The Mental Health Act and its regulations had been approved for implementation from 15 June 2010. These are now exciting times for psychiatric care in Malaysia as we start building the blocks of the structures and processes of what would be the future face of psychiatry for years ahead.

The law prescribed for psychiatric hospitals (both public and private) for the acute management of people with mental disorders; psychiatric nursing homes for the purposes of accommodation, nursing and rehabilitative care and community mental health centres for community care treatment. Both the psychiatric hospitals and community health centres must have attached with it community mental health teams which is to be multidisciplinary in nature.

The four large psychiatric hospitals in the country has long been the bastion of psychiatric care but with the opening up of general hospital psychiatric units with inpatient, outpatient and community based services, much of the care is shifting albeit at a slower pace.

The general hospital psychiatric unit has to be enhanced, in terms of capacity and facilities to carry out the essential task of providing basic, easily accessible and mainstream care for all psychiatric illnesses. They should be the cornerstone of the future of psychiatry in Malaysia and psychiatric care should be built around these units. The role of the psychiatric nursing homes needs to be redefined and understood clearer.

A key feature of psychiatric care is ensuring follow up and this has been excellently achieved by the current hospital based community psychiatric teams. Its function will now have to enlarged both in terms of areas of coverage as well as its functions. These will require capacity building and training. These community teams worked either on the principle of case management or assertive outreach. Medication adherence, providing practical care and family support within a multidisciplinary context seemed to work in the Malaysian setting. Indeed, data from the registry of Schizophrenia showed that almost all patients with schizophrenia are being treated with medication and the atypical share is about 30% in first contact patients.

Pursuant to this, there should be a change in thinking about the capacities and roles of consumers and developing structures that encourage and support consumer participation; and the involvement of a wide variety of people and services that will ultimately help in improving the lives of citizens with mental illness.

The ultimate goal is to improve the lives of those with mental illness. Services such as hospital based community psychiatric services help facilitate recovery, other elements that include supported employment, supported education and helping with housing that really bring patients to the next level of care and promote independence and creating a sense of new self.

The new direction must include best available care and approaches for providing individual supports, inpatient/outpatient care, crisis response, housing, employment and self-help.