Since the early decades, provision of health services received greater emphasis from the government of Sri Lanka. Health care is provided free through a vibrant government system- though the private sector flourishes mainly through outpatient care in urban settings. The administrative authority of the health system is governed by the Ministry of Health, Nutrition and Indigenous Medicine while implementation is carried out by nine provincial directors of health services across 26 health administrative regions managed by the regional director of health services. Each regional health directorate is divided into medical officer of health divisions for provision of preventive health services.

Map of nine provinces	Map of 25 districts

The administrative pyramid structure

(Figure 1: Map of nine provinces, Map of 25 districts, and the administrative pyramid structure)

At national level, the Directorate of Mental Health is the central organization of the Ministry of Health executing national mental health programme. The Directorate is responsible for development of technical strategies and guidelines, policy development, development of annual operational plans and budgets, resource mobilization, and capacity building in collaboration with relevant sectors and monitoring and evaluation of the national mental health programme.

Sri Lanka has taken major strides in its mental health services over the past 15 years, especially, the post-tsunami period (since 2005) has seen a dramatic change in the provision of mental health services. In 2005, the Mental Health and Psychosocial Task Force developed the "National plan of action for the management and delivery of psychosocial and mental health services” for People affected by the Tsunami Disaster. In October 2005 the Mental Health Policy of Sri Lanka 2005–2015 was approved, which clearly defines the need for decentralized, community-based services. The policy laid out an operational framework for the next decade which is currently under revision and the policy aims to develop comprehensive and high quality mental health care services for health promotion, prevention of mental disorders, treatment and rehabilitation, that are effective, accessible, equitable and affordable for the whole population across their lifespan in a collaborative and multi-sectoral manner while preserving and promoting the human rights and dignity of individuals.

A major shift occurred at the level of organization of services, from institutionalized mental health-care delivery to care in smaller facilities. In 2007, the major mental hospital at Angoda was restructured into the National Institute of Mental Health.

There are 7 tertiary care hospitals established in Sri Lanka which are directly governed by the Ministry of Health. All these institutions possess Acute psychiatric in- patient wards to treat psychiatric patients. Currently Acute inpatient units are available in 23 of the 26 districts and also in few regionally managed institutions. Presently there are 61 adult inpatient units, three child inpatient units and one forensic unit in the country.

Similarly Medium stay units were available only in five districts in 2004, which has now expanded to 15 districts. The outreach clinics currently exist in almost all health divisions. In addition, Community support centers are being set up at district level to serve as hubs for promotion of mental wellbeing.

Mental outreach clinics provide close-to-home services in Sri Lanka to enable better care and follow up on clients, and to reduce the treatment gap.

Figure 2: Map of Expansion of Mental Health Services in Sri Lanka

Mental health clinics support continuity of care, assessment, treatment and home visits. These are conducted by Medical Officer Mental Health or Medical Officer Mental Health Focal Point or Consultant Psychiatrist. Home visits are mainly for the defaulted and also provide assistance to them and their caretakers. Home visits are done by a team consisting of Medical Officer, Nursing officer and Psychiatry Social Worker.

As gender based violence is one of the main issues faced by women and children, Gender- Based Violence (GBV) desks and Mithuru Piyasa centres have been set up and managed in tertiary care institutions in selected districts. They collaborate with other relevant services such as police, social services, child protection, probation, legal/justice, non governmental organizations and education.

Map of Mental Health Services Expansion in Sri Lanka

Two main hospitals that specialize in child care, Lady Ridgeway Hospital in Colombo and the Sirimavo Bandaranayke Specialized Children Hospital in Kandy, address child mental health needs. In addition to the regular outpatient clinics and inpatient services, the Lady Ridgeway Hospital for Children conducts specialized programmes to address the following: Specific Learning Disabilities (SLD), Attention Deficit Hyperactivity Disorder (ADHD), early intervention for Autism Spectrum Disorder (ASD) and family support for children with behavioral disorders. To make child care available at district level, Directorate of Mental Health has promoted child psychiatry outpatient clinics in all district hospitals. Currently there are four Child and Adolescent Psychiatrists working in 4 districts addressing promotive, preventive, clinical and rehabilitative care for children and adolescents. Ministry of Health is planning to establish a comprehensive child mental health service with special emphasis on the care for children with special needs in collaboration with the professionals and the provincial health services.

The number of Rehabilitation Centres in Sri Lanka has grown from one in 2000 to 22 in 2017. These include medium-stay (6 months) and long-stay (1 year-plus) rehabilitation centres. Medium stay units provide services to individuals who do not require intensive medical interventions, but need further treatment and support to develop life competencies for them to live productively. An important part of rehabilitation is occupational therapy that builds life and vocational skills. The rehabilitation centres focus on the client’s learning of daily life skills such as self-care, cooking, and cleaning. Most of these centres are hospital based and the management of these centres may differ from one district to another. In addition to these government rehabilitation centres, non governmental organizations such as ‘Nest’ and ‘Sahanaya’ have their own facilities.

