circle of care project presentation gathering
TRANSCRIPT
Microsoft Word - coc Booklet.docCircle of CareCircle of CareCircle
of CareCircle of Care Project Presentation GatheringProject
Presentation GatheringProject Presentation GatheringProject
Presentation Gathering
7777thththth April 2007 April 2007 April 2007 April 2007 PJ HiltonPJ HiltonPJ HiltonPJ Hilton
“From Factual To Functionality”
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Content Page No. Introduction and Objectives 2 Message from the Chairperson 3 Participating Projects 4 Program Overview 5 - 6 Brief reports:
1. Family Support Group (Kuching Sarawak) 7 – 10 2. Coffee Corner (Psychiatry Department, Hospital Tuanku Jaafar,
Seremban, N. Sembilan) 11 – 21 3. Car Wash Project (Psychiatry Department, HUSM, Kelantan) 22 – 24 4. Car Wash & Polish (Hospital Bahagia Ulu Kinta, Perak) 25 – 30 5. Family Support Group (Pulau Pinang) 31 – 34 6. Bakeri Harmoni (Psychiatry Department, Hospital Alor Star, Kedah) 35 – 42 7. Flower Nursery (Klinik Kesihatan Pasir Mas, Kelantan) 43 – 49 8. Kedai Sihat Sentosa (Hospital Sentosa, Kuching, Sarawak) 50
Criteria of Evaluation (include sample of marking scheme) 51 Results 52 Photo Gallery 53 – 55 Acknowledgement (all committees name) 56 Editor: Dr. Abdul Kadir Abu Bakar Sub-editor: Prof. Dr. Mohd Hussain Habil
CIRCLE OF CARE
PROJECT PRESENTATION GATHERING
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The Circle of Care program begins in year 2003 as part of the Malaysian Contribution Program from the philanthropic funds of Johnson & Johnson. Since its existence, many had benefited from it. Activities that had taken place is parallel with the focus on three main groups:
1. Family Link Program This focuses in imparting formal education on mental health to patients and caregivers. The program is self-perpetuating and it helps empower patients/caregivers in managing with the mental health condition better.
2. Job Placement Activities This is an intensive patient rehabilitation program where it enclosed strong partnership from psychiatrists. As mostly patients would loose their normal functioning skills due to the mental illness, the job placement activities help patients to regain some basic functioning skills as well as regaining self- confidence in the society
3. Mental Health Awareness Campaign This basically is to create disease awareness among the public and to remove the stigma against mental illnesses.
Overall, we can summarized the Circle of Care program as follows:
Objectives:
Enhance Johnson & Johnson’s image as a caring corporate citizen and living up to our credo values
Further increase public awareness of mental diseases
Provide an avenue of support for caregivers/families of patients with mental diseases
to learn more about the disease and share their experience
Be in alignment with the prevention and removal of the stigma or isolation related to mental illnesses
To further strengthen our partnership with the Ministry of Health,
Malaysian Psychiatric Association and Malaysian Mental Health Association
Introduction and Objectives
CIRCLE OF CARE
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In the management of schizophrenia patients, we always talk
about symptom control and forget about our role to bring back patients to reality of life. The opportunity is now within our reach especially when our new second generation antipsychotic enable us to put our patients in a better platform to remission and recovery.
With this regard, our idea in creating the Circle of Care projects to
empower our patients to function is timely and most welcomed. We are delighted that our organization had been honored in being asked to coordinate this noble project.
On behalf of the Malaysian Psychiatric Association, I would like to
acknowledge the support, skill and commitment to those who lead community projects under the MPA/Circle of Care program. I also hope they would be more prime motivator for others who still are not taking the opportunity to participate. I also hope there will be more creative proposals for the rest of the year’s allocation. Professor Dr. Mohamad Hussain bin Habil Chairperson (Circle of Care Program) President (Malaysian Psychiatric Association)
Message from the Chairperson
Michelle Moh Lee Pin Jong Khim Woo Ang Kok Hwa
Sarawak
Hospital Tuanku Jaafar, Negeri Sembilan
3 Car Wash Project
Hospital Universiti Sains Malaysia, Kelantan
4 Car Wash & Polish
Hospital Bahagia Ulu Kinta, Perak
5 Family Support Group
Hospital Alor Setar, Kedah
7 Flower Nursery
Dr Khairi b Che Mat Ku Mhd Zaki bin Ku Isa
Klinik Kesihatan Pasir Mas, Kelantan
8 Kedai Sihat’
Hospital Sentosa, Sarawak
Circle of CareCircle of CareCircle of CareCircle of Care Project Presentation GatheringProject Presentation GatheringProject Presentation GatheringProject Presentation Gathering
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Prof. Dr. Mohd Hussain Habil
Closing Remarks
End 1230-1245
Lunch
Judging & Comments 1145-1200
Dr Khairi b Che Mat Ku Mhd Zaki bin Ku
Isa
(Kedah)
(Perak)
Dr. Asrenee Abd Razak
(N Sembilan)
Presentation 2
Presentation1“ Family Support
Registration 0830 - 0900
Speaker Agenda Time
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Program Program
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Dr. Yen Teck Hoe – Vice President Dr. Siti Nor Aizah Ahmad – Secretary Dr. Abdul Kadir Abu Bakar – Asst. Secretary Dr. Ahmad Hatim Sulaiman – Treasurer Dr. Jesjeet Singh Gill – Committee Member Dr. Salina Abdul Aziz - Committee Member Dr. Philip George - Committee Member Dr. Mohd. Fadzillah Abdul Razak – Committee Member Assoc. Prof. Dr. Aili Hanim Hashim – Committee Member Mr. Rajinder Singh - Committee Member
MPA Organizing
Committee
Prof. Dr. Abdul Hamid Abdul RahmanProf. Dr. Abdul Hamid Abdul RahmanProf. Dr. Abdul Hamid Abdul RahmanProf. Dr. Abdul Hamid Abdul Rahman Head of Department and Consultant Psychiatrist University Kebangsaan Malaysia Dr. Marhani MidinDr. Marhani MidinDr. Marhani MidinDr. Marhani Midin Consultant Psychiatrist and Lecturer University Kebangsaan Malaysia Dr. Mohd Fadzillah Abdul RazakDr. Mohd Fadzillah Abdul RazakDr. Mohd Fadzillah Abdul RazakDr. Mohd Fadzillah Abdul Razak Consultant Psychiatrist
Kuala Lumpur Hospital
Honorable
Judges
Prof. Prof. Prof. Prof. Dr. Mohd Hussain HabilDr. Mohd Hussain HabilDr. Mohd Hussain HabilDr. Mohd Hussain Habil Head of Department and Consultant Psychiatrist
University Malaya
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Project: Family Support Group Dr Kadir, the Director of Hospital Sentosa, Kuching, first introduced the
Family Link Education Program to the people of Sarawak in 2003. The program was advertised in the local newspaper to invite the public to enroll. Mental illness patients and their family members who visited the Hospital Sentosa were encouraged to attend this program. The Hospital Sentosa has played a major role by providing the venue for this entire program. This program was held at Hospital Sentosa Psychiatric Training Centre. On the registration day, participants are require fill-up the registration form and stated the reason for attending the program. The counselor kept the registration forms. The aim of this program is to educate and change the public perception of what mental illness is.
The Family Link Education Program consisted of eight topics such as understanding symptoms and causes of mental illness, healthy patient-family relationship, medicine and medical care, crisis management, daily life adjustment, recovery pathways, patients’ rights and review. Fund collected from the registration fee is used for refreshment, materials and graduation ceremony for the participants. The 7th, 8th and 9th Class of the program was conducted on April, September and December 2006 by a medical consultant, counselor cum instructors. Below are introduction of the main instructors for this program.
• Dr Gan Chee Kuan was the medical consultant and instructor on the topic on medication for mental illness. He was also the consultant for the Mental Health Counseling and Leadership Training course.
• Mr. Vincent Ang was a former RTM announcer and program producer. He hosted the Chinese counseling program namely “Please listen to me” for five years. Working along side with various doctors and medical specialists from both East and West Malaysia. This program included talks and discussion on mental health, counseling and psychology etcetera. He was an editor in the mass media before joining RTM. He was also the participant in the 6th class of Family Link Education Program on October 2005. After joining the program, he has attended the 3rd Asia Pacific Family Support Group Meeting & 1st Malaysia on 2 – 4 December 2005 in Penang.
In the developed country such as USA, statistic has shown that a doctor had to
serve 18,000 mental illness patients per day. In Malaysia, the statistic has reported that 6 out of 10 people had depression.
The counselors are unable to cultivate a deeper relationship with the participants and their family members. It is impossible to do follow up visit with limited manpower or support group to handle the participants with mental illness in order to assist them on the road to recovery together with their family members.
