NIMH Media Bulletin V1 2022

Preface

The Angoda Mental Asylum was declared open on 31st January 1926 which is one of the oldest health care facilities in South Asia. The former Mental Hospital was upgraded to the National Institute of Mental Health (NIMH), Sri Lanka by a Cabinet decision on 31st October 2008. Hence declared as the central point for all psychiatric services particularly clinical, specialized, and training and research.

Mental health services including therapeutic care, rehabilitation and combatting social stigma have ameliorated over the years since then due to relentless commitment by dedicated mental health service providers of all the staff categories. This was complemented by infrastructure and human resource development overtime. Establishment of the Media Unit of NIMH in 2016, played a key role in uplifting mental health services through raising awareness.

NIMH expanded the 1926 National Mental Health Helpline to WhatsApp services with the support of Airtel which was one of the most successful interventions recently established. This made mental health services promptly accessible to the community. LGBTQ awareness, upgrade of adolescent unit, special Christmas celebration for forensic unit, establishment of “Pathum Piasa” resident for rehabilitated female clients and “Navodaya” shop for sale of products made by clients are some of the paramount mental health activities in NIMH during the past year.

The concept of an annual magazine is intended to strengthen existing mental health programmes. This magazine namely The NIMH Media Bulletin will raise awareness on mental wellbeing and psychiatric conditions and will be accessible through NIMH official website. (https://nimh.health.gov.lk).

I like to thank the media team members, Director NIMH, Deputy Director NIMH, Dr Pushpa Ranasinghe Consultant Psychiatrist, for the support rendered and technical contributors to the magazine.

Dr Kavinda J. De Silva Senior Medical Officer

In charge officer of the Media Unit NIMH

Editorial Board

Dr. Kavinda De Silva

Ms. K.D.C.K. Migunthanna

Mr. Ashan Basnayake

Mr. Sarith Wijesinghe

Support

Mr. Lakmal Jayabuddhi

Mr. Sandeepa Indrachapa

Mr. Naveen Yasas

Mr. Ruwan Kumara

Mr. Suraj Lakmal

Editorial Supervision

Dr. Arosha Wijewickrama (Deputy Director)

NIMH Media Bulletin Volume 1 2022

© National Institute of Mental Health, Sri Lanka

National Institute of Mental Health, Sri Lanka

Mulleriyawa New Town

Tel: 0112 578 234 7

Fax: 0112 578 238

Email: info@nimh.health.gov.lk

Web: http://nimh.health.gov.lk

Facebook: https://www.facebook.com/pg/NIMH.Angoda ,

Instagram: https://www.instagram.com/?hl=en

YouTube: https://www.youtube.com/c/NationalInstituteofMentalHealthSriLanka

(A state institution under the Ministry of Health of the Democratic Socialist Republic of Sri Lanka)

Director’s Message

T

I'm elated to word my thoughts for this year's magazine while closing in on the year's end.

As a national institution that shoulder the burden of a nation's mental health, a cause that at the time is very crucial- the visibility of our efforts and our message to the community is detrimental.

This magazine will reflect back on our journey this year and I'm confident that this magazine will memorialize what the year 2022 looked like to us in an endeavor leading the mental health care in Sri Lanka.

Dr. Dammika Wijesighe

he 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 patients with mental illness. The former Mental Hospital was upgraded to a National Institute in 2008. The Half Way Home, Mulleriyawa (HWH) and the School of Nursing, Mulleriyawa are also under the administration of NIMH since 2008.

The NIMH has a total of around 1500 beds and annually around 8000 patients are admitted seeking treatment for all types of mental illness. NIMH provides acute care, Intermediate Care and long term care as well as specialized services. There are about 900 inward patients treated at NIMH on any given day.

The NIMH is the main training centre in Sri Lanka for undergraduate and post graduate trainees in Psychiatry from Medical and allied fields, for basic and in service training for health staff as well. All postgraduate trainees in MD psychiatry undergo a compulsory training for a minimum period of 6 months at the NIMH.

Preliminary Care

Out-patient services

In-patient care

Specialized Care

Other Services

Year in Review

Staff Vaccination against Covid19

Opening “Sithmal Nimawum” Sales Centre for Sales and Exhibit Clients’ Products & Services

Opening of Infection Control Unit

Sinhala & Hindu New Year Celebration at Section C

Opening “Deegayu” Senior Citizens’ Rehabilitation & Care Centre

Opening Female Intermediate Care Home

Cricket Match for NIMH Staff

World Children’s Day Celebration

Christmas Celebration at Forensic Rehabilitation Unit

Addressing the Mental Health Concerns of LGBTQ Community

Articles by Staff

NIMH and Covid 19

By Public Health Unit

The response of The National Institute of Mental Health was an organized and coordinated effort which started well before the 1st case was detected. Our response was focused on regular & transparent communication, coupled with an agile management strategy to respond to changing scenarios.

