managing mental illness
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8/10/2019 Managing Mental Illness
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COMMANDER’S GUIDE IN
MANAGING MENTAL ILLNESSAMONG MILITARY PERSONNEL
Lt Kol (Dr) Lotfi bin AnuarHAT Tuanku Mizan
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Mental illness• Adalah penyakit yang melibatkan gangguan
fungsi otak yang boleh menyebabkan
perubahan kepada proses pemikiran,perasaan dan tingkah laku yang menyebabkangangguan kepada aktiviti tugasan seharian.
•
11.1% dewasa di Malaysia mengalamipenyakit mental (1996)• 2020 penyakit mental adalah penyebab kedua
hilang upaya di dunia
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Jenis-jenis Penyakit Mental• 1. Neurosis•
2. Psikosis• 3. Kecelaruan personaliti
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Neurosis• Pesakit mengalami perubahan dan gangguan di dalam
pemikiran, perasaan dan kelakuan tanpa menjejaskankewarasan 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 takutmelampau akan bahaya yang mereka tidak ketahui
puncanya.
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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
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Kecelaruan Personaliti• Kecelaruan ini akan menyebabkan seseorang
itu mengalami ke cacatan perwatakan ataukarakter
• Masalah ini boleh memberi kesan kepadaperhubungan interpersonal dengan orangsekelilingnya.
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PUNCA PENYAKIT MENTAL• Multifactorial
1. genetik2. gangguan bahan kimia dalam otak3. jangkitan virus
4. pengambilan dadah dan ubatan terlarang5. sejarah hidup yang getir6. taraf sosioekonomi yang rendah
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Rawatan• Ubat-ubatan• Psikoterapi• Kaunseling• Terapi pemulihan cara kerja•
Pemulihan psikososial
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MEDICAL BOARD
&
KES-KES FORENSICPSYCHIATRY
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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 UntukMentadbir dan Mengurus Pesakit Mentaldi dalam Tentera Darat”.
• 5 categories: FE, LE, BE, NIL or Unfit formilitary service
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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
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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 moderatedepression
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P2 S2 PES BE• Soldier has wider limitation• Excuse handling firearm, big parade, night
duties, operational duties, driving militaryvehicle
• Physical training is excused at the initial
stage of treatment only.• Eg: MDD with Psychosis, severe depression,
brief psychotic disorder, Residual typeschizophrenia
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P2 S8 PES Unfit for military service• The soldier is suggested to be terminated
from military service due to chronicunrecovered 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 toplead) dan criminal responsibility
• It was deal through the court marshal• The most common case
1. Drug abuse and trafficking2. Absent (AWOL)3. Aggression
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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 accusedfound insane
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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
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Criminal Responsibility• Psychiatric opinion is sought on the influence of
psychiatric disorder on criminal responsibility•
Before anybody can be convicted of a crime, theprosecution must prove beyond a reasonabledoubt that the defendant:
• 1. Carried out an unlawful act (actus reus)•
2. had at the time the state of mind necessaryto 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.
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Issues in Criminal Responsibility1. Fitness to trial.2. If found guilty, should he held the criminal
responsibility for the offence (insanitydefense).
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Thank You
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