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National Institute of Mental Health - Annual Report 2016
Annual Report 2016 Sri Lanka
National Institute Of Mental Health Ministry Of Health - Sri Lanka.
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National Institute of Mental Health - Annual Report 2016
Our Vision To Lead the Nation in Mental Health Care
Our Mission To provide comprehensive and evidence based Mental Health Services appropriate to the Local Context through state of the art approaches to patient care, capacity building, advocacy, community
engagement,
multi-sector
collaboration and research delivered by competent
and
reliable
staff.
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Contents 1. 2. 3. 4.
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Director’s Message ...............................................................................................................................7 Introduction ..........................................................................................................................................8 Services Offered at NIMH......................................................................................................................9 Out Patient Services............................................................................................................................10 4.1. 4.2.
Out Patient Department & Psychiatric Intensive Care Unit........................................................10 Out Patient Services...................................................................................................................11
4.2.1. 4.2.2. 4.2.3. 4.2.4. 4.3. 4.4. 4.5. 4.6.
Out-Patient Clinics..................................................................................................................11 Dental Unit.............................................................................................................................11 Community Psychiatry Programme........................................................................................13 Colombo Out Reach Ambulance Service................................................................................14
Day Rehabilitation Centre...........................................................................................................15 Day Treatment Centre................................................................................................................17 Day ECT Centre...........................................................................................................................19 Gender Based Violence Prevention Unit....................................................................................20
5. In Patient Services...............................................................................................................................22 5.1.
In-Ward Care..............................................................................................................................22
5.1.1. Acute & Intermediate Care.....................................................................................................22 5.1.2. Long Term Care.......................................................................................................................23 5.1.3. Isolation Unit..........................................................................................................................24 5.2.
ECT Unit......................................................................................................................................25
5.3.
Forensic Psychiatry Unit.............................................................................................................26
5.4.
Psycho-Geriatric Unit..................................................................................................................29
5.5.
Adolescent Psychiatry Unit.........................................................................................................30
5.6.
Perinatal Psychiatry Unit............................................................................................................31
5.7.
Learning Disability Unit..............................................................................................................32
5.8.
Medical Ward.............................................................................................................................33
5.9.
Nutrition Unit.............................................................................................................................34
5.10. Halfway Home –Mulleriyawa.....................................................................................................35 6. Ancillary Services................................................................................................................................38 6.1.
Planning & Development Unit....................................................................................................38
6.1.1. 6.1.2. 6.1.3. 6.1.4. 6.1.5.
Quality Management Section.................................................................................................38 Public Health Section..............................................................................................................39 Infection Control.....................................................................................................................39 Disaster Management Section................................................................................................40 Health Informatics Section.....................................................................................................40
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6.2.
Training Unit & Research Unit....................................................................................................42
6.3.
SGNO Office................................................................................................................................44
6.4.
School of Nursing Mulleriyawa...................................................................................................44
6.5.
Administration Department.......................................................................................................40
6.5.1. Overseer’s Office....................................................................................................................46 6.5.2. Diet Branch.............................................................................................................................46 6.5.2.1. Kitchen................................................................................................................................46 6.6.
Accounts Department................................................................................................................46
6.7.
Diagnostic Services.....................................................................................................................47
6.7.1. 6.7.2. 6.7.3. 6.7.4.
Laboratory..............................................................................................................................47 EEG . ......................................................................................................................................48 ECG . ......................................................................................................................................48 X-Ray Department..................................................................................................................49
6.8.
Pharmacy Department...............................................................................................................50
6.9.
Physiotherapy Unit.....................................................................................................................51
6.10. Occupational Therapy Department............................................................................................52 6.11. Psychiatric Social Work Unit.......................................................................................................54 6.12. Medical Record Room................................................................................................................56 6.13. Other . ......................................................................................................................................56 6.13.1. Telephone Exchange...............................................................................................................56 6.13.2. Drivers....................................................................................................................................56 6.13.3. Maintenance Team.................................................................................................................56 7. Special Activities..................................................................................................................................57 7.1. 7.2. 7.3.
World Mental Health Day...........................................................................................................57 Special Projects & Activities.......................................................................................................58 Staff Welfare...............................................................................................................................59
Annexures I: Cadre Details of NIMH...........................................................................................................60 Annexures II: Research Submitted to Ethical Review Committee, NIMH...................................................63 Annexures III: Annual Financial Report, 2016, NIMH.................................................................................64 Acknowledgements....................................................................................................................................65
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Table of Figures
v Figure 1: Annual OPD Visits, 2016..............................................................................................................10 Figure 2: Annual Clinic Visits, 2016.............................................................................................................11 Figure 3: Annual Dental Visits, 2016...........................................................................................................12 Figure 4: Correction of teeth......................................................................................................................13 Figure 5: Annual Community Visits, 2016..................................................................................................14 Figure 6: Activities of Day Rehabilitation Centre, 2016..............................................................................17 Figure 7: Annual Summary of DTC, 2016....................................................................................................18 Figure 8: School Counselling Programme...................................................................................................18 Figure 9: Annual Day ECT, 2016..................................................................................................................19 Figure 10: Annual GBV Incidents, 2016......................................................................................................21 Figure 11: Annual GBV Victims by Age, 2016.............................................................................................21 Figure 12: Annual Admissions, 2016..........................................................................................................22 Figure 13: Annual Isolation Unit Cases, 2016.............................................................................................25 Figure 14: Annual ECT Patients, 2016.........................................................................................................25 Figure 15: Annual Forensic Clinic Visits, 2016............................................................................................28 Figure 16: Activities of Forensic Psychiatry Unit.........................................................................................29 Figure 17: Annual Admission to Psycho-Geriatric Unit, 2016.....................................................................30 Figure 18: Annual Admissions to Adolescent Psychiatry Unit, 2016..........................................................30 Figure 19: Annual Admissions the PPU, 2016.............................................................................................31 Figure 20: Annual Admissions to LDU, 2016...............................................................................................32 Figure 21: Annual Admission to Medical Ward, 2016................................................................................33 Figure 22: Annual Medical Clinic Visits, 2016.............................................................................................33 Figure 23: Opening of Nutrition Unit by DGHS...........................................................................................34 Figure 24: Summary of Patients in HWH, 2016..........................................................................................36 Figure 25: Activities of HWH, 2016.............................................................................................................37 Figure 26: Opening of PDU.........................................................................................................................41
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Figure 27: Activities of NTS, 2016...............................................................................................................45 Figure 28: Annual Laboratory Tests, 2016..................................................................................................47 Figure 29: Annual EEG Tests, 2016.............................................................................................................48 Figure 30: Annual ECG Tests, 2016.............................................................................................................48 Figure 31: Annual X-Ray Tests, 2016...........................................................................................................49 Figure 32: Annual Summary of Pharmacy, 2016........................................................................................50 Figure 33: Annual Physiotherapy Sessions, 2016.......................................................................................51 Figure 34: Annual OT Sessions, 2016..........................................................................................................53 Figure 35: Annual Summary of PSW Activities, 2016.................................................................................55 Figure 36: World Mental Health Day Activities..........................................................................................58 Figure 37: Special Activity Highlights, 2016................................................................................................59
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1. Director’s Message It is with great happiness that I write my 2nd Director’s message for the National Institute of Mental Health (NIMH), the largest tertiary care hospital in Sri Lanka caring for patients with mental illness.
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Carrying on the plans set in my previous message, I have been investing my time in activities which builds the knowledge, skills and attitudes of my staff as well building infrastructure for patients. I plan to make improving visibility of this great institution and its staff of one my main aims in the coming years. The year 2016 has been a busy year continuing the work of the previous years in promotion, prevention, cure and rehabilitation of people and their families affected by mental disorders. It is heartening to note the team culture that is being built in NIMH and the realization that without a combined effort we cannot succeed. The in-service training programme initiated this year now covers all types of staff and it is my hope that this will lead to better decision making and team work. Another landmark achievement this year is the initiation of a Planning & Development Unit (PDU) for NIMH, the 1st of its kind. As per the recommendation of the DGHS, this PDU could arguably be the only unit in the country where Planning, Quality Management, Public Health, Infection Control, Disaster Management, & Health Informatics are all physically in one location, making it very efficient. I am grateful to the MO (Planning) and NO (Quality Management) for their commitment to see it through as well as the rest of the PDU team. In addition to the key focus areas of staff training, team building and infrastructure development there have been many highlights over the year 2016. We have seen a lot of community support for ward management and community related activities such as World Mental Health Day. It’s heartening to note the appearance and functions of the Halfway Home have been greatly enhanced through many initiatives which you can read about in the report below. None of these activities can be achieved without the dedication of the 1,200 full-time staff working tirelessly around the clock. Apart from the Director and Deputy Director the dedication of our Consultants and our Medical Staff, Nursing Staff, Paramedical Staff, Administrative Staff, Other Staff and as well as the Support Staff must be appreciated. An honorable mention should be made of Prof. H Gambheera who has retired this year after many years of dedicated service. We also warmly welcome our new Consultant Psychiatrist Dr Saman Weerawardana.
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2. Introduction The National Institute of Mental Health (NIMH) was established in 1927 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. The NIMH has around 1,200 full-time staff. The top administration of NIMH comprises of a Director and a Deputy Director who oversee affairs via the Planning &Development Unit, Administration Department & Finance Department. As at 31st December 2016, NIMH had nearly 65 doctors including 9 Consultant Psychiatrists, a Consultant Physician, a Consultant Microbiologist, a Consultant Hematologist, 57 Grade Medical Officers and 3 Dental Surgeons. There were also 4 Special Grade Nursing Officers, 7 Ward Sisters, 427 other grade Nursing Officers, 15 Psychiatric Social Workers, and 9 Occupational Therapists.
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3. Services Offered at NIMH
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4. Out Patient Services 4.1. Out Patient Department & Psychiatric Intensive Care Unit Patients are admitted to NIMH via OPD, according to their permanent address. If the patient hasn’t a permanent address, he or she is admitted on rotation vise method. Patients can come on their own or can be brought by their families, by police, by prison or other non-relatives. Patients are assessed by admission doctor with a nursing officer from the relevant admission ward. All admissions are entered into an Excel data sheet. All discharge documents are being scanned to enter to the system at patient discharge. Aggressive patients are admitted to the acute ward after managing them in PICU. Patients who are not admitted to the hospital, are referred to a nearby psychiatric clinic. At the end of the year, OPD has started a new service. Patients and the relatives are served some beverages (tea) in the OPD.