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After each graduation, graduate who wishes to assist in this program are encouraged to stay on. Further training provided by the counselors to improve the support group so that they have the counseling skill, experience of being counsel and etcetera. Before a counselor can counsel any person, he or she must first receive counseling to uncover any hidden issue so that the hidden issue will not interfere with any situation arising during the counseling case.
Mr. Vincent Ang has provided the Mental Health Counseling Training Course for 17 members of the support group in July 2006 on the important of active listening and empathy. Active listening is to listen with the mind and heart during counseling session. Empathy is the intimate comprehension of another person’s thoughts and feeling, without imposing our own judgment or expectations. This course includes self-development; love your inner child, basic helping skills and solution focused brief therapy.
Harvard University in year 2003 has introduced a new course on ‘Brave to become a Happy Person’. This course has become very popular to the student compared to the economic course provided by the University. Stress and mental illness is the hottest issue now in the advance country. WHO has issued a statement that mental illness will be top in the year 2020 replacing heart attack. In the world, every day there are new mental illness patients, but there are not enough doctor, psychiatrist and counselor to cater for the tremendous increase.
Today society is sick and it is mostly related to the problem the children are facing at home. 18% of the children 5 years old and above will develop mental illness. A problem is not a problem at all but when it is not take care off that is the real cause of a problem. There is a saying that ‘the sin of the father will fall upon their children.’ For example: Parent frequently gets drunk in front of their children. They may fight with each other in front of the children. They make promises they don’t keep. Their own lives are frequently and obviously in disorder and disarray, an their attempts to order the lives of their children seem to make little sense to these children. Since children do not have the benefit of comparison when they are young, their parents are godlike figures to their children eyes. When parents do things a certain way, it seems to the young child that is the only way to do them and it is the way they should be done without and question or doubt. In Japan, a studied has showed that the root problem of mental illness patient is related to their childhood experience. That is the reason why a course is organized for the support group on “Stave Off Melancholy Psychologically Self Therapy” which included human relationship, building up a healthy self image, reclaiming love and care of your inner child and rational emotive therapy (RET). A course on “Life, Learning, Growth – Psychological test” are taken by the support group so that they are able to recognize and understand themselves more deeply before they are able to assist anyone. Mental health is an ongoing process of
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dedication to reality at all costs because life is a continuous and never ending of self- examination. The source of danger to the world lie more within us than outside, and that is why the process of constant self-examination and contemplation is essential for ultimate survival. During the courses, Mr. Vincent Ang has try out the musical therapy that is very popular in the USA by playing soft music with the loudness of not more than 60dB. Playing soft music for the duration of 20 – 40 minutes either one or twice per day depending on the therapy session will help improve the emotional mood of the listener and will help to elevated the function of the brain. Besides that it will also help to release stress and tension. Music therapy is used to enhance speedy recovery for depression, bipolar and cancer patient. Appointments are made to visit the participants with mental illness by the counselor. The counselor together with 2 to 3 of the support group member makes the visitation. After each visitation, the counselor keeps a proper recording. The main aim of visitation and follow up is to help the patient to stand up and begin to help himself/herself by building up his/her self-confidence level and self discipline which is the basic set of tools require to solve life’s problem and last but not least being responsible. The process of confronting and solving problems is a painful experience. Before a problem can be solved, we must accept responsibility for it by acknowledging, “This is my problem and its up to me to solve it.” With this acknowledgement, it is the first step to the path of recovery. Patients that are not yet consciously willing or ready to recognize that the “old self” and “the way thing used to be” are outdated, they are not aware that their depression is signaling that major change is required for their recovery. Then the next step is to accompany the patient to walk the journey out of the problem through many follow-up visits together with their family member. By gathering feedback from either patients or their family member through visit or telephone until there is improvement. As for the each new batch of participants in the future, interviewed will be conducted to get an actual details of each of the family background. Based on this information, the participant will be categorized into three groups.
• Normal – If the participant has the passion to help in the program, they will be trained to be instructors in the future class, to be a counselor and etcetera.
• Mental illness patient – Information on the medical condition will be obtained and working together with their medical doctor and family member to come up with step to improve the condition of the patient. Patients that have recovered will be invited to present their testimony when the program is being conducted.
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• Problematic – Counselor will be able to help by giving counseling. Provided the problematic participant are willing to accept being counsel.
In summary, the objective of this program is to equip individuals with the necessary tools to combat mental illness in their daily lives. At the same time, helping the public to come forth to seek treatment or counseling when they are having mental illness instead of hiding in the dark which will cause disastrous impact on their family. When a person in a family is mental ill, the whole family is also mentally ill. Prepared by 21 March 2007 VINCENT ANG Instructor Family Link Education Program Kuching, Sarawak
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Project: Coffee Corner 1. Pengenalan Ringkas Aktiviti : 1.1 Mereka Yang Terlibat :
Ketua Jabatan = Penasihat
Occupational Therapists = Penyelaras
Pembantu Perawatan Kesihatan = Pembantu Penyelaras
Pesakit Day-Care ( 15 orang - = Sekurang-kurangnya 6 - 8 Skizofrenia ) orang akan hadir setiap masa
untuk aktiviti Coffee-Corner
Ahli FLP = Memberi sokongan dengan menjadi pelanggan coffee corner apabila membawa pesakit hadir kerawatan susulan dan juga memberi cadangan positif apabila berjumpa mereka
Peniaga di pasar = Pembelian barangan kering dan basah ( harga yang ditawarkan lebih murah daripada pasaran kerana memahami tujuan pembelian )
Circle-of-Care = Telah bermurah hati menderma RM5000.00 untuk memulakan aktiviti
Carers, pesakit dan staf jabatan = Pelanggan tetap Coffee-Corner
Perbelanjaan = Seperti dilampiran A
Sebab-Sebab Pemilihan Aktiviti Coffee-Corner:
2.1 Pesakit yang hadir sebagai Day-Care Patients (sekurang-kurangnya 3 bulan ) memerlukan satu aktiviti yang boleh dijadikan pengukuran perkembangan mereka secara realistik yang berkait rapat dengan kehidupan seharian mereka
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2.2 Aktiviti boleh dijadikan sebagai latihan untuk job placement pesakit jika bersesuaian
2.3 Komponen aktiviti boleh dijadikan sebagai alat pemerhatian dan penilaian
keatas pesakit:
membeli barangan untuk dimasak – basah dan kering
persiapan penyediaan menu
memasak menu jualan
mengemas meja hidangan
mengemas dan menyusun peralatan
membuat kiraan hasil jualan pada hari tersebut 2.4 Aktiviti dapat membantu pesakit membentuk skil :
keyakinan diri
harga diri
2.5 Semua pesakit yang dirujuk ke Day-Care Centre secara otomatik akan diletakkan kedalam aktiviti Coffee-Corner ini kerana mereka semua boleh menyumbang didalam melaksanakan aktiviti berdasarkan kebolehan minima mereka
Jenis-jenis tugas yang diberi berdasarkan kepada pemerhatian dan juga penilaian yang dibuat oleh Occupational Therapists.
