National Institute of Mental Health

Angoda, Sri Lanka

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Support Halfway Home Mulleriyawa

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Help us lead the fight to provide quality care

A major part of NIMH is Halfway Home Mulleriyawa, a 600-bed psychiatric hospital for women from all parts of Sri Lanka.

In recent years many improvements have been made to the halfway home - also called Unit 2 - which include: assignment of dedicated doctors, reintegrating over 200 patients back into the community and the development of various projects for the women at the home - e.g., community housing, horticulture, vocational training and elders’ placement.

While great strides have been made, more work is needed and we need the community’s help. The Special Care Unit (SCU) is a residential ward at the home that provides specialized care 24 hours a day for 30 residents who have been diagnosed with primary mental and physical health problems.   

All types of problems are managed on this unit. The main criteria for admission being that the residents have problems carrying out normal activities of daily living and gradually become totally dependent on others. The residents on this unit therefore require a high level of medical and nursing input to meet their basic needs.

There are many reasons for this ranging from acute and chronic physical illness to debilitating mental impairment. Problems often manifest in poor physical health, poor dietary intake, sleep disturbance, memory impairment, confusion and difficulties in understanding and communicating. Behavioural and emotional changes are frequently seen with this client group. Each person is unique and experiences these problems in their own way.

Viewing the problems on a continuum can be a useful way to understand what the staff on the unit manages, but it is important to realize that this only provides a rough guide to the difficulties they manage.  At any one time approximately a third of the patients on the unit fulfill criteria for high dependency care.

Low-dependency needs

Most problems usually begin gradually with very minor changes in the person's abilities or behaviour. At the time, such signs are often mistakenly attributed to stress of daily living. It is only when looking back that we realise that these signs were probably the beginnings of more acute or chronic problems.

Confusion and agitation is a common early sign of both physical and mental changes in health. Someone with these problems may include:

  • having difficulty directly communicating their problems and needs  
  • repeating themselves 
  • losing interest in eating and have poor diet
  • a disturbed sleep pattern
  • neglecting their hygiene and self care
  • showing poor judgement, or find it harder to make decisions 
  • losing interest in other people or activities 
  • becoming more anxious and agitated.

Medium-dependency needs

As a person’s problems progress, the changes often become more marked. The person will need more support to help them manage their day-to-day living. They may need frequent reminders or help to eat, wash, dress and use the toilet. They sometimes become increasingly forgetful - particularly of names - and may repeat the same question or phrase over and over because of the decline in memory or increase in confusion. They may also fail to recognise people or confuse them with others. Some people at this stage become very easily upset, angry or aggressive - perhaps because they are feeling frustrated - or they may lose their confidence and become very clingy.

Other symptoms may include:

  • becoming confused about where they are, or wandering off and becoming lost
  • becoming muddled about time and getting up at night because they are mixing up night and day 
  • putting themselves or others at risk through their forgetfulness or confusion 
  • behaving in ways that may seem unusual, such as going outside in their nightclothes 
  • experiencing difficulty with perception, and in some cases hallucinations.

High-dependency needs

At this stage, the person will need even more help, and will gradually become totally dependent on others for nursing care. Loss of memory may become very pronounced, with the person unable to recognise familiar objects or surroundings or even those closest to them, although there may be sudden flashes of recognition. The person may also become increasingly frail. They may start to shuffle or walk unsteadily, eventually becoming confined to bed or a wheelchair.

Other symptoms may include:

  • difficulty in eating and, sometimes, swallowing
  • considerable weight loss - although some people eat too much, and put on weight 
  • incontinence, losing control of their bladder and sometimes their bowels as well 
  • gradual loss of speech though they may repeat a few words or cries out from time to time.

The person may become restless, sometimes seeming to be searching for someone or something. They may become distressed or aggressive - especially if they feel threatened in some way. Angry outbursts may occur during close personal care, usually because the person does not understand what is happening.

Programme of care

The Special Care Unit is not a single intervention but a set of related interventions comprising of:

  • individualized assessment and care plans tailor made for each resident
  • specially designed environment that assists residents in their activities of daily living, enhancing their quality of life, reducing tension and agitation and overall providing a positive therapeutic setting 
  • specific techniques in: behavioural, medical and medication management
  • special selection and supervision of staff members

The Special Care Unit is resource-intensive requiring a multi disciplinary team of dedicated medical, nursing, physiotherapists, occupational therapists and support staff working 24 hours to meet the needs of this challenging group of patients.


There are many ways you can support the work of the Special Care Unit and help us lead the fight to provide quality mental health services.

Provide for a group of patients: You can supply the basic requirements for a group of patients with high dependency needs for between 1 to 12 months of the year. This would consist of providing the following requirements for however many patients you choose. This list is for one patient for one month.

  • 84 pampers
  • 1 bottle of cologne
  • 1 tin of talc
  • 84 packets of surgical dressings
  • 2 tubes of baby cream
  • 1 tin of nutritious milk (sustegen)
  • 336 plastic aprons
  • 2 boxes disposable gloves
  • 8 air fresheners
  • 8 cans of mosquito repellent spray
  • 1 kilogram of washing powder
  • 10 surgical face masks

Make a financial donation: Help us lead the fight to provide quality care by making a donation, or by giving a gift in memory of someone dear. This is a very special way to remember a loved one; it honours their memory while giving hope to others who have mental health problems.

Volunteering: Do you have some time to spare? Volunteering is flexible, ranging from a few hours a year to several hours a week. It's your choice. In return we'll reimburse agreed out-of-pocket expenses and provide you with all the information and support you need.
Corporate involvement: There are lots of ways you and your company can provide support, from holding a fundraising event at work to sponsoring an event at the SCU. Or, by providing the basic needs for a group of high dependency patients on the Special Care Unit. The generous support that we receive from companies allows us to continue providing services for these deserving ladies on the Special Care Unit. By supporting this work you will:

  • boost employee morale and build loyalty
  • encourage team-building and leadership skills
  • enhance your brand

Supporting a good cause is a great way to develop team work and have fun whilst raising money for a vital cause such as caring for the mentally ill.

To help make a difference in your community and lead the fight to provide quality care, contact Dr. Hemapala or Matron at 0112578242 or email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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