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ANNUAL REPORT

2014

National Institute of Mental Health

Ministry of Health

Sri Lanka

OUR VISION

The Centre of excellence

For psychiatric care & mental well being

OUR MISSION

Acute, Intermediate, rehabilitative care & specialized Services

underpinned by

Excellent care & Management

Meaningful patient and family involvement

Maximum Independence and activities

Patient’s rights

Clear Operational policies

OUR VALUES

We believe that patients with mental health problems have a right to a

normal life

We try to make a homely atmosphere

We put our patients first

We aim for united team

We value hard work and loyalty

CONNTENT

DIRECTOR’S MESSAGE 01

INTRODUCTION 03

IN- PATIENT SERVICES 05

FORENSIC PSYCHIATRY UNIT 08

PSYCHO-GAERIATRIC UNIT 11

ADOLESCENT PSYCHIATRY UNIT 13

PREGNANCY & PUERPERAL CARE UNIT 13

LEARNING DISABILITY UNIT 14

MEDICAL WARD 15

PHYSIOTHERAPY UNIT 15

PHARMACY 15

DENTAL UNIT 16

INFECTION CONTROL UNIT 17

DIAGNOSTIC SERVICERS 18

OUT PATIENT SERVICES 19

COMMUNITY PSYCHIATRY PROGRAMME 20

COLOMBO OUT – REACH AMBULANCE SERVICE 21

DAY TREATMENT CENTRE 22

DAY ECT UNIT 23

GENDER BASED VIOLENCE PREVENTION UNIT 24

OCCUPATIONAL THERAPY UNIT 26

PSYCHIATRIC SOCIAL WORK UNIT 28

REHABILITATION PROGRAMME 30

TRAINING AND RESEARCH UNIT 32

PRODUCTIVITY, QUALITY AND SAFETY OF PATIENT CARE SERVICES 33

HEALTH INFORMATION UNIT 35

CLINICAL GOVERNANCE UNIT 35

HALFWAY HOME - MULLERIYAWA 36

SCHOOL OF NURSING MULLERIYAWA 39

SPECIAL ACTIVITIES 40

SPECIAL PROJECTS 44

STAFF WELFARE 47

ANNEX 1 48

ANNEX 2 49

ANNEX 3 51

Annual Report 2014 National Institute of Mental Health (NIMH)

Page 1

DIRECTOR’S MESSAGE

The year 2014 is the 7th consecutive year that I write the Director’s message to the

annual report of the National Institute of Mental Health (NIMH). This year’s annual

report too presents the dedicated service rendered by our staff and the well –

wishers to patients, their families and to the community.

During the year 2014 the National Institute of Mental Health worked hard towards

promotion of mental wellbeing, preventing mental disorders, treatment and

rehabilitation of people and their families affected by mental disorders.

As the Director of the NIMH I had the privilege to guide the institution to provide its

services in collaboration with many other local, regional, national and international

agencies. Institution also extended mental health promotional and awareness raising

activities among school children, school teachers, police officers, prison officers,

officers working in the forces and many private institutions.

This report gives a snap shot view of the activities taken place during the year 2014. I

thank and appreciate all my dedicated staff who worked tirelessly for the betterment

of Mental Health services and to make the year 2014 a great success.

Dr. Jayan Mendis

Director


Page 2


Page 3

INTRODUCTION

The National Institute of Mental Health (NIMH) was established in 1927 and it is one of the

oldest hospitals in South Asia. At present it is the largest tertiary care hospital in Sri Lanka

caring for patients with mental illness. The former Mental Hospital was upgraded to a National

Institute in 2008. The Half Way Home, Mulleriyawa (HWH) and the School of Nursing,

Mulleriyawa are also under the administration of NIMH since 2008.

The NIMH has a total of around 1500 beds and annually over 8000 patients are admitted

seeking treatment for all types of mental illness. NIMH provides acute care, intermediate care

and long term care as well as specialized services. There are about 1000 inward patients

treated at NIMH on any given day. The NIMH is the main training centre in Sri Lanka for

undergraduate and post graduate trainees in psychiatry from medical and allied fields, for basic

and in-service training for health staff as well. All postgraduate trainees in MD psychiatry

undergo a compulsory training for a minimum period of 6 months at the NIMH. The NIMH has

around 1,500 full-time staff. The administration of NIMH comprise of a Director and a Deputy

Director. As at 31stDecember 2014, NIMH had nearly 71 Doctors including 8 Consultant

Psychiatrists, a Consultant Physician, a Consultant Microbiologist, a Consultant Haematologist

and 2 Dental Surgeons. There were also 5 Special Grade Nursing Officers, 445 other grade

Nursing Officers, 14 Psychiatric Social Workers, and 7 Occupational Therapists (Annex 1).


Page 4

Preliminary care

24 hr emergency admissions via Psychiatric Intensive Care Unit (PICU)

24 hr outpatient department (OPD)

In-patient care

Treatment facilities for acutely ill patients

Rehabilitation facilities - occupational therapy, horticulture therapy, ward-based

activities

Services for psychiatric social work related issues of patients

Physiotherapy, Laboratory, EEG, ECG and Radiography services

Isolation facility for communicable diseases

Oral health care

Specialized care

Forensic Psychiatry care

Elderly mental health care

Care for adolescents with mental illness

Care for pregnant and post-partum women with mental illness

Care for learning disabilities

Specialized Medical Ward, Dermatology Clinic, Wound Clinic

Out-patient services

Day ECT facility

Day Treatment facility for minor mental illnesses

Day Rehabilitation facility

Alcohol Relapse Prevention Therapy

Gender Based Violence prevention and care

Colombo Outreach Ambulance Service

Community psychiatric care

Continued care at NHSL and outreach clinics

Other Services

Postgraduate and undergraduate trainings in psychiatry

In-service training for the staff

Promotion of ethical research in mental health

Promotion of community mental-wellbeing

Elimination of stigma


Page 5

IN-PATIENT SERVICES

OUT-PATIENT DEPARTMENT (OPD) & PSYCHIATRIC INTENSIVE CARE

UNIT (PICU)

The NIMH has a unique system of allocating patients to the Consultant Psychiatrists according

to their area of residence. On admission a joint psychiatric assessment is done by the Medical

Officer and the relevant Nursing Officer at the OPD. Patients can be brought directly by their

families or by police, airport office, and prisons or transferred from other health care

institutions. Sometimes patients may voluntarily seek treatments.

The patients who are not aggressive or violent are directly admitted to the acute care wards or

specialized units. If inward treatment is not needed, patients are referred to the psychiatric

clinics closer to their place of residence. Aggressive or violent patients are admitted to the PICU

for the initial management and thereafter transferred to the relevant acute care wards.

There were 11,723 OPD contacts during the year 2014, of which 9,792 (83%) were admitted.

Among the admissions 2,591 (26%) needed PICU care. Of the admissions 1,341 (13.6%) were

transferred to the NIMH from the other hospitals.

Table 1 distribution of the OPD contact at NIMH, 2014

65

12

89

8

47

87

20

72

49

2

52

11

46

2 3

83

1

51

9

61

2

11

72

3

13

60

86

18

25

91

11

04

To

tal

Co

nta

cts

Cli

nic

Re

ferr

al

Ad

mis

sio

ns

PIC

UA

dm

issi

on

s

Tra

nsf

er

In

Male Female Total


Page 6

IN-WARD CARE (ACUTE, INTERMEDIATE & LONG TERM CARE)

There are 8 acute care wards (4 males and 4 females) and 8 intermediate care wards (4 males

and 4 females), providing inward care under the 8 Consultant Psychiatrists. The stay in the

acute wards is usually limited to around 30 days. If the treating team decides that the patients

can be managed in the society, he/she will be discharged straight from the acute care ward. If

that patient needs further treatment, they will be transferred to an intermediate care wards.

However if the patient becomes violent and restless again while in an intermediate care ward,

he/she will be transferred back to the acute care ward for further management.

In addition, there are two male wards providing long-term care at NIMH and female long term-

care is provided at the HWH-Mulleriyawa. There are two fee levying long term unit’s (Villas),

(one male and one female) at NIMH where only limited number of patients can be admitted.

Each ward has a multi-disciplinary team (MDT) consisting of a Consultant Psychiatrist, Senior

Registrar, Registrars, Medical Officers, Nursing Officers, Psychiatric Social Workers,

Occupational Therapist and Supportive Staff. Same MDT team treats the patient whether the

patient is in acute care or intermediate care wards.

