Community based care is said to hold the key to responsive mental health services that are more suited to the wishes of the individuals.
Institutionalized care (such as living in a hospital for the duration of one’s life) and rehabilitation programmes do not serve the chronic mentally ill person well, as they foster dependency and compliance rather than autonomy.
The medical model of fix and cure is not enough for those who have the combined challenges of illness and social unfriendliness.
Community based care provides an opportunity for collaboration with other services already serving the people. Therefore, services can be adapted and developed to meet the needs according to each locality (such as rural locations, remote and isolated areas and semi urban – even urban city life).
There is a growing awareness in Sri Lanka that adults who have spent most of their lives in an institution (mental hospital, orphanages etc) have suffered from a loss of personal identity, a loss of dignity, impaired social and personal care skills, and also a deterioration in their physical and mental wellbeing (this is by no means an exhaustive list of the effects of institutionalization).
Community based care allows people to regain control over their own recovery. The move away from large Psychiatric institutions to a single ward for the relief of acute episodes which need a short period of inpatient care in a District General Hospital, and the training of Psychiatric Medical Officers, has enabled people to stay closer to home and remain in contact with their own communities. This is a great move forward and must continue.
Nest can then figure highly in the range of options open to the individual sufferer: without that form of additional support community based services as an alternative to institutionalization will not necessarily meet the need. Attitudes also have to change, if Community Based Care is to supersede the current system of institutionalized care.
Sally Hulugalle and Kamini de Soysa first visited Unit 2, now called The Halfway Home, Mulleriyawa, in October 1984, and on the way back to Colombo, they went straight to Anne Ranasinghe who suggested they organize an Island wide campaign, “The Forgotten Women”. Sadly, Mrs. Anne Ranasinghe died a few years ago.
They were determined to make life more comfortable for the Women in Unit 2. What Sally and Kamini had found that day were over 1500 women incarcerated for life, and subject to enormous suffering.
Mattresses, linen, pillows, toiletries, sanitary items, clothes, slippers were sent by many individuals and Companies in response to “The Forgotten Women” campaign. Hand to hand, items were distributed to the Women and many large items of equipment to the 14 wards. Running water was provided. Receipts were sent to every donor. Many individuals and groups began visiting Unit 2.
Nest has continued to nurture and help the women to acquire skills to used at home and in the community. Numbers have reduced to around 400 women. Nest works there every day, except weekends, thanks to an MOU signed in 2004 with the Ministry of Health. Nest runs a Skills Development Centre at the Half Way Home. From a dilapidated ‘Admission ward’ Nest has created a place where women can spend the day actively involved in numerous activities such as: