mental health care in poor resource settings

Mental Health care in poor resource settingsWhat can be done?

An experience from AcehIndonesia

Marthoenis3rd course of NCDs

Kobenhavn Universitet

The contents

Situation of Aceh before 2004 Tsunami 2004 (Mental) health programmes Pasung Now

Indonesia

Aceh

Current Population: 4,5 Million out of 237 millions in Indonesia

29 years military conflict One the poorest province in Indoenesia One of the lowest HDI in Indonesia

Tsunami 2004

Banda Aceh, Calang and Meulaboh were among the hardest area hit by tsunami 2004

In total; 170.000 died and 500.000 homeless

Tsunami 2004

Population Before the Tsunami was 4,271,000 (2004) and as of 15 September 2005 was 4,031,589

Infrasctructures and local government were collaps Main general hospital was destroyed

After the Tsunami

MoU Heilsinski, December 15, 2006

Health care Reconstructions

Building new hospital and health posts Training and re-training the health officers

(nurse, midwife, GP) „Mental health programmes“

Pasung!

We have some 18.000 cases like this, how do we start?

Resources!:

Some 500 CMH nurses Strong commitment from the local goverment

BUT

Regulation? Mental Hospital : Only one with 350 beds 6 Psychiatrists for 4.4 million population

Row 1 Row 2 Row 3 Row 40

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Column 1

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The Programme:

Network between trained nurse Case finding Family of the patient Mental health cadre Referral system Local social health Insurance

Theoretically

The BarriersSaraceno et al 2007

Barrier 1: Low Political will

Barrier 2: Resistence to decentralization

Barrier 3: Difficulties in integrating Mental Health in PHC

Barrier 4: weak Human resurce capacity and development

Barrier 5: Mental health Leadership often lack of public health skills

What is missing here?

Aceh Health Insurance (2010)

Social health insurance to ensure all people have access to proper health care!

Premium paid by the local goverment

Problem Similar number of resource while the

demand of health service is inreasing

Moral hazard

However

Messages!

Mental health is sooooooooooooooo much neglected

But we can do something! Start from now Start from your self Start from a small thing

Terima Kasih