Table 2 Age distribution of the patients admitted to NIMH, 2014

76

21

29

70

10

94

15

7

65

44

23

14

01

99

2

17

9

40

12

0

44

43

71

20

86

33

6

10

5

<1

1y

12

-16

Y

17

-49

Y

50

-69

Y

70

YA

BO

VE

un

kn

ow

nMale Female Total


Page 7

Table 3 Diagnosis of the patients discharged from NIMH, 2014

Figure 1 Distribution of the admission to NIMH by area of residence, 2014

23

8

46

9

26

21

15

35

28

5

33

16

9

4

8

6 1

93

30

14

39

11

67

22

9

36

71

1

2

1

43

1

49

9

40

60

27

02

50

14

69

24

0

5

10

7

Org

an

ic M

en

tal

Dis

ord

ers

su

bst

an

ce a

bu

se

de

lusi

on

al

dis

ord

ers

Mo

od

dis

ord

ers

So

ma

tofo

rm d

iso

rde

rs

dis

ord

ers

of

ad

ult

pe

rso

na

lity

me

nta

l re

tard

ati

on

ad

ole

nce

nce

be

ha

vio

ura

l d

iso

rde

rs

dis

ord

ers

of

psy

cho

log

ica

ld

ev

elo

pm

en

t

Be

ha

vio

ura

l &

em

oti

on

al

dis

ord

ers

ccu

rrin

g i

n c

hil

dh

oo

d…

un

spe

cifi

ed

Male Female Total


Page 8

FORENSIC PSYCHIATRY UNIT

Forensic Psychiatry Unit (FPU) is the largest specialized unit of NIMH and it is the only such

facility in Sri Lanka. It consists of two wards (male and female), a rehabilitation unit, a

horticulture area and two clinics held at the Prison Hospital, Welikada and the National

Hospital of Sri Lanka (NHSL). The wards 21 and 25 house male and female patients with bed

strengths of 103 and 24 respectively.

An outreach clinic is held every Wednesday at room 22, NHSL, for out-patients with issues

related to forensic psychiatry. The clinic receives referrals from Judicial Medical Officers

(JMOs), from District Courts, Magistrate Courts, Police, Non-Government Organizations (NGOs)

and the general medical and surgical wards of the NHSL. A psychiatric liaison service is

provided to the Prison Hospital Wellikada Colombo and two out-patient clinics are held every

Monday by the multidisciplinary team. The team conducts assessments, provide treatment and

court reports for prison inmates. Every Wednesday a Registrar in Psychiatry visits the

psychiatry ward of the Prison Hospital.

Court appearances were made by the Consultant Psychiatrist when summoned by the

respective courts to give expert evidence. The Senior Registrar and Registrars were also given

the opportunity to witness the court proceedings as a part of their training.

Under the Community Forensic Psychiatry Initiative regular visits were made to prevent re-

offending and clinical relapses and identified several high risk patients discharged from the

courts in close by areas. During 2014, unit has issued 805 court reports regarding inward

patients, 289 reports through the Prison Hospital and 165 reports through the out patients

clinic at the NHSL. Scene of crime visits and home visits were also conducted. These were done

in order to gather information on alleged crimes, their circumstances, about the offenders and

the victims. During these visits, the team visited relevant places such as the local hospitals and

police stations and interviewed scene of crime officers (SOCO) and villagers in order to gather

further information.


Page 9

FORENSIC PSYCHIATRY RESOURCE CENTER

Forensic Psychiatry Resource Center was established in 2013 in order to coordinate the

forensic psychiatry service by keeping forensic records, coordinating outreach clinics,

arranging trainings and providing necessary information for the trainees and other health

professionals when necessary. A new email information service was commenced in November

2014 by the Forensic Psychiatry Resource Center of FPU. The aim of introducing the email

address [email protected] was to provide the support and guidance to the

professionals involved in judicial matters regarding forensic psychiatry related issues when

necessary. Any health professionals can contact the Forensic Psychiatry Resources Center

through this email address.

VISITORS’ BOARD

Visitors’ Board is held for mentally ill patients with major criminal charges who were not fit

enough to plea for a long time. The board comprise of representatives of Secretary - Ministry of

Justice, Secretary – Ministry of Health, Commissioner of Prison and a Consultant Psychiatrist.

Visitors’ board meetings were held on 3 occasions in 2014 for which around 23 mentally ill

offenders were produced and 16 were released, counting to 101 since 2010.

FORENSIC PSYCHIATRY REHABILITATION UNIT

Forensic Psychiatry Rehabilitation Unit (FPRU), opened in 2010 is the only such facility in Sri

Lanka. A structured rehabilitation programme is conducted by the unit. FPRU provides its

service for around 50 patients a day. Individual assessments are conducted by the Occupational

Therapist attached to the unit. The FPRU has submitted 130 functional assessment reports

within the year 2014.

OPEN SCHOOL

Open school is one of the major programmes held in the FPRU. It is an educational programme

conducted by National Institute of Education (NIE) in collaboration with NIMH since February

2012. It helps individuals to get formal education through activities and lessons under the

guidance of well-trained school teachers. Open school sessions are held on every Thursday.

Around 40 sessions were held in 2014 and around 40 to 50 people attended each session.

mailto:[email protected]


Page 10

ACTIVITY PROGRAMME

A structured activity programme is conducted by the FPRU and includes creative therapies

such as arts, music, drama and narrative therapy, training on work skills such as making soft

toys and greeting cards, training on Activities of Daily Living (ADL) such as cookery and self-

care activities and indoor/outdoor sports such as volleyball, cricket, carom and darts. A

horticulture therapy programme is also conducted along with the rehabilitation programme.

These activities are conducted by the staff of the FPRU with the help of volunteers.

VOLUNTEERS

FPRU has been supported by many volunteers from the beginning. Ms. Araliya Abeysekara, an

undergraduate, volunteering in the FPRU since 2012, was the selected at the BEST YOUTH

VOLUNTEER OF SRI LANKA in 2014 by the United Nations Development Programme (UNDP).

Mrs. Dilani Ranasinghe, a mental health consumer, volunteering as a trainer of making soft toys

for FPRU since 2012 was appreciated by the WHO country representative to Sri Lanka in 2014.

SPECIAL EVENTS

FPRU celebrates the national events with the inmates of the unit every year as part of their

rehabilitation. The aim of celebrating these events is to connect the inmates to their cultures

instead of being isolated in an institution. Sinahala and Tamil New Year, Vesak, Christmas,

Thaipongal and other cultural events were celebrated in 2014.


Page 11

PSYCHO-GAERIATRIC UNIT

The Psycho-Geriatric Unit (PGU) was established in 1999 for the specialized care for elderly

patients suffering from dementia. There are 2 separate wards with bed capacity of 20 each for

male and female patients under the care of two Consultant Psychiatrists. In 2014, 119(49%)

male and 121(51%) female patients were admitted.

This unit provides pharmacological as well as non-pharmacological treatments for geriatric

patients through a multi-disciplinary team. Following activities were carried out, aiming

reduced disturbances at home, rehabilitation and reintegration of patients quickly in to the

society.

Rehabilitation activities and cognitive function stimulating activities such as singing,

listening to music, drawing, making crafts to improve the diminishing social skills.

Reminiscence Therapy –help to remember past events and actions over and over to

strengthen the memory.

Activities of Daily Living (ADL) Training - bathing, continence, dressing, feeding, toileting.

The NEUROPSYCHIATRIC OUT-PATIENTS CLINIC is conducted at room 43 NHSL, every

Monday from 2-4.pm for patients with dementia.

DEMENTIA HELP LINE (011-3140844) operates through the unit 24/7


Page 12

SPECIAL ACTIVITIES

Two meeting of patients and their care givers were held during 2014 – to educate them on

dementia and offered guidance to overcome the problems they face when looking after such

patients. A two day training programme for caregivers was held with the participation of

Medical Officers and Nursing Officers from NIMH and other hospitals, Occupational Therapists

and Care Givers of Elders’ Homes. A meeting was held with the Director Provincial Social

Service, Western Province to launch a programme to identify inmates with dementia staying at

elder’s homes in the province

Table 4 Admissions to Psycho-Geriatric Unit, 2010-2014

11

1

11

4

12

7 1

52

11

9

98

91

94

12

9

12

1

2010 2011 2012 2013 2014

Male Female


Page 13

ADOLESCENT PSYCHIATRY UNIT

Adolescent Psychiatry Unit was opened on 15th December 2014 as the first ever unit

specifically designed for the adolescent patients in Sri Lanka. Patients, both males and females,

below 18 years are admitted to the unit under the care of the eight Consultant Psychiatrists and

the respective teams take the responsibility of the clinical care of the patient. The unit has 6

rooms with inward facilities for 9 patients including library facilities and facilities for engaging

in sports, learning and playing. Both acute management of the disturbed patients and their

rehabilitative aspects are looked after by the respective clinical team.

PREGNANCY & PUERPERAL CARE UNIT

Established in 2007, the Pregnancy & Puerperal Care Unit is the first ever in South East Asia.

The unit provides specialized care for women who develop psychiatric illnesses during

pregnancy or following childbirth where their babies/family members are also allowed to stay

with the patient. The unit has 8 rooms, each room comprising of 3 beds for the patient, the

baby and the care giver.

