 36 6.2.2. Hepatitis B Programme 36 6.3. Training Unit & Research Unit 37 6.4. SGNO Office 38 6.5. School of Nursing Mulleriyawa 38 6.6. Administration Department 39 6.6.1. Overseer’s Office 39 6.6.2. Diet Branch 39 6.6.3. Kitchen 39 Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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6.7. Accounts Department 39 6.8. Diagnostic Services 40 6.8.1. Laboratory 40 6.8.2. EEG 40 6.8.3. ECG 41 6.8.4. X-Ray Department 41 6.9. Pharmacy Department 42 6.10. Physiotherapy Unit 42 6.11. Occupational Therapy Department 43 6.12. Rehabilitation Centre 45 6.13. Psychiatric Social Work Unit 47 6.14. Medical Record Room 49 6.15. Other 49 6.15.1. Telephone Exchange 49 6.15.2. Drivers 49 6.15.3. Maintenance Team 49 7. Special Activities 50 7.1. World Mental Health Day 50 7.2. Special Projects& Activities 51 7.3. Staff Welfare 52 Annexure I: Cadre Details of NIMH 53 Annexure II: Research Submitted to Ethical Review Committee, NIMH 55 Annexure III: Annual Financial Report, 2016, NIMH 56 Acknowledgements 57
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Table of Figures Figure 1: Figure 2: Figure 3: Figure 4: Figure 5: Figure 6: Figure 7: Figure 8: Figure 9: Figure 10: Figure 11: Figure 12: Figure 13: Figure 14: Figure 15: Figure 16: Figure 17: Figure 18: Figure 19: Figure 20: Figure 21: Figure 22: Figure 23: Figure 24: Figure 25: Figure 26: Figure 27: Figure 28: Figure 29: Figure 30: Figure 31: Figure 32: Figure 33: Figure 34: Figure 35: Figure 36: Figure 37: Figure 38: Figure 39: Figure 40: Figure 41: Figure 42: Figure 43: Figure 44: Figure 45: Figure 46: Figure 47:
Annual OPD Visits, 2017 Annual Clinic Visits, 2017 Types of Treatment, 2017 Annual Dental Visits, 2017 Correction of teeth Annual Community Visits, 2017 Activities of Day Rehabilitation Centre, 2017 Annual Summary of DTC, 2017 Activities of Navodaya, 2017 Annual Day ECT Data, 2017 Annual GBV Incidents, 2017 Types of Incidents, 2017 Annual GBV Incidents by Age, 2017 Annual Admissions, 2016 Activities of Ward 22, 2017 Activities of Ward 27, 2017 Activities of Male Villa, 2017 New Residential Villa Annual Isolation Unit Cases, 2017 Activities of Isolation Unit, 2017 Annual ECT Clients, 2017 Annual Forensic Clinic Visits, 2017 Activities of Forensic Psychiatry Unit Annual Admission to Psycho-Geriatric Unit, 2017 Annual Admissions to Adolescent Psychiatry Unit, 2017 Annual Admissions the PPU, 2017 A renovated PPU, 2017 Annual Admissions to LDU, 2017 Annual Admission to Medical Ward, 2017 Annual Medical Clinic Visits, 2017 Activities of Nutrition Unit, 2017 Summary of Clients in HWH, 2017 Activities of HWH, 2017 Activities of PDU, 2017 Annual Laboratory Tests, 2017 Annual EEG Tests, 2017 Annual ECG Tests, 2017 Annual X-Ray Tests, 2017 Annual Summary of Pharmacy, 2017 Annual Physiotherapy Sessions, 2017 Activities of OT Department, 2017 Annual OT Sessions, 2017 Monthly Rehabilitation Centre Summary, 2017 Activities of Rehabilitation Centre, 2017 Annual Summary of PSW Activities, 2017 World Mental Health Day Activities, 2017 Special Activity Highlights, 2017 Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
1. Director’s Message It is with great happiness that I write my 3rd Director’s message for the annual report of National Institute of Mental Health (NIMH), the largest tertiary care hospital in Sri Lanka caring for patients with mental illness. Carrying on the plans set in 2015, I have been investing my time in activities which builds the knowledge, skills and attitudes of my staff as well building infrastructure for patients. I plan to make improving visibility of this great institution and its staff of one my main aims in the coming years. The year 2017 has been a busy year continuing the work of the previous years in promotion, prevention, cure and rehabilitation of people and their families affected by mental disorders. It is heartening to note the team culture that is being built in NIMH and the realization that without a combined effort we cannot succeed. The in-service training programme initiated this year now covers all types of staff and it is my hope that this will lead to better decision making and team work. Many notable events occurred in 2017. With a new focus on multi-disciplinary rehabilitation, a Rehabilitation Centre was opened. This centre will act as a coordination point for all arms of rehabilitation with the final outcome being a rehabilitated client who works independently in society. To reduce the stress levels of staff working in mental health units, a Yoga Programme was initiated under the leadership of Yoga Acharini and celebrity Mrs. Anoja Weerasinghe and I’m happy to say this has been a great success for the staff. It has now been extended to the clients as well. In addition to the key focus areas of staff training, team building and infrastructure development, there have been many highlights over the year 2017. We have seen lot of community support for ward management and community related activities such as World Mental Health Day. It’s heartening to note the appearance and functions of the Halfway Home have been greatly enhanced through many initiatives which you can read in the report further. None of these activities can be achieved without the dedication of the 1,200 full-time staff working tirelessly around the clock. Apart from the Director and Deputy Director the dedication of our Consultants and our Medical Staff, Nursing Staff, Paramedical Staff, Administrative Staff, Other Staff and as well as the Supportive Staff must be appreciated. A honorable mention should be made of Consultant Psychiatrists Dr DPD Wijesinghe and Consultant Microbiologist Dr. Rohini Wadanamby who both retired this year after many years of dedicated service. We also warmly welcome our new Consultant Psychiatrists Dr. Sajeewana Amarasinghe and Dr. L.V. Hettiarachchi. Dr. H.M.K. Wickramanayake Director, National Institute of Mental Health
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2. Introduction The National Institute of Mental Health (NIMH) was established in 1926 and it is one of the oldest hospitals in South Asia. At present, it is the largest tertiary care hospital in Sri Lanka caring for clients with mental illness. The former Mental Hospital was upgraded to a National Institute in 2008. The Half Way Home, Mulleriyawa (HWH) and the School of Nursing, Mulleriyawa are also under the administration of NIMH since 2008. The NIMH has a total of around 1500 beds and annually around 8000 clients are admitted seeking treatment for all types of mental illness. NIMH provides acute care, intermediate care and long-term care as well as specialized services. There are about 900 inward clients treated at NIMH on any given day. The NIMH is the main training center in Sri Lanka for undergraduate and post-graduate trainees in Psychiatry from Medical and allied fields, for basic and in-service training for health staff as well. All postgraduate trainees in MD psychiatry undergo a compulsory training for a minimum period of 6 months at the NIMH. The NIMH has around 1045 full-time staff. The top administration of NIMH comprises of a Director and a Deputy Director who oversee affairs via the Planning & Development Unit, Administration Department & Finance Department. As at 31st December 2017, NIMH had 76 doctors including 9 Consultant Psychiatrists, a Consultant Physician, a Consultant Microbiologist, a Consultant Hematologist, 61 Grade Medical Officers and 3 Dental Surgeons. There are 3 Special Grade Nursing Officers, 4 Ward Sisters, 268 other grade Nursing Officers, 7 Pharmacists, 6 MLTs,3 Psychiatric Social Workers, and 9 Occupational Therapists. Clinical Services at NIMH are based on the multi-disciplinary team approach. Both the outpatient services and the inpatient services are interlinked, and the service provision is done mainly through 08 General Psychiatry Units and one Forensic Psychiatric Unit. Service Recipients are divided among the 08 general psychiatry units based on the geographical location of their area of residence. Other clinical and para clinical services such as Medical Services, Laboratory Services, Dental Services, Other investigations, Physiotherapy and Nutritional Services are provided as and when requested by the main psychiatry team. All patients who are admitted are admitted under the care of a Consultant Psychiatrist and the multi-disciplinary team working under the guidance of that Consultant comprising of Medical Officers, Nursing Officers, Occupational therapists and Psychiatric Social Workers are responsible for the care of the client. Each patient admitted to NIMH is assigned a Key Medical Officer and Key Nursing Officer to coordinate his care plan. Patients with special needs such as the elderly, adolescents, those with learning disability and pregnant mothers are admitted in specialized units however the clinical care is provided based on the geographical area of residence by the relevant general psychiatry team. All admissions done by order of the Magistrate or superior courts due to criminal matters are looked after by the Forensic Psychiatric Unit. Outpatient services provided by the OPD, the Day Treatment Centre, The Gender Based Violence Prevention Unit and the Day ECT Unit are also linked to the 08 General Psychiatry Units.
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Offered at NIMH 3. Services Services Offered at NIMH
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Preliminary Care • 24 hr Emergency admissions via Psychiatric Intensive Care Unit (PICU) • 24 hr outpatient department (OPD)
Out-patient services • Day ECT facility • Day Treatment facility for minor mental illnesses • Day Rehabilitation facility • Alcohol Relapse Prevention Therapy • Gender Based Violence prevention and care • Colombo Outreach Ambulance Service • Community Mental Health Care • Continued care at NHSL and outreach clinics
In-patient care • Treatment facilities for acutely ill patients • Rehabilitation facilities - rehabiliation center, occupational therapy, horticulture therapy, ward-based activities • Psychiatric social services related to issues of clients • Physiotherapy, Laboratory, EEG, ECG and Radiography services • Isolation facility for communicable diseases • Oral health care
Specialized Care • Forensic Psychiatry care • Elderly mental health care • Care for adolescents with mental illness • Care for Pregnant and post-partum women with mental illness • Care for patients with learning disabilities • Specialized Medical Ward • Dermatology Clinic • Wound Clinic
Other Services • Postgraduate and undergraduate trainings in Psychiatry • In-service training for the staff • Promotion of ethical research in mental health • Promotion of community mental-wellbeing • Elimination of stigma
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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4. Out Patient Services 4.1. Out Patient Department & Psychiatric Intensive Care Unit Clients are admitted to NIMH via OPD, according to their permanent address. If the client hasn’t a permanent address, he or she will be admitted on a rotation method. Clients can come on their own or can be brought by their families, by police, by prison or other non-relatives. Clients are assessed by admission doctor with a nursing officer from the relevant admission ward. All admissions are entered into a computerized sheet. All discharge documents are being scanned to enter to the system at client discharge. Aggressive clients are admitted to the acute ward after managing them in PICU. Clients, who are not admitted to the hospital, are referred to a nearby psychiatric clinic. At the latter part of the year, OPD has started a new service by providing tea toclients and the relatives.
