Patients receive medication from health care staff at National Psychiatric Hospital No 1. — VNA/VNS Photo Minh Quyết

Doctor Tạ Đình Cao from the National Psychiatric Hospital No 1 speaks to Sức khỏe & Đời sống (Health & Life) newspaper on providing care to patients with mental disorders in the community.

How many patients with mental disorders are there in Việt Nam? How are psychiatric facilities, particularly National Psychiatric Hospital No 1, providing care and treatment for them?

According to the World Health Organisation’s classification (ICD-10), there are around 300 mental and behavioural disorders. 

In Việt Nam, a ministerial-level research project led by National Psychiatric Hospital No 1 on the incidence of the ten common mental disorders was carried out in 2002.

The research showed that the most common mental disorders such as schizophrenia, depression, anxiety, behavioural disorders in adolescents, dementia or alcoholism accounted for 14.9 per cent of the total cases. If we take into account the country’s population of 96 million, the number of people affected by these disorders stands at more than 14 million. 

However, only patients with schizophrenia, depression and epilepsy are receiving care and treatment in the community - about 320,000 people - a very modest figure compared to the number of people diagnosed with mental disorders. 

At the moment, Việt Nam has 45 central psychiatric hospitals, including three at the national level and 42 at the provincial level. There are also non-communicable disease prevention departments (including psychiatric divisions) at provincial centres for disease control (CDCs); as well as psychiatric departments in general hospitals. There is almost no specialised department for psychiatry at the district level. 

National Psychiatric Hospital No 1 is currently looking after about 600 inpatients. 

Is at-home treatment for people with mental disorders recommended?

Managing and providing care for people with mental disorders in the community is very important to psychiatry. Since around 1998-2000, the national target programme on protecting the community’s and children’s mental well-being has been approved by the Prime Minister. This has been carried out by the Ministry of Health (MOH) and related departments to effectively contribute to social welfare and order. 

Mental disorders result in significant burdens and we do not have enough resources to provide life-long inpatient care and treatment. Moreover, to relieve the burdens on families and society, we need to reintegrate patients back into the community in a stable state, where they can perform simple tasks to help their families. 

Therefore, managing, providing care and rehabilitation for people with mental disorders is a prioritised recommendation of the MOH and particularly the psychiatry sector. 

What are the current management models for patients with mental disorders in the community? 

Currently, the target programme on health care and population for 2016-2020 has come to an end. At the moment, according to the PM’s Decision No 155/QĐ-TTg on community mental well-being is part of the National Plan for Prevention and Control of Non-communicable Diseases and Mental Disorders for 2022-2025. 

During this period, several management and financing mechanisms have changed, notably, localities will proactively allocate funding for community mental health care. Therefore, there are two models of management and dispensing medication for patients with mental disorders in the community. 

The first is an old model where patients are examined, diagnosed and given prescriptions at a provincial health facility, then they are assigned to a local medical station for monitoring and drug dispensing. They will be given medications directly by medical staff at these stations. 

In the second model, patients will receive examination and treatment according to health insurance policies and then be assigned to local health stations for monitoring, but they will not be given medications at these stations. They will need to go to district or provincial-level health facilities for prescriptions and drug dispensing. This can be difficult for the patients in terms of transportation. 

In reality, there are many issues that need to be addressed in managing people with mental disorders in the community, such as the tragic cases of patients causing harm to others around them. What can we do to prevent similar incidents from happening?

Managing patients in their community is not only a responsibility of the health sector but also other departments, organisations and authorities of all levels, as well as the patient’s family. Most patients regain their state of stability after some time of hospitalisation, after which they will return home for care and rehabilitation from their family and community. 

However, there could be a few reasons why some patients relapse and develop irrational emotions and behaviours such as screaming, aggression or wandering 

The first reason could be that the patient has an irregular medication schedule or stops taking medication. Therefore, the first thing to do is for the family to ensure that they take their medication regularly, in addition to enhancing the family’s awareness of caring for people with mental disorders. 

The second thing is to strengthen the early detection and screening of mental disorders to provide treatment to the patients before they exhibit the behaviours mentioned above, this is very important.

The third thing is to have policies and frameworks to deliver medications directly to patients with mental disorders in their locality so that they do not abandon their treatment. 

At the moment, if their treatment is covered by health insurance, the patients need to go to a district or provincial-level hospital for drug dispensing (which requires a certified physician for prescriptions). 

This makes it difficult for patients as there are many other factors affecting their treatment such as geographical distances, finances and family. In fact, a significant number of patients quit their treatment due to these reasons. 

What are the challenges in managing and providing care for patients?

As I mentioned, the challenges in managing patients with mental disorders lie in the limited coordination between different sectors, as well as the modest funding for mental health care.

Another challenge is the lack of staff, as currently, the ratio of psychiatrists at the district level is largely non-existent or unevenly distributed. Psychiatry is a unique discipline and it is facing issues in attracting and retaining medical personnel. 

Allowances and support for grassroots health workers are also another issue, as managing and medicating patients is a huge workload for local medical staff, which often discourages them. — VNS