In 2014, there were 118 admissions (pregnant and post-partum mothers) and 95 babies, these

admissions included 17 transfers from all over the island

Table 5 Admissions to Pregnancy & Puerperal Care Unit, 2007-2014

3 8

10

12

12

18

12

20

30

68

58

10

3

11

0

14

0

10

1

98

2007 2008 2009 2010 2011 2012 2013 2014

Antinatal Mothers Postnatal Mothers


Page 14

LEARNING DISABILITY UNIT

Opened in 2008, the Learning Disability Unit (LDU) aims to rehabilitate clients with learning

disability and associated behavioural problems and to train and educate their parents,

guardians on rehabilitation skills to provide care for patients with special needs. In the unit

there are 6 rooms to accommodate patients individually. The unit encourages a care giver to

stay with the patient. Patients are admitted to the LDU as a direct admission or transferred

from other acute wards. Psychiatric Social Workers help to solve patient’s family problems.

Some patients are referred to the Occupational Therapy Unit for special programme and

volunteers also help patients to do various leisure activities.

In 2014 there were 59 admissions to the LDU. Patients were trained on activities of daily living

according to a time table. e.g. mouth care, bathing, table manners, dressing, toilet training and

improving interpersonal relationships. Entertainment programmes were also conducted. e.g.

listening to radio, playing as a group, singing and playing musical instruments. Cognitive

development programmes conducted included drawing, playing carom, work book activities

and creative activities such as playing with building blocks. Programmes were also conducted

to improve life skills of parents and by standers. e.g. lectures about learning disability

discussions on how children with learning disability should looked after at home. Patients are

under the care of all 8 Consultant Psychiatrists and the medical team.

Table 6 Admissions to Learning Disability Unit, 2008-2014

10

26

36

60

46

45

46

14

26

15

18

12

16

13

2008 2009 2010 2011 2012 2013 2014

Male Female


Page 15

MEDICAL WARD

Medical ward was stablished in 2005 under the supervision of a Consultant Physician and 2

Medical Officers. In 2014 there were 3 Medical Officers giving a 24/7 on call coverage. The aim

of the Medical Unit is to provide specialized medical care to the inward psychiatric patients

with co-morbidities. There are separate male and female wards with a total of 20 beds. In

addition a medical clinic is held 6 days per week at the unit to attend to referrals from

Psychiatric Units. During year 2014 there were 856 admissions to the medical ward, out of

them 75 were transferred to other tertiary care hospitals for further management.

PHYSIOTHERAPY UNIT

There are 2 Physiotherapists attached to the unit, who attend to referrals in the unit or in the

respective wards. During the year, around 2200 patients/referrals were seen at the NIMH and

the HWH Mulleriyawa.

PHARMACY

There are 6 pharmacists managing 6 sections: Drug stores, surgical consumable stores, surgical

non-consumable stores, outpatient department, indoor pharmacy, HWH Mulleriyawa including

patients of the community housing project. Out Patient Department functions from 8am to

4pm. In addition, drugs are issued to the community clinics at Modara, Pannipitiya, Kotahena.

Skin ointments and other preparations are made by the Pharmacists for the Wound Care Clinic

and the Dermatology Clinic. Medical Supplies Management Information System (MSMIS)

project was started in 2014 and all pharmaceuticals are issued from MSD through this.


Page 16

DENTAL UNIT

Dental Unit at NIMH provides its services to all in ward patients of NIMH, HWH-Mulleriyawa

and also to the surrounding community. The main vision of the Dental is Unit to provide state of

the art services towards the challenged patients in the future in a well-equipped friendly

environment that matches the services provided by the developed countries. The treatment

facilitates include routine screening, basic treatments such as fillings, extractions, scaling and

minor oral surgeries. Emergencies such as oral facial trauma, dental alveolar infections

requiring farther treatment are referred to the Dental Institute, Colombo.

In 2014, services were expanded to cover all units of the NIMH (n=2769) which includes the

PPU, LDU, Adolescent Unit, the HWH- Mulleriyawa, the patients who have been under long

term care in ward 22, 27, male villas, female villas etc.

SPECIAL ACTIVITIES

A mega mobile clinic was carried out at the HWH-Mulleriyawa in May 2014 (details are

given under the HWH-Mulleriyawa).

Dental Surgeons of the NIMH supported the age estimation carried out by the Institute of

Legal Medicine and Toxicology, Colombo for the purpose of providing National Identity

Cards for the long term care wards at NIMH (details are given under special projects).

Organized a seminar for the staff of NIMH on oral cancers during the health week 2014 with

the participation of a Dental Surgeon and a Medical Officer from the National Cancer

Control Programme.


Page 17

INFECTION CONTROL UNIT

The Consultant Microbiologist supervises the work of the infection control Nurses (ICNO). The

ICNO carried out daily ward rounds and supervision in relation to out -breaks, general hygiene,

hand washing practice and waste management. The ICNO coordinates with the Psychiatric

team and the Consultant Microbiologist. Liaisons Nurse meetings were held once a month

giving an opportunity to discuss issues related to infection control. Health education

programmes were carried out for new staff recruits regarding infection control and waste

management.

ISOLATION UNIT

The Isolation Unit consists of 04 separate rooms, constructed according to the National

Infection Guidelines. The activities of the unit are supervised by the Consultant Microbiologist

in coordination with the ICNO and the Psychiatric teams. During the year 2014, 219 patients

were admitted to this unit. A special safety uniform has been provided for all staff members to

prevent the spread of infections among them.

WOUND CARE CLINIC The wound care clinic, started in June 2012, is conducted every Friday morning by the

Consultant Microbiologist. During the year 2014, 85 referrals were received from the wards of

NIMH and the HWH-Mulleriyawa.

Table 7 Admissions to the Isolation Unit, 2014

30

41

8

18

19

15

1

1 2 3

2

1 3

1

MR

SA

Co

nju

nct

ivit

is

TB

Fe

ve

r

Dia

rrh

oe

a

Sca

bie

s

Ch

ick

en

Po

x

He

p B

HIV

Mu

mp

s

Me

asl

es

En

do

the

liti

s

He

rpe

s Z

ost

er

Ra

dio

Act

ive

Io

din

eT

he

rap

y


Page 18

HEPATITIS B PROGRAM

This programme was started in 2011 under the guidance of the Consultant Microbiologist. First

the patients in the long term care wards and the hospital staff were vaccinated for Hep-B and

tested for Hep-B antibodies under this programme. Under the second phase of the programme,

patients in the acute and intermediate care wards were vaccinated against Hep-B. In the year

2014, 564 patients were given the first dose; second dose was given to 64 patients. Similarly,

74 newly recruited staff members were vaccinated and 311 staff members were tested for the

Hep-B surface antibody.

DIAGNOSTIC SERVICES

LABORATORY

The Laboratory is supervised by a full time Consultant Haematologist and a visiting Consultant

Microbiologist. There are six MLTs at present. The Laboratory performed a total of 1,076,993

test during the year 2014 which included 25,266 haematological tests, 78,840 bio-chemical

tests, and 3,587 microbiological tests, and 2888 samples were sent to the NHSL and MRI for

other special investigations. Also Internal and External Quality control programmes were

carried out for haematological, biochemical and microbiology Investigations.

EEG, ECG, X-RAY UNITS

EEGs are used to distinguish psychiatric disorders from epileptic disorders. Normal routine

EEG, routine EEG with activation procedure (hyperventilation & photic), Sleep records (Natural

& drug induced) and Sleep deprived EEG are taken at the Unit. A total of 433 EEGs were taken

in 2014.The ECG Unit has two cardiographers and during the year 2014, 8818 ECGs were

done.X-ray Department was started in 1971. There are 02 Radiographers working at present

and around 2000 Patients were referred in 2014. X-ray room was renovated based on the

recommendation by the Atomic Energy Authority to prevent unnecessary radiations to staff

and patients and as a result it was possible to obtain the license after many years. A brand new

“SHIMADZV” RAD speed x-ray machine worth 8 million was installed in 2014. This ceiling

mounted type machine is more suitable to our patients who may not corporate fully to the

procedure.


Page 19

OUT PATIENT SERVICES

OUT-PATIENT CLINICS

Out-patient clinics are held six days a week in room No 22, NHSL to follow up on patients who

are discharged into the care of families or institutions and to assess new patients. Consultant

Psychiatrists and the respective Medical Staff review the patients at these clinics. The

Psychiatric Social Workers too attended the clinics.

NEUROPSYCHIATRIC CLINIC is held every Monday from 2-4pm in Room No.43 NHSL.

ALCOHOL AND DRUG ABUSE PREVENTION CLINIC is held every Friday at 2 pm at

Room No 22, NHSL.

PRISON CLINIC is held every Monday 2pm at the Welikada Prison.

OUT-REACH CLINICS

There are several outreach clinics conducted by the NIMH (Delgahawattha, Rajamalwattha,

Lunawa and Pannipitiya).The aim of these clinics are to follow-up the discharged patients in

the community. A Consultant Psychiatrist visits and conducts these clinics once a month with

the help of a Medical Officer, Community Psychiatric Nurse, a Pharmacist and a Supportive Staff

member. Around 50 patients are seen per day at these clinics.