OPD Visits by Month 1200 1000 800 600 400 200 0
Figure 1: Annual OPD Visits, 2016
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4.2. Out Patient Services
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4.2.1. Out-Patient Clinics
Total Clinic Visits by Consultant 6000 5000
4000 Male
3000
Female
2000 1000 0 JM
HG/SW
PR
DW
JH
KR
MG
RJ
Figure 2: Annual Clinic Visits, 2016
4.2.2. Dental Unit 2016 was the year when oral care was integrated as part of the overall management of the psychiatric patient admitted to NIMH. I.e. it is now compulsory that every patient admitted to NIMH undergoes a thorough dental checkup. This is vital to bring awareness to the patient and for the improvement of the general hygiene, as psychiatric patient needs assistance and guidance to help them get back to their routine habits in order to regain acceptance. In addition to the routine dental care, the staff of Dental Unit goes one step further to improve aesthetics and give a better smile to the patient. This gives them confidence and to feel good with a positive attitude. Such procedures include: •
Correction of median disesteem
•
Corrections of discoloration of teeth
•
Correction of irregularities of teeth
It has been observed that the patients who start dental treatment with reluctance have returned to the clinic on their request. There is a clear indication to us that when positive changes are made, they look for further improvement. Stain removal after tobacco and betel use is carried out as reinforcement. Mostly
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the young patients prefer to maintain and discontinue the habitual use of betel. The staff play a key role here. The sterilizing/disinfection techniques have been improved with the oversight of the Consultant Microbiologist. All members of the staff have come together as a team to give maximum care & provide safety to the patient when it comes to sterility. The dental team has formulated an action plan for the future of dentistry in a psychiatric hospital. We have conveyed these ideas to be incorporated into hospital master plan. These ideas are mainly geared to developing a dental unit for the special care patient as no such facility is available in Sri Lanka; although it is a recognized specialty in the developed world. Finally, we welcome 2 new Dental Surgeons to our team and bid adieu to some staff who served NIMH for 5 years.
Dental Visits by Month 900 800 700 600 500 400 300 200 100 0
OPD Ward
Figure 3: Annual Dental Visits, 2016
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Figure 4: Correction of teeth
4.2.3. Community Psychiatry Programme Established in 2010, Community Psychiatry Unit (CPU) is staffed with 4 Community Psychiatry Nurses (CPN) at present. The unit maintains a database with all the information on admissions such as patient’s name, age, address, contact number, date of admission, BHT number, ward number and the respective Consultant. The place of follow-up is entered once the patients are discharged from the NIMH. This programme enables tracing defaulters, ensuring follow up and detecting new patients. The staff liaise with the Regional Directors of Health Services, Medical Officers of Health (MOH), and Medical Officers of Mental Health (MO-MH). The treatment defaulters either while on leave from in–ward care or those who have defaulted clinic visits as well as difficult patients i.e. those who do not take medication, are provided with IM Depot medication, which in turn helps to prevent repeated admissions to NIMH. In addition, new patients referred by the CPN, MOMH, Public Health Midwife or Grama Niladaris also visited by the CPU team. Depending on the case they are either admitted or provided community based treatment as advised by the Consultant Psychiatrist. Sometimes the team visits patients in the community to resolve the legal or social issues of patients.
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Depot Injection & Community Visits by Area 30
25 20 15
Wellampitiya
10
Modara
5
Gampaha
0
Figure 5: Annual Community Visits, 2016
4.2.3.1. Out-Reach Clinics There are several outreach clinics conducted by the NIMH (Delgahawattha, Rajamalwattha, Lunawa and Pannipitiya). The aim of these clinics are to follow-up the discharged patients in the community. A Consultant Psychiatrist visits and conducts these clinics once a month with the help of a Medical Officer, Community Psychiatric Nurse, a Pharmacist and a Supportive Staff member. Around 50 patients are seen per day at these clinics. 4.2.4. Colombo Out Reach Ambulance Service To extend the services given to the patients in the community, the Colombo Outreach Ambulance Service was started in the year 2013. This ensures prompt assessment and treatment of patients who are aggressive at home and difficult to be brought to the hospital using conventional transport. When the request to bring a patient comes from a close relative of the patient, he/she should produce adequate proof about the relationship to the patient and valid information about the patient’s health condition e.g. Diagnosis cards, clinic books. The patient is visited by a team comprise of a Medical Officer, a Nursing Officer/Community Psychiatric Nurse, Psychiatric Social Worker and a supportive staff in an Ambulance. Initial assessment of the patient’s condition and the requirement of in-ward care is decided by the respective Consultant Psychiatrist based on the information provided by the Medical Officer, Community Psychiatric Nurse and the Psychiatric Social Worker. If there is a need, help of the Police, Grama Niladari and Community members are sought. After the initial assessment, if the Medical Officer decides that the patient needs admission to NIMH, he/ she is brought to NIMH in the same ambulance.
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The ambulance is sent if the patient’s area of residence is within a 50km radius of the NIMH. A fixed administrative fees of Rs. 1000 and a refundable deposit of Rupees 1000 are charged from the relative. Ministry of Health has given its approval for this project and the cost of visiting the patient is reimbursed 15 from the relatives on mileage basis (Rs. 50 per km).
4.3. Day Rehabilitation Centre People with mental health disabilities need more than hospitalized care and medication to help them get recovered. Achieving confidence through developing life and social skills plays a vital role in enabling persons suffering from mental illness to gain personal independence and reintegration into the community. Interventions are needed to support them to achieve a holistic balance in the quality of their lives, social, financial, occupational, educational & spiritual. The day rehabilitation centre in the National Institute of Mental Health operates with a wide range of structured rehabilitation programmes including social, vocational and recreational activities. These programmes aim to help our clients to understand their mental health conditions and manage their symptoms, learn independent living skills and obtain adequate support to live successfully in the community. Further these programmes provide vocational and social skills to prepare them for meaningful roles of their choice. Hence, we access available resources in the community for their recovery. During the year 2016, 24 new clients were registered with the service. There were 16 male and 08 female clients were among the total and all referrals directed from Colombo district. Group therapy sessions & community outings During the year, two (02) social skills training groups were carried out and 12 participants were benefited. Communication groups, activity sessions and community outings were organized to provide opportunities for them to practice newly learned social skills in their normal environments. Three community outings were organized to HSBC call centre premises at Rajagiriya, “Samantha” cinema at Dematagoda and “water world” Kelaniya. Trainings Five (05) health staff members of General Hospital, Polonnaruwa and Divisional Hospital, Manampitiya were successfully completed their training in psycho-social rehabilitation and establishment of day rehabilitation services. Volunteer support Three (03) post graduate diploma students in counseling in the University of Colombo worked very closely with our service users as volunteers. While they get their clinical exposure, especially they supported
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for art therapy sessions, computer training and special education classes for the people with learning disabilities. Establishment of consumer forum of the National Institute of Mental Health The consumer forum was established on 19th August 2016 at the day rehabilitation centre with presence of the director- NIMH, staff and the national organizers of the Consumer Action Network Mental Health Lanka (CANMH Lanka). Initially 18 mental health service users were registered as the members. Visits Ms. Marilyn Pattison, the president of the World Federation of Occupational therapists visited the centre on 12th January 2016. New activities and vocational opportunities • The sales opportunity was expanded at the “Fashion Bug” for the productions made by the clients by introducing new soft toy productions. In addition, their creations were exhibited and sold at the HSBC premises and sales outlets organized at the NIMH hospital premises. • A basic computer training programme was started for the clients at the “Nanasala” computer centre. Exhibition of art therapy productions The clients significantly contributed for the art therapy exhibition organized for the first time at the NIMH to commemorate the world mental health day – October 2016. They created large scale art productions to facilitate their self awareness and personal growth. Further, those striking creations made the school children who visited NIMH, fascinated and brought them new knowledge and understanding about mental health. Future priorities • Establish a life skills training group for the clients • Set-up a forum for the caregivers, volunteers and donors who closely work with the day rehabilitation service.
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Establishment of NIMH Consumer Forum
Visit of WFOT President, Ms. Marilyn Pattison
Community Outings with DRC Clients
Trainees from GH Polonnaruwa
Figure 6: Activities of Day Rehabilitation Centre, 2016
4.4. Day Treatment Centre This centre has been established to give outside clients psychiatric services. The main objective is the application of psycho-therapeutic techniques for minor mental health problems and support other mental health disorders. Workshops to uplift the knowledge of mental health among teachers and the community were held. Workshops were also held on the ‘Anti-Narcotics’ theme. All these services are provided by trained staff in a completely anonymous environment. Providing a friendly and prompt service to the clients who come to the center is a prime objective of our staff.
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No of new clients No of sessions No of one day sessions No of clients prescribed medication Successfully ended clients Awareness programmes Alcohol anonymous group
231 1051 14 501 45 06 05
Figure 7: Annual Summary of DTC, 2016
To commemorate World Anti-Narcotics Day, under the guidance of Consultant Psychiatrist Dr. DPD Wijesinghe, a nationwide poetry competition was held under the themes of ‘dangers of narcotics and the joy of breaking free from narcotics’. The poems were vetted by renowned songwriter Bandara Eheliyagoda, who was also the chief guest at the prize giving ceremony on 10.11.2016. Another initiative that was started under the guidance of Consultant Psychiatrist Dr DPD Wijesinghe, is the abolition of alcohol from funerals and other religious events. The first such programme was held Moratuwa Divisional Secretariat Office for the Grama Niladhari and Development Officers on 21.06.2016.