2.6 Dimasa yang sama tiada kemudahan tempat makan/minum orang awam di Jabatan Psikiatri Psikiatri & Kesihatan Mental, yang terletak kira-kira 1.5 km daripada bangunan utama Hospital Tuanku Jaafar, Seremban
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PROJECT PRESENTATION GATHERING
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Maka cadangan telah dibuat oleh pelanggan jabatan agar bahagian pemulihan ( Occupational Therapy – memandangkan bahagian ini memang sudah sediada dengan kemudahan untuk memasak ) menjual barangan makanan / minuman panas
Cadangan dipersetujui dan aktiviti dimulakan secara serius 3 tahun yang lepas. Ianya dilaksanakan hanya pada hari Selasa dan Khamis daripada jam 8.00 pagi – 12.00 tengahari bertempat di tempat letak kereta doktor. Hanya pada kedua-dua hari tersebut ( Hari Klinik Pesakit Luar Psikiatri ) jabatan menerima pelanggan yang agak ramai
3. Pengukuran Tahap Pencapaian :
Coffee-Corner adalah satu aktiviti pemulihan yang sangat relevan kepada pesakit yang telah kronik ( kebanyakan skizofrenia ) dan hanya memerlukan maintenance therapy untuk meneruskan kehidupan
Aktiviti dijadikan sebagai latihan skil bekerja dan juga socialization untuk pesakit
Membantu keluarga meminimakan masa pesakit berada dirumah terlalu panjang tanpa membuat apa-apa kerja
3.2 Kepada Professionals (Pakar, Pegawai Perubatan, Occupational Therapists :
Coffee-Corner dijadikan sebagai tools untuk membuat pemerhatian dan penilaian perkembangan pesakit ( seperti didalam Occupational Performance Areas-OPA dan Occupational Performance Components- OPC )
3.3 Kepada Pesakit :
Pesakit looking forward terhadap aktiviti ini. Hadir diwaktu yang ditetapkan. Tidak perlu lagi diberitahu apakah tugas-tugas mereka. Akan melaksanakannya seperti yang telah dimaklumkan sebelum ini
Looking forward kepada imbuhan tunai ( walaupun tidak seberapa amaunnya ) kerana menghargai sumbangan mereka menjayakan aktiviti ini
Looking forward kepada aktiviti outings yang dilaksanakan menggunakan keuntungan daripada hasil titik peluh mereka
3.4 Kepada Keluarga :
Merasa bangga yang pesakit masih boleh mengambil bahagian didalam aktiviti yang mereka sendiri nampak hasilnya
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Mengaggap kehadiran pesakit di Day-Care (8.00 pagi-4.00 petang) adalah sebagai ‘ pergi bekerja ‘ walaupun imbuhan yang adapat amatlah tidak seberapa. Pesakit diberi peluang untuk menyimpan dan berbelanja sendiri imbuhan tunai yang didapati hasil daripada aktiviti ini
4. Proses Pengumpulan Data ;
Kaedah penilaian pesakit _ Occupational Therapists menggunakan FAA ( Functional Abilities Assessment ). Kaedah ini digunakan oleh Occupational Therapists di seluruh negara dan ianya adalah salah satu daripada kaedah penilaian secara resmi yang dimasukkan kedalam SOP-Standard of Practice for Occupational Therapy in Mental Health ( seperti dilampiran B )
Perkembangan pesakit direkod kedalam folder pesakit
5. Analisa dan Interpretasi Performance Pesakit:
Hasil daripada penilaian dan pemerhatian dan juga maklumbalas lisan yang diterima, penilaian semula dan perbincangan dibuat secara berterusan diantara staf dan juga pesakit mengenai prestasi mereka
Menggalakkan pesakit untuk lebih aktif lagi dan memupuk nilai-nilai positif bekerja dan berinteraksi
Ada dikalangan pesakit memang menunjukkan ketiadaan perubahan yang besar tetapi sedikit apa perkara positif yang telah berubah, boleh dianggap sebagai satu kejayaan jika dibandingkan dengan prestasi mereka sebelumnya
6. Strategi Untuk Perubahan :
Buat permulaannya Day-Care hanya menjual minuman dan makanan ringan sahaja seperti air kotak, air tin, air mineral, gula-gula, keropok, kekacang dan wafer yang diletak diatas troli sahaja dan dijual oleh seorang pesakit
Diatas permintaan ramai pelanggan klinik pesakit luar psikiatri untuk menjual makanan dan minuman panas, idea ini dipandang serius
Mendapat berita mengatakan Circle-of-Care dibawah Malaysian Psychiatric Association ada menyediakan peruntukan memulakan aktiviti rehab untuk pesakit
Permohonan dibuat dan berjaya mendapat RM5000.00 dan perbelanjaan dibuat seperti dilampiran A.
Pesakit yang dirujuk (bersama penjaga) ke Day-Care diberi penerangan terhadap aktiviti ini
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Kebenaran diberi oleh Ketua Jabatan Psikiatri dan Pengarah Hospital untuk memulakan aktiviti
Aktiviti dimulakan dan mendapat sambutan yang baik daripada pelanggan luar dan staf
7. Kesan Perubahan :
Aktiviti dimulakan dan mendapat sambutan yang baik daripada pelanggan luar dan staf
Menyediakan kemudahan bagi orang awam mendapatkan makan / minum sementara menunggu pesakit untuk berjumpa doctor
Maklumbalas lisan daripada pelanggan yang berasa bangga melihat pesakit sendiri yang secara aktif terlibat terus didalam aktiviti jualan makan dan minuman di dalam aktiviti Coffee-Corner ini
Maklumbalas lisan yang positif daripada penjaga pesakit berkaitan dengan performance pesakit dirumah terutama dengan kerja-kerja domestik yang terlibat didalam aktiviti Coffee-Corner
Apa yang perlu dibanggakan adalah pesakit yang hadir sebagai Day- Care Patients dan terlibat secara lansung didalam aktiviti Coffee- Corner ini semenjak 3 tahun yang lepas tidak relapse dan dimasukkan ke wad
8. Cadangan :
Mempelbagaikan lagi menu jualan
Mempelawa ahli FLP atau sukarelawan mengambil bahagian secara terus didalam aktiviti ini seperti mengajar memasak menu-menu yang lain
Membuka gerai berlesen (oleh ahli FLP / sukarelawan ? ) dengan mengambil pesakit secara sepenuh masa untuk membantu menjalankan perniagaan
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BIL.
PESAKIT
Jurujual, Kerani - di 2 tempat
Tidak dapat bertahan lama di semua tempat kerja. Kembali ke Day-Care – Juruwang Coffee-Corner
2.
K.S.N
Operator di kilang tepung, part-time cleaner, bekerja di beberapa restoran dan kedai makan
Tidak dapat bertahan lama di semua tempat kerja. Kembali semula ke Day-Care – Juruwang Coffee-Corner
3.
F.H
Tiada
4.
L.L
Tiada
5.
H.P.K
Jurujual di kedai buku
Tidak dapat bertahan lama. Kembali ke Day-Care. Aktif di dalam membantu membuat persiapan di Coffee-Corner
6.
L.H.Y
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8.
P.C.H
Tiada
Tidak berapa aktif tetapi boleh melaksanakan tugas-tugas pembersihan meja, pinggan- mangkuk dengan pengawasan minima dan keluarga bangga dengan prestasi yang ditunjuk.
9.
C.C
Tiada
Pesakit mild MR – dapat membantu tugas pecucian pinggan-mangkuk dengan pengawasan minima.
10.
V.L
Tiada
Produktif di Coffee-Corner dan berjaya berinteraksi secara positif dengan staf dan pesakit lain ( paranoid schiz ) jika dibandingkan sebelumnya
11.
S.K.H
12.
S.O
Kembali melanjutkan pelajaran
Diberitahu – dropped out selepas beberapa bulan dan tidak hadir ke Day-Care lagi
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TARIKH
PERKARA
LAMPIRAN B UNIT PEMULIHAN CARAKERJA HOSPITAL TUANKU JAAFAR SEREMBAN
FUNCTIONAL ABILITY ASSESSMENT FORM Name of patient : In/Out : Diagnosis : Sex : Age : Address :
Occupation : Marital status : Educational level : FAMILY HISTORY: ………………………………………………………………………………………………
………………………………………………………………………………………………
DATE
VII Time management
VIII Money management
B TASK ORGANISATION
I Attention Span
II Problem Solving
III Decision Making
IV Frustration Tolerance
V Memory Functioning
VI Verbal Instruction
VII Learning Ability
C MOTOR TASK
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HOSPITAL UNIVERSITI SAINS MALAYSIA, KUBANG KERIAN.
2. PENGENALAN
2.1 Projek Bengkel Cuci Kereta merupakan salah satu aktiviti utama
yang telah dijalan oleh Unit Rehabilitasi Psikososial HUSM. Projek ini telah
mendapat peruntukan kewangan daripada Malaysian Psychiatric
Association (MPA) dan Syarikat Ubat Jansen Cilag berjumlah RM 4200
yang disalurkan melalui Persatuan Perubatan Psikologi Kelantan
(PERSIKOL) pada tahun 2003. Keseluruhan peruntukkan yang diberi telah
digunakan untuk membeli kelengkapan peralatan bagi mengendali projek
tersebut manakala tapak bengkel (rangka besi berbumbung dan stor
simpanan) telah disediakan oleh pihak Hospital USM.
2.2 Bengkel ini telah dirasmikan oleh Pengarah Hospital U.S.M pada 5
Ogos 2003 dan mula beroperasi pada 6 Ogos 2003. Pada peringkat
awalnya bengkel ini dikendalikan oleh oleh 4 orang pesakit psikiatri yang
menjalani pemulihan di Unit Rehabilitasi Psikososial HUSM, Kubang Kerian
dengan dibantu oleh seorang Pembantu Perubatan dan seorang Atenden
Kesihatan. Bengkel ini juga telah mendapat sambutan yang amat
menggalakkan selepas ianya dimulakan.
Secara umumnya projek ini diadakan bagi memberi kemahiran am kepada
pesakit sebelum mereka kembali ke kehidupan sebenar selepas keluar dari
hospital.
kepada masyarakat
batasan-batasan yang terdapat padanya yang disebabkan oleh
penyakit yang dialaminya.
perbelanjaan kewangan dan dalam membuat keputusan.
3.24 Membantu pesakit supaya untuk meningkatkan keyakinan diri dan
dapat berdikari serta tidak bergantung kepada orang lain.
3.25 Mengurangkan persepsi negatif masyarakat terhadap pesakit-pesakit
mental
4. PERJALANAN PROJEK
4.1 Sejak ditubuhkan sehingga kini Bengkel cuci kereta Unit Psikososial HUSM
telah menjalankan operasi pada setiap hari bekerja bermula pukul 9:00 pagi
dan berakhir pada pukul 5 petang.