Figure 1: Annual OPD Visits, 2017
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
4.2. Out Patient Services 4.2.1. Out-Patient Clinics The general psychiatry clinics are held at National Hospital of Sri Lanka to make travel for clients easier.
Figure 2: Annual Clinic Visits, 2017
4.2.2. Dental Unit During the year 2017, our dental unit has taken one step forward by improving infection control within the dental clinic environment following the infection control training programme held in August 2017 at the Maharagama Dental Institute for dental supportive staff. This included well monitoring of the sterilization and disinfection procedures following improving their knowledge and attitude towards infection control. We aim to give much attention to improve oral health of the hospitalized clients with mental illnesses; our dental team has given more time for treating the hospitalized clients than OPD clients. We provide dental care for three wards per day, as morning and evening sessions, conducted on a roster basis. A dental surgeon now treats at the Half Way Home Mulleriyawa once a week, removing the need for referring and transporting clients to NIMH for dental treatments. Despite of the fact that the number of ward clients are less than OPD clients as depicted by the statistics, in comparison to the previous year, the number of the ward clients treated has increased. Lack of motivation, dental phobia, lack of co-operation, lack of understanding of the treatment plan, andhaving to perform treatments for several dental problems per client are the factors behind the longer treatment times for psychiatric clients.
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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Figure 3: Types of Treatment, 2017
Figure 4: Annual Dental Visits, 2017
Figure 5: Correction of teeth 6
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
4.2.3. Community Psychiatry Programme Community Psychiatry Unit (CPU) was established in 2010 and it is staffed with 4 Community Psychiatry Nurses (CPN) at present. The unit maintains a database with all the information on admissions such as client’s name, age, address, contact number, date of admission, BHT number, ward number and the respective Consultant. The place of follow-up is entered once the clients are discharged from the NIMH. This programme enables tracing defaulters, ensuring follow up and detecting new clients. The staff liaises with the Regional Directors of Health Services, Medical Officers of Health (MOH), and Medical Officers of Mental Health (MO-MH). The treatment defaulters either while on leave from in-ward care or those who have defaulted clinic visits as well as difficult clients i.e. those who do not take medication, are provided with IM Depot medication, which in turn helps to prevent repeated admissions to NIMH. In addition, new clients referred by the CPN, MOMH, Public Health Midwife or Grama Niladari also visited by the CPU team. Depending on the case, they are admitted or provided community based treatment as advised by the Consultant Psychiatrist. Sometimes the team visits the clients in the community to resolve the legal or social issues of clients.
Figure 6: Annual Community Visits, 2017
4.2.3.1. Out-Reach Clinics There are several outreach clinics conducted by the NIMH (Delgahawattha, Rajamalwaththa, Lunawa and Pannipitiya). The aim of these clinics are to follow-up the discharged clients in the community. A Consultant Psychiatrist visits and conducts these clinics once a month with the help of a Medical Officer, Community Psychiatric Nurse, a Pharmacist and a Supportive Staff member. Around 50 clients are seen per day at these clinics.
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4.2.4. Colombo Outreach Ambulance Service To extend the services given to the clients in the community, the Colombo Outreach Ambulance Service was started in the year 2013. This ensures prompt assessment and treatment of clients who are aggressive at home and difficult to be brought to the hospital using conventional transport. When the request to bring a client comes from a close relative of the client, he/she should produce adequate proof about the relationship to the client and valid information about the client’s health condition e.g. Diagnosis cards, clinic books. The client is visited by a team comprise of a Medical Officer, a Nursing Officer/Community Psychiatric Nurse, Psychiatric Social Worker and a supportive staff in an Ambulance. Initial assessment of the client’s condition and the requirement of in-ward care is decided by the respective Consultant Psychiatrist based on the information provided by the Medical Officer, Community Psychiatric Nurse and the Psychiatric Social Worker. If there is a need, help from Police, Grama Niladari and Community members are sought. After the initial assessment, if the Medical Officer decides that the client needs admission to NIMH, he/she is brought to NIMH in the same ambulance. The ambulance is sent if the client’s area of residence is within a 50km radius from NIMH. A fixed administrative fees of Rs. 1000 and a refundable deposit of Rupees 1000 are charged from the relative. Ministry of Health has given its approval for this project and the cost of visiting the client is
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
4.3. Day Rehabilitation Centre The Day Rehabilitation Service in the National Institute of Mental Health serves for people recovering from mental health problems with partially stable clinical state. People who were discharged from psychiatric services and /or followed up from the community psychiatric clinics are the frequent services users of this service. Currently, the service operates with the recovery concept which brings new meaning and hope for the client’s life and promotes a way of living satisfying and contributing life, even with the limitations caused by mental illness. Depending on client’s functional status and abilities, the clients get trained in social skills and vocational skills under structured working programme consisting of individual and group sessions. At present the service is supervised by Consultant Psychiatrist Dr. Saman Weerawardhane. It is well supported by the NIMH occupational therapy service, multidisciplinary team professionals and special volunteers and donors who give their valuable contribution for the smooth running of the service. Statistics During the year 2017, 22 clients were referred to the service from NIMH and peripheral psychiatric clinics. Group therapy sessions Two social skills training groups including 18 sessions were conducted and 12 clients were benefited. Eight people participated for two anger management groups which focused on identifying anger and training for dealing successfully with anger. Community outings A day trip was organized to Seethawaka Botanical Garden, Awissawella with the aim of facilitating clients to develop their social skills, promote positive relationships and participation in leisure. 10 clients, staff and one volunteer participated. “Nanasala” Computer Trainings Basic computer skill trainings for clients were conducted at the “Nanasala” center with the support of Occupational therapy department. One such training was successfully conducted by the planning division for the NIMH staff. Exhibitions and Sales An exhibition and sale stall was arranged at the Colombo Arcade, along with the national programme to commemorate the world health day. Beautiful sewing products, jewellery and crafts made by the clients were exhibited and sold. A mental health promotional exhibition stall was arranged in Diyatha Uyana along with mental health day celebrations organized by NIMH. Income Generation Activities • Three clients were facilitated to run small-scale business projects during the New Year season. Special loans were given to them by the NIMH and assisted by the day rehabilitation service. They run a successful business with ready-made garments, shoes, toys and other house hold items. • Clients were also busy with making and selling wesak lanterns and decorations during the wesak season on May. • We had constructive discussions with the management of Arpico and Fashion Bug to create job opportunities in their sales out outlets for the recovered clients. One client was successfully placed in the Arpico super center at Thalahena. Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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• Three clients started their work in bookshops and communication centers. • Four clients continually contributed for the soft toys project which was supported by Fashion Bug. During the year, they have supplied products worth of over Rs.100, 000. • The lunch packet selling project was also successful during the year and reached the target of selling 40 lunch packets per day. New initiatives • The clients were encouraged to engage in agricultural work along with ongoing horticulture programmes. A shramadana programme was organized to prepare new agricultural site with the support of the day treatment, horticulture, occupational therapy and rehabilitation centre staff with clients. • An out-door badminton court was built to fulfill clients physical and leisure needs. • A leaflet was prepared and distributed among wards and community psychiatric clinics. • The Sinhala and Hindu New Year was celebrated by organizing a get-together and avurudu lunch at the centre with 40 participants including clients, their guardians and staff. Consumer forum - National Institute of Mental Health 2017 was a successful year for the consumer forum. They conducted regular meetings and held the annual general meeting on September 2017 with the presence of Director NIMH, Consultant Psychiatrist and representatives from Consumer Action Network Mental Health Lanka (CANMH Lanka). They actively involved in membership promotional movements and income generation activities.
Our new leaflet
Our client creations
Our team and clients at work
NIMH Consumer Forum @ World Mental Health Day
Figure 7: Activities of Day Rehabilitation Centre, 2017 10
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
4.4. Day Treatment Centre (Navodaya) This centre has been established to give psychiatric services to outside clients. The main objective is to apply psycho-therapeutic techniques for minor mental health problems and support other mental health disorders. No of new clients No of sessions No of one day sessions No of clients prescribed medication Successfully ended clients Referred for further treatment Awareness programmes Alcohol anonymous group
213 871 41 356 15 49 05 10
Figure 8: Annual Summary of DTC, 2017 Some activities completed in 2017 include: • The official name of the Day Treatment Centre was changed to Navodaya. • An orientation programmewas held for the visiting Bangladesh nurses team. • A community mental health awareness program was held at St John’s College Nugegoda .The coordinators were Dr. Wajiramali & N/O Sunethra Weerasekara. • A weekly session on Mindfulness Therapy was done for 6 clients in the Alcohol Anonymous Group. A total of eight sessions were conducted by Dr Gamunu (SR). • Conducted Psychiatric Clinic at Health Camp at Dharmapala Vidyalaya, Pannipitiya. • An awareness program for community was held at Diyath Uyana concurring with World Mental Health Day. • An awareness program for school children was held at Navodaya Center concurring with World Mental Health Day. • An awareness program for school children was held at Kothalawala MV, Kaduwela. This was conducted by Dr Anoma (SR) & N/O Mr Bandara. • An awareness program for school children was held at Ashoka Vidyalaya, Colombo regarding substance misuse. • A health camp was held At Homagama Mawathagama Vidyalaya. This was conducted by Health Ministry. Participants Were Dr Indika, NO Mr Ruwansiri Weerasingha, NO Mrs Sunethra Weerasekara, NO Mrs MGS Malkanthi.
