mental health reform & forensic psychiatric services “the past, the present and the future”...

Mental Health ReformMental Health Reform & &

Forensic Psychiatric ServicesForensic Psychiatric Services

“The Past, The Present and The Future”“The Past, The Present and The Future”

Dr. Myo Kyaw OoDr. Myo Kyaw OoSenior Medical Officer/Consultant PsychiatristSenior Medical Officer/Consultant Psychiatrist

Bellevue Hospital Bellevue Hospital December 2, 2011December 2, 2011

Mission Mission

To improve the mental health of the To improve the mental health of the people of Jamaica so that individuals will people of Jamaica so that individuals will

attain a state of well being, where the attain a state of well being, where the individual will rely on his/her own individual will rely on his/her own

abilities, be able to cope with life, work abilities, be able to cope with life, work productively, make a contribution to productively, make a contribution to

his/her community and live harmoniously his/her community and live harmoniously with otherswith others

Mental Health Reform: The reallocation of services and phasing out Bellevue Hospital June 2003Mental Health Reform: The reallocation of services and phasing out Bellevue Hospital June 2003

Principles of Mental Health ReformPrinciples of Mental Health Reform

DecentralizationDecentralization

DeinstitutionalizationDeinstitutionalization

De-stigmatizationDe-stigmatization

DecentralizationDecentralization

Four Health Regions 1997Four Health Regions 1997

Regional & Parish PsychiatristsRegional & Parish Psychiatrists

Regional Community Mental Health ServicesRegional Community Mental Health Services

Community Mental Health StaffsCommunity Mental Health Staffs

Mental Health Act 1997, Amendment Bill 1999Mental Health Act 1997, Amendment Bill 1999

Strategic Mental Health Plan 1999Strategic Mental Health Plan 1999

Strategic Mental Health Plan 2009-2014Strategic Mental Health Plan 2009-2014

Common Principles Common Principles Mental Health PolicyMental Health Policy

EquityEquity

Human rightsHuman rights

Role of scientific evidenceRole of scientific evidence

integrationintegration

Psychiatric Specialty ServicesPsychiatric Specialty Services

General Adult PsychiatryGeneral Adult Psychiatry

Child & Adolescent PsychiatryChild & Adolescent Psychiatry

Addiction PsychiatryAddiction Psychiatry

Forensic PsychiatryForensic Psychiatry

Disaster PsychiatryDisaster Psychiatry

Geriatric PsychiatryGeriatric Psychiatry

Consultation-liaison PsychiatryConsultation-liaison Psychiatry

Forensic Psychiatric ServicesForensic Psychiatric ServicesJamaicaJamaica

History of Forensic PsychiatryHistory of Forensic Psychiatry

King George III, Queen Victoria, M’NaghtenKing George III, Queen Victoria, M’Naghten

Role of psychiatry and the LawRole of psychiatry and the Law

Role of Psychiatry and defenseRole of Psychiatry and defense

Role of psychiatry and sentencingRole of psychiatry and sentencing

Role of psychiatry and disposalRole of psychiatry and disposal

Jamaica Landmarks in psychiatryJamaica Landmarks in psychiatry

Mental Hospital Act 1873Mental Hospital Act 1873Community mental health services 1960sCommunity mental health services 1960sClosure of Forensic ward BVH 1975Closure of Forensic ward BVH 1975Mental Health Act 1997Mental Health Act 1997Mental Health Strategic Plan 1999Mental Health Strategic Plan 1999Bill to amend Mental Health Act 1999Bill to amend Mental Health Act 1999Amendment to Criminal Justice Amendment to Criminal Justice (Administration) Act 2005(Administration) Act 2005

Forensic Psychiatric ServicesForensic Psychiatric Services

Regional PsychiatristsRegional Psychiatrists

Bellevue HospitalBellevue Hospital

UHWIUHWI

DCSDCS

Community Mental Health CentersCommunity Mental Health Centers

Psychiatrists in private practicePsychiatrists in private practice

Treatment services, assessment & Treatment services, assessment & expert’s opinionexpert’s opinion

Fitness to pleaFitness to plea

Fitness to stand trialFitness to stand trial

Fitness for sentencingFitness for sentencing

Diminished responsibilityDiminished responsibility

Fitness to be executedFitness to be executed

Mental Health ReformMental Health Reform

Cabinet approved reform on March 20, 2006Cabinet approved reform on March 20, 2006

The Development of Community Mental The Development of Community Mental Health Services and De-Institutionalization.Health Services and De-Institutionalization.

