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Annual Report 2019 Sri Lanka
National Institute of Mental Health Ministry of Health - Sri Lanka
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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 client care, capacity building, advocacy, community engagement, multi-sector collaboration and research delivered by competent and reliable staff
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Table of Contents Director’s Message .............................................................................................................................................. 8 Services Offered at NIMH .................................................................................................................................. 10 Outpatient Services............................................................................................................................................ 11 Outpatient Department & Psychiatric Intensive Care Unit ........................................................................... 11 Out-Patient Clinics ......................................................................................................................................... 12 Dental Unit ..................................................................................................................................................... 13 Navodaya (Day Treatment Centre) ................................................................................................................ 14 Day ECT Centre............................................................................................................................................... 15 Gender Based Violence Prevention Unit ....................................................................................................... 16 National Mental Health Helpline – 1926 ....................................................................................................... 18 Inpatient Services............................................................................................................................................... 19 Inward Acute Care ......................................................................................................................................... 19 Forensic Psychiatry Unit................................................................................................................................. 21 Adolescent Psychiatry Unit ............................................................................................................................ 23 Perinatal Psychiatry Unit................................................................................................................................ 24 Learning Disability Unit .................................................................................................................................. 25 ECT Unit.......................................................................................................................................................... 26 Isolation Unit .................................................................................................................................................. 27 Medical Ward................................................................................................................................................. 28 Rehabilitative Services ....................................................................................................................................... 29 Day Rehabilitation Service ............................................................................................................................. 29 Rehabilitation Centre ..................................................................................................................................... 30 Ward Based Rehabilitation ............................................................................................................................ 32 Intermediate Ward(s) ................................................................................................................................ 32 Long Term Ward(s)..................................................................................................................................... 33 Villa(s)......................................................................................................................................................... 34 Halfway Home Mulleriyawa ....................................................................................................................... 35 Occupational Therapy Unit ................................................................................................................................ 36 Psychiatric Social Work Unit .......................................................................................................................... 37 Community Psychiatry Unit ........................................................................................................................... 38 Horticulture Therapy Unit .............................................................................................................................. 39 Ancillary Services ............................................................................................................................................... 40 Planning & Development Unit ....................................................................................................................... 40 Planning Section ......................................................................................................................................... 40
6 Quality Management Section .................................................................................................................... 40 Public Health Section, Health Promotion Unit & Public Health Inspector................................................. 42 Infection Control Unit ................................................................................................................................ 43 Disaster Management Section ................................................................................................................... 44 Health Informatics Section......................................................................................................................... 45 Computer Maintenance Unit ..................................................................................................................... 45 Media Unit ..................................................................................................................................................... 46 Training Unit & Research Unit ....................................................................................................................... 47 Nutrition Unit ................................................................................................................................................. 49 Kitchen ........................................................................................................................................................... 49 Special Grade Nursing Officer’s (SGNO) Office .............................................................................................. 50 School of Nursing Mulleriyawa ...................................................................................................................... 50 Medical Record Room .................................................................................................................................... 51 Diagnostic Services......................................................................................................................................... 52 Laboratory Department ............................................................................................................................. 52 Electroencephalography (EEG) Unit........................................................................................................... 53 Electrocardiography (ECG) Unit ................................................................................................................. 54 X-Ray Department...................................................................................................................................... 55 Physiotherapy Unit ........................................................................................................................................ 56 Pharmacy Department ................................................................................................................................... 57 Administration Department........................................................................................................................... 58 Inquiries & Transport Unit ......................................................................................................................... 58 Overseer’s Office........................................................................................................................................ 58 Diet Branch................................................................................................................................................. 58 Accounts Department .................................................................................................................................... 59 Shroff.......................................................................................................................................................... 59 Other .............................................................................................................................................................. 60 Telephone Exchange .................................................................................................................................. 60 Drivers ........................................................................................................................................................ 60 Maintenance Team .................................................................................................................................... 60 Special Activities ................................................................................................................................................ 61 Annexures I: Cadre Details of NIMH .................................................................................................................. 67 Annexures II: Research Submitted to Ethical Review Committee, 2019 ........................................................... 69 Annexures III: Annual Financial Report of NIMH. 2019 ..................................................................................... 71 Acknowledgements............................................................................................................................................ 73
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Table of figures
Figure 1: Annual OPD Sessions, 2019................................................................................................................. 11 Figure 2: Annual Clinic Sessions, 2019 ............................................................................................................... 12 Figure 3: Annual Summary of Dental Unit, 2019 ............................................................................................... 13 Figure 4: Presentation at World Oral Health Day .............................................................................................. 13 Figure 5: Annual Summary of Navodaya, 2019.................................................................................................. 14 Figure 6: Annual Day ECT Sessions, 2019........................................................................................................... 15 Figure 7: Annual Summary of GBVPU, 2019 ...................................................................................................... 17 Figure 8: Annual 1926 Calls, 2019 ...................................................................................................................... 18 Figure 9: Annual Acute Ward Admissions, 2019 ................................................................................................ 19 Figure 10: Distribution of Mental & Behavioral Disorders, 2019 ...................................................................... 20 Figure 11: Visitor's Board & Open School Summary, 2019 ................................................................................ 21 Figure 12: Annual Forensic Clinic Visits, 2019.................................................................................................... 21 Figure 13: Annual Psycho-Geriatric Unit Admissions, 2019............................................................................... 22 Figure 14: Annual Admissions to Adolescent Unit, 2019 ................................................................................... 23 Figure 15: Annual Admissions to the PPU, 2019................................................................................................ 24 Figure 16: Annual Admissions to LDU, 2019 ...................................................................................................... 25 Figure 17: Annual ECT Patients, 2019 ................................................................................................................ 26 Figure 18: Annual Isolation Unit Cases, 2019 .................................................................................................... 27 Figure 19: Annual Admission to Medical Ward, 2019 ....................................................................................... 28 Figure 20: Annual Summary of Day Rehabilitation Service, 2019 ..................................................................... 29 Figure 21: Annual Rehabilitation Activities of Rehabilitation Centre, 2019 ...................................................... 31 Figure 22: Activities of Rehabilitation Centre, 2019 .......................................................................................... 31 Figure 23: Annual Admissions to Intermediate Wards, 2019 ............................................................................ 32 Figure 24: Activities of Halfway Home Mulleriyawa, 2019 ................................................................................ 35 Figure 25: Annual OT Sessions, 2019 ................................................................................................................. 36 Figure 26: Annual Activities of Psychiatric Social Work Unit, 2019 ................................................................... 37 Figure 27: Activities of Quality Management Section, 2019 ............................................................................. 41 Figure 28: Activities of Public Health & Health Promotion, 2019 ...................................................................... 42 Figure 29: Activities of Media Unit, 2019 .......................................................................................................... 46 Figure 30: Annual Summary of Laboratory, 2019 .............................................................................................. 52 Figure 31: Annual Summary of EEG Unit, 2019 ................................................................................................. 53 Figure 32: Annual Summary of ECG Unit, 2019 ................................................................................................. 54 Figure 33: Annual Summary of X-Ray Department, 2019 .................................................................................. 55 Figure 34: Annual Physiotherapy Sessions, 2019............................................................................................... 56 Figure 35: Annual Summary of Pharmacy, 2019................................................................................................ 57 Figure 36: Special Activity Highlights of NIMH, 2019......................................................................................... 66
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Director’s Message It is with great happiness that I write my 1st Director’s message for the annual report of National Institute of Mental Health (NIMH), the largest tertiary care hospital in Sri Lanka caring for clients with mental illness. Picking up the successful baton that was passed to me by the previous Director is a challenging but pleasant task. This year has been about investing time in improving the knowledge, skills, and attitudes of my staff especially in quality and safety. I am confident these efforts in training, infrastructure building, and research will give NIMH prominence in the coming years. The year 2019 has been busier than usual improving on the work of the previous years in promotion, prevention, cure and rehabilitation of people and their families affected by mental disorders. As always, the team culture that is now built in NIMH is a key secret to our progress. I can see that the regular in-service training programmes which covers all types of staff is catalyzing all strata of our team to help in better decision making and teamwork. Many significant events occurred in 2019. First, I and my team introduced an overall focus on preventive care, quality and safety by the introduction of a series of workshops throughout the year; focusing both on specific diseases such as Diabetes & Hepatitis as well as introducing standards of advanced care planning. This was evident with the inaugural Patient Safety Day series of workshops for staff. Secondly, with the evergrowing burden of mental health in Sri Lanka, it is easy to forget the aspect of quality. In this regard, I and my team have been working closely with our clinical units especially regarding patient safety, focusing on falls & absconding. I am happy to state that these initiatives are already bearing fruit. We are continually encouraged by the outstanding community support we receive every year for ward management and community related activities such as World Mental Health Day. I invite you to read about our many activities and events in this report. None of these can be achieved without the dedication of the 1,045 full-time staff working tirelessly around the clock guided by Director, Deputy Director, Consultants, Medical Officers, Matrons, Nurses & other Sectionals Heads. The dedication of our entire staff must be appreciated. A honorable mention should be made of Dr Kapila Wickramanayake who left us this year after 5 years of transformative work in mental health as the previous Director. He has been instrumental in expanding & strengthening the infrastructure of NIMH that we see today. We also warmly welcome our new Consultant Child and Adolescent Psychiatrist, Dr Wajantha Kotalawala.