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Official name board changes to Navodaya
Clients at World Mental Health Day
Teaching school children at Navodaya on WMHD
Mindfulness Therapy Sessions
Teaching sessions for Bangladesh nursing students
School children on subtance abuse teaching session
Figure 9: Activities of Navodaya, 2017
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
4.5. Day ECT Centre The Out Patient Electroconvulsive Therapy Unit (OPEU) has made a large contribution to upgrade the overall client care in the community.The main focus is to minimize unnecessary admissions and keep the client with their family to enrich their mental health. This service given here is free of charge. This was established in 2014.The OPEU consists of a theatre and a ward with 2 beds. In year 2017, 60 clients were given ECT. • This service is provided from Monday to Saturday including public holiday at the OPEU. • Clients can be referred for day ECT from OPD/Clinics/Day Treatment Centre by a Consultant Psychiatrist attached to the NIMH who is responsible for the overall management of the client. • Consultant Psychiatrists’ from other institutions can refer a client to OPEU only through a NIMH Consultant Psychiatrist with a completed pre-ECT assessment form and ensuring that the client is fasting and the necessary investigations are available. • Client should arrive on or before 7.30 am accompanied by a relative who will be in close contact with the client for the next 24 hours and personal transport should be available for the client to return home after ECT. • The client’s informed consent and the concurrence of the accompanying relative is obtained. • Any client developing complications during or after ECT shall be admitted to the NIMH under the care of the referring Consultant Psychiatrists. • If a client does not comply in the next appointment for more than a week; the course is considered over unless the client or a relative correspond with the unit.
Figure 10: Annual Day ECT Data, 2017
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4.6. Gender Based Violence Prevention Unit Gender Based Violence prevention unit was ceremonially opened on 8th March in 2012 by Dr. F.R. Mehtha, WHO representative to Sri Lanka. It helped in establishing a friendly environment for survivors of gender based violence, to access services and speak freely about their problems. It also counsel perpetrators to reduce incidence of GBV and to train staff to deal with GBV survivors. The trained staff of the unit provides quality, culturally and age appropriate counseling, psychotherapy, medical, social and legal support. It also increases survivor’s safety and perpetrator’s accountability by coordinating and linking core services. One consultant Psychiatrist, one doctor, one nurse and one supportive staff member was appointed to ensure the training and functioning of the unit. There are at least one GBVP trained nurse in each ward for screening and referral to unit. Family meeting are arranged and counseling is offered by a consultant Psychiatrist or medical doctor or trained nursing officer when needed. Home visits done by the Community Psychiatric Nurses or Psychiatric social workers if needed. It has a regular Data Base Entry for GBV monitoring. In addition, training programmes were conducted for Medical, Nursing, Counseling, Psychology and university students. GBV staff conduct awareness raising workshop at institutional and community level. Some of the activities carried out in 2017 include: • A GBV awareness raising programme was conducted for group of Bangladesh staff at NIMH. • An awareness programme titled “Domestic Violence & Mental health” was conducted at bank of Sanasa Development- Godigama. 300 women participated. • An awareness workshop on “GBV and Maternal Health Issues” was conducted for Doctors, Nurses, Psychiatric Social Workers and Journalists at National Institute of Mental Health. • A “GBV and Mental Health Issues” awareness raising programme was held for staff of Department of Inland Revenue was conducted while distributing items for residents at Half Way Home,Mulleriyawa. • A Hurt, Insult, Threat and Scream (HITS) study was conducted at the Thalangama District Hospital with the team of Psychiatrist, Medical Officer, Psychiatric Social Workers and Psychologist. Information was gathered from the seventy five in the study group. • An awareness raising GBV programme was conducted for staff at Ministry of Social Services. Overall seventy five people participated. • The unit conducted a three days in-service workshop to improve the knowledge regarding ”Legal aspect of sexual harassment in work place”. • Lectures on “legal aspect of domestic violence” and “causes and effect of GBV” was conducted for the nursing officers at NIMH. 40 nurses participated. • A “Sexual Harassment Awareness Raising Programme” was conducted for all staff and caretakers of clients at Athurugiriya District Hospital. • An awareness programme on “Suicidal Prevention and GBV” was conducted for all staff at the Thalangama District Hospital. • The unit conducted a one day workshop to improve the knowledge regarding prevention of work place sexual harassment for all staff at NIMH in commemoration of the International day for “Elimination of Violence again Women”. Overall 100 staff members participated. During the year of 2017, a total number of 244 Clients were registered and out of them 134 were females and 110 were males. The main problem identified was domestic violence. In addition limited financial resources, psychological harassment, unidentified underlying psychotic disorder, and consuming alcohol (which involved intimate partner and domestic violence) were identified. 92 clients were referred by wards and OPD in NIMH, 86 clients were referred by the outside (community). 30 clients were referred by Police Station of Mulleriyawa, NHSL, Nawagamuwa & Thalangama clinics. There were 04 clients referred by the Women in Need. The clients have made 912 follow-up visits by the end of this year. The unit has conducted 420 family meetings. 14
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
The Prevention of Child Maltreatment Unit had a total number of 19 clients registered from adolescence admissions in 2017. Of them, the main problems wereconductive disorder, psychotic problems, substance abuse, and poor school performance.
Figure 11: Annual GBV Incidents, 2017
Figure 12: Types of Incidents, 2017
Figure 13: Annual GBV Incidents by Age, 2017
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5. In Patient Services 5.1. In-Ward Care 5.1.1. Acute & Intermediate Care The hospital has acute, combined, and intermediate care facilities which are distributed as 6 acute wards, 4 combined wards and 6 intermediate wards. The stay in the acute/combined wards is usually limited to 30 days. If the treating team decides that the clients can be managed in the society, he/she will be discharged directly from the acute/combined care ward. If that client needs further treatment and rehabilitation, they will be transferred to an Intermediate care ward. However, if the client becomes violent and restless again while in an Intermediate Care ward, he/she maybe transferred back to the acute care ward for further management. Each ward has a multi-disciplinary team (MDT) consisting of a Consultant Psychiatrist, Senior Registrar, Registrars, Medical Officers, Nursing Officers, Psychiatric Social Workers, Occupational Therapist and supportive staff. Nearly the same MDT team treats the client whether the client is in acute care or intermediate care wards and in follow up care.
Figure 14: Annual Admissions, 2016
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
5.1.2. Long Term Care Ward 22 With the theme ‘Home feel environment to the client�, Ward 22 has many regular activities for its 68 clients which is manned by 1 Medical Officer, 8 Nursing Officers and 10 Health Assistants. Every 3rd week of the month, clients have an activity for maintaining their personal hygiene.Every day around 15 clients are sent to Occupational Therapy Unit for art therapy, music therapy, meditation, and making flowerpots. Around 07 clientsare sent to horticulture unit for planting, cultivating the vegetable patch and garden cleaning. In ward clients participate in religious activities in the morning and evening every day. Bed ridden clients are given total nursing care. Clients are trained to become independent on certain daily living activities. In year 2017, Ward 22 underwent a major renovation by re-painting and tiling with the financial aid of Rev. Kelaniye Attadassi Thero and reopened after repairs on International Mental Health Day (10th October 2017) followed by an Almsgiving. Speaker of Parliament Hon. Karu Jayasuriya was the chief guest accompanied by HE Thilina Wewelpanawa at the reopening ceremony.
Ward Activities
Horticulture Therapy
Opening ceremony of refurbished ward
The refurbished ward
Figure 15: Activities of Ward 22, 2017
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Under the theme “Home feel environment”, Ward 27 33 clientsare attended to by 1 medical officer, 7 nursing staff and 9 health assistants. Clients are free to have a walk outside the ward and within the hospital area. The main aim is to rehabilitate these clients by engaging in daily living activities on their own. Ward 27
Aside from the bed bound clients, there are about 15 clients who are routinely engaged in horticulture which Under thetotheme “Home feel environment” 33 clients are attended to byto1 pay medical officer, 7 nursing is attached the ward. Income from the horticulture project is spent salaries to the clients, deposit staff and 9 health assistants. Clients are free to have a walk outside the ward and within the hospital
in the bank clients, buying refreshments to the clients such as biscuits tea, buying area. The accounts main aim of is tothe rehabilitate these clients by engaging in daily living activities on theirand own. garden requirements such as fertilizers and seeds, use for recreational activities such as going on
Aside from the bed bound clients, there are about 15 clients who are routinely engaged in horticulture pilgrimages, picnics, and some amount the crops is allocated for the clients. make herbal which is attached to the ward. Incomeoffrom the horticulture project is spent to They pay salaries to the porridge, clients, deposit in the bank accounts of the clients, buying refreshments to the clients such as biscuits fruitand salad,manioc jackrequirements fruits curry et cetera. tea, buying and garden such as fertilizers and seeds, use for recreational activities such as going on pilgrimages, picnics, and some amount of the crops is allocated for the clients. They make herbal porridge, fruit salad, manioc and jack fruits curry et cetera.
Others are dealing with some occupational therapy activities at occupational therapy unit. In the afternoon
Others are dealing with some occupational therapy activities at occupational therapy unit. In the these clientsengage in some rehabilitative activities such as cooking, art therapy, and music therapy. Some afternoon these clientsengage in some rehabilitative activities such as cooking, art therapy, and music
therapy. Some the clientsthe were attending the Yoga meditationwhich programme which by is conducted by of the clients wereofattending Yoga meditation programme is conducted the rehabilitation unit the rehabilitation unit at NIMH.One client is a member of the hospital cleaning service.
at NIMH.One client is a member of the hospital cleaning service.
Horticulture Therapy Horticulture Therapy
WardWard based activities based
Year celebrations NewNew Year celebrations
Vesak c elebrations
activities
Vesak c elebrations
Figure Figure 16: Activities of Ward 27,27,2017 16: Activities of Ward 2017 Some of the highlights of the year include: • In January, all the clients and ward staff celebrated the start of the new year with a small ceremony, • In April, clients attended to the New Year festival which was organized by NIMH &achieved victory in some events. • In May, clients were engaged in making Vesak lanterns for sale & decoration. Buddhist clients observed ‘Sil’. In addition clients went on a guided visit to Vesak Thorana and Dansal in Colombo.
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• • • •
The clients had a vegetable stall on the Public Day of the International Mental Health Day. The clients participated in the Christmas celebrations in the hospital during Christmas season. The garden outside of the ward is well maintained by the clients withnew colorful flower pots. Fruits and vegetable plants were planted by university students.
