Dementia care in DMHP.

28-Sep-14 SIPSCON-2014 slide 1 of 29

A service-model for home-based care in late-stage dementia: its

scope, scale and policy implications.

(from knowledge to action)

Ramkumar G S MD(Formerly) Field Psychiatrist @ DMHP,

Kottayam.http://communitypsyindia.wordpress.com/


How to implement what we know?

• “the science of delivery”

• “3rdrd wave of research in global health”—the newest and emerging wave that builds on the preceding biomedical 1st wave and clinical-epidemiological 2nd wave.

http://globalhealth.thelancet.com/2014/07/23/putting-collaboration-heart-applied-research-and-delivery-global-health


Overview of presentation.

• A case example of a way to implement care for dementia in our health system.

• Why dementia? – it is a case example of a chronic illness which need a disease management approach.

• DMHP Palliative care program• Training, Task-sharing, horizontal

integration between programs, sharing and pooling of resources and manpower.

• Scope, scale and implications.


DMHP Service pattern.• Multidisciplinary team of

Psychiatrist (or trained MO), Psychologist (MPhil), social worker (MSW), Nurse.

• Outreach clinics in CHCs or PHCs.

• Kottayam district has 16 such monthly outreach sites.


Review of clinical data base of DMHP-Kottayam district.

• 270 of the total 725 registered are part of the clinical database.

• 12 patients were diagnosed with dementia.• Similar findings are reported from [1] DMHP

clinics from Pallakad district [2] increased utilization of DMHP clinics by elderly patients.

1. Nikhil U G, Sumesh T P, Anoop G, Shaji K S. Mental health services for older people. Indian J. Psychol. Med. 2014;36(4):449-50

2.. Tharayil HM, Thomas A, Balan B V, Shaji KS. Mental health care of older people: can the district mental health program of India make a difference? Indian J. Psychol. Med. 2013;35(4):332–4


How to provide care for the elderly demented patient.(Scope)

• Monthly clinic based care would be inadequate.

• No provision till yet for anticholinesterase medications in DMHP drug wish list.

• Mobility of care personnel to home.• Behavioral and Psychological symptoms

(BAPD) cause maximum care taker burden. It is the commonest reason for consultation.


Referral letter


Overview of palliative care program


Access to homes.


Baseline assessment of the available human resource.

• A needs assessment survey was done among the palliative care nurses when they assembled at the district level for their monthly meeting.

• Responses from seventy nurses were received and are summarized.


Summary findings


Training


To what extent is it applicable to other contexts (Scale)

• Presence of both programs through out Kerala.

• Well organised supervisory system with record keeping with direct-involvement of MO in palliative program.

• Direct involvement of local self governments and NGOs in palliative programs.

• DMHP can compliment it by horizontal interaction.


Mental health initiatives through palliative service infrastructure.

• Mental Health Action Trust. (Mallapuram,Waynad, Kozhikode)

• Mehac Model. (Ernakulum, Alapuzha)

• IMHANS model.

Also “Critically review the existing model of DMHP”

Mental Health Interventions- From Clinic to Community and beyond: Presidential Address, SIPSCON2014, Dr CJJ.


Policy implication• NCD- Mental health

integration.• Horizontal interaction

between vertical programs.

• Amalgamation of Centrally Sponsored Schemes.

• Provide comprehensive care at doorstep.


• Affirmative policies cutting across program silos needed for developing such intersectional models of care.

• Pooling of resources and finances.

• Sharing of personnel in the field for task sharing

• Incentive structure for collaborative and interdisciplinary work.


Barriers and facilitators in intersectoral linkage processes.

• Systematic, qualitative review of studies describing attempts to coordinate activities of multiple service agencies.

• System-level intersectoral linkages between the mental health and non-clinical sectors: a qualitative systemic review ; Harvey Whiteford et al, Aust N Z J Psychiatry October 2014 vol 48 no. 895-906

Facilitators

Interagency coordinating committees or intersectoral/ interface workers engaged in joint service planning.Formalised interagency collaborative agreements.A single care plan.Cross-training of staff.Service co-location.Blended funding initiatives.

Barriers

Adequacy of funding and technology.Ensuring realistic workloads.Overcoming ‘turf issues’ between service providers and disagreements regarding areas of responsibilityEnsuring integration strategies are implemented as planned.Maintaining stakeholder enthusiasm.


Questions and comments

Don't reinvent the wheel, just realign it. Anthony J. D'Angelo

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Dementia care in DMHP.

Health & Medicine

Transcript of Dementia care in DMHP.