managing mental illness

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



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



Jenis-jenis Penyakit Mental• 1. Neurosis•

2. Psikosis• 3. Kecelaruan personaliti



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.



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 ataukarakter

• Masalah ini boleh memberi kesan kepadaperhubungan interpersonal dengan orangsekelilingnya.



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



Rawatan• Ubat-ubatan• Psikoterapi• Kaunseling• Terapi pemulihan cara kerja•

Pemulihan psikososial



MEDICAL BOARD

&

KES-KES FORENSICPSYCHIATRY



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



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 moderatedepression



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



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



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, 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.



Issues in Criminal Responsibility1. Fitness to trial.2. If found guilty, should he held the criminal

responsibility for the offence (insanitydefense).



Thank You

managing mental illness

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