Managing Mental Illness

COMMANDER’S GUIDE IN MANAGING MENTAL ILLNESS AMONG MILITARY PERSONNEL

Lt Kol (Dr) Lotfi bin Anuar HAT Tuanku Mizan

Mental illness • Adalah penyakit yang melibatkan gangguan fungsi otak yang boleh menyebabkan perubahan kepada proses pemikiran, perasaan dan tingkah laku yang menyebabkan gangguan kepada aktiviti tugasan seharian. • 11.1% dewasa di Malaysia mengalami penyakit mental (1996) • 2020 penyakit mental adalah penyebab kedua hilang upaya di dunia

Jenis-jenis Penyakit Mental • 1. Neurosis • 2. Psikosis • 3. Kecelaruan personaliti

Neurosis • Pesakit mengalami perubahan dan gangguan di dalam pemikiran, perasaan dan kelakuan tanpa menjejaskan kewarasan meraka • Contoh: Kemurungan • Kemurungan adalah perasaan sedih yang melampau dan berpanjangan di luar kebiasaan sehingga mengganggu fungsi kehidupan seharian. • Juga perasaan bimbang, resah dan gelisah, tertekan, tegang, berpeluh, berdebar-debar dan berasa takut melampau akan bahaya yang mereka tidak ketahui puncanya.

Psikosis • Pesakit mengalami perubahan yang amat ketara di dalam pemikiran, perasaan, tingkah laku dan kewarasan. • Mendengar suara ghaib dan berkomunikasi dengannya • Mempunyai kepercayaan pelik dan memberi reaksi melampau kepada pesakit • Bercakap merapu, berkelakuan aneh, marah dan aggressif tanpa sebab munasabah • Eg schizophrenia, bipolar mania

Kecelaruan Personaliti • Kecelaruan ini akan menyebabkan seseorang itu mengalami ke cacatan perwatakan atau karakter • Masalah ini boleh memberi kesan kepada perhubungan interpersonal dengan orang sekelilingnya.

PUNCA PENYAKIT MENTAL • Multifactorial 1. genetik 2. gangguan bahan kimia dalam otak 3. jangkitan virus 4. pengambilan dadah dan ubatan terlarang 5. sejarah hidup yang getir 6. taraf sosioekonomi yang rendah

Rawatan • • • • •

Ubat-ubatan Psikoterapi Kaunseling Terapi pemulihan cara kerja Pemulihan psikososial

MEDICAL BOARD & KES-KES FORENSIC PSYCHIATRY

DKT Status • Apply to tri-service with some additional for the RMAF • Refer to MKTD/ G1/1767/ (D&P) dated 28 Jan 2008, “Garis Panduan Untuk Mentadbir dan Mengurus Pesakit Mental di dalam Tentera Darat”. • 5 categories: FE, LE, BE, NIL or Unfit for military service

P2 S2 PES FE • Healthy soldier, require no medication or minimal medication or psychotherapy only • Has to undergo normal soldier routine • Eg: marital dysharmony, conflict, work related stress, acute stress reaction

P2 S3 PES LE • Soldier has limitation in military duties within a period of time • Excuse from handling firearms or usage under supervision depending on CO approval • Eg: general anxiety disorder, panic disorder. Adjustment disorder, mild to moderate depression

P2 S2 PES BE • Soldier has wider limitation • Excuse handling firearm, big parade, night duties, operational duties, driving military vehicle • Physical training is excused at the initial stage of treatment only. • Eg: MDD with Psychosis, severe depression, brief psychotic disorder, Residual type schizophrenia

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P2 S8 PES Unfit for military service • The soldier is suggested to be terminated from military service due to chronic unrecovered illness. • Commanding Officer has to support the discharge through BAT F8 • Maximum percentage of disability is 20%

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Forensic Psychiatry • Penentuan kelayakan membela diri (fit to plead) dan criminal responsibility • It was deal through the court marshal • The most common case 1. Drug abuse and trafficking 2. Absent (AWOL) 3. Aggression

Armed Forces Act 1972 • Section 33:

Discharge of servicemen of unsound mind • Section 80: Attempting to commit suicide • Section 92: Field punishment • Section 131: Provisions where accused found insane

When Does Forensic Psychiatry Involve In Court Marshal? • When the case involve psychiatric patient • When the judge of court marshal or lawyer asking for psychiatric opinion or evaluation. • As an expert witness • Fitness to trial • Fitness to undergo field punishment • To assess state of the mind at the time of offence

Criminal Responsibility • Psychiatric opinion is sought on the influence of psychiatric disorder on criminal responsibility • Before anybody can be convicted of a crime, the prosecution must prove beyond a reasonable doubt that the defendant: • 1. Carried out an unlawful act (actus reus) • 2. had at the time the state of mind necessary to commit a crime (means rea) • The person’s mental state at the time of act is important in determining whether the person is guilty or not.

Issues in Criminal Responsibility 1. Fitness to trial. 2. If found guilty, should he held the criminal responsibility for the offence (insanity defense).

Thank You