Mentally ill need a social lifeline

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Source: The Star Online

Learning to get by: Nurses conducting a domestic therapy class for recovering mental health patients as part of UMMC’s rehabilitation programme. Pic from the Star Online.

Learning to get by: Nurses conducting a domestic therapy class for recovering mental health patients as part of UMMC’s rehabilitation programme. Pic from the Star Online.

KUALA LUMPUR: Mental health patients who have just recovered from severe or long-term illnesses could be at risk of slipping back without psychosocial rehabilitation, a service that is sorely lacking in Malaysia.

According to the Malaysian Mental Health Association (MMHA), many hospitals and treatment centres focus more on symptom remission, but not all provide extended care to ensure patients can reintegrate into society.

MMHA deputy president Datuk Dr Andrew Mohanraj gave an example of a schizophrenic patient who is brought in for treatment and given appropriate psychotropic medications to cure hallucinations and delusions.

“After a period, his hallucinations and delusions go away and symptom remission is achieved, but what about the skills lost in the process, the low self-esteem, the interruption in studies or work life, and social awkwardness?

“Psychosocial rehabilitation aims to reinstill lost skills and improve the functioning of former mental health patients and not just treat the symptoms,” he told The Star.

At the moment, many hospitals and treatment centres focus more on the symptom remission, which means patients are only given treatment when symptoms of the illness occur.

Once healed of the immediate symptoms, regular treatment and handing out of medication is then stopped, but the patient’s healing process may not be complete.

Dr Mohanraj observed that psychosocial rehabilitation facilities do exist in government-run hospitals and community mental health centres.

Non governmental organisations like the MMHA also operate day psychosocial rehabilitation programmes.

However, psychiatric inpatient care is almost non-existent in the private healthcare sector, hence the services nationwide are still limited.

“Many private healthcare providers are hesitant to venture into psychiatric inpatient care, most likely because such facilities are perceived as not lucrative enough to match the efforts to adhere to Health Ministry guidelines,” he said.

The Mental Health Act 2001 has already outlined the need for high standards of care for inpatient facilities – like prohibiting rooms designed like cells.

It also provides stringent requirements when setting up residential and recreational areas for inpatient facilities for both public and private healthcare providers of psychiatric inpatient care.

“The very high standards are good for providing quality care and to protect rights of patients while preventing abuse.

“However, there are also aspects of the Act that are not appealing for the private healthcare sector to start private inpatient facilities,” said Dr Mohanraj.

Most patients requiring psychosocial rehabilitation are also likely to be unemployed because of their illness, and therefore unable to foot the “out of pocket” expenses.

Dr Mohanraj also said insurance companies on the whole were unwilling to cover psychiatric inpatient care.

“This means the Government has to shoulder the burden of providing such care and no significant private psychiatric inpatient care is available in the country at present,” he said.

The MMHA is one of the few non-governmental organisations offering psychosocial services for mental health patients, but its facilities are limited in capacity.

“Treating only someone’s symptoms is only creating a lifeless soul, but psychosocial rehabilitation aims to create people who live a life fulfilling to themselves and to others around them,” said Dr Mohanraj.