Promoting Mental Health Care in Taiwan-Policy and practice developments Happy Tan, MD MPH MHS Director, Mental Health Office, DOH Superintendent, Taoyuan Mental Hospital, DOH Nov 11, 2011

1985 Hospital Accreditation : every 3-4 years improve the quality of care for psychiatric patients 1986 Psychiatric Network Projects increase mental health budget improve supply and accessibility 1987 Division of Mental Health, Bureau of Medical Affairs, Department of Health 1988 Experimental community services projects encourage setting up of community rehabilitation centers and half way houses Development of Mental Health Polices in Taiwan

1989 Board certificated for psychiatrist 1990 Mental Health Law improve human right of persons with mental illness compulsory admission of dangerous psychotic patients 1995 National Health Insurance free treatment for major psychotic patients 1995 Disabilities Protection Act 1997 Sexual Offend Prevention Law 1998 Domestic Violent Prevention Law 2007 revised Mental Health Law Development of Mental Health Polices in Taiwan

March 2009 Mental Health Office, DOH Future: July 2012, Department of Mental Health, Bureau of Health and Social Welfare Development of Mental Health Polices in Taiwan

Psychiatric Medical Facility The rapid rising of psychiatric hospitals and beds in 1996 is due to the encouraging project for underserved areas from 1992 and annual accreditation system for mental health institutes * NHI launched in 1995

6 Psychiatric Beds in Taiwan acute chronic total acutechronictotal

Psychiatric beds (per 10,000) 1.84 millions bed globally, 4.6 bed per 10 thousand, and 68.6% in mental hospitals From: WHO: Atlas-country profiles on mental health resources 2005, DOH Taiwan 2005

8 Psychiatric Day Care in Taiwan Day care

9 Residential house and sheltered workshop Sheltered workshop Halfway houses Sheltered workshop

TaiwanS. KoreaJapanChinaHongKongSingaporeUSAUKFranceGermanyFinlandAustralia Psychiatrists Psychiatric Nurses Psychologist OT Social Workers Mental Health Atlas, WHO 2005; WFOF 2005, DOH, Taiwan 2007 number/100,000 Mental Health Professionals

The development of Taoyuan Mental Hospital (TMH) Acute, chronic, day care for adult and children, home care, half way house, reh center Acute, chronic beds Acute, chronic, day care (adult and child), home care, half way house, reh center, vocatinal training

12 Service: Service: younger than 7 y/o Autism (90%) 、 development delay Autism (90%) 、 development delay (10%) Occupancy rate: 88% Treatment goal Promote language communication, cognition, interpersonal interaction and self arrangement, Modification of maladjustment behavior, Provide emotional support and related information to the family Child day hospital in TMH - Integrated early intervention (50 beds) Child day hospital in TMH - Integrated early intervention (50 beds)

13 Service:13-22 y/o Service: y/o Schizophrenia 60% Bipolar disorder 20% Autism 10% Mental retardation 10% : 98% Occupancy rate : 98% Treatment goal Reconstruct daily activity, cultivate independent ability Modify inappropriate behavior Promote recognition of disease and treatment compliance Help management of psychosocial stress Computer learning Outdoor teaching Adolescent day hospital (50 beds) Art Therapy

14 Service:23 y/0 Service: older than 23 y/0 Occupancy rate: 91% Treatment goal Cultivate compliance and prevent relapse Help construct daily activity Learn social skill and improve interpersonal relationship Promote independent living ability in the community Learn to manage psychosocial stress Singing contest ExerciseActivity Adult day hospital (200 beds) Group psychotherapy

The community programs Half way house Rehabilitation center Vocational training

Promoting Methadone Maintenance Therapy (MMT) services in Taiwan Starting from Feb, 2006 initiated by CDC. 1 st MMT clinic : Taoyuan Mental Hospital providing training programs, creating computerized management system, advocating Initial half year free service for HIV(+) cases After half year, subsidize by Department of Health –Total subsidize: Heroin abusers with HIV positive –Partial subsidize: Heroin abusers without HIV MMT clinics at psychiatric hospitals, psychiatric departments and public health stations, at present there are 100 sites. Every day there are over 11,000 cases.

4600 Case number of MMT MMT pilot plan , , , , , , , MMT pilot planexpanded MMT Accessibility Plan End of MMTAccess. Plan AIDS preventionprogram End of AIDS preventionprogram subsidize infectionscreening subsidize first visit andeach day’s Methadonedispensing. 100sites 6sites

Remarkable reduce of new HIV Cases by IDU Remarkable reduce of new HIV Cases by IDU Transmission (CDC, Taiwan 2010) Transmission (CDC, Taiwan 2010) The % of IDU among HIV infection 2004 ： 41.5% ↓ 2005 ： 72.6% ↓ 2006 ： 61.2% ↓ 2007 ： 37.0 % ↓ 2008 ： 21.9 % ↓ 2009 ： 10.7% ↓ 2010 ： 4.4%