4.2 Pesakit-pesakit yang datang menjalani pemulihan di bengkel cuci kereta
adalah merupakan pesakit yang telah dirujuk untuk menjalani pemulihan di
Unit Rehabilitasi Psikosial dan telah dinilai oleh Pakar Psikiatri dan Jurupulih
Carakerja Unit Rehabilitasi Psikososial.
4.3 Gaji atau upah pesakit dibayar berdasarkan jumlah kenderaan yang dicuci
yang mana separuh (50%) daripada bayaran yang diterima akan dibagi
diantara pesakit yang mencuci kenderaan tersebut.
4.4 Separuh (50%) lagi dimasukan dalam tabung Unit Rehabilitasi Psikososial
bagi kegunaan membeli keperluan bengkel dan membiayai tambang dan
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Psikososial HUSM.
5.1 Oleh kerana tapak projek berada dalam kawasan Hospital, perkhidmatan
projek hanya ditawar kepada kakitangan-kakitangan HUSM sahaja Purata
kenderaan yang dicuci adalah 4 hingga 8 buah sehari bergantung kepada
kemampuan dan jumlah pesakit yang hadir.
5.2 Pendapatan pesakit sehari adalah diantara RM 5 hingga RM 15 sehari
seorang bergantung kepada jumlah kenderaan yang dicuci oleh mereka.
5.3 Setakat ini 6 orang telah didiscajkan daipada projek ini kerana telah
mendapat pekerjaan ditempat lain dan seorang telah berjaya menyambung
pelajaran dalam bidang kemahiran di Giat MARA.
6. KESIMPULAN
6.1 Melalui projek ini, pesakit telah dapat mempelajari konsep bekerja sebenar
yang mana ia menekan orientasi kerja dan ‘reinforcement”. dan pesakit juga
dapat belajar kemahiran baru dan meningkatkan pengalaman bekerja
sebagai persediaan untuk kembali ke pangkuan masyarakat .
6.2 Projek ini juga telah membantu menambahkan pendapatan pesakit dan
mengurangkan serba sedikit beban keluarga. Dengan pendapatan yang
diperolehi secara berterusan, pesakit boleh dibantu untuk merancang
pengurusan kewangan dan belajar hidup berdikari
Disediakan Oleh : Disahkan Oleh :
25
Project: Car Wash & Polish DR HJH RABAIAH MOHD SALLEH CONSULTANT FORENSIC PSYCHIATRIST HOSPITAL BAHAGIA ULU KINTA INTRODUCTION Hospital Bahagia Ulu Kinta, the largest of 4 psychiatric institutions in Malaysia came into operation way back in 1911. Then, it had a population of about 5000 inmates, some of whom had been brought in from places as far as Singapore and Sumatra, Indonesia. Slowly over time, with the advancement of better medicine and good psychiatric care provided, Hospital Bahagia Ulu Kinta (HBUK) was able to bring its total number of inmates to the present average of 1900-2200 Admissions to HBUK are either via civil or medico-legal admissions. The definition of medico-legal or forensic admissions is admissions via referrals through the courts, prisons and other relevant detention centers. Forensic psychiatric patients are those patients who have had some problems with the law. Usually their first contact with HBUK is as a result of running foul of the law and the judicial system. A large majority of the mentally disordered offenders gets referred by the courts for a psychiatric assessment as is provided for under the Malaysian Criminal Procedure Code (CPC). A psychiatric report is issued at the end of their stay, which is then used in courts. Most of them do not come back as forensic admissions anymore. However the law provides for readmissions to the Forensic Wards HBUK under Section 344 of the CPC, a section of the law which provides for detention because the patients (accused in the court of law) were not fit to stand trial and Section 348 of the CPC which provides for detention because the patients were found guilty as charged but acquitted because of insanity at the time of offence. Thus, most of the patients at the Forensic Wards of HBUK are those detained under the above-mentioned sections of the Malaysian CPC, 142 patients under section 348 CPC and 28 patients under section 344 CPC, out of which 15 are female forensic patients. The majority was diagnosed to be suffering from schizophrenia (90%) while the rest had diagnoses, which included bipolar mood disorder, organic mental disorder, mental sub normality and personality disorder with poor impulse control. FORENSIC REHABILITATION Forensic psychiatric patients are difficult to treat. They are involuntarily committed for treatment, and few would seek inpatient treatment of their own violation, despite or perhaps because of gross psychiatric and functional impairment. A psychosocial approach to treatment focuses on the reduction of psychiatric symptoms, primarily
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through medication and the development of functional skills associated with relapse prevention and adaptation to less restrictive environments. The ultimate goals are recovery, reestablishment of normal roles in the community, development of a personal support network and increased quality of life. With the objective of preparing patients for an independent life in the community, a paradigm shift from totally custodial to active promotion of Psychosocial Rehabilitation with the support of a multidisciplinary team was actively pursued. Psychosocial Rehabilitation Therapy starts from the day a patient is received into the forensic wards. There are 5 wards especially designated for forensic male patients, comprising of ward 23 as a high security forensic ward, ward 22 and 24 as medium security forensic wards and ward 21 and 25 as open forensic wards. The Forensic Car Wash and Car Polish Projects are projects initiated especially for patients who have undergone rigorous assessment and work-up before they finally become residents in the open wards 21 and 25. Thorough and comprehensive patient assessment is an essential prerequisite to the appropriate provision of rehabilitation therapy services. Ward 21 is a 12-bedded ward while ward 25 is able to hold 25 patients. Most of the patients in these two wards are stable, quite motivated, may or may not have good family support but essentially they are all stable enough to be discharged back into the society. In preparation for their eventual discharge, being job-placed is one of the main focuses of the patients and staff attached to the wards. PROGRESS The Fountain Car Wash Project was initiated and officially declared open by YB Dato Hj. Ahmad Husni bin Hanadzlah, Member of Parliament for Tambun on 26 July 2003. With a grant of RM5000 from the Malaysian Psychiatric Association (MPA) and a further RM2000 from the Forensic Funds a simple extension was made next to ward 25. Technical assistance was given by several other Government and Private agencies to do the necessary drilling and pumping up of underground water to be used for the project. Electrical wiring and other necessary perihelia were sponsored by the Hospital Support Services. Seeing that the Car Wash Project was so viable and noting that the regular clientele had increased, the staff running the project agreed that the Project be extended further. Thus The Car Polish Project took off early this year (2007). Once again, the Malaysian Psychiatric Association (MPA) was approached and a grant of RM4960 was approved in October 2006. Part of the grant was used to extend the Project site further so as to accommodate more vehicles, which now include hospital ambulances, buses and lorries. A couple of nursing staff and patients were initially sent for “training” at a nearby petrol station. Since then, many more patients had undergone on the job training and the Project has gone into full swing. To date, the management of the Hospital Support Services had pledged their support to assist in sending all types of hospital vehicles for washing and polishing. The charges, worked out to be cheaper than those offered by outside agencies.
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Being a big institution with approximately 1400 staff, getting customers is not too difficult. Even then, the public is also welcomed and with better publicity, more vehicles are coming in for the service. OBJECTIVES ACHIEVED What was initially thought to be a way of earning money for ward activities, turn out to be more than that. Being a structured activity, the patients are kept fully occupied. The Car Wash Project operates between 9 am to 5 pm everyday of the week except Mondays. 12 patients are divided into 2 shifts. At the end of the week, each patient receives an emolument of RM15 to be used as and when they like. At the same time, budgeting skills are put in place where the patients are encouraged to spend their hard-earned pay wisely and saved some for rainy days. With money stored away, their self-esteem increased. At the same time, because they work in groups and have to interact with the nursing staff and clients, there was subtle improvement in their communication and social skills. From there, some of them have graduated into better employment with higher pay as security guards, grass cutters, gardeners etc. It must be mentioned that all categories of staff are actively involved in the Project, from the Ward Attendants, to Medical Assistants, Occupational Therapist, Social Welfare Officers, Medical Officers and Psychiatrist-In-Charge. They each have their own roles in making sure that the principles and objectives of psychosocial rehabilitation are met and the ultimate aim of developing the patient’s life skills, which will make their transition to life in the community easier. Charges wash and vacuum with polish Motorbike RM2.00 Car RM6.00 Van RM8.00 4-Wheel Drive RM12.00 Lorry (1 ton) RM15.00 Lorry (3ton and above) RM30.00 Bus RM50.00 CONCLUSIONS Despite the initial setbacks, in terms of lack of funding and number of interested staff, and the risks involved, the Forensic Car Wash and Polish Project, has seen remarkable changes among the patients, not only among those involved directly, but also patients from other forensic wards. The conflict between those who think that safety is paramount, that patients cannot be trusted to be responsible and that individual choice can be sacrificed for the greater good and those who argue that some patients need the opportunity to take responsibility and that individual choice is important both as a right and as a basis for therapy needed to be worked out before
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the multidisciplinary staff were reassured enough to take up the challenge of dealing with the “difficult and dangerous to handle patients”. Both patients and staff recognized the Project as the carrot dangling at the end of a long pole, that the light at the end of the tunnel lies in being moved upwards from a closed, high security ward to an open ward and given the honour of being job-placed as a car-wash and polish assistant and later graduate to better paying jobs is the ultimate achievement. THE BEGINNING
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“From Factual To Functionality”
1
Content Page No. Introduction and Objectives 2 Message from the Chairperson 3 Participating Projects 4 Program Overview 5 - 6 Brief reports:
1. Family Support Group (Kuching Sarawak) 7 – 10 2. Coffee Corner (Psychiatry Department, Hospital Tuanku Jaafar,
Seremban, N. Sembilan) 11 – 21 3. Car Wash Project (Psychiatry Department, HUSM, Kelantan) 22 – 24 4. Car Wash & Polish (Hospital Bahagia Ulu Kinta, Perak) 25 – 30 5. Family Support Group (Pulau Pinang) 31 – 34 6. Bakeri Harmoni (Psychiatry Department, Hospital Alor Star, Kedah) 35 – 42 7. Flower Nursery (Klinik Kesihatan Pasir Mas, Kelantan) 43 – 49 8. Kedai Sihat Sentosa (Hospital Sentosa, Kuching, Sarawak) 50
Criteria of Evaluation (include sample of marking scheme) 51 Results 52 Photo Gallery 53 – 55 Acknowledgement (all committees name) 56 Editor: Dr. Abdul Kadir Abu Bakar Sub-editor: Prof. Dr. Mohd Hussain Habil
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The Circle of Care program begins in year 2003 as part of the Malaysian Contribution Program from the philanthropic funds of Johnson & Johnson. Since its existence, many had benefited from it. Activities that had taken place is parallel with the focus on three main groups:
1. Family Link Program This focuses in imparting formal education on mental health to patients and caregivers. The program is self-perpetuating and it helps empower patients/caregivers in managing with the mental health condition better.
