Monday, April 20, 2009

mental health....and OT

A CALL has gone to Federal government of Nigeria to integrate mental health services into Primary Health Care (PHC), even as the nation is being described as the country with the most retrogressive mental health law in the world. The call for integration was made as part of agitation for complete review of the nation’s mental health programme towards improvement of health service to Nigerians.

Making the call in Lagos last week during a mental health stakeholders” meeting at the Lagos State University Teaching Hospital (LASUTH), Prof. Oye Gureje of the Department of Psychiatry, University of Ibadan, Ibadan, noted that there exists a major deficit between the need for mental health service and available resources to address the need. He opined that there may be no improved mental health services in Nigeria, until the National Mental Health Programme and Action Plan promulgated in 1991 is well implemented in addition to availability of essential drugs in primary care clinics and reduction of stigma.

Gureje, who lamented the yawning treatment gap in the management of mental disorders in the country, said result of a large Nigerian study revealed that 90 per cent of all cases of mental illness in Nigeria, obtained no treatment within the last 12 mobnths while in serious cases, 82 per cent had no treatment access. Among those who obtained treatment, only 6 per cent do so withing the first do so in the first year of uillnes while it takes an average of six years for the average mental illness patient in Nigeria to seek and obtain treatment.

“Even though 1 in 12 Nigerians will have a mental illness at any given time, and one or two persons in the nation out of eight will experience a mental illness within their lifetime, the real impact of mental disorders is not because they increase chances of dying, but because they cause considerable disability and impairment of role functioning.”

Gureje noted that, in Nigeria, the average loss in earning in 2002 among persons with serious mental disorders was grossed N21.6 billion amounting to N60,126 per person. He described as “grossly inadequate” the general response to the burden of mental health in the country. “Mental disorders often go unnoticed even though effective treatment is available for most, and when treated, it is often too lateand frequently inappropriate.”

He said a functional PHC, is crucial to any attempt to deliver good health care everywhere. “Primary care providers are poor at detecting mental health problems. Most commonly offer inappropriate or inadequate treatment wghile the primary care clinics hardly have the essential medications for common mental health problems. “ In his view, a lot can still be done with the available resources if only the health service system was better organised.

THERE is currently a ratio of one resident doctor to 2000 patients at the Federal Neu-opsychiatric Hospital, Yaba, Lagos. President of the hospital’s branch of the Association of Resident Doctors, Dr. Niran Okewole noted this while lamenting acute shortage of staff in the system just as he noted that the Associaltion’s industrial action embarked upon last week was to ensure quality patient care.
Okewole argued that even though the hospital has a total number of 80,000 registered patients, total number of resident doctors is just 40 leaving a ratio of 2,000 patients per doctor. He said: “Over the years, there has been an exponential increase in the number of patients being seen in the hospital. this in itself is a good thing because it suggests that public awareness of psychiatric services is growing. However, the number of specialist available to attend to this teeming mass has dwindled.”

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.

What Occupational therapy has to do with Mental health:

The overall goal of occupational therapy in community mental health is to help people develop the skills and obtain the supports necessary for independent, interdependent, productive living. Particular emphasis is given to interventions that result in improved quality of life and decrease hospitalization.

Occupational therapists and occupational therapy assistants provide purposeful, goal-oriented activities that teach and facilitate skills in:

cognition (e.g., problem solving);
independent living including using community resources, home management, time management, management of medication, and safety in the home and community;
avocational interest and pursuits:
interpersonal and social skills;
stress management;
activities of daily living (e.g.; hygiene);
role development (e.g., parenting);
self-sufficiency and interdependency; and

Occupational therapy services include:

adapting (changing) the environment at home, work, and school to promote an individual's optimal functioning
providing education programs, experiential learning, and treatment groups or classes;
consulting with employers responding to requirements of the Americans with Disabilities Act;
functional evaluation and ongoing monitoring of clients for placement in jobs and housing;
providing assistance or guidance with client-run support groups;
goal setting and rehabilitation plan development with client; and
providing guidance and consultation to persons in all employment settings, including supportive employment.
Occupational therapists and occupational therapy assistants working in the area of community mental health are employed by or provide consultation to:

adult day care centers,
day treatment centers,
home health agencies,
community rehabilitation programs,
mental health clinics and hospitals,
clubhouse programs,
outpatient psychiatric clinics,
foster care residents,
sheltered workshops,
group and private homes,
community support programs.

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