Dr. Dhammika Wijesinghe Director, National Institute of Mental Health
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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 Halfway 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 1409 beds and annually around 7000 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 1200 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 and provide 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 of 31st December, 2019, NIMH had 14 Consultant Psychiatrists, a Consultant Physician, a Consultant Haematologist, 66 Grade Medical Officers and 3 Dental Surgeons. There are 3 Special Grade Nursing Officers, 5 Ward Sisters, 362 other Grade Nursing Officers, 7 Pharmacists, 6 MLTs, 9 Psychiatric Social Workers, and 9 Occupational Therapists. (For the full cadre details please refer Annexures I: Cadre Details of NIMH).
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Services Offered at NIMH Preliminary Care • 24 hr Emergency admissions via Psychiatric Intensive Care Unit (PICU) • 24 hr outpatient department (OPD) • 24 hr 1926 National Mental Health Helpline
Out-patient services • Day Treatment facility for minor mental illnesses • Day ECT facility • 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 clients • Medical Ward • 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 • Adolescent Psychiatry Unit • Perinatal Psychiatriy Unit • Learning Disability Unit • 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 via Health Promotion Unit
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Outpatient Services Outpatient Department & Psychiatric Intensive Care Unit Date established: 1926 Main Objective: The Outpatient Department & Psychiatric Intensive Care Unit acts as the central hub for all OPD and admission registrations including psychiatric emergencies. Services Offered: • • • • • • • •
Management of clients at Outpatient Department via advice & referral who do not require admission. Admission of clients voluntarily. Admission of clients on a non-voluntary basis via relatives, non-relatives, Police, or Prison. Admission of clients who have no identifiable details on rotation basis. Management of psychiatric emergencies at admission. Administration of injections, dressings. Administration of Hepatitis B injection for staff. Providing tea for clients and relatives.
Figure 1: Annual OPD Sessions, 2019
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Out-Patient Clinics Date established: 1939 Main Objective: The general psychiatry clinics are held at National Hospital of Sri Lanka. The main aims are to give specialized psychiatry care in a clinic setting and to make travel for clients easier. Services Offered: • • • • •
General Psychiatry Clinics Psycho-Geriatric Clinics Substance Abuse Clinics Forensic Clinics Adolescent Clinics
Figure 2: Annual Clinic Sessions, 2019
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Dental Unit Date established: 1972 Main Objective: The Dental Unit aims to improve oral health of the inward clients and outpatients and alleviate stigma in society towards NIMH. Services Offered: • •
Provide treatments for oral diseases for inward clients and outpatients. Promotion of oral health for inward clients and outpatients.
Highlights of 2019: •
On behalf of World Oral Health day, 20th March 2019, a lecture and presentation was given to the staff of NIMH regarding early detection prevention of oral cancer.
Figure 3: Annual Summary of Dental Unit, 2019
Figure 4: Presentation at World Oral Health Day
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Navodaya (Day Treatment Centre) Date established: 2012, Renamed to Navodaya in 2017 Main Objective: The main aim of Navodaya is to apply psycho-therapeutic techniques for minor mental health problems and support other mental health disorders. Services Offered: • • • • • •
Treatment of minor mental health problems. Alcohol and Substance Abuse Clinic. Neurotic Clinic. Child and Adolescent Clinic. Conduct mental health awareness programmes and health camps in Navodaya and in public areas such as schools & banks. Conduct in-service and external training in mental health.
Total no. of services provided
6518
New registrations
566
Revisits
1635
Sessions
2201
One day sessions
16
Issued medication
1500
Information desk - helpline calls received
1319
Information desk – visits
845
Awareness programmes & health camps conducted
25
No. of participants for above programmes & camps
1182
Referred clients
54
Family education
572
Orientation visits
299
Figure 5: Annual Summary of Navodaya, 2019
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Day ECT Centre Date established: 2014 Main Objective: The main aim of Day ECT Centre is to minimize unnecessary admissions for ECT and keep the client with their family to enrich their mental health. Services Offered: • •
The Day ECT service is offered from Monday to Saturday including public holidays. The Day ECT service can be referred by Consultant Psychiatrist attached to NIMH or other Consultant Psychiatrists who can refer to a Consultant Psychiatrist at NIMH with a Pre-ECT assessment form.
Figure 6: Annual Day ECT Sessions, 2019
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Gender Based Violence Prevention Unit Date established: 2012, Prevention of Child Maltreatment Unit was established in 2015 Main Objective: The main aim of Gender Based Violence Prevention Unit (GBVPU) is to establish a friendly environment for survivors of gender-based violence & reduce incidence of gender-based violence. (GBV) Services Offered: • • • •
The GBVPU provides quality, culturally and age appropriate counseling, psychotherapy, medical, social, and legal support to survivors of GBV. The GBVPU counsels’ perpetrators to reduce the incidence of GBV. The GBVPU arranges group counselling at family meetings. Coordination of "Committee regarding sexual harassments in the workplace" at NIMH
Highlights of 2019: • • •
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On 1st of February 2019, GBV awareness raising programme was conducted for supportive staff members who have received new appointments at NIMH. GBV awareness raising programmes was conducted for all multidisciplinary staff members of Kaluthara district at Base Hospital Horana on 1st of March 2019. The programme in commemorating the International Women’s Day 2019 was successfully concluded on 11th of March 2019. As a main component in the event, a speech competition among staff members of NIMH was arranged to raise awareness in gender equality, sexual harassment in workplace and related legal issues. Also facilitated four mental health staff professionals appreciating their contribution in developing & uplifting the quality of the service through the unit. Conducted the advanced Psychological First Aid programme on 17th of May 2019 for community volunteers following the Easter Sunday bomb blast attack. On 12.11.20, a programme on “Suicide prevention & female suicide” was held at Athurugiriya. Conducted a one-day workshop on 26th of November 2019 for Health staffs & probation officers of Gampaha area. Overall, 75 members participated at Gampaha District General Hospital. Paper on study of prevalence of Gender Based Violence at the workplace among a selected group of female staff was conducted with a self- administered questionnaire during June – July at NIMH. The finding was presented Consultant Psychiatrist Dr. Vindya Wijebandara at Annual Academic Session of College of Psychiatrists - 2019 One day workshop was conducted at NIMH to improve knowledge regarding cyber-violence for all staff at NIMH in commemoration of the International day of “Elimination of Violence against Women” on 25th 0f November 2019. Overall, 150 staff members participated. Conducted a lecture for police officers and government servants of police stations relevant to the scope of the Child & Women Bureau of the division, on 28th of December 2019 at New Siri Festival Hall, Nugegoda, based on the theme of “Child & Women of the present Commercialization Society”.
17 Summary of GBVPU activities - 2019 No. of new clients
463
No. of female clients
258
No. of male clients
205
No. of follow up
859
Referrals to NIMH
144
Referrals to Community
79
Referrals to Clinic
65
Referrals to 1926
85
Referrals to Women in Need
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Rape
-
Sexual harassment
05
Physical assault
145
Forced marriage
01
Limited resources
85
Psychological harassment
121
Others
28
Figure 7: Annual Summary of GBVPU, 2019
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National Mental Health Helpline – 1926 Date established: 15th of October, 2018 Main Objective: The aim of National Mental Health Helpline is to help clients easily by connecting them with a mental health care provider to answer their queries and de-escalate emergency situations with clients. Services Offered: • • • • • •
Is a service which runs 24/7. Provides a portal for inquiries related to mental health. Provides a connection to care during times of distress. Provides support in emergencies such as risk of suicide. Provides comprehensive and coordinated responses in short and long term. Connects clients with an extensive psycho-social network around the country.
Figure 8: Annual 1926 Calls, 2019
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Inpatient Services Inward Acute Care Date established: 1926 Main Objective: The aim of Inward Acute Care is the comprehensive management of acutely ill clients. Services Offered: • • • • • • • •
Comprehensive inward psychiatric care. Management of all psychiatric emergencies. Seclusion rooms for unstable clients. Coordination of referrals to other specialties. Transfer of clients to other hospitals for interventions and/or referrals. Provision of basic rehabilitation. Management of psycho-social factors via community centric programmes. Training of in-house staff, visiting medical, nursing, and allied health students on management of acutely ill clients.
Figure 9: Annual Acute Ward Admissions, 2019
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Figure 10: Distribution of Mental & Behavioral Disorders, 2019
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Forensic Psychiatry Unit Date established: 1940s Main Objective: The aim of Forensic Psychiatry Unit is to provide comprehensive forensic mental healthcare. Services Offered: • • • • • • • • •
Outpatient services via Forensic Outpatient Clinic, NHSL. Comprehensive inward care via male (Ward 21) and female (Ward 25) units. Clinic services at Welikada Prison, Colombo Remand Prison, Magazine Prison (+ Women’s Section), Prison Hospital (Colombo 9), & Institute of Forensic Medicine (Colombo 10). Holding of quarterly Visitor’s Board. Gymnasium services for clients and staff. Rehabilitation of clients via Forensic Psychiatry Rehabilitation Unit. Rehabilitation of clients via Horticulture Area. Open school service conducted by National Institute of Education. Referrals to Magistrate’s Court & High Court.
