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Friday, May 10, 2013
Bridge the mental health treatment gap;
The Straits Times (Singapore)
April 6, 2013 Saturday
SECTION: OPINION; Others
The Straits Times reported yesterday that more mental health patients are being
cared for in the community by trained general practitioners, under a partnership
with the Institute of Mental Health. A psychiatrist says that even more can be
done to make sure people who are unwell mentally get the treatment they need.
Chong Siow Ann For The Straits Times
WHEN my colleagues and I conducted the Singapore Mental Health Study which
assessed the mental health status of the adult resident population, we had
anticipated that mental illness would be prevalent in the local population and
that most would have their onset early in life, as is common elsewhere. These
turned out as we predicted. What caught us by surprise was the number of people
with mental illness who had never sought help.
The proportion of people who have an illness that requires care but do not
receive treatment is known as the treatment gap. Wide treatment gaps for mental
illness are common worldwide. They are wider in developing than in developed
countries, with the proportion of those receiving help corresponding with a
country's overall spending on health care - in particular, mental health care.
However, even in the world's biggest economy and most powerful nation, this
under-treatment is still considerable: 31 per cent of the United States
population are estimated to be affected by mental illness every year, of which
67 per cent are not treated. In Europe where mental illness affects 27 per cent
of people yearly, 74 per cent of them receive no treatment, which seems even
more egregious when compared with diabetes where only 8 per cent of people in
Europe are not treated.
In Singapore, we found that six out of 10 people with major depression have
not sought help.
Even more startling are disorders like obsessive compulsive disorder and
alcohol misuse disorders, where nine out of 10 did not have any sort of
When mental illnesses remain untreated, they tend to worsen, develop more
complications and become less responsive to any subsequent treatments. Research
has found that untreated mental illness is associated with school failure,
teenage pregnancy, unemployment, spousal violence, substance abuse, chronic
medical conditions and poor quality of life.
There are a number of steps in the help-seeking process for the mentally ill
person - becoming aware of the illness, perceiving the need for treatment, and
then actively seeking treatment. All these are influenced by a myriad of factors
like age, gender, race, education, religion, the beliefs and attitude of family
and friends, the prevailing culture, the availability and accessibility of
mental health services, financial resources and insurance coverage.
It has often been suggested - almost to the point of stereotyping - that
Asians have a tendency to focus more on physical features than on emotional or
psychological ones, leading to this remissive attitude about seeking help from
mental health professionals. There is also a deep and pervasive fear of
discrimination and stigma.
My colleagues and I in the mental health treatment field thus tried the
usual conventional ways of reaching out to the public - with awareness-raising
campaigns and public talks.
As is often the case, after such a public talk, some members of the audience
would approach me and ask help for a family member who is manifestly unwell
mentally but vehemently refuses to seek help. Most times, what would emerge from
the account is similar: A family member or loved one has suffered years of a
smouldering mental illness but refuses treatment because he does not consider
himself unwell. The distress of these family members is often palpable, as is
their helplessness. There is usually nothing very helpful that I can offer,
which leaves me feeling wretched.
This lack of awareness of the presence of an illness is called anosognosia
and is commonly found in a serious mental illness like schizophrenia.
It can be baffling to any observer as the person is so obviously unwell.
Writer Oliver Sacks, in his clinical tale The Man Who Mistook His Wife For A
Hat, described it as such: "It is not only difficult, it is impossible... to
know their own problems... And it is singularly difficult, for even the most
sensitive observer, to picture the inner state, the 'situation' of such
patients, for this is almost unimaginably remote from anything he himself has
This enigma presents a particular challenge in providing help to these
individuals as they would refuse needed treatment since they do not perceive
that they are ill in the first place.
Still, much can be done to narrow these treatment gaps.
There is already a raft of initiatives under way as part of Singapore's
National Mental Health Blueprint and Policy.
Early detection systems for certain mental illnesses have been implemented
in the community and general hospitals. Training in the recognition and
management of mental disorders is being provided to care providers in the
various social sectors and grassroots organisations. The Straits Times reported
yesterday that more general practitioners are being trained to care for patients
with mental health conditions.
Further public awareness campaigns have been mounted. Medisave and
MediShield have been extended to include coverage for mental illnesses.
While these measures are certainly good and overdue, more needs to be done.
Schools, for example, are important settings for mental health promotion and
implementing preventive measures since many mental illnesses have an early
onset, in adolescence or early adulthood.