Mandated Ministry of Health to pursue further Mandated Ministry of Health to pursue further consultations and community involvement.consultations and community involvement.

Facilities for Forensic patientsFacilities for Forensic patients

Forensic ward closed in 1975Forensic ward closed in 1975Criminal Justice (Administration) Act (Amendment) 2005Criminal Justice (Administration) Act (Amendment) 2005Cabinet Approval Decentralization & Development of Cabinet Approval Decentralization & Development of Community Mental Health Services 2006Community Mental Health Services 2006Bellevue HospitalBellevue HospitalPolice jails Police jails Department of Correctional ServicesDepartment of Correctional Services– Tower Street ACCTower Street ACC– St. Catherine ACCSt. Catherine ACC– South Camp ACCSouth Camp ACC– Fort Augusta ACCFort Augusta ACC– Juveniles facilitiesJuveniles facilities

Bellevue HospitalBellevue Hospital

3000 inpatients in 19653000 inpatients in 1965

1500 inpatients in 19901500 inpatients in 1990

800 inpatients in 2011800 inpatients in 2011

policy decision made closure of forensic policy decision made closure of forensic psychiatric ward in 1975 psychiatric ward in 1975

Transfer of patients to TSACCTransfer of patients to TSACC

Bellevue is under reformBellevue is under reform

What do we have between What do we have between Bellevue and Prisons ???Bellevue and Prisons ???

Balanced?Balanced?

BellevueBellevue Community Mental Health Community Mental Health ServicesServices

Acute psychiatric wards Acute psychiatric wards in general hospitalsin general hospitals

Facilities for chronic Facilities for chronic mentally ill to offer mentally ill to offer rehabilitation and rehabilitation and occupational therapyoccupational therapy

Child & Adolescent Child & Adolescent psychiatric servicespsychiatric services

What we do not want to see…What we do not want to see…

Criminalization of mentally illCriminalization of mentally ill

Trans-institutionalizationTrans-institutionalization

Strategic Mental Health PlanStrategic Mental Health Plan

Amendment to Criminal Justice Amendment to Criminal Justice (Administrative) Act 2005(Administrative) Act 2005

UK, US, SingaporeUK, US, Singapore

What are the challenges?What are the challenges?

What model of care for forensic psychiatric What model of care for forensic psychiatric patients?patients?

Woodbridge Hospital SGWoodbridge Hospital SG

1851 built facility, fully restructured1851 built facility, fully restructured2000 psychiatric beds on 25 hectare 2000 psychiatric beds on 25 hectare campuscampusRange of psychiatric facilities, adult, child Range of psychiatric facilities, adult, child & adolescent, geriatric, addiction, forensic, & adolescent, geriatric, addiction, forensic, community, special clinicscommunity, special clinicsNational Mental Health Blue Print 2007-National Mental Health Blue Print 2007-2012201288 millions in 2007, 35 millions in 200988 millions in 2007, 35 millions in 2009

Caribbean/RegionalCaribbean/Regional

BarbadosBarbados

Trinidad & TobagoTrinidad & Tobago

What do we have??What do we have??

What commitment ?What commitment ?

What have we invested?What have we invested?

Mentally ill OffendersMentally ill Offenders

Jails & Remand CentreJails & Remand CentrePrisonsPrisonsOther institutions & communityOther institutions & community

What do we have?What do we have?

What do we need?What do we need?

Mental Health ServicesMental Health Services

Ministry of Health for Ministry of Health for police jailspolice jails

Bellevue & General Bellevue & General HospitalsHospitals

University HospitalUniversity Hospital

Health CentersHealth Centers

Prison Psychiatric Prison Psychiatric ServicesServices

Sessional PsychiatristsSessional Psychiatrists

PsychologistsPsychologists

Nursing staffNursing staff

Probation officersProbation officers

ChaplainChaplain

Child Development Child Development AgencyAgency

Mental Health Reform Mental Health Reform Justice ReformJustice Reform

Inter-agencies or multi-agencies Inter-agencies or multi-agencies involvementinvolvement

““Investment begins with a vision”Investment begins with a vision”

Justice Reform: Principle of Justice Reform: Principle of Therapeutic JurisprudenceTherapeutic Jurisprudence

in Criminal Justicein Criminal Justice

Criminal ResponsibilityCriminal Responsibility

Actus Reus & Mens ReaActus Reus & Mens Rea

Jail DiversionJail Diversion

Drug CourtDrug Court

Mental Health CourtMental Health Court

Objective isObjective is .. ..

