Wed, Mar 23, 2011
The New Paper
TWO strangers, worlds apart, but they both suffer from the same debilitating illness of depression.
They say their struggle with depression is one that few can understand.
And one of their biggest fears is that when their caregivers die, they will be alone.
Janice (not her real name), 28, was diagnosed with depression two years ago, while Dylan (not his real name), who is in his late 30s, was diagnosed more than 15 years ago.
Both found their present jobs through the Institute of Mental Health's (IMH) Job Club.
Janice is a receptionist and Dylan is a shop assistant.
Both their employers are aware of their conditions.
In Parliament on March 4, Health Minister Khaw Boon Wan said the stigma surrounding mental illness needs to be reduced, "so that the patients can be more confident to come forward for treatment and after receiving treatment, to integrate back into the community".
While Janice and Dylan try to integrate into the community, both say it remains hard for them to hold onto their jobs because it's a constant battle juggling their mental illness and the demands of work.
Janice was too shy to meet with this reporter, and agreed only to an interview over the phone.
But she had a happy, girlish voice and chuckled often during the interview.
Ten years ago, she was an "average teenager" studying at one of the "top six" junior colleges here, she said.
She was introverted but had friends, and even a best friend.
Most of her friends, including her best friend, went on to polytechnics or worked after their A levels, so Janice went to university alone.
"I was very, very lonely and I had no friends. I constantly felt ostracised by my peers in university too," she recalled.
She admitted that at that time, she was already prone to being "over-sensitive".
She also had problems with her mother.
"She's not the affectionate type and I could never get any verbal affirmation from her. She never listened to how I felt," she said.
"I decided that unless I did something drastic, she would not care about me. I decided to rebel."
A few weeks into university, she dropped out. That decision "forced" her mother to pay more attention to her.
At her mother's insistence, she found an administrative job in a factory.
But once again, things took a turn for the worse because she couldn't get along with her boss.
She left the job after three weeks, cooped herself up at home for a year and "did nothing".
Her temper also went from bad to worse, she added.
"I not only threw tantrums, I threw things. I knew I needed help, but I was in denial. I felt that going to a psychiatrist meant something was really wrong with me," she said.
During this period, Janice also lost her best friend, who could not understand her mood swings.
They have not spoken since.
While she had consulted private psychiatrists before, at 26, Janice decided to go to IMH, where she was diagnosed with depression.
Since then, she has been on medication and sees her doctor at IMH once every month.
Although she feels better these days, she said medication does not make her "self-esteem issue go away".
Janice has had four jobs so far, but she leaves when she cannot cope with the stress.
She has been in her current job for the past three months, but hopes to find a full-time job soon.
She still finds it tough adapting to changes in her workplaces, but said: "When I have a job, I feel I have purpose in life. Without one, I feel inferior, useless, and have low self-esteem."
That sentiment is also echoed by Dylan. When he's not working, negative thoughts surge into his mind.
"I just keep thinking, 'Why, why, why. Why am I like that?' So I need to keep myself occupied," he said.
Dylan said he has been suffering from low self-esteem since young, but didn't know it was an issue as he did not have problems with his studies.
It was only during national service that something in him snapped.
"I don't know why, but I just could not take the stress in the army," he said.
His mother took him to a psychiatrist and he was diagnosed with depression.
Even though he has a business degree, Dylan says work poses a huge challenge for him and stress would trigger his depression.
His condition became so bad that in 2006, he was warded briefly at IMH for having suicidal thoughts.
He has since improved and sees his doctor at IMH once every two to three months. But he is unsure whether he will ever fully recover.
"I don't have that much hope. I've been dealing with this for so long. I've never really been happy before," he said.
Dylan hardly goes anywhere else apart from work, preferring to stay at home to watch TV.
But watching drama serials sometimes triggers his condition, especially if the show features "useless sons".
"I feel like I'm a useless son. My mother implies that about me too," he said.
His mother, who is in her 70s, works part-time in a funeral procession band. They live in a terrace house in the east.
Dylan's father died when Dylan was 17 years old.
Said Dylan: "When she goes, I'll be alone. I might even end up dying without people realising until there's a bad smell in the house."
In the meantime, he's trying to save up to buy a new computer, so he can set up Facebook and Twitter accounts and make more friends.
He hopes to find a girlfriend in the future, though he lamented: "I've no money, who would want me?"
Agrees Janice: "It's hard to find someone who will accept me. But it would be nice have someone love me the way I am."
For now, she's content going out with her mother and relatives.
She said: "All these years, I have not socialised with anyone else. I'm not in touch with people I've met at work either."
Janice wants to find a stable job so she can start giving back to her parents.
"I don't want them to worry about me anymore. I want to rediscover myself.
"For a long time, my mind has been a blank. I'm trying now to learn what it means to be me," she said.