Highlights of 2019: • • •
Clients participated in the New Year Festival in January 2019. Clients actively took part in Vesak lantern making project. Clients actively took part in Vesak, Poson, and Christmas celebrations.
No. of Visitor’s Boards held
02
No. of open school sessions held
37
Figure 11: Visitor's Board & Open School Summary, 2019
Figure 12: Annual Forensic Clinic Visits, 2019
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Psycho-Geriatric Unit
Date established: 1998 Main Objective: The aim of Psycho-Geriatric Unit is to provide comprehensive mental healthcare for the elderly client particularly those suffering from dementia. Services Offered: • • • • • • • • • • • •
Outpatient services via Psycho-Geriatric Clinic, NHSL. Community-based clinics in Modara. Comprehensive inward psycho-geriatric care. Comprehensive geriatric assessment per client in a multi-team approach. Management of all psychiatric emergencies. Coordination of referrals to other specialties. Transfer of clients to other hospitals for interventions and/or referrals. Rehabilitative activities such occupational therapy and reminiscence therapy. Management of psycho-social factors via community centric programmes. Awareness programmes in public areas and via holistic care programme via Geriatric Association, Training of in-house staff, visiting medical, nursing, and allied health students in management of psychogeriatric clients. State of the art lecture hall facilities and library relevant to psycho-geriatric care.
Highlights of 2019: • •
A holistic care programme was held in Jaffna. A day care center model is currently being piloted.
Figure 13: Annual Psycho-Geriatric Unit Admissions, 2019
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Adolescent Psychiatry Unit Date established: 2015 Main Objective: The main aim of Adolescent Psychiatry Unit is to provide comprehensive psychiatric care in a safe environment for clients between 12-18 years. Services Offered: • • • • • • • •
Outpatient management of adolescents via Child & Adolescent Psychiatry Clinic, NIMH Comprehensive inward psychiatric care for adolescent clients. Management of all adolescent related psychiatric emergencies. Coordination of referrals to other specialties. Transfer of clients to other hospitals for interventions and/or referrals. Rehabilitative activities. Management of psycho-social factors via community centric programmes. Training of in-house staff, visiting medical, nursing, and allied health students in management of adolescent ill clients.
Highlights in 2019: •
Initial work on a 1926 chatline was initiated by Adolescent Psychiatry Unit with Airtel. The chatline will use the SMS method to allow younger mental health clients to interact with a more familiar medium to them.
Figure 14: Annual Admissions to Adolescent Unit, 2019
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Perinatal Psychiatry Unit Date established: 2007. The 1st ever in South-East Asia. Main Objective: The main aim of Perinatal Psychiatry Unit is to provide specialized care for women who develop psychiatric illness in and around the pregnancy or following childbirth. Services Offered: • • • • • •
Comprehensive inward psychiatric care for pregnant and post-partum clients. Management of all pregnancy and post-partum related psychiatric emergencies. Facilities for baby & bystander to stay with mother. Provision of rehabilitative activities. Management of psycho-social factors via community centric programmes. Training of in-house staff, visiting medical, nursing, and allied health students in management of pregnant and post-partum clients.
Figure 15: Annual Admissions to the PPU, 2019
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Learning Disability Unit Date established: 2008 Main Objective: The main aim of Learning Disability Unit is 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. Services Offered: • • • • • • •
Comprehensive inward psychiatric care for clients with learning disabilities. Management of all psychiatric emergencies. Facilities for bystander to stay with the client. Rehabilitative activities such as activities of daily living, life skill programmes, cognitive development programmes. Management of psycho-social factors via community centric programmes. Programmes to improve life skills of parents and bystanders such as lectures on learning disability and discussions on how children with learning disability should looked after at home. Training of in-house staff and visiting medical, nursing, and allied health students in management of clients with learning disability.
Figure 16: Annual Admissions to LDU, 2019
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ECT Unit Date established: 1940s Main Objective: The main aim of ECT Unit is to provide quality electroconvulsive therapy for all outpatient and inpatient clients at NIMH. Services Offered: • • •
Comprehensive ECT care for clients from managing Pre-ECT assessment to Post-ECT recovery. Management of emergencies relating to ECT. Dedicated card-based system for equitable distribution of ECT for all clients.
Figure 17: Annual ECT Patients, 2019
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Isolation Unit Date established: 2011 Main Objective: The main aim of Isolation Unit is to prevent the spread of communicable disease among clients by isolating them in a secure environment. Services Offered: • • • •
Comprehensive isolation care for infected clients. Protective isolation for severely immunocompromised patients. Source isolation to confine the infectious agent and prevent it’s spread. Training of in-house staff, visiting medical, nursing and allied health students in management of isolated clients.
Figure 18: Annual Isolation Unit Cases, 2019
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Medical Ward Date established: 2005 Main Objective: The main aim of Medical Ward is to provide specialized medical care to the inward psychiatric clients with co-morbidities. Services Offered: • • • • •
Outpatient medical management of clients via Medical Clinic, NIMH. Comprehensive medical care for admitted clients. Coordination of medical referrals of psychiatric units. Coordination of transfers of clients to Tertiary Care Hospitals for specialized management. Management of medical problems of clients admitted to High Dependency Unit in Ward 20.
Figure 19: Annual Admission to Medical Ward, 2019
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Rehabilitative Services Day Rehabilitation Service Date established: 2015 Main Objective: The aim of Day Rehabilitation Service is to help outpatient clients who are recovering from mental health problems and need psycho-social support by promoting recovery and reducing the impact that may accompany with their illness. Services Offered: •
•
•
•
Improvement of skills development o Social skills training group o Therapeutically engaging them in o Anger management training group shopping, banking, public transportation, o Activities of daily living training group meal preparation, and similar skills which o Stress management and relapse increase their independence. prevention training group Inculcation business promotion habits via business promotion unit o “Sith Mal Nimevum” sales outlet o Production of craft and sewing products o Lunch packets selling project for sale at Ministry of Health o Soft toy project (supported by Fashion o Cement flowerpot making project Bug) o Enhancement of vocational skills in o Work opportunities in Sashini Fashion, computer training via NIMH-NAITA Angoda computer training center in Navodaya. Outreach support for clients o Home visits via community centric o Placement of clients in regular jobs in the programmes private sector o Family meetings via community centric programmes Coordinating community access via Consumer Forum of the National Institute of Mental Health
Number of referrals
47
No. of client who are continuing service
07
No. of clients who got vocational training
15
Social skills sessions
18
No. of client’s job opportunities
12
Anger management sessions
16
No. of clients who resettled with families
15
Community outings / trips
02
No. of clients who discontinued service
13
Exhibitions & sales events
03
Figure 20: Annual Summary of Day Rehabilitation Service, 2019
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Rehabilitation Centre Date established: 15th March 2017 Main Objective: The aim of Rehabilitation Centre is to improve clients’ lost skills with special attention for vocational training targeting employment to produce a productive individual. Services Offered: •
Rehabilitation process is carried out in 4 levels o Level 1 – to improve basic activities of daily living o Level 2 – to improve extended activities of daily living o Level 3 – for vocational training (in addition; NAITA training center is functioning for Computer application assistant, Handcraft, Tailoring, Pastry and Baker) o Level 4 - to facilitate social re integration and employment
Highlights of 2019: •
Expansion of NAITA training with Pastry & Baker training course in January.
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Expansion of Job oriented skills training by starting book binding at Rehabilitation Center in February. (NIMH clinic books, Exercise books of different categories and CR books of different categories were started being produced)
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In March, “Punarjeewa” a Cultural Programme by Prof Ariyarathna Kaluarachchi and team was done for 200 clients organized by Divisional Secretariat – Kolonnawa.
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As a tradition, an April New Year Festival was organized for clients and staff. The event was organized in 06 categories of units to ensure the maximum participation of inward clients.
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The second anniversary of Rehabilitation Center was celebrated in May by Products sale by Clients with fresh food ad juices, handcraft, leather, and other products.
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Poson was celebrated by Bhakthi Geetha Programme on stage by clients and staff.
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Certificate awarding of 2nd batch of NAITA Apprentices of NIMH was held in July.
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Annual trip for clients was in Kandy and Peradeniya in August.
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World Mental Health Day was celebrated as usual in October with the main organizing coordination by Rehabilitation Center.
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The canteen run by the clients under rehabilitation was declared open in parallel to the World Mental Health Day Celebrations at NIMH premises.
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In December, clients and staff participated in an Exhibition organized by “Senehasa Education, Resource, Research and Information Center” (SERRIC) run by Sri Lanka Army with the client’s products of National Apprentice and Industrial Training Authority (NAITA) trainee students coordinated by NAITA officials.
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Christmas Carol was held for the entertainment of inward clients by the Rehabilitation Center clients organized and trained by the staff of Rehabilitation Center.
