Speaking of mental health problem, we know that it is one of the main public health problems in our country. We hear about it on the news all the time. It accounts for a large proportion of the disability-adjusted life year (DALY) – number of years lost due to health problems, disabilities and premature death of a country. Also, treatment of psychiatric patients can be complicated and costs a lot of money, especially in low and middle-income countries where specialists are scarce. This is when the community based-services come in to assist, and ensure that psychiatric patients receive proper treatment and can live a more fulfilling life after they are discharged from the hospital.
Community-based services are known to assist patients in rehabilitation process, preventing relapse, maintaining relationships, and securing job. The services align with policies from Department of Mental Health, Ministry of Public Health, which focus on shortening the period of hospitalization and returning patients to their families. And to respond to the policies, psychiatric services had been integrated into Primary Health Care provided by community nurses in the Primary Care Units (PCUs). However, a concern about specialty skills needed for treating psychiatric patients has been raised since most of the nurses in PCUs has passed a training course for primary medical care, but not the psychiatric care.
To find out what experiences of psychiatric patients are like in PCUs, two researchers from School of Nursing, Walailak university: Associate Professor Dr. Naiyana Noonil and Associate Professor Dr. Saifon Aekwarangkoon went to the PCUs in areas of Nakhon Si Thammarat, Surat Thani, Krabi, and Phang Nha. The study “Psychiatric Patients’ Experience in Receiving Services Provided by Nonspecialist Community Nurses, Southern Thailand”, by the two researchers, is funded by Thailand Nursing and Midwifery Council. The process of the study started by building trust and a sense of security between patients and researchers. There were 11 patients, 10 with major depressive disorder and one with schizophrenia, the age ranging from 29 to 63 years, participating in the study. They were told about the study’s objectives and able to quit anytime during the interview. The interview consisted of semi-structure questions and took about 40-60 minutes in a confidential room.
Associate Professor Dr. Naiyana Noonil Associate Professor Dr. Saifon Aekwarangkoon
The result of the study suggested that patients’ experience of the services provided by community nurses can be divided into two categories: barrier experiences (negative), and facilitating experiences (positive).
The barrier experiences are caused by deep suffering in psychiatric symptoms, treatment side effects, loss of human’s values, and loss of daily functioning that are not recognized by the community nurses. Even though patients are happy to see the nurse, the home visit by the nurse can cause a stigmatization of patients as being mad. Patients realized that taking medicine is important in coping with physical problem, but it is not enough for deep mind caring. “It seems like my suffering is there, and nobody could see it,” mentioned one of the patients. “They are doing very good in helping me with my physical symptoms, but that doesn’t cover what is needed for the mind”. Thus, this implies that specialists are needed for the work in PCUs.
However, the patients know that the nurses are sincere and willing to help. They help boost patients’ self-esteem and encourage them to be able to live with society. One of the patients mentioned that the nurses even changed their uniform when come visiting in order to blend in and reduce the stigmatization. Besides, they also help patients get a job by cooperating with business owners and organizations.
The study has showed how important the community-based services are for psychiatric patients, and the specialists are needed in PCUs. This leads to the next step of how psychiatric treatment can be improved to better the services. “Now we continue our works. We write books, and train public health volunteers,” said Assoc. Prof. Dr. Saifon. “We try to create mental health awareness and provide knowledge for children.” Knowing that no matter how you feel, you can talk about it and never be lonely, children are now more capable of understanding their emotions, expressing their feelings as well as connect with others in family, and strengthen their relationships. This is believed to be a good start in preventing and reducing risks of developing a mental illness in a long run. “Children are our hope. And for me, the patients are heroes,” said Assoc. Prof. Dr. Saifon.
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Photos by Assoc. Prof. Dr. Naiyana Noonil and Assoc. Prof. Dr. Saifon Aekwarangkoon
Article by Settaboot Onphakdee