2. Job Placement Activities This is an intensive patient rehabilitation program where it enclosed strong partnership from psychiatrists. As mostly patients would loose their normal functioning skills due to the mental illness, the job placement activities help patients to regain some basic functioning skills as well as regaining self- confidence in the society
3. Mental Health Awareness Campaign This basically is to create disease awareness among the public and to remove the stigma against mental illnesses.
Overall, we can summarized the Circle of Care program as follows:
Objectives:
Enhance Johnson & Johnson’s image as a caring corporate citizen and living up to our credo values
Further increase public awareness of mental diseases
Provide an avenue of support for caregivers/families of patients with mental diseases
to learn more about the disease and share their experience
Be in alignment with the prevention and removal of the stigma or isolation related to mental illnesses
To further strengthen our partnership with the Ministry of Health,
Malaysian Psychiatric Association and Malaysian Mental Health Association
Introduction and Objectives
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In the management of schizophrenia patients, we always talk
about symptom control and forget about our role to bring back patients to reality of life. The opportunity is now within our reach especially when our new second generation antipsychotic enable us to put our patients in a better platform to remission and recovery.
With this regard, our idea in creating the Circle of Care projects to
empower our patients to function is timely and most welcomed. We are delighted that our organization had been honored in being asked to coordinate this noble project.
On behalf of the Malaysian Psychiatric Association, I would like to
acknowledge the support, skill and commitment to those who lead community projects under the MPA/Circle of Care program. I also hope they would be more prime motivator for others who still are not taking the opportunity to participate. I also hope there will be more creative proposals for the rest of the year’s allocation. Professor Dr. Mohamad Hussain bin Habil Chairperson (Circle of Care Program) President (Malaysian Psychiatric Association)
Message from the Chairperson
Michelle Moh Lee Pin Jong Khim Woo Ang Kok Hwa
Sarawak
Hospital Tuanku Jaafar, Negeri Sembilan
3 Car Wash Project
Hospital Universiti Sains Malaysia, Kelantan
4 Car Wash & Polish
Hospital Bahagia Ulu Kinta, Perak
5 Family Support Group
Hospital Alor Setar, Kedah
7 Flower Nursery
Dr Khairi b Che Mat Ku Mhd Zaki bin Ku Isa
Klinik Kesihatan Pasir Mas, Kelantan
8 Kedai Sihat’
Hospital Sentosa, Sarawak
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Prof. Dr. Mohd Hussain Habil
Closing Remarks
End 1230-1245
Lunch
Judging & Comments 1145-1200
Dr Khairi b Che Mat Ku Mhd Zaki bin Ku
Isa
(Kedah)
(Perak)
Dr. Asrenee Abd Razak
(N Sembilan)
Presentation 2
Presentation1“ Family Support
Registration 0830 - 0900
Speaker Agenda Time
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Program Program
6
Dr. Yen Teck Hoe – Vice President Dr. Siti Nor Aizah Ahmad – Secretary Dr. Abdul Kadir Abu Bakar – Asst. Secretary Dr. Ahmad Hatim Sulaiman – Treasurer Dr. Jesjeet Singh Gill – Committee Member Dr. Salina Abdul Aziz - Committee Member Dr. Philip George - Committee Member Dr. Mohd. Fadzillah Abdul Razak – Committee Member Assoc. Prof. Dr. Aili Hanim Hashim – Committee Member Mr. Rajinder Singh - Committee Member
MPA Organizing
Committee
Prof. Dr. Abdul Hamid Abdul RahmanProf. Dr. Abdul Hamid Abdul RahmanProf. Dr. Abdul Hamid Abdul RahmanProf. Dr. Abdul Hamid Abdul Rahman Head of Department and Consultant Psychiatrist University Kebangsaan Malaysia Dr. Marhani MidinDr. Marhani MidinDr. Marhani MidinDr. Marhani Midin Consultant Psychiatrist and Lecturer University Kebangsaan Malaysia Dr. Mohd Fadzillah Abdul RazakDr. Mohd Fadzillah Abdul RazakDr. Mohd Fadzillah Abdul RazakDr. Mohd Fadzillah Abdul Razak Consultant Psychiatrist
Kuala Lumpur Hospital
Honorable
Judges
Prof. Prof. Prof. Prof. Dr. Mohd Hussain HabilDr. Mohd Hussain HabilDr. Mohd Hussain HabilDr. Mohd Hussain Habil Head of Department and Consultant Psychiatrist
University Malaya
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Project: Family Support Group Dr Kadir, the Director of Hospital Sentosa, Kuching, first introduced the
Family Link Education Program to the people of Sarawak in 2003. The program was advertised in the local newspaper to invite the public to enroll. Mental illness patients and their family members who visited the Hospital Sentosa were encouraged to attend this program. The Hospital Sentosa has played a major role by providing the venue for this entire program. This program was held at Hospital Sentosa Psychiatric Training Centre. On the registration day, participants are require fill-up the registration form and stated the reason for attending the program. The counselor kept the registration forms. The aim of this program is to educate and change the public perception of what mental illness is.
The Family Link Education Program consisted of eight topics such as understanding symptoms and causes of mental illness, healthy patient-family relationship, medicine and medical care, crisis management, daily life adjustment, recovery pathways, patients’ rights and review. Fund collected from the registration fee is used for refreshment, materials and graduation ceremony for the participants. The 7th, 8th and 9th Class of the program was conducted on April, September and December 2006 by a medical consultant, counselor cum instructors. Below are introduction of the main instructors for this program.
• Dr Gan Chee Kuan was the medical consultant and instructor on the topic on medication for mental illness. He was also the consultant for the Mental Health Counseling and Leadership Training course.
• Mr. Vincent Ang was a former RTM announcer and program producer. He hosted the Chinese counseling program namely “Please listen to me” for five years. Working along side with various doctors and medical specialists from both East and West Malaysia. This program included talks and discussion on mental health, counseling and psychology etcetera. He was an editor in the mass media before joining RTM. He was also the participant in the 6th class of Family Link Education Program on October 2005. After joining the program, he has attended the 3rd Asia Pacific Family Support Group Meeting & 1st Malaysia on 2 – 4 December 2005 in Penang.
In the developed country such as USA, statistic has shown that a doctor had to
serve 18,000 mental illness patients per day. In Malaysia, the statistic has reported that 6 out of 10 people had depression.
The counselors are unable to cultivate a deeper relationship with the participants and their family members. It is impossible to do follow up visit with limited manpower or support group to handle the participants with mental illness in order to assist them on the road to recovery together with their family members.
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After each graduation, graduate who wishes to assist in this program are encouraged to stay on. Further training provided by the counselors to improve the support group so that they have the counseling skill, experience of being counsel and etcetera. Before a counselor can counsel any person, he or she must first receive counseling to uncover any hidden issue so that the hidden issue will not interfere with any situation arising during the counseling case.