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Figure 21: Annual Rehabilitation Activities of Rehabilitation Centre, 2019
Annual Trip
Book Binding with clients
Opening of Rehabilitation Canteen
Figure 22: Activities of Rehabilitation Centre, 2019
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Ward Based Rehabilitation Intermediate Ward(s) Date established: 2007 Main Objective: The aim of the Intermediate Ward(s) is to rehabilitate clients who are recovering from mental health problems by giving psycho-social support & promoting independence. Services Offered: • • • • • • •
Comprehensive inward psychiatric care. Coordination of referrals to other specialties. Transfer of clients to other hospitals for interventions and/or referrals. Rehabilitative activities via activities of daily living, vocational skills training, social skills training, communication skills training, housekeeping training, cookery training, and money management training focusing on income generation. Reintegration into society by placement of clients in jobs. Management of psycho-social factors via community centric programmes. Training of in-house staff and visiting medical, nursing, and allied health students in psycho-social rehabilitation of clients.
Figure 23: Annual Admissions to Intermediate Wards, 2019
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Long Term Ward(s) Date established: 2007 Main Objective: The aim of the Long-Term Ward(s) 22 and 27 is to engage in long term rehabilitation in those clients who are unable to be rehabilitated in an intermediate setting and those who have been successfully rehabilitated in the intermediate setting but have not found social placement yet. Services Offered: • • • • • • • •
Comprehensive inward psychiatric care. Coordination of referrals to other specialties. Transfer of clients to other hospitals for interventions and/or referrals. Rehabilitative activities via activities of daily living, spirituality & meditation training, vocational skills training, social skills training, communication skills training, housekeeping training, cookery training, art therapy, music therapy and money management training focusing on income generation. Horticulture therapy. Reintegration into society by placement of clients in job opportunities. Management of psycho-social factors via community centric programmes. Training of in-house staff, visiting medical, nursing and allied health students in psycho-social rehabilitation of clients.
Highlights of 2019: • • •
Clients participated in new year celebrations & avurudu celebrations. Clients celebrated Vesak Poya by making Vesak lanterns and observing sil. Clients sold the harvested fruits and vegetables in Mental Health Day stall.
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Villa(s) Date established: 1926 Main Objective: The aim of the Villas is to engage in paid long-term rehabilitation in those clients who are unable to be rehabilitated in an intermediate setting and have not yet found social placement. Services Offered: • • • •
Comprehensive inward psychiatric care. Coordination of referrals to other specialties. Transfer of clients to other hospitals for interventions and/or referrals. Rehabilitative activities via activities of daily living, spirituality, communication skills training, occupational therapy, music therapy, & art therapy.
Highlights of 2019: • • •
Clients participated in new year celebrations & avurudu celebrations. Clients celebrated Vesak Poya by making Vesak lanterns and observing sil. Clients participated in “Annual Villa’s Day” ceremony which was organized by Villas Society.
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Halfway Home Mulleriyawa Date established: 2008 Main Objective: The aim of Halfway Home Mulleriyawa is to rehabilitate, empower and socially reintegrate female residents who have had long term institutionalized care due to mental illnesses complicated with poor family/relations support. Services Offered: • • •
• •
Comprehensive inward psychiatric care. Improve quality of life and minimize their feeling of institutionalization by providing homely environment within the institution. Developing or redeveloping life-skills need for successful social reintegration via: o Training and improving Activities of Daily Living (ADLs). o Training and improving Instrumental Activities of Daily Living (IADLs). o Increasing life experiencing of clients by gradual exposure to society & social events. o Financially empowering the possible residents by Incorporating them into income generating rehabilitation programmes (horticulture, handcraft, sewing) or providing job opportunities to suitable residents (cleaner, domestic helper). o Providing necessary support for suitable residents to live in the society independently via Community Home Project. Reclaiming the lost civil rights of residents (provide National Identity Cards, Voting Rights) Legal support to settle their legal issues such as marriage & properties.
Highlights of 2019: • •
New Year Festival was held on 6th April 2019 for the 11th consecutive time organized by UNESCO Club of Royal Collage Colombo. Principal of Royal Collage Mr. B. A. Abeyrathna was the chief guest. Residents with 6 staff members went on a 2 day trip to Katharagama and Yala on 8th of August 2019.
Avurudu Celebrations – Client Race
Annual Outing
Figure 24: Activities of Halfway Home Mulleriyawa, 2019
36
Occupational Therapy Unit Date established: 1950s Main Objective: The aim of Occupational Therapy Unit is to provide occupational therapy service needs for inward and outpatients of NIMH. Services Offered: •
•
• • •
Provide relevant assessments regarding patients’ needs via: o Cognitive assessment. o Functional assessment. o Skill assessment. Group therapy sessions on: o Activities of daily living o Anger management. o Reminiscence therapy. training o Drama therapy. o Creative writing. o Social skill training. o Art therapy. o Life skill training. o Music therapy. Engage in therapeutic activities. Participate in home visits with multi-disciplinary team. Participate in outpatient clinics at Psychogeriatric Clinic (NHSL), Prison Clinics (Welikada Prison), Forensic Psychiatry Clinic (NHSL), & Psychiatry Clinic at Pannipitiya
Highlights of 2019: • • • •
Visited to Manelwatta Temple with 20 patients Visited to Diyatha Uyana, Gangarama Temple, and Beira Park Movie outing (Thala) Visited Baptist Church, Kotikawatta with 25 patients
Activity Total visits Number of new admissions Referred to vocational training Job oriented skills training Successful individual care plan
Figure 25: Annual OT Sessions, 2019
No. of patients 45364 793 23 159 30
37
Psychiatric Social Work Unit Date established: 1968 Main Objective: The aim of Psychiatric Social Work Unit is to enable people to manage the social factors in their lives like relationships, housing, and employment that allow them to get well and stay well by therapy, support, and advocacy. Services Offered: • • • • • • • • • • •
Assess patients and develop client’s specific social plans of care. Provide therapy/counseling for carers & family members to deal with client’s mental health problem. Interviews with admitted patients, members of their families, agency staff and others, and through collateral investigations. Help clients to get services and financial assistance from institutions and agencies like Police, Pension Department, Legal Aids, and other NGO and/or government organizations. Reviews resident and family social situations as necessary and modify social plan of care. Provides direct crisis intervention services when required. Maintain case records and prepare social reports. Arrange the services from referral agencies to help patients send back to the community. Work as a member of multidisciplinary team in community mental health programmes Helps clients and their families to obtain financial, legal and medical services. Provide placement of clients in jobs, rehabilitation homes, and halfway homes at low cost or free of charge.
Highlights of 2019: • •
Organized a national workshop for psychiatric social workers who are working psychiatric units all over the country regarding legal awareness and professional ethics Organized social reintegration program for Unit II patients with the help of social service department.
Figure 26: Annual Activities of Psychiatric Social Work Unit, 2019
38
Community Psychiatry Unit Date established: 2010 Main Objective: The aim of Community Psychiatry Nursing Programme is to give psycho-social support to clients at the level of the community via psychotherapy & support. Services Offered: • • • • • • • • • • •
Conduct Community Outreach Clinics at Gangodawila, Pannipitiya, Grandpass, Rajagiriya, Rajamalwatta, & Delgahawatta. Conduct Prison Mental Health Service Clinics at Welikada Prison, Colombo Remand Prison, Magazine Prison, Female Prison, JMO Office, Prison Hospital, & NHSL. Assess patients in the community and develop client’s specific plans of care. Carry out community-based day to day nursing focused on Activities of Daily Living. Coordinate with mental health focal points in Provincial & Regional Health Service. Provide therapy/counseling for carers & family members to deal with client mental health problem. Maintains case records to trace defaulters, ensure follow up and detect new clients. Arranging the services from referral agencies to help patients send back to the community. Work as a member of multidisciplinary team in community mental health programmes. Dispense medication at the client’s locality via depot programme across the Western Province. Participate in clinical decision making in Ward Rounds of NIMH.
Highlights of 2019: • • • • • • •
Participated in National Committee Meeting, Mental Health Unit. Conducted School Programme. Participated in counselling workshop at Foundation Institute. Conducted health camps in Pannipitya Dharmapala Vidayala & BOI World Trade Centre. Conducted World Mental Health Day programmes in CDs Delgahawatta, Kaduwela, & Rajagiriya. Conducted ‘NIMH for Consumers’ workshop On World Mental Health Day. Conducted multiple psychological first aid camps for Easter Sunday victims in Kochikade area.
39
Horticulture Therapy Unit Date established: 2003 Main Objective: The aim of Horticulture Therapy Unit is to make a productive individual through rehabilitation by art and science of plants and nature. Services Offered: • • • • • •
Support of rehabilitation of clients referred via Horticulture Therapy, Therapeutic Horticulture, Social & Community Horticulture, & Vocational Horticulture. Rehabilitation of clients by recreational activities. Rehabilitation of clients by household activities. Support in social re-integration of clients through horticulture therapeutic measures, recreational activities, and activities of daily living. Support in improving social skills by money handling, shopping, going on picnics etc. Provide job-oriented skills training for clients referred. (Flowerpots, Plant nursery, Mushroom etc.)
Highlights of 2019: • • • • •
Introduced the “GAP project” to Horticulture Therapy Unit by Agriculture Officer of Divisional Secretariat Office, Kolonnawa. Initiated Ornamental Flowers project. Initiated a project with a non-governmental organization named “Jeewanalanka”. They donated instruments needed for agriculture. Mushroom project was re-started. Products sale stall at Public Day of World Mental Health Day Celebrations 2019.