Table 7 Patients seen at NHSL, 2014

63

2

16

0

20

3

13

5

49

14

9

23

9

53

1

13

64

2

ge

n.p

sych

iatr

y fore

nsi

c

sub

sta

nce

ab

use

ge

ria

tric

New Patients Followup Patients

http://www.nimh.lk/index.php?option=com_content&view=article&id=14:opdnationalinstituteofmentalhealthangodasri-lanka&catid=6:services-for-special-populations-at-the-national-institute-of-mental-health-angoda-sri-lanka&Itemid=4


Page 20

COMMUNITY PSYCHIATRY PROGRAMME

Established in 2010, Community Psychiatry Unit (CPU) is staffed with 4 Community Psychiatry

Nurses (CPN) at present. The unit maintains a database with all the information on admissions

such as patient’s name, age, address, contact number, date of admission, BHT number, ward

number and the respective Consultant. The place of follow-up is entered once the patients is

discharged from the NIMH.

This programme enables tracing defaulters, ensuring follow up and detecting new patients.

The staffs liaise with the Regional Directors of Health Services, Medical Officers of Health

(MOH), Medical Officers of Mental Health (MO-MH). The treatment defaulters either while on

leave from in–ward care or those who have defaulted clinic visits as well as difficult patients i.e.

those who do not take medication are provided with IM Depot medication, which intern help to

prevent repeated admissions to NIMH.

In addition, new patients referred by the CPN, MOMH, Public Health Midwife or Gramma

Niladari are also visited by them. Depending on the case they are either admitted or provided

community based treatment as advised by the Consultant Psychiatrist. Sometimes the team

visits patients in the community to resolve the legal or social issues of patients.


Page 21

COLOMBO OUT-REACH AMBULANCE SERVICE

To extend the services given to the patients in the community, the Colombo Outreach

Ambulance Service was started in the year 2013. This ensures prompt assessment and

treatment of patients who are aggressive at home and difficult to be brought to the hospital

using conventional transport. When the request to bring a patient comes from a close relative

of the patient, he/she should produce adequate proof about the relationship to the patient and

valid information about the patient’s health condition e.g. Diagnosis cards, clinic books. Initial

assessment of the patient’s condition and the requirement of in-ward care is decided by the

respective Consultant Psychiatrist based on the information provided by the Medical Officer,

Community Psychiatric Nurse and the Psychiatric Social Worker. The patient is visited by a

team comprise of a Medical Officer, a Nursing Officer/Community Psychiatric Nurse,

Psychiatric Social Worker and a Supportive Staff in an ambulance. If there is a need, help of the

Police, Grama Niladari and Community members are sought. After assessment, if the Medical

Officer decides that the patient needs admission to NIMH, he/she is brought to NIMH in the

same ambulance. The ambulance is sent if the patient’s area of residence is within a 50 km

radius of the NIMH. A fixed administrative fees of Rs 1000 and a refundable deposit of rupees

1000 will be charged from the relative. Ministry of Health has given its approval for this project

and the cost of visiting the patient is reimbursed from the relatives on mileage basis (Rs 50 per

km). In year 2014, 25 patients were brought to the hospital.


Page 22

DAY TREATMENT CENTRE

Day Treatment Centre (DTC) was started in 2012, as an outpatient’s facility. The aim of the unit

is to provide psychological treatment for wide variety of minor psychiatric or neurotic

disorders. School mental health programmers, community awareness programmers and

alcohol relapse prevention programmers are among other services provided by the unit.

ALCOHOL RELAPSE PREVENTION PROGRAMME

This programme at the DTC was started in 2013 and clinics are held every Tuesday and

Thursday. In January 2014, the Alcohol Anonymous Group was started as an extended step of

the programme. This Group gathers once in two weeks. After detoxification, inward patients

are referred to this relapse prevention programme. In addition, those suffering from Alcohol

Dependency Syndrome from the community too seek care at the DTU. After providing

Psychotherapy, they are followed up at the anonymous group. In addition to this the DTC

conducts awareness programmes on alcohol and substance use especially in schools. Several

programmes were conducted in 2014 during which correct knowledge about addictive

substances and alcohol, risk of using, how to get rid of and where to go for treatment were

discussed openly. The unit developed practical tools to help schools to promote positive mental

health among their students and identify and address those with minor problems at an early

stage and build their resilience. It also provide knowledge on how to identify and direct them to

relevant therapeutic centers without delay. Further, 18 community awareness progrmmes were

conducted in year 2014 at MOH offices and other Government Institutes to raise the mental

health literacy among the public servants on current issues such as substance abuse.

Table 8 Clients registered at Day Treatment Centre, 2012-2014

38

27

7

28

2

38

78

5 9

86

2012 2013 2014

New Registered Clients Sessions done


Page 23

DAY ELECTRO CONVULSIVE THERAPY (ECT) UNIT

The ECT unit has made a large contribution to upgrade the overall patient care at NIMH. The

ECT unit consists of a theatre and a 20 bedded ward. In year 2014, 9633 ECTs were given to

total of 1860 patients and the majority were (57%) males.

The day ECT unit was established In October 2014 to minimize unnecessary admissions and

keep patients with their family to enrich their mental health. This service is given free of

charge, from Monday to Saturday including Public Holidays.

Patients can be referred from OPD/Clinics/Day Treatment Centre, etc by a Consultant

Psychiatrist attached to the NIMH who is responsible for the overall management of the

patient. Psychiatrist form any other institutes can refer a patient for day ECT only through a

Consultant Psychiatrist attached to the NIMH.

Referring Consultant Psychiatrist should complete the pre-ECT assessment form and

ensures that the patient is fasting and the necessary investigations are available.

Patients should arrive on or before 7.30 a.m. accompanied by a relative who will be in close

contact with the patient for the next 24 hours and personal transport should be available

for the patient to return home after ECT.

Any patient developing complications during or after ECT will be admitted to the NIMH

under the care of the referring Consultant Psychiatrists.

If a patient does not comply with the next appointment for more than a week, the course is

considered to be over unless the patient or a relative corresponds with the unit.


Page 24

GENDER BASED VIOLENCE PREVENTION UNIT

Gender based violence (GBV) prevention unit is an evolving addition to NIMH, since 2012. This

was an initiative given the evidence that gender based violence is increasingly identified in the

community as well as among mental health clients in Sri Lanka. Since the inception there has

been increasing requests for intervention by both genders and by couples. Unit’s philosophy

highly respects non-violence, gender equality, and sensitivity to family and cultural norms

among the ethnically diverse client population.

Unit works in collaboration with local mental health services and relevant NGOs. Services

include: reducing violence among partners through education, treatment of mentally unwell

and promoting mental wellbeing. Psychotherapeutic and counselling services are aimed at

curbing violence, flouring harmony among couples and partners and addressing sexual

difficulties.

Unit also collaborate with legal sectors in relevant cases. Unit is supported by Consultant

Psychiatrists, trained Medical Officers and Nursing Officers including Registrars and Senior

Registrars in psychiatry who have training as well as special interest in the context. During the

year 2014, 168 (59%) female and 117 (41%) male clients attended the unit.

Table 9 Type of incidents reported to GBVP Unit, 2014

Se

xu

al

Ha

rass

me

nt

Ph

ysi

cal

Ass

au

lt

Lim

itin

g R

eso

urc

es

Psy

cho

log

ica

l A

bu

se

Ab

use

un

de

rin

flu

en

ce -

Alc

oh

ol


Page 25

SPECIAL ACTIVITIES

A GBV prevention workshop was held at Talangama District Hospital in May 2014. Objective

of the workshop was to increase awareness on GBV and educating strategies to prevent it

among, all categories of staff, including Hospital Staff, Staff of Foreign Employment Bureau,

and Police Officers of Talangama Division. Further workshops were held at Nawagamuwa

District Hospital, Monaragala RDHS Office, District Hospital Athurugiriya and District

Hospital Piliyandala.

A hall mark achievement was gained in November 2014 when the unit successfully

launched a 3 day workshop on advanced training on Intimate Partner Violence. More than

30 Medical Officers and 30 Nursing Officers were trained by expert hands through joint

collaboration and sponsorship of WHO Country office in Sri Lanka and NIMH Angoda.

Certified and skilled Medical Officers and Nursing Staff through the course made a network

of joint collaborators in an array of MOMH areas.

On the International Women’s Day 2014, a special talk was held by Prof Chandra

Gunawardena, Emeritus Professor of the Faculty of Education of the Open University of Sri

Lanka to increase awareness of mental health consequences of GBV.

A novel initiative of the unit includes executing a programme to curb the ‘sexual harassment in

workplaces’ based on the Domestic Violence Prevention act No 34. Moreover respecting the

women’s rights, promoting realistic social expectation from women, education on life skills

(Jeevana Kusalatha) and awareness of effective communication among partners are high-up on

the agenda for the unit.