Mr. Vincent Ang has provided the Mental Health Counseling Training Course for 17 members of the support group in July 2006 on the important of active listening and empathy. Active listening is to listen with the mind and heart during counseling session. Empathy is the intimate comprehension of another person’s thoughts and feeling, without imposing our own judgment or expectations. This course includes self-development; love your inner child, basic helping skills and solution focused brief therapy.
Harvard University in year 2003 has introduced a new course on ‘Brave to become a Happy Person’. This course has become very popular to the student compared to the economic course provided by the University. Stress and mental illness is the hottest issue now in the advance country. WHO has issued a statement that mental illness will be top in the year 2020 replacing heart attack. In the world, every day there are new mental illness patients, but there are not enough doctor, psychiatrist and counselor to cater for the tremendous increase.
Today society is sick and it is mostly related to the problem the children are facing at home. 18% of the children 5 years old and above will develop mental illness. A problem is not a problem at all but when it is not take care off that is the real cause of a problem. There is a saying that ‘the sin of the father will fall upon their children.’ For example: Parent frequently gets drunk in front of their children. They may fight with each other in front of the children. They make promises they don’t keep. Their own lives are frequently and obviously in disorder and disarray, an their attempts to order the lives of their children seem to make little sense to these children. Since children do not have the benefit of comparison when they are young, their parents are godlike figures to their children eyes. When parents do things a certain way, it seems to the young child that is the only way to do them and it is the way they should be done without and question or doubt. In Japan, a studied has showed that the root problem of mental illness patient is related to their childhood experience. That is the reason why a course is organized for the support group on “Stave Off Melancholy Psychologically Self Therapy” which included human relationship, building up a healthy self image, reclaiming love and care of your inner child and rational emotive therapy (RET). A course on “Life, Learning, Growth – Psychological test” are taken by the support group so that they are able to recognize and understand themselves more deeply before they are able to assist anyone. Mental health is an ongoing process of
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dedication to reality at all costs because life is a continuous and never ending of self- examination. The source of danger to the world lie more within us than outside, and that is why the process of constant self-examination and contemplation is essential for ultimate survival. During the courses, Mr. Vincent Ang has try out the musical therapy that is very popular in the USA by playing soft music with the loudness of not more than 60dB. Playing soft music for the duration of 20 – 40 minutes either one or twice per day depending on the therapy session will help improve the emotional mood of the listener and will help to elevated the function of the brain. Besides that it will also help to release stress and tension. Music therapy is used to enhance speedy recovery for depression, bipolar and cancer patient. Appointments are made to visit the participants with mental illness by the counselor. The counselor together with 2 to 3 of the support group member makes the visitation. After each visitation, the counselor keeps a proper recording. The main aim of visitation and follow up is to help the patient to stand up and begin to help himself/herself by building up his/her self-confidence level and self discipline which is the basic set of tools require to solve life’s problem and last but not least being responsible. The process of confronting and solving problems is a painful experience. Before a problem can be solved, we must accept responsibility for it by acknowledging, “This is my problem and its up to me to solve it.” With this acknowledgement, it is the first step to the path of recovery. Patients that are not yet consciously willing or ready to recognize that the “old self” and “the way thing used to be” are outdated, they are not aware that their depression is signaling that major change is required for their recovery. Then the next step is to accompany the patient to walk the journey out of the problem through many follow-up visits together with their family member. By gathering feedback from either patients or their family member through visit or telephone until there is improvement. As for the each new batch of participants in the future, interviewed will be conducted to get an actual details of each of the family background. Based on this information, the participant will be categorized into three groups.
• Normal – If the participant has the passion to help in the program, they will be trained to be instructors in the future class, to be a counselor and etcetera.
• Mental illness patient – Information on the medical condition will be obtained and working together with their medical doctor and family member to come up with step to improve the condition of the patient. Patients that have recovered will be invited to present their testimony when the program is being conducted.
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• Problematic – Counselor will be able to help by giving counseling. Provided the problematic participant are willing to accept being counsel.
In summary, the objective of this program is to equip individuals with the necessary tools to combat mental illness in their daily lives. At the same time, helping the public to come forth to seek treatment or counseling when they are having mental illness instead of hiding in the dark which will cause disastrous impact on their family. When a person in a family is mental ill, the whole family is also mentally ill. Prepared by 21 March 2007 VINCENT ANG Instructor Family Link Education Program Kuching, Sarawak
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Project: Coffee Corner 1. Pengenalan Ringkas Aktiviti : 1.1 Mereka Yang Terlibat :
Ketua Jabatan = Penasihat
Occupational Therapists = Penyelaras
Pembantu Perawatan Kesihatan = Pembantu Penyelaras
Pesakit Day-Care ( 15 orang - = Sekurang-kurangnya 6 - 8 Skizofrenia ) orang akan hadir setiap masa
untuk aktiviti Coffee-Corner
Ahli FLP = Memberi sokongan dengan menjadi pelanggan coffee corner apabila membawa pesakit hadir kerawatan susulan dan juga memberi cadangan positif apabila berjumpa mereka
Peniaga di pasar = Pembelian barangan kering dan basah ( harga yang ditawarkan lebih murah daripada pasaran kerana memahami tujuan pembelian )
Circle-of-Care = Telah bermurah hati menderma RM5000.00 untuk memulakan aktiviti
Carers, pesakit dan staf jabatan = Pelanggan tetap Coffee-Corner
Perbelanjaan = Seperti dilampiran A
Sebab-Sebab Pemilihan Aktiviti Coffee-Corner:
2.1 Pesakit yang hadir sebagai Day-Care Patients (sekurang-kurangnya 3 bulan ) memerlukan satu aktiviti yang boleh dijadikan pengukuran perkembangan mereka secara realistik yang berkait rapat dengan kehidupan seharian mereka
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2.2 Aktiviti boleh dijadikan sebagai latihan untuk job placement pesakit jika bersesuaian
2.3 Komponen aktiviti boleh dijadikan sebagai alat pemerhatian dan penilaian
keatas pesakit:
membeli barangan untuk dimasak – basah dan kering
persiapan penyediaan menu
memasak menu jualan
mengemas meja hidangan
mengemas dan menyusun peralatan
membuat kiraan hasil jualan pada hari tersebut 2.4 Aktiviti dapat membantu pesakit membentuk skil :
keyakinan diri
harga diri
2.5 Semua pesakit yang dirujuk ke Day-Care Centre secara otomatik akan diletakkan kedalam aktiviti Coffee-Corner ini kerana mereka semua boleh menyumbang didalam melaksanakan aktiviti berdasarkan kebolehan minima mereka
Jenis-jenis tugas yang diberi berdasarkan kepada pemerhatian dan juga penilaian yang dibuat oleh Occupational Therapists.