All circulars sent by Government of Sri Lanka, especially Ministry of Health were adhered to.

Action plans were sent to and approved by Ministry of Health.

All basic Covid 19 prevention methods such as social distancing, hand washing, wearing of face masks were established before the 1st wave from the front gate until the client was admitted. This included the relocation of the OPD to a more open area and segregation of different risk levels.

Wards were divided into categories below. All categories had dedicated staff, strict infection control protocols and recreational activities for clients. Most units had CCTV to facilitate distant observation

o CAT1 care wards:A dedicatedteam ofdoctors,nurses &healthstaffmanagedthese wards which were reserved for Covid positive clients. The wards were equipped with CCTV and Audio Communication to reduce the contact incidents. A unique telephone calling facility for clients to call their relatives on a timed basis was introduced by Mobitel. Clients were given recreational activities. Managed by Consultant Physicians and Consultant Psychiatrists. The Mental Health Covid Treatment Units are MHCTU 1 (20 Beds) & MHCTU 2 (10 Beds).

o CAT 2 care wards: This category was to manage clients suspected of Covid 19 and quarantine patients as per the prevailing protocols. Managed by Consultant Physicians and Consultant Psychiatrists. The Isolation Units are ISO 1 (4 beds), ISO 2 (8 beds), LDU (6 beds).

o CAT 3 care wards: This was a unique requirement to NIMH to reduce the burden of CAT 2 wards.

o CAT 4 care wards: These wards were to manage low risk admissions and remaining patients who could not be discharged.

o CAT 5 care wards: This was for the closed management of long term patients.

Clinic services were functioning as follows:

o Clinics at Navodaya, Prisons, and Community were active throughout via distant methods and

o Returned to usual clinics with covid prevention measures.

o NHSL Clinics were active with advice of NHSL Covid Cell.

o Community Visits were continued with strict covid prevention measures.

o Isolated areas were also given coverage in coordination with local MOH & PHI.

A total of 20 internal circulars were published in multiple languages to manage the Covid 19 response. These were broadly covering the following areas.

General Covid response

Management of outbreaks

Changes in ward layout

Categorization of admissions (CAT 1, CAT 2, CAT 3, CAT 4, CAT 5) Checklist for OPD Checklist for Wards Checklist for Isolation

Provision of outpatient drugs

RAT Testing

Checklist for Covid positive clients

Managing staff exposures

Conducting Navodaya clinics

PCR Testing

Staff risk assessment

Internal cluster management

Public gatherings

Conducting outpatient clinics

Admission algorithms Managing transfers

Conducting Community Clinic Depot Medication Recreation for clients

Allocation of MHCTU Staff

Cleaning ECT Management Managing staff burnout

Achievements

Seclusion of clients

Client visitation

o Service of Covid 19 Mental Health Treatment Units (CAT 1 care wards) for Covid 19 positive clients:

The Mental Health Covid Treatment Unit of NIMH was declared (according to circular No.DDG/NCD/V/12/2020) open by the Director General of Health Services, Dr. Asela Gunawardene, in August with the presence of the Dr. Sunil De Alwis, Additional Secretary Medical Services, Ministry of Health, Dr. Champika Wickramasinghe, Deputy Director General Non Communicable Diseases, Dr. Jayasundara Bandara, Project Director, Sri Lanka Covid 19 Emergency Response and Health Systems Preparedness Project and the NIMH staff. This is a dedicated special treatment unit catering for Covid positive patients with acute psychiatric illnesses; renovation funded by World Bank grants.

In 2021, 294 Covid positive male patients and 143 female patients with acute psychiatric illnesses were treated at MHCTU 1 and MHCTU 2 wards.

o Service of Covid-19 Isolation Units (CAT 2 care wards) for Covid-19 suspected clients:

The Covid 19 Isolation Units was the initial response to the pandemic. The initial ISO 1 was the already available Isolation Unit in NIMH. With ISO 2 NIMH was declared as the National Quarantine Center for Psychiatric Patients during the Covid 19 Pandemic

(According to circular No.DDG/NCD/70/2020). The NIMH has 16 isolation rooms functioningsince06.04.2020forthis purposeandanother08roomswereaddedbyopening Isolation 2 Unit. This was declared opened by the Director General of Health Services of Sri Lanka, Dr Anil Jasinghe. The repair and refurbishment of the old abandoned building was done by the Sri Lanka Army using their own funds.