Figure 8: School Counselling Programme
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4.5. Day ECT Centre The Out Patient Electroconvulsive Therapy Unit (OPEU) has made a large contribution to upgrade 19 the overall patient care in the community.The main focus is to minimize unnecessary admissions and keep patient with their family to enrich their mental health. This service is given free of charge. This was established in 2014. The OPEU consists of a theatre and a 02-bedded ward. In year 2016, 84 patients were given ECT. • This service is provided from Monday to Saturday including public holiday at the OPEU. • Patients can be referred for day ECT from OPD/clinics/Day treatment centre by a consultant psychiatrist attached to the NIMH who is responsible for the overall management of the patient. • Psychiatrists’ from other institutes can refer a patient for day only through a consultant psychiatrist with a completed pre-ECT assessment form and ensuring that the patient is fasting and the necessary investigations are available. • Patient should arrive on or before 7.30 am accompanied by a relative who will be in close contact with the patient for the next 24 hours and personal transport should be available for the patient to return home after ECT. • The patient’s informed consent and the concurrence of the accompanying relative is obtained. • Any patient developing complications during or after ECT shall be admitted to the NIMH under the care of the referring consultant psychiatrists. • If a patient does not comply in the next appointment for more than a week, the course is considered over unless the patient or a relative correspond in the unit.
Total Day ECT by Month 100 90 80 70 60 50 40 30 20 10 0
Admissions/New Readmission
Figure 9: Annual Day ECT, 2016
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4.6. Gender Based Violence Prevention Unit Prevention of Gender Based Violence Prevention Unit (GBVPU) was ceremonially opened on 08th, March in 2012 by Dr. F.R. Mehtha, WHO representative to Sri Lanka. The unit consists of one consultant psychiatrist, one medical officer, one nurse and one supportive staff member. The aim of the unit is to provide counseling, necessary psychological, psychiatric, legal supports and medical treatment when required. After the first visit, a family meeting arranged and counseling is offered by the team consist of consultant psychiatrist, a medical officer, and a trained nursing officer. Home visits are done by the community psychiatric nurses or psychiatric social workers if needed. Also, they are maintaining a database for GBVPU. In addition, training programmes were conducted for medical, nursing, counseling and university students. During the 2016, 348 clients (total number of adult and adolescence) were registered at the GBVP unit. 198 clients were Female and 150 clients were Male. Among them the main problems were domestic violence and psychological harassment. Some problemsfaced are limited resources, consuming alcohol and unidentified, underline, psychotic disorders between intimate partners of family members. 82 clients were referred by in-ward and OPD in NIMH, 130 clients were referred by outside (from community), 130 clients were referred by Police Station of Mulleriyawa, NHSL, Nawagamuwa and Thalangama clinics. 06 clients were referred by the Woman in Need. The clients have made 895 follow up visits by the end of this year. The unit also conducted 476 family meetings during this year. The prevention of child maltreatment unit was on 1st of October 2015, Celebrating the International Children’s Day. A total number of 30 clients were registered as adolescence admissions, due to abuse and behavioral changes. Special Programmes of Gender Based violence prevention conducted by GBVP unit in 2016 • In January 27th “Awareness Programme of GBV”one day workshop for nursing staff at the accident service in NHSL, overall more than 25 participated. • 9th of February 2016 “GBV and how effect the children” program at the RahulaBalika Vidyalaya for parents. Overall 300 parentsparticipated. • 14th of February 2016 “Awareness Programme of GBV” at the Thalangama Hospital for staff of all categories and volunteers, about 300 participants participated. • 8th of March 2016, “Work Place Harassment” awareness program was conducted by NIMH and coordinated by woman in need for all staff of NIMH, celebrating woman’s day. • 28th of March 2016, “Common Mental Health Problems and awareness of GBV” Programme at Sethsiripaya for all staff, overall 300 participated.
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• 18thof March 2016. “Awareness of GBV” Programme for nurses undergoing post Basic management training at NIMH overall 300 nurses participated.
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• 26th,27th ,28th of July 2016, “Child Abuse and Violence” for school counselors in Colombo district was conducted by NIMH and Day treatment center. Overall 400 counselorsparticipated. • 2nd of November 2016, “Awareness of GBV” Programme for all in charge officers in NIMH, overall 40 in in charge officers participated. • 18th of November 2016, “Awareness of GBV” Programme for nurses who are in a six months psychiatric training group in NTS at Mulleriyawa. Overall more than 75 nurses participated.
Total TotalNumber NumberofofIncidents Incidentsby byMonth Month 4040 3535 3030 2525 2020 1515 1010 55 00
Figure 10: Annual GBV Incidents, 2016
Total TotalNumber NumberofofVictims Victimsby byAge Age 1%1% 6%6% 7%7% 11% 11%
0 to 1111 0 to 1212 to to 1717 1818 to to 2525
32% 32%
2626 to to 4040 43% 43%
Figure 11: Annual GBV Victims by Age, 2016
4141 to to 6060 6161 && above above
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5. In Patient Services 5.1. In-Ward Care 5.1.1. Acute&Intermediate Care At the beginning of 2016, there were 8 acute care wards (4 male and 4 female) and 8 Intermediate Care wards (4 males and 4 female), providing inward care under 8 Consultant Psychiatrists. At the latter part of 2016 this has been rearranged to 6 acute wards, 4 combined wards and 6 intermediate wards. The stay in the acute/combined wards is usually limited to around 30 days. If the treating team decides that the patients can be managed in the society, he/she will be discharged directly from the acute/combined care ward. If that patient needs further treatment and rehabilitation, they will be transferred to an Intermediate Care ward. However, if the patient becomes violent and restless again while in an Intermediate Care ward, he/she maybe transferred back to the acute care ward for further management. Each ward has a multi-disciplinary team (MDT) consisting of a Consultant Psychiatrist, Senior Registrar, Registrars, Medical Officers, Nursing Officers, Psychiatric Social Workers, Occupational Therapist and supportive staff. Nearly the same MDT team treats the patient whether the patient is in acute care or intermediate care wards and in follow up care.
Admissions by Month 800 700 600 500 400 300 200 100 0
Figure 12: Annual Admissions, 2016
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5.1.2. Long Term Care Ward 22
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Ward 22 has many regular activities for our patients. Every 3rd week of the month, patients have an activity of maintaining personal hygiene.Every day around 15 patients are sent to Occupational Therapy Unit. They also send about 07 patients to horticulture unit for planting, cultivating the vegetable patch and garden cleaning. In ward patients participate in religious activities in the morning and evening every day. They arrange the environment to worship “Lord Buddha”. They pick flowers, lightning lamps & observe pansil. Some of the other highlights include: •
On 1st of January patients & staff members celebrated the New Year & boil milk with together wishing prosperity.
•
On the 16th of January patient participated to Thai Pongal celebration which was held in the hospital.
•
On the 13th and 14th of April, patients celebrated the Sinhala & Tamil New Year with patient & staff members. They participated to boil milk & to wish prosperity.
•
In the month of May some money was donated for the people who were suffering from flood.
•
In the month of June, we made a Vesak Lantern & exhibited it on Poson Full Moon Poya Day. Those days’ patients participated to ice cream & Roti Dansal which were held in hospital premises.
•
On the last day of Vesak Lantern exhibition, we organized chanting Pirith Programme.
•
On the 6th of October, many of the patients & staff members participated to mental health day walk.
•
On 10th and 12th of October,many of our patient’s creations were exhibited at Mental Health Day Exhibition in the hospital.
•
In the month of November, we prepared a proper place to keep Buddha statue & arranged a proper environment for patients to worship by donations of all nursing staff & supportive staff members.
•
On the 12th November social work students (Bachelor of PSW), organized a one-day physical exercise programme. It was conducted by Sri Lanka Navy officers & Soldiers. Many patients involved in it & enjoyed the activity.
•
Some patients were sent to church on the opinion of OT for the Christmas Day festival. We celebrated Christmas day with patients & all staff members in our ward.
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Ward 27 Long Term Care ward (27) at NIMH is maintaining under the concept of “Home feel environment” to the Patient. There are 35 patients at present in this ward and staff consists of one medical officer, 08 nursing staff and 11 health assistants. All the patients in this ward are residing in this hospital for more than 2 years. They are not bounded to the ward. They are free to have a walk outside of the ward. The main aim is to rehabilitate these patients by engaging in daily living activities on their own. To fulfill it, horticulture therapy programmes and occupational therapy programmes are conducted by the ward staff. There are about 15 patients who are routinely engaged with horticulture which is attached to the ward. They spend their morning in the garden. Apart from that others are dealing with some occupational therapy activities in the morning such as cooking, art therapy, and music therapy. There are few disable patients in the ward who on conservative management. And one patient is working in hospital cleaning service. The income from the horticulture project is spent to pay salaries to the patients, deposit in bank accounts of the patients, buying refreshment to the patients such as biscuits and tea, and Garden requirements such as fertilizers and seeds. Special rehabilitative projects had been carried out last year. They are: •
Maintaining a flower plant bed (Anthurium) using recycled plastic lotion containers.
•
Garden embellishing by constructing stairs to overcome the difficulty to arrive to the garden.
•
Patient had been involved in ironing their clothes under supervision of the staff.
There will be some more rehabilitative project in the coming year. 5.1.3. Isolation Unit The Isolation unit consists of 04 separate rooms with 11 beds, constructed according to the management of the clients care. The unit is supervised by the Consultant Microbiologist in coordination with the ICNO and psychiatric teams. During the year 2016,192 patients were admitted to this unit. Protective isolation and source isolation has been provided for all patients mainly Conjunctivitis, Diarrohea, Scabies, MRSA, Tuberculosis, and Pyrexia of Unknown Origin. Standard precautions have been provided for all staff members to prevent the spread of infection among them.
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Total Number of Patients by Disease Mumps, 1 Chicken Pox, 1 MRSA, 9
HIV, 1
Syphilis Symplex, 2
25
Leprosy, 1
TB, 15
Scabies, 11
Conjunctivitis, 84 Diarrhoea, 48
Figure 13: Annual Isolation Unit Cases, 2016
5.2. ECT Unit The unit consists of a mini theatre and 20 bedded ward in 2016. ECTs were given to a total of 10458 patients. A card system was started in 2014 to give better patient care for the in-ward patients. It limits the routine ECT s to maximum of 45 per day and the system functioning well in 2016 too. It increased the reserved treatment and carrying time of each patient and it has helped to reduce unnecessary incidents happening due to overcrowding. The ECT unit has made a significant contribution to the overall patient of NIMH.
