mental health care in poor resource settings
TRANSCRIPT
Mental Health care in poor resource settingsWhat can be done?
An experience from AcehIndonesia
Marthoenis3rd course of NCDs
Kobenhavn Universitet
The contents
Situation of Aceh before 2004 Tsunami 2004 (Mental) health programmes Pasung Now
Indonesia
Aceh
Current Population: 4,5 Million out of 237 millions in Indonesia
29 years military conflict One the poorest province in Indoenesia One of the lowest HDI in Indonesia
Tsunami 2004
Banda Aceh, Calang and Meulaboh were among the hardest area hit by tsunami 2004
In total; 170.000 died and 500.000 homeless
Tsunami 2004
Population Before the Tsunami was 4,271,000 (2004) and as of 15 September 2005 was 4,031,589
Infrasctructures and local government were collaps Main general hospital was destroyed
After the Tsunami
MoU Heilsinski, December 15, 2006
Health care Reconstructions
Building new hospital and health posts Training and re-training the health officers
(nurse, midwife, GP) „Mental health programmes“
Pasung!
We have some 18.000 cases like this, how do we start?
Resources!:
Some 500 CMH nurses Strong commitment from the local goverment
BUT
Regulation? Mental Hospital : Only one with 350 beds 6 Psychiatrists for 4.4 million population
Row 1 Row 2 Row 3 Row 40
2
4
6
8
10
12
Column 1
Column 2
Column 3
The Programme:
Network between trained nurse Case finding Family of the patient Mental health cadre Referral system Local social health Insurance
Theoretically
The BarriersSaraceno et al 2007
Barrier 1: Low Political will
Barrier 2: Resistence to decentralization
Barrier 3: Difficulties in integrating Mental Health in PHC
Barrier 4: weak Human resurce capacity and development
Barrier 5: Mental health Leadership often lack of public health skills
What is missing here?
Aceh Health Insurance (2010)
Social health insurance to ensure all people have access to proper health care!
Premium paid by the local goverment
Problem Similar number of resource while the
demand of health service is inreasing
Moral hazard
However
Messages!
Mental health is sooooooooooooooo much neglected
But we can do something! Start from now Start from your self Start from a small thing
Terima Kasih