Help With/For The Insane

[Mobaan]

There is an unfortunate sick women in the village (certified insane) , pretty much abandonned by family , doctors and hospitals claim that they can not help anymore .

Till recently crazy bouts lastet 3-5 days ,but now for over 3 month it is like living next to a nuthouse ( which really is what it amounts to ).

The Pujay Ban claims his hands are tiedand says that the family would have to take care .

So far , so good (bad) . Now she becomes violent and destroys property -hers and others -at will .

How can one deal with such a situation , when everybody sticks his head in the sand and does not want to be involved?

[Boo]

poor woman, I don't know any organization that might be able to help her (and you) but I suppose, eventually she will end up doing something so dangerous or illegal that someone like the police will have to get involed & at best put her in prison.

This is the downside to life in Thailand imo, in Uk she would have been taken under a protection order to a facility better able to cope with her condition.

[mizzi39]

Unfortunately there is no Dept.of Mental Health (per say) in Thailand. Family is expected to care for her. The problem is that there are virtually no resouces to help the family deal with the her even if they wanted to help, so you can't really blame them for their frustrations. Thailand is way behind the times when it comes to dealing with Mental Health issues. The situation sounds intolerable. Maybe a move may be in order? Best of Luck.

[Flatouthruthefog]

Unfortunately there is no Dept.of Mental Health (per say) in Thailand. Family is expected to care for her. The problem is that there are virtually no resouces to help the family deal with the her even if they wanted to help, so you can't really blame them for their frustrations. Thailand is way behind the times when it comes to dealing with Mental Health issues. The situation sounds intolerable. Maybe a move may be in order? Best of Luck.

Sadly you don't say where you are.

In Chiang Mai we have Suan Prung, a big mental hospital with (from what I've seen and heard over several years) a good reputation.

This place takes patients referred to them from a very wide area. One I know came from a long way south of Tak. Good doctors here in the north refer many families of 'potential patients' to Suan Prung. The SP doctors and staff seem to be very caring, and there is always an English speaking doctor on duty, day time, at admissions.

I have visited 3 patients there over the years, 1 Thai and 2 'farang' and am very impressed.

Communications in the medical world here are not good. I suggest you ask the most reputable doctor in your area how this woman can be moved to SP or a similar place closer to you.

Well done for making this a plea for help, not just a complaint. Much as that is justified!

Good luck!

[stander]

Antifreeze!!

[tim armstrong]

Unfortunately there is no Dept.of Mental Health (per say) in Thailand. Family is expected to care for her. The problem is that there are virtually no resouces to help the family deal with the her even if they wanted to help, so you can't really blame them for their frustrations. Thailand is way behind the times when it comes to dealing with Mental Health issues. The situation sounds intolerable. Maybe a move may be in order? Best of Luck.

There is a Dept. of Mental Health within the main Dept of Health in Bangkok, and usually a large psych. hospital in each province. Mental health problems of this kind are usually dealt with by a psychiatrist based in your main provincial town, and the local community nurses at village community health clinics. The place to start is with your community clinic or local GP, to find out if she actually is known to the system. Thais are afraid of mental health problems because they often think they are 'contagious' or have connections to ghosts, and bad karma - which is one reason they keep their distance.

If the person is known, she may have stopped taking her medication or not been visited for a while. If there is no one to monitor her medication, she may be able to receive a monthly injection, depending on the diagnosis, (which sounds like a psychotic disorder). The cost of medication to people in this situation is usually free, but there maybe issues here as well if there are relatives. Suggest you get a sympathetic Thai person to go with you to the local clinic nearest to her to discuss the problem,and make an assessment. But be careful about getting too involved,(unless you want to)-especially if relatives know a farlang is interested, as you may be asked for a financial contribution.

Less well known is that many towns and villages have a network of local business people who do actually provide some welfare type assistance to people in these circumstances. Local administrators know who to contact.

But almost certainly the situation probably can be improved on - to everyone's benefit.

[Mobaan]

Unfortunately there is no Dept.of Mental Health (per say) in Thailand. Family is expected to care for her. The problem is that there are virtually no resouces to help the family deal with the her even if they wanted to help, so you can't really blame them for their frustrations. Thailand is way behind the times when it comes to dealing with Mental Health issues. The situation sounds intolerable. Maybe a move may be in order? Best of Luck.

There is a Dept. of Mental Health within the main Dept of Health in Bangkok, and usually a large psych. hospital in each province. Mental health problems of this kind are usually dealt with by a psychiatrist based in your main provincial town, and the local community nurses at village community health clinics. The place to start is with your community clinic or local GP, to find out if she actually is known to the system. Thais are afraid of mental health problems because they often think they are 'contagious' or have connections to ghosts, and bad karma - which is one reason they keep their distance.