Table 9 Referrals done by GBVP Unit

OCCUPATIONAL THERAPY UNIT

60

2

0 5 1

9

17

9

2 13

10

46

14

19

5

0

35

55

Psy

colo

gy

Se

rvic

e

Po

lice

Wo

me

n I

nN

ee

d

Le

ga

lS

up

po

rt

So

cia

lS

erv

ice

oth

ers

2012 2013 2014


Page 26

OCCUPATIONAL THERAPY UNIT

The occupational therapy (OT) service in the NIMH primarily operates for promoting recovery,

health and wellbeing of people with mental health problems through occupation and enables

people to participate in the activities of everyday life. Occupational Therapists achieve this

outcome by working with people and communities to enhance their ability to engage in the

occupations they want to, need to, or are expected to do, or by modifying the occupation or the

environment to better support their occupational engagement. The unit conducted

assessments, group therapy sessions, cultural and religious events, leisure activities, vocational

training, awareness raising programmes and activities to work against stigma. During the year

2014, 780 in-patients and 21 out-patients have received the OT service.

The most successful task of the OT Unit during the year was launching of the “MINDFUL

CREATIONS – LOVING HEARTS CAN CHANGE MINDS”, project in October 2014, along with

World Mental Health Day Celebrations, which aimed to promote the art and crafts of the clients

and creating awareness for the need for sustainable avenues of income generation. It also helps

to enhance their self-confidence through giving sense of value, opportunities and hope. A

special exhibition and a sale was organized at the OT unit with the products made by persons

recovering from mental illnesses and the event also focused on getting media attention to

deliver positive messages to the public against stigma and discrimination.


Page 27

A special vocational training on leather work and shoe making was initiated in collaboration

with the Industrial Development Board (IDB). As a result 15 trainees including mental health

consumers and health supportive staff were given a 03 month basic training followed by on-

the-job training in private sector.

“Feelings 2014” the art exhibition was organized for the 4th successful year with creations

made by clients of NIMH and Half-Way Home Mulleriyawa.

The weekly cookery training programme was introduced with the support of a volunteer

cookery instructor. The computer training unit was refurbished with new equipment to

provide various computer based facilities for the staff and public at a concessional rate.

Number of picnics and a day trip were organized to Colombo city, Kandy, Peradeniya and

Pinnawala to facilitate long hospital stay clients to enhance their leisure and social skills

and to promote community participation. The event was sponsored by Pastor Lakdas Perera

and Peoples’ church, Narahenpita. Thaipongal, Sinhala and Hindu New Year, Vesak and

Christmas festivals were celebrated with clients which gave an excellent opportunities for

them to exhibit their talents and skills. A special musical show and a dinner party was

organized for 400 patients with the financial support of Mr. Udeepa Peiris.

Clinical training and orientation programmes were organized for Medical Students, BSc

Occupational Therapy Students and Nursing Students. The OT department also supported

workshops organized by the Consumer Action Network in Mental Health (CANMH) and the

Forensic Rehabilitation Centre of the Forensic Psychiatry Unit, NIMH.


Page 28

PSYCHIATRIC SOCIAL WORK UNIT

The psychiatric social work unit (PSW) consists of 4 PSW’s and 10 Development Assistants –

(Mental Health) at present. After 32 years of service 4 senior PSW’s retired and they will be

remembered by the PSW unit due to their great and unique contribution for the Mental Health

Service in Sri Lanka.

During the year, 2162 family visits were done for 685 male patients and 710 of female patients.

Court appearances were done for 25 clients, 3 patients were handed over to the Probation and

Child Care Services Colombo, 2 Clients were granted their pension and W&OP, 6 clients were

given letters for financial aid (Samurdhi /living allowances). With the recommendation of the

PSW, 1 female and 1 male received houses from the Housing Authority, 3 clients were granted

legal aid by the Legal Aid Commission. A women of 75 years who was a resident at HWH for

nearly 40 years was returned to her relatives in 2014. This gives evidence for the sincere

collaboration developed with other government and non-governmental authorities to support

persons with mental illness.

During the year, 23 clients presented with a variety of social problems such as private medical

reports, property problems, placements, court cases, counselling and welfare benefits. Among

them were 7 significant. One was a school girl of 16 years referred by a village priest, had been

sexually abused by a family member. After assessing the information given by mother and

neighbours, the girl was referred to the DTC for management who was later found to be

completely cured.

During 2014, 25 bank accounts were opened at the National Savings Bank, Kirulapana and Rs.

5,800,000 were deposited. The PSW unit led the project of getting NIC and voting rights to long

stay patients at HWH-Mulleriyawa & NIMH (details are given under special projects).

The PSYCHIATRIC SOCIAL WORK TRAINING PROGRAMME was conducted in May 2014

specifically designed for 22 Development Officers, with the help of Mental Health Training

Division of NIMH. These Development Officers were from General, District, Base or Rural

Hospitals and M.O.H Offices. The main purpose of this training programme was to train them on

the role of the PSW in the multi-disciplinary team to support people with mental disorders.

During the first three months they were taught basics in psychiatry and psychiatric social work

coupled by 3 months of practical training. A five day training programmes was also coordinated


Page 29

for counselling students from the National Institute of Social Development and University of

Colombo.

The PSW Unit contributed to celebrate World Mental Health Day 2014 by organizing a street

drama. Chief Guest was Dr. F.R. Mehta W.H.O Country Representative. The message was to raise

awareness to deal with expressed emotions, identify relapses and to challenge against stigma.


Page 30

REHABILITATION PROGRAMME

WARD BASED REHABILITATION - INTERMEDIATE CARE WARDS

Patients in intermediate care wards are taught and trained to develop their self-care: brushing

teeth, having showers, bathing, washing their clothes etc. The four female intermediate-care

wards have ward based kitchens where the patients are trained to develop skill of cooking. In

the male intermediate-care wards, patients spend their time on vocational rehabilitation e.g.

making joysticks, painting, cultivating plants, making candles, etc. The rehabilitation

committee, chaired by the Director, NIMH comprises of almost all the major staff categories.

Sinhala and Tamil New Year Festival is organized annually by the rehabilitation committee

since 2012 at the T. B. Illangarathne grounds. In year 2014 the New Year Festival was organized

with the participation of around 400 in-ward patients and staff.

WARD BASED REHABILITATION - LONG TERM CARE WARDS

In ward 27 there are 39 patients who are under the care of the eight Consultant Psychiatrists in

NIMH. Of them 25 Patients engage in rehabilitation activities. Other patients are either having

severe mental retardation or are bed ridden. As part of their main rehabilitation programme

patients usually work from 8.00am to 12 noon at the cultivation of vegetable farms which span

2 acres, with the support of the Nursing Officers and Supportive Staff. The harvest is collected

daily and sent to the ‘Shakti’ Sales Center. Patients engage in leisure activities in the afternoon

e.g. singing songs, watching television and reading newspaper.

Table 10 Income from the Horticulture Project, 2011-2014

Rs150,984.00

Rs462,899.00

Rs354,495.00

Rs183,912.00

Rs10,715.00 Rs64,428.00

Rs11,500.00

Rs32,969.00

2011 2012 2013 2014

INCOME FROM THE HORTICULTURE PROJECT Annual Income Amount Deposited


Page 31

Total income from the cultivation during the year was Rs.120, 000 and Rs.12,000 was deposited

in the savings accounts of the patients. Rs. 25,200 was spent for their food and beverages. The

rest was used to purchase raw materials needed for the cultivation. In 2014, a ground water

well was constructed within the ward premises for watering plants, saving the water bill

substantially. In Ward 22 there are 68 patients of which 20 patients have been allocated to

horticulture therapy on daily basis, 20 patients have been referred to vocational training, 6

patients were employed by the cleaning service of the NIMH and were allocated to the HWH-

Mulleriyawa. Other patients help in carrying out the daily activities of the ward such as

bringing food from the kitchen to the unit, helping to serve food among patients, washing and

drying clothes, bathing patients. Oversees voluntary groups have been supporting the unit on

Thursdays by engaging with patients for recreational activities.


Page 32

TRAINING AND RESEARCH UNITS

The Training Unit of NIMH conducted many national as well as international training programs

over the year 2014 (Annex 2). Research unit of the NIMH completed its second year during year

2014. The unit promotes high quality of research in mental health through the Ethics Review

Committee (ERC) established in 2012. The ERC is in the process of developing Terms of

Reference (TOR), Standard Operating Procedures (SOPs) and necessary forms in accordance

with the national and international guidelines. The committee has the membership of the

Federation of Ethics Review Committees, Sri Lanka (FERCSL) and is working towards applying

for international accreditation.