40
Ancillary Services Planning & Development Unit Planning Section Date established: 2016 Main Objective: The aim of Planning Section is to strengthen the Director in all the Hospital Planning and Development activities. Services Offered: • • • • • • •
Focal Coordination for the Management, Development and Planning Unit of Ministry of Health. Support in-service improvement of the institution. Development of Annual Action Plan and other relevant plans. Preparation of Performance reports and Progress reports. Coordinate and Conduct Hospital Management Committee Meeting and other meetings related to Hospital Planning and Development Management of Institutional Human resources Preparation of Project Proposals for Hospital development.
Highlights of 2019: • •
Development of Hospital Master Plan is ongoing in 2019 Revision of existing Hospital Clinical Guidelines is ongoing in 2019
Quality Management Section Date established: 2011 Main Objective: The aim of Quality Management Section is to be the focal point of National Institute of Mental Health coordinates all Quality and Safety activities in NIMH. Services Offered: • •
• • •
Focal point for Directorate of Healthcare Quality & Safety, Ministry of Health. Surveillance of clinical events and adverse events are monitored by the Quality Management Unit and send information periodically to Directorate of Healthcare Quality and Safety as per Ministry requirement. Establish and monitor the activities of 50 WITs (Work Improvement Team) Conduct key meetings in quality improvement o Quality & Safety Steering Committee o Clinical Governance Meeting o Quality Liaison Nurses Meeting Conduct Clinical Audits regarding safety issues (absconding; restrains, falls) for process improvements.
41 Highlights of 2019: • • • • •
Celebrated ‘World Patient Safety Day’ for the 1st time. Helped reduce absconding of patients using a unique incident reporting system in collaboration with Administration. This saw a reduction of absconding from 559 in 2017 to 318 in 2019. Helped reduce patient falls by analyzing data and conducting awareness programme with relevant wards. This saw a reduction in falls from 501 in 2018 to 318 in 2019. Clinical audit was performed in kitchen to improve quality of food preparation for clients and staff. Conducted a Productivity Promotion Award ceremony in 2019. The progress was assessed in 3 sectors as Direct patient care, Supportive care & special units. The assessment done by qualified judge panel from National Productivity Secretariat, NIMH, & others. Ward 10 was the best (“A” Grade) in Direct patient care and Forensic Rehabilitation Unit in (“A” Grade) among Special Units. The SGNO ‘B’ room was the best (“B” Grade) in Supportive Care Category.
Productivity Promotion Award - Adjudication
Productivity Promotion Award - Ceremony
1st Patient Safety Day of NIMH
Output of productivity programmes
Figure 27: Activities of Quality Management Section, 2019
42
Public Health Section, Health Promotion Unit & Public Health Inspector Date established: 2016 (Public Health & Public Health Inspector), 2019 (Health Promotion) Main Objective: The aim of the Public Health Section is to engage in disease prevention & control as well as health promotion. Services Offered: • • • • • • • • • •
Supervision of the general cleanliness of the hospital Supervision of the waste disposal system and the sewerage system & obtaining the scheduled waste license for the institution. Monitor the cleanliness of the kitchen periodically and sanitation of the kitchen staff by screening them and liaising with the Public Health Inspector in performing tests to check the quality of food. Assist in providing safe water to the institution by performing tests to check the quality of drinking water sources liaising with PHI. Provide technical supervision & coordination of Infection control Nursing Officers and PHI activities. Conduct infection control activities in the hospital liaising with Infection Control Nursing Officers under the supervision of Consultant Microbiologist. Play advisory role in monthly Infection Control Liaison Nurses meetings. Liaise 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. Conduct vaccination and sterilization programme for cats and dogs in the hospital premises. Conduct Health Promotion Programmes for staff and general public.
Highlights of 2019: • •
Health Promotion Unit was officially established in 2019. The unit consist of MO Public Health, Health Promotion Nurse and 30 liaison nurses for health promotion in wards. The following programmes were conducted in 2019: o A programme to celebrate drugs prevention day was held with a debate, video display, & lecture. o Conducted an awareness programme on Hepatitis to celebrate World Hepatitis day. o Conducted a lecture on oral cancer to commemorate World Head and Neck Cancer Day. o Conducted a programme to commemorate Breast Milk Promotion Day. o Conducted a programme to commemorate World Diabetes Day by screening of the staff for risk factors, drama, & exhibition for staff and public. o Conducted a programme to commemorate World AIDS Day.
World Diabetes Day Cat & Dog vaccination & sterilization programme Figure 28: Activities of Public Health & Health Promotion, 2019
43
Infection Control Unit Date established: 2011 Main Objective: The aim of the Infection Control Unit is to ensure good sanitation to minimize the infections in the institution. Services Offered: • • • • •
• • • •
Carry out daily ward rounds by Infection Control Nursing Officer (ICNO) according the Infection Control Unit checklist. Supervise the general hygiene, hand washing practice, and waste management. Screen the emergence of infectious disease outbreaks other diseases like Dengue. Conduct Wound Care Clinic with Consultant Microbiologist. Carry out Hepatitis B Vaccination Programme which includes o Vaccinate all staff and test for HBsAb. o Vaccinate all long-term clients and other clients as much as possible. o Test HBsAb in clients whenever possible. Carry out training programmes for Infection Control Liaison Nurses, Nursing Staff, Health Support Staff, * Cleaning Staff. Hold monthly Infection Control Liaison Nurses meetings. Coordinate and conduct Annual Infection Control Meeting. Supervise sterility maintenance of equipment and sterile packs.
Highlights of 2019: • • • • •
An infection control liaison 3-day workshop was held for nurses. An awareness programme for nursing officers and staff was held. A patient safety day exhibition was conducted in collaboration with Quality Management Unit. Introduction of Varicella immunization programme among female staff of reproductive age. Extension of the current vaccination programme against Hepatitis B among all the clients in NIMH. The annual Hepatitis B vaccine programme saw 138 staff and 158 clients vaccinated.
44
Disaster Management Section Date established: 2016 Main Objective: The aim of Disaster Management Section is to coordinate disaster preparedness and response of the institution at institutional level and national level. Services Offered: • • • • • • • • • •
Identification of hazards within the institution and assess the risk and update annually. Preparation of Hospital Disaster Preparedness and Response Plan for the institution according to the risk assessment and update accordingly and/or annually. Advocate and coordinate the necessities to reduce the risk for recognized hazards. Coordinate for the necessary steps needed for the disaster preparedness in the institution. Practically testing of the Hospital Disaster Preparedness and Response Plan and identify the gaps and lapses. Facilitate the disaster resilient environment within the institution. Coordinate the training for staff relevant to institutional disaster management. Coordinate and facilitate Hospital Disaster Management Committee. Support in National Disasters for relief activities mainly focusing the psychological first aid and mental health issues. Liaise with Disaster Preparedness and Response Division of Ministry of Health.
Highlights of 2019: • •
•
Training on Occupational Safety and Health at Workplace was carried out with the resource persons from Employers’ Federation of Ceylon for the Hospital Maintenance Unit members and registered construction agents. Psychological first aid teams were dispatched from the very beginning of bomb blast in April Easter Sunday. The programme was led by the Consultant Psychiatrist Dr Mrs Pushpa Ranasinghe with visits to the National Hospital where victims were treated and to home and field visits where the victim’s close contacts were residing. Initially daily visits were done for one month and then was gradually tailed off. The necessary counselling, therapeutic treatment and social support were provided through professionally trained mental health officials. Establishment of Emergency Alert System for Halfway Home Mulleriyawa.
45
Health Informatics Section Date established: 2016 Main Objective: The aim of Health Informatics Section is to be the focal point for all data needs of NIMH. Services Offered: • • • • •
• • •
Assist in preparation of Annual Action Plan, Annual Performance Report, Director’s Meeting, & various requests for data from Ministry of Health and other Ministries. Coordinate with Consumables Division for all the hospital data forms. Maintain digital datasets of Midnight Summary & Incident Summary. Planning & Maintenance of Hospital Information System. Coordinate data needs of health data systems such as 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), MHMIS (Mental Health Management Information System) Coordinate data needs of Clinical Governance meeting. Assist Director to make information available for citizens as per Right to Information Act. Compilation of Annual Report of NIMH.
Highlights of 2019 •
In October 2019, The Hospital Information Management System was soft launched by DGHS, Dr Anil Jasinghe at OPD, NIMH. The system will initially encompass registration, admission, & discharge.
Computer Maintenance Unit Date established: 25th March 2019 Main Objective: The aim of Computer Maintenance Unit is to coordinate all the computer maintenance activities NIMH. Services Offered: • • • •
On-site inspection of all computer related issues. Servicing of computers at the unit. Repair of computers at the unit. Maintenance of anti-virus software of all computers.
Highlights of 2019: • •
Audit of all computers was performed in April 2019. The 1st regular computer maintenance schedule was initiated in December 2019 with the target of servicing all computers at least once per year.