Male Villas The Male Villas is a paid long term stay which charges a nominal fee. Some of the highlights of 2017: • Annual Villas Day was celebrated on 2017-6-17. This was organized by the Guardians Association of Villas and was presided by Director, hospital staff, family members, and other invitees. Events such as dancing & singing were held on that day. Lunch, snacks & prizes were given to the clients. • Shifting of the Male Villas occurred on 2017-12-03. Ward staff and patients were shifted to new premises with all the medical, surgical items and all the other utilities. • Christmas Carol Programme was organized by the Guardians Association of Villas on 2017-1214. The function was held on ground of villas. Staff of Occupational Therapy Unit and patients of other wards also attended this programme. Snacks and drinks were arranged and supplied by the Guardians Association of Villas. • A Musical Event was held on 2017-09-02 at the Bishop College Auditorium. Mrs. D.N Sooriyaarachchi invited all the clients and staff to participate in that event. Transport facilities, tickets and snacks were arranged and supplied by her.
Villa’s Day
Musical Event
Christmas Celebrations
Christmas Celebrations
Figure 17: Activities of Male Villa, 2017
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Female Villas
Figure 18: New Residential Villa The Female Villas is a paid long term stay which charges a nominal fee. The main highlight of the year 2017 was the construction of a new residential villa. On 11th of December 2017, a residential villa for female clients was built as a donation worth Rs.8 Million by Mr. & Mrs. Lal Perera and their daughter Miss. Manisha Perera. It was declared open by the Speaker of Sri Lanka Parliament Hon. Karu Jayasuriya. The Minister of Health Hon Dr. Rajitha Senarathna and Minister of Justice and Foreign Affairs Hon.Thalatha Athukorala graced the occasion. Many magnanimous donations given in cash and kind by friends and relatives of clients also helped to make this donor driven project a reality.
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5.1.3. Isolation Unit The Isolation unit consists of 04 separate rooms with 11 beds and is supervised by the Consultant Microbiologist in coordination with the ICNO and psychiatric teams. During the year 2017, 285clients were admitted to this unit. Protective isolation and source isolation has been provided for all the clients.
Figure 19: Annual Isolation Unit Cases, 2017
Attending to a client
Newly refurbished Isolation Unit
Figure 20: Activities of Isolation Unit, 2017
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5.2. ECT Unit The unit consists of a mini theatre and 20 bedded ward in 2017. ECTs were given to a total of 10458 clients in 2017. A card system is in place to give a better client care for the in-wardclients. It limits the routine ECTs given per day to maximum of 45 and the system was functioning well in 2017. It increased the reserved treatment and carrying time of each clientand it has helped to reduce the unnecessary incidents happening due to overcrowding. The ECT unit has made a significant contribution to overall clientcare of NIMH.
Figure 21: Annual ECT Clients, 2017
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5.3. Forensic Psychiatry Unit FORENSIC PSYCHIATRY UNIT Forensic Psychiatry Unit is the largest specialized unit of NIMH. It consists of two wards (male and female), a rehabilitation unit, a horticulture area and a set of outreach clinics held at the Welikada prison complex, the National Hospital of Sri Lanka (NHSL), Institute of Legal Medicine and Toxicology and the detention home for male adolescents at Makola. The bed strengths of wards 21 (male) and 25 (female) are 103 and 24 respectively. Dr. T.S.S. Mendis was the Consultant Forensic Psychiatrist in charge of the service. Dr. L.V. Hettiarachchi, Consultant Forensic Psychiatrist, took over the unit in August 2017. The Forensic Psychiatry team consists of Senior Registrars, Medical Officers, Occupational Therapist and a Psychiatric Social Worker. Around 20 registrars in Psychiatry worked in the unit on three-month rotation as part of their training. Around 25 nursing officers and 25 supportive staff members are working in the two wards and the rehabilitation unit. An outreach clinic is held every Wednesday at room 22, NHSL, for out-patients with issues related to Forensic Psychiatry. The clinic receives referrals from District Courts, Magistrate Courts, Police, Non-Government Organizations (NGOs) and the general Medical and Surgical wards in NHSL. Another outreach clinic is held at the Institute of Forensic Medicine and Toxicology in order to assess the patients referred by the Judicial Medical Officers (JMOs) every Tuesday. A Psychiatric liaison service is provided to the Prison Hospital Welikada Colombo and four outpatient clinics are held every Monday and Wednesday by the multidisciplinary team. The team conducts assessments, provide treatment and court reports for prison inmates. With the support of the adolescent unit of NIMH, the Forensic Psychiatry service of NIMH conducts a clinic for inmates at the detention home for male adolescents at Makola. Under the Community Forensic Psychiatry Initiative regular visits were made to prevent reoffending and clinical relapses and identified several high-risk patients discharged from the courts in close by areas. The Forensic Psychiatry Service of the NIMH commenced a “Legal aid clinic” with technical support of the Legal Aid Commission of Sri Lanka in September 2017,in order to provide legal aid for persons with psycho-social disabilities in need. The Legal Aid Commission and the NIMH working together to provide necessary legal support for the persons who have to stay in the hospital for a long time due to unavailability of legal support, legal illiteracy and poor family support. During 2017, the unit has issued 453 court reports regarding inward patients, 496 reports through the Prison Hospital, 214 reports at the Institute of Forensic Medicine and 141 reports through the out patients’ clinic at the NHSL. Scene of crime visits and home visits were also conducted. These were donein order to gather information on alleged crimes, their circumstances, about the offenders and the victims. During these visits, the team visited relevant places such as the local hospitals and Police stations and interviewed scene of crime officers (SOCO) and villagers in order to gather further information. FORENSIC PSYCHIATRY RESOURCE CENTER (FPRC) Forensic Psychiatry Resource Center was established in 2013 in order to coordinate the Forensic Psychiatry service by keeping forensic records, coordinating outreach clinics, arranging trainings and providing necessary information for the trainees and the other health professionals when necessary. The FPRC conducted liaison with prison medical officers and regional psychiatrists in order to provide Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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necessary information in relation to Forensic Psychiatry, via its official email nimhforensic@hotmail.com Forensic Psychiatry Resource Center, along with the Legal Aids Commission and the Sri Lanka College of Psychiatrists organized a continuous professional development programme for the Consultant Psychiatrists and MD trainees on Forensic Psychiatry in 2017. VISITORS’ BOARD Visitors’ Board is held under the chapter 31 of the penal code act no 15 of 1979, for mentally ill patients with major criminal charges who were not fit enough to plea for a long time. The board comprise of representatives of Secretary - Ministry of Justice, Secretary – Ministry of Health, Commissioner of Prison and a Consultant Psychiatrist. Visitors’ board meetings were held on 4 occasions in 2017 for which mentally ill offenders were produced and were released, counting to 101 since 2010. FORENSIC PSYCHIATRY REHABILITATION UNIT (FPRU) Forensic Psychiatry Rehabilitation Unit (FPRU), opened in 2010 is the only such facility in Sri Lanka. A structured rehabilitation programme is conducted by the unit. FPRU provides its service for around 50 patients a day. Individual assessments are conducted by the Occupational Therapist attached to the unit. One nursing sister, two nursing officers and three supportive staff members were in service at the unit in year 2017. OPEN SCHOOL Open school is one of the major programmes held in the FPRU. It is an educational programme conducted by National Institute of Education (NIE) in collaboration with NIMH since February 2012. It helps individuals to get formal education through activities and lessons under the guidance of welltrained school teachers. Open school sessions are held on every Thursday. Around 40 sessions were held in 2017 and around 40 to 50 people attended each session. ACTIVITY PROGRAMME A structured activity programme is conducted by the FPRU and it includes creative therapies such as arts, music, drama and narrative therapy, training on work skills such as making softtoys and greeting cards, training on Activities of Daily Living (ADL) such as cookery and selfcare activities and indoor/outdoor sports such as volleyball, cricket, carom and darts. SPECIAL EVENTS FPRU celebrates the national events with the inmates of the unit every year as part of their rehabilitation. The aim of celebrating these events is to connect the inmates to their cultures instead of being isolated in an institution. Sinhala and Tamil New Year, Vesak, Christmas,Thaipongal and other cultural events were celebrated in 2017 as usual.
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Figure 22: Annual Forensic Clinic Visits, 2017
Multi-disciplinary meeting with a client
Rehabilitation
Figure 23: Activities of Forensic Psychiatry Unit
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5.4. Psycho-Geriatric Unit The Psycho-Geriatric Unit includes ward numbers 17 (male) and 20 (female). Each ward has a capacity of twenty to be admitted at once for treatment purposes. Total nursing care is being given for ADL/IADL dependent patients everyday by nursing staff of the ward. There are two Consultant Psychiatrists especially trained for this unit. Clients with Dementia are treated from all over the country. Work that has been done throughout the year includes: • Twice weekly Psycho Geriatric workshop done at Ward 17 lecture hall organized by consultant psychiatrist Dr. Kapila Ranasinghe. Topics covered ranged from traumatic brain injury to comprehensive geriatric assessment. • Caregivers meeting was conducted by Dr Pushpa Ranasinghe of Ward 20. • Regular lectures are held for 6 month Psychiatric trainee nurses, staff nurses and nursing students on Dementia nursing care by Nurse-In-Charge Mr Wickramasinghe of Ward 17 as well as staff of Ward 20. • A four bedded High Dependency Unit was established in Ward 20. • Clients are encouraged to participate in religious activities.
Figure 24: Annual Admission to Psycho-Geriatric Unit, 2017
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5.5. Adolescent Psychiatry Unit Established in 2015, The Adolescent Psychiatry Unit is the first ever unit specifically designed for the adolescent clients in Sri Lanka. Clients, both males and females, below 18 years are admitted to the unit under the care of the Consultant Psychiatrists.The respective teams take the responsibility of the clinical care of the client. The staff consists of 7 nurses and 7 supportive staff members. The unit has 6 rooms with inward facilities for 12 clients including library facilities and facilities for engaging in sports, learning and playing. Rehabilitative activities which are carried out ardrawing, hand crafting and music.
