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Project: Family Support Group In February 2004, Janssen-Cilag, the pharmaceutical division of Johnson and Johnson invited Prof. Dr Marcus Chiu from the Hong Kong Baptist University to give an interactive workshop for potential tutors of the Family-to-Family psycho-education program, now known as the Family Link Education Program. Janssen-Cilag invited about 100 potential tutors from all over Malaysia to attend the full-day workshop at the Crystal Crown Hotel in PJ. The participants included psychiatrists, doctors, social workers and more importantly carers (family members) of the mentally ill. Since then the Family Link Program, FLP in short, has spread throughout the length and breadth of our country and has proven to be an excellent means of education for the general public as well as the carers of the mentally ill. For too long, mental disorders have remained shrouded with secrecy, shame and stigma and continue to be discriminated against. But through the FLP the family can now aid in recovery (i) by getting early treatment for their ill relative, (ii) by learning about the illness and how to deal with it, (iii) by accepting the fact that the ill relative is mentally ill and (iv) by reacting with sympathy instead of with anger. Two psychiatrists from Penang , Dr Lau Kim Kah and Dr A. Bharathy were at the interactive workshop and they were so impressed with the objectives and usefulness of the 8-module course adapted by Prof Marcus from the 12 module course of NAMI (National Alliance for the Mentally Ill) of USA that the following month they started the first course at the General Hospital Penang. The first batch of about 30 participants included a few psychiatrists, a specialist doctor whose brother was mentally ill, a few hospital psychiatric nurses, social workers and carers who are relatives of the mentally ill. The tutors were all psychiatrists who shared their experiences of their clinical work with the mentally ill patients and their carers. Since March 2004, Penang has already conducted courses in English, Malay and Chinese for more than 250 participants. Nationwide the total number of participants has exceeded 2000. The dropout rate for all the batches were very low and the general view of all who attended the modules was that it should have been introduced much earlier. The goals for the caregivers who attend the FLP are:

(i) understand various aspects relating to care of the mentally ill (ii) caregivers share their experience and problems in their daily lives (iii) gain knowledge to empower themselves to help their loved ones

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(iv) help other families in similar situations (v) understand that mental illness is a brain disease and treatable (vi) that discrimination is wrong and is too widespread (vii) that stigma attached to the mentally ill is largely a result of deep

misunderstanding of mental illness. Almost all the participants were very happy to have attended the FLP Courses. They all felt that a whole load of burden had been lifted from their shoulders when they learnt that mental illness is an equal opportunity disease, striking families from all walks of life, regardless of age, race, income, religion or education. They learnt that mental illness is a brain disorder that interferes with normal brain chemistry and that genetic factors create a predisposition in some people and that life stresses may trigger the onset of symptoms. Most importantly they learnt that the illness is not anybody’s fault. The illness is not caused by poor parenting or weak character. These illnesses present difficult challenges but help is available. Support, education and a community of friends who understand can make family life satisfying and meaningful again. We received comments from participants like,” It is very hard to tell you how much this has meant to me. It has been a wonderful experience. A super workshop, highly informative, but more so because of the in-depth contact with the emotional issues involved.” Others say,” The most important aspect to me was in learning about what my mentally ill relative feels and experiences. I have so much more understanding now of so many of his actions and reactions.” “ The concept of this family education is great. We, as participants have a tool with the potential to impact many lives.” Patients suffering from serious mental disorders, particularly schizophrenia, need good family support in order to maximize their personal functioning in daily life. Families and caregivers who attend the 8-module course gain greater awareness and knowledge and are able to cope better with the patients as well as manage family stress. In 2004 and 2005, Janssen-Cilag had provided all the FLP books written by Dr Marcus Chiu (in English and Chinese) , organized a training course for trainers in a leading hotel with Dr Marcus Chiu in attendance and funded a number of Certificate Presentation Ceremonies. Local dignitaries and hospital Directors were invited to grace the grand occasions. The press was invited to highlight the usefulness and importance of FLP. The main shortcoming of the Family Link courses conducted thus far is on evaluation and training of trainers. The carers need to be given evaluation at the beginning of the course, at the end of the course and also six-months after the course to better assess the effectiveness of the program. They should also be persuaded to join a family support group in their locality so that there is continuing support and