School-based screening programmes and lessons to teach children stress
management and some basic aspects of mental illness may help. Teachers and
parents should also be educated in recognising features of mental illnesses that
are common in children, since children are most unlikely to seek help on their
own and depend on adults looking after them. Often and unfortunately, these
adults - parents in particular - tend to normalise signs and symptoms of mental
illness as part of the to-be-expected turmoil of growing up and adolescence
angst. This is, of course, understandable as few parents would like to think
their child mentally ill.
In the workplace, there should be programmes on early screening and
recognition, and processes in place to ensure that workers with mental disorders
are not discriminated against but are given the necessary assistance to preserve
their skills and re-enter the workforce.
There is scope too for bold and innovative thinking. Technology allows for
Internet- and telephone-delivered psychotherapy to increase access to care.
There can also be collaboration with spiritual and traditional healers who, from
our research, are often consulted by those with emotional and psychological
But for the average Singaporean, the best way to reduce the treatment gap is
vigilance. If you think a family member is unwell mentally, speak to someone you
know who has experience in mental health like your family doctor or even a
mental health professional like a clinical psychologist or psychiatrist.
Even if the unwell person is unwilling to seek help on his own, advice can
still be sought on his behalf from these care providers. There are also
helplines available (see below). If there is any danger to the person or others,
police assistance can be asked for to have the person escorted to the emergency
room of a hospital.
But the most important hurdle to overcome is that inevitable initial
reluctance to even approach anyone for help.
The writer, Associate Professor Chong Siow Ann, is a senior consultant
psychiatrist and the vice-chairman, medical board (research) of the Institute of
Stigma exacts heavy toll
Published on Apr 09, 2013
ASSOCIATE Professor Chong Siow Ann's commentary ("Bridge the mental health treatment gap"; last Saturday) brings up many valid points regarding the treatment of mental illness in Singapore.
While depression is a more easily recognisable and commonly accepted mental illness, there are many other conditions that are not so easily recognisable.
In such cases, not only does the patient refuse treatment, but his family members are also reluctant to help him get properly diagnosed because of the stigma associated with mental illness, choosing instead to ignore the symptoms, hoping it is only a passing phase arising from stress.
The common approach to mental illness is not to make a mountain out of a molehill, unlike the stance on physical illnesses like cancer.
The stigma associated with mental illness apparently carries a higher cost than the illness itself, and may affect the patient's employment and social life. Untreated mental illness leads to a generally poor quality of life for the patient, as pointed out by Prof Chong.
Other than general practitioners, school, marriage and social counsellors should be trained to recognise the symptoms of mental illness and propose treatments.
Also, is there a way to remove the stigma of seeing a psychiatrist? Other than the Institute of Mental Health, which unfortunately attracts stigma, there is hardly any affordable psychiatric treatment available to the public.
Until the situation is remedied, I fear the mental health treatment gap will not narrow.
Vicky Chong (Madam)
Why some mentally ill people refuse treatment
Published on Apr 09, 2013
I AGREE with Associate Professor Chong Siow Ann ("Bridge the mental health treatment gap"; last Saturday) on the causes of the mental health treatment gap in Singapore - the stigma in society, the tendency for Asians to focus more on physical features than emotional or psychological ones, and family members denying that their loved ones are having mental health problems, even if it is obvious to them.
A possible reason why some people with mental ailments are unwilling to seek treatment is that they are trapped in a bubble of denial, perhaps due to the high expectations they set for themselves and also the high expectations of people around them.
Some employers discriminate against people with mental ailments.
Then, there are those who fear that employing people with mental ailments may affect the company's performance. It is not that they discriminate against such people, it is just that there are certain tasks in which employees cannot afford to make mistakes, regardless of whether it is due to negligence or the individual's constraints.
As humans, self-preservation is in our nature. When faced with a dilemma of whether to seek help for mental illness and risk being stigmatised, or suffer in silence and keep our jobs, we would normally opt for the latter.
I admit that it is difficult to eliminate the stigma faced by mentally ill people. Still, like what Prof Chong has said, we should keep up the effort in integrating those with mental ailments and help them on the road to recovery.
Sam Li Ying (Ms)
More GPs take on mental health cases;
Partnership with IMH a success, with high levels of patient satisfaction reported
The Straits Times (Singapore)
April 5, 2013 Friday
Poon Chian Hui
MORE doctors in neighbourhood clinics are now managing patients with mental
health conditions. And patients have welcomed the arrangement.
A partnership with the Institute of Mental Health (IMH) to have stabilised
patients cared for in the community has seen the network of general
practitioners (GPs) grow from 34 in 2009 to 53 today. And more than 1,300
patients have been referred to their care from IMH since the partnership was
forged in 2005.
Programme director and IMH consultant psychiatrist Goh Yen Li said the
initiative has been a success so far.