There should be There should be NONO mentally ill in prison. mentally ill in prison.

To provide a comprehensive rehabilitationTo provide a comprehensive rehabilitation

To reduce recidivism To reduce recidivism

Mental illness in prisonsMental illness in prisons

Disorders present before admission and Disorders present before admission and exacerbated by incarcerationexacerbated by incarceration

Disorders develops during incarcerationDisorders develops during incarceration

Factors relatedFactors related

Widespread misconception that all with Widespread misconception that all with mental illness are a danger to societymental illness are a danger to societyGeneral intolerance of people to difficult General intolerance of people to difficult and disturbing behaviourand disturbing behaviourSensational stories in the media of some Sensational stories in the media of some charged with offencescharged with offencesFailure to promote treatment rehabilitationFailure to promote treatment rehabilitationLack of mental health services/ poor and Lack of mental health services/ poor and inefficient access to servicesinefficient access to services

Poor physical conditionsPoor physical conditions

Situational crisesSituational crises

Violence, harassmentViolence, harassment

Discrimination, stigmatizationDiscrimination, stigmatization

VictimizationVictimization

Abuse and human right violationsAbuse and human right violations

Mentally ill in prisonsMentally ill in prisons

PsychoticPsychotic

Non-psychoticNon-psychotic

Psychotic GroupPsychotic Group

GG pleasure with or without court dateGG pleasure with or without court date

RM pleasure, unfit to plea with court dateRM pleasure, unfit to plea with court date

Convicted & SentencedConvicted & Sentenced

Diminished responsibilityDiminished responsibility

psychotic during incarcerationpsychotic during incarceration

Majority Schizophrenia & Drug PsychosisMajority Schizophrenia & Drug Psychosis

Non-psychotic groupNon-psychotic group

Adjustment disorderAdjustment disorderDepression & suicideDepression & suicidePersonality disorderPersonality disorderGender identity disorderGender identity disorderSubstance abuse disorderSubstance abuse disorderConduct disorderConduct disorder

““DUAL DIAGNOSIS”DUAL DIAGNOSIS”

PreventionPrevention

No drugs …No abusersNo drugs …No abusers

No precursors…No manufacturing No precursors…No manufacturing processprocess

How are you going to make prisons safe?How are you going to make prisons safe?

How do inmates receive their supply?How do inmates receive their supply?

Zero Tolerance Policy?Zero Tolerance Policy?

Demand ReductionDemand Reduction

Educational Approach, school education, Educational Approach, school education, public education, sport & culturepublic education, sport & culture

Health & medical Measure, treatment and Health & medical Measure, treatment and rehabilitation programsrehabilitation programs

Community involvementCommunity involvement

Economic empowermentEconomic empowerment

Regional & International Cooperations Regional & International Cooperations Caribbean & OAS Caribbean & OAS

Causes of Drug AddictionCauses of Drug Addiction

Moral/SpiritualMoral/Spiritual

BiologicalBiological

PsychodynamicPsychodynamic

BehaviouralBehavioural

Socio-culturalSocio-cultural

Individual-drug-environmentIndividual-drug-environment

INTEGRATIVEINTEGRATIVE

IntegrativeIntegrative

No single causeNo single cause

Interaction of range of causesInteraction of range of causes

Bio-Psycho-SocialBio-Psycho-Social

Bio-Psycho-Socio-CulturalBio-Psycho-Socio-Cultural

General outline of demand reductionGeneral outline of demand reduction

Treatment & RehabilitationTreatment & Rehabilitation

Prevention & follow-upPrevention & follow-up

Models of Treatment facilitiesModels of Treatment facilities

Residential basedResidential based

Hospital or centresHospital or centres

Short, medium, long Short, medium, long termterm

Outpatient basedOutpatient based

Drug Court TreatmentDrug Court Treatment

Prison basedPrison based

Treatment ApproachesTreatment Approaches

Individual therapyIndividual therapy

Group therapyGroup therapy

Family therapyFamily therapy

Special program ( juvenile, Drug court, Special program ( juvenile, Drug court, prison based, combined HIV,STI, TB, prison based, combined HIV,STI, TB, therapeutic communities, cultural)therapeutic communities, cultural)

Changing Model of CareChanging Model of Care

Recovery is not an event but the processRecovery is not an event but the process

Incarceration by itself does little to break Incarceration by itself does little to break the cycle of illegal drug use and crimethe cycle of illegal drug use and crime

