Towards a comprehensive national policy on social care -Part 2:

Need for psycho-social support stressed

By Prof. Rajiva Wijesinghe

One of the current vital needs which is not adequately provided for is psycho-social support. There is a need therefore of coordinating counselling mechanisms. This is best done by the Ministry of Health, which should allocate responsibility for the coordination of work in each Division to the Medical Officer.

For this purpose, as well as for better coordination in general, it would make sense for the Health Ministry, and the Education Ministry too, to ensure that areas of responsibility for local officials were commensurate with those of other government officials, on the basis of Divisional Secretariats.

The MoH, or a Psycho-Social counsellor and coordinator designated by him and reporting to him should provide psycho-social support to communities in the designated DS division and initiate support mechanisms in the community with stakeholders.

The following academic qualifications, knowledge, technical skills and experience are desirable for this work:

A degree in Psychology or Diploma in Counselling Psychology/Guidance and Counselling from a recognised learning institution;

* At least two years’ experience in the field of counselling, training, group facilitation, supervision and/or community-based psychosocial programming;

* Special interest, understanding, sensitivity and proven skills of working with groups of internally suffering vulnerable children and adults and appropriate stress management and prevention skills.

* Good organisational management and leadership skills. Must be able to develop strategies and coordinate with stakeholders and partners or caregivers.

The scope of work should include responsibilities to be performed at three different levels:

A) Treatment

The officer is responsible in the division to

· Treat/facilitate and or refer clients for proper treatment to ensure psycho-social well-being

· Conduct counselling sessions at individual, family and group level

· Organise relaxation programs

· Referrals for additional clinical treatment

· Establish a counselling office and drop in centres for those with special needs.

· Provide therapy based on recommendations by the psychiatrist

B) Early interventions /prevention

The Officer is responsible for the following

· Use of vulnerability index to identify people at risk

· Identify causes of psycho-social problems in the division and initiate remedial measures.

· Conduct awareness program on matters which affect the mental health of an individual

· Train community volunteers in inter personal psychotherapy for groups

· Basic counselling and basic education on protection concerns related to women and children

· Early psycho-social education

· Development of family-friendly environment

· Development of an oversight mechanism to check on vulnerability due to family, social or economic factors and to trigger intervention in the event of individuals beginning to slip mentally

C) Development

The Officer is responsible in the division to

· Develop psycho-social related resources, knowledge and networks

· Organise programs to ensure that the needs of individuals and family are met

· Contribute in other programs to include psycho-social knowledge and inputs to maximise the impact

· Develop supportive groups within the community for the vulnerable population such as children, women and elders

· In collaboration with all stakeholders, set up community psycho-social support groups and work at village level

· Work with a psychiatrist in designing training programs for teachers on child psychology issues, holding workshops at community level and schools in collaboration with the ministries of Health and Education.

· Identify, recognise and share best practices with all stake holders / support groups

· Organise personality development programs

· Set up an effective monitoring and supervision system within the DS office

· Frequent assessment and reporting

Social care

The Ministry of Social Services, provincial ministries and Officials must work towards a care and support system with a focus on people’s well-being and support to empower them to stay independent for as long as possible. It should provide better information to help people make choices about their care; give people more control over their care; improve support for carers; improve the quality of care and support; and improve integration of different services.

Among areas of care and support, with suggested functions are:

Dementia- To get loved ones early help who struck by diseases including Alzheimer’s Disease .While there remains no cure, early diagnosis can help people take control of their condition and plan for the future;-senior citizens in divisions are visited periodically and activity pathways suggested and/or facilitated;

Senior citizens-Retiring public officials and those from outside reaching retiring age should be recognised for their skills and experience if they wish voluntarily to empanel themselves in a database to offer services voluntarily or at a cost. They should also be empowered to initiate services and undertake enterprises in a self sustaining manner-M/SS initiates service with retiree senior citizens providing management support;

End of life care strategy - Promoting high quality care for all adults at the end of life. Its aim is to provide people approaching the end of life with more choice about where they would like to live and die.

It encompasses all adults with advanced, progressive illness and care given in all settings- senior citizens assisted with the right to choose as to place of retirement or access to hospices;

Day care or residential facilities built with investments by senior citizens or families- provide quality care in healthy aesthetically and environmentally friendly settings with provision for tax and other benefits for investments-M/SS with private partnership initiates an island wide self sustaining programme;

Mental health-One in four adults experience mental illnesses at some point during their lifetime and one in six experience symptoms at any one time – making mental illness the largest single cause of disability in our society. Our policies need to focus on outcomes, emphasising identification of what actually happens to the health of the patient as a result of the treatment and care they receive, as well as giving emphasis to the voice of patients and service users-M/SS coordinates review between beneficiary, care giver and family;

Learning disabilities- Improving the life chances of people with learning disabilities and the support provided to their families. People with learning disabilities should lead their lives like any other person, with the same opportunities and responsibilities, and be treated with the same dignity and respect. This means inclusion, particularly for those who are most often excluded, empowering those who receive services to make decisions and shape their own lives-M/SS coordinates with stakeholders and protects rights of those with learning

disabilities;