Titles of research proposals submitted during 2014

1. A psychological study regarding the manner in which the cured mental patients are socialize

2. Socio-demographic and clinical variables of patients requiring ECT cycles

3. Development of mental health first aid guidelines for helping a suicidal person in Sri Lanka: Delphi Study

4. Re-thinking mental health

5. Personality traits in teenage pregnant mothers in Moratuwa & Dehiwala MOH areas

6. A study on the stage of surviving domestic violence in male &female domestic violence survivors at NIMH

7. A Study on the attitudes of the health staff to wards mentally ill persons at NIMH

8. A sociological study of social isolation due to mental illness

9. Common life events and their associations with relapse of disease among patients with Schizophrenia

10. Violence against women in Sri Lanka

11. Naturalistic study of patients with acute mania: outcome at two weeks

12. Psychiatric disorders in Sri Lankan female offenders in a Forensic Psychiatry setting

13. Analysis in to reporting of suicide in Sri Lankan newspapers

14. Oral health status and associated factors in hospitalized psychiatric in Colombo district

15. A Study on the psycho social problems faced by the family members of Dementia patient

16. The effectiveness of family psycho-education program for Schizophrenic patient's family members - A study at Kolonnawa Divisional Secretariat

17. Co-morbidities and other associated factors among patients with schizophrenia admitted to NIMH

18. Satisfaction of the services provided among patients admitted to the NIMH


Page 33

PRODUCTIVITY, QUALITY AND SAFETY OF PATIENT CARE SERVICES

During the year 2014, improvements of the quality of the patient care service were carried out

according to the guidelines given by Directorate of Healthcare Quality and Safety. The NIMH

monitors 10 main activities to strengthen the quality of the service. The 5 indicators selected

for 2013 were provision of safe water, sanitation facilities, diet services, nursing care and

clinical care (Annual Report 2013).

5 indicators (2014)- patients waiting time in OPD, patient’s safety, notification of

communicable disease, monitoring of quality improvement programme, in service

training

Routine recording of all patients’ waiting time in the OPD (time from arrival to OPD to the time

taken to be reviewed by the Medical Officer on-call) is carried out. Random cross checks are

carried out to ensure the accuracy of this information. To ensure patient safety, data collection

on the incidents such as those more common at a mental health institute (absconding, assaults

on other patients, assaults on staff, damage on property, suicide or attempt to suicide, self-

harm) as well as those seen in other hospital settings (needle prick Injury, cat/dog related

bites) is carried out on daily basis and a discussion in the form of a monthly clinical governance

meeting is held to arrive at new guide lines and protocols if necessary.

Certificate of commendation for productivity 2013/ 2014 by the National Productivity

Secretariat


Page 34

Notifiable diseases are identified at the ward level and notified to Infection Control Nursing

Officer (ICNO) and the relevant Medical Officer of Health (MOH) of the area of residence or the

Kolonnawa MOH if detected among long stay patients. A survey is planned to be carried out to

ensure the coverage, quality and timeliness of the notifications. Monitoring of the quality

improvement programme is carried out by the number of the Working Improvement Team

(WIT) circles conducted monthly by the ward staff. According to the needs of the institution

training need are identified for each staff category and a schedule was prepared for the in-

service training.

FOOD COMMITTEE

The Nutrition Unit of the NIMH was established in December 2014, after the recruitment of two

Nutritionists with the aim of improvement of the nutritional status of in-patients. The

Nutritionists actively participate in planning special diets for patients, follow up and nutrition

counselling. The Nutrition Unit also provides necessary guidance to the Diet Stewards on food

safety and food quality while giving technical assistance to the staff involved in the diet supply

chain. In addition, the unit is in the process of establishing of guidelines on food hygiene

practices, good processing practices and practices for minimizing nutritional losses. The food

committee meeting chaired by the Director is being coordinated by the Unit.

PUBLIC ADDRESSING SYSTEM

A new public addressing system consisting of 97 speakers were installed in all units in the

hospital, saving time and the resources used earlier to broadcast messages related to

administration , and welfare activities.


Page 35

HEALTH INFORMATION UNIT

The routine Information Systems: Admission Record Information System, Gender Based

Violence Information System and “Health Net”- the web based information system to collect

performance and facility information were continued to function well. The information

gathered from these systems were used both at local and central level for decision making and

planning. During the year 2014 the Unit contributed to the NIMH cost accounting project,

compiling the annual report and clinical governance data.

Electronic Indoor Mobility and Motility Record (EIMMR) Information System continued to

function well during the year 2014. According to the recommendation of the Department of

National Achieves new racks were installed to store the records with the recommended spacing

between racks.

CLINICAL GOVERNANCE UNIT

This Unit was established in 2010 with the aim of improving patient care and clinical services.

In the year 2014, six clinical governance meetings were held with the participation of all staff

categories where there were opportunities to create awareness, identify the short comings and

root causes. Corrective actions have been implemented to prevent future recurrences.

Table 2 11 Incidents reported at NIMH, 2014

57

8

57

2

26

3

10

3

62

25

41

50

36

22

8

Ab

sco

nd

ing

Acc

ide

nt

Ass

au

lt o

n p

ati

en

t

Ass

au

lt o

n s

taff

Da

ma

ge

to

pro

pe

rty

De

ath

Se

lf I

nfl

icte

d I

nju

ry

An

ima

l re

late

d I

nju

ry

Tri

ed

to

ab

sco

nd

Att

em

pt

to s

uic

ide

clin

ica

l in

cid

en

t


Page 36

HALFWAY HOME –MULLERIYAWA

Half-Way Home (HWH) Mulleriyawa, has 483 female residents with chronic mental illness and

different functional capacities originating from all over the country. Almost one third of them

are fit to be discharged and would be able to live and work outside the HWH if given the right

environment and opportunities. The information given below highlights the events that have

occurred at the Half-Way Home in 2014.

EXTENSION TO THE WARDS

To make the living environment more spacious and patient friendly, the front section of the 7

wards was made in to a veranda with a ward based kitchen.

RELOCATING DOGS

In 2014 there were 74 dog – bites in the institution (from January to August). As a measure to

reduce the dog population, NEST – HWH-Mulleriyawa branch organized a two day program to

shift some ferocious dogs known to bite the inmates frequently to other location. With the help

of a veterinary team, 55 dogs were shifted from premises to a similar close by environment

where their needs are fulfilled. After that there was a marked reduction of dog bites

(September to December).


Page 37

COMMUNITY HOMES

Upstairs of the existing community home was renovated and a new community house started

in February 2014. It consist with 3 bed rooms, a living room, a dining room, a kitchen and a

bathroom. The fully furnished house handed over to residents. The monthly rental, electricity

and water bills are covered through donations

HANDING OVER NON-CLINICAL WASTE TO “PRADESHIYA SABAWA”

Non-clinical solid waste was discarded within the premises which led to environmental

pollution and producing breeding places for mosquitos and flies. This was discussed with

relevant authorities of Kotikawaththa Mulleriyawa- Pradeshiya Saba and they agreed to take

over the non-clinical solid waste. A waste collection center was built to store the segregated

waste till it is collected by the Pradeshiya Saba, twice a week.

HORTICULTURE PROJECT

About 1 ½ acres land is allocated for the horticulture project and several kinds of vegetables

and fruits are cultivated. In 2014 new “Katuanoda” (soursop/ custard apple) cultivation was

started over about ¼ acres area. About 15 residents are attached to the project. In 2014 total

income was Rs. 122 182.25 and net profit was Rs. 115,492.25. Half of the profit is divided

among the residents attached to the project and rest of it was deposited to an account.


Page 38

CELEBRATIONS

New Year Festival 2014 was sponsored by UNESCO club of Royal College – Colombo. Chief gust

was Mr. Upali Gunaskara, Principal – Royal College. A “Wesak Bhakthi geetha” program was

organized by the Occupational Therapy Unit with the sponsorship from several volunteers. The

annual “Wesak Dharmadesanawa”, “Wesak” decorations and “Wesak” lantern competitions was

sponsored by the Royal College Colombo.

SPECIAL EYE CLINIC

Eye problems are common among the residents due to their old age, or due to the medical

problems such as diabetes or hypertension or as a side effect of some of psychiatric

medications. Most of these eye diseases may go undetected either because they cannot explain

their eye problems due to the psychiatric conditions or to the associated poor cognitive

functions. Considering this Dr. M. L. Dharmarathne, Consultant Eye Surgeon at National Eye

Hospital, Colombo organized a screening program for eye diseases with help of the Vision Care

Optical Services (Pvt.) Ltd. This was held in November and about 400 residents were screened.

Out of them 41 residents were found to have refractive errors and they were donated

spectacles by the Vision Care Optical Services (Pvt.) Ltd. Another 61 were found to have

cataract and 24 of them underwent cataract surgery by the end of 2014. They were given lenses

free of charge.