Offenders sentenced to Incarceration Offenders sentenced to Incarceration exhibit high rate of RECIDIVISM once they exhibit high rate of RECIDIVISM once they are releasedare released

Drug Abuse Prevalence in Drug Abuse Prevalence in prisonsprisons

Drug Abuse in prison is very commonDrug Abuse in prison is very common

Estimated 22% - 86%Estimated 22% - 86%

Most frequently used illicit drug “ Most frequently used illicit drug “ Cannabis” 8% - 60%Cannabis” 8% - 60%

British Study 60% heroin user reported British Study 60% heroin user reported use in prison, more than 25% initiated use use in prison, more than 25% initiated use in prisonin prison

Factors associated with substance Factors associated with substance abuse in prisonabuse in prison

Age, Ethnicity, Conduct disorder, abuses, Age, Ethnicity, Conduct disorder, abuses, school difficultiesschool difficulties

Psychiatric disordersPsychiatric disorders

Antisocial personalityAntisocial personality

Support systemSupport system

Length of sentenceLength of sentence

JamaicaJamaica

Proposal to establish Drug Abuse Facility Proposal to establish Drug Abuse Facility 19981998

OAS/CICAD Belize City Drug Abuse OAS/CICAD Belize City Drug Abuse workshop 2001workshop 2001

OAS/CICAD St. Lucia Drug Abuse OAS/CICAD St. Lucia Drug Abuse workshop 2004workshop 2004

DCS Drug Abuse Survey 2005DCS Drug Abuse Survey 2005

DCS Drug Abuse Training Seminar 2006DCS Drug Abuse Training Seminar 2006

Drug Abuse Survey in Drug Abuse Survey in Jamaican PrisonsJamaican Prisons

20052005

MethodologyMethodology

4 maximum security prisons 4 maximum security prisons

Sampling Frame of 3434 inmatesSampling Frame of 3434 inmates

Stratified sampling method usedStratified sampling method used

Estimated prevalence rate 45% ± 5%Estimated prevalence rate 45% ± 5%

A total of 440 inmatesA total of 440 inmates

42 items, 4 sections Questionnaire used42 items, 4 sections Questionnaire used

Results - AgeResults - Age

A Total of 440 inmatesA Total of 440 inmates

Male 82% (360), Female 18% (80)Male 82% (360), Female 18% (80)

Age range – 18 to 73 yearsAge range – 18 to 73 years

Majority 53% (Age range 23-34)Majority 53% (Age range 23-34)

Results – Age group by GenderResults – Age group by Gender

Age groupAge group MaleMale FemaleFemale TotalTotal

17-2217-22 2525 88 33 (8%)33 (8%)

23-2823-28 9999 2121 120 (27%)120 (27%)

29-3429-34 9898 1515 113 (26%)113 (26%)

35-4035-40 7171 1212 83 (19%)83 (19%)

41-4641-46 3535 1212 47 (11%)47 (11%)

47-5247-52 2020 99 29 (6%)29 (6%)

53 & over53 & over 1212 33 15 (3%)15 (3%)

Results – Education by genderResults – Education by gender

LevelLevel MaleMale FemaleFemale TotalTotal

PrimaryPrimary 224224 2525 249 (57%)249 (57%)

SecondarySecondary 128128 3737 165 (38%)165 (38%)

TertiaryTertiary 88 1818 26 (5%)26 (5%)

Results – Literacy levelResults – Literacy level

LevelLevel MaleMale FemaleFemale TotalTotal

ExcellentExcellent 5757 4040 97 (22%)97 (22%)

GoodGood 8989 2424 113 (25%)113 (25%)

Can help selfCan help self 120120 99 129 (29%)129 (29%)

Just a littleJust a little 6666 66 72 (16%)72 (16%)

Can not read/writeCan not read/write 2828 11 29 (8%)29 (8%)

KnowledgeKnowledge

Ganja is a drugGanja is a drug 72%72%

Ganja smoking is harmfulGanja smoking is harmful 61%61%

Alcohol, tobacco & beady are drugsAlcohol, tobacco & beady are drugs 78%78%

Ganja improves sexual performanceGanja improves sexual performance 33%33%

Alcohol improves sexual performanceAlcohol improves sexual performance 38%38%

Addiction is drug dependencyAddiction is drug dependency 85%85%

A link between drug abuse & STIA link between drug abuse & STI 73%73%

PrevalencePrevalence

PrevalencePrevalence NoNo YesYes

Drug abuse before incarcerationDrug abuse before incarceration 163163 273 ( 62% )273 ( 62% )