2.6 Dimasa yang sama tiada kemudahan tempat makan/minum orang awam di Jabatan Psikiatri Psikiatri & Kesihatan Mental, yang terletak kira-kira 1.5 km daripada bangunan utama Hospital Tuanku Jaafar, Seremban
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Maka cadangan telah dibuat oleh pelanggan jabatan agar bahagian pemulihan ( Occupational Therapy – memandangkan bahagian ini memang sudah sediada dengan kemudahan untuk memasak ) menjual barangan makanan / minuman panas
Cadangan dipersetujui dan aktiviti dimulakan secara serius 3 tahun yang lepas. Ianya dilaksanakan hanya pada hari Selasa dan Khamis daripada jam 8.00 pagi – 12.00 tengahari bertempat di tempat letak kereta doktor. Hanya pada kedua-dua hari tersebut ( Hari Klinik Pesakit Luar Psikiatri ) jabatan menerima pelanggan yang agak ramai
3. Pengukuran Tahap Pencapaian :
Coffee-Corner adalah satu aktiviti pemulihan yang sangat relevan kepada pesakit yang telah kronik ( kebanyakan skizofrenia ) dan hanya memerlukan maintenance therapy untuk meneruskan kehidupan
Aktiviti dijadikan sebagai latihan skil bekerja dan juga socialization untuk pesakit
Membantu keluarga meminimakan masa pesakit berada dirumah terlalu panjang tanpa membuat apa-apa kerja
3.2 Kepada Professionals (Pakar, Pegawai Perubatan, Occupational Therapists :
Coffee-Corner dijadikan sebagai tools untuk membuat pemerhatian dan penilaian perkembangan pesakit ( seperti didalam Occupational Performance Areas-OPA dan Occupational Performance Components- OPC )
3.3 Kepada Pesakit :
Pesakit looking forward terhadap aktiviti ini. Hadir diwaktu yang ditetapkan. Tidak perlu lagi diberitahu apakah tugas-tugas mereka. Akan melaksanakannya seperti yang telah dimaklumkan sebelum ini
Looking forward kepada imbuhan tunai ( walaupun tidak seberapa amaunnya ) kerana menghargai sumbangan mereka menjayakan aktiviti ini
Looking forward kepada aktiviti outings yang dilaksanakan menggunakan keuntungan daripada hasil titik peluh mereka
3.4 Kepada Keluarga :
Merasa bangga yang pesakit masih boleh mengambil bahagian didalam aktiviti yang mereka sendiri nampak hasilnya
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Mengaggap kehadiran pesakit di Day-Care (8.00 pagi-4.00 petang) adalah sebagai ‘ pergi bekerja ‘ walaupun imbuhan yang adapat amatlah tidak seberapa. Pesakit diberi peluang untuk menyimpan dan berbelanja sendiri imbuhan tunai yang didapati hasil daripada aktiviti ini
4. Proses Pengumpulan Data ;
Kaedah penilaian pesakit _ Occupational Therapists menggunakan FAA ( Functional Abilities Assessment ). Kaedah ini digunakan oleh Occupational Therapists di seluruh negara dan ianya adalah salah satu daripada kaedah penilaian secara resmi yang dimasukkan kedalam SOP-Standard of Practice for Occupational Therapy in Mental Health ( seperti dilampiran B )
Perkembangan pesakit direkod kedalam folder pesakit
5. Analisa dan Interpretasi Performance Pesakit:
Hasil daripada penilaian dan pemerhatian dan juga maklumbalas lisan yang diterima, penilaian semula dan perbincangan dibuat secara berterusan diantara staf dan juga pesakit mengenai prestasi mereka
Menggalakkan pesakit untuk lebih aktif lagi dan memupuk nilai-nilai positif bekerja dan berinteraksi
Ada dikalangan pesakit memang menunjukkan ketiadaan perubahan yang besar tetapi sedikit apa perkara positif yang telah berubah, boleh dianggap sebagai satu kejayaan jika dibandingkan dengan prestasi mereka sebelumnya
6. Strategi Untuk Perubahan :
Buat permulaannya Day-Care hanya menjual minuman dan makanan ringan sahaja seperti air kotak, air tin, air mineral, gula-gula, keropok, kekacang dan wafer yang diletak diatas troli sahaja dan dijual oleh seorang pesakit
Diatas permintaan ramai pelanggan klinik pesakit luar psikiatri untuk menjual makanan dan minuman panas, idea ini dipandang serius
Mendapat berita mengatakan Circle-of-Care dibawah Malaysian Psychiatric Association ada menyediakan peruntukan memulakan aktiviti rehab untuk pesakit
Permohonan dibuat dan berjaya mendapat RM5000.00 dan perbelanjaan dibuat seperti dilampiran A.
Pesakit yang dirujuk (bersama penjaga) ke Day-Care diberi penerangan terhadap aktiviti ini
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Kebenaran diberi oleh Ketua Jabatan Psikiatri dan Pengarah Hospital untuk memulakan aktiviti
Aktiviti dimulakan dan mendapat sambutan yang baik daripada pelanggan luar dan staf
7. Kesan Perubahan :
Aktiviti dimulakan dan mendapat sambutan yang baik daripada pelanggan luar dan staf
Menyediakan kemudahan bagi orang awam mendapatkan makan / minum sementara menunggu pesakit untuk berjumpa doctor
Maklumbalas lisan daripada pelanggan yang berasa bangga melihat pesakit sendiri yang secara aktif terlibat terus didalam aktiviti jualan makan dan minuman di dalam aktiviti Coffee-Corner ini
Maklumbalas lisan yang positif daripada penjaga pesakit berkaitan dengan performance pesakit dirumah terutama dengan kerja-kerja domestik yang terlibat didalam aktiviti Coffee-Corner
Apa yang perlu dibanggakan adalah pesakit yang hadir sebagai Day- Care Patients dan terlibat secara lansung didalam aktiviti Coffee- Corner ini semenjak 3 tahun yang lepas tidak relapse dan dimasukkan ke wad
8. Cadangan :
Mempelbagaikan lagi menu jualan
Mempelawa ahli FLP atau sukarelawan mengambil bahagian secara terus didalam aktiviti ini seperti mengajar memasak menu-menu yang lain
Membuka gerai berlesen (oleh ahli FLP / sukarelawan ? ) dengan mengambil pesakit secara sepenuh masa untuk membantu menjalankan perniagaan
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BIL.
PESAKIT
Jurujual, Kerani - di 2 tempat
Tidak dapat bertahan lama di semua tempat kerja. Kembali ke Day-Care – Juruwang Coffee-Corner
2.
K.S.N
Operator di kilang tepung, part-time cleaner, bekerja di beberapa restoran dan kedai makan
Tidak dapat bertahan lama di semua tempat kerja. Kembali semula ke Day-Care – Juruwang Coffee-Corner
3.
F.H
Tiada
4.
L.L
Tiada
5.
H.P.K
Jurujual di kedai buku
Tidak dapat bertahan lama. Kembali ke Day-Care. Aktif di dalam membantu membuat persiapan di Coffee-Corner
6.
L.H.Y
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8.
P.C.H
Tiada
Tidak berapa aktif tetapi boleh melaksanakan tugas-tugas pembersihan meja, pinggan- mangkuk dengan pengawasan minima dan keluarga bangga dengan prestasi yang ditunjuk.
9.
C.C
Tiada
Pesakit mild MR – dapat membantu tugas pecucian pinggan-mangkuk dengan pengawasan minima.
10.
V.L
Tiada
Produktif di Coffee-Corner dan berjaya berinteraksi secara positif dengan staf dan pesakit lain ( paranoid schiz ) jika dibandingkan sebelumnya
11.
S.K.H
12.
S.O
Kembali melanjutkan pelajaran
Diberitahu – dropped out selepas beberapa bulan dan tidak hadir ke Day-Care lagi
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TARIKH
PERKARA
LAMPIRAN B UNIT PEMULIHAN CARAKERJA HOSPITAL TUANKU JAAFAR SEREMBAN
FUNCTIONAL ABILITY ASSESSMENT FORM Name of patient : In/Out : Diagnosis : Sex : Age : Address :
Occupation : Marital status : Educational level : FAMILY HISTORY: ………………………………………………………………………………………………
………………………………………………………………………………………………
DATE
VII Time management
VIII Money management
B TASK ORGANISATION
I Attention Span
II Problem Solving
III Decision Making
IV Frustration Tolerance
V Memory Functioning
VI Verbal Instruction
VII Learning Ability
C MOTOR TASK
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HOSPITAL UNIVERSITI SAINS MALAYSIA, KUBANG KERIAN.
2. PENGENALAN
2.1 Projek Bengkel Cuci Kereta merupakan salah satu aktiviti utama
yang telah dijalan oleh Unit Rehabilitasi Psikososial HUSM. Projek ini telah
mendapat peruntukan kewangan daripada Malaysian Psychiatric
Association (MPA) dan Syarikat Ubat Jansen Cilag berjumlah RM 4200
yang disalurkan melalui Persatuan Perubatan Psikologi Kelantan
(PERSIKOL) pada tahun 2003. Keseluruhan peruntukkan yang diberi telah
digunakan untuk membeli kelengkapan peralatan bagi mengendali projek
tersebut manakala tapak bengkel (rangka besi berbumbung dan stor
simpanan) telah disediakan oleh pihak Hospital USM.
2.2 Bengkel ini telah dirasmikan oleh Pengarah Hospital U.S.M pada 5
Ogos 2003 dan mula beroperasi pada 6 Ogos 2003. Pada peringkat
awalnya bengkel ini dikendalikan oleh oleh 4 orang pesakit psikiatri yang
menjalani pemulihan di Unit Rehabilitasi Psikososial HUSM, Kubang Kerian
dengan dibantu oleh seorang Pembantu Perubatan dan seorang Atenden
Kesihatan. Bengkel ini juga telah mendapat sambutan yang amat
menggalakkan selepas ianya dimulakan.
Secara umumnya projek ini diadakan bagi memberi kemahiran am kepada
pesakit sebelum mereka kembali ke kehidupan sebenar selepas keluar dari
hospital.
kepada masyarakat
batasan-batasan yang terdapat padanya yang disebabkan oleh
penyakit yang dialaminya.
perbelanjaan kewangan dan dalam membuat keputusan.
3.24 Membantu pesakit supaya untuk meningkatkan keyakinan diri dan
dapat berdikari serta tidak bergantung kepada orang lain.
3.25 Mengurangkan persepsi negatif masyarakat terhadap pesakit-pesakit
mental
4. PERJALANAN PROJEK
4.1 Sejak ditubuhkan sehingga kini Bengkel cuci kereta Unit Psikososial HUSM
telah menjalankan operasi pada setiap hari bekerja bermula pukul 9:00 pagi
dan berakhir pada pukul 5 petang.
4.2 Pesakit-pesakit yang datang menjalani pemulihan di bengkel cuci kereta
adalah merupakan pesakit yang telah dirujuk untuk menjalani pemulihan di
Unit Rehabilitasi Psikosial dan telah dinilai oleh Pakar Psikiatri dan Jurupulih
Carakerja Unit Rehabilitasi Psikososial.
