Code of Conduct for Trainees

National Institute of Mental Health is a premier mental health training institution in Sri Lanka. NIMH welcomes all approved trainees.

While you undergo your training at this institution it is of primary importance that you inculcate correct attitudes towards mental health care, and those suffering due to psychiatric illness.

Towards these objectives we would like you to go through the following details about our institution, its services and expected conduct of a professional working in mental health.

National Institute of Mental Health (NIMH) was started in 1926 as the Mental Hospital-Angoda, being the main institution serving patients with mental illness in Sri Lanka. It has gone through many evolutions and developments over its nearly 100 years of history. It was re-named National Institute of Mental Health in 2008 and is considered the final referral centre as well as a centre of excellence in mental health care in Sri Lanka.

NIMH serves the whole country with referrals and admissions from all areas of the country. The services provided at NIMH include acute psychiatry care, follow-up (provided at hospital clinics as well as community clinics), psychotherapy, rehabilitation, and supported employment.

It is a health care institution under the Ministry of Health and functions as any other hospital in the country. An important difference is that NIMH is authorized by Law to admit and keep patients with psychiatric illness without the consent of the patient concerned (involuntary admissions). However this is an infrequent event and most patients receive care in hospital on a voluntary basis.

There are multiple staff categories employed at NIMH under the administration of the Director and Deputy director. These include consultants in psychiatry and other disciplines, post-graduate trainees in psychiatry and other specialities, medical officers, dental surgeons, special grade nursing sisters, nursing sisters and nursing officers, social workers, physiotherapists, occupational therapists, pharmacists, medical laboratory technologists, EEG and ECG technicians, etc. and support staff.

Additionally there are trainees of various categories completing training periods of different durations. Also there are volunteers from different organizations who provide valuable service and contribute to patient care.

The primary objective of the NIMH is patient care. Other activities such as training, staff development, educational activities and research are additional activities of the institution.

1. Safety of patients who are attending to inward and clinic services of NIMH is of primary concern.

You should not at any time compromise the safety of patients in any way. This includes giving any medication which you are not authorized to give, involving patients in activities without authorization or supervision and taking in-ward patients out of the hospital without authorization.

2. Be mindful of patients who pose risks of suicide, falls, aggression and absconding.

3. Always follow the advice and seek guidance from doctors and nurses before taking responsibility for patients.

4. Please bring any concerns you have regarding safety issues of patients to the notice of the medical team and nursing staff.

1. You are expected to maintain confidentiality for all information which you come across regarding patients and their families. Under no circumstances should you divulge any such information to others. This includes your family members, friends, spouses, and fellow students and trainees. This applies even after you leave NIMH, following your training period.

2. You are permitted to discuss patients and their illnesses with your colleagues and trainers if this is required as part of your training requirements. Even then it would be good practice to not use identifying details of patients in large forums.

3. You are prohibited from taking any photographs without permission within the hospital. You require the permission of the director to take photographs of the hospital premises.

4. If you need to take photographs of any clinical signs or take recordings it should be with the informed consent of the patient and under the direct supervision of a medical officer.

5. You are prohibited from posting any information/recordings/photographs of patients or their families on social media. Similarly you should not engage in online discussion/chats/webinars/webcasts regarding patients. If there is any requirement to do so you should obtain permission from your training supervisor.

6. You should not take photographs or make copies of bed head tickets. Please note the bed head tickets (BHT) are government property and you are not permitted to make copies without the permission of

Director-NIMH.

7. You are permitted to note down details from the bed head ticket for academic/training purposes only.

If you need to take photographs of any clinical investigation for academic purposes, it should be under the direct supervision of a medical officer.

8. Any recordings/photographs should be edited to remove the identifying details of patients before publishing/printing them.

9. If there are any patients who are personally acquainted with you it is best if you don‘t get involved in their clinical management. If the treating clinicians want your input as part of the management of the patient, you will be invited to do so.