Drug abuse during incarcerationDrug abuse during incarceration 233233 201 ( 201 ( 46%46% ) )

PrevalencePrevalence

Drug abuse before incarceratedDrug abuse before incarcerated 62%62%

Drug abuse during incarcerationDrug abuse during incarceration 46%46%

Type of Substances abusedType of Substances abused(N=305)(N=305)

TypeType NumberNumber

GanjaGanja 172 (39%)172 (39%)

TobaccoTobacco 98 (22%)98 (22%)

AlcoholAlcohol 21 (5%)21 (5%)

CrackCrack 6 (1%)6 (1%)

ValiumValium 5 (1%)5 (1%)

InhalantInhalant 3 (0.7%)3 (0.7%)

Pattern of AbusePattern of Abuse

TypeType DailyDaily WeeklyWeekly OccasionallyOccasionally

GanjaGanja 98 (22%)98 (22%) 1313 62 (14%)62 (14%)

TobaccoTobacco 75 (17%)75 (17%) 77 42 (10%)42 (10%)

AlcoholAlcohol 9 (2%)9 (2%) 11 32 (7%)32 (7%)

ValiumValium 6 (1%)6 (1%) 00 6 (1%)6 (1%)

CrackCrack 4 (0.9%)4 (0.9%) 00 3 (0.7%)3 (0.7%)

InhalantsInhalants 1 (0.2%)1 (0.2%) 00 2 (0.5%)2 (0.5%)

Factors affecting frequencyFactors affecting frequency

FactorsFactors StatisticsStatistics

MoneyMoney 122 (28%)122 (28%)

AvailabilityAvailability 63 (14%)63 (14%)

Afraid of Disciplinary actionAfraid of Disciplinary action 11 (3%)11 (3%)

Afraid of being seenAfraid of being seen 6 (1%)6 (1%)

Reason for Drug useReason for Drug use

To feel more relaxedTo feel more relaxed 119119 27%27%To meditateTo meditate 9999 23%23%To cope with prisonTo cope with prison 8484 19%19%To sleepTo sleep 6565 15%15%CuriosityCuriosity 4646 11%11%LonelyLonely 3636 8%8%Peer pressurePeer pressure 2626 6%6%AddictionAddiction 2222 5%5%ReligionReligion 88 2%2%

Source of supply in prisonSource of supply in prison

Fellow inmatesFellow inmates 189189 43%43%

Correctional officersCorrectional officers 13 13 3% 3%

Over prison wall/fenceOver prison wall/fence 8 8 2% 2%

Family/friendsFamily/friends 5 5 1% 1%

Motivation for changeMotivation for change

Want to stop drug abuseWant to stop drug abuse 150150 34%34%

Request assistance to stopRequest assistance to stop 113113 26%26%

Interest to participate in program 348Interest to participate in program 348 79%79%

Best group to sensitize drug abuse Best group to sensitize drug abuse programprogram

GroupGroup StatisticsStatistics

Recovering addictsRecovering addicts 233 233 (53%)(53%)

ChurchChurch 108 108 (25%)(25%)

FamilyFamily 34 34 (8%)(8%)

Fellow inmateFellow inmate 29 29 (7%)(7%)

OthersOthers 22 22 (5%)(5%)

Correctional officersCorrectional officers 14 14 (2%)(2%)

Survey Summary Survey Summary

Prevalence of drug abusePrevalence of drug abuse 46%46%

Ganja is most commonly abusedGanja is most commonly abused 39%39%

34%34% of inmates are motivated to quit and of inmates are motivated to quit and 26%26% requested assistance. requested assistance.

79%79% showed interest to participate in the showed interest to participate in the drug abuse program in prison.drug abuse program in prison.

Principle of Therapeutic Principle of Therapeutic JurisprudenceJurisprudence

Prof. Bruce WinnickProf. Bruce Winnick

Prof. David WexlerProf. David Wexler

Application of TJApplication of TJOffenders with underlying drug abuse problems Offenders with underlying drug abuse problems

Incarceration alone does not help or reduce Incarceration alone does not help or reduce recidivismrecidivism

Therapeutic principle is applied in Judicial Therapeutic principle is applied in Judicial processprocess

Diversion Programme Drug Court & Mental Diversion Programme Drug Court & Mental Health CourtHealth Court

Prison Based ProgrammePrison Based Programme

Parallel ModelParallel Model

Diversion ProgrammeDiversion Programme

Drug Court Treatment & RehabilitationDrug Court Treatment & Rehabilitation

May 2001 Kingston, July 2001 Montego BayMay 2001 Kingston, July 2001 Montego Bay

Drug Court Act 1999Drug Court Act 1999

Offenders with Minor Offences who meet Offenders with Minor Offences who meet eligible criteriaeligible criteria

Bail offeredBail offered

Six months outpatient programme under Six months outpatient programme under court supervision and weekly urine testingcourt supervision and weekly urine testing

What about those ineligible What about those ineligible Offenders?Offenders?