46
Media Unit Date established: 2018 Main Objective: The aim of Media Unit is to coordinate all media needs of NIMH thereby reducing stigma by promotion of mental health events. Services Offered: • • • • • •
Manage all media needs of institutional events. Coordinate with external media agencies. Perform media surveillance function and address news which can affect mental health. Maintain social media presence. Coordinate website media work. Be the focal point for digital media work.
Highlights of 2019: •
The Media Unit has covered 86 institutional events.
1st year anniversary
The team at work! Figure 29: Activities of Media Unit, 2019
47
Training Unit & Research Unit Date established: 2006 (Training Unit), 2008 (Research Unit) Main Objective: The aim of Training Unit & Research Unit is to coordinate training and research activities in mental health for NIMH and National Level. Services Offered: • • • • • • • • •
Conduct monthly Ethical Review Committee (ERC) meetings. Coordinate all project proposals for training with Ministry of Health. Coordinate all logistical requirements for training that goes through the Training Unit. Conduct monthly Continuous Professional Development (CPD) programmes for Medical Officers. Conduct Journal Club for Postgraduate Trainees. Assist researchers in research submissions for ERC. Coordinate elective placements for trainees in mental health. Conduct orientation programmes on NIMH for visiting students and delegates. Facilitate & Coordinate In-Service Training Programmes
Highlights of 2019: •
•
The Library was officially shifted to a new, quieter location to allow better quality study environment for students. There are currently over 6000 books in the library and some books can only be found in National Institute of Mental Health. In-Service Training Programmes (ET&R Funds) o Skills & Attitude development programme for newly appointed supportive staff members (group 1) to NIMH (session 01). o Induction training on mental health for newly appointed nursing officers to NIMH. o Training on occupational safety and health at workplace. o Workshop on Gender-Based Violence (GBV) prevention for the police officers. o Workshop on Research for the Medical Officers of NIMH (CPD 1) . o Workshop on updates on dermatological illnesses and cosmetic medicine for the Medical Officers (CPD 2). o Leadership and management course for Medical Officers (CPD 3). o Workshop on updates on surgical illnesses for Medical Officers (CPD 4). o Advanced communication skills course and updates of information technology for Medical Officers (CPD5). o Workshop on updates on pediatrics for Medical Officers (CPD 6). o Workshop on developing management skills among in charge Nursing Officers. o Workshop on rehabilitation in psychiatry for Nursing Officers. o Workshop on psychiatric subspecialties for Nurses. o Workshop on management of violence and aggression for Nursing Officers. o Workshop on infectious controls in hospital environment for Nursing Officers. o Workshop on non-communicable diseases for the Nurses. o Workshop on crisis intervention in psychiatry for the Nurses. o Workshop on research for Nurses. o Skills & attitude development programme for newly appointed supportive staff members (group 2).
48 o •
Workshop on falls prevention for supportive staff.
External Training Programmes o Post Graduate training for Registrars and diploma trainees in Psychiatry. o 6 weeks training programme for Medical officers of Mental Health (MOMH). o Training programme on psychiatric emergencies for the Pre intern Medical Officers. o 1-day workshop on psycho pharmacology for registrars and diploma trainees in Psychiatry. o 2 weeks each clinical training for 3rd year medical students at University of Colombo. o 1 week each clinical training for the 3rd year medical students at University of Sri Jayewardenepura. o 2 days each training for the final year medical students at University of Kelaniya. o Professorial psychiatric appointment for medical students of Kotelawala Defence University. o 1-month clinical training for BSc nursing students at University of Ruhuna. o 1-month clinical training & theory and practical examination for BSc nursing students at University of Peradeniya. o 1-month clinical training & Viva Examination for BSc nursing students at Eastern University. o 1-month clinical training for BSc nursing students of Kotelawala Defence University followed with a clinical examination. o 6 weeks elective psychiatric training for the BSc nursing students at University of Sri Jayewardenepura. o 2 days training programme for the students of Paali & Buddhist University. o 5 weeks each clinical training for the student nurses of each Nurses training Schools (NTS) in Sri Lanka followed with a viva voce examination. o 2 weeks Psychiatry training programme for the student nurses of Lanka Hospital. o 2 weeks Psychiatry training programme for the student nurses of International Institute of Health Sciences (NHS).
49
Nutrition Unit Date established: 2016 Main Objective: The aim of Nutrition Unit is to optimize the nutritional status of patients of NIMH. Services Offered: • • • •
Provides nutritional care for both in-patient and out-patient of the institute. Help to improve knowledge on nutrition among the hospital staff. Coordinate the Food Committee of NIMH. Supervise the food hygiene in kitchen and canteen.
Highlights of 2019: • • • •
Establishment of the Nutrition Unit at Halfway Home and attaching one Nutritionist to the unit. Upgrading the raw food tender with more extra food items. Started ordering some extra food items such as yoghurt/fruits for the long-term care wards on monthly basis. Providing and implementing suggestions to improve the quality of the hospital diet.
Kitchen Date established: 1926 Main Objective: The aim of the kitchen is to provide healthy meals for all in-ward clients and supportive staff members. Services Offered: • • • •
Prepare and distribute meals for all in-ward clients. Prepare and distribute meals for health assistants on duty. Provide space for donor food preparation. Provide special requirements of food for institutional activities as needed.
50
Special Grade Nursing Officer’s (SGNO) Office Date established: 1926 Main Objective: The aim of Special Grade Nursing Officer’s (SGNO) Office is to be the focal point for all administrative and clinical requirements for nurses in NIMH. Services Offered: • • • • • • • •
Coordination the Midnight Summary of the institution. Allocate the human resources of nurses in NIMH as per situational need. Coordinate in-service training programme for nurses. Coordinate resource persons for external training programmes NTS (Mulleriyawa), NTS of Private Hospitals, & Universities of Ruhuna, Peradeniya, Eastern, and Kotelawala Defense University. Clinical supervision of nursing at students, graduates & post-basic level. Mentor nursing activities such as in Productivity, Quality, Infection Control, & Health Education. Support in decision making on nursing matters. Conduct weekly Nurse’s Journal Club.
School of Nursing Mulleriyawa Date established: 1961 Main Objective: The aim of School of Nursing Mulleriyawa is to provide the knowledge and practice of mental health and psychiatric nursing for the nursing officers of Sri Lanka. Services Offered: • • • • •
Coordinate training requirements of all-island student nurses for psychiatry component. Coordinate training requirements for Nursing Leaders for psychiatry component. Conduct school awareness programmes as part of training. Conduct community awareness programmes as part of training. Conduct community recreational programmes as part of training.
51
Medical Record Room Date established: 1926 Main Objective: The aim of Medical Record Room is to preserve and manage all medical and non-medical records of NIMH. Services Offered: • • • •
Store all medical records including BHTs, investigations, forensic case reports, and clinical ledgers. Store all non-medical records including admission records, administrative, & financial records. Retrieve records for clinical purposes. Retrieve medical records for legal purposes.
52
Diagnostic Services Laboratory Department Date established: 1949. Modern laboratory was established in 2007. Main Objective: The aim of Laboratory is to provide medical laboratory testing services in accordance with the applicable standards to satisfy the expectation of clinical staff and the administration. Services Offered: • • • •
Biochemistry related testing. Hematology related testing. Microbiology related testing. Coordinating specimens sent to MRI, RIA, & NHSL.
Figure 30: Annual Summary of Laboratory, 2019
53
Electroencephalography (EEG) Unit Date established: 1994 Main Objective: The aim of EEG Unit is to be the cluster center for all EEG needs of NIMH and neighboring hospitals. Services Offered: • • • •
Routine EEG. Video EEG. EEG to confirm brain death of patients at ICU of NIID, and Colombo East Base Hospital, Mulleriyawa. Pediatric EEG at NIDDM & Colombo East Base Hospital.
Figure 31: Annual Summary of EEG Unit, 2019
54
Electrocardiography (ECG) Unit Date established: 2000s Main Objective: The aim of Electrocardiography (ECG) Unit is to provide all ECG needs of NIMH. Services Offered: • •
Routine ECGs at the unit & for non-ambulatory clients are done at the client ward/unit. Urgent ECGs are done at the client ward/unit.
Figure 32: Annual Summary of ECG Unit, 2019
55
X-Ray Department Date established: 1971 Main Objective: The aim of X-Ray Department is to provide a diligent & quality radiographic service to the hospital. Services Offered: • •
Routine and urgent X-Rays. Provide radiographic service to not only NIMH but also perform a cover-up function for NIID and CEBH Mulleriyawa.
