Source: Straits Times, 26 Aug 2009
SEVERELY mentally disturbed patients at the Institute of Mental Health (IMH) now spend far less time strapped to their beds or in straitjackets.
They also spend less time – 21 days, down from the previous 27 – in the hospital’s eight-month-old high-dependency psychiatric care unit before being moved to the general wards.
The IMH’s approach in handling acutely disturbed patients bagged it the Most Outstanding Project prize in the Customer Service Project category of the recent Asian Hospital Management Awards held in Ho Chi Minh City, Vietnam.
The 10 beds in the $400,000 high-dependency unit are laid out in two rooms and monitored round the clock.
At any one time, six to seven beds are taken, and the nurse-to-patient ratio is one-to-one, or, at most, one-to-two.
IMH declined to say what the previous nurse-to-patient ratio was.
The patients there have ailments like those in the general wards – such as schizophrenia, anxiety and bipolar disorders – but are in a more serious condition and are less stable.
Most cannot be cured, but early and aggressive treatment gives them a chance to resume life in the community, say psychiatrists.
Dr Habeebul Rahman, an associate consultant in general psychiatry at IMH, said the move to step up intensive care for this group of patients – which brings standards in line with those in Britain, Canada and Australia more than 10 years ago – has made a difference.
He explained that IMH’s approach is three-pronged:
# Biological, through the prescribing of higher doses of medication;
# Psychological, through care associated with the medications provided; and
# Social, through counselling.
Mr Aziz Abdul Hamed, a nurse clinician at the high-dependency unit, said of the patients there: ‘Like you and I, these patients just need someone to hear them out most of the time. We do that and try to allay their fears and anxiety.’
Still, every nurse there – though trained to handle these patients – carries a handheld device to raise the alarm in case a patient turns violent.
Closed-circuit TV cameras also monitor what is going on.
Dr Habeebul stressed that while some patients lash out when they hallucinate or become paranoid, not all severely disturbed patients are aggressive.
‘Most of them tend to be depressed and suicidal and need intensive monitoring,’ he said.
He said IMH was looking into introducing ‘step-down care’, in which patients and their family members or caregivers are educated on the importance of following through with the medication after their discharge.
This can speed up recovery rate and cut the length of hospitalisation for these patients.
There are no figures for bipolar or anxiety disorders here, but an estimated 20,000 people suffer from schizophrenia here, 10 per cent of whom need institutional care.