Total ECT Patients by Month & Gender 700 600 500 400 300
Male
200
Female
100 0
Figure 14: Annual ECT Patients, 2016
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5.3. Forensic Psychiatry Unit Forensic Psychiatry Service is the largest specialized unit of NIMH. It consists of two wards (male and female), a rehabilitation unit, a horticulture area and a set of outreach clinics held at the Welikada prison complex, the National Hospital of Sri Lanka (NHSL), Institute of Legal Medicine And Toxicology and the detention homes for adolescents at Makola and Ranmuthugala. The wards 21 and 25 house male and female patients with bedstrengths of 103 and 24 respectively. Dr. L.A.P. de Alwis was the consultant forensic psychiatrist in charge of the service. The forensic psychiatry team was consisted of three senior registrars, three medical officers, an Occupational Therapist and a Psychiatric Social Worker in year 2016. Around 10 registrars in psychiatry worked in the unit on threemonth rotation as part of their training. Around 25 nursing officers and 25 supportive staff members were also working in the two wards and the rehabilitation unit as well. An outreach clinic is held every Wednesday at room 22, NHSL, for out-patients with issues related to forensic psychiatry. The clinic receives referrals from District Courts, Magistrate Courts, Police, Non-Government Organizations (NGOs) and the general medical and surgical wards of the NHSL. Another outreach clinic was commenced at the Institute of Legal Medicine and Toxicology in 2016 in order to assess the patients referred by the Judicial Medical Officers (JMOs) on every Tuesday. A psychiatric liaison service is provided to the Prison Hospital Wellikada, Colombo and four out-patient clinics are held every Monday and Wednesday by the multidisciplinary team. The team conducts assessments, provide treatment and court reports for prison inmates. With the support of the adolescent unit of NIMH, the forensic psychiatry service of NIMH commenced another two clinics at the detention homes for adolescents at Makola and Ranmuthugala to provide mental healthcare for the inmates. The number of clinics conducted by the FPU increased up to twenty-four clinics per month in 2016. Under the Community Forensic Psychiatry Initiative regular visits were made to prevent reoffending and clinical relapses and identified several high risk patients discharged from thecourts in close by areas. During 2016, unit has issued 534 court reports regarding inward patients, 329 reports through the Prison Hospital and 192 reports through the out patients’ clinic at the NHSL. Scene of crime visits and home visits were also conducted. These were done in order to gather information on alleged crimes, their circumstances, about the offenders and the victims. During these visits, the team visited relevant places such as the local hospitals and police stations and interviewed scene of crime officers (SOCO) and villagers in order togather further information.
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FORENSIC PSYCHIATRY RESOURCE CENTER (FPRC) Forensic Psychiatry Resource Center was established in 2013 to coordinate the forensic psychiatry service 27 by keeping forensic records, coordinating outreach clinics, arranging trainings and providing necessary information for the trainees and other health professionals when necessary. The FPRC conducted liaison with prison medical officers and regional psychiatrists to provide necessary information in relation to forensic psychiatry, via its official email nimhforensic@hotmail.com The Forensic Psychiatry Resource Center conducted two national level workshops within year 2016. The first workshop was organized for consultant psychiatrists from countrywide. It aimed to improve their knowledge regarding the legal aspects of mental health. The second workshop series was organized for the prison welfare officers from all the prisons in Sri Lanka. 108 prison welfare officers and 12 prison counselors were trained regarding the mental health in prison settings. VISITORS’ BOARD Visitors’ Board is held under the chapter 31 of the penal code act no 15 of 1979, for mentally ill patients with major criminal charges who were not fit enough to plea for a long time. The board comprise of representatives of Secretary - Ministry of Justice, Secretary – Ministry of Health, Commissioner of Prison and a Consultant Psychiatrist. Visitors’ board meetings were held on 4 occasions in 2016 for which around 23 mentally ill offenders were produced and 16 were released, counting to 101 since 2010. FORENSIC PSYCHIATRY REHABILITATION UNIT (FPRU) Forensic Psychiatry Rehabilitation Unit (FPRU), opened in 2010 is the only such facility in SriLanka. A structured rehabilitation programme is conducted by the unit. FPRU provides its service for around 50 patients a day. Individual assessments are conducted by the Occupational Therapist attached to the unit. The FPRU has submitted 60 functional assessment reports within the year 2016. OPEN SCHOOL Open school is one of the major programmes held in the FPRU. It is an educational programme conducted by National Institute of Education (NIE) in collaboration with NIMH since February 2012. It helps individuals to get formal education through activities and lessons under the guidance of well-trained school teachers. Open school sessions are held on every Thursday. Around 40 sessions were held in 2016 and around 40 to 50 people attended each session.
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ACTIVITY PROGRAMME A structured activity programme is conducted by the FPRU and includes creative therapies such as arts, music, drama and narrative therapy, training on work skills such as making soft toys and greeting cards, training on Activities of Daily Living (ADL) such as cookery and selfcare activities and indoor/outdoor sports such as volleyball, cricket, carom and darts. A horticulture therapy programme is also conducted along with the rehabilitation programme. A United Nations’ Development Programme funded organic gardening programme was commenced in year 2015 by “Y Generation”, a youth volunteer organization with the guidance of the FPRU. It helps the inward patients to engage in gardening with getting proper knowledge, so that they can continue gardening in their own homes when they are back. SPECIAL EVENTS FPRU organized an eye clinic for the patients from all the wards of NIMH on 30th November 2016 jointly with the National Institute of Education and Sri Lanka Broadcasting Corporation. The eye clinic was conducted by Sri Lanka eye donation society. 125 sets of spectacles were distributed among patients who were identified to have visual impairments. FPRU celebrates the national events with the inmates of the unit every year as part of the rehabilitation. The aim of celebrating these events is to connect the inmates to their cultures instead of being isolated in an institution. Sinhala and Tamil New Year, Vesak, Christmas, Thai Pongal and other cultural events were celebrated in 2016 as usual.
Forensic Clinic Visits by Month 200 180 160 140 120 100 80 60 40 20 0
Male Female
Figure 15: Annual Forensic Clinic Visits, 2016
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29
Prison Counseling Workshop
Eye Clinic
Figure 16: Activities of Forensic Psychiatry Unit
5.4. Psycho-Geriatric Unit The Psycho-Geriatric Unit includes ward numbers 17 (male) and 20 (female). Each ward has a capacity of twenty to be admitted at once for treatment purposes. There are two Consultant Psychiatrists especially trained for this unit. Patients with Dementia are treated from all over the country. Work that has been done throughout the year includes: • Establishment as a separate area as an auditorium at Ward 17. It includes a facility for a library, giving opportunities for medical doctors, nursing officers, & other paramedical staff to learn about Dementia. • Establishment of High Dependency Treatment Unit at Ward 20 with 4 beds. • Establishment of Occupational Therapy Unit, where reminiscence therapy is carried out on a daily basis. • Get clients to participate in religious activities daily. • Conducted educational programmes on Dementia in January 2016. • Provided lecture sessions for Elderly Secretariat Office. • Conducted ‘Social Service in Elderly Care’ in March 2016. This programme was supported by the Social Services Department and National Elderly Secretariat Office. • Provided resources to make the national policy regarding Sri Lankan elders. • Provided training for diploma trainees from National Institute of Social Development. • Conducted a training programme regarding elderly care organized by Vocational & Technical Training Authority
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Total Admissions by Month 20 18 16 14 12 10 8 6 4 2 0
Male Female
Figure 17: Annual Admission to Psycho-Geriatric Unit, 2016
5.5. Adolescent Psychiatry Unit Adolescent Psychiatry Unit was opened on 15th December 2015 as the first ever unit specifically designed for the adolescent patients in Sri Lanka. Patients, both males and females, below 18 years are admitted to the unit under the care of the eight Consultant Psychiatrists and the respective teams take the responsibility of the clinical care of the patient. The staff consists of 7 nurses and 7 supportive staff. The unit has 6 rooms with inward facilities for 9 patients including library facilities and facilities for engaging in sports, learning and playing. Rehabilitative activities such as drawing, hand crafting and music are being carried out.
Total Admissions by Month 12
10 8 6
4 2 0
Figure 18: Annual Admissions to Adolescent Psychiatry Unit, 2016
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5.6. Perinatal Psychiatry Unit Established in 2007, The Perinatal Psychiatric Unit is the first ever in South East Asia. The unit31 provides specialized care for women who develop psychiatric illnesses in and around the pregnancy or following child birth where their babies and family members are also allowed to stay with the patient. The unit has 8 rooms. Each room comprises of 3 beds for the patient, the baby and the care giver. In 2016 there were 107 admissions of Pregnant and post-partum mothers and 96 babies, these admissions included 38 transfers from D.M.H, C.S.H.W, NHSL (Ward 59), B.H. Homagama, DGH Negombo, BH Awissawella, CSTH Kalubovila, TH Anuradapura, BH Puttalama, DGH Chilaw, GH Kaluthara, BH Panadura, DH Moratuwa, LRH, BH Horana and GH Polonnaruwa In 2016 January the unit was renovated, refurbished and redecorated.
Total Admissions by Month 16 14 12 10 8 6 4 2 0
Mother Baby
Figure 19: Annual Admissions the PPU, 2016
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5.7. Learning Disability Unit The Learning Disability Unit or LDU was established in 2008. The aims of this unit are to: • Rehabilitate clients with learning disability and associated behavioral problems. • Train and educate their parents, guardians on Rehabilitation skill to provide care for patients with special needs. In the unit, there are 6 rooms to accommodate patients individually.Patients are under the care of all 08 consultant psychiatrist and the medical team. The unit encourages a care given to stay with the patient. Patients are admitted to the LDU as a direct admission or transferred from other acute wards.Psychiatric social workers help to solve patient’s family problems. Some patients are referred to the occupational therapy unit for special programmes and volunteers also help patients to do various leisure activities. Patients are daily reviewed by the doctor for management of restlessness and medical condition. Patients are also trained on activities of daily living according to a time table such as mouth care, bathing, table manners, dressing, toilet training and improving interpersonal relationships. Some special activities include: • Entertainment Programmes such as listening to radio, playing as a group, and singing. • Cognitive development programmes conducted included drawing, playing carrom, work book activities, and creative activities such as playing with building blocks. • Programmes to improve life skills of parents and bystanders such as lectures about learning disability and discussions on how children with learning disability should looked after at home.
