The Experiences of the Department of Mental Health, in helping the survivors from the Tsunami Disaster By Dr.Wachira Pengjuntr, M.D. Deputy Director General Department of Mental Health Ministry of Public Health, Thailand 2 3 4 5 Health Care System in Thailand Office of the Permanent Secretariat The Permanent Secretariat

The Local Administration

Provincial Public Health Office Head Of the Provincial Public Health Office

District Public Health Office Head of the District Public Health Office

Provincial Hospitals/General Hospitals (93)

Community Hospitals (716)

Health Office (4,000+) 6 Mental Health Services System

Ministry of Public Health University Hospitals

Ministry of Defense Hospitals Dept. of Mental Health Ministry of Interior Hospitals Tertiary Care Psychiatric Hosp.(17) Metropolitan Hospitals

Office of PermanentSecondary Care Secretary General Hosp. MOPH Primary Care Private Hospitals and Clinics Comm. Hosp./ Health Center

People with mental problems Psychiatric patients

7 Management of patients with mental disorders

Psychiatric Hosp. Both 13% 9%

78%

Primary & Secondary Care setting

8 The Roles and Responsibilities of The Department of Mental Health

During the Emergency Phase

9 Established the Mental Health Center for Thai Tsunami Disaster ( MHCT) at The Department of Mental Health, Ministry of Public Health, Province

10 Department of Mental Health

Mental Health Center for Thai Tsunami Disaster

The mobile teams Suan Saranrom Psychiatric in the 6 provinces Hospital in 11 12 A Teleconference Room at the MHCT

13 14 15 16 Set up Mental Health Mobile Teams Each team consists of 10 personnel 1 Psychiatrist 2-3 Psychologists 1 Social Worker 2 Psychiatric Nurses 1 Pharmacist 1 Assistant Nurse 1 Driver

17 18 19 The Responsibilities of the Mobile Teams

20 21 22 23 24 25 26 The Roles and Responsibilities of The Department of Mental Health

During the Post Impact Phase

27 New Concept

• From Providers to Facilitators • From Victims to Survivors • From Function Oriented to Area Oriented • From Individual to Family and Community

28 Deliver psychoeducation through variousvarious mediamedia

Website MHCT @ http://www.dmh.go.th/dmhmcc/dmh_tsunami//

29 Public Education

30 Training health personnel and volunteers

31 32 Training the Volunteers

33 Main content of the training course • Disaster and normal stress responses • Roles and responsibilities of the helpers • Secondary trauma and self care • Early intervention for the survivors: psychological first aid, brief assessment, etc. • Psychoeducation for public • Working with families and communities • Referring System

34 35 Organized the workshop and conferences

36 37 38 Post Tsunami Mental Health Assessment (8th weeks post-disaster) Adult : From DMH & TUC Displaced Community Community % Phang Nga Krabi/Phuket Severe PTSD 12.1 6.8 3.0 Mod. PTSD 15.4 11.2 6.2 Children : Displaced Community % Phang Nga/ Krabi/Phuket Severe PTSD 13.3 8.1 Mod.PTSD 31.6 28.3 The Roles and Responsibilities of The Department of Mental Health

During the Recovery Phase

40 Strengthening the network in the community for the continuous and permanent recovery

41 The meeting at the Center of Public Health Surveillance and Relief After Tsunami Disaster

In the six southern

42 Plans of the Intervention and Rehabilitation for the Tsunami survivors (2005-2006) Guideline to Follow Up and Rehabilitation 2 months – 2 years period after the Tsunami Disaster

Health Center/Community Promote Community Actions

H.C./Community Home visit/ Community Health Status Assessment Basic At Risk ? N Counseling Y Refer to Provincial/General Hosp./Comm. Hosp.

Treatment Comm./Gen.Hosp. 1 Year Follow up? Y Follow up N

Provincial/Psychiatric Hosp. Psychiatric Team 44 GuidelineGuideline forfor PrimaryPrimary CareCare andand ReferringReferring SystemSystem

Comm./Gen.Hosp. Patients Admission from The Community

N BasicBasic Nurses Screening CounselingCounseling Y Medical Doctor Diagnosis N Y Doctor + Nurse Treat by medicine & Counseling

Doctor + Nurse 1 Year Follow up

N Doctor Patients with Severe Symptom Y Provincial/Psychiatric Hosp. Psychiatric Team 45 - Psychoeducation for Public - Training Courses for the community leaders such as VHV, monks, imam, etc. - Follow up the risk group and the patients - Surveillance on PTSD, Depression, Suicide and Drug Abuse - Research study - Database and report system development

46 Ment al Health Recover y Center

ศ ูนยฟนฟูสุขภาพจิต กรมสขุ ภาพจิต

47 Thank you

48