Prison Based ProgrammePrison Based Programme

Prison based Prison based ProgramProgram

? Legislation? Legislation

Political willPolitical will

Budget commitmentBudget commitment

Outpatient Drug CourtOutpatient Drug Court

LegislationLegislation

Court supervisionCourt supervision

Probation period after Probation period after graduationgraduation

Criminal offence not Criminal offence not recordedrecorded

to address ALL Mental Health Issues including substance abuseto address ALL Mental Health Issues including substance abuse

Punitive Model without Rehabilitation Punitive Model without Rehabilitation does not solve underlying issuesdoes not solve underlying issues

Try innovative methods and programsTry innovative methods and programs

What we need?What we need?

Forensic Psychiatric HospitalsForensic Psychiatric HospitalsCommunity Forensic Psychiatric ServicesCommunity Forensic Psychiatric ServicesFaculty of Forensic Psychiatry & Law, UWIFaculty of Forensic Psychiatry & Law, UWIOngoing combined or cross training of Law & PsychiatryOngoing combined or cross training of Law & PsychiatryProfessionals with special interestProfessionals with special interestPartnership building & networkingPartnership building & networkingLegal & Mental Health Reform Legal & Mental Health Reform Proper enumeration & classificationProper enumeration & classificationResearch & evaluationResearch & evaluationLegislation Legislation

There is no good health There is no good health without a good mental without a good mental

healthhealth

nobody is immune to mental illnessnobody is immune to mental illness

““Making mental health a Making mental health a Jamaican Priority, investing Jamaican Priority, investing in development of forensic in development of forensic psychiatric services through psychiatric services through

advocacy and actions”advocacy and actions”

Policy directionPolicy direction

Secured Forensic psychiatric hospitalSecured Forensic psychiatric hospitalCommunity Forensic ServicesCommunity Forensic ServicesHR & legislativesHR & legislativesQuality assurance guidelines Quality assurance guidelines Training & ResearchTraining & ResearchInter-agencies co-ordination (Ministries of Inter-agencies co-ordination (Ministries of Health/Justice/National Security Health/Justice/National Security Advocacy & support groupsAdvocacy & support groupsBudgetary commitmentBudgetary commitment

Plan includes..(not limited to)Plan includes..(not limited to)

Promotion & preventionPromotion & preventionDetection & screeningDetection & screeningProper treatmentProper treatmentReferral upon releasedReferral upon releasedNon-discriminatory Non-discriminatory Respect with human right principlesRespect with human right principlesConsultation, inclusion of inmates/staff/community for Consultation, inclusion of inmates/staff/community for strategic planningstrategic planningHR issues, trainingHR issues, trainingResearch & EvaluationResearch & EvaluationNet working, inter-agencies, Regional and Global Net working, inter-agencies, Regional and Global partnershippartnership

To ensure development of forensic To ensure development of forensic psychiatric services and to stop psychiatric services and to stop mentally ill entering to prisonsmentally ill entering to prisons

We need “a change”We need “a change”

Political will & commitmentPolitical will & commitmentPhilosophical concept with a visionPhilosophical concept with a vision

budgetarybudgetary

There is no good health without a good There is no good health without a good mental healthmental health

Lets make Mental health a priority through Lets make Mental health a priority through your action and advocacyyour action and advocacy

A great push, a great investmentA great push, a great investment

Nobody is immune to mental illnessNobody is immune to mental illness

““The Great Push”The Great Push”“Investing in Mental Health”“Investing in Mental Health”

Timely investment in Forensic Timely investment in Forensic ServicesServices

Healthy minds, Healthy people, Healthy NationHealthy minds, Healthy people, Healthy Nation

One Nation, One People, One LoveOne Nation, One People, One Love

Thank YouThank You

Dr. Myo Kyaw OoDr. Myo Kyaw Oo

MBBS, DPM, DM Psych.MBBS, DPM, DM Psych.

December 2, 2011December 2, 2011

Norman Manley Law School UWINorman Manley Law School UWI