In a survey of 114 patients early last year, more than 90 per cent reported
high levels of satisfaction, citing reasons such as "the GP spends time
listening to me" and "the GP was patient".
Said Dr Goh: "GPs are often the first point of contact for patients with
mental illnesses. This places them at the forefront in detecting, treating and
referring a patient with mental illness."
Any GP can assess a person for mental illness and, if required, refer him to
a specialist at a public hospital. But GPs under the partnership will manage
stable patients after they have received specialist care.
To help these doctors along, training is provided by the IMH.
A one-year graduate diploma programme was started in 2010 to train GPs on
how to recognise and manage mental disorders. IMH plans to increase the number
of clinical attachments under this diploma, so GPs can get more experience in
handling mental patients.
The latest batch of 24 GPs graduated two weeks ago. Among them is Dr Low Kee
Hwa, 55, who said he has recently been able to pick out more people with
depression or anxiety disorders.
One example he gave was of a woman in her 60s who visited five months ago
complaining of chest discomfort. But she was actually suffering from depression.
Sensing something amiss, he probed further. The patient broke down in tears
and revealed how strained relationships with her children were causing her
Said Dr Low: "I have observed that more patients are now more willing to
talk about common mental issues. So it would be essential for GPs to be able to
treat these conditions."
But seeing someone who is mentally ill can take three times as long as a
consultation for simple ailments such as a cold, which can be done within 10
Which is why Dr Low will sometimes ask the patient to return when the clinic
is not so crowded.
Regular talks by health-care experts are also open to all GPs as some mental
health conditions, such as dementia and depression, can be tricky to
Dr Srinivasa Sastry Malladi of IMH's geriatric psychiatry department said
these conditions commonly affect the elderly. But symptoms - problems with
appetite, sleep, motivation and memory - can be very similar and may confuse
doctors, he said. Dr Malladi, who recently gave a talk to 110 GPs on how to tell
the two conditions apart, said it is vital that correct diagnoses are made even
at the primary-care level.
On top of training, the GP partners are supported by a team of IMH case
managers. They remind newly referred patients of their appointments with the GPs
and contact the patients afterwards to find out about their experience.
Meanwhile, GPs can contact the case managers if they encounter problems,
such as patients not keeping to their treatment. The doctors can also call a
24-hour hotline operated by IMH to consult its specialists.
Another safeguard for the patients is that they are referred to the care of
GP partners only if they are stable, said Dr Goh. This means they have not been
hospitalised for the past six months and require similar medication each time.
GPs can reach out to mentally ill patients
The Straits Times (Singapore)
April 9, 2013 Tuesday
FORUM LETTERS; Online Story
A PATIENT with mental health conditions will feel more at ease at a
neighbourhood clinic ("More GPs take on mental health cases"; last Friday) than
at the Institute of Mental Health (IMH).
While training and clinical attachments at the IMH will allow general
practitioners (GPs) to manage the mentally ill whose conditions have stabilised,
these doctors must also possess a sense of empathy and patience.
Equally important is a congenial atmosphere for good doctor-patient
discussions. Hence, consultations should be done during off-peak periods in the
Staff at the registration counter, who are the first point of contact for
the patient, should be tactful and tolerant when dealing with the mentally ill.
Given our fast-paced and stressful environment, depression and anxiety are
common mental challenges that we may encounter from time to time.
It is thus imperative that more GPs work in partnership with the IMH to
reach out to patients with such conditions.
Jeffrey Law Lee Beng
Posted by Grey Steppenwolf at 10:31 PM
MOH launches revised set of Dementia Clinical Practice Guidelines
April 5, 2013 Friday 3:50 AM GMT
SINGAPORE: Singapore's Health Ministry has launched a revised set of Dementia
Clinical Practice Guidelines to address future challenges in the management of
the disease in the years ahead. The guidelines were last revised five years ago.
Speaking at the third International Neurocognitive Symposium, Health Minister
Gan Kim Yong said the revised guidelines cover issues such as diagnostic
considerations for mild cognitive impairment, ethical and legal issues related
to dementia, and the management aspects of Young Onset Dementia. The aim is to
help improve the care of patients with dementia. Mr Gan explained that as
Singapore's population ages, the number of people suffering from dementia is
expected to rise. Based on estimates, the country currently has about 28,000
elderly aged 60 years and above who have dementia. By 2030, this figure is
expected to more than double to 80,000. Thus, Mr Gan said it is important for
healthcare professionals to keep themselves up to date on developments in
dementia care. The ministry is also working with its partner agencies to
implement community-based mental health services for dementia and to expand
capacity to meet growing demand. Late last year, it launched two Dementia Care
Shared Teams. These teams comprise specialists, allied health professionals and
psychologists who work with primary care doctors to provide assessment,
treatment and support for dementia patients. The ministry is also expanding thecapacity in its memory clinics by
Prof's stress: False diagnosis 'possible';
Doc relied on account by Tey to diagnose disorder
The Straits Times (Singapore)
April 5, 2013 Friday
Lim Yan Liang And Walter Sim
THE psychiatrist who diagnosed law professor Tey Tsun Hang with acute stress
disorder told a court yesterday that he may have made a "false diagnosis", as he
relied on Tey's account of his interrogation.
