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Department of Psychiatry and Mental Health

The Department of Psychiatry and Mental Health at Muhimbili National Hospital provides health care for patients with mental health problems who are suffering from psychological, addiction and psychiatric disorders that are either inpatients or outpatients. Apart from medical interventions which are provided to patients, the Department also provides the psychosocial interventions which include psychotherapies (individual, family or group), occupational therapy, resolving social problems as well as provision of mental rehabilitation services at Vikuruti rehabilitation village which is situated at Chamazi area (Mbande) about 25km away from Dar-Es-Salaam.

1.1 Capacity:

The Department bed capacity is 70 though normally it is admitting about 3 to 10 inpatients per day hence bed occupancy is always more than 100% due to high demands of services. There are four wards for admitting inpatients namely acute ward which has the capacity for admitting 12 patients (6 males and 6 females) who are acutely mentally disturbed; there are two general wards which provide the continuous phase of treatment after stabilizing the acute disturbing symptoms, one ward is for males (24 patients) and the other one is for females (24 patients); as well as a private/IPPM ward with the capacity of 10 beds (5 males and 5 females).

1.2 Staff:

The Department has clinical staff from Muhimbili National Hospital ( Medical Doctors, Mental Health Specialists, Mental Health Supper Specialists, Nurses, Social workers, occupational Therapists, artisans, livestock officer and supporting staff at Vikuruti rehabilitation Village) as well as academic staff from Muhimbili University of Health and Allied Sciences (MUHAS); these are Professors in Psychiatry and Mental Health, Medical Specialists in Psychiatry and Mental Health together with Psychologists. Staff form MNH and MUHAS have been working together as per memorandum of understanding between these two institutions; participate in both teaching and clinical activities as well as in research related activities.

1.3 Organization:

Psychiatry and Mental Health Department is currently organized into 5 major units (1 to 5) with the plan to add four more (6 to 9) as shown here under:

  1. Acute and Emergency Psychiatry
  2. Adult General Psychiatry unit
  3. Child and Adolescents Unit
  4. Addiction Unit
  5. Rehabilitation Unit
  6. Community Psychiatry Unit
  7. Organic and Liaison Psychiatry Unit
  8. Psychotrauma unit
  9. Psychosocial Management Unit

1.3.1 Acute and Emergency Psychiatry

The acute care unit deals with mentally unwell patients admitted with acute or severe mental illnesses (acutely disturbed patients) and who need closer monitoring and care until they stabilize. Such conditions are those with emergency psychiatry including agitation, aggressiveness, suicidality (Ideation and plans), etc. The medical staff in this unit has special training on acute care for mentally unwell patients. Patients get closer monitoring and management and once have stabilized they are transferred to the general wards.

1.3.2 Adult General Psychiatry Unit

The general psychiatry unit is further divided into 4 subunits/firms based on catchment areas of Dar-Es-Salaam (Ilala, Temeke, Kinondoni and Magomeni) in which patients are assigned based on his/her residence; while those who are coming outside Dar-Es-Salaam will be assigned units based on the firm which is on admitting duty. The unit is responsible for all mentally unwell patients, being in-patients during continuous phase of treatment as well and outpatients during maintenance phase (follow-ups).

1.3.3 Child and Adolescents Unit

This unit currently takes care of the children who under sixteen years of age and suffer from mental illness, psychological distress, psycho-trauma, substances and alcohol related problems to mention a few. We are on the process to include the adolescents up to 19 years of age. Children and adolescents need special care and attention that differ from the adults.

1.3.4 Addiction Unit

This unit provides treatment of related alcohol and substances abuse related problems. The treatment includes both in-patient care (detoxification therapy) as well as the outpatient care; and provides both biological and psychosocial management. The unit also provides substitution therapy for those who inject opioid (Heroin), that is methadone assisted therapy (MAT) through methadone clinic.

1.3.5 Rehabilitation Unit

Under this unit we do provide the occupational therapy for both inpatients and outpatients, this is at the department as well provision of long term residential mental rehabilitation services at Vikuruti rehabilitation village. Occupation and rehabilitation services are provided to any patient with mental illness and who is also on need of these services after being assessed. The services are individualized and planned accordingly to the patients needs and goals that health provider want that particular patient to achieve.

1.3.6 Other Units to be established

The Department is also on the process to establish more units which are community psychiatry, Organic and Liaison psychiatry Unit, Psycho-trauma unit and Psycho-trauma unit. Lack of sufficient number of staff has made these plans to delay however strategic plans are in place to ensure they soon start to function.

1.3.7 Community Psychiatry Unit

The unit will be responsible of provisional of health psycho-education, home visiting and community care of the mentally unwell patients and outreach services to the community and to other hospitals.

1.3.8 Organic and Liaison Psychiatry Unit

This unity will deal with physical and neurological conditions that have impact on the mental wellbeing, e.g. Epilepsy, Meningitis, Encephalitis; mental health problems due to head injury, stroke, severe and cerebral malaria, Diabetes mellitus, High blood pressure, HIV related mental health problems e.t.c.

1.3.9 Psycho-trauma Unit

Establishment of Psycho-trauma unit that will take care of psychological distress and mental illness due to various trauma like sexual abuse, physical abuse, emotional abuse and other aspects of gender based violence (GBV), various aspects of loss, manmade and natural catastrophes like bomb blasts, floods, earthquake etc. respectively. Currently we do also provide psycho-trauma services but not in a formed unit designated for these services.