Figure 25: Annual Admissions to Adolescent Psychiatry Unit, 2017
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5.6. Perinatal Psychiatry Unit Established in 2007, The Perinatal Psychiatry Unit (PPU) in NIMH is the first ever unit established in South East Asia. The unit provides specialized care for women who develop psychiatric illnesses during pregnancy or following child birth. The unit allows not only the mother and the babybut family members are also allowed to stay with the client. The unit has 8 rooms. Each room comprises of 3 beds each for the client, the baby and the care giver. • In 2017 there were 109 admissions of pregnant and post-partum mothers and104 babies. • These admissions included 46 transfers from D.M.H, C.S.H.W, N.H.S.L (WD 59), L.R.H, BH Homagama, BH Horana, GH Anuradhapura, BH Moratuwa, DGH Negombo, BH Biyagama, TH Kegalle, BH Awissawelle, GH Kalutara, BH Karawanelle, GH Hambanthota, BH Marawila, BH Embilipitiya, GH Badulla, PH Welikada and BH Mulleriyawa.
Figure 26: Annual Admissions the PPU, 2017
Figure 27: A renovated PPU, 2017
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5.7. Learning Disability Unit This was established in 2008.The Learning Disability Unit or LDU aims to rehabilitate clients with learning disability and associated behavioral problems by training and educating their parents, guardians on rehabilitation skills to provide care for clients with special needs. In the unit, there are 6 rooms to accommodate clients individually.Clients are under the care of all Consultant Psychiatrists and the medical team. The unit encourages a care giver to stay with the client.Clients are admitted to the LDU as a direct admission or transferred from other acute wards. Psychiatric social workers help to solve client’s family problems. Some clients are referred to the occupational therapy unit for special programmes and volunteers also help clients to do various leisure activities. Clients are daily reviewed by a doctor. Clients are trained on activities of daily living according to a time table such as mouth care, bathing, table manners, dressing, toilet training and improving interpersonal relationships. Some special activities include: • Cognitive development programmes conducted include drawing, playing carrom, work book activities, and creative activities such as playing with building blocks. • Entertainment Programmes such as listening to radio, playing as a group, and singing. • Programmes to improve life skills of parents and bystanders such as lectures about learning disability and discussions on how children with learning disability should looked after at home.
Figure 28: Annual Admissions to LDU, 2017
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5.8. Medical Ward Medical ward was established in the year 2005 under a Consultant Physician. The aim of the Medical unit is to provide specialized medical care to the inward psychiatric clients with co-morbidities. There are separate male and female sections with a total of 20 beds. In addition to the ward, a separate medical clinic is held for 6 days of the week, to attend to referrals from psychiatric units. The Medical ward is well equipped for an emergency management; with a specialized Physiotherapy Unit and Nutrition Unit. During year 2016 there were 599 admissions and 4899 clinic clientswere seen in the medical wards. Out of them 61 were transferred to other tertiary care hospitals for further management.
Figure 29: Annual Admission to Medical Ward, 2017
Figure 30: Annual Medical Clinic Visits, 2017
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
5.9. Nutrition Unit Established in 2016, The Nutrition Unit of NIMH aims to improve the nutrition care for patients at NIMH and to contribute towards uplifting the field of psychiatry nutrition in Sri Lanka. Some of the highlights of 2017: • NIMH became the first government hospital in Sri Lanka to start a 31 days menu. It improved the nutritional quality and acceptance of diet among patients. A similar 31 day diabetic diet is to be commenced in January 2018. Similar modifications are to be introduced for other special diets as well. • In collaboration with all the stakeholders, raw food delivery from suppliers were systematized to enhance the quality of raw food. • The Nutrition Unit provided technical guidance (machinery, skill development) for kitchen to improve the hygiene, efficiency and quality of cooked food. • Food trolleys were introduced for appropriate food delivery to wards. A universal food measuring system was commenced in all the wards to provide food in appropriate portion sizes. • Nutrition Care Circle was formulated in the hospital encompassing all the categoriesinvolved in nutrition delivery - Nutrition Unit, Medical officers, Nursing Staff, Diet Branch and Supportive staff. A total of 15 workshops were held for all these categories which had an immense impact in improving the nutrition care. These ongoing care circle programs are being held monthly and new issues are being addressed. • In December, The Nutrition Unit conducted a public food demonstration focused on Psychiatry nutrition.
With Hon. Minister of Health @ WMHD ‘17
31 Days Food Menu
Universal Food Measuring System
Figure 31: Activities of Nutrition Unit, 2017
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5.10. Halfway Home - Mulleriyawa Half-Way Home (HWH) Mulleriyawa has female residents with chronic mental illness and different functional capacities originating from all over the country. Almost one third of women are fit to be discharged and would be able to live and work outside the HWH if given the right environment and opportunities. Some of the highlights of 2017 are: • Pirith Ceremony - An all-night Pirith chanting ceremony was held at Half Way Home Mulleriyawa on the 10th of March in view of commemorating Women’s Day 2017. A colorful “Perahera” was also organized prior to Pirithchanting ceremony.It was held under the patronage of the Director, NIMH. It was followed by an alms giving on the 11th of March. • New Year Festival - The annual New Year Festival for 2017 was held on the 8th of March. It was sponsored by UNESCO club of Royal College, Colombo. The Chief Guest was Mr. B.A. Abeyrathna, Principal - Royal College. Some of the teachers, students of the UNESCO club and few parents participated. Director, Deputy Director and Consultant Psychiatrists, and some SeniorStaff members from NIMH also participated. • Renovation of Ward 01 - Ward 01 is one of the acute wards. Most of the residents are dependent on the staff for Activities of Daily Living due to age related physical weaknesses or mental illnesses. With the view of improving their quality of life and facilitate mobility and physical activity, Ward 01 and its surrounding garden was renovated bytiling the floor, fixing a sound system, and building up a concrete boundary fence around the ward & garden. This was funded by Ward 01’s permanent donor, The Lay Missionary Association of Our Lady of Fatima. • Renovation of Ward 10 - Ward 10 is one of the rehabilitation wards. This ward was renovated with the view to make it a more homely environment. The renovation included tiling the floor, dividing bed area in to cubicles with short walls to represent bed rooms, replacing old windows and window frames with modern type aluminum windows and window frames, and adding extension to Nurse’s duty room to facilitate ward observation easily. It was funded by Hatton National Bank. Total number of residents at the beginning of 2017 New admissions Deaths Discharges Figure 32: Summary of Clients in HWH, 2017
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433 42 8 29
Pirith Ceremony
New Year Festival
Renovation of Ward 01
Renovation of Ward 10 Figure 33: Activities of HWH, 2017 Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
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6. Ancillary Services 6.1. Planning & Development Unit The Planning and Development Unit of NIMH was inaugurated in 2016 at NIMH and declared open on 10.06.2016 by the Deputy Director General – Medical Services I of the Ministry of Health. The PDU was opened based on the Ministry of Health General Circular 02-88/2015. It consists of Planning Section, Quality Management Section, Public Health Section, Disaster Management Section, Health Informatics Section, & Media Coordination Section.
6.1.1. Planning Section NIMH PDU Planning Section was established to strengthen the Director in ensuring all Ministry requirements in Planning and Project Management were met. The Annual Action Plans and Hospital Master Plan Implementation were initiated.
6.1.2. Quality Management Section The Quality Management Section of the NIMH, PDU coordinated all the Quality Management activities in NIMH. All data surveillance of clinical events and adverse events reporting was monitored by the Quality Management Section. Coordination of the Clinical Governance Meetings was also done by the Quality Management Section with able assistance of the Health Informatics Section. In the year 2017, 5 Clinical Governance Meetings were conducted. Periodical data was sent to the Ministry of Health Healthcare Quality Secretariat as per the ministry requirement. The Ministry guidelines on areas of development in Quality were implemented.
6.1.3. Public Health Section The Public Health Section has provided services and coordinated activities in year 2017. Some of them were as follows, 1. Liaised with cleaning service providers and supervised the general cleanliness of the hospital premises. Conducted training programmes for cleaning service staff liaising with the infection control nursing officers. 2. Supervision of the waste disposal system and the sewerage system. An action plan and budget estimation was prepared and processed to repair the existing drainage system, sewer lines and manholes in aid with Sri Lanka health sector development project/world bank funds. 3. Carried out infection control activities in liaising with infection control nursing officers. Conducted infection control monthly meetings by liaising nurse. 4. Assisted in providing safe water to the Institution by performing tests to check the quality of drinking water sources liaising with PHI. 5. Monitor the cleanliness of the kitchen and sanitation of the kitchen staff. Liaised with Public Health Inspector in performing tests to check the quality of food. 6. Liaised with Public Health Inspector in preventive activities such as identification of dengue breeding sites, fogging activities, control flies, control bed bugs and other entomological issues. 7. Health education to the staff and outsiders. Conducted an awareness programme on healthcare waste management to the staff.
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8. Providing technical supervision and coordination for the activities of Infection control nursing officers and Public Health Inspector. 9. Environmental improvement was continued through activities in Haritha Mithuru Kawaya and by initiating a landscape project for the front area of hospital premises. Planted trees at the hospital premises for the “Wanaropa” programme. 10. This unit provides information for Injury surveillance as per Ministry of Health NCD unit guidelines.
6.1.4. Disaster Management Section Disaster Management section is attached to the Planning Unit and in action for 2 years. The section runs with a Medical Officer; Disaster Management who is the focal point for the institution. The Disaster management activities carried out for year 2017 are: • Active participation in Disaster Relief activities in National Disasters namely; in Meethotamulla Garbage collapse in April and Floods in May. Disaster Management section was coordinating all the relief activities and was dispatching medical relief teams as well as Psycho Social First aid teams. • In Meethotamulla Garbage Collapse; as it was a sudden major disaster the impact on psycho social well being was high. Therefore, National Institute of Mental Health had a big responsibility in providing Psycho Social First Aid to the victims. Dr. Mrs. Pushpa Ranasinghe; Consultant Psychiatrist who is in charge of the Kolonnawa area headed the teams and participated enthusiastically in person forscreening Post Traumatic Psychological Disturbances and Psycho Social First Aid. Follow up of those victims were done and necessary interventions were done by the teams. • In major floods in May which affected several districts, had a great demand of medical relief teams; Disaster Management section coordinated the teams headed by one or two Medical Officers to affected areas with emergency treatment measures. We could dispatch a medical relief team to a distant area in Udugama in Galle district where there was a huge impact and in need of medical care. • Our institution was in an urgent need of fire safety measures which we could fulfill in 2017. Fire extinguishers were installed to meet the need of entire institutional premises as well as the Halfway Home premises. Staffs of both premises were trained for the importance of Fire safety measures and the use of fire extinguishers with practical sessions. • Emergency sign boards were installed in all the buildings indicating emergency exits and directions. • As the next project of disaster preparedness, Hazardous areas of institutional premises were identified and demarcated with adhesive tapes.