Dr Michael Yong, director of psychological medicine at Alexandra Hospital,
said he was under the impression that Tey was interrogated by the Corrupt
Practices Investigation Bureau (CPIB) from 8am to 6pm on April 2 last year, and
that he was kept in a small and poorly ventilated room for "multiple
interrogations" in that time.
Deputy Public Prosecutor Andre Jumabhoy, who was cross-examining him,
pointed out this "frame of reference" was inaccurate. He said Tey reached the
CPIB between 9am and 10am, and was not held for "the whole period".
The DPP said it had been "punctuated by breaks in between of two hours or
so" when Tey was taken to his residence - twice - and his office to retrieve
"So as I asked you before: If the information that is given to you is
inaccurate or wrong it may well result in a false diagnosis'" asked Mr Jumabhoy.
Dr Yong replied: "Yes, that is possible."
The psychiatrist had earlier agreed with the DPP that diagnoses of
psychiatric conditions depended "a large part" on information disclosed by a
patient - unlike illnesses like cancer, which rely on clear empirical evidence.
Dr Yong is one of Tey's witnesses in a "trial within a trial" to determine
whether his six statements recorded by CPIB officers last April and May were
voluntary, and can be used as evidence in court.
Tey, a suspended associate professor at the National University of Singapore
(NUS), is facing six charges of corruptly obtaining gifts and sex from former
student Darinne Ko, 23, in exchange for better grades.
Tey had relied on Dr Yong's medical report to show that threats by
anti-graft officers had adversely affected his mental state, contributing to
"acute stress disorder". As such, he claims his statements should be rendered
Earlier yesterday, the prosecution and defence crossed swords over a bid to
admit as evidence six cautioned statements recorded last July.
These documents recorded what Tey said in response to each of his charges,
and differ from the six main statements made in April and May that are now in
Tey said the cautioned statements are vital in rebutting the prosecution's
assertions that he was "making things up" along the way, adding that they
contain information that he had brought up in court this week, but failed to put
to CPIB officers when they testified in January.
But Mr Jumabhoy countered that admitting the cautioned statements at this
stage would defeat the point of the trial within a trial - as they "impinged on"
the content of the six main disputed statements, and may prejudice the court's
Mr Jumabhoy said Tey should not "get a second bite" by producing new
material months later, adding that Tey was "making a mockery of the process" as
a former district judge and lawyer, and could be "running rings around this
Chief District Judge Tan Siong Thye ruled for the cautioned statements to be
admitted because "it is his entitlement".
But Mr Jumabhoy later sliced apart Tey's claims made in his testimony this
week, by highlighting nine instances that did not exist or were taken out of
context from the cautioned statements from last July.
Tey countered: "You don't expect the cautioned statements to be a complete
story because they were only recorded in a great rush, running over 13 hours."
Tey had also called upon the dean of the NUS law faculty, Professor Simon
Chesterman, and Assistant Professor Tracey Evans Chan, the colleague who bailed
The trial within a trial continues today with the cross-examination of Dr
Yong. Medical officer Sharon Ong, who attended to Tey at Alexandra Hospital and
is now at Jurong Polyclinic, is also expected to testify.
Hang pretends to be suffering from mental sickness: Prosecution
Copyright 2013 Singapore Government News, distributed by Contify.com
All Rights Reserved
Singapore Government News
April 5, 2013 Friday 6:30 AM EST
Singapore: The prosecution counsel in a sex-for-grades trial tried to prove
during the Thursday hearing in the court that the law professor Tey Tsun Hang
was pretending to be suffering from acute mental disorder.
Hang, a former district judge, is contending the voluntariness of 6
statements he made to the Corrupt Practices Investigation Bureau (CPIB). He
maintained that the CPIB obtained his confession statement under duress.
Hang is defending himself against six charges of corruptly obtaining
gratification in the form of gifts and sex from his then-student Darinne Ko Wen
Hui, 23, during a period between May and July 2010 in exchange for higher
The court will come to a conclusion if the professor's statements are
acceptable at the end of the "trial within a trial." The main corruption trial
would then be conducted after checking the validity of the statements.
