Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation.
OBJECTIVE
Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability.


METHODS
Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings.


RESULTS
Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2.


CONCLUSIONS
Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.
Silove
Derrick
D
School of Psychiatry, University of New South Wales, Australia. d.silove@unsw.edu.au
Manicavasagar
Vijaya
V
Baker
Kim
K
Mausiri
Manual
M
Soares
Marce
M
de Carvalho
Florentino
F
Soares
Aristedes
A
Fonseca Amiral
Zulmira
Z
D000328:Adult; D001315:Australia / Q000453:epidemiology; D002391:Catchment Area, Health; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012307:Risk Factors; D012920:Social Behavior Disorders / Q000150:complications / Q000453:epidemiology*; D012940:Social Problems; D014857:Warfare