Figure 33: Annual Summary of X-Ray Department, 2019
56
Physiotherapy Unit Date established: 2000s Main Objective: The aim of Physiotherapy Unit is to assist the clinical team in promoting the mobility and independence of clients at NIMH. Services Offered: • • • • • • •
Routine physiotherapy. Routing physiotherapy at ward for non-ambulatory clients. Performing chest physiotherapy to obtain sputum samples for investigations. Infrared treatment. Ultrasound treatment. Short wave diathermy treatment. Muscle stimulation treatment
Figure 34: Annual Physiotherapy Sessions, 2019
57
Pharmacy Department Date established: 1926 Main Objective: The aim of Pharmacy Department is to maintain an effective supply chain of Pharmaceuticals, Surgical Consumables, Surgical Dressings, Surgical Non-Consumables, & Oxygen for the benefit of the client. Services Offered: • • • • • • • •
Outpatient dispending of drugs for OPD clients. Indoor Pharmacy at NIMH & Halfway Home for all clients in wards and units at NIMH. Consumable Store supplies consumable surgical items and dressings for all clients at wards and units at NIMH and Halfway Home. Non-Consumable Surgical Section supplies & repairs non-consumable items to all wards and units. Preparation Section supplies external preparation for all clients at wards and units. The Local Purchase Section supplies medicines to in-ward clients on a name patient basis. Dispense drugs in the community at outreach clinics at Pannipitiya, Kotahena, Modara, & Raiagiriya. Coordinate Drug Therapeutic Committee meeting with Medical Supplies Division, Ministry of Health.
Highlights of 2019: • • •
Local purchase procedure was initiated through the MIMIS system. The duration of prescribing a local purchase drug and issuing it to patients has been significantly reduced. Improvement in qualitative process for issuing drugs from indoor pharmacy according to the ‘Manual of Management of Drugs’ issued by Ministry of Health. Introduction of Methylphenidate tablet to clinic patients after approval from Drug Therapeutic Committee & relevant authorities. Month
Local Purchase
Drugs
Surgical Consumable
Dressings
January
50571.90
9744735.47
1144828.15
February
206735.60
7753496.41
March
131466.22
April
Non Consumable
Lotion
Dental
Oxygen
505112.79
258244.09
75140.45
64765.58
973072.60
109675.86
83613.24
78246.64
44894.45
3802371.11
852130.01
221353.28
9641.98
70648.44
88817.12
17884320.63
772149.74
89136.19
41177.30
24449.46
May
44339.10
1238119.35
331138.91
56685.44
77840.00
60083.26
June
65516.68
4980493.79
1714957.16
244210.31
July
64645.84
3122860.93
3426.97
215431.20
August
159053.80
338955.23
142704.54
173214.78
September
68694.76
2446327.94
1310407.53
53017.58
October
84550.78
7030221.89
513731.86
780753.46
November
188510.40
4718375.20
700816.67
140029.14
December
61783.00
1290539.42
141692.21
Total
1214685.2
64350817.37
8601056.35
2588620.03
1193600.00
4308.73
21393.97
103810.00
15859.65
74365.00
9304.47
69568.27
61203.63
26719.56
5283.21
46791.07
35543.00
51852.18
33296.10
46502.17
44816.50
63718.92
46981.52
21840.00
20378.84
788000.00
6804.00
2007302.70
746181.33
Figure 35: Annual Summary of Pharmacy, 2019
18811.73 362606.90
583406.48
58
Administration Department Date established: 1926 Main Objective: The aim of Administration Department is to assist the top management in human resources management, project management, and resource planning. Services Offered: • • • • • • • • • • • •
Assist Director in general administration. Administration of Overseer’s Office & Supportive Staff. Preparation of administrative returns for Ministry of Health. Manage documentation and coordinate projects as per approved Annual Action Plan. Manage documentation of utility payments for NIMH. Manage documentation of all staff needs (appointment, promotions, disciplinary, pension). Manage documentation of all dietary needs of clients warded in NIMH. Issue Internal Circulars. Manage Public Address System. Coordinate medical board. Coordinate court matters. Coordinate all transport needs of NIMH.
Inquiries & Transport Unit The Inquiries & Transport Unit plays the main administrative role for all legal and transport matters of NIMH. The office directly supports clients by managing their personal belongings when warded. In addition, the office manages telegrams received, handles police inquiries, and maintains the Admission Ledger of NIMH.
Overseer’s Office The overseer office plays the main coordinating role for all the supportive staff in the hospital managing the Health Assistant needs for wards, units, offices, mortuary, transport & maintenance units. The office plays a key role in the logistical arrangements of clients who have passed away.
Diet Branch The diet branch plays a facilitator’s role in organizing the diet orders from all the ward via receiving the diet, marking documents of patients. It also receives rail warrants of patients.
59
Accounts Department Date established: 1926 Main Objective: The aim of Accounts Department is to assist the top management in financial & inventory management. Services Offered: • • • • • • • • •
Assist Director in general financial matters of NIMH. Assist Director in preparing budgetary allocations for NIMH. Preparation of financial returns for Ministry of Health. Financial management of all projects of NIMH. Financial management of all utility payments of NIMH. Financial management of staff salaries. Coordination of Technical Evaluation Committees. Coordination of Tender Boards. Coordination of Condemning Boards.
Shroff The Shroff plays the main role in physical cash management in NIMH. The Shroff is responsible for managing payment of vouchers prepared by Accounts Department, giving salaries to staff, accepting payments for paid services in NIMH, and allowing temporary deposits of monies relevant to NIMH.
60
Other Telephone Exchange The telephone exchange is tasked with running the communication needs of the entire hospital. The exchange handles client inquiries, links clients with health staff and vice versa, and surveils the integrity of the internal telephone network.
Drivers The driver’s team form 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.
Maintenance Team The maintenance team looks after the day to day running repairs of NIMH under the purview of the Quality Management Unit. The team looks after general maintenance, masonry work, carpentry work, plumbing work, welding work, & electrical repairs.
61
Special Activities
New Year Celebration
Opening of NAITA Apprenticeship Centre
Annual Pirith Chanting Ceremony
Commencement of Buddhist Shrine Renovation
Upgrading Open School Programme
School Mental Health Promotion Programme
Int. Women’s Day – Speech Competition
Int. Women’s Day – Volleyball Competition
62
Bakmaha Divuruma – Oath to eradicate drugs
Horticulture Therapy Project
Vesak Programme
“Mental Health Response to Trauma” Program
Re-opening of OPD
Work Improvement Teams (WIT) Meetings
Poson Programme
NAITA Certificate Award Ceremony
63
World Hepatitis Day
Observational Visit by DGH Chilaw
Counselling Workshop
ECHO E-Learning Programme for CPN
Breastfeeding Workshop
Sewing Machine Repair Programme
World Diabetes Day
Legal Awareness & Professional Ethics Workshop
64
World Mental Health Day - 1926 Promotion in Pettah
World Mental Health Day - School Art Competition
World Mental Health Day – Essay Competition
World Mental Health Day - Walk
World Mental Health Day - Concert
World Mental Health Day – Media Conference
World Mental Health Day – Carers Meeting
World Mental Health Day – Street Drama
65
World Mental Health Day – Opening of HIMS
World Mental Health Day – Re-opening Ward 12
World Mental Health Day – Public Day
World Mental Health Day – Suicide Prevention Lect.
Cyber Crimes Workshop
Winner of National Essay Competition
World AIDS Day
Exhibition at SERRIC
66
Christmas Celebration Ward 8
Christmas Programme
Child and Adolescent Psychiatry Conference
NIMH Wins at Cricket!
Christmas Programme
Exhibition at SERRIC
Christmas Programme
Farewell of Director - Dr Kapila Wickramanayake
Figure 36: Special Activity Highlights of NIMH, 2019
67
Annexures I: Cadre Details of NIMH
National Institute of Mental Health
Approved Cadre
In Position
Director
01
01
Deputy Director
00
01
Consultant
12
12
Medical Officer
76
64
Dental Surgeon
03
03
SGNO
06
04
Accountant
01
01
Administrative Officer
02
01
Ward Sister
25
05
Nurse
415
360
PSW
20
09
Occupational Therapist
16
09
Medical Laboratory Technologist
06
06
Physiotherapist
02
02
Radiographer
02
02
Pharmacist
07
07
Dispenser
02
02
Development Assistant
00
00
PHI
01
01
EEG recordist
02
02
Cardiographer
02
02
Development Officer
10
10
Information and Communication Technology Assistant
03
02
Public Management Assistant
44
29
Ward Clerk
12
06
Nutritionist
02
02
Diet Stewards
04
03
House Warden
05
04
Health Driver
11
11
Telephone Operator
04
02
Hospital Overseer
08
07
Cook
09
06
Lab Orderly
02
02
Seamstress
02
02
Plumber
01
01
Attendant
250
127
-
375
Supportive staff
68 Approved
Halfway Home, Mulleriyawa
cadre
In position
Medical Officer
07
06
SGNO
01
01
Nurses
82
62
Occupational Therapist
02
02
Nutritionist
00
01
Diet stewards
02
02
Hospital Overseer
02
02
Cook
02
01
Telephone Operator
02
01
Attendant
42
19
-
55
Supportive Staff
Approved
Nurses Training School
Cadre
In Position
Principal
01
01
Senior Nursing Tutor
06
03
Nursing Tutor
04
02
Clinical instructor
00
00
Librarian
00
00
PMA
01
01
House Warden
04
03
Health Driver
02
01
Cook
03
01
-
10
Supportive Staff Totals Per Category Director
01
PSW
09
Nutritionist
02
Deputy Director
01
Occupational Therapist
11
Diet Stewards
05
Consultant
11
MLT
06
House Warden
07
Medical Officer
71
Physiotherapist
02
Health Driver
12
Dental Surgeon
03
Radiographer
02
Telephone Operator
03
Accountant
01
Pharmacist
07
Hospital Overseer
09
Administrative Officer
01
Development Assistant
00
Cooks
08
SGNO
05
PHI
01
Lab Orderly
06
Principal (NTS)
01
EEG recordist
02
Seamstress
02
Ward Sister
05
Cardiographer
02
Attendant
146
Senior Nursing Tutor
03
Development Officer
10
Supportive staff
460
Nurse
422
ICT Assistant
02
Nursing Tutor
02
PMA
29
Clinical Instructor
00
Ward Clerk
06
69
Annexures II: Research Submitted to Ethical Review Committee, 2019 Expressed emotions, Medication adherence and its’ association with disease prognosis in 120/01/2019 121/02/19
122/02/2019
123/02/2019
patients with Schizophrenia in Teaching hospital, Anuradhapura Explore factors affect on low self esteem of mentally ill patients follow up from National Institute of Mental Health Sri Lanka. Challenges faced by family care givers of psychiatric patients at National Institute of Mental Health Sri Lanka. Factors affecting the government sector nurses for not engaging in higher education in two selected government hospital in Colombo district.