If the person is known, she may have stopped taking her medication or not been visited for a while. If there is no one to monitor her medication, she may be able to receive a monthly injection, depending on the diagnosis, (which sounds like a psychotic disorder). The cost of medication to people in this situation is usually free, but there maybe issues here as well if there are relatives. Suggest you get a sympathetic Thai person to go with you to the local clinic nearest to her to discuss the problem,and make an assessment. But be careful about getting too involved,(unless you want to)-especially if relatives know a farlang is interested, as you may be asked for a financial contribution.

Less well known is that many towns and villages have a network of local business people who do actually provide some welfare type assistance to people in these circumstances. Local administrators know who to contact.

But almost certainly the situation probably can be improved on - to everyone's benefit.

Thanks very much everybody for the input . I have contacted the local hospital/nurse and indeed they are responsive and will get into the act (I hope). BTW the location is in Udon Thani Province.

[ronz28]

Tough situation, her violence is a risk you are wise to try to mitigate. Hopefully, she just needs to take some meds to clear her mind or at least to calm her down. It may be worth your peace of mind to follow-up and update Pujay Ban as he may not be aware of the help you found but he might be able to offer some help on getting the family involved too.

[tim armstrong]

Moban, good to hear you got some action. The community nurses in Thailand are generally quite well trained and helpful. Psychiatrists on the other hand are a mixed bunch, and have a tendency to over prescribe medication, simply to keep patients quiet.

In the past patients often stopped their meds. because of the side effects, which could be permanent. eg.constant tremors, shuffling gait,uncontrolled facial movements and sun susceptibility. Newer meds have many fewer side effects, are effective but more expensive. So public hospitals in Asian countries are still inclined to go for the cheaper options. Most patients know that the side effects of the old meds, make them look odd, so they stay at home often alone and -- get frustrated, angry and ill - again. Contrary to myth the majority of people with a mental illness have normal intelligence, so when they are well,they can be counselled and advised about the effects of their behaviour on others.

[Mobaan]

Moban, good to hear you got some action. The community nurses in Thailand are generally quite well trained and helpful. Psychiatrists on the other hand are a mixed bunch, and have a tendency to over prescribe medication, simply to keep patients quiet.

In the past patients often stopped their meds. because of the side effects, which could be permanent. eg.constant tremors, shuffling gait,uncontrolled facial movements and sun susceptibility. Newer meds have many fewer side effects, are effective but more expensive. So public hospitals in Asian countries are still inclined to go for the cheaper options. Most patients know that the side effects of the old meds, make them look odd, so they stay at home often alone and -- get frustrated, angry and ill - again. Contrary to myth the majority of people with a mental illness have normal intelligence, so when they are well,they can be counselled and advised about the effects of their behaviour on others.

Tim Armstrong ,

you seem to have a grasp on the mental illness situation . This lady when she is affected ( now pretty much constantly) is talking up a storm , almost 24 hours a day . It is amzing where she gets the energy form to be up almost all day long and talk and sing and shout (vulgarities for the most ). Nobody knows if she has any medication. People stay away from her . Family would like to not know anything about ther etc . I hope the nurses can get something done . She refuses our offers for food , because she is afraid to be poisioned .Otherwise she seems to be in decent physical condition , appearently she gets enough food from the Wat.

The local Puya Ban claims not to know any contacts for her family , but I suspect , that this the normal "I dont want to get involved "issue - as usual.

If the hospital/nurse can not get any thing accomplished , would it be advisable to contact the police. Or might it help to contact the abbot of the Wat where she gets her food?

I already have resigned to the fact that I as usual will have to foot the bill for the damages she caused to the property .

As mentioned earlier I am more than willig to help with the cost of medication, but we will have to find a way to get her to take it . There was mention of a monthly shot in the arm, what would that be ? Any idea about the costs !

[Kwasaki]

Sorry to hear of your plight, we have a lady next door to us that goes off the rails now and again but has her mother and father taking care but they go out and leave her sometimes and she gone into one, everyone locks up because she once came out running into the soy with a big knife.

l always wai her back when she's about and l feel sorry for her really she is ok when she taking her medication.

l only watch out if any kids are about and tell them to go home when she is having problems they are my main worry but all the neighbours just except it and take it in there stride.

[Thanyaburi Mac]

Try calling these outfits, they might be able to refer you to a Thai government facility that could handle the problem. There is a mental hospital in the Din Daeng area of Bangkok, I just can't remember the name of it.