Dr Michael Yong, Hang's psychiatrist from Alexandra Hospital, said that Hang
could have faked his mental condition. Yong also added that his diagnosis would
not be correct if Hang furnishes fake information about his sickness.
Refrain from DIY brain zapping - for now
The Straits Times (Singapore)
March 25, 2013 Monday
TRANSCRANIAL direct current stimulation (tDCS) shows promise as a treatment
for various neuropsychiatric conditions ("Zipping ahead by zapping the brain";
I received training, and conducted and published research on the treatment
of depression with tDCS at Australia's Black Dog Institute, University of New
South Wales, a world-leading research centre for mood disorders.
I had tDCS administered to me during training, and it was very tolerable.
Although there have been no reports of seizures or other major safety risks,
there have been reports of skin burns after tDCS. Conductive rubber electrodes
covered by sponges soaked in saline are used in tDCS research to reduce this
Hence, the use of metallic electrodes is potentially dangerous and not
Although at least five randomised controlled trials have been published in
leading psychiatric journals reporting the efficacy of tDCS in relieving
clinical depression, the mechanism of action has not been fully elucidated.
As a practising psychiatrist, I look forward to the day when this technology
can be packaged as a portable and simple-to-use device for the benefit of my
In the meantime, much still needs to be learnt about tDCS, and members of
the public should refrain from assembling their own devices for their own
Chan Herng Nieng (Dr)
In need of helping hands
The Straits Times (Singapore)
March 24, 2013 Sunday
Volunteers are needed especially for unloved charities or causes such as the
Lee Siew Hua
A man tutors a boy. It is an unremarkable scene, except that they are huddled
over homework in a grey, featureless void deck and the tall, kind man is
befriender to a former prisoner's child.
For three years, Mr Daniel Gan, 45, has been a responsible adult figure in
the convulsed childhood of the primary school pupil, whose parents have died.
Befrienders are volunteers who offer support to those in need.
Mr Gan was an engineer at Seagate Technology when he signed up with one of
its charity beneficiaries, Life Community Services Society, which uplifts
children of prisoners.
Now a pastor, he says of his young friend: "He is self-motivated and always
wants to be in front."
They meet every fortnight, mainly for tuition at the request of the boy's
caregiver, a relative. The chatty boy also loves to play at a reservoir. "On
occasion, I bring him and his sister home to meet my children," says Mr Gan, who
has three children aged 14 to 18.
Life Community prizes volunteers such as Mr Gan, who are asked to befriend a
traumatised child for at least one year. He is uncommon, however, even if one in
three persons here volunteers, according to a recent National Volunteer and
Philanthropy Centre survey.
For, while some causes are popular, there are also unloved charities.
Veteran volunteers such as Ms Debbie Fordyce, 58, who has worked with
Transient Workers Count Too for seven years, says that people are attracted to
causes or communities that appear "naturally disadvantaged". Orphans, the blind,
abused women, cancer victims, cats and dogs, and nature, are examples.
"It takes greater empathy to offer help to problems that some feel is a
result of bad choices: HIV/Aids patients, drug offenders, ex-prisoners,
prostitutes," she says.
Less empathy still is accorded to migrant workers because people think they
are better off here than in their own country, she says. "We feel good about
helping the helpless, but these guys, especially the young men who come in large
numbers and gather in public spaces, look more menacing and dangerous than
The 2012 Individual Giving Survey by the National Volunteer and Philanthropy
Centre offers a gauge of what is popular in volunteerism.
Most people - 53 per cent - volunteer informally or not through an
organisation. This could be helping a neighbour or stranger. Religion (23 per
cent), education (19 per cent) and social services (15 per cent) rank next in
Environment and animals - hip causes for the young - are midway on the scale
at seventh place (3 per cent).
In all, there are 2,093 charities registered with the Commissioner of
Mr Willie Cheng, 59, who sits on the boards of non-profit groups and penned
Doing Good Well, has reflected on the "mismatch" between volunteers and dire
needs. He says: "People often volunteer to help out in a charity because they
have or know of someone close to them who is a beneficiary."
The 2006 State of Giving Report says 54 per cent of people volunteer out of
Neglected charities can tap this to pull in volunteers. "Reach out to those
people who have some ready connection to the charity through its beneficiaries,
board of directors, and so on,'' he suggests.
Episodic volunteering is another way. "If a charity crafts volunteering
opportunities that allow for bite-sized volunteering with flexible schedules,
then it has a much better chance of getting volunteers,'' he adds.