This article was first published in The New Paper.
Mon, Mar 23, 2009
The Straits Times
By Lee Hui Chieh
THE national mental health hospital is looking at how it can better track and care for its outpatients, especially those more prone to violence.
The Institute of Mental Health (IMH) has set up a committee to study this, after a former patient allegedly torched Member of Parliament Seng Han Thong.
Questions about how IMH's more than 30,000 outpatients are monitored surfaced after 70-year-old Ong Kah Chua, who has been in and out of the hospital with a history of paranoid delusion, allegedly set the MP for Yio Chu Kang on fire at a community event in January.
Ong is now back in IMH, where he will remain until the Law Minister decides otherwise, based on doctors' reports.
The Straits Times understands that one of the changes being considered by IMH involves ensuring that patients at high risk of hurting themselves or others, are followed up more closely if they miss their appointments.
All patients are sent reminder letters, but those with suicidal tendencies, aggressive behaviour, or a history of violence, will be visited at home by nurses if they remain no-shows despite the letters.
This had been done previously, but less systematically.
Doctors said that community care is the way to go, rather than institutionalisation.
Dr Lee Cheng, the chief of IMH's department of community psychiatry, said: 'The best indication of violence is a past history of it. If a patient has no past history, is it justified to keep him institutionalised forever?
'If we admit him by force, it's too extreme. At the end of the day, no one would dare seek treatment because by doing so, you would be deemed dangerous.'
To ensure chronic patients stick to treatment and prevent relapses, IMH already runs two home-visit programmes, similar to those in countries like the United States, Australia and Britain.
Dr Joshua Kua, the chief of IMH's department of geriatric psychiatry who heads the seniors' home-visit programme, noted: 'The concept of having patients with mental illnesses going back to the community, leading as normal a life as possible, is in line with the international movement of psychiatry.'
The programmes have shown good results - patients have been re-admitted fewer times, and have stayed for shorter periods when hospitalised.
Retiree Amos Madina, 62, said of his father, who has dementia and is on the seniors' home-visit scheme: 'He's so much better now. He smiles at visitors, watches TV quietly, and doesn't spit and scream.'
General practitioners (GPs) have been roped in for another programme that lets stable patients get treated in their own neighbourhoods, making it more convenient for them. It also reduces the stigma that some still attach to visiting IMH.
The results so far show that GPs' care is 'not worse than specialist care', said the programme's director, Dr Nelson Lee.
One GP, Dr Roy Ang, treats about 50 such patients, and has sent only two back to IMH since joining the scheme in 2006.
'Most of them are very stable and compliant. In fact, they are more compliant than my other patients with high blood pressure or high cholesterol,' he said.
A 31-year-old woman who refused to seek medical help for depression for five years before her mother convinced her to go, has been well for the last six years.
She switched to seeing a GP in 2005 because she works and finds it more convenient to see the doctor during weekends.
Her mother, who takes her to her monthly appointments, said: 'I also make sure she takes her medication every day, as I don't want her illness to come back.'
This article was first published in The Straits Times.
Signs of psychological trouble
WHAT are some of the signs that your child may be suffering from psychological problems? Psychiatrists point to some of the things that you could look out for:
Sleep or appetite problems
Behaviour and speech that seem out of character
Difficulty concentrating or a lack of motivation
A drop in academic performance
Becoming increasingly withdrawn from families and peers, preferring to keep to oneself at home
Becoming argumentative towards family and friends
Hallucinations, delusional beliefs, odd or impulsive behaviour and even suicidal tendencies.
If there has been a recent crisis such as the loss of a loved one, a divorce or school stress, be sure to check on how the child is coping. Take note of how he is performing in school and how he is interacting with others.
Who to call for help:
Touchline: 1800-377-2252
Youth Challenge: 6336-3434
Tinkle Friend: 1800-274-4788
Befrienders of Youth: 6256-4440
SOS: 1800-221-4444
Parentline: 6289-8811
The Singapore Association of Mental Health (SAMH) will launch a mobile outreach team in July that will conduct house visits to members of the public with mental health concerns.
The measure was announced by Deputy Prime Minister Teo Chee Hean at the annual SAMH charity dinner held on Friday at Resorts World Convention Centre. In his address, he repeatedly emphasised the need to "foster a more inclusive society".
"By working together, the sum of our collective efforts is larger than what we could each do on our own," Mr Teo said. "It is important to encourage people to seek help early through education, and to reduce discrimination against those with mental illness."
Mr Teo also highlighted the achievements of SAMH in recent years. The Creative Hub at Goodman Arts Centre, which promotes mental health recovery through expressive arts such as music and dance, attracted 1,558 people in 2012. The facility opened in October 2011. Some 460 youth and their families also benefited from the YouthReach Centre, a specialised community mental health service for children and youth, since it started in August 2006.