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empowerment in other areas of care. As family members gain insight into the illness, a good percentage of them are expected to avail themselves to be trained to be tutors to increase the number of classes so that more people in the community could be reached with the FLP Courses. Getting new volunteers to be tutors is not an easy task but if we could follow the NAMI example where the task of the trainer could be simplified with specific instructions for each lesson, the job would be less daunting. Currently, there are around 2000 patients with schizophrenia being treated in the Psychiatric Department in Penang Hospital. We believe there is also an equal number, if not more, of patients suffering from various stages of depression. Thus the Circle of Care has only touched the tip of the iceberg in its effort to bring awareness of mental illness to the general public. Since 2006, the “Circle of Care” has encouraged Kebajikan Psikiatri of GH Penang to monitor various volunteer bodies, mainly NGOs, to run the FLP. At the moment, D’Home Mental Health Association, Pg CARE, Mitra Centre of Than Shang Temple as well as the hospital staff are conducting FLP from time to time. “Circle of Care has promised to give special grants for each course successfully completed and continues to supply printed materials in English as well as in Chinese written by Dr Marcus Chiu to every participant. The Bahasa version is in the process of being translated. The momentum created by the Circle of Care in its drive to create mental health awareness to the public must not be lost. It is timely that Minda Malaysia, the national association of family support for the mentally ill must begin to monitor and assess the effectiveness of the FLP Modules. Dr Marcus Chiu and his team of helpers from Hong Kong and Taiwan must regularly be invited to Malaysia to generate publicity and to provide re-training for the tutors as well as encourage more carers to be trained to run the FLP Modules. Of course, in time, our own locals could be effective trainers themselves. At the 3rd Asia Pacific Conference in December 2005, we were all very encouraged to see so many Asian countries making great strides in promoting the FLP. Tens of thousands of carers have been exposed to the FPL in Philippines, Korea, Japan Hong Kong and Taiwan. Malaysia has only reached between 2000 and 3000 participants in the FLP. We have a long way to catch up with the rest of our neighbours but with Janssen-Cilag supporting this venture we believe that we have the ability to expand and be on par with them in a few more years. The importance and urgency of the mental health awareness program can be illustrated if we were to know that at least one person in 9 Malaysians suffers from mental illness ranging from depression to schizophrenia. Out of this, 7 to 10% may commit suicides in the next 10 to 15 years after being diagnosed with the illness. The general public tends to think of the mentally ill as

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‘mad’ and a danger to the public. That is why, in the past the mentally ill were locked up in asylums. This is actually a misconception as the percentage of patients being violent is low. With correct diagnosis and treatment, patients are able to live in the community with their family and friends. This is reflected in the current Goverment policy on mental health, which is moving from institutionalized care to home care. The ‘Circle of Care” Mental Health Awareness Program is officially organized by the Malaysian Psychiatric Association, and supported by the Ministry of Health with sponsorship from Janssen-Cilag, a division of Johnson & Johnson. The burden of care for the mentally ill I heavy and often, that means the caregiver is not only under stress of care giving but often have to sacrifice their lifestyle and to similarly suffer from the stigma attached to mental illness. In conclusion, we the local community in Penang, are very grateful that Janssen-Cilag has come forward at this opportune time to promote greater awareness of the plight of the mentally ill and their families. Through the Family Link Education Program we hope that the inner city and the rural areas could be reached to beak down barriers and prejudice against those stricken with mental disorders. Presented by: Leong Eng Khoon Secretary Pg CARE and D’Home Penang.

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Project: Bakeri Harmoni Aktiviti rehabilitasi psikiatri –memasak (BAKERI HARMONI)

Tempat: Unit Pemulihan Carakerja (Pemulihan Psikiatri) Hospital Alor Star,

Kedah Darulaman

Latar belakang projek:

Pesakit-pesakit psikiatri yang telah lama mengidap penyakit mental perlu dilatih

dalam kemahiran yang memberikan mereka keyakinan diri serta membuka ruang

untuk tujuan mencari pendapatan supaya mereka boleh hidup berdikari. Maka satu

projek telah dipilih untuk memberi munafaat kepada mereka iaitu projek bengkel

membuat roti dan biskut (Bakeri).

Objektif projek:

1. Memberikan skil latihan kerja (work skill) kepada pesakit yang mendapat

rawatan pesakit dalam mahupun pesakit luar. Pesakit yang sesuai akan

dikenalpasti dan dirujuk oleh Pakar Perunding Psikiatri /Pegawai Perubatan

yang merawat / kakitangan Jabatan.

2. Mengajar kemahiran merancang, mengadun, membakar dan membungkus

bun dan cara membuat beraneka jenis biskut.

3. Memberi pendedahan terhadap aspek pemasaran dan menjual produk yang

dihasilkan.

4. Memberi peluang mendapat pendapatan sampingan semasa menghadiri

sessi pemulihan ini .

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5. Memberi kemahiran dan keyakinan diri untuk hidup berdikari.

6. Menanamkan jalinan kerjasama, setiakawan dan memberikan sokongan

antara satu klien dengan klien yang lain.

