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38 Improving efficiency of mental health care provided for patients with severe mental illness-SMIs (schizophrenia, schizoaffective disorder and bipolar affective disorder), a success story from ampara, a rural region of eastern sri lanka
  1. Hiranya Wijesundara
  1. District General Hospital, Ampara, Sri Lanka


Background In Ampara Health District, I provide services to a rural population of 273,286 population in 3810km2 as sole psychiatrist. Multidisciplinary Area Mental Health Team(MDT), included multi-centred full-time staff(Medical Officers, Nursing Officers, Psychiatric Social Workers and assistant staff) and part-time staff(Occupational Therapist and Speech Therapist). Limited scope of services provided for patients with SMIs, was recognized by the team.

Aims To improve holistic bio-psycho-social management through MDT input. Areas chosen to intervene include data surveillance system, pharmacological treatment, psycho-social interventions, physical health and service delivery. Method:Patients and Carers feedback were gathered. Using Monthly Quality Circle meetings, existing situation was analysed. Interventions were designed with ideas of MDT to target each aspect of the problem. Team members were delegated to lead various interventions in the project from 2016–2018.

Results There were 641 patients with SMIs at central clinic in 2016. Outcome indicators for each intervention were developed and monitored. In an audit(165 patients), consultant review rate increased with reduction of rate of relapses. Monthly average number of general & targeted psycho-social interventions increased, while stability of high-risk patients improved. Screening for physical comorbidities increased. To improve service delivery, additional peripheral clinic was initiated, and availability of common medications increased. In qualitative indicators, high patient satisfaction and increased community engagement in health promotional programs, were noted.

Conclusions Outcome indicators showed increased number of bio-psycho-social interventions and positive impact on outcome of patients. Service development through leading MDT is challenging but successful. This project won the Award for Mental Health Team of the Year at BMJ South Asia Awards for Health Care Excellence in 2018.

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