6.1.5. Health Informatics Section The Health Informatics Section of PDU, NIMH is responsible for all data needs of NIMH. The work of this section entails: Routine • eIMMR System • Admission Record Information System • Gender Based Violence Information System • HRMIS (Human Resource Management for Medical Officers) • HRIS (Human Resource Information System for All Staff) New Innovations • Relaunch of website www.nimh.health.gov.lk • Converting all Midnight Summary data from paper based format to digital format
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The information gathered from these systems were used both at local and central level for decision making and planning. During the year 2017 the Unit contributed to compile the Annual Report and Clinical Governance Data.
Calling for volunteers via social media
Fire Extinguisher Training
Visit of Hon. Minister of Health
Training of cleaning service
Figure 34: Activities of PDU, 2017
6.2. Infection Control The Consultant Microbiologist supervises the work of the Infection Control Nurses (ICNO). The ICNO carried out daily ward rounds according to the Infection control checklist and supervision in related to out-breaks, general hygiene, hand washing practice and waste management. The ICNO coordinates with the Psychiatric team and Consultant Microbiologist. Liaisons nurse meetings were held once a month giving an opportunity to discuss issues related to Infection Control. Health education programmes were carried out for staff including cleaning service, infection control and waste management. Waste management A new waste bin was introduced for discarding dirty polythene which are collected by visitors of patients in each ward
6.2.1. Wound Care Clinic The wound care clinic, started in January 2012 and it is conducted every Friday morning by the Consultant Microbiologist. During the year 2017, 87 referrals were received from the wards of NIMH and HWH Mulleriyawa.
6.2.2. Hepatitis B Programme This programme was started in 2011 under the guidance of the Consultant Microbiologist. First the patients in the long term care wards and the hospital staff were vaccinated against Hepatitis B and tested for Hepatitis B antibodies under this programme. Under the second phase of the programme patients in the acute and intermediate care wards were vaccinated against Hepatitis B. In the year 2017, 148 patients and 20 newly recruited staff members were vaccinated for Hepatitis B. 36
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
6.3. Training Unit & Research Unit In the year 2017 the Training Unit was responsible for the following teaching/learning activities: • • • • • • • • • • • • • • • • • • • • •
Post Graduate training for Registrars and diploma trainees in Psychiatry. 6 weeks training programme for Medical officers of Mental Health(MOMH) Training programme on Psychiatric emergencies for the Preintern Medical Officers 1 day workshop on Psycho geriatrics for the Doctors of NIMH 2 weeks clinical training for 3rd year medical students of University of Colombo 1 week clinical training for the 3rd year medical students of University of Sri Jayewardenepura 2 days training for the final year medical students of University of Kelaniya. 1 month clinical training for BSc nursing students of University of Ruhuna 1 month clinical training for BSc nursing students of Eastern University 1 month clinical training for BSc nursing students of Kothalawala Defence University followed with a clinical examination 6 weeks elective Psychiatric training for the BSc nursing students of University of Sri Jayewardenepura 1 day workshop on Psychogeriatrics for the Nurses of NIMH 5 weeks each clinical training for the student nurses of each Nurses training Schools (NTS) in Sri Lanka followed with a viva voce examination. 2 weeks Psychiatry training programme for the student nurses of Lanka Hospital 12 In-Service training programmes (each programme consist of 3 days) conducted in each month of 2017 for the Nursing staff and Supportive staff Training programme on Skills development and violence prevention for the supportive staff of NIMH 5 days workshop on mindfulness based cognitive behavioral therapy for the staff of NIMH Yoga programme for the doctors, Nurses and clients of NIMH. 1 day workshop on Psycho pharmacology 1 day workshop on prevention of violence and human made disasters. 2 days training programme for the students of Paali & Buddhist University
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6.4. SGNO Office The Special Grade Nursing Officer (SGNO) Office is the central coordination point for all the nursing activities in NIMH. There are two SGNO offices. The male SGNO office is located near the entrance and the female SGNO office is located near the Villas. These offices look after all administrative, training, and research activities related to nursing staff throughout the year.
6.5. School of Nursing Mulleriyawa School of Nursing, Mulleriyawa is the specialized institution of nursing education for mental health and Psychiatric Nurse Training programme for student nurses and staff nurses in various government hospitals in the country. The academic staff consists of the Principal, two Special Grade Nursing Officers, four grade one nursing tutors and one clinical instructor. All the academic staffs are qualified with BSc Nursing. Hostel facilities are available for 150 students. The trainees obtain clinical experience at National Institute of Mental Health (NIMH), Angoda and Halfway Home, Mulleriyawa. This programme is conducted for student nurses for five weeks period, who are attached to government nursing institutions all over the country during the second and third year of their three year nursing diploma programme. Nearly 2000 students were trained during the year 2017 from Schools of Nursing in Ampara, Anuradhapura, Badulla, Batticaloa, Colombo, Galle, Hambantota, Jaffna, Kandana, Kandy, Kalutara, Kurunegala, Matara, Military School of Nursing (Anuradhapura), National School of Nursing Sri Jayewardenepura, Rathnapura and Vavuniya. Some activities include: • All nursing officers conducted health education programmes for clients in NIMH during their training period. • All the groups of student nurses and nursing officers organized a concert for clients at Halfway Home, Mulleriyawa as a recreational therapy at the end of their training period. • Vesak and Christmas festivals were celebrated by nursing students with clients in Halfway Home, Mulleriyawa. • Special Mental Health and Psychiatric Nursing Programme were conducted for nursing officers. • Student nurses participated to all the activities of World Mental Health Day programme at NIMH.
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6.6. Administrative Department The Administrative Department is the main administrative arm to the Director. Under the guidance of the Director and Administrative Officer, the Administrative Department is responsible for all personnel files, planning of infrastructure, management of utilities, and preparation of administrative reports.
6.6.1. Overseer’s Office The overseer office plays the main coordinating role for all the supportive staff in the hospital. The team consists of 1 overseer, 8 assistants and 1 supportive staff.
6.6.2. Diet Branch The diet branch plays a facilitator’s role in organizing the diet orders from all the ward and units. There are 3 clerks in the diet branch for receiving the diet, making documents of patients and receiving rail warrants of patients. The diet branch coordinates the food requirements of 29 wards. Some of the highlights of 2017 are: 1. A delicious and nutritious diet was introduced to all the patients. 2. Portion control was introduced for high protein diet. 3. The diabetic diet was improved to helpthe clients with diabetes to control their sugar level.
6.6.3. Kitchen The kitchen is responsible for the food preparations of all in-ward clients and many supportive staff members. Over 3000 meals are served daily. Under the guidance of the Nutrition Unit; the kitchen has now been updated to cater for a variety of nutritional requirements. The team consists of 8 cooks and 12 assistants.
6.7. Accounts Department The Accounts Department is the main financial arm to the Director. Under the guidance of the Director and the Accountant, the Accounts Department is responsible for all salaries, coordination of tenders, and preparation of financial statements.
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6.8. Diagnostic Services 6.8.1. Laboratory The laboratory staff include the Consultant Hematologist, consultant Microbiologist (visiting), medical officer, 6 MLT, 1 lab orderly, and 5 supportive staff members. The laboratory performed a total number of 141235 lab investigations for 2017 which included 33360 Hematology investigations, 98380 Biochemical tests and 9495 Microbiology investigations. Also around 3300 samples were sent to the RIA Lab of NHSL, MRI, and STD clinic for other special investigations of our patients. Other highlights of 2017 include: • In 2017 the new 05 part Hematology Analyzer to perform the Full Blood Count as well as a Class 2 BIO SAFETY Cabinet for Microbiology section was obtained. • The Laboratory started to perform special investigations such as Troponin Iscreening test and Dengue antigen (NS 1) for the patients of NIMH and Mulleriyawa Halfway Home. • Internal and external quality assurance programme with MRI and BIO RAD. • During the Dengue epidemic period, Full Blood Count & Biochemistry analysis was done for the patients of Thalangama hospital and Piliyandala hospital.
Figure 35: Annual Laboratory Tests, 2017
6.8.2. EEG The EEG Department consists of 2 EEG Recordists and 1 supportive staff. It covers the EEG requirements of NIMH, Colombo East Base Hospital as well as National Institute of Infectious Diseases. In the year 2017, 420 EEGs were performed.
Figure 36: Annual EEG Tests, 2017 40
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
6.8.3. ECG The Cardiography Department was started in NIMH in 2002 with 02 cardiographers and 02 fully manual Cardio fax machines. At present there are 02 cardiographers and 01 supportive staff in the department with 02 fully automatic machines. Total ECGs done per month vary from 800 to 1000.
6.7.4. X-Ray Department Figure 37: Annual ECG Tests, 2017
X-Ray Department commenced services in 1971. Today the unit has been upgraded with SHIMADZU RAD
6.8.4. X-Ray Department
SPEED X-Ray machine and PROMAX automatic film processor. Our aim is to produce good quality x-rays and X-Ray Department commenced services in 1971. Today the unit has been upgraded with SHIMADZU as wellRAD as toSPEED prevent staffmachine and patients unnecessary radiation. The department extends radiographic X-Ray and from PROMAX automatic film processor. Our aim is to produce good quality x-rays and as well as to prevent staff and patients from unnecessary radiation. The department service to Colombo East Base Hospital and IDH in emergencies. extends radiographic service to Colombo East Base Hospital and IDH in emergencies. There are two radiographers working at present. During the year 2017, 6000 radiographic examinations There are two radiographers working at present. During the year 2017, 6000 radiographic were done. examinations were done.