SPECIAL DENTAL CLINIC

In the absence of a Dental Unit at HWH-Mulleriyawa residents were sent to the Dental Unit

NIMH. Residents with physical disabilities or with uncooperative behavior may have

undetected dental problems as it is difficult to send them to NIMH. In overcoming this problem

a special Dental Clinic was held at HWH-Mulleriyawa in May 2014, organized with the

participation of about 15 Dental Surgeons of the mobile units of the offices of the RDHS area

Colombo, the Dental Institute, Colombo and the mobile units of the Sri Lanka Dental

Association. About 400 residents were assessed and necessary treatments were done. Some of

them were followed up at the Dental Unit, NIMH. A special Dental Record was introduced for

each residents.


Page 39

SCHOOL OF NURSING MULLERIYAWA

The School of Nursing Mulleriyawa is the only institution in Sri Lanka which conducts mental

health and psychiatric nursing courses for registered nurses and student nurses. The academic

staff consists of the principal, two special grade nursing tutors, four grade 1 nursing tutors and

one clinical instructor. All the academics are qualified in BSc nursing. Hostel facilities are

available for 150 students. The trainees obtain clinical experience at HWH-Mulleriyawa.

Five weeks mental health and psychiatric nursing training was conducted for the nursing

students who are attached to government nursing school island wide as a part of their three

year nursing diploma. Total of 1753 nursing students were trained during the year 2014

from schools of nursing Kurunegala, Hambantota, Kandy, Anuradhapura, Colombo,

Kaluthara, Rathnapura, Sri jayawrdanapura, Ampara, Badulla, Galle, Kandana, Matara,

Jaffna, Batticaloa, Vavuniya and Military School of Nursing Anuradhapura.

In addition concerts for clients in HWH-Mulleriyawa were arranged by Nursing Students at

the end of their five week mental health and psychiatric nursing training. Sinhala and Hindu

New Year, Vesak and Christmas festivals, were celebrated by Nursing Students with clients

in HWH-Mulleriyawa.

Twelve rooms not used due to various reasons were completely renovated and put in to use.

In addition roof of the new quarters’ complex was repaired along with the gutters and the

drainage system around the building from the World Bank funds


Page 40

SPECIAL ACTIVITIES

MENTAL HEALTH DAY CELEBRATIONS

An Island wide inter-school quiz competition was organized with the approval of the Ministry

of Education among schools representing various parts of the country. Questions were

prepared on general knowledge for the first rounds, i.e. related to general health, art, sports etc

in the local as well as global settings and subsequent rounds included questions related to

mental health. The Final round was held on 13th October 2014 at NIMH with the participation

of the Director/National Operation, Ministry of Education as the Chief Guest. The quiz

Competition gave an opportunity to the school children, teachers as well as family members to

enrich their knowledge regarding mental illness. The final round of the quiz competition was

held between the Ananda College, Colombo 10 and the Ghanodaya Vidyalaya, Kaluthara. The

Annada College became the winner.


Page 41

The “Mental Health Day Walk” was held on the 10th of October 2014 with the participation of

around 1000 patients, special guests, well-wishers and employees. The Director General of

Health Services Dr. Palitha Maheepala, Director/Mental Health, Dr. Rasanjalee Hettiarachchi,

representatives from WHO and the Rotary Club Battaramulla were among the special guests.

Nearly 20 Inmates who were bed ridden for years at the HWH-Mulleriyawa joined the walk in

wheel chairs with the help of the Supportive Staff. The Walk started from the Diyatha Uyana,

Battaramulla, alone Sri Jayawardanapura Mawata, up to the end of the Japanese Sri Lanka

Friendship Road.


Page 42

The “Open Day” and the “Art and Craft Exhibition” was held on 11th and 12th of October 2014 at

NIMH. Around 100 arts under the theme of “Feelings 2014-Art Against Stigma” and Craft

produced by inmates of NIMH and the HWH-Mulleriyawa were displayed and sold at the

exhibition. The “Open Day” at NIMH -opened doors to the public to get an idea of the services

provided by NIMH including rehabilitation & occupational therapies. In addition CANMH Sri

Lanka-the consumer activity network- displayed and sold their products of their clients to the

visitors to the open day. The event was ceremonially opened by the First Lady, Madam Shiranthi

Rajapajsha and also visited by the Minister of Parliamentary Affairs, Hon. Ms Sumedha P

Jayasena.


Page 43

The handcrafts produced by the inmates and the day clients of the Occupational Therapy

Department were launched under the trade name “MINDFUL CREATIONS”. The products

included stitched and woven clothes, handy crafts, greeting cards, jewelry made of paper pulp,

leather work produced under the guidance of the Industrial Development Board, and were

displayed for the public. An exhibition photographs taken by Dr. Jeewarnaga Gunasekara

Medical Officer (Mental Health) working at NIMH, titled “LIVING WITH SCIZOPHRENIA”

depicting the theme of the World Mental Health Day 2014 was also held during these days.

A ‘street drama’ was staged during the ‘open day’ of the NIMH relating to the theme of the

World Mental Health Day 2014 ‘LIVING WITH SCIZOPHRENIA’. The actors represented different

categories (nursing officers, social workers, supportive staff) of staff at NIMH


Page 44

SPECIAL PROJECTS

NATIONAL IDENTITY CARDS & VOTING RIGHT

Under the process of social re-integration of the long stay residents of the HWH-Mulleriyawa

and the NIMH two important activities were initiated during the year 2014: obtaining National

Identity Cards for 400 females at the HWH-Mulleriyawa and 125 males at the NIMH and

establishing their voting rights. More than 95% of the long-stay residents do not have a

National Identity Card because they do not have the necessary documents such as the Birth

Certificate or any proof of their age, details such as their date of birth or a permanent address,

to apply for it. The project was supported by the Institute of Legal Medicine & Toxicology,

Colombo (Chief Judicial Medical Officer, Odentologists and the Staff), Commissioner General of

Registration of Persons, Commissioner General of Elections, Divisional Secretariat Kolannawa,

Grama Niladharis of Malpura and Rajasingha Gama-Mulleriyawa New Town. As the first step

residents with satisfactory mental state were selected after an assessment. Approximate age of

the patients was assessed by a team led by the chief JMO. A team consisting of Judicial Medical

Officers and Odentologists visited the HWM and NIMH and carried out the clinical evaluation

with the support of the Dental Surgeons at NIMH. Residents were given permanent addresses

in the DS division Kolonnawa as advices by the former Divisional Secretariat Mr. U. W.

Senarathne. Inmates of HWM and NIMH were registered at the Grama Niladari Divisions of

Rajasinghe Gama and Malpura respectively. The NIC were issued to about 600 inmates in 2014

and alone with the registration in the voters list they obtained their voting rights. The issuing

of NIC also helped the clients to obtain employment and to open savings accounts. The above

achievements carried out as part of their psychosocial rehabilitation have paved the pathway

for their independent living in the society.


Page 45

WASTE MANAGEMENT PROJECT

During year 2014, World Bank funds (10 Million) was allocated by Ministry of Health for the

above project. Existing sewerage system was old and damaged causing water to leak out and

damage to the surrounding environment.

To store the segregated waste temporary, two buildings, consisting of 4 rooms were

constructed at NIMH and HWH-Mulleriyawa. In addition, staff quarters, more than 180 in

number were grouped into 3 zones for the purpose of waste disposal and 3 buildings with 3

separate waste disposal rooms in each were constructed for the 3 zones.

Waste water form HWH Mulleriyawa was drained to the adjacent paddy fields in the past

and many complaints were received from the neighbours. With the guidance form the

Central Environmental Authority and Environmental and Occupational Health Unit,

Ministry of Health, a waste water recycling system was constructed and the treated water is

planned to be used for the pineapple plantation of the horticulture project of HWH. This

project was planned as an Eco-productivity project. The damaged waste water drainage

system at HWH Mulleriyawa was also renovated.

Sewerage treatment plant of NIMH was built in 1981 and was not functioning for many

years. The sewerage plant was repaired with the technical assistance form the Building

Department, at a cost of 9 million rupees. A new toilet complex was built to serve the needs

of the visitors to the NIMH and HWH-Mulleriyawa.

The old drainage system was renovated at the cost of Rs. 3,284,400.00 with the addition of

new pipelines and gully pits.


Page 46

HEALTH CARE COST ACCOUNTING PROJECT

Health Care Cost Accounting Project was started in 2014 according to the guidelines given by

the Ministry of Health with the aim of managing the scarce resources affectively while

minimizing the cost. Under the supervision of the Director, a Development Officer was

appointed for the task. The system of costing followed was Step-down Cost Accounting and

only recurrent cost was considered.

As the first step all the cost centres were identified and categorized in to overhead,

intermediate and final cost centres (Annex 3). While final cost centres are directly involved

in managing patients, intermediate cost centres are not directly involved in patient

management but support their management, whereas overhead cost centres are

responsible of running intermediate and final cost centres.

All the direct costs, which can clearly be allocated to a particular cost centre, were allocated

to previously identified overhead, intermediate and final cost centres.

As the second step the total cost for the overhead cost centres were calculated. The total

overhead cost was stepped down to the intermediate and final cost centres according to the

total number of staff and the patients in each intermediate and final cost centre. The

calculated total cost of the intermediate cost centres were stepped down to the final cost

centres again according to the total number of staff and the patients in each of the final cost

centres yielding the total cost of each final cost centre.

