building
up policies and strategies for mental health sector up
until
the years 2000-2020
Assistant Prof. PhD Tran Viet Nghi
Director of the Mental Health Institute - Hanoi
A. According to a clinic-epidemiological survey in many cities and
provinces for several years focusing on 10 main psychiatric diseases with
diagnostic criteria of ICD 9 (International Classification of Diseases), we
obtain the following data :
1. The total prevalence
rate of mental diseases in the population is about 10 % (7-8 % in rural area,
11-12 % in urban area).
2. The prevalence rate
of schizophrenia : 0.6 % (0.3 – 1 %)
3. The prevalence rate
of epilepsy : 0.5 % (0.3 – 1.5 %)
4. The prevalence rate
of emotional disorder : 1 – 5 % in which depression is
common in practice, at least accounts for 3 %.
5. The prevalence rate
of severe oligophrenia : 0.5 % (0.3 – 1.5 %)
6. The prevalence rate
of psychopathy : 0.5 – 1 %
7. The prevalence rate
of post-traumatic mental disorders (cranio-cerebral
trauma)
8. The prevalence rate
of neurosis : 4-6 %
B. Some diseases at high risk :
Owing the major changes in the national economic structure,
industrialisation, speedy urbanisation and mechanical population growth, the
unsound urban concentration of people in market mechanism is the environmental
factor affecting mental health and several diseases emerge and increase such as :
1. Substance abuse
including :
·
Drug abuse, accounting for 0.15 – 1.5 %
·
Alcohol abuse, accounting for 0.21 – 3 %
2. Behavioural
disorders, particularly severe in
adolescents of 10 – 17 years, accounting for : 3.7 %
The above-mentioned list is still deficient for not including some
common diseases having great impact on the health of people, due to
unfavourable socio-psychological factors such as :
·
Depression, anxiety in different forms, especially
hidden depression with many systemic, vegetative, viscera disturbances, general
asthenia…
·
Behaviour disturbances in adolescence such as
aggressiveness, violence, unruly motorbike race, abuse of drugs, alcohol,
tobacco, psychedelics medicines and other controlled substances.
·
Suicide, traffic accidents related to driver’s
psychology and abuse of substances…
If the data of investigation were complete, more reliable with full coverage
of all those disorders, the rate of mental disorders in our country would be
approximately the same as the data published in many other countries in the
world and in the region, i.e. around 20 – 25 % of the population.
A. General objectives
:
·
Promoting mental health of people
·
Decrease of prevalence rate of mental diseases with
clearly identified causes
·
Prevention and control of mental diseases emerging
from the economic change (depression, drug and alcohol abuse, suicide…)
·
Facilitating long-term remission by preventive
measures, socio-psychological rehabilitation for chronic mental patients with
complicated causes
B. Specific objectives
:
1.
For endogenous
mental diseases (schizophrenia, cyclothymia,
epilepsy)
·
Enhancing the quality of care, early diagnosis and
early treatment
·
Good selection of appropriate and effective therapeutical methods
·
Organising preventive care so as to reduce chronic
disease rate, increase remission rate and stabilisation rate
·
Focusing on community-based socio-psychological
rehabilitation and home visit by building a good network of mental health care
with involvement of doctors and experts having proficient professional skills
and management, organisational experiences
2.
For organic mental
diseases
Co-ordinating
with other clinical and paraclinical specialities to
make on-time detection and early treatment, developing infantile psychiatry,
elderly psychiatry with relation to brain lesions caused by malnutrition, neuro-infections, neuro-traumas.
3.
For mental diseases
caused by socio-psychological factors
-
Drug abuse
·
Education and communication to raise awareness about
the hazards of drug addiction, warning everyone in community and particularly
high-risk groups, adolescents against drug use; self-protection and social
welfare preservation.
·
Searching the appropriate, feasible and affective
models in long-term treatment of drug addiction on community basis, with
support of psychotropic medicines, methadone, traditional
medicines.
-
Alcohol abuse,
alcohol addiction
·
Chimio-epidemiological
study on alcohol abuse
·
Research into clinical characteristics and therapeutic
methods for delirium tremens
·
Communication and recommendation for drinkers
proposing motion to the government and all levels of authority about finding
solutions for preventing high risk of alcohol abuse in the coming decade.
-
Anxiety, depression
and suicide
·
Study on clinical epidemiological characteristics of
anxiety, depression suicide design… finding out measures for early detection
and treatment, prevention of suicide.
-
Behavioural
disorders
·
Combining with schools, youth unions to find out
children, adolescents affected by these disorders, and to preserve them from
the risk of substance abuse at school.
1.
Continuing to build
up, develop and strengthen mental health care network from central to local
level
·
Central level : promoting and
accepting new technology, incessantly perfecting facilities and equipment to
meet the needs of investment, scientific research and retraining staff.
·
City and provincial
level : every city and
province needs to set up a mental hospital with 50-100 sickbeds to satisfy the
need of investment for mental health care, according to its specific size of
population. Along with constructing the station (Provincial Mental Health
Centre) for management, investment organisation, health care and prevention in
community and in local area.
·
District level : constructing a
mental clinic at every district and township, and reserving 3-5 sick beds in
district hospital to manage emergencies of mental diseases.
·
Precinet and Commune level : integrating mental health
care in the general health care system, especially in the sphere of education
and training for manpower development, expansion of patient management at home,
socio-psychological rehabilitation, avoiding all perturbations for patients and
their families.
2. Developing infantile psychiatry and elderly psychiatry
In psychiatric hospitals, 10 % of total sickbeds is
designed for children and number of sickbeds for the elderly.
3. Promoting quality of diagnosis and treatment for psychiatric
doctors at district level, training general practitioners in integrated mental
health care, and replenishing the staff of psychiatrists so as to have 1
psychiatrist for 10.000 people, training specialists in postgraduate
qualifications (specialised doctors at first degree, second degree, Masters of
Psychiatry, PhD in Psychiatry); gradually training social workers,
psychologists working in the field of mental health care and as counsellors on
mental health.
4. Enhancing scientific research into applying and
assimilating technological progress for prevention and treatment
of mental diseases.
5. Enlarging and enlisting international co-operation, receiving
technological transfer from developed countries.
6. Successfully carrying out education and communication on mental hygiene,
socialisation of mental health care and protection.
7. Well performing legal medicine expertise in psychiatry,
protecting legitimate rights of citizens during illness, contributing to the
people’s respect for the law.
8. Supplying sufficient medicines for treatment and
prevention at every level of health service, and equipments needed for
diagnosis, research and training.