7. Melatih kemahiran pengurusan kewangan untuk membolehkan klien berdikari

dalam kehidupan seharian.

8. Mengajar klien kemahiran menyediakan makanan seimbang dan berkhasiat

untuk diri dan juga keluarga (piramid makanan seimbang).

9. Mengajar tentang keselamatan dan penggunaan peralatan yang tajam serta

cara penggunaan peralatan elektrik yang betul.

10. Mengajar peradaban makan yang betul semasa makan bersama.

Kriteria Pemilihan Pesakit:

1. Pesakit yang sudah stabil .dan tiada kecacatan fizikal.

2. Mempunyai minat di dalam memasak .

3. Boleh bertutur dan faham Bahasa Malaysia/ Bahasa Inggeris

4. Memerlukan skil kemahiran kerja asas iaitu membuat kek,bun dan biskut.

5. Memerlukan skil untuk menguruskan wang.

6. Perlu mempelajari skil komuniti.

7. Perlu meningkatkan skil bersosial. .

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Jenis penilaian yang digunakan oleh Jurupulih Perubatan Carakerja adalah:

1) FUNCTIONAL ABILITY ASSESSMENT

2) CANSAS (Camberwell Assessment of Needs Short Schedule)

Setiap pesakit yang dirujuk akan dibuat penilaian terlebih dahulu. Penilaian amatlah

penting untuk mengetahui:

1) Sejarah keluarga

2) Sejarah Perubatan

3) Sejarah Kerja (Work History)

4) Ubatan yang diambil

Semuanya dianalisa dan dibuat pelan penjagaan individu. Setiap pesakit mempunyai

pelan penjagaan individunya yang tersendiri. Di dalamnya terdapat:

a) Tujuan rawatan

b) Jenis aktiviti yang akan dijalankan

c) Tempoh perlaksanaannya

d) Pemantau aktiviti.

Secara idealnya, pelan ini perlu dibincang bersama pesakit serta keluarga pesakit

agar mereka dapat bersama-sama melaksanakan apa yang dirancang dengan

teratur dan jelas. Ianya amatlah penting bagi mendapat hasil pemulihan yang lebih

baik jika adanya kerjasama dan sokongan daripada keluarga pesakit.

Setelah penilaian pertama dibuat dan jangkamasa telah ditetapkan di dalam pelan

tadi maka selepas mencapai jangkamasa yang telah ditetapkan penialian kali kedua

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adalah dilaksanakan sekali lagi untuk mengetahui samada ada perubahan

(improvement) dan jika ada tujuan rawatan pemulihan yang belum dicapai maka

adalah perlu dibuat penggubahsuaian tujuan rawatan pemulihan untuk mendapat

pencapaian yang lebih baik untuk setiap pesakit.

Penilaian yang dijalankan perlulah berterusan sehingga kesemua tujuan jangka

pendek dan jangka panjang yang disenaraikan di dalam pelan penjagaan

individunya tercapai. Proses pemulihan memerlukan jalinan yang mampan antara

‘multidisciplinary team’ dan juga ahli keluarga pesakit.

Pelaksanaan projek:

• Projek ini telah mendapat bantuan dana dari Persatuan Psikiatri Malaysia

(Malaysian Psychiatric Association) melalui program “CIRCLE OF CARE”.

Peruntukan sebanyak RM 7,000.00 telah diterima.

• Sebanyak RM 5440.00 telah dibelanjakan untuk membeli peralatan bakeri

seperti :

1) Mesin pengadun tepung,- RM 800.00

2) Oven x 2 - RM 2,400.00

3) Peti ais - RM 1,300.00

4) Almari barang – RM 940.00

RM 5440.00

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• Lokasi bakeri ini dijalankan di dapur Wad Perempuan Psikiatri lama .

• Projek ini telah dirasmikan oleh Dato’ Dr Zahari bin Che Dan , Pengarah

Kesihatan Negeri Kedah pada 2 hb Disember 2004 di Jabatan Psikiatri dan

Kesihatan Mental , Hospital Alor Star, Kedah dan secara rasminya dinamakan

“ BAKERI HARMONI “.

• Bakeri Harmoni beroperasi untuk tiga hari sahaja iairtu pada hari Ahad, Isnin

dan Selasa dari jam 9 pagi hingga 12.30 tengahari.

• Antara aktiviti yang dijalankan termasuklah membuat donut , bun berinti

sardin pelbagai jenis kek seperti chiffon pandan, oren , coklat , kek marble.,

kek coklat moist dan lain-lain.