Total Admissions by Month & Gender 5 4 3 2
Male
1
Female
0
Figure 20: Annual Admissions to LDU, 2016
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5.8. Medical Ward Medical ward was established in 2005 under a Consultant Physician. The aim of the medical 33 unit is to provide specialized medical care to the inward psychiatric patients with co-morbidities. There are separate male and female sections with a total of 20 beds. In addition to the ward, a separate medical clinic is held 6 days per week, to attend to referrals from psychiatric units. The medical ward is well equipped for an emergency management setting; with a specialized Physiotherapy Unit and Nutrition Unit. During year 2016 there were 599 admissions and 4899 clinic patients seen in the medical wards. Out of them 61 were transferred to other tertiary care hospitals for further management.
Medical MedicalClinic ClinicVisits Visitsby byMonth Month 600 600 500 500 400 400 300 300 200 200 100 100 00
Figure 21: Annual Admission to Medical Ward, 2016
Total TotalAdmission Admissionby byMonth Month&&Gender Gender 50 50 45 45 40 40 35 35 30 30 25 25 20 20 15 15 10 10 55 00
Male Male Female Female
Figure 22: Annual Medical Clinic Visits, 2016
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5.9. Nutrition Unit The Nutrition Unit which was established in December 2014, currently consists of a Medical Officer in Nutrition and two Nutritionists. During the year 2016, a fund of Rs. 1,000,000 was allocated for NIMH by Nutrition Division, Ministry of Health for the establishment of Nutrition Promotion Clinics. Along with the World Mental Health day celebrations, the refurbished Nutrition Unit was opened on 12th October 2016 by Director General of Health Services. The Unit conducts training programmes to the Diet stewards, Ward clerks and Public management assistants who are involved in the diet supply chain. Also, establishing Nutrition Care Circles with the participation of the nursing staff in every ward/unit was initiated ensuring proper delivery of special diets to the inward patients. Meanwhile, the necessary technical guidance is provided to acquire necessary equipment for hospital kitchen to improve quality and efficiency of diet preparation. Some of the activities include: • In commemoration of the Nutrition month a food demonstration programme was conducted targeting all the staff. • To enhance the nutritive value and quality of diet of inward patients, a new menu of 30 different diets for 30 days of the month was introduced and it is to be implemented in January 2017. • The Food committee meeting of NIMH is held by the Nutrition Unit where any issues regarding the diet supply are addressed. • Currently, nutrition screening of the inward patients is being conducted, aiming future nutritional interventions.
Figure 23: Opening of Nutrition Unit by DGHS
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5.10. Halfway Home –Mulleriyawa Half-Way Home (HWH) Mulleriyawa, has female residents with chronic mental illness and 35 different functional capacities originating from all over the country. Almost one third of them women are fit to be discharged and would be able to live and work outside the HWH if given the right environment and opportunities. • National Independence Day 2016 was celebrated at Half Way Home – Mulleriyawa with the participation of Principal – Royal College Colombo, Director, Deputy Director and some of other staff of NIMH and staff of Half Way Home – Mulleriyawa. • There were two new permanent donors introduced to Ward 02 – Special Care Unit and Ward 05. Ward 02 – Civil Security Department and Ward 05 – Sewa Wanitha Organization of Ministry of Defense. There were some malfunctions of old wiring system. This was corrected by complete rewiring and fixing new plug-points, switches and bulbs according to current requirement for ward 02, 05 and conference room of the front building. This was sponsored by Sewa Wanitha organization of Ministry of Defense. • New name-board was fixed in parallel with the events of Women’s Day 2016. • Two new guard-rooms were built up at main gate and back gate to facilitate security officer’s duty. The Main guard-room was opened on 14th of March 2016.CCTV system was setup to monitor main and back gates. • Y’s Men’s Club of Moratuwa donated 143 sets of plastic containers (one large - 20 litres, one small) on 22nd October 2016. These are to be used to store each resident’s cloths and other personal stuffs separately in view of improving their sense of privacy as another aspect of rehabilitation. • Well-equipped Physiotherapy unit started at Half Way Home – Mulleriyawa. It was opened by Dr. Kapila Wickramanayake – Director National Institute of Mental Health (NIMH) Angoda. Before that all the residents except very few need unequipped bed-site physiotherapy, were sent to physiotherapy unit NIMH . But due to some shortcomings such as lack of transport facilities and lack of staff to accompany, it was very difficult to provide regular physiotherapy for the residents. This was corrected by starting a Physiotherapy unit at Half Way Home – Mulleriyawa. • 25 residents and 6 staff members went on a trip to Pinnawala on 01/09/2016. • Tamil residents of Half Way Home Mulleriyawa organized Thai Pongal festival with the help of other residents and staff. • In a view of providing boiled cooled drinking water for the residents a new electric water boiler with capacity of 200L, was setup.
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• A “Wesak Bhakthi Geetha” program was organized by Occupational Therapy unit and sponsored by some individual volunteers. It was held at Half Way Home Mulleriyawa with the presence of director and some consultants from NIMH. • The annual “Wesak Dharma Desanawa” was arranged by Royal College – Colombo on 06/05/2014 at Half Way Home Mulleriyawa. About 200 residents, some of teachers and students from Royal College and staff of Half Way Home were participated. • As another Wesak program an Ice-cream Dansala was arranged by staff with the help of a donor, at Half Way Home – Mulleriyawa for residents and staff of the institution.
Total number of residents at the beginning of 2016 New admissions Deaths Discharges Figure 24: Summary of Patients in HWH, 2016
448 2 8 1
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New Signboard
New Guard Room with CCTV Facilities
New Donors for Wards 2 & 5
Donations from Y’s Men’s Club of Moratuwa
Celebration of National Independence Day
Community Outing to Pinnawala
Opening of Physiotherapy Unit Figure 25: Activities of HWH, 2016
New Water Boiler
37
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Ancillary Services
6.1. Planning & Development Unit The Planning and Development Unit of NIMH a long felt need for the Institute was inaugurated in 2016 at NIMH and declared open on 10.06.2016 by the Deputy Director General – Medical Services 1 of the Ministry of Health. The PDU was opened based on the Ministry of Health General Circular 02-88/2015. It consists of the following sections. •
Planning Section
•
Quality Management Section
•
Public Health Section
•
Disaster Management Section
•
Health Informatics Section
•
Media Coordination Section
PDU – Planning Section NIMH PDU Planning Section was a brand new addition to NIMH in 2016. It was established to strengthen the Director in ensuring all Ministry requirements in Planning and Project Management were met. The Annual Action Plans and Hospital Master Plan Implementation were initiated. The Vision and Mission Statement of NIMH for the next ten years was also revised. 6.1.1. Quality Management Section The Quality Management Section of the NIMH, PDU coordinated all Quality Management activities for year at NIMH. All data surveillance of clinical events and adverse events reporting was monitored by the QM Section. Coordination of the Clinical Governance Meetings was also done by the QM Section with the able assistance of the Health Informatics Section. In the year 2016, 3 Clinical Governance Meetings were held. Periodical Data was sent to the Ministry of Health Healthcare Quality Secretariat as per the ministry requirement. The Ministry guidelines on areas of development in Quality were implemented.
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6.1.2. Public Health Section Public Health Section of NIMH, PDU has provided many services in different areas. Some of the services 39 that were carried out during the year of 2016 are as follows, •
Supervision of the waste disposal system and the sewerage.
•
Liaised with cleaning service and supervision of the general hygiene and the cleanliness of the hospital premises.
•
Carried out preventive activities such as, identification of Dengue breeding sites and fogging activities, preventive measures taken to reduce head lice, body lice, flies and other entomological issues in collaboration with public health inspector
•
Carried out monthly meetings with head of the units addressing current issues and solutions with the help of infection control nursing officer (ICNO).
•
Provision of health education to staff and outsiders.
•
Injury Surveillance as per Ministry of Health NCD Unit guidelines
•
Providing technical supervision and coordination for the activities of ICNOO and PHI.
6.1.3. Infection Control The consultant Microbiologist supervises the work of the Infection Control Nurses (ICNO). The ICNO carried out daily ward rounds according to the Infection control checklist and supervision in related to out-breaks, general hygiene, hand washing practice and waste management. The ICNO coordinates with the psychiatric team and consultant microbiologist. Liaisons nurse meetings were held once a month and Infection Control committee meetings were held once per 03 months giving an opportunity to discuss issues related to Infection Control. Health education programmes were carried out for staff regarding Infection Control and waste management. Waste Management During year 2014, World Bank Fund (10 million) was allocated by Ministry of Health for the waste management project to construct 02 building, consisting of 04 rooms to store the segregated waste temporarily at NIMH and HWH-Mulleriyawa. In 2016 this was rearranged by introducing waste transporting carts from the wards to waste store area.
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6.1.3.1. Wound Care Clinic The Wound Care Clinic, started in January 2012 is conducted every Friday morning by the consultant Microbiologist. During the year 2016, 117 referrals were received from the wards of NIMH and the HWH Mulleriyawa. 6.1.3.2. Hepatitis B Program This programme was started in 2011 under the guidance of the consultant Microbiologist. First the patients in the long term care wards and the hospital staff were vaccinated against Hepatitis-B and tested for Hepatitis-B antibodies under this programme. Under the second phase of the programme, patients in the acute and intermediate Care wards were vaccinated against Hepatitis-B. In the year 2016, 447 patients were vaccinated for HepatitisB –Similarly 13 newly recruited staff members were vaccinated and 55 staff members were tested for the Hepatitis –B surface antibody. 6.1.4. Disaster Management Section Disaster Management Section which is functioning under planning unit at the National Institute of Mental Health was established in 2016. In 2016 the Disaster Management Section was mainly involved in the following activities. •
Deployment of health staff for relief medical work and psychological first aid during Kelani River Floods affecting the Kolonnawa and Kaduwela MOH areas and “Salawa Blast” in May/ June 2016.
•
Implementation of Disaster Preparedness Plan was carried out according to the Risk assessment at National Institute of Mental health.
