ANNEX VI

REPORT OF THE WORKING GROUP 2

STEPS TO BE UNDERTAKEN IN STRENGTHENING

VARIOUS LEVELS OF CARE

A.     TARGET

The target of this recommendation is the government of the countries affected by the tsunami 

B.     OBJECTIVE

The objective of this recommendation is to present a model, which can be workable in resource poor countries.  The model may be modified according to the cultural context of the country.  One basic objective beyond the model is to ensure access to basic care for people with all kinds of mental problems, ranging from mild psychological distress to severe mental disorder 

C.     GENERAL RECOMMENDATION

1.      Anti stigma activities should take place across all the sectors.

2.      There needs to be inter-ministry coordination to discuss, create and implement mental health and social policies. 

3.      A basic system to keep and share the information for mental health and psychosocial care should be improved. 

4.      Administrators responsible for planning mental health and social services should be sensitized for the issues of this field.

5.      The workers are a valuable and sometimes scarce resource and as such should be supported in their work to prevent secondary traumatization and burnout

6.      The levels of care should be integrated in the existing health and social services system.

7.      The detailed recommendations are made, as follows, according to an adaptation of the “Pyramid Model” submitted by WHO and the service coverage matrix as proposed by Dr. Hunter.

8.      Indicators for quality of care should be developed in future to measure the effectiveness of this model.  

D.     Service Coverage Matrix

Long    Diagnosis       Early             Promotion

Term   Treatment      Recognition    and    

                                      Rehab  Intervention    support         prevention

Specialty Care                     ○          ○                ○                   ○

Primary Health Care                                ○                ○                   ○

Formal and informal care                                            ○                   ○

outside the health

sector

Self & Family                                                             ○                  ○

Care

E.     SECTORS

Specialty Sector

MEMBER

Psychiatrist, Psychologist, Psychiatric Nurse, Social Worke 

ESSENTIAL ROLE

Inpatient/Outpatient Treatment, Outreach, Community Treatment 

RECOMMENDATION

1.      Accessibility: Acute treatment should be available at district level.

2.      Community Mental Health Team: Specialist sector should embody community mental health approach.

3.      Outreach: Specialist sector should include outreach in the community.

4.      Training: Specialty sector should train and supervise the primary health sector for mental health related issues.  (This does not necessarily include supervising the formal and informal care outside the health sector, which often operates on non-psychiatric skills.)

5.      The community mental health sector should receive regular training and guidance  

Primary Health Sector 

MEMBER

General Physician, Nurse, Midwife, Medical Assistant, Health Assistant,   

ESSENTIAL ROLE

Early Detection, Referral, Basic Mental Health Care, Case Follow-up, Psychosocial education to client and family as part of destigmatization 

ADDITIONAL ROLE

Counseling, Psychosocial education to community, Prevention, Training and Supervision of the informal care sector (when relevant), Linkage / facilitator between different sectors 

RECOMMENDATION

1.      Referral System: to strengthen a functional referral system among primary health sector, and all other sectors. Family folder method may be introduced.

2.      Enhancement of the capacity: to strengthen the capacity of primary health sector to cope with mental health related issues

3.      Primary health care workers should be supervised, including assistance in preventing burnout.  

Formal and Informal Care Outside the Health Sector  

MEMBER

Counselors, and other qualified workers working outside the health sector, Teachers, NGO workers, Religious leaders, Women leaders, Natural helpers / elders,  

ESSENTIAL ROLE

Early Detection, Referral, Basic Social and Psychological Support, Prevention and Promotion 

RECOMMENDATION

1.      Guideline: The guidelines need to be developed for the members.

2.      Training and supervision: There should be training and supervision for the members.  The supervision should include protection of workers from burnout.

3.      Support: The government should provide support and protection to this sector.  The support may include financial support

4.      Coordination; Like other sectors, this sector should have coordination, even when activities are informal. 

Self and Family Sector

PREREQUISITE

Safety, basic needs and family reunification should be provided by the government. 

MEMBER

Self and family. 

ROLE

Self-awareness.

Ideas on coping and on helping others cope   

RECOMMENDATION

1.      Information and education: Information and education should be provided to the community.

2.      Self-help group: The government may encourage self-help groups to be formed.

3.      Children and adolescents may be involved in peer to peer support.