The International Journal of Psychosocial Rehabilitation


Psych Rehab. & Community Care in Mongolia

Responsible institutions
Ministry of Health and Social Welfare
Department of Strategic Planning and Management
Center for Mental Health

Project Time-frame
September 1997 to September 2000

Main Goals
To reorient the current mental health service from one that is specialist and hospital based to one that provides comprehensive community based services including health promotion and disease prevention strategies.

The Mongolian National Health Policy as submitted to parliament in 1997 has included the following policy statements on mental health; 1) the integration of mental health services in the general health service at all levels; 2) appropriate training in mental health and psychosocial skills for all health personnel as well as those in the other sectors like social welfare, community development, education labor; 3) development of health promotion programs for healthy attitudes amongst the young and prevent the adverse psychosocial consequences of social changes like substance abuse, suicide, violence and criminality.
The reorientation of mental health services as defined above requires a new way of conceptualizing mental health care and prevention and hence sensitization of key policy makers and mental health care providers becomes a key issue. In addition, providers of mental health care require additional training to effectively develop and implement treatment, care and prevention activities within this new conceptual framework.

Project Description
The project will initially be undertaken in Ulaanbatar city which is served by six health districts. The Center for Mental Health (CMH) works closely with the six health districts and mental disorders detected are referred to this center.
There are four programs of work. The first programme of work is the integration of mental health care in general health care. The programme aims to train family physicians to conduct psycho social interviews, and to assess and manage five priority mental health problems in the community; depression, anxiety, crisis and psychiatric emergencies, chronic psychoses and alcohol problems. Corresponding district psychiatrists from the CMH will visit these family doctors to monitor and supervise their mental health care activities. During these visits psychiatrists will also assist doctors in the recording and reporting of mental health data of patients.

The second programme of work is the provision of Community Mental Health Care through the Psychosocial Rehabilitation of Chronic Psychotic Patients. Strategies for this programme include:

1. The creation of a family care programme, which provides psycho-education and care to families of the chronic psychiatric patient.

2. The creation of a day care program: to be implemented within the neighborhood of the patient's residence.

3. Involving non-medical staff in community mental health services to demonstrate to psychiatrists the expanded role of non-medical staff.

The third programme is to upgrade and reorient the psychiatrists participating in the project. postgraduate programmes for psychiatrists will be introduced to shift their orientation to a more community based approach to care. The course will aim to update psychiatrists in aspects of contemporary psychiatry including social psychiatry, clinical disorders in children and adults, and modern strategies of psychiatric treatment and psychosocial management in the community. Additionally, the course will promote skills to enable psychiatrists to work as teachers and trainers of family doctors and other social and community workers.

The fourth programme of work is to reorient non-medical staff to their role in community based mental health care. This strategy will utilise non-medical staff in selected community based mental services and will also demonstrate to psychiatrists that psychosocial rehabilitation programmes can be effectively and efficiently implemented by social workers, nursers, psychologists and teachers.

Performance Indicators
These will include the following: number of consultees at the district health centers in Ulaanbatar city with mental health problems as recorded by the trained family doctors compared to those who were not trained; number and regularity of visits psychiatrists make to the health centres per month; number of admissions at the mental hospital in Ulannbatar city; number of discharges from the mental hospital; average length of stay in the mental hospital; type and number of rehabilitation programmes initiated; number of patients and their diagnosis (ICD 10) included in the rehabilitation programmes; number of family members involved in rehabilitation programmes; type of non-medical staff in charge of psychosocial rehabilitation programmes; activities undertaken by the family doctor and or school doctor as a team in health promotion programmes in school as well as health promotion programmes for nomadic communities.

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