4.3 Gaji atau upah pesakit dibayar berdasarkan jumlah kenderaan yang dicuci
yang mana separuh (50%) daripada bayaran yang diterima akan dibagi
diantara pesakit yang mencuci kenderaan tersebut.
4.4 Separuh (50%) lagi dimasukan dalam tabung Unit Rehabilitasi Psikososial
bagi kegunaan membeli keperluan bengkel dan membiayai tambang dan
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Psikososial HUSM.
5.1 Oleh kerana tapak projek berada dalam kawasan Hospital, perkhidmatan
projek hanya ditawar kepada kakitangan-kakitangan HUSM sahaja Purata
kenderaan yang dicuci adalah 4 hingga 8 buah sehari bergantung kepada
kemampuan dan jumlah pesakit yang hadir.
5.2 Pendapatan pesakit sehari adalah diantara RM 5 hingga RM 15 sehari
seorang bergantung kepada jumlah kenderaan yang dicuci oleh mereka.
5.3 Setakat ini 6 orang telah didiscajkan daipada projek ini kerana telah
mendapat pekerjaan ditempat lain dan seorang telah berjaya menyambung
pelajaran dalam bidang kemahiran di Giat MARA.
6. KESIMPULAN
6.1 Melalui projek ini, pesakit telah dapat mempelajari konsep bekerja sebenar
yang mana ia menekan orientasi kerja dan ‘reinforcement”. dan pesakit juga
dapat belajar kemahiran baru dan meningkatkan pengalaman bekerja
sebagai persediaan untuk kembali ke pangkuan masyarakat .
6.2 Projek ini juga telah membantu menambahkan pendapatan pesakit dan
mengurangkan serba sedikit beban keluarga. Dengan pendapatan yang
diperolehi secara berterusan, pesakit boleh dibantu untuk merancang
pengurusan kewangan dan belajar hidup berdikari
Disediakan Oleh : Disahkan Oleh :
25
Project: Car Wash & Polish DR HJH RABAIAH MOHD SALLEH CONSULTANT FORENSIC PSYCHIATRIST HOSPITAL BAHAGIA ULU KINTA INTRODUCTION Hospital Bahagia Ulu Kinta, the largest of 4 psychiatric institutions in Malaysia came into operation way back in 1911. Then, it had a population of about 5000 inmates, some of whom had been brought in from places as far as Singapore and Sumatra, Indonesia. Slowly over time, with the advancement of better medicine and good psychiatric care provided, Hospital Bahagia Ulu Kinta (HBUK) was able to bring its total number of inmates to the present average of 1900-2200 Admissions to HBUK are either via civil or medico-legal admissions. The definition of medico-legal or forensic admissions is admissions via referrals through the courts, prisons and other relevant detention centers. Forensic psychiatric patients are those patients who have had some problems with the law. Usually their first contact with HBUK is as a result of running foul of the law and the judicial system. A large majority of the mentally disordered offenders gets referred by the courts for a psychiatric assessment as is provided for under the Malaysian Criminal Procedure Code (CPC). A psychiatric report is issued at the end of their stay, which is then used in courts. Most of them do not come back as forensic admissions anymore. However the law provides for readmissions to the Forensic Wards HBUK under Section 344 of the CPC, a section of the law which provides for detention because the patients (accused in the court of law) were not fit to stand trial and Section 348 of the CPC which provides for detention because the patients were found guilty as charged but acquitted because of insanity at the time of offence. Thus, most of the patients at the Forensic Wards of HBUK are those detained under the above-mentioned sections of the Malaysian CPC, 142 patients under section 348 CPC and 28 patients under section 344 CPC, out of which 15 are female forensic patients. The majority was diagnosed to be suffering from schizophrenia (90%) while the rest had diagnoses, which included bipolar mood disorder, organic mental disorder, mental sub normality and personality disorder with poor impulse control. FORENSIC REHABILITATION Forensic psychiatric patients are difficult to treat. They are involuntarily committed for treatment, and few would seek inpatient treatment of their own violation, despite or perhaps because of gross psychiatric and functional impairment. A psychosocial approach to treatment focuses on the reduction of psychiatric symptoms, primarily
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through medication and the development of functional skills associated with relapse prevention and adaptation to less restrictive environments. The ultimate goals are recovery, reestablishment of normal roles in the community, development of a personal support network and increased quality of life. With the objective of preparing patients for an independent life in the community, a paradigm shift from totally custodial to active promotion of Psychosocial Rehabilitation with the support of a multidisciplinary team was actively pursued. Psychosocial Rehabilitation Therapy starts from the day a patient is received into the forensic wards. There are 5 wards especially designated for forensic male patients, comprising of ward 23 as a high security forensic ward, ward 22 and 24 as medium security forensic wards and ward 21 and 25 as open forensic wards. The Forensic Car Wash and Car Polish Projects are projects initiated especially for patients who have undergone rigorous assessment and work-up before they finally become residents in the open wards 21 and 25. Thorough and comprehensive patient assessment is an essential prerequisite to the appropriate provision of rehabilitation therapy services. Ward 21 is a 12-bedded ward while ward 25 is able to hold 25 patients. Most of the patients in these two wards are stable, quite motivated, may or may not have good family support but essentially they are all stable enough to be discharged back into the society. In preparation for their eventual discharge, being job-placed is one of the main focuses of the patients and staff attached to the wards. PROGRESS The Fountain Car Wash Project was initiated and officially declared open by YB Dato Hj. Ahmad Husni bin Hanadzlah, Member of Parliament for Tambun on 26 July 2003. With a grant of RM5000 from the Malaysian Psychiatric Association (MPA) and a further RM2000 from the Forensic Funds a simple extension was made next to ward 25. Technical assistance was given by several other Government and Private agencies to do the necessary drilling and pumping up of underground water to be used for the project. Electrical wiring and other necessary perihelia were sponsored by the Hospital Support Services. Seeing that the Car Wash Project was so viable and noting that the regular clientele had increased, the staff running the project agreed that the Project be extended further. Thus The Car Polish Project took off early this year (2007). Once again, the Malaysian Psychiatric Association (MPA) was approached and a grant of RM4960 was approved in October 2006. Part of the grant was used to extend the Project site further so as to accommodate more vehicles, which now include hospital ambulances, buses and lorries. A couple of nursing staff and patients were initially sent for “training” at a nearby petrol station. Since then, many more patients had undergone on the job training and the Project has gone into full swing. To date, the management of the Hospital Support Services had pledged their support to assist in sending all types of hospital vehicles for washing and polishing. The charges, worked out to be cheaper than those offered by outside agencies.
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Being a big institution with approximately 1400 staff, getting customers is not too difficult. Even then, the public is also welcomed and with better publicity, more vehicles are coming in for the service. OBJECTIVES ACHIEVED What was initially thought to be a way of earning money for ward activities, turn out to be more than that. Being a structured activity, the patients are kept fully occupied. The Car Wash Project operates between 9 am to 5 pm everyday of the week except Mondays. 12 patients are divided into 2 shifts. At the end of the week, each patient receives an emolument of RM15 to be used as and when they like. At the same time, budgeting skills are put in place where the patients are encouraged to spend their hard-earned pay wisely and saved some for rainy days. With money stored away, their self-esteem increased. At the same time, because they work in groups and have to interact with the nursing staff and clients, there was subtle improvement in their communication and social skills. From there, some of them have graduated into better employment with higher pay as security guards, grass cutters, gardeners etc. It must be mentioned that all categories of staff are actively involved in the Project, from the Ward Attendants, to Medical Assistants, Occupational Therapist, Social Welfare Officers, Medical Officers and Psychiatrist-In-Charge. They each have their own roles in making sure that the principles and objectives of psychosocial rehabilitation are met and the ultimate aim of developing the patient’s life skills, which will make their transition to life in the community easier. Charges wash and vacuum with polish Motorbike RM2.00 Car RM6.00 Van RM8.00 4-Wheel Drive RM12.00 Lorry (1 ton) RM15.00 Lorry (3ton and above) RM30.00 Bus RM50.00 CONCLUSIONS Despite the initial setbacks, in terms of lack of funding and number of interested staff, and the risks involved, the Forensic Car Wash and Polish Project, has seen remarkable changes among the patients, not only among those involved directly, but also patients from other forensic wards. The conflict between those who think that safety is paramount, that patients cannot be trusted to be responsible and that individual choice can be sacrificed for the greater good and those who argue that some patients need the opportunity to take responsibility and that individual choice is important both as a right and as a basis for therapy needed to be worked out before
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the multidisciplinary staff were reassured enough to take up the challenge of dealing with the “difficult and dangerous to handle patients”. Both patients and staff recognized the Project as the carrot dangling at the end of a long pole, that the light at the end of the tunnel lies in being moved upwards from a closed, high security ward to an open ward and given the honour of being job-placed as a car-wash and polish assistant and later graduate to better paying jobs is the ultimate achievement. THE BEGINNING
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