6.1.5. Health Informatics Section The Health Informatics Section of PDU, NIMH is responsible for all data needs of NIMH. The work of this section entails: Routine • EIMMR System • Admission Record Information System • Gender Based Violence Information System • HealthNet (web based information system to collect performance and facility information) • HRMIS (Human Resource Management for Medical Officers) • HRIS (Human Resource Information System for All Staff)
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New Innovations • Networking of Planning Unit
41
• Converting all incident data from paper based format to digital format The information gathered from these systems were used both at local and central level for decision making and planning. During the year 2016 the Unit contributed to compile the Annual Report and Clinical Governance Data.
Figure 26: Opening of PDU
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6.2. Training Unit & Research Unit In the year 2016 the Training Unit was responsible for the following teaching/learning activities: Programme Name Orientation Program
Trainees/ Participants
Number
• Nursing students-All island NTS (01 day)
1898
• Nurses in post basic nursing schoolmanagement and supervision
388
• Nurses in post Basic Nursing Schoolsix-month psychiatric Nurses training
74
Resource Personnel Mental Health Training Unit
3 days in-service • Developing skills for Excellent training for the performance in psychiatric nursing nurses 12 program for the year and • Development skills in mental health for supportive staff members 40 participants for each program • Violence and Aggression management for the staff at NIMH (group 1) • Psycho-social RehabilitationWorkshop for nursing officers • Infection control-workshop nursing officers
for
480
Special Grade Nursing Officers & Mental Health Training Unit
40
TOT Nurses
100
Mental Health Training Unit
• Developing skills in specific areas in psychiatric Nursing • Improving Dignity in mental health for Nursing Officers • Violence and Aggression management for the staff at NIMH (group 2) • Psychiatric Emergencies and other specific areas 5 days In-service • For the nurses in NIMH training program Training program
• Supportive programs)
staff
members
(2
• Attendant Training (3 months) • Mental health training conducted by RDHS
60 100
National Institute of Mental Health - Annual Report 2016
University training • program • • • • • • • Other Training
University of Ruhuna University of Eastern KDU University of Ruhuna KDU (group 1) KDU (group 2) University of peradeniya University of Eastern
Hospital • Durdans hospital (2 weeks)
Mental Health Training Unit
37
Mental Health Training Unit
08
• IIHS (2 weeks)
14
Violence Manage- • Six month psychiatric Nurses training ment program group 1 practical session • Six month psychiatric Nurses training group 2
38
-
Group 01
17
-
Group 02
25
-
Group 03
29
-
Group 04
20
-
Group 05
22
-
Group 06
26
tour • Trainee attendant group-TH Kegalle
14
• Sri Lanka Navy
46
• Counseling student of Sri Lanka Pali & Buddhist University
134
• Counselling Colombo
group-University
NIC Mr.Saman, Mental Health Training Unit
Dr. R. Jayasinghe (Consultant Psychiatrist) Dr. N Ranaweera (SR in Psychiatry) NIC Mr.Saman, Mental Health Training Unit
Mental Health Training Unit
50 of
• Sri Lanka Air force
75
• Sri Lanka Navy
18
Training &practical • OSCE Exam for KDU Exam • Viva Voce exam
43
38
• Supportive staff members
• Counseling group-NICD Anuradhapura
43
29 16 41 23 58 58 34 14
• IIHS (2weeks)
Education (01day)
Pg.
120 260
Mental Health Training Unit
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10 days training • National Training program in Mental program Health Nursing (40 participants for each)
200
Asia foundation, Ministry of Health & NIMH
o Sinhala Medium - 4 programs o Tamil Medium - 1 program Training for others
• Mental Health training for preinterns medical officers • Common psychological problems in school children and counselling skills for school counselors (1 day 3 programs)
International Workshop
Development Intellectual Nursing officers (3 days)
Disorders-
100
NIMH
450
NIMH,Ministry of Health & Ministry of Education
40
Dr. Sherva Cooray Consultant psychiatrist in UK
6.3. SGNO Office The SGNO Office is the central coordination point for all nursing activities in NIMH. This is actually two offices. The male SGNO office is located near the entrance and the female SGNO office is located near the Villas. These offices look after all administrative and training activities related to nursing staff throughout the year.
6.4. School of Nursing Mulleriyawa School of Nursing, Mulleriyawa is the specialized institution of nursing education for mental health and Psychiatric Nurse Training programme for student nurses and staff nurses from various government hospitals in the country. The academic staff consists of the principal, two special grade nursing officers, four grade one nursing tutors and one clinical instructor. All the academic staffs are qualified with BSc Nursing. Hostel facilities are available for 150 students. The trainees obtain clinical experience at National Institute of Mental Health (NIMH), Angoda and Halfway Home, Mulleriyawa. This programme is conducted for the student nurses for five weeks period who are attached to government nursing all over the country during the second year and third year of their three year nursing diploma programme. A Total of 1969 of students were trained during the year 2016 from Schools of Nursing in Ampara, Anuradhapura, Badulla, Batticaloa, Colombo, Galle, Hambantota, Jaffna, Kandana, Kandy, Kalutara, Kurunegala, Matara, Military School of Nursing (Anuradhapura), National School of Nursing Sri Jayewardenepura, Rathnapura and Vavuniya. This programme is also conducted for a one month period for the nursing officers of Ward Management and Supervision Training Programme and for the nursing officers of Teaching and Supervision Training programme in Post Basic College of Nursing, Colombo. The total number of nursing officers in Ward Management and Supervision Training Group was 326 and 84 nursing officer were trained in the Teaching and Supervision Training group. Some activities include:
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• All those nursing officers conducted health education programmes for clients in NIMH during their training period.
45
• All the groups of student nurses and nursing officers arranged concert for clients at Halfway Home, Mulleriyawa as a recreational therapy at the end of their training period. • Vesak and Christmas festivals were celebrated by nursing students with clients in Halfway Home, Mulleriyawa. • Special Mental Health and Psychiatric Nursing Programme for 75 nursing officers was started 15th September 2016 and theory and clinical experience will be finished in March of 2017. • Student nurses of school of nursing Kurunegala and nursing officers of special programme participated to all the activities of World Mental Health Day programme at NIMH. • The student nurses held a mental health camp for school children to develop their memory capacity and to discuss the problems of learning with the guidance of Consultant Psychiatrist Dr. Neil Fernando • An exhibition was done to educate the community at Himbutana village. Through this activity, dangerous effects of substance usage and prevention methods were discussed.
Figure 27: Activities of NTS, 2016
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6.5. Administration Department The Administration Department is the main administrative arm to the Director. Under the guidance of the Director and Administrative Officer, the Administration Department is responsible for all personnel files, planning of infrastructure, management of utilities, and preparation of administrative reports. 6.5.1. Overseer’s Office The overseer office plays the main coordinating role for all supportive staff in the hospital. The team consists of 1 overseer, 8 assistants and 1 supportive staff. 6.5.2. Diet Branch The diet branch plays a facilitator role in organizing the diet orders from all the ward and units. There are 5 diet clerks. 6.5.2.1. Kitchen The kitchen is responsible for the food preparations for the all in-ward patients and many supportive staff members. Over 3000 meals are served daily. Under the guidance of the Nutrition Unit; the kitchen has now been updated to cater for a variety of nutritional requirements. The team consists of 9 cooks and 3 assistants.
6.6. Accounts Department The Accounts Department is the main financial arm to the Director. Under the guidance of the Director and Accountant, the Accounts Department is responsible for all salaries, coordination of tenders, and preparation of financial statements.
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6.7. Diagnostic Services 6.7.2.1. 1 Laboratory
47
The Laboratory staff includes a Consultant Hematologist, Visiting Consultant Microbiologist, 1 Medical Officer, 6 MLT, 1 Lab Orderly, and 5 Supportive Staff. The Lab performed the total number of 1,25373 tests for 2016, which included 33225 hematologist tests, 88385 of Biochemical tests and 3763 of Microbiological tests. Also, around 3150 samples were sent to the NHSL-RIA lab and MRI for other special investigations. Some of the highlights include: • Internal and external quality assurance programme was performed with MRI – Colombo. In addition to that BIO- RAD external quality control process was used for hematology which is started from 2016. • In 2016 the laboratory received the fully Automated Bio-Chemistry Analyzer. As a result,the turnaround time of patient’s sample is reduced when compared with semi-auto Analyzer, and as a quality measure now daily QC’s and calibrators are used to ensure results of investigations. After receiving the fully automated analyzer, the exact value of the test result can be issued for special tests such as CRP, CPK and also, we could increase the varieties of investigations. • In 2016, we could get the new Bio-Safety cabinet for Processing Microbiological investigations especially for AFB.
Laboratory Tests by Month 12000 10000
8000 6000
Urgent
4000
Routine
2000
0
Figure 28: Annual Laboratory Tests, 2016
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6.7.2 EEG The EEG Department consists of 2 EEG Recordists and 1 supportive staff.
EEG Tests by Month 45 40 35 30 25 20 15 10 5 0
Urgent Routine
Figure 29: Annual EEG Tests, 2016
6.7.3 ECG The ECG Department consists of 2 ECG Recordists and 1 supportive staff.
ECG Tests by Month 1200 1000
800 600
Urgent
400
Routine
200
0
Figure 30: Annual ECG Tests, 2016
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National Institute of Mental Health - Annual Report 2016
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6.7.4 X-Ray Department
49 At NIMH X Ray department was started in 1971 with one radiographer and one static X-Ray machine. that time x ray films were processed manually. At present the X-Ray Department is fully renovated with a new “Promax� automatic film processor which was installed in year 2016. At present, there are two radiographers and one supportive staff member are working in the x ray department. The department also extends radiographic service to the Colombo East Base Hospital and IDH in emergencies. During the year 2016, 5239 radiographic examination were done.