De-addiction rehabilitation units (Alcohol Rehabilitation Centres) are another initiative to combat the increasing use of alcohol. There are seven centres located in Gampaha, Kandy, Jaffna, Batticaloa, Kurunegala, Badulla and Kilinochchi. The client-centered model of these centres requires voluntary admission; however, they may be encouraged and motivated to enroll by community workers and the mental health professionals. The rehabilitation activities include play therapy, group therapy, counseling, gardening, religious programs and family interventions.

Several technical committees have also been appointed to function as Technical Advisory Bodies to guide respective programmes by providing technical guidance, advising and monitoring national and provincial programmes. The National Mental Health Advisory Council (NMHAC) was established in 2007 to advise the Ministry of Health on decisions to be executed by the Director Mental Health. The chair appointed was the Secretary of Health with the Director General of Health Services as the convener, which sustained a diverse, interdisciplinary team with both technical and administrative expertise. Within a couple of years, it was reconfigured as the National Committee in Mental Health to be chaired by the Director General of Health Services and convened by the Director Mental Health.

The mental health legislation, or Mental Health Act, has been under deliberation since the year 2005. After years of multiple drafts and competing interests, a diverse task force consisting of representatives from Ministry of Health, World Health Organization, Sri Lanka College of Psychiatrists, Non Governmental Organizations , and other stakeholders have compiled the Draft Act and is being reviewed currently to develop into the final stage. The Act will replace the present 1956 Mental Diseases Ordinance.

Considering the increasing health, social and financial burden in the country, the National Authority on Tobacco and Alcohol Act, No. 27 of 2006 created the National Authority on Tobacco and Alcohol (NATA) and defined prohibited acts or offences. The National Policy on Alcohol Control was passed by the cabinet in 2015 and was launched in August 2016.  In the content of these policies and the desire to accomplish higher standards of good mental health has received considerable emphasis.

Responding to mental health needs during emergency situations is another area that has been developed over the past few years and the mental health teams, other community officers and volunteers groups provide psychosocial support for victims of natural disasters and emergency situations. The Directorate of Mental Health has trained the teams of master trainers and established them in all vulnerable districts. During disasters, the Directorate of Mental Health mobilizes these teams to train the staff of affected areas and take actions to establish psycho-social support in the community. 

"Consumer and Carer Groups" is a nationally widespread concept. There are about 70 groups representing most districts, 10 of them are registered as non-profit entities. The Consumer Action Network Mental Health Sri Lanka (CANMH Lanka), which operates from the National Institute of Mental Health is one successful such organization. The network was established for the collaboration of people affected with mental health issues and their carers to advocate for a secure mental health system. Ministry of Health has already developed a “National guideline for the establishment and implementation of consumer and carer associations of persons with mental disorders” with the participation of all relevant stakeholders.

There have been major gains in human resource development for mental health across cadres to support the growing demands on services. The mental health sector provide its services through a multidisciplinary team consisting of Consultant Psychiatrists, Medical Officer  Mental Health, , Psychologists, Counselors, Occupational Therapists, Speech Therapists, Physiotherapists, Psychiatric Social Workers and Community workers. Each of these professionals plays an important role in providing comprehensive and holistic mental health care to Sri Lankans. Many of these disciplines have become stronger and more established over the past 15 years. Medical Officer Mental Health (Focal point) assists the Regional Director of Health Services and coordinates and all Mental Health services within the district, having a close linkage with the national level, district health team and all other relevant departments and community groups.  Within a region (district), services are provided through a network of medical institutions and health Units.

District review meetings act as a platform for the Mental Health Directorate to monitor and guide service provision. The meetings are conducted by the Regional Director of Health Services with the support of Consultant Psychiatrist and Medical Officer Mental Health (focal point). The review is attended by Consultant Community Physicians, all Medical Officers of Mental Health, Medical Officer  in-charge of rehabilitation centres, Medical Officers of Health and officers from other relevant ministries. These meetings review district mental health services (gaps and challenges), outreach clinics, school programmes and other initiatives carried out in the district. Further, mental health-related guidelines that are developed at the national level are customized and implemented at the local district level through this platform.

Provincial review meetings are chaired by the Provincial Director of Health Services. The Regional Director of Health Services, all Consultant Psychiatrists, Consultant Community Physicians, Social services officers, representatives from the National Dangerous Drug Control Board, Chief Pharmacist, Chief Accountant and other relevant officials attend these meetings. Unresolved issues from district-level meetings are presented here at the policy level for discussion and solution.