Mac

Manarom Hospital

As the nation's first and only private hospital for mental and behavioral health care, Manarom Hospital is committed to attain and enhance a leadership role in behavioral health, mental health, and psychiatric services. Located Sukhumvit Soi 70. Child and adolescent, geriatric services. Chemical dependency treatments.

http://www.manarom.com/

Mental Health Association of Thailand Under the Royal Patronage 356/10, Sriayudhaya, Tungphyathai, Rajthevee, Bangkok 10400 245-2733 245-2734 Mental Illness

Department of Mental Health Department of Mental Health, Ministry of Public Health, Tivanont, Taladkwan, Muang, Nonthaburi 11000 951-1300-41 951-1369

[tim armstrong]

Moban, good to hear you got some action. The community nurses in Thailand are generally quite well trained and helpful. Psychiatrists on the other hand are a mixed bunch, and have a tendency to over prescribe medication, simply to keep patients quiet.

In the past patients often stopped their meds. because of the side effects, which could be permanent. eg.constant tremors, shuffling gait,uncontrolled facial movements and sun susceptibility. Newer meds have many fewer side effects, are effective but more expensive. So public hospitals in Asian countries are still inclined to go for the cheaper options. Most patients know that the side effects of the old meds, make them look odd, so they stay at home often alone and -- get frustrated, angry and ill - again. Contrary to myth the majority of people with a mental illness have normal intelligence, so when they are well,they can be counselled and advised about the effects of their behaviour on others.

Tim Armstrong ,

you seem to have a grasp on the mental illness situation . This lady when she is affected ( now pretty much constantly) is talking up a storm , almost 24 hours a day . It is amzing where she gets the energy form to be up almost all day long and talk and sing and shout (vulgarities for the most ). Nobody knows if she has any medication. People stay away from her . Family would like to not know anything about ther etc . I hope the nurses can get something done . She refuses our offers for food , because she is afraid to be poisioned .Otherwise she seems to be in decent physical condition , appearently she gets enough food from the Wat.

The local Puya Ban claims not to know any contacts for her family , but I suspect , that this the normal "I dont want to get involved "issue - as usual.

If the hospital/nurse can not get any thing accomplished , would it be advisable to contact the police. Or might it help to contact the abbot of the Wat where she gets her food?

I already have resigned to the fact that I as usual will have to foot the bill for the damages she caused to the property .

As mentioned earlier I am more than willig to help with the cost of medication, but we will have to find a way to get her to take it . There was mention of a monthly shot in the arm, what would that be ? Any idea about the costs !

Mobaan,

The monthly shot in the arm depends on the diagnosis. Some illnesses can be medicated in this way, others not. Injectible medications of this type are designed to slowly release the medicine over a long period, but they may take 1-2 wks to start. In the short term, for the behaviour you describe, the lady would ideally be medicated with a fast acting tranquilliser that would calm her down. She would be admitted to a psych. hospital for diagnosis, assessment and the commencement of a long term treatment plan. In countries with more advanced mental health systems this would now take from 1-2weeks, depending on her progress. Her family,interested others, and a community based mental health team, would then take over her management and she would be discharged home.

Large old psych. hospitals in these western countries have mostly been replaced by acute psych. units attached to regional hospitals. The idea being to keep patients in the community.

In Thailand and other Asian countries community nurses manage those patients at home whose symptoms are controlled by the medication. Not all patients can be managed in this way, especially those with some types of schizophrenia, but most can. Unfortunately, a small number do need long term hospitalization, or constant monitoring. Because of the costs and resources involved, Thailand and other countries, still takes the view that large hospitals (1500-2000 patients) are the way to go.

Many families also still believe in 'out of sight out of mind' The Manoram hospital mentioned is very expensive, very medication orientated, and caters mainly for wealthy Bangkok Thais.

To your credit,you seem to be very concerned for this person as much as understandably, seeing her as a problem. If she can be assessed quickly, and medicated appropriately, without being reduced to an over tranquillised patient, she may be able to live at home. But she would need nurses to check regularly, psychiatrist input, and someone living near her to let the nurses know if her symptoms start to reappear.

I've seen quite miraculous changes in patients in remote villages in other countries, where there is both some reliable mental health input, and the illness is explained to neighbours. But it depends a lot on how much empathy there still is for this lady. For sure, treatment options are much better than they were 20 years ago, but attitudes still have a way to go. I would also be trying to get the relatives a bit more involved, as you may be seen as the rescuer for this lady.

Ending up in a long term psych. hospital should be the last option, only after all other choices have been exhausted. Regards