MENTAL HEALTH

1. All clinics have regular visits (for patient care, training, supervision and support) from dedicated mental health or psychiatric nurses from health centers, hospitals or mobile teams based in the district.

2. All clinics have access (by referral or by periodic clinic visits) to specialist mental health expertise (psychiatrists, psychologists, occupational therapists) and social workers from district or regional level at least once a month.

3. In every clinic there is a member of staff who has had continuing education in psychiatry or mental health (including community aspects) in the last year.

4. In every clinic there is at least one person trained in counselling and the management of victims of violence and rape.

1.1 Mental health policy document for provinces.
1.2 List of visiting psychiatric staff at nearest health centre, district hospital, psychiatric specialist hospital or outreach service.
1.3 Mental health assessment guidelines.
1.4 Psycho-social rehabilitation checklist for community work.
1.5 Checklist for daily living skills for rehabilitated patients.
1.6 Admission procedures under current Mental Health Act.
1.7 Emergency medication protocol.
1.8 Essential drug list for Primary Health Care.
1.9 24 Hour ability to telephone or use radio to psychiatric unit of district hospital or nearest Mental Hospital.
1.10 Posters and pamphlets on mental health, severe psychiatric conditions, available services and user rights.

2.1

3.1 Emergency and routine medication provided according to protocol and EDL.

Recognising mental illness

4.1 Clinic staff consider risk factors for mental health within their catchment area: poverty, social power, unemployment, ill health, homelessness, migrancy, immigrants, isolated persons, HIV positives etc.
4.2 Staff identify and provide appropriate interventions for patients with depression, anxiety, stress related problems, male violence, substance abuse and special needs of women (childbearing, abortion, sterilisation, disability, malignancy etc.)
4.3 Clinic staff recognise the expression and signs of emotional distress and mental illness early (especially in young patients or in relapse of a psychiatric condition).
4.4 Clinic staff participate in the promotion of healthy life style in clinic attendees and the community.

Organising services

4.5 Staff organise the clinic to have quarter periods of the day set aside for booked interviews.
4.6 Staff provide prompt help from or at the clinic if a patient’s condition in the community deteriorates.
4.7 Staff ensure time is allocated for home visits to patients who have returned from mental hospital.
4.8 Staff ensure there is no segregation or stigmatisation at the clinic of patients who have to use other services e.g. family planning, antenatal care, etc.
4.9 Staff arrange access to a consistent member of staff for each consultation.

Managing care

4.10 Specially trained staff are able to

4.10.1 Maintain relationships with patients that are just, caring, and based on the principles of human rights.
4.10.2 Perform an adequate medical examination which:-

4.10.2.1 Identifies the general mental state e.g. psychotic or depressed.
4.10.2.2 Identifies the severity and level of crisis.
4.10.2.3 Rules out systematic illness.
4.10.2.4 Records temperature and blood glucose level.
4.10.3 Take a history that includes previous service use such as admission to hospital.
4.10.4 Take a family history and evaluate support.
4.10.5 Develop a sustained therapeutic relationship with patients and their families.
4.10.6 Know and implement standard treatment guidelines especially the section on delirium with acute confusion and aggression, acute psychosis and depression.

4.11 General nurses are able to:-

4.11.1 Detect and provide services for severe psychiatric conditions as a component of comprehensive Primary Health Care.
4.11.2 Make appropriate and informed referrals to other levels of care.
4.11.3 Provide basic psychiatric care and assess urgency and severity of symptoms.
4.11.4 Provide individual community maintenance and care for stable long-term patients who have severe psychiatric conditions and have been discharged from hospital.
4.11.5 Provide each stable long-term user with individualised comprehensive care which includes:-

4.11.5.1 An ongoing assessment of mental state, functional ability and social circumstances.
4.11.5.2 Familiarity with the internationally recognised diagnostic system.
4.11.5.3 An ability to detect and monitor distress and relapse.
4.11.5.4 An ability to provide basic counselling and support to patient and family.
4.11.5.5 A basic knowledge, criteria and pathways for referral for disability grants.
4.11.5.6 Knowing community referral and support organisations.
4.11.5.7 The follow-up of all cases returned to community after hospitalisation and keeping a register.

4.11.5.8 An ability to use records to facilitate continuity of care, such that:-
4.11.6 The condition of patients in the community is monitored and poor compliance, functional deterioration, substance abuse and family conflict community ridicule are identified.
4.11.7 The onset of mental deterioration in HIV positive patients is recognised.
4.11.8 The prescription of sedation for aggressive of violent patients only as appropriate when other measures fail.
4.11.9 Coping with disturbed, intoxicated, aggressive suicidal behaviour without resorting to violence, abuse of undue physical restraint.

4.12 Clinic staff provide patient and caregiver satisfaction with assistance in alleviating family burden, achieving social integration, improving quality of life and general functioning while improving symptoms.

4.13 Clinic staff conduct consultations in privacy and in a confidential way and informed consent is obtained for communication to others.

5.1 Referral pathways to other levels or types of care are known and expedited.

6.1 Patients, relatives and the community receive high quality information on mental health and mental illness.
6.2 Patients and their supporters are given individualised education when their situation is reviewed.
6.3 Patients and their supporters are educated on how to recognise predisposing factors and conditions to prevent relapse.
6.4 Clinic staff use education in the family and community to address ignorance, fear, and prejudice regarding patients with severe psychiatric conditions attending the clinic.

7.1 Records are kept according to protocol with emphasis on confidentiality and accuracy.
7.2 A register of psychiatric patients in the community is maintained.
7.3 Staff record mental health indicators on:-

7.3.1 The number and mix of cases
7.3.2 The frequency of contact

7.4 Staff analyse indicators and develop appropriate action.

8.1 Staff participate in community awareness programmes for mental health according to the national and international calendar.
8.2 Staff participate in the training of family and carers of patients to plan an active role in their rehabilitation.
8.3 Staff encourage patient and caregiver support groups in community.
8.4 Staff keep the addresses and phone numbers of people assisting with mental health and social problems (e.g. women’s shelters, community self-help groups).

9.1 Staff respect and where appropriate seek collaborative association with local traditional healers.
9.2 Staff collaborate with all community services e.g. crisis counselling (lifeline, priests with counselling skills) and mental health groups especially those for youth.
9.3 Staff collaborate with the hospital for planning discharges to the community.