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ST 6 Apr 2013: Bridge the mental health treatment gap
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
treatment.
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
ever known."
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
woes.
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.
stopinion@sph.com.sg
The writer, Associate
Professor Chong Siow Ann, is a senior consultant
psychiatrist and the vice-chairman, medical board (research)
of the Institute of
Mental Health.
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)
ST 5 Apr 2013: More GPs take on mental health cases
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
stress.
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
minutes.
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
differentiate.
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
clinic.
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
CNA 5 Apr 2013: MOH launches revised set of Dementia Clinical Practice Guidelines
MOH launches revised set of Dementia Clinical Practice Guidelines
Channel
NewsAsia
April 5, 2013 Friday 3:50 AM GMT
S Ramesh
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 the
capacity in its memory clinics by
ST 5 Apr 2013: Doc relied on account by Tey to diagnose disorder
Prof's stress: False diagnosis 'possible';
Doc relied on account by Tey to diagnose disorder
The Straits Times (Singapore)
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
evidence.
"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
inadmissible.
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
dispute.
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
mind.
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
system".
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
him out.
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.
yanliang@sph.com.sg
waltsim@sph.com.sg
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
grades.
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.
ST 25 Mar 2013: Refrain from DIY brain zapping - for now
Refrain from DIY brain zapping - for now
The Straits Times (Singapore)
March 25, 2013 Monday
FORUM LETTERS
TRANSCRANIAL direct
current stimulation (tDCS) shows promise as a treatment
for various neuropsychiatric conditions ("Zipping ahead
by zapping the brain";
March 11).
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
risk.
Hence, the use of
metallic electrodes is potentially dangerous and not
advised.
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
depressed patients.
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
safety.
Chan Herng Nieng
(Dr)
ST 24 Mar 2013: In need of helping hands
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
mentally ill
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
helpless."
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
popularity.
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
Charities.
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
"personal interest".
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
volunteers."
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
Australia does.
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
grandchildren.
"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."
siewhua@sph.com.sg
AUTISTIC ADULTS
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
responsible."
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-
Kallang GRC.
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
too.
They can help
raise funds as the centre runs at a deficit of about $300,000
a year.
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
whole day."
To volunteer:
E-mail Ms Paula Teo, senior manager of Autism Association
(Singapore) at paula@autism-association.org.sg 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
class.
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
money".
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
public outreach.
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 info@clubheal.org.sg or go to
www.clubheal.org.sg
-- 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
clients.
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
insights.
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
children.
"He was very
withdrawn but is now a strapping polytechnic student," says Mr
Wong, beaming.
To volunteer:
E-mail befrienders@life-community.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
FOREIGN WORKERS
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
here.
"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
Briton.
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
their cause.
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
India restaurants.
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
ideal.
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
roles.
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
repatriation.
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
people."
To volunteer:
E-mail info@twc2.org.sg, call the TWC2 office at 6247-7001 or
go to twc2.org.sg
-- CHEW SENG KIM
END-OF-LIFE
PATIENTS
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
warms."
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
patient.
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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