5.11 Mental health care The Directorate of Mental Health is the national-level focal point responsible for the National Mental Health Programme within the MoH, Sri Lanka. The Directorate is responsible for policy development and strategic planning, coordination, supporting implementation and monitoring and evaluation of mental health services in the country. A Mental Health Act has been under deliberation since 2005. After years of multiple drafts and competing interests, a diverse task force consisting of representatives from the MoH, WHO, Sri Lanka College of Psychiatrists, NGOs and other stakeholders have compiled a draft act, and this is being reviewed currently prior to finalization. The Act will replace the present Mental Diseases Ordinance of 1956. The National Mental Health Advisory Council (NMHAC) was established in 2007 to advise the Director Mental Health. The Secretary of Health was appointed as the Chair with the DGHS as the convener, and consisted of a diverse, interdisciplinary team with both technical and administrative expertise. Within a couple of years, it was reconfigured as the National Committee on Mental Health, chaired by the DGHS and convened by the Director Mental Health. The mental health sector provides its services through a multidisciplinary team consisting of consultant psychiatrists, MOs of mental health, psychologists, counsellors, occupational therapists, speech therapists, physiotherapists, psychiatric social workers and community workers. Over the past 15 years, there have been major gains in HR development for mental health across all cadres to support the growing demands on services. At the district level, an MO Mental Health is the focal point. The MO assists the Regional Director of Health Services and coordinates all mental health services within the district, having a close linkage with the national level, district health team and all other relevant departments and community groups. Within a district, services are provided through a network of medical institutions and health units. A major shift has occurred in the level of organization of services, from institutionalized mental health-care delivery to care in smaller facilities and outpatient care closer to people’s homes. In 2007, the main mental hospital located at Angoda was restructured into the National Institute of Mental Health. There are seven tertiary-care hospitals in Sri Lanka with facilities for acute psychiatric inpatient care. In addition, acute inpatient units are currently available in 23 of the 26 districts and in few regionally managed institutions.
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