1.3.10 Psychosocial Management Unit

Moreover the psychosocial interventions unit is on the process to be formally established; however we do routinely provide Psycho-social services for our patients as well as the provision of Psycho-social services to the key populations, through Muhimbili Health Information Centre (MUHIC) mobile clinics. The key populations include injecting drug users (IDUs), men who have sex with men (MSM), commercial sex workers (CSWs).

1.4 Ward Rounds

Ward rounds are conducted on the daily basis by medical specialists, residents, registrars and interns medical officers together with nurses; this includes weekends and public holidays. We do conduct major ward rounds four times per week where by each firm has specific day of conducting major ward round; Monday (Magomeni firm), Tuesday (Temeke firm), Wednesday (Ilala firm) and Friday (Kinondoni firm).

During major ward rounds in additional to specialists, registrars and nurses, the Community psychiatry nurses, social workers, occupational therapist and the students (under graduates, post graduates, nurse students etc.) are also included. During this round most of the teachings are taken place.

1.5 Training

The department is involved in training of both undergraduate, postgraduate medical students taking Master of Medicine in Psychiatry and Mental Health and those who are taking Master of Science in clinical psychology; who are under MUHAS. We are also involved in training the intern doctors, nurse students and from time to time we do receive elective students from different countries as well as students who are taking social studies and occupation therapy coming for field attachment at our department. As part of continuing education we do conduct Journal clubs every Thursdays morning, grand round every Fridays morning and also participating on School of medicine’s symposium of MUHAS.

1.6 Summary of the Functions o the Department of Psychiatry and Mental Health:

  1. Undertake medical care of out-patients and in-patients (Children, adolescents, adults and elders) with mental illness in accordance with medical ethics and mental health act of Tanzania (2008), Mental Health Policy of Tanzania as well as the standard operating procedures of the department (SOPs).
  2. Provision of programs/projects/research for the improvement or advancement of mental health, hence improve the quality of life of the people of the United Republic of Tanzania.
  3. Provision of a conducive teaching environment for training medical personnel and allied staff.
  4. Provision of conducive environment and facilitate the training of both undergraduate and postgraduate students.
  5. Provision of VCT services, continuous health profession training on HIV, stigma and discrimination against HIV/AIDS, as well as training on GBV and alcohol use.
  6. Provision of medical assisted therapy (MAT) for those who are addicted by heroin as well as provision of other substances and alcohol related problems.
  7. Provision of community psychosocial intervention through mobile clinics.

1.7 Accessing the Mental Health Services

You need a referral from municipal hospitals, referral from a doctor from other department or self referral to be accessible to our services. Making appointment depends on whether is a public or private patient, outpatient clinics are conducted based on firms and specific day, Monday (Temeke firm), Tuesday (Kinondoni firm), Wednesday (Magomeni firm) and Friday (Ilala firm). Private patients are seen by their preferred doctors regardless of their catchment areas.

On Wednesday there is also a new case clinic which is responsible for those new patients whom do not need the emergency care, this clinic involves all firms. Thursday is the day for child and adolescents’ clinic.

The admitting team (i.e. on call doctors) which includes the specialist, resident and intern doctor is the one which is responsible for attending all the emergencies including the patients who need admission.

1.8 Functions:

  1. To undertake medical care of out-patients and in-patients with mental illness in accordance with medical ethics and mental health act as well as the standard operating procedures of the department
  2. To conduct programs/projects/research for the improvement or advancement of mental health, hence improve the quality of life of the people of the United Republic of Tanzania
  3. To provide a conducive teaching environment for training medical personnel and allied staff
  4. To provide conducive environment and facilitate the training of both undergraduate and postgraduate students.
  5. Provide VCT services, continuous health profession training on HIV, stigma and discrimination against HIV/AIDS, as well as training on GBV and alcohol use

1.9 Visiting the clinic.

You need a referral from a doctor or self to make appointment. Outpatient clinics are conducted based on firms and specific day, Monday (Temeke firm), Tuesday (Kinondoni firm), Wednesday (Magomeni firm) and Friday (Ilala firm). On Wednesday there is also a new case clinic which is responsible for those new patients whom do not need the emergency care, this clinic involves all firms. Thursday is the day for child and adolescents’ clinic. The admitting team (i.e. on call doctors) which includes the specialist, resident and intern doctor is the one which is responsible for attending all the emergencies including the patients who need admission.

Guiding Principles

Integrity

MNH has a social responsibility to improve the health of future generations. Guided by fundamental ethical principles of access and equity and in compliance with related laws and regulations, MNH will work with integrity in the pursuit of high quality clinical services. Respect Our patient and our workforce are our greatest resources. We are committed to a patient centred hospital environment and workforce built on respect for diversity, trust, communication, and institutional teamwork at all levels within the organization. .

Respect

Our patience and workforce are our greatest resources. We are committed to a patient centred hospital environment and workforce built on respect for diversity, trust, communication and institutional team work at all levels within the organization.

Quality

MNH will accomplish objectives by using all available resources to continually ensure best value for patients and stakeholders. This strategic planning process directs available resources to achieve strategic goals in the most cost effective manner. MNH shall collaborate with the Ministry of Health (Government), Muhimbili University College of Health Sciences (MUHAS), Muhimbili Orthopaedic Institute (MOI), Ocean Road Cancer Institute (ORCI), the Dar es Salaam Municipal and other referral hospitals to deliver the highest quality services within existing resources.

Security

MNH is committed to ensure the security of the Hospital. MNH will work proactively with patients, employees, and Hospital security officials to maintain a secure work environment for patients, staff, and Hospital assets.

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