Total cost of the individual final cost centre was divided by total inpatient days for the given

centre yielding per patient per day cost of individual final cost centres (Annex 3)


Page 47

STAFF WELFARE

2014 saw a renaissance in the Hospital Welfare Association. The Association elected a new

Council and an Executive Committee in the early part of the year. The Constitution of the

Association was amended to bring in few major changes to the association to better stream line

its function. Staff welfare was the expected mission. The benefits offered at death of loved ones,

child births and other major life events were increased dramatically. The Association also

organized a Blood Donation Day at the hospital premises which had a very successful outcome

with around 100 donating blood.

The Hospital Welfare Association also continues to support and work together with the

Hospital Sports Club and Hospital Buddhist Association to promote sports and religious

activities amongst the staff and clients. Annual Pirith Ceremony and Alms Giving was

organized by the Buddhist Association.

Sports Society of the NIMH alone with the all the hospitals and the health institutions in the

country organized an island wide inter institution six a side cricket tournament. It was held at

T. B Iilangarathne Grounds with the participation of 33 teams. Director General of Health

Services Dr. Palitha Maheepala was the chief guest for the occasion


Page 48

ANNEX 1

NIMH NIMH

Director 01 EEG Recordists 02

Deputy Director 01 Radiographer 02

Consultants 10 Pharmacist 08

Medical officer 37 Dispensers 01

Dental Surgeon 03 ICT Assistant 01

Accountants 01 Medical Record Assistants 01

Administration Officer 01 Ward clerk 10

Matron 04 Lab orderly 01

Nurses 372 Diet Stewards 02

Ward Sisters 07 House Warden 04

Technical Officer 01 Drivers 09

Medical Laboratory Technologist 06 Cooks 11

Public Management Assistant 28 PHI 01

Psychiatric Social Workers 04 Telephone Operator 01

Development Assistants 11 Seamstress 02

Development Officer 10 Nutritional 02

Occupational Therapist 07 Overseers 05

Physiotherapist 02 Attendants 130

ECG Recordist 02 Supportive Staff 368

Half-Way Home, Mullariyawa Nurses Training School

Medical Officers 04 Principle 01

Nurses 73 Special grade nursing Tutors 02

Matron 01 Nursing tutors Grade 1 04

Public Management Assistant 01 Clinical Instructor 01

Occupational Therapist 02 Cooks 02

Diet Stewards 01 House Warden 02

Cooks 03 Attendants 00

Overseers 01 Drivers 01

Attendants 31 Supportive Staff 10

Supportive Staff 46


Page 49

ANNEX 2

Programme Participants No. Resource Personnel

International

workshops

and trainings

Mental Health Training Program -

Bangladesh Doctors (5 days)

19 Mental Health Training Unit

The Psychiatry of Development

Intellectual Disorder Workshop - Medical

officers (5 days)

35 Dr. Sherva Cooray (Consultant

Psychiatrist-UK)

Conference of Psychiatry update - Medical

Officers (01 day)

100 World Psychiatric Association,

Asian Federation of Psychiatric

Associations

Role of Psychologist in Mental Health

Services - All Trainees Doctors (01 day)

40 Dr.Verity Wilkinson & Dr. Jennie

Robertson from UK

Local

training

programs

2 batches of Medical Officers Mental

Health (6wks)

35

Mental Health Training Unit

Psychiatric Social Workers / Development

officers(90days)

35


Nursing Officers from District Hospital

Higurakgoda(14days)

06


Mental health training for staff of Meth

Sevana

50


Trainee teachers from Teachers training

school – Maharagama (2 days)


Development Officers in North & East -

Program for counselling support for the

war affected


Mental health training for Nursing staff

from Asiri Hospitals (pvt)(4 days)

160


Mental health training for Nursing

Students from Lanka Hospital(14 days)

40


Forensic Psychiatry Rehabilitation &

Occupational Therapy for Nurses (6days)


Gender base Violence training for doctors

& nurses


Violence management program 28 Mental Health Training Unit

Training for

undergradua

te students

Mental health training for Nursing

Students from Eastern University &

Ruhuna University (01 month)


Clinical Training– University of Sri

Jayawardanapura


Staff Training Induction program for Newly appointed

nurses (10 days) 2 programs



Page 50

General Principals of Psychiatric Nursing

for nurses

50 Rebecca Rollo – Registered Mental

Health Nurse UK

Team Building & Personality Development

for all staff

100 Mr. Prasanthalal De Alwis –

President’s Counsel Lions Club of

Sri Jayawardanapura Kotte

Staff Training Child Mental Health 100 Dr. Jayan Mendis – Director, NIMH

Kidney disease, Cancer, Non

Communicable Disease

100 Dr. Vindya Kumarapeli – Deputy

Director, NIMH

Good Parenting 100 Dr. Swarna Wijethunga Consultant

Child Psychiatrist

Orientation

programs

Nursing Students – All island NTS (01

day)


Training &

Practical

Exams

Health Service Assistants 33 Ministry of Health

Education

tour

Diploma in Public Health Inspectors –

North Western Province

70


Attendant training students of National

Hospital Sri Lanka


Undergraduate Students in Psychology –

University of Peradeniya


Diploma in Counselling (Tamil students) -

National Institute of Social Development


Diploma in Counselling (Sinhala students)

-Damrivi Foundation


Certificate in counselling – Buddhist &

Pali University of Sri Lanka


Medical students of Indigenous Medicine–

University of Colombo


Diploma in Counselling students –

National Institute of Social Development


Volunteers from District Hospital -

Akuressa


Medical Assistant Qualifying course - Sri

Lanka Navy


Undergraduate Students in External

degree program – University of Kelaniya


Counselling Training Students Maldivian



Page 51

ANNEX 3

Cost for the month of December - 2014

OVERHEAD

cost centre

INTERMEDIATE

cost centre

FINAL

cost centre

COST - PER PATIENTS

PER DAY (Rs)

Administrative

Section OPD Ward 1 2,232.45

Training Unit Laboratory Ward 2 2,349.11

Research Unit PICU Ward 3 1,892.19

Clinical

Governance Unit ECT Ward 4 2,274.99

Health

Information Unit Ward 18 ( Medical Ward) Ward 5 2,536.74

Quality Unit ECG Ward 6 2,612.58

Maintenance

unit EEG Ward 7 2,679.01

Medical Record

Room X RAY Ward 8 2,758.87

Telephone

Exchange Physiotherapy unit Ward 9 2,399.87

Security Services Kitchen Ward 10 2,417.08

Cleaning

Services CSSD /PICU & Isolation unit Ward 11 3,060.84

Consumable

Stores

Psychiatry Social Work

(PSW) unit Ward 12 3,009.44

General Stores Occupational Therapy Unit Ward 13 2,084.39

Transport

Section

Forensic Psychiatry

Rehabilitation Unit Ward 14 1,886.69

Library Horticulture Unit Ward 15 2,431.37

Mortuary Community Psychiatry Unit Ward 16 2,320.22

Doctor's

Quarters Dental Unit Ward 17 2,444.98

Matron Quarters Indoor Pharmacy Ward 20 2,840.63

Nurses Quarters Outdoor Pharmacy Forensic Male 21 1,516.30

PMA Quarters Drug Stores Forensic Female 25 3,823.07

Supportive Staff

Quarters Surgical Stores PPU 3,084.75

LDU 1,864.81

Long term care Ward 22 4,064.88

Long term care Ward 27 1,443.99

Male Villas 1,878.85

Female Villas 3,730.74

Day Treatment Center 1,295.60

GBV Unit 2,082.48


Page 52

Sincere gratitude to:

Director and all the Consultants for their guidance and advice.

Dr. Arosha Wijewickrama, Dr. Dilini Wijesuriya, Dr Janaka Weeragalla, Dr. M.R.

Galappaththi, Dr. T.D.N.S Hemapala, Dr. Priyasha Wijenayake, Dr. Chamila

Abeywickrama, Mr. S. L. Ajith Kumara, Ms. Shamika Rathnayake, Mrs. Punya Perera, Ms.

K L A P Liyanage, Mr. Ashoka Sanjeewa, Mr. Pradeep Gunarathne, Ms. Jayamini

Subeshika, Mrs Shashika Wickramarachchi for their write-ups.

Principle NTS, Special Grade Nursing Officers and Officers in-charge of Wards/Units for

providing necessary information for this report.

Administrative Officer, the Accountant, the staff from the Administration Brach and the

Finance Branch for providing the necessary information and support.

Ms. H.M.K.D Herath, Medical Record Officer for collection and compilation of data

Dr. A.M.A. Kanchana Kumara, Medical Officer (Health Informatics) for his untiring

support in compiling this report.

Edited by

Dr. Vindya Kumarapeli

Deputy Director

National Institute of Mental Health

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