Figure 38: Annual X-Ray Tests, 2017 Figure 37: Annual X-Ray Tests, 2017
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6.9. Pharmacy Department The Pharmacy Department includes six pharmacists, one dispenser and six supportive staff. The department is in charge of providing services at Outpatient Department, 2 Indoor Pharmacies (NIMH & Unit II), Drug Stores, local purchase of pharmaceuticals, Consumable Stores, Non Consumable Stores, Oxygen and Preparations. They provide services in 4 Out Clinics at Kotahena, Pannipitiya, Rajagiriya & Modara. The Indoor Pharmacy provides services for 31 wardsand units in NIMH and Indoor Pharmacy for 13 wardsin Unit 2. The Outpatient Department caters to around 80 clients per day. Some of the highlights of the year 2017: • Played a key role in helping the flood victimsduring the flooding in Kolonnawa, Rajagiriya, Baddegama, & Galwana. • Had sudden requirements of some medicines such as Oseltamivir during infections and viral diseases. • Participated inworkshops and trainings conducted by Medical Supplies Division. • As a team, we had participated almost all activities and special occasions in NIMH. • Mrs. A.K.M. Egodawaththa who has worked as our chief pharmacist, retired after 27 years of service. Month January February March April May June July August September October November December
Total
Local Purchase 7365.52 6280.00 5390.80 1355.01 31844.00 1025.00 1206.40 25934.00 85615.00 98866.03 66279.23 69743.21
Drugs
Surgical Non Dressings Consumable Consumable
5562528.68 3580707.81 919357.08 2641194.53 3467287.47 4311247.19 3074105.10 2943449.98 667642.44 3206212.10 2686021.18 459676.43
400904.20 33519429.99
45701.09 152311.74 1655547.54 57655.50 442309.45 105261.32 137304.83 111574.77 795224.42 327198.96 649307.98 292387.42
Lotion
Dental
Oxygen
197055.67 43370.37 213804.00 11900.41 111696.64 132138.06 524177.66 548382.88 293256.26 22475.07 38928.68 0.00
0.00 190844.12 69698.73 98460.67 394950.46 152295.98 495000.00 0.00 0.00 39743.96 297714.56 0.00
0.00 3644.85 7491.00 10645.20 10006.94 79275.35 16497.00 12365.00 0.00 8258.00 65240.25 0.00
0.00 64111.38 0.00 22670.63 0.00 0.00 0.00 39435.63 27650.90 0.00 0.00 0.00
48688.00 56289.00 57032.00 57959.00 102199.00 49489.00 78518.00 45643.00 41905.00 44778.00 81390.00 85560.00
4771785.02 2137185.70
1738708.48
213423.59
153868.54
749450.00
Figure 39: Annual Summary of Pharmacy, 2017
6.10. Physiotherapy Unit There are two physiotherapy units, one is at NIMH and other one is at HWH Mulleriyawa. There is one physiotherapist attached to each unit. They attend to referrals in the unit or in the respective wards. During the year around 2000 patient/referrals were seen at NIMH and HWH - Mulleriyawa.
Figure 40: Annual Physiotherapy Sessions, 2017 42
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
6.11. Occupational Therapy Department The Occupational Therapy (OT) Department has been providing services for over than 7 decades. The aim is to “engage people with mental health problems in meaningful activities or occupations can improve their quality of life benefiting both their physical and mental wellbeing”. Occupational therapy engages people in activities that facilitate recovery and help their return to the community. There are 09 Occupational Therapists working at NIMH including the therapists working at Forensic Psychiatry Service, Day Rehabilitation Center, Psycho Geriatric Unit, Learning Disability Unit and Rehabilitation Center. The OT units have received 710 new referrals within year 2017. Some of the activities of 2017 are: Regular Activities • Religious programmes to meet their spiritual needs • Communication group and physical exercise programme in addition to a choice of art and leisure activities. • General activities such as training Activities of Daily Living, Anger Management, Social Skills, & Life Skills. • Creative activities such as Creative Writing& Art, Reminiscences Therapy, Music therapy, Sports Therapy, & Cookery. • Vocational and income generating activities such as Work Skills, Jewelry making, Rug weaving, Handicrafts, Carpentry, Computer and Printing, Gardening, Rattan work,& Sewing. Special Activities • Working with the “Rehabilitation Center”, 120clientswere referred for occupational therapy. • The clients were participated in Thai Pongal, Sinhala and Tamil New Year, Vesak, Poson, Ramazan Festival, Christmas and many other entertainment events throughout the year. • There were several communityfamiliarization visits for long stay clients to Seethawaka Botanical Garden (35 clients participated) and Kotikawaththa church (25 clients attended to holy mass) • The OT unit contributed to the World Mental Health Day 2017 with an educational exhibition and sale stall for public at Diyatha Uyana and organized the Open Day including cognitive games, craft exhibition, art therapy sessions and vocational assessments. • There were clinical trainings formedical students, nurses, social workers, counselors, OT Diploma and OT Degree student at OT unit. A number of foreign students and volunteers were engaged with OT activities and acquired valuable experience. • 2week specializedtraining programmes were conducted for some outstation occupational therapists. • Participated in several workshops onart therapy and drama therapy conducted by foreign specialists. One of the occupational therapists had the privilege to represent the Community
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Mental Health Day Educational Exhibition – DiyathaUyana
Students visiting us on Open Day
Community familiarization visits
Making Wesak lanterns
Group therapy session
Figure 41: Activities of OT Department, 2017
Figure 42: Annual OT Sessions, 2017 44
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
6.12. Rehabilitation Centre The rehabilitation center of NIMH was declared open on 15th May 2017 with the aim of coordinating all the rehabilitation activities done for the clients namely; general rehabilitation, occupational therapy, horticulture therapy and vocational training. The center is under the Consultant Psychiatrist Dr. (Mrs.) Renuka Jayasinghe and Medical team, Nursing officers, Occupational therapists and Psychiatric social workers with the support of health supportive staff. Process of rehabilitation is been focused on 4 levels: Improve the basic activities of daily living (Ex: personal hygiene, day to day household work) Level 2 Improve extended activities of daily living (Ex: life skills, social skills, communication skills) Level 3 Improve employment targeted skills Level 4 Facilitate social re integration Level 1
Currently rehabilitation center can cater for 30 – 40 clients per day. Therefore clients are being categorized for general rehabilitation at occupational therapy unit and for special rehabilitation at rehabilitation center that can be re-employed and re integrated to society successfully. Services we offer are: • • • • •
Helping in maintaining personal hygiene. Developing skills in everyday life. Guiding on a healthy lifestyle. Assisting management of complex living activities. Vocational training programmes including hand craft, sewing, leather works, foot ware, et cetera. • Helping in legal & social security benefits.
Several volunteers are joining us in many activities such as music therapy, drama therapy, art therapy, yoga, handcraft and English teaching.Many organizations help us in employment and social re integration.They are District secretariat offices, Vocational training centers, National Apprentice and Industrial Training Authority (NAITA) and Sri Lanka Youth services. Some of the highlights of 2017 were: • Celebration of April’s Sinhala Tamil New Year festival with a “Bak Maha Ulela” • Contributed to World Mental Health Day in October in Public Exhibition, Concert and Public Day. • Christmas was celebrated with a carol performed by the clients and gifts were distributed by Santa Claus. This event was organized by a team of volunteers. We were able to send 12 clients back to home successfully with good employment and to their usual home environment with good family support. But some of them have difficulties in re employment and finding a place to live due to many social problems, which the staff of the rehabilitation center couldn’t resolve. The aim of the rehabilitation center for next year is to expand the services to more clients and to improve the vocational training activities by training the staff as skilled instructors and facilitating the infrastructure.
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The aim of the rehabilitation center for next year is to expand the services to more clients and to improve the vocational training activities by training the staff as skilled instructors and facilitating the infrastructure.
42: Monthly Rehabilitation Centre Summary, 2017 Figure Figure 43: Monthly Rehabilitation Centre Summary, 2017
Opening ofofRehabilitation Centre Opening Rehabilitation Centre
Art Therapy Workshop bya avolunteer volunteer Art Therapy Workshop by
Paper Quilling
Yoga programme by a volunteer
Paper Quilling
Yoga programme by a volunteer Figure 43: Activities of Rehabilitation Centre, 2017
Figure 44: Activities of Rehabilitation Centre, 2017
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46
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
6.13. Psychiatric Social Work Unit Social work is a value-based helping profession which seeks to improve the quality of life of individuals, families, groups and communities by intervening through various social work methods. Social workers are playing a significant role in protecting vulnerable, disadvantaged and marginalized people by empowering them in their own society. Persons with mental health problems and their family care givers face many socio-economic problems and right violations. This is especially true among persons with mental illness; their struggle to remain in the social main stream against social exclusion while struggling with aversive symptoms of illness and side effects of treatment. Their family carers bear a big burden because of troublesome behaviors of relations, facing emotional distress and frustration. Thus, social workers in mental health settings have a major role to play in their domain for desirable change. The PSW section in NIMH comprises of 3 designated Psychiatric Social Workers and 10 Development Assistant Officers who are covering the duty of PSWs. All the Social Workers are attached to a Consultant Psychiatrist depending on an area basis or assigned responsibility. Duties and responsibilities expected from PSWs are as follows; • Being a Multi-Disciplinary Team (MDT) member, help the other MDT members for treatment process by searching for social back ground and/ history of clients which is essential for the treatment plan by doing home/field visits, contacting local clinics, and contacting Grama Niladharis and/or other reliable sources • Discharge planning • Social re-integration and inclusion of recovered clients • Follow up of discharged clients and make necessary arrangements to reduce stigma and discrimination • Organizing and conducting educational/ awareness programmes for various target populations and take necessary steps to empower service users in the society economically and socially • Welfare, social beneficiary and securing economic rights of clients • Help client to have continuing employment and intervene at occupation-based issues • Helping people to begin self-employments • Protecting people from legal procedures against them • Use appropriate social work methods such as forming self-help groups and community organizing to empower people in society • Linking people with resources • Intervene with legal concerns on behalf of the service users especially when they have no capacity. • Provide counseling and carrier guidance counseling when necessary
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February
March
April
May
June
July
August
September
October
November
December
388
335
328
296
365
364
329
343
369
329
377
368 4191
Social re-integration with family
153
122
144
127
143
141
158
157
155
143
165
171 1779
No. of placements in social care homes
19
22
20
17
19
19
14
14
17
28
16
21
226
No. of family meetings conducted
83
54
61
46
67
54
54
77
66
57
69
73
761
Follow up (Phone)
236
211
232
232
245
249
246
245
231
248
248
247 2870
Follow up (Visit)
169
189
183
177
188
194
199
299
199
199
223
203 2422
Home/Field Visits
264
222
213
204
223
215
225
226
235
221
248
234 2730
Mobile programmes
16
17
16
16
17
16
16
17
17
16
16
17
197
Community/Outreach clinics
29
28
27
27
29
27
27
28
29
29
27
28
335
6
6
8
8
13
4
12
8
6
10
5
10
96
Other programs
Figure 45: Annual Summary of PSW Activities, 2017
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Total
January
No. of referrals received
Task
6.14. Medical Record Room The Medical Record Room is one of the oldest units in NIMH with records stretching back as far as 1884. The unit consists of 3 attendants. The Medical Record Room stores all medical and nonmedical records of NIMH.
