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of the treated psychotic patients, 70 had improved quality of life in three months; and
of the treated psychotic patients, 80 improved in Global Assessment of Function GAF in three months.
6.9 Timor-Leste:
Mental health in Timor-Leste: Dr Gaspar P. Quintao
Timor-Leste activities in strengthening the PHC system to deliver care for mental and neurological disorders were conducted in two sub-districts:
Lequidoe sub-district of Aileu district and Maliana sub-district of Bobonaro district. The strategies adopted to strengthen the PHC involved community
mental health awareness, assisting mental health case managers to deal with difficult cases through phone calls to psychiatrist and site visit, training
general health workers to identify cases of epilepsy and ongoing training for psychiatric nurses.
The combined population of the two study areas was 3242. The estimated number of cases of epilepsy assuming a prevalence of 1 would
be 423. Before the beginning of the project, 95 patients were on regular treatment, i.e. a treatment gap of 70.7. After implementation of the
project, 112 patients were on regular treatment, i.e. a treatment gap of 53.7.
Carbamazepine, the anti-epileptic medication used in the pilot projects, was provided free of cost, kind courtesy of the Royal Government
of Thailand, through a government-to-government exchange, facilitated by the WHO Regional Office.
Impact indicators:
An increase in the number of patients attending psychiatric clinic and community-based services.
Reduction in treatment gap from 70.7 to 53.7.
Challenges: The challenges faced were limited drug supply,
geographical factors such as remote locations and poor access by road, external factors such as presidential and parliamentary elections being
conducted during the project period, logistics and shortage of human resources, people’s faith in the unconventional systems and traditional faith
healers, and stigma and discrimination towards mentally ill patients preventing people from seeking help.
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6.10 Viet Nam:
Community mental health programme:
Dr Truong Le Van Ngoc
A 2002 estimate showed the rate of mental and neurological disorders in the population to be 14.9. An action plan was developed which
attempted to integrate mental health-care into PHC.
The objective of the plan was to increase the quality of mental health services and integrate this care into commune health centres. The target set
was mental health services should include implementation of programmes in 70 of communes administrative units. Of the patients detected with
mental and neurological disorders, 50 should be managed and supported to live in the community.
Impact indicators:
All the provinces 100 are covered by the programme 6363 provincescities.
Of the communes, 70 are covered by the programme for schizophrenia and 7 by the programme for epilepsy.
Of all the patients, 49 patients with schizophrenia are managed, of which 70 of patients are stable.
Challenges: Limited mental health workforce, inadequate training of
health workforce, overworked health staff, competing priorities, limited awareness about mental health and poor communication in remote areas.
7. Scaling up programmes to strengthen the
primary health-care delivery system for mental health-care
Bhutan: Scaling up programmes to strengthen the primary health-care delivery system for mental health-care: closing the treatment gap for epilepsy
The delegates of Bhutan presented their plans to scale up the treatment gap project for epilepsy. This will be done in two phases. In the first phase, in
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2012, they will scale up the project in nine districts in the east Lhuntshi, Tashi Yangtse, Tashigang, Mongar, Samdrup Jongkhar, Pemagatshel,
Bumthang and Trongsa. In the second phase, the project will be scaled up in the remaining 10 districts in the west and central region Zhemgang,
Sarpang, Tsirang, Dagana, Wangdue, Gasa, Haa, Paro, Chhukha and Samtse.
The implementation plan involves assessment of the treatment gap for epilepsy in the individual districts and then setting the targets based on the
local situation. Support will be garnered from local healers, religious groups, VHWs, family and the community at large for care of people with mental
and neurological disorders. In addition, there will be sensitization of community leaders and use of local mass media to sensitize the community
on mental health issues.
Strengths: While delineating the strengths of community care for
mental and neurological disorders the importance of a functioning and well-maintained primary health network system in the country was
mentioned. The importance of the strategies being concurrent with the Eleventh Five Year Plan FYP was highlighted.
Challenges: The challenges faced were inaccessible hilly terrain, and
communities located in remote areas. The people are agrarian, with poor literacy and unaware of the services available. There are limited mental
health professionals and PHC workers are overloaded with vertical public health programmes.
Promotion of mental well-being in schools: the programme will be scaled-up in 18 schools of Punakha district apart from the three pilot
schools with the focus on three areas: evaluation pre- and post- assessment, monitoring and feedback between schools and districts
programmes.
