Kilinochchi District is one of the areas which has been seriously affected by the thirty years of ethnic war which Sri Lanka has faced in the recent past. Indices like per capita income, nutritional level and educational level also show that it is one of the poorer districts. Due to the war, the records of mentally ill patients before 2009 are not available in Kilinochchi’s Government Hospitals.
Since 2010 Kilinochchi’s mental health team have been working hard to create a database, and clinical notes of the district’s mentally ill patients. However, this has been difficult as most of the population live in villages; and due to the poorly developed transport system they have difficulties going to the Kilinochchi’s General Hospital.
Additionally, there is shortage in the number of professionals provided for the government’s mental health services. This has lead to the pillars of the mental health team becoming the community support assistants who work mainly in the field. It is the community support assistants who bring most of the patients into the system and follow them in their communities to ensure that they have regular clinic follow ups and, if necessary, hospital admissions.
There are now records of the mentally ill patients from 2010 as the doctors and staff of the mental health team have maintained clinical notebooks.
From time to time, the need to develop a technology assisted database was considered but it did not succeed because to several reasons including the unavailability of an expert in this field of technology. The Mental Health Project of the Kilinochchi District has been initiated as a fulfillment of a long term requirement. It takes place in collaboration with NICST (Network for Improving Critical care Systems and Training).
Progression of the project
Scoping meeting were conducted between Dr. Jegaruban (Medical Officer in Psychiatry; District General Hospital Kilinochchi) and the collaborators to elicit the platform requirements and clinical variables.
A mobile data collection tool was developed using an open source web based application to enable capture of admission, clinic, and home visit information. Data will be visualised using a business analytics tool.
The GN (Grama Niladhari) areas in Kilinochchi district has been divided into nine CSO (Community Support Officers’) areas and one area that is outside the Kilinochchi district. Ten Community Support Officers have been appointed one to each of these ten areas, to follow up the mentally ill patients in the Kilinochchi District and report back the patients’ wellbeing, the amount of contact they have with their family members, and the stability of their condition to the MHC clinical team.
Patients who have been admitted into the Kilinochchi Hospital are referred to and reviewed by the MHC team, during their inpatient stay. This forms the foundation of admission to the MHC and other relevant support services. Upon discharge from the hospital setting, the patient is then offered a community clinic and outreach follow up.
Home visits will be made to each patient and their current health status captured using the mobile application. Records of patients who are missing, or whose family members are concerned, or who themselves feel they require more support are then captured by the electronic system and followed up by the medical team.
The Project was further progressed on 17th August 2016 by introducing the mobile app and the electronic data collection system to the Kilinochchi District Hospital mental health team and the community service officers. Mobile applications were installed on android devices purchased for the community service officers. Patient identifiable information is not being stored on these mobile devices. Each device have a secure unique two step authentication process. CSO’s were trained to use the mobile data collection instrument by being made to enter the data through their mobile app for the first time. Training in using the data collection portal and in accessing the dashboards was provided to all stakeholders.
Data is entered by a trained member of staff at the mental health clinic into the data system through an online platform using an admission form, clinic form, ward form, death form, and risk assessment form. Support with data entry and the IT system are provided through the NICST team.
To develop an electronic platform which enables the clinicians to visualise real time information regarding patients’ demographics, diagnosis, comorbidities, treatment regimes and follow them up into community clinics and home visits as part of the Mental Health Clinic (MHC) care.