Learning Disability Unit (LDU) with 6 rooms was taken for the isolation purpose as the requirement of space for the CAT 2 care was high.

In 2021, CAT 2 care wards have given their service for 913 of Covid suspected clients with acute psychiatric illnesses.

How our teams functioned with Covid 19 challenge:

o Infection Control Unit

Arranged awareness programs to all staff category regarding Hand hygiene, Donning & Doffing of PPE, Proper mask usage, Taking PCR sample & handing over to the laboratory.

Making of triple packs in house; > 1000 from Infection Control Unit in 2021.

Supply polyethene aprons and face shields to all staff who brings patients to the out clinic.

Theunit has coordinated >5000PCR collections

theinfectioncontrol unit in 2021

Conducting mass public, staff and patient vaccination programs.

o Navodaya

Follow up done via phone and Skype.

Medication was sent via post.

Prescriptions were sent via WhatsApp.

o Community Psychiatry Unit

Peripheral clinics with safety precautions

Conducted clinics in isolated areas with full PPE

IM injections were continued with full safety precautions.

Monthly clinics medication were sent via post

o Training Unit

Continued trainings using Zoom Technology.

World Mental Health Day 2022

By M.W.S.R. Ruwangani (Special Grade Nursing Officer NIMH)

The World Health Organization recognizes World Mental Health Day on 10 October every year.

History of World Mental Health Day; was celebrated for the first time on October 10, 1992, at the initiative of Deputy Secretary General Richard Hunter. Up until 1994, the day had no specific theme other than general promoting mental health advocacy and educating the public. The day is marked for global mental health education and awareness. The overall objective of World Mental Health Day is to raise awareness of mental health issues around the world and to mobilize efforts in support of mental health. The Green ribbon is the international symbol of mental health awareness the theme of 2022's World Mental Health Day, set by the World Federation for Mental Health, is 'Make mental health and well‐being for all a global priority’.

Around one in every nine people lives with a diagnosable mental health disorder. Stigma and misunderstanding are major problems. World mental health day was created to educate the public about mental health and decrease the stigma surrounding mental health issues. Educating the public about the warning signs of mental health issues can help keep people safe. Most mental illnesses are isolating by nature. Increasing awareness around mental health issues also helps those who suffer from mentally ill conditions to feel less alone.

The main warning signs of mental illness are as follows:

• Excessive paranoia, worry, or anxiety.

• Long‐lasting sadness or irritability.

• Extreme changes in moods.

• Social withdrawal.

• Dramatic changes in eating or sleeping patterns.

World Mental Health Day is a chance to talk about mental health in general, how we need to look after it, and how important it is to talk about things and get help if you are struggling. We can celebrate and promote World Mental Health Day by Share experiences. A great way to mark World Mental Health Day is to share your own mental health experiences, Spark conversations on social media, Check‐in with your mental health, Practice Self Care, Express daily gratitude, and Reach out to loved ones.

A mental health day is a day, you take off from work or school, and minimize any commitments or responsibilities. You can use this time to focus on relieving stress, relaxing, having fun, and preventing burnout. There are 5 steps you can take to help improve your mental health and well‐being, these are connected, be active, take notice, keep learning and give. As a person in part of our community, need to be aware of mental health and practice correct actions to maintain equal facilities with others every day, not only for World Mental Health Day.

Prescribing play activities for Children

Play is an essential component in the normal developmental trajectory of children. Play activities are noted in varied forms in many mammals as well. Dr. David Whitebread, senior lecturer in psychology and education, from University of Cambridge, explained that play is the highest achievement of human species and it paves path to intellectual development and problem solving skills. Play is an opportunity to build the capacity for creativity, organizing ability, socializing skills, caring and sharing, working both independently and together, flexibility especially when encountering a novel and uncertain events. In addition, play provides the ability to regulate self by emotional regulation which is a key predictor of academic performance. Hence, it is crucial for being successful in later life.

The Greek philosopher Plato described play as a mean of developing talents for adult. He said “play turned the eye of their souls”. The concept of play based learning had been developing from 19th century. However, the freedom to play is restricted by parents in the recent past due to urbanization and subsequent scarcity of space. Parents perceive that the effects of ensuring protection from accidents and crimes by preventing outdoor play activities in the cities, but ideally speaking the negative impact of stopping children from playing are more. Parents also have the misconception that if their children start education early, then only they will perform well in this competitive world. To overcome this, the United Nations declared 28th of May as the world play day to provide awareness to public regarding the rights of children to play, have fun, do sport and relax.