6.15. Other 6.15.1. Telephone Exchange The telephone exchange consists of 1 telephone operator with 3 assistants running the communication needs of the entire hospital. In the year 2017 a new telephone exchange system was installed.
6.15.2. Drivers The driver’s team forma a vital cog of the NIMH wheel looking after every aspect of transport. They are responsible for shuttling the team for the NHSL and Community Clinics. They are also responsible for mobile client care and emergency transfers. There are 11 health drivers with 7 supportive staff. They manage a vehicle fleet which includes 5 ambulances.
6.15.3. Maintenance Team The maintenance team looks after the day to day running repairs of NIMH under the purview of the Planning & Development Unit.
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7. Special Activities 7.1. World Mental Health Day The Annual World Mental Health Day Exhibition organized by NIMH was held in grand scale very successfully at Diyatha Uyana under the patronage of Hon. Dr. Rajitha Senaratne MP, Minister of Healthcare, Nutrition and Indigenous Medicine. As part of many events to commemorate the World Mental Health Day 2017 the National Institute of Mental Health very successfully organized a first of its kind, a Live Talent Show called ‘Prathiba’ that was the combined effort of the clients, staff and well respected Artists. The Chief Guest was Dr. Chithramalee De Silva, Director Mental Health and the Guest of Honor was Veteran Artist Mrs. Mali Jayaweerage. A Public Day is also a part of the World Mental Health Day Celebrations 2016; Director Mental Health visited to open the arts and crafts exhibition.
World Mental Health Day Exhibition
World Mental Health Day Exhibition
Prathibha Concert
Prathibha Concert
Public Day
Poster Competition
Figure 46: World Mental Health Day Activities, 2017 50
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
7.2. Special Projects & Activities
Mental Health Directorate - Sharing of Experiences
Quality Improvement in Patient Care – Trolleys
Visit of St. Sebestian’s Church, Mulleriyawa
Farewell of Dr DPD Wijesinghe
Pirith Ceremony at Half Way Home
NIMH Peace Conference
World Health Day 2017 - Exhibition Stall by NIMH
Avurudu Ulela
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Annual Vesak Sil Programme
International Nurses’ Day
Poson Poya Celebrations
Opening of Dining Area for Training Unit
Blood Donation Campaign
Inauguration of Yoga Programme
Figure 47: Special Activity Highlights, 2017
7.3. Staff Welfare The good work started in the year 2016 by the Hospital Welfare Association were expanded in the year 2017. The Associationelected a new Council and an Executive Committee at the beginning of the year. The benefits offered atdeath of loved ones, child births and other major life events were continued. The Association organizedthe Annual Blood Donation Day at the hospital premises which had a very successful outcome. The Hospital Welfare Association continues to support and work together with the Hospital Sports Club and Hospital Buddhist Association to promote sports and religious activities among the staff and clients.
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Annexure I: Cadre Details of NIMH National Institute of Mental Health Director Deputy Director Consultants Medical Officer Dental Surgeon SGNO Accountant Administrative Officer Ward Sisters Nurses PSW Occupational Therapist Medical Laboratory Technologist Physiotherapist Radiographer Pharmacist Dispenser Development Assistant PHI EEG recordist Cardiographer Development Officer Information and Communication Technology Assistant Public Management Assistant Ward Clerk Nutritionist Diet Stewards House Warden Health Driver Telephone Operator Hospital Overseer Cooks Lab Orderly Seamstress Plumber Attendant Supportive staff
Approved Cadre 01 01 10 66 03 06 01 02 04 383 09 09 06 02 02 06 03 07 01 02 02 10 01 44 12 01 03 04 11 03 08 20 02 02 01 250 444
In Position 1 0 11 61 3 3 0 0 5 391 9 9 6 1 2 7 2 1 1 2 2 10 01 23 6 2 2 3 11 1 5 7 1 2 1 142 254
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Halfway Home, Mulleriyawa Medical Officer Matron Nurses Occupational Therapist Nutritionist Diet stewards Hospital Overseer Cooks Telephone Operator Attendant Supportive Staff Nurses Training School Principal Senior Nursing Tutor Nursing Tutor Clinical instructor PMA House Warden Health Driver Cooks Supportive Staff
Director Deputy Director Consultants Medical Officer Dental Surgeon SGNO Principal (NTS) Accountant Administrative Officer Ward Sisters Senior Nursing Tutor Nurses Nursing Tutor Clinical Instructor
54
Totals Per Category 1 PSW 0 Occupational Therapist 11 MLT 66 Physiotherapist 3 Radiographer 3 Pharmacist 0 Development Assistant 0 PHI 0 EEG recordist 5 Cardiographer 2 Development Officer 454 ICT Assistant 3 PMA 0 Ward Clerk
Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Approved cadre 04 01 64 02 01 01 02 04 00 42 29 Approved Cadre 01 06 03 00 01 04 01 03 09
3 11 6 2 2 7 11 1 2 2 10 2 23 6
In position 5 0 63 2 0 1 2 1 1 24 26 In Position 0 2 3 0 1 1 1 2 8
Nutritionist Diet Stewards House Warden Health Driver Telephone Operator Hospital Overseer Cooks Lab Orderly Seamstress Attendant Supportive staff
2 3 4 12 2 7 10 1 2
Annexure II: Research Submitted to Ethical Review Committee, NIMH 70/01/17
71/02/17 72/02/17 73/02/17 74/02/17 75/05/17 76/05/17 77/05/17 78/0/17 79/06/17 80/06/17 81/08/17
82/09/17
83/09/17 84/11/17 85/11/17 86/11/17 87/12/17
A comparison of renal functions using estimated glomerular filtration rates in patients with Psychiatric illness treated with Lithium Carbonate and never treated with Lithium Carbonate Audit on Antipsychotic prescription pattern for adult patients at Psychiatry outpatient clinic, BH Marawila Delusional disorder (jealous type): frequency of presentation to Mental Health Services, Psychological Mechanisms and Psychosocial correlates Perceived training and educational needs of the nurses working in the National Institute of Mental Health Clinical audit on illness knowledge of patients with Schizophrenia (Psychosis), Bipolar Affective Disorder or Depression taking treatment at DGH - Chilaw Patient satisfaction survey on the quality of care at Psychiatric outpatient clinic in Sri Lanka Awareness on legal aspect of physical restraining among psychiatric nurses working in National Institute of Mental Health Perception of day light in Psychiatric patients in relation to agitation levels in hospital wards of National Institute of Mental Health Relationship between use of cannabis and the presence of Schizophrenic symptoms among male Psychotic patients in National Institute of Mental Health Determinants of re-hospitalization among patients with Schizophrenia admitted to National Institute of Mental Health A study on the different factors that are affecting the efficacy of Schizophrenia treatment at the National Institute of Mental Health The knowledge on Depressive Disorder, utilization of information sources and associated factors among patients followed –up for depression at General Psychiatric clinics of the National Institute of Mental Health prevalence rates of overweight andunderweight among long stay patients with diagnosed Schizophrenia, measured by body composition estimates; a descriptive cross sectional study in National Institute of Mental Health Evaluation and development of a consensus guideline for therapeutic security of a Forensic psychiatr4ic unit in Sri Lanka Demographic and clinical correlates of maternal Filicide Examination of the factors related to readmission as explained by the guardian of the patients with Psychiatric disorders in National Institute of Mental Health The remission rate among client seeking treatment for heroin dependence at outpatients clinic services Assess the prevalence of physical violence and associated factors among nurses working in psychiatric wards in National Institute of Mental Health
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Annexure III: Annual Financial Report, 2017, NIMH
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka
Acknowledgements • Director, Dr Kapila Wickramanayake and all the Consultants for their guidance and advice. • Deputy Director Dr. Lalith Poddalgoda for his guidance and advice. • Dr.Rikaz Sheriff, Dr Sujani Perera, Dr Upeka Mettananda, Dr. Thanuja Siriwardene, Dr. Arosha Wijewickrama, for Compiling and Co-Editing. • A special thanks to the following wards and units who sent their write-ups and photos • Accounts Department • Diet Branch • ECG Department • Forensic Unit • Isolation Unit • Male Villa • Occupational Therapy Department • Public Health Section • Training & Research Unit • Ward 20 • X-Ray Department • Community Psychiatry Nurses • Day Rehabilitation Centre • EEG Department • GBV Prevention Unit • Laboratory Department • Navodaya • Pharmacy Department • Perinatal Psychiatry Unit • Unit II (Halfway Home) • Ward 22 • Diet Branch • Dental Clinic • Disaster Management Section • Female Villa • Infection Control Unit • Learning Disability Unit • Nutrition Unit • Physiotherapy Department • Rehabilitation Centre • Ward 17 • Ward 27 • Principal NTS, SGNO, and Nurses in Charge of Wards and Units for providing necessary information. • Officers in Charge of Allied Health Departments for providing necessary information. • Administrative Officer, Accountant together with their staff for providing necessary information and support. • Ms. Nishani Chathurika and Ms. Roshini Dushanthi, Medical Record Officer(s), Health Information Section, Planning and Development Unit for their tireless efforts in collecting the data required. • All Medical Officers, Nursing Officers, and Supportive Staff of Planning & Development Unit for being a tower of strength and support.
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Annual Report - 2017 National Institute of Mental Health Ministry of Health - Sri Lanka