The long-term care wards at the National Institute of Mental Health (NIMH), Angoda currently house 104 men and 306 women above the age of 40. Having been admitted due to various psychiatric illnesses, many of their guardians have not come forward to take them home.
Residents of the long-term care wards, who are likely to spend the rest of their lives there, have undergone rehabilitation, according to NIMH Planning Medical Officer Dr. Ridmi Liyanage. However, she said that families showed reluctance to take them home due to various reasons, one being the anxiety about their behaviour.
“Some families tend to think these patients will scream, shout, and throw tantrums. But other than a little muttering, they are harmless and keep to themselves,” she said during The Sunday Morning’s visit to the NIMH.
Some patients are brought in by the Police and most become permanent residents of the institute. Although steps such as informing the Police of their readiness to be reunited with their families and newspaper advertisements calling their guardians to take them back are followed, they yield no results.
Dr. Liyanage said that despite their attempts, many families were not interested in taking their family members back. As of 3 April, about 40% of the institute’s in-patients were residents of the long-term care wards. While the hospital can provide food for them from Government funds, most of their care is dependent on donations.
Though rehabilitated, many of them are unable to take care of themselves alone and need support, which some families are unable to offer due to financial difficulties, especially those which emerged with the country’s economic crisis. She attributed this to the recent increase of long-term residents. Other families, she said, had abandoned the patients.
“Factors like shame caused by stigma also play a role here,” she noted. These residents have been treated for conditions such as schizophrenia, bipolar disorder, depression, personality disorders, and dementia.
Current situation
At present, Dr. Liyanage noted that only a few beds remained at the long-term wards. The emptying of a bed only happens when a resident passes away.
However, most of these long-term residents of the NIMH tend to live longer as they receive constant medical attention. Yet, Dr. Liyanage stressed that the home environment with their family around them was the best for their well-being.
Almost 75% of the residents of the long-term wards are women. The reason for this gendered aspect is attributed to men being breadwinners or being seen as potential income earners, giving families a reason for or relief in having them back. There is also research which provides evidence that older women are more vulnerable to mental health problems.
The patients, or clients as the doctors prefer to call them due to efforts towards destigmatising psychiatric illnesses, are often admitted involuntarily by their families or the Police. As they come to the institute empty-handed, it becomes the duty of the NIMH to provide them with everything, including their basic needs such as clothes and toothbrushes.
“Unlike other hospitals, we have an additional duty of giving them what they need. But the funds provided by the Government are not enough for this, so we have to rely on material donations,” she said.
Clients are first admitted to the acute ward and once the acute situation is resolved, the intermediate ward takes over their care. When the condition is satisfactory, they become ready to be discharged. This is when their families or guardians are notified, according to Dr. Liyanage.
When the guardians come to take them home, they are educated on the conditions of the patient. Once the client goes home, the institute’s Psychiatric Social Workers (PSWs) and Community Psychiatric Nurses (CPNs) continue to monitor and administer treatment through the clinic system.
Upgrades to the NIMH
Dr. Liyanage shared that long-term care was an emerging need that would grow as the ageing population increased. She spoke of plans to expand the facility to provide the long-term patients, along with other patients of the institute, with higher quality care.
“The current long-term ward appears as a typical hospital ward, which is not ideal for the home-like environment we want for long-term clients,” she pointed out.
Improving the existing buildings and constructing new facilities to provide its clients with their own rooms instead of the ward set-up is on the agenda, according to NIMH Director Dr. Dammika Alahapperuma. He said that discussions were ongoing with the Ministry of Health in this regard.
“The Government is closely monitoring the situation now and there are ongoing discussions for the upgrade,” he said.
The NIMH also has a care home system where houses external to the facility are rented by the institute. Patients undergoing rehabilitation can go to work from the care home and return in the evening. With a warden placed to care for them, they are eased into gaining independence.
It is also hoped that the NIMH will be able to permanently secure facilities or rent additional spaces in order to expand this operation, since only a few such care homes are operating at present due to their high costs.
At present, the residents partake in activities such as gardening in the institute’s spacious grounds, cooking in their in-ward kitchens, and even baking cakes. While Dr. Liyanage said that the Government’s support adequately provided all of its patients with meals, they were in need of other material goods required for activities. There was also a strong need for donations of adult diapers given the high number of bedridden patients, she said.
According to the United Nations Population Fund (UNFPA), Sri Lanka is one of the fastest ageing countries in the world. By 2030, it is estimated that one in five people in Sri Lanka will be above the age of 50.