Mr Laurence Lien, chief executive of the National Volunteer and Philanthropy
Centre, notes the rosy trend of episodic volunteerism, with his survey showing
that seven in 10 volunteers help occasionally, rather than weekly or monthly.
"Go a step further to convert these occasional volunteers to regular
Charities can also market their cause, using social media. "When used
strategically, these tools can help organisations better advocate to change
mindsets and values," says Mr Lien, 42, also a Nominated Member of Parliament.
More radically, Dr Radiah Salim, 50, who founded Club Heal to offer day
rehabilitaton for the mentally ill, suggests compensating volunteers, which
She says Club Heal is willing to pioneer a project to engage out-of- work
people, with some monetary compensation from the Government.
Ms Denise Phua, 53, the Autism Resource Centre president and
Moulmein-Kallang GRC MP, says: "Don't just do what we like; do what they need
and match their needs with what we can give."
Ultimately, friendship is the volunteer's greatest gift, even for daunting
causes. Manager Then Kim Yuan, 27, of the Lee Ah Mooi Old Age Home, says people
ask if they can clean the place or donate.
He suggests donating services. Better still, linger with the lonely elderly
residents and simply chat. Children are welcome as the residents miss their
"I want the elderly to have a home away from home,'' he says.
One regular volunteer, administration clerk Ruby Lim, 49, says: "They hardly
have any interaction. I have grannies who say, 'We want to chat, please come
again, when'' We lighten their lives a little."
A glimpse into a different world
When they first met last September, the teen volunteers wondered if the
autistic adults might whack them.
But soon, the six accounting students from ITE College Central were cycling,
baking and doing crafts with autistic youths from the Eden Centre For Adults.
The day activity centre at a Hougang void deck serves 40 adults with
moderate to severe autism.
One of the ITE student, S. Thivyan, 18, says they have bonded with the
autistic adults and find their world fascinating. He says: "They make us more
Their autistic friends, aged 18 to 28, pursue tasks with much discipline, he
feels. He finds Mr Lu Yong Cheng, 22, for instance, creative and endearing. He
loves to clean windows at the centre when he is there from Tuesday to Thursday.
The autistic adults learn to do data entry and document shredding, and can
work on micro projects for companies, with guidance from staff and volunteers.
The ITE students had called the centre to do a 10-week school project on
work processes and are returning as volunteers.
The centre is looking for "compassionate and competent volunteers", says Ms
Denise Phua, 53, president of the Autism Resource Centre and MP for Moulmein-
They can show up once a week or month to help the 12 staff organise and
guide the autistic adults in daily skills, for instance, cooking their own
meals. There is work therapy such as gardening. Music or Pilates are good ideas
They can help raise funds as the centre runs at a deficit of about $300,000
It is not easy to find volunteers as the "reciprocity and positive
interaction" that they tend to look for may not be present, says senior
consultant Anita Russell of the Autism Resource Centre.
That is because autism is a developmental condition that inhibits social
skills and communication.
Eden and the St Andrew's Autism Centre serve a sliver of the autistic
population of about 31,000. The need is greatest for adults, for at age 18 they
finish basic education and services dry up.
But at the centre, they are proudly occupied. They comment on their own work
as they thump computer keyboards or say a cheery hello to visitors. They love
routines and have personal timetables tacked to the wall.
Mr Lu's 62-year-old father, cabbie Garee Lu, 62, says the centre gives him
some respite as he is the sole caregiver after his wife died of diabetes three
years ago. He pays a means- adjusted fee of $70 a month.
He says: "Yong Cheng looks forward to coming here. It keeps him alert the
To volunteer: E-mail Ms Paula Teo, senior manager of Autism Association
(Singapore) at firstname.lastname@example.org or go to autismlinks.org.sg
-- Housewife-volunteer Rosni Ali (centre) teaching yoga to help the
mentally ill de-stress. -- ST PHOTO: EDWARD TEO
MENTALLY ILL PATIENTS
They dream of marrying and having a job
Garbed in jeans and gossamer headscarf, housewife Rosni Ali, 56, shows her
gym class in a mosque how to destress.
She mixes yoga poses with Pilates and tai-chi moves as her students, who
have mental illness, breathe deeply.
Twice a week, she volunteers with Club Heal, a day rehabilitation service
set up last year by Malay-Muslims. Her jitters about the patients are replaced
with a new respect.
"They are pure, not gossippy. They care for each other. This is our second
home," she says as the patients relax over snacks.