125/02/19
The effect of mindfulness meditation on emotional intelligence of Mental health nurses at National Institute of Mental Health Sri Lanka.
126/03/19
Need of rehabilitation of mentally ill people of Sri Lanka Psychiatric Social Worker NIMH - Mulleriyawa
127/05/19
Burdens of Informal Caregivers of Patients with Dementia Comparison of characteristics and clinical and functional outcome of patients with
128/05/19
Schizophrenia on oral second – generation antipsychotics and first generation long acting antipsychotic injectable attending Outpatient clinics and Community Mental Health Service of National Institute of Mental Health
129/05/19 130/05/19
A Socio Psychological study on mentally retarted people caused by domestic violence. (A case study conducted at the National Institute of Mental Health - Angoda) Adherence to Anti-depressants among gender based violence patients attending to National Institute of Mental Health in Sri Lanka. Sleep pattern disturbance and associated factors among patients admitted to intermediate
131/05/19
132/05/19
wards in National Institute of Mental Health in Sri Lanka. Single blind randomized control trial to evaluate the effectiveness of Electroconvulsive Therapy (ECT) in acute Schizophrenia
133/06/19
Knowledge and attitude regarding Neuroleptic Malignant Syndrome (NMS) Management among Nurses who are working in National Institute of Mental Health, Sri Lanka.
134/06/19
Job satisfaction of Nurses in field of Psychiatry with special reference to National institute of Mental Health. Self reported practice and awareness with its associated factors on occupational hazards and safety practices among medical laboratory technicians working in government tertiary care health institutions in Colombo district. Translation and validation of Glasgow Anti-psychotic Side effects Scale (GASS) to Sinhala: a self-administered screening instrument to assess second generation anti-psychotic induced side effects. A project to prevent inpatients absconding from the National Institute of Mental Health, Sri Lanka. Implementation status, knowledge and attitudes of traders on inspection and rating of food handling establishments using the H800 format in the Battaramulla MOH area
135/08/19
136/08/19 137/08/19 138/08/2019
70 139/08/19 140/08/19 141/08/19
142/08/19
143/10/19
144/10/19
145/10/19
Challenges faced by Mental Health workers in delivering the Mental health services to service users in North, South and West provinces of Sri Lanka. Knowledge, attitudes and practices among caregivers of patients with Schizophrenia Job satisfaction among registered nurses who are working in National Institute of Mental Health, Sri Lanka. Assessment of quality of life among caregivers of patients with mental illness in National Institute of Mental Health, Sri Lanka. Sociodemographic and clinical characteristic of people presented with deliberate self-harm attempts and attempted suicides to District General Hospital Mullaitivu. Internalized stigma and associated factors in Psychiatric outpatients with Schizophrenia in Anuradhapura, Sri Lanka Motives of deliberate self harm among adolescent girls with borderline personality traits: An exploratory study in the western province
71
Annexures III: Annual Financial Report of NIMH. 2019 Object Code Grand total Total 1001 1002
Description Recurrent Expenditure Personal Emoluments salaries and Wages Overtime and Holiday Payments
Allocation
Expenditure in year 2019
Surcharge
Savings
EXP %
1,332,974,094.00
1,291,962,967.96
10,855,340.82
41,011,126.04
96.92
1,059,628,094.00
1,047,619,222.04
9,603,500.25
12,008,871.96
98.87
475,915,444.00
470,605,582.06
4,659,634.57
5,309,861.94
98.88
347,709,371.00
344,709,650.92
1,637,187.66
2,999,720.08
99.14
1003
Other Allowances
236,003,279.00
232,303,989.06
3,306,678.02
3,699,289.94
98.43
Total
Travelling Expenses
1,310,000.00
1,308,309.34
6,372.96
1,690.66
99.87
1101
Domestic
1,310,000.00
1,308,309.34
6,372.96
1,690.66
99.87
Total
147,722,500.00
128,339,010.07
114,537.54
19,383,489.93
86.88
4,875,000.00
4,421,917.23
-
453,082.77
90.71
1202
Supplies Stationery and office Requisties Fuel
4,242,500.00
4,130,728.18
-
111,771.82
97.37
1203
Diets and Uniform
119,500,000.00
100,915,976.15
108,680.65
18,584,023.85
84.45
Diets
119,500,000.00
100,915,976.15
108,680.65
18,584,023.85
84.45
1204
Medical Supply
10,000,000.00
9,848,846.51
2,001.89
151,153.49
98.49
1205
Other Maintenance and Expenditure
9,105,000.00
9,021,542.00
3,855.00
83,458.00
99.08
20,982,500.00
19,878,670.24
-
1,103,829.76
94.74
3,630,000.00
3,267,705.81
-
362,294.19
90.02
2,030,000.00
1,574,827.87
-
455,172.13
77.58
15,322,500.00
15,036,136.56
-
286,363.44
98.13
1201
Total 1301 1302 1303
Vehicles Plant and communivation Building and Structures
Total
Services
98266000
89874047.58
1125119.68
8391952.42
91.46
1401
Transport
200000
101327
0
98,673.00
50.66
6766000
6457142.94
5514
308,857.06
95.44
45650000
41657788.82
559802.84
3992211.18
91.25
Electricity
16650000
15798900.23
559802.84
851,099.77
94.89
3,141,111.41
89.17
1402 1403
Postaland Communication Electricity and Water
water
29000000
25858888.59
1404
Rents and Local Taxes
-
-
-
-
-
1409
Other
138,020,000.00
121,056,865.13
-
16,963,134.87
87.71
Security
20,000,000.00
14,798,583.63
-
5,201,416.37
73.99
Cleaning Services
115,000,000.00
105,151,251.50
-
9,848,748.50
91.44
Other
3,020,000.00
1,107,030.00
-
1,912,970.00
36.66
Total
Transfers
5,065,000.00
4,943,708.69
5,810.39
121,291.31
97.61
1506
property Loan Interest to Public Servants
4,415,000.00
4,311,470.19
4,810.39
103,529.81
97.66
1508
Other
650,000.00
632,238.50
1,000.00
17,761.50
97.27
72
Annual financial Report of NIMH - 2019 National Institute of Mental Health,Unit II,NTS Mulleriyawa Financial Expenditure (capital) - 2019 Expenditure in Object Code Description Allocation year 2019 Surcharge Grand total Recurrent Expenditure 98,484,866.95 62,964,487.12 450,977.02 111-01-05-2001(11) Rehabilitation and Improvement of 46,945,048.70 34,680,933.55 450,977.02 111-01-20-1-2001(11) Rehabilitation of Improvement of 5,000,000.00 1,383,814.03 111-01-05-0-2102(11) Purchasing of office equipments 6,000,000.00 5,462,192.31 111-02-13-13-2103(11) Purchasing of Hospital equipments 4,500,000.00 652144.86 111-01-05-0-2002(11) Internal Telephone lines establish 10,483,368.33 8822291.23 111-02-20-1-2401(11) iInservice Training Programme 3,215,756.64 2969385.02 111-01-05-0-2103(11) Establishment of electric Lift for 11,031,960.00 2550073.94 111-01-05-0-2003(11) vehical repairs 2,650,479.00 1,324,770.02 111-02-20-17-2506(11) Renovation at the NTS Mulleriyawa 1,942,209.28 1,942,209.28 111-02-14-35-2509(11) Mental Health day Activities 5,936,000.00 2,396,627.88 111-02-14-20-2509 Purchasing of emergency systems 780,045.00 780,045.00 -
Savings 35,520,379.83 12,264,115.15 3,616,185.97 537,807.69 3,847,855.14 1,661,077.10 246,371.62 8,481,886.06 1,325,708.98 3,539,372.12 -
73
Acknowledgements Chief Editor Dr Dhammika Wijesekara (Director)
Co-Editors Dr Arosha Wijewickrama (Deputy Director) Dr Mohamed Rikaz Sheriff Dr Upeka Mettananda Dr Sujani Perera
Data Collection Mrs. Nishani Chaturika
Front & Back Artwork by Media Unit, NIMH CD Preparation by Planning Unit, NIMH
74