Sri Lanka is a lower middle-income small island nation in the Indian Ocean with a multi-ethnic population of 22 million. The healthcare system of the country is well-established and fairly advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka saw a rapid development over the last four decades as the care model transformed from an asylum-based one, established during the British colonial times, to a district-wise hospital-based care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals started to also provide community-based care. The newly added community based services include outreach clinics, residential intermediate rehabilitation centres, home based care, community resource/support centres and telephone help lines. There is no or little separate funding for community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. Paradoxically, it conforms an advantage by making care delivery from the hospital to the community continuous, as it is the same team that provides both hospital- and community-based care. In addition to the essential mental health care provision in the community with this basic infrastructure, each community service has improvised and adapted utilization of other resources available to them, formally as well as informally, to compensate their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly of the civil administration. Though sustainability maybe questionable when services involve informal resources from the non-health sectors, it has so far proven useful and effective, in a resource-poor environment, as it brings the community and various sectors together to facilitate services to support their own community.
Community-based psychiatry services in Sri Lanka: A new model in the making