X-Ray Tests by Month 700 600 500 400 300
Urgent
200
Routine
100 0
Figure 31: Annual X-Ray Tests, 2016
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National Institute of Mental Health - Annual Report 2016
6.8. Pharmacy 6.8. PharmacyDepartment Department There are 8 pharmacists and 6 supportive staff managing 6 sections: Drug stores, surgical consumable stores,
There are 8 pharmacists and 6 supportive staff managing 6 sections: Drug stores, surgical consumable surgical non-consumable stores, outpatient department, indoor pharmacy, and HWH Mulleriyawa including stores, surgical non-consumable stores, outpatient department, indoor pharmacy, and HWH Mulleriyawa community housing project patients. The Out PatientDispensary functions from 8am to 4pm. In addition, including community housing project patients. The Out Patient Dispensary functions from 8am to 4pm. In drugs are drugs issuedare to the community clinics at Modara, Pannipitiya, and Kotahena. Skin ointmentsSkin andointments other addition, issued to the community clinics at Modara, Pannipitiya, and Kotahena. preparations are made by are the made Pharmacists the Wound Care Clinic and theCare Dermatology All data is and other preparations by theforPharmacists for the Wound Clinic andClinic. the Dermatology uploaded to Medical Supplies Management System (MSMIS).System In 2016, Pharmacy Clinic. All data is uploaded to Medical SuppliesInformation Management Information (MSMIS). In 2016, Pharmacy Department participated and issued drugs in health campsaffected for people affected the of flood Departmentparticipated and issued drugs in health camps for people in the flood in areas areas of Kolonnawa, Kalanimulla. Kolonnawa, Rajagiriya,Rajagiriya, Kalanimulla. Drugs
Surgical Consumable
Dressings
Lotion
Dental
January
Local Purchase 40407.75
14,88,941.30
48320
0
15815.24
10990.58
February
24639.41
1,033,622.00
320,537.41
0
17770
45068.49
March
14784.8
1,674,475.72
108,013.68
83,770.02
24,414.01
0
April
20182.06
844672.81
628,923.89
262,335.91
33,630.35
0
May
5937.96
741972.94
17226.66
141,832.70
0
0
June
6594.96
1,399,824.80
314,956.39
194,476.77
0
111,171.71
July
67128.3
1476534.49
408898.1
290314.53
14499.59
0
August
9546.2
7270868.47
596,568.17
282,185.05
244,73.66
12,989.60
September
35973.26
881983.37
151809.3
0
0
0
October
15021.16
1,867,967.40
204193.46
435456.28
112933.94
0.02
November
14358.56
1765310.3
278760.78
281381.14
159.844
29,759.16
December
51700
306071.99
853461
0
16822.5
0
Total
306274.42
19263304.29
3931668.84
1971752.4
236045.47
209979.54
Month
Figure of Pharmacy, 20162016 Figure32: 32:Annual AnnualSummary Summary of Pharmacy,
National Institute of Mental Health - Annual Report 2016
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51
6.9. Physiotherapy Unit
51in the There are 2 Physiotherapists attached to the unit, who attend to referrals in the unit or respective wards. During the year, around 2001 patients/referrals were seen at the NIMH and the HWH Mulleriyawa.
Physiotherapy Sessions by Month 250
200 150 100 50 0
Figure 33: Annual Physiotherapy Sessions, 2016
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National Institute of Mental Health - Annual Report 2016
6.10. Occupational Therapy Department Occupational Therapy Department, established in the 1950s, consists of two large units. It provides care for acute, intermediate and long-stay patients. The department at NIMH operates under the belief that “engaging people with mental health problems in meaningful activities or occupations can improve their quality of life benefiting both their physical and mental wellbeing”. Occupational therapy is not simply about being busy, but rather about engaging people in activities that facilitates recovery. This focus helps people regain skills lost due to their illness or develop new skills that can help their return to the community. There are 09 Occupational Therapists working at NIMH including the therapists working at forensic psychiatry service, day rehabilitation center, psycho geriatric unit and learning disability unit. There are six therapists working in the main OT units have received 728 new referrals within year 2016. Departmental daily activity programme includes religious programmes to meet their spiritual needs, communication group and physical exercise program in addition to a choice of art and leisure activities. Each patient is assessed and allocated in activities according to their therapy needs and interests. The assessment is conducted on request and includes functional assessments, cognitive assessments and IQ tests. A number of therapy groups provide activities of daily living training, training in anger management, social skills training, life skills training, creative writing, creative art, reminiscences therapy, music therapy, sport therapy, work skills and cookery. Several vocational and income generating activities such as jewelry making, rug weaving, handicrafts, carpentry, computer and printing, gardening, and sewing are available to meet their therapy needs as well. The clients were encouraged and supported to celebrate all religions and national festivals including the Thai Pongal, New Year, Vesak, Poson, Ramazan Festival and Christmas throughout the year. There were 06 community familiarization visits for long stay clients: 1. Kelaniya Temple – 25 clients participated using public transport service. 2. Arcade Independence Square – 32 clients participated for world Occupational therapy day celebration 3. Samantha Film Hall Dematagoda – 25 clients participated to watch “Hoganapokuna” film. 4. Galle Face Green – 22 clients are Participated 5. Narahenpita Church – 25 clients attended to holy mass 6. Kotikawaththa church – 27 clients attended to holy mass The visits support the development of their social and independent living skills.
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The OT unit contributed its fullest to celebrate the World Mental Health Day 2016. The OT department contributed to the historical keynote event “Prathiba” concert which organized by the institution and organized the open day “Art and Craft” exhibition with the creations from NIMH and mental health 53 units Island wide. The OT department also engages in clinical training of Medical, Nursing, Social Work, Counselling, OT Diploma and OT Degree students. A number of foreign students and volunteers also engaged with OT activities and acquired valuable experience. Two-week specialized training programs were conducted for staff to open new rehabilitation centers in Higurakgoda, Polonnaruwa and Manampitiya as well.
OT Sessions by Month 4000 3500 3000 2500 2000 1500 1000 500 0
Figure 34: Annual OT Sessions, 2016
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National Institute of Mental Health - Annual Report 2016
6.11. Psychiatric Social Work Unit Social Work is a value-based helping profession which seeks to improve the quality of life of individuals, families, groups and communities by intervening through various social work methods. Social workers are playing a significant role in protecting vulnerable, disadvantaged and marginalized people by empowering them in their own society. Persons with mental health problems and their family care givers face many socio-economic problems and right violations. This is especially true among persons with mental illness; their struggle to remain in the social main stream against social exclusion while struggling with aversive symptoms of illness and side effects of treatment. Their family careers bear a big burden because of troublesome behaviors of relations, facing emotional distress and frustration. Thus, social workers in mental health settings have a major role to play in their domain for desirable change. The PSW section in NIMH comprises of 3 designated Psychiatric Social Workers and 10 Development Assistant Officers who are covering the duty of PSWs. All the Social Workers are attached to a Consultant Psychiatrist depending on an area basis or assigned responsibility. Duties and responsibilities expected from PSWs are as follows; • Being a Multi-Disciplinary Team (MDT) member, help the other MDT members for treatment process by searching for social back ground and/ history of patients which is essential for the treatment plan by doing home/field visits, contacting local clinics, and contacting Grama Niladharis and/or other reliable sources • Discharge planning • Social re-integration and inclusion of recovered patients • Follow up of discharged patients and make necessary arrangements to reduce stigma and discrimination • Organizing and conducting educational/ awareness programs for various target populations and take necessary steps to empower service users in the society economically and socially • Welfare, social beneficiary and securing economic rights of patients • Help patient to have continuing employment and intervene at occupation-based issues • Helping people to begin self-employments • Protecting people from legal procedures against them • Use appropriate social work methods such as forming self-help groups and community organizing to empower people in society
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• Linking people with resources • Linking people with resources Intervene Intervene with when they have nono capacity. • with legal legal concerns concernson onbehalf behalfofofthe theservice serviceusers usersespecially especially when they have capacity.
55
Provide Provide counselling counselling and • and carrier carrierguidance guidancecounselling counsellingwhen whennecessary necessary December
November
September
136 124 141 120
120 118 131 1496
No. of placements in elderly homes
6
7
7
7
9
9
8
7
7
4
9
14
94
No. of placements in rehabilitation homes
14
9
16
10
10
15
14
9
9
16
8
8
138
No. of family meetings conducted
56
47
32
53
47
52
39
53
49
41
46
44
559
Follow up (Phone)
128
127 160 130 133
159 144 153 174
139 153 161 1761
Follow up (Visit)
151
134 128 146 154
132 150 142 151
143 165 147 1743
Social background search
102
80
99
95
97
108
Home/Field Visits
110
86
94
112 111
Mobile programmes
17
17
18
17
Community/Outreach clinics
28
28
28
Referred to other clinics
47
54
50
102
92
103
92
92
1160
102 114 102 115
110 110
96
1262
17
17
17
18
16
17
18
16
205
28
28
28
28
28
28
28
28
28
336
43
45
39
42
54
45
47
53
41
560
Figure AnnualSummary SummaryofofPSW PSWActivities, Activities,2016 2016 Figure 35:35: Annual
98
Total
120 120 115 139
October
112
August
Social re-integration with family
July
254 243 266 3109
June
280 262 285 264
May
226 253 225 276
April
February
275
March
January
No. of referrals received
Task
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National Institute of Mental Health - Annual Report 2016
6.12. Medical Record Room The Medical Record Room is one of the oldest units in NIMH with records stretching back as far as 1884. The unit consists of 3 attendants. The Medical Record Room stores all medical and non-medical records of NIMH.
6.13. Other 6.13.1. Telephone Exchange The telephone exchange consists of 1 telephone operator with 3 assistants running the communication needs of the entire hospital. In 2016 a new telephone exchange system was installed. 6.13.2. 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 patient care and emergency transfers. There are 11 health drivers with 7 supportive staff. 6.13.3. Maintenance Team The maintenance team looks after the day to day running repairs of NIMH under the purview of the Quality Management Unit.
National Institute of Mental Health - Annual Report 2016
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7. Special Activities
57
7.1. World Mental Health Day
The Annual World Mental Health Day Walk organized by NIMH was held in grand scale very successfully under the patronage of Hon. Dr. Rajitha Senaratne MP, Minister of Healthcare, Nutrition and Indigenous Medicine. The Walk started off from Diyatha Uyana and concluded at Ape Gama. An Inter School Quiz competition was held on mental health. As part of the many events to commemorate the World Mental Health Day 2016 the National Institute of Mental Health very successfully organized a first of its kind, a Live Talent Show that was the combined effort of the clients, staff and well respected Artists. The Chief Guest was Dr. Palitha Maheepala, Director General of Health Services and the Guest of Honor was Veteran Artist Dr. Jayalath Manorathna. A Public Day is also part of the World Mental Health Day Celebrations 2016; DGHS visited to open the arts and crafts exhibition.