Club Heal, embedded at Darul Aman Mosque in Eunos and a Bukit Batok East
void deck, is open weekdays for services from counselling to symptom management
Its 50 clients are served by a part-time manager and 10 dedicated
volunteers, mainly nurses on their day-off.
Club founder and president Radiah Salim, 50, a polytechnic doctor, wistfully
highlights the need for more volunteers as "we are small and new, and don't have
Operating costs are about $20,000 a month.
Helpers are hard to come by because of stigma and unfounded fear of
pyschiatric disorders, says club manager Hamidah Bahashwan, 55.
People are also busy with work or the good life, Dr Radiah thinks.
"We hope retired nurses and teachers will come forward. Volunteers bring
such joy," she says.
The 2011 Singapore Mental Health Survey indicated that 12 per cent of the
population will have at least one form of mental illness in their lifetime.
With enough helpers, she can start a network of "healing friends" to do home
visits. Some patients fear stepping outside the house so befrienders can show
them how to perform daily tasks such as grocery shopping or taking public
transport, or keep them company.
Volunteers give caregivers precious respite too. Housewife Jamaliah Buang,
52, who accompanies her 20-year-old mentally fragile daughter to Club Heal
daily, says: "She used to have difficulty waking up but now, she looks forward
to coming here."
Her daughter is also preparing for her O levels with help from another
client, who finds that daily rehabilitation has spurred her to be positive,
active and busy.
"Idleness is the devil's workshop," she says.
Dr Radiah's dream is that the club will one day be run by patients, plus
caregivers. Already, a bipolar patient who is a National University of Singapore
arts graduate helps run club programmes, which include care- giver support and
Club manager Hamidah says the mentally ill have dreams like anyone. "They
want to marry, have a job."
To volunteer: E-mail Club Heal at email@example.com or go to
-- Volunteer Daniel Gan, 45, a former engineer and now a pastor, meets a
boy fortnightly to give him tuition at the void deck of his Housing Board flat.
-- ST PHOTO: CHEW SENG KIM
CHILDREN OF PARENTS IN JAIL
Helping kids through pain
Children whose parents revolve in and out of jail hide emotional scars and
rarely have positive image of adults.
So their adult befrienders stick around for at least a year to bond and
steer them away from parental footsteps, says Life Community Services Society
chief executive James Wong.
The charity helps children whose parents are in jail or were once
incarcerated. It works with low-income families too. In all, it serves 950
Befrienders spend six to eight hours a month with each youngster in the
vulnerable seven-to-13 age group who are enrolled in the charity's Friends of
Children project. These hours can go to tuition or outings as well.
Many find it tough to commit a whole year, so volunteers are not easy to
find, Mr Wong, 56, says.
Life Community cares for 150 children, usually at the request of their
parents, but counts 60 befrienders. Children with no befrienders get structured
aid, such as counselling, birthday celebrations and bursaries.
Still, befrienders play a more personal, influential role. They are from all
walks of life and include couples, a grandfather in his 70s and young people.
There is a sister project for 70 teenagers whose parents are also in jail.
Ten mentors guide them through activities.
Ms Margaret Teng, manager of the Friends Of Children and Youth projects,
says: "You can't see the emotional pain. It makes befriending very challenging."
Each befriender is linked to a case worker. They gather quarterly to share
If befriending seems daunting, Mr Wong hopes kind souls will support their
first Run For Life race on June 8. The goal is to raise $400,000.
The poster child for the East Coast Park race is "little Sam", nine, who
loves running. He saw the police take his father away. His mother died when he
was three and now, his ailing grandmother cares for him.
Sam was physically and sexually abused. A couple is befriending him.
The inmate population last year was 9,901, according to the Singapore Prison
Service. Half that number may have offspring, Mr Wong figures, so prison-linked
charities tend to only fragments of needs.
But he sees fruit. He marvels that befriended children are back to help. A
boy whose father was on Death Row sings at donor events and teaches guitar to
"He was very withdrawn but is now a strapping polytechnic student," says Mr
To volunteer: E-mail firstname.lastname@example.org or call 6837-3700.
Register for Run For Life on June 8 at
http://regonline.activeglobal.com/runforlife or go to www.life-community.org
-- Project coordinator Debbie Fordyce (right) speaking with foreign workers
and a volunteer at a restaurant in Rowell Road. -- ST PHOTO: DESMOND LIM
Hot meal and a listening ear
The idea that foreign workers are perpetual outsiders in Singapore helps to
explain why their cause seems short of regular volunteers.
Think of the migrant worker as an honorary Singaporean instead, suggest
veteran volunteers serving some of the one million low-wage transient toilers
"Let's say that while they are here, they should be honorary Singaporeans,"
says Mr John Gee, 59, immediate past president of Transient Workers Count Too
(TWC2) and a volunteer since its 2002 inception.
