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11th Johor Mental Health Conference: Deinstitutionalization

I just came back from Johor Mental Health Conference. This was my second attendance for the conference, and both as a delegate. I hope to attend it as a speaker the next time, Insyaallah.

I was interested about the keynote address given by Prof. Hermann from Melbourne on the first day. She talked about the Australian mental health policy and touched largely regarding the effect of deinstitutionalization for the homeless psychiatric patients. It was interesting to note that she sincerely acknowledged that Australia is still failing in deinstitutionalization of psychiatric patients although it is a developed country and has a very well-established and systematic health delivery systems.

I felt Malaysia is way way back than Australia in term of deinstituonalizing the mentally ill.

The first problem lies in the acceptance of our community towards the mentally ill. I am generalizing Malaysians when I’m speaking about this problem. Malaysians at large still think that mentally ill people should be living together with ‘those who have the same problems’ and separated from the ‘normal’ people. Malaysians also think that the government should take the fullest responsibility in caring for these mentally ill people. Things are made worst when psychiatrically impaired persons are admitted to the ward repeatedly, and the family will express their intention and utmost desire and request for the patient to be kept longer in a psychiatric institution thus the expressions of:

“kami tak tau nak buat apa lagi dengan dia ni, doktor hantar jer lah dia masuk Tg. Rambutan, bagi dia duduk lama-lama sikit kat situ, at least kat situ ada orang yang tengok dia makan ubat”

“lepas dia baik nanti, baru bagi dia keluar”

“kami ni semua kerja, mana ada masa nak tengok dia makan ubat dan bawa dia jumpa doktor”

“dia ni memang menyusahkan family la doktor, ada ker dia boleh pukul mak saya, saya balun la balik. Celaka punya anak”

These requests may have been accepted by the doctors 10 or 20 years ago, and patients will be happily transferred to the four psychiatric institutions available.

However, with the wave of deinstitutionalization that started in the 1960s in the west, and the introduction of a more comprehensive community care in Malaysia since 1990s, these requests were less entertained, and responsibility given to the family for the long term care of the mentally ill. The four psychiatric institutions were gradually minimizing their number of beds, and expansion of capability for psychiatric care in govermentment hospitals intensified.

Deinstitutionalization should be done concurrently with the empowerment of the family to care of the patients. Families should be prepared with basic knowledge of the illness (so that they understand the cause of it, the symptoms and indicators of relapses), the importance of medications and continuous follow-ups and the psychosocial rehabilitation programmes.

Then, the surrounding communities (neighbours, village folks etc) should be educated about mental health through small and short explainations, for example after solat jemaah or friday prayer, sermons at the church etc. The community in which the patients live must be told that a recovering/recovered mentally ill people is still part of their social fabric and should not be isolated.

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Saturday, July 18, 2009 - Posted by | Community Psychiatry

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