• Biasanya 4 orang klien akan dilatih pada satu masa dibantu oleh tenaga

kerja terdiri daripada seorang Jurupulih Perubatan Carakerja , seorang

Pembantu Perawatan Kesihatan (perempuan) dan seorang anggota

perempuan mengikut giliran dari Wad Perempuan Psikiatri. Mereka dilatih

dari mula proses membuat sehinggalah membakar. .

• Seorang klien yang pernah memiliki bakeri sendiri telah bersetuju untuk

memberi tunjuk ajar dan memberi bimbingan dalam menjayakan projek ini.

Klien ini telah banyak membantu di dalam melatih pesakit menjalankan

aktiviti-aktiviti di Bakeri Harmoni.Ada juga peralatan memasak yang

disumbangkannya selain daripada sumbangannya mengajar pesakit lain.

• Klien yang baru dirujuk akan diberi tunjukajar dari awal sehingga akhir proses

melaksanakan setiap masakan yang perlu dipelajari di Bakeri Harmoni..

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• Pesakit lelaki dan perempuan boleh menyertai Bakeri Harmoni kerana ianya

bergantung kepada situasi pesakit. Jika pesakit lelaki ia tinggal seorang diri

dan tidak berkeluarga maka amatlah perlu ia mempelajari skil memasak.

Minat juga memainkan peranan yang penting di dalam perkara ini.

• Pihak keluarga juga memainkan peranan yang amat penting di dalam proses

pemulihan pesakit .Mereka juga digalakkan untuk menyertai aktiviti bakeri

bersama ahli mereka untuk mereka mengetahui cara-cara untuk melatih ahli

keluarga mereka menjalankan aktiviti semasa di rumah. Masa yang lebih

panjang adalah bersama keluarga maka amatlah dititikberatkan penyertaan

keluarga jika mereka boleh bersama-sama semasa aktiviti.

• Selain daripada keluarga, Kumpulan Sokongan Keluarga Psikiatri juga

memainkan peranan yang penting di dalam proses pemulihan pesakit.

Sumbangan mereka di dalam projek Bakeri Harmoni ini juga dapat membantu

pesakit. Ada di antara mereka yang membantu di dalam memasarkan hasil

bakeri untuk dijual di kedai-kedai luar.

• Ada antara klien psikiatri lelaki yang dilatih untuk menjual hasil Bakeri di

dalam Hospital Alor Star, Kedah termasuk di Klinik Pakar Perunding Psikiatri.

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Pencapaian

• Seorang pesakit harian yang menyertai bakeri telahpun mulai menunjukkan

perkembangan positif di mana dia telah mulai membantu ibunya membawa

kuih ke kedai makanan untuk dijual.

• Pesakit yang lain pula telah mulai menunjukkan minat untuk memasak biskut

raya sendiri di rumah

• Ada di antara klien Psikiatri yang telah diberi kepercayaan membuka

perniagaan sendiri dengan bantuan modal dari Jabatan Kebajikan

Masyarakat Alor Star , Kedah.

• Bakeri harmoni telah mengadakan aktiviti khas iaitu jualan biskut raya setiap

kali sempena menyambut Hari Raya mulai tahun 2004 -2006. Pencapaianya

adalah seperti berikut: :

� Jualan biskut pada tahun 2004 adalah sebanyak RM1,138.00

� Jualan biskut raya pada tahun 2005 adalah sebanyak RM 604.35

� Jualan biskut raya pada tahun 2006 adalah sebanyak RM 1,711.00. Upah

kepada 6 orang pesakit yang menyertai projek jualan hari raya telahpun

diberikan sebanyak :RM 470.00. Keuntungan bersih sebanyak:RM 580.00

telah diserahkan kepada bendahari Persatuan Psikiatri Negeri Kedah.

inisiatif pesakit untuk lebih berusaha dan maju ke hadapan di dalam kehidupan

seharian mereka. Walaupun kejayaan yang ditunjukkan adalah tidak begitu besar

namun keberkesanannya adalah begitu memberansangkan kepada pesakit yang

menyertainya.Bakeri telah mengembang sayapnya dengan memperkenalkan hasil

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jualannya yang terbaru iaitu pizza Oleh itu, adalah diharapkan Bakeri Harmoni ini

dapat memberikan sumbangan yang besar didalam memberikan pemulihan kepada

klien-klien Psikiatri agar mereka dapat kembali berdikari sehingga ke tahap yang

maksima dan kembali ke pangkuan keluarga dan komuniti khasnya .

Papan tanda masuk ke bakeri Seorang pesakit sedang membuat

aktiviti di Bakeri Harmoni

Seorang pesakit dan kakitangan sedang menyiapkan kek di Bakeri Harmoni