Medical Treatment In addition to pharmacological treatment, electro convulsive therapy, cognitive behavioral therapy, occupational therapy, exposure, and horticulture therapy are being used at NIMH for the treatment of patients. In addition to shortage of medication being an ongoing problem, the hospital also has had several quality failures of the drugs as well. When the medicines are out of stock, alternatives are being used for the treatments. However, it was relayed that most of these alternatives have more side effects than the high-quality medicines that are out of stock. Furthermore, there are also instances where the families of the patients were asked to bring some medication from outside. Due to the high cost, the discharged patients also struggle to afford their medication. According to the details gathered these issues have led to an increase in relapses and recurrent admissions. It should be noted that when patients undergo constant relapses their cognitive impairment significantly worsens. In the instances where the patients become aggressive, if the verbal de-escalation is not fruitful, oral medication is provided to make the patient calm. If it fails, measures are taken to sedate the patient and restrain him/her. In more extreme situations where the patient cannot be sedated, and the patient acts violently, measures are taken to move the patient to a seclusion room. However, since most male wards are staffed by female nurses, patient management in such situations is carried out by the support staff who do not train for the task. Therefore, the effectiveness of such patient management is questionable. It was reported that most of the time support staff refused to adhere to the existing protocols when handling patients. As per the advice given by medical experts, only chemical restraint should be used on the patients and not mechanical restraint. This brings out the importance of having high dependency units in the wards where the patients with violent tendencies could be managed separately without risking the wellbeing of other patients. During emergencies, in addition to reporting the matter to the on-call doctor, the nursing staff and the support staff of the wards take steps to manage the situation. If the support staff of the ward could not handle the situation, assistance is sought out from the nearby wards and the overseer’s office. In the event of an absconding, the security personnels of the hospital as well as the police will be informed. However, it was observed that the NIMH lacked a proper system for managing such situations. Having a specially trained team to respond to such situations immediately, and having a panic alarm system were suggested as solutions. In addition, during medical emergencies, if the medical ward of the hospital could not manage the situation it was mentioned that the patient will be transferred to the National Hospital or to the Mulleriyawa East Base Hospital. Rehabilitation For the purpose of rehabilitation, the patients are divided into 4 categories or levels(level 1 improving the basic activities of daily living, level 2 - improving extended activities of daily living, level 3 - providing vocational training, and level 4 - preparing for re-employment and social reintegration) based on the patients’ condition. Only somewhat stable patients are brought to 5|Page