World Mental Health Day Walk
World Mental Health Day Walk
Prathiba Concert
Public Day
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National Institute of Mental Health - Annual Report 2016
Art Exhibition
Inter-School Quiz Competition Figure 36: World Mental Health Day Activities
7.2. Special Projects& Activities
Pirith Chanting Ceremony
AvuruduUlela
Donation of New Villa Building
Farewell of Prof. H. Gambheera
National Institute of Mental Health - Annual Report 2016
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59
Visit of First Lady
Blood Donation Drive
Bakthi Geetha Recital
Pol Roti Dansala
Figure 37: Special Activity Highlights, 2016
7.3. Staff Welfare 2016 saw the good work started in 2015 expanded in the Hospital Welfare Association. The Association elected a new Council and an Executive Committee in the early part of the year. The benefits offered at death of loved ones, child births and other major life events were continued. The Association also organized the Annual Blood Donation Day at the hospital premises which had a very successful outcome. The Hospital Welfare Association also continues to support and work together with the Hospital Sports Club and Hospital Buddhist Association to promote sports and religious activities amongst the staff and clients.
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National Institute of Mental Health - Annual Report 2016
Annexures I: Cadre Details of NIMH
Approved Cadre
In Position
Director
01
01
Deputy Director
01
01
Consultants
10
10
Medical Officer
66
52
Dental Surgeon
03
03
SGNO
06
04
Accountant
01
01
Administrative Officer
02
01
Ward Sisters
04
07
Nurses
383
369
PSW
09
04
Occupational Therapist
09
08
Medical Laboratory Technologist
06
06
Physiotherapist
02
02
Radiographer
02
02
Pharmacist
06
09
Dispenser
03
02
Development Assistant
07
11
PHI
01
01
EEG recordist
02
02
Cardiographer
02
02
Development Officer
10
09
Information and Communication Technology Assistant
01
01
Public Management Assistant
44
23
Ward Clerk
12
06
Nutritionist
01
01
National Institute of Mental Health
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Diet Stewards
03
02
House Warden
04
Health Driver
11
61
Telephone Operator Hospital Overseer Cooks Lab Orderly Seamstress Plumber Attendant Supportive staff
03 08 20 02 02 01 250 444
02 06 10 01 02 01 170 356
Approved cadre
In position
Medical Officer
04
05
Matron
01
-
Nurses
64
58
Occupational Therapist
02
02
Nutritionist Diet stewards
01
01
01
01
Hospital Overseer
02
02
Cooks
04
01
Telephone Operator
00
01
Attendant
42
25
Supportive Staff
29
52
Approved Cadre
In Position
Principal
01
01
Senior Nursing Tutor
06
02
Nursing Tutor
03
04
Clinical instructor
00
01
PMA
01
-
House Warden
04
01
Health Driver
01
01
Cooks
03
03
Supportive Staff
09
11
Halfway Home, Mulleriyawa
Nurses Training School
04 11
Pg.
62
National Institute of Mental Health - Annual Report 2016
Totals Per Category Director
1
PSW
4
Nutritionist
2
Deputy Director
1
Occupational Therapist
10
Diet Stewards
3
Consultants
10
MLT
6
House Warden
5
Medical Officer
57
Physiotherapist
2
Health Driver
12
Dental Surgeon
3
Radiographer
2
Telephone Operator
3
SGNO
4
Pharmacist
9
Hospital Overseer
08
Principal (NTS)
1
Development Assistant
11
Cooks
14
Accountant
1
PHI
1
Lab Orderly
1
Administrative Officer
1
EEG recordist
2
Seamstress
2
Ward Sisters
7
Cardiographer
2
Attendant
195
Senior Nursing Tutor
2
Development Officer
9
Supportive staff
419
Nurses
441 ICT Assistant
1
Nursing Tutor
4
PMA
27
Clinical Instructor
1
Ward Clerk
6
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Annexures II: Research Submitted to Ethical Review Committee, NIMH
63
1. Consumer perception of recovery from severe mental disorders: As described by patients at NIMH 2. Differential Response to ECT in treatment of in-ward patients with Schizophrenia, at NIMH-Sri Lanka. 3. Psychological distress among aspiring Sri Lankan migrant labour workers and associated demographic variables 4. A study on risk of Metabolic Syndrome among outpatients receiving Clozapine in a tertiary care setting. 5. Validation of the Sinhalese version of Cornell scale for Depression in Dementia (CSDD-S) in Sri Lanka 6. Association between duration of the illness prior to Clozapine and treatment outcome of patients with resistant Schizophrenia 7. A study to translate and validate Mac Arthur Competence Assessment Tool-criminal Adjudication (MacCAT-CA) to assess competence to stand trial in Sri Lanka and to establish empirical correlates of competence to stand trial in Sri Lanka. 8. A research on reasons for admissions to National Institute of Mental Health by passing local hospitals, a Qualitative study. 9. Injection site complications of depot antipsychotic medications in patients who are being treated at National Institute of Mental Health, Sri Lanka.
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National Institute of Mental Health - Annual Report 2016
Annexures III: Annual Financial Report, 2016, NIMH Annexures III: Annual Financial Report, 2016, NIMH
Annual Financial Report 2016 Total Report NIMH + Unit II + NTS Object code Grand Total Total 1001
Description Recurrent Expenditure Personal Emoluments Salaries and Wages
Net Provision 1,232,057,510.07 901,221,510.07 283,794,469.52
Total Expenditure N Savings (Excess) Expenditure % 201 January-2016 e 159,867,072.28 243,354,565.10 62.32 772,044,522.35 129,176,987.72 69.51 278,283,611.77 5,510,857.75 76.76
1002
Overtime and Holiday Payments
187,985,905.25
137,773,818.28
50,212,086.97
66.41
1003 Total 1101 1102 Total
Other Allowances Travelling Expences Domestic Foreign Supplies
429,441,135.30 1,110,000.00 1,110,000.00 154,660,000.00
355,987,092.30 502,363.84 502,363.84 86,524,170.32
73,454,043.00 607,636.16 607,636.16 68,135,829.68
66.09 36.20 36.20
1201
Stationery and Office Requisties
3,300,000.00
2,300,923.63
999,076.37
65.24
1202 1203
Fuel Diets and Uniforms Diets Uniforms Medical Supplies Other 1.Waste Management 2.Other Maintenance and Expenditure Vehicles Plant and Machinery Buildings and Structures Services Transport Postal and Communication Electricity and Water Electricity Water Gas Rents and Local Taxes Other Security Cleaning Services Others Transfers Welfare Programmes Retirements Benefits Public Institutions Subscriptions and Contributions Fees Property Loan Interest to Public Sevants Other Other Recurrent Expenditure Losses and Write off
4,430,000.00 129,000,000.00 129,000,000.00 6,250,000.00 11,680,000.00 11,680,000.00 22,400,000.00 3,700,000.00 2,000,000.00 16,700,000.00 146,816,000.00 6,196,000.00 62,520,000.00 17,620,000.00 35,900,000.00 9,000,000.00 300,000.00 77,800,000.00 14,230,000.00 54,000,000.00 9,570,000.00 5,850,000.00
2,815,101.26 69,714,183.12 69,714,183.12 6,144,865.62 5,549,096.69 5,549,096.69 21,480,474.92 3,065,506.55 1,254,304.89 17,160,663.48 102,868,989.26 5,260,621.66 41,414,458.69 13,770,452.29 24,956,092.82 2,687,913.58 147,821.00 56,046,087.91 10,973,247.64 39,701,670.27 5,371,170.00 5,282,424.28 -
1,614,898.74 59,285,816.88 59,285,816.88 105,134.38 6,130,903.31 6,130,903.31 919,525.08 634,493.45 745,695.11 (460,663.48) 43,947,010.74 935,378.34 21,105,541.31 3,849,547.71 10,943,907.18 6,312,086.42 152,179.00 21,753,912.09 3,256,752.36 14,298,329.73 4,198,830.00 567,575.72 -
45.10 35.90 35.90
1204 1205
Total 1301 1302 1303 Total 1401 1402 1403
1404 1405
Total 1501 1502 1503 1505 1506 1508 Total 1701
39.51
41.49 41.49 62.95 62.99 52.60 64.18 42.02 68.16 41.69 53.09 42.33 16.83 15.33 40.31 32.92 43.47 33.47 68.43
-
-
4,650,000.00
4,110,105.78
539,894.22
73.11
1,200,000.00
1,172,318.50 -
27,681.50 -
85.69
Pg.
National Institute of Mental Health - Annual Report 2016
65
Acknowledgements
65 •
Director, Dr. Kapila Wickramanayake and all the Consultants for their guidance and advice.
•
Deputy Director Dr. Lalith Poddalgoda for his guidance and advice.
•
Dr. Rikaz Sheriff, Dr. Upeka Mettananda, Dr. Keshan Serasinghe, Dr. Arosha Wijewickrama, and Dr. ThanujaSiriwardene for Compiling and Co-Editing.
•
Dr. Dilini Wijesooriya (Dental Unit), Dr. Janaka Weeragalla (Halfway Home Mulleriyawa), Mr. Pradeep Gunarathna (Forensic Psychiatry Unit), and Mr. Ashoka Sanjeewa (Day Treatment Centre & Day Rehabilitation Centre) for their detailed write ups.
•
Principal NTS, SGNO, and NIC of Wards and Units for providing necessary information.
•
Officers in Charge of Allied Health Departments for providing necessary information.
•
Administrative Officer, Accountant together with their staff for providing necessary information and support.
•
Ms. Roshini Dushanthi, Medical Record Officer, Health Information Section, Planning and Development Unit for her tireless efforts in collecting the data required.
•
Mz. Nishani Chathurika for helping with translations & typing.
•
All Medical Officers, Nursing Officers, and Support Staff of Planning & Development Unit for being a tower of strength and support.