Offender health - Development and delivery of a cross government Health and Criminal Justice Program improving health and social care outcomes for adults and children in contact with the criminal justice system, focusing on early intervention, liaison and diversion. This is also an important component of the reducing re-offending and health inequalities agenda, with many offenders having mental health and/or substance misuse problems and social care needs-M/SS coordinates services with MoH and M/W&C;

Long-term conditions - A condition that cannot be cured, but can be managed through medication and/or therapy. There is no definitive list of long-term conditions – diabetes, asthma and coronary heart disease can all be included. Person-centred, personalised support plans had led to significant improvements for clients, including reduced support – M/SS guides persons at risk for long-term care by MoH;

Substance misuse services Local level treatment facilities intended in 2007 Act- M/SS with Police Department, Probation and Child Care, Dangerous Drugs Control Board and MoH promote the setting up of treatment facilities and disseminates knowledge of services.

All officials of the Ministry of Social Services shall be responsible for monitoring the situation in the Divisions in which they work, and for preparing vulnerability indices with the assistance of Grama Niladharis.

They shall develop programs to ensure community support structures, by liaising with citizens’ groups and community and non-governmental organisations in addition to government. Encouragement of training programs should be accompanied by promotion of interventions that promote activity and self-reliance among those needing support.

Representatives of the Central and or Provincial Ministries of Social Services should be involved with the Divisional Women and Children Units, so as to coordinate work with families and communities for the Disabled and the Elderly.

An oversight mechanism should be developed to check on vulnerability due to family, social or economic factors and to trigger intervention in the event of individuals beginning to slip physically (or mentally).

Targets for attention could include families with one or both parents away, for migrant or other labour or other reasons, and the families of those in prison. Special attention must be paid to migrant labour as well as affected families.

The underlying principle of care should be to empower those who have limited resources and hence opportunities for fulfilling their potential. Emphasis should be on strengthening their capacity to look after themselves as possible, with support from family and community as available, so as to take their place as productive members of society on the basis of equality and dignity.

Protection of children who come into contact with the Law

The following guidelines should be followed to prevent secondary victimisation of children in need of care and protection as well as juvenile offenders. Responsibilities should be shared between the judiciary as well as probation officers, with monitoring by the National Child Protection Agency (NCPA). The presence of court registrars is essential when district based cases involving women and children are taken up.

The need for strict adherence to the system laid down, and the maintenance of records, must be made clear.

1 (Day one) Child at risk Information

Before the end of each working day, the Magistrate’s Court Registrar should send following particulars of institutionalized children to designated fax numbers of the NCPA and Provincial Probation Commissioner

* Name and age of child
* Nature of case: whether care and protection or child offender
* Placement to – whether remand home/voluntary home/hospital/adult remand
* Name and mobile number of escorting officer
* Next court date and order (for example, probation report/further police investigation report/any other orders)

Action 2 (Day one) Immediate Protective Response

Probation Commissioner/representative to call and inform the relevant probation officer immediately

NCPA Officer to contact the officer in charge of the relevant institution – ward of hospital by 9 pm the same day and

* Verify arrival
* Speak to the child and ascertain if basic needs have been met/inquire if any complaints related to safety and well-being/record any requests

* Communicate as appropriate with officer-in-charge of the institution to address needs or concerns of the child

* Identify special cases – for example custodial assaults/other special situations and needs – refer to designated supervisors at NCPA for action
* Communicate with the designated representative of the Probation Commissioner and ascertain the responsible Probation Officer

Action 3 – (Day two up to second court date) Quick Resolution of care and custody

* Speak to the probation officer and ascertain the next steps to be taken with regard to the care and custody of the child and the time required. Prescribed format to be filled by the NCPA Officer.

* Provide necessary support for the probation officer to complete the required actions up to the second court date.

* Registrar of the Magistrate’s Court to notify the proceedings and orders made at the end of the working day on the first and second court dates to designated fax numbers of the NCPA and Provincial Probation Commissioner

* Prescribed status report to be filled by the NCPA Officer after the second court date with observations and recommendations and submitted to the designated supervisor within three days of the second court date

* Unresolved protection issues must be tabulated and a quarterly report prepared for analysis and action at a higher level.

Methodology for finalising procedures

* Discussion with Secretary, Ministry of Justice/Secretary, MoCD – Chairperson NCPA, Probation Commissioner of the Central Government

* MoJ to seek approval of the Chief Justice/JSC for the new reporting procedure to be established islandwide in all Magistrate’s Courts

* MoCD – NCPA and Probation Central Office to have necessary consultations with Provincial Commissioners

* Develop an amendment to the CYPO to incorporate the new procedure – follow up actions by MoJ – frame regulations under NCPA Act sec. 14(j) and 38 – follow up by NCPA and MoCD

* NCPA to identify suitable human resources

* Probation Central Office and Commissioner Western Province to discuss the possibility of a national hotline and a 24-hour response facility to be operated by the central office with the support of Provincial Departments

* Magistrates to be notified through the JSC

* Joint trainings for NCPA officers and provincial probation officers to implement the procedure in the best interest of children

* User satisfaction survey to be developed to obtain the feedback of children. Baseline to be established and periodic reports to be obtained and analysed to measure effectiveness of the procedure.

* Pilot in a selected province and roll out incrementally.