Report on Volunteer Placement in the Solomon Islands with the WHO Pacific Mental Health Network

Dr Ashok N Singh

Introduction

I worked for three months teaching mental health to nurses, the sole psychiatrist and various other health professionals in the Solomon Islands. I also developed policies and protocols for Community Mental Health and Rehabilitation Services on behalf of a joint project between the WHO and the Royal College of Psychiatrists.

This three months experience was wonderful and a profoundly creative experience. During this period I gained valuable experience which will contribute to work with people from a wide range of cultures. It also developed my skills to manage with limited resources. This three month placement helped me to understand the perception of mental health and illness in other cultures, the impact of global recourses - that is financial, cultural and environmental – on indigenous cultures and most importantly the understanding of means by which mental health diagnosis and treatment can be delivered where resources are scarce and the ability to prioritise those scarce resources is vital. There were also personal challenges; living there was at times quite lonely even though the people were extremely courteous and very helpful. All in all this three month placement was enormously worthwhile.

                                                                          Dr Ashok Singh

Overview

This three month placement in the Solomon Islands had 5 main aspects:

1.  Clinical Skills:  Joint consultation (including home and prison visits) with psychiatrists and senior nurses to improve diagnoses, prescribing, psychosocial rehabilitation and psycho-education with patients and families.

2.  Management Skills:  To promote skills for the service and the team by holding and chairing regular meetings with Director of mental health, psychiatrist and senior nurses.  Also teach staff to be able to do simple audit and data collection.

3.  To develop WHO model for CMHT and to establish individual care plans.

4.  To reduce relapse and readmission rate.

5.  To improve mental health services to the local prison.

Teaching component

In addition to the above I was also asked to teach the following topics to the senior nursing staff:

1. Assessment of suicide and deliberate self-harm.
2. Psychopathology and mental state examination.
3. Pharmacological treatment and side effects.
4. Management of violence and aggression.
5. Legal aspects of mental health and mental treatment act.
6. Psychosexual medicine.

and to teach 12 medical directors from provinces on:

1. The assessment and management of deliberate self-harm and suicide prevention.
2. The management of acutely disturbed behaviour.

These teaching sessions were undertaken over a 2 month period. These sessions were all class room based and also involved workshop format.

                                                                                           Teaching session with senior nursing staff

Other aspects on my work focused on Service Development:

1. Relapse prevention and relapse signature workshops - 11 attended.
2. 2 audit workshops at Honiaria.  6 senior and 6 junior staff attended.
3. 2 audits completed:
   1. Demographic data collection 
   2. Reasons for non-compliance with depot injections.
4. "Chairing a meeting" with agenda items. 7 workshops and 42 attended.
5. 2 meetings with local architect regarding CMHT office building and renovation.
6. CMHT operational policy and triaging workshops - 5 core group members and several workshops.
7. Joint assessment with senior staff in the prison - 4 assessments.
8. Total number of out patient joint assessments - more than 70 (including family members where possible).
9. Total number of assessments with CMHT members - 17 new patients.
10. Total number of in-patient joint assessments with psychiatrist and senior nurses - 71
11. Special population (postnatal and perinatal psychosis) joint assessments - 4.  Also this included psycho-education, family education and pharmacological treatment.
12. Family visits with CMHT members - 8

Kilu'ufi Hospital 5^th – 9^th April, 2010: 

Kilu'ufi Hospital is the second largest hospital in Solomon Islands and is located near Auki, the capital of Malaita Province. I spent some time there during April 2010.

The national psychiatric unit at Kilu'ufi Hospital has 20 in-patient beds.  There are no psychiatrists and the services are nurse led. The unit is 30 minutes flying time from the capital.

While at Kilu’ufi I carried out joint assessment with senior nurses and psychiatrist; 15 in-patient and 7 out patient assessments in total.

I also organised a workshop on audit and data collection which 6 staff attended and a workshop on psychosocial rehabilitation which 5 staff attended.

The following documents were developed during my visit:

1. Prison referral form

1. CMHT patient allocation form
2. Relapse signature and prevention (individualised form)
3. CMHT individual care plans
4. CMHT operational policy.
5. CMHT triage form.
6. Several books, self help manual and DVD given to CMHT to begin a resource centre for service users.

Extensive training has been given to staff and CMHT triage form is now being used routinely.Their skills (ie history taking and mental state examination) have improved.

I assisted with management training to senior staff and team leader and focussed on how to establish and maintain:

1. Out-patient appointment book.
2. CMHT appointment book.
3. Community treatment card.
4. Out patient appointment card.
5. How to manage a team.
6. Managing CMHT vehicle (log book)
7. Maintaning a team communication diary.
8. Manage CMHT recurring budget.
9. How to manage and supervise a team member and their PDP.

Mentoring of local psychiatrist has started about management skills and he is now sharing responsibility for service development and training.

Discussion with carers has started to establish a carers' forum/pressure group.

Part of budget has now been devolved to CMHT team leader for recurring expenses in order to ensure its sustainability even after the departure of the visiting consultant.

The community mental health team is now established comprising of 1 team leader, 3 qualified nursing staff and nurse aide and the team is now fully operational.

                                                                                                               Dr Ashok Singh with CMHT

Mental Health services in the Solomon Islands facehuge Challenges and one of my main suggestions for development would be for the development of a strategy for a National mental health service to include;

Next Stage of Development requires:

1. Political commitment.
2. Strengthening and building capacity to provide quality of care and services.
3. Developing and implementing evidence based preventative practices at community level and developing information systems to capture relevant data.

And Finally….        

The community mental health team (CMHT) was inaugurated on the 6^th of May by a service user in the presence of more than 50 invited guests from Ministry of Health, INGOs, NGOs, departments of police, prison service, the local media and the ceremony was addressed by Dr Adu-Krow and myself.