"The approach should be integrative rather than exclusionary," says the
Some companies and foundations are upfront that they support charities that
"contribute" to Singapore. "They feel bound to prioritise causes that are of
benefit to Singapore,'' Mr Gee notes.
TWC2 treasurer Alex Au, 61, says building Singapore counts as contribution.
"We are part of what fragmentary social safety net there is for them,'' he says,
then paints a "dystopia" of hungry workers on the streets if no one champions
Mainly, long-term volunteers are eyed for the Cuff Road Project, launched in
2008 to provide free meals for destitute foreign workers.
Out of a job, the men remain in Singapore while disputes with bosses over
salary or injury claims are settled. About two-thirds are injured.
Last year, the project dished out 101,775 meals costing $2.20 each in Little
This project, led by mentors, has 20 volunteers, from students to retirees.
They are evenly split between active and occasional helpers.
They register workers for meals and, vitally, also advise, educate and
befriend the bereft men. For that, more Burmese and Tamil translators would be
Ms Debbie Fordyce, 58, the project coordinator, seeks long-term volunteers
who will preferably serve weekly "so the men get to know and trust them, and so
they come to understand issues well".
TWC2 runs monthly Heartbeat introduction sessions to explain volunteer
Volunteers also work on research projects, digital communications, rescue of
maids trapped in abusive households and fundraising. Its Care Fund, which should
have $100,000 at any time, pays for medical emergencies, shelter and
While TWC2 is in the news as a voice for migrant workers, it still needs
volunteers. Ms Fordyce, an American, says: "Migrant workers, living apart and
largely beyond our sphere of consideration, just don't matter enough to many
To volunteer: E-mail email@example.com, call the TWC2 office at 6247-7001 or
go to twc2.org.sg
-- CHEW SENG KIM
Befriending those in their twilight years
Madam Koh Lai Kim, 96, has dementia and cancer, and is nearly blind.
"It can be trying on the family as she gets frustrated with herself and the
rest of us,'' says daughter Tan Ee Leng, a leather goods business owner.
But her mother "will perk up and be quite chatty" when a befriender couple
spend an hour with her each month.
Indeed, Madam Koh, coiffed and elegant, exchanges Cantonese witticisms with
Ms Winnie Choo, 55, a neo-natal nurse, and her husband Edmund Tan, 63, a retired
quality manager, when they pop by her bungalow in the East Coast area.
The women clasp hands, lean close at the table. Ms Choo coaxes her to
calculate her age, to spark her memory.
It is a tender hour, with a lightness and normalcy that belies the reality
that this is an end-of-life patient.
Later, after Madam Koh slowly, graciously walks them to the door, Ms Choo, a
home-care volunteer with Agape Methodist Hospice, says: "Seeing her, the heart
She will pen brief observations for the hospice. She notices that Madam Koh
is eating less, compared to their first encounter last year.
"For the first time, she said if we come back in two, three months, she may
not be here."
Volunteers such as the couple are gems. The hospice cares for 80 patients,
with half needing befrienders. There is a shortfall, with 30 volunteers on paper
but only 10 of them active.
Nanyang Polytechnic nurse lecturer Lai Bew Meng, 50, who is in charge of
hospice volunteers, says it is ideal if she can match two volunteers with every
But barriers abound in recruitment: People have fears. They prefer visiting
patients near their own homes or they cannot speak dialect. Some want to cook
and deliver food but not stay to talk.
"Our presence matters," she says.
Veteran volunteers guide new ones. There is quarterly training too. The
hospice would like to start a transport service, with volunteers accompanying
patients to hospital appointments. But there are no takers yet.
Ms Pearl Lee, group director of communications and fundraising at Methodist
Welfare Services, says: "Sometimes the older person may not communicate well
with counter staff. Hospitals can be pretty bewildering."
Hospice staff nurse Rebecca Indra, 44, says that without transport, some
patients skip appointments for palliative and geriatric care.
One patient, a man in his 70s with lung cancer, has no one to take him to
hospital so she books home-care doctors to see him more often.
He feels abandoned but can care for himself and even bathes his handicapped
wife and cooks noodles for her. His stoicism shines through.
Ms Lai, a volunteer for 15 years, often sees such resolve. "Volunteers are
privileged to be part of a patient's life."
To volunteer: E-mail Mr Robin Ho, homecare adminstrator of Agape Methodist
Hospice at RobinHo@amh.mws.org.sg or call 6478-4725 or go to www.mws.org.sg
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