Play can be used a modality of assessment to understand children’s emotions and also to detect neuro developmental disorders such as Autistic Spectrum Disorder (ASD) and Attention Deficit Hyperactive Behaviour. Furthermore, play creates a venture to reflex upon their own thoughts. Play therapy is therapeutic tool to heal children with emotional disorders. For example, when a child pretends to be the teacher to his younger brother, she bosses him and through this way, she is practicing how to regulate her emotions. In ASD, play is prescribed with the view of enhancing eye contact (Eg : Bubble blowing), social interactions (Eg : Ball passing) and turn taking. In normal children, through board games, rules and turn taking can be taught.

David Whitebread’s research focused on developing a play based approach to support children’s writing. Children wrote longer and better structured stories when they first play with doll characters in the story rather than providing instructions. According to the Hanen Centre (2016), pretend play is important in children's development. Research found that pretend play at age 3 and 4 are linked to better language skills at the age of 8 and 9.

Nowadays, as the importance of play is not appreciated by parents as in the past and viewed as a negative thing, it’s high time to create awareness in order to make children enjoy their childhood and actively engage in play not only alone but also with the whole family as one unit and to create home as a safe heaven. In this current Sri Lankan context, as schools are not happening regularly, children has enough time to play and parents also given enough leave to stay home and work from home due to financial crisis, we can start playing together to improve happiness, unity

and mental and physical well being of the child and family. Let’s don’t lose track of the magic of playing and let’s ensure each child receive this rich diet of play experiences age appropriately.

Reference

1. David Whitebread, etl., A report on the value of children’s play with a series of policy recommendations, 2012 https://www.csap.cam.ac.uk/media/uploads/files/1/david-whitebread---importance-of-playreport.pdf

2. UN convention on the Rights of the child, Article 31

Anger and Your Child

Dr Wishva Uduwage, Senior Registrar in Child and Adolescent Psychiatry. Lady Ridgeway Hospital for children, Colombo.

Anger is one of the basic emotions (Ekman, Friesen, & Ellsworth (1982)), like sadness, joy, fear etc. It’s common nowadays to see children and adolescents with problems of poor anger control. Therefore, it’s noteworthy for us to know the “basics of anger”.

Everyone experiences anger and it’s a perfectly normal response in frustrated or difficult situations. Parents must have witnessed anger in their children from infancy to adolescence. An infant as young as 4 months can show their anger towards the care giver, when he/she is hungry, sleepy, etc. A toddler can become angry when limits are being set while they run, jump, climb heights etc. An adolescent may express their anger when they are rejected by peers, being punished by their parents, when they are victims of injustice, etc.

It's important for the parent to identify when the expression of anger is abnormal in a child. Sometimes your child may cry, scream, throw away their personal belongings, and destroy household items. This sort of behavior can damage the child’s self esteem. Furthermore, with anger outbursts children can become violent and tend to hit others, which can hurt the child and the care giver both physically and emotionally. Therefore, in the above circumstances actions should be taken by the care giver to rectify those harmful behaviors.

The adult care giver must first be aware of the causes of anger in children, before taking action to correct it. These causes can be described divided into factors related to the child and factors related to the parent/care giver.

Factors pertaining to the parent/ care giver are numerous it’s important to first figure out whether the child’s anger is due to such factor as at times correcting that factor itself will lead to ease the child’s anger. Sometimes the parent might be harsh and punitive in disciplining the child for which child can react with anger. Parental conflicts leading to chaotic home environment can be so disturbing for the child’s mind leading him/ her to be defiant, angry and aggressive. The current social context has led parents to be busy with their own commitments in employment and household chores, making less time available for them to spend ‘quality time’ with children. So, the anger in a child can be a way of yearning for the parental love and care.

Factors related to the child are being born with an anger prone temperament, intellectual impairment, mental illness like Depression, Anxiety. Depression in children and especially in adolescents have become common during this post pandemic period and irritability, anger are among common ways of presentation.

After being aware of above its good to know what a parent can do, when they see their child’s anger is abnormal. First try to look at yourself and find out whether there are factors that can be corrected. If so take immediate action to rectify.

In an outburst of anger,

Unless your child is facing some danger avoid giving attention to him/her as it’s your attention that they require and the attention given will reinforce the behavior. Do not shout at your child with anger, children learn from you and it will set a bad example. Instead, you can address the child in a firm voice and tell him/her that you don’t recommend this kind of behavior at any cost. Parent/caregiver should have the control during this situation.

At times your child is calm appreciate the good behaviors and help him/her to improve their skills on areas they like, ex Art, sports, and music.

Avoid criticizing your child always.

Manage your time and spend “quality time” with your child, which will build trust, warmth in between you and him/her.

If you suspect the child needs treatment for a psychiatric illness or you are unable to control their anger by doing above seek help from the nearest psychiatric clinic/ child and adolescent psychiatry clinic.