10. If one of your acquaintances asks you to find information regarding a patient known to them while you are at NIMH, it is best that you do not do so. Refer all such requests to the doctors or nurses involved in the patient‘s care.

1. The patients of this institution and their relatives expect a level of care from all staff and trainees attached to this institution. Therefore you have a responsibility towards the service users of this institution while you are attached to NIMH.

2. The patients and families who utilize our services will be happy to contribute to your training as much as possible most of the time. Consider this a privilege given to you. Do not abuse this privilege.

3. You are expected to treat all patients, whether voluntary or involuntary and their relatives with respect, humanity and equality.

4. Behavioural abnormalities of patients should never be a source of amusement. Never make fun of patients.

5. Patients should not be invited to perform for you (sing/dance) regardless of whether they consent for it or not. It can be permissible only at times when it‘s part of their therapeutic/management plan.

Always obtain guidance from the treating team when in doubt.

6. You may be tempted to relate what a patient has said/mimic a patient for amusement of your friends and family. This is wrong. Patients may say/do things in an abnormal manner which is an indication of their illness and should invite our compassion rather than amusement.

7. There may be times you are expected to listen to distressing information of patients‘ lives (abuse/trauma/sexual/drug habits etc.). You are expected to learn from this information in order to make you a more effective professional. You should not be judgmental about patients going by this information (calling a patient murderer/rapist/thief etc.)

8. There may be times when patients express religious/political/social views which are against your own personal beliefs. You should never discriminate against patients based on this or try to change/convert them to your point of view. It may be an abuse of your relationship with the patient if you were to argue with patients about these matters.

9. It is forbidden for you to enter into any type of sexual or romantic relationship with a patient or a family member, whether within the hospital, outside the institution or on clinic follow-up. If you receive any sexual invitation from any service user, inform about it to the ward medical/nursing staff or to your training supervisor.

1. As a person receiving professional training your patients and their family members will expect a level of professionalism from you. This includes your dress, manner of talking with them and how you conduct yourself within the hospital and outside.

2. Be respectful and fair in your dealings with service users to enable them to build a trusting relationship with you. Covering your face while interacting with them or use of gloves when it‘s unnecessary to do so, is disrespectful and should not be done. If you are in doubt about whether you should use barrier precautions e.g. where possibility of infection transmission is present, you should clarify this with the doctors or nurses involved.

3. There are multiple staff categories contributing to patient care in NIMH. You need to be polite and courteous in your interaction with all of them. There may be times when the staff in a ward are very busy and unable to help you with your training activities. Please be patient and be mindful that they need to prioritize patient care first.

1. The service users of NIMH expect to be provided care by all those associated with the institution. You, even as a temporary member of the care team may be able to do much to help our service users.

2. Please be ready to help and contribute as much as possible to the management of patients. This may be in helping within the wards, rehabilitation programmes, therapeutic programmes or teaching activities.

You are in this institution for the purpose of learning and training. It is your responsibility to ensure that the time you spend is spent effectively. The primary source of learning and training will be the interactions with the service users. Additionally there may be teaching activities conducted in the wards, in the Health Education Centre, and in specialized units in the hospital. NIMH has a library with a collection of material on Psychiatry and related subjects. Please use all these resources to help you in your training.

1. NIMH strives to ensure the safety of everyone who is working and training within the institution. If at any time you feel unsafe due to actions of a service user in the institution, remove yourself from the area, and ask any member of staff for help.

2. NIMH is a large institution spread over a large geographical area. It is possible to feel lost if you are not oriented in the environment. Ensure that you are aware of where you are and know how to get back to familiar areas.

1. If you have any complaints regarding safety of patients, your own safety, or concerns about conduct of staff, you can bring them to the notice of a doctor or nurse in the unit concerned or your training supervisor. If you need urgent advice you can contact any senior member of the medical staff or the

Director through the telephone exchange.

2. If you need clarification regarding your training, schedules or leave, you can obtain advice from your training supervisor or the medical officer-training.

We hope the above guidelines will help you while you are at NIMH, and wish you success in your training programme.