The High Dependency Psychiatric Care Unit IMH

IMH Press Release 21 May 2009

THE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT: HOW INTENSIVE CARE AND
HEALTH EDUCATION TRANSLATE TO BETTER HEALTHCARE AT THE INSTITUTE OF
MENTAL HEALTH

HDPCU, the High Dependency Psychiatric Care Unit at Ward 31A officially opens on 21 May 2009. Funded by the Ministry of Health (MOH) as a Healthcare Service Development Plan (HSDP), its objectives are to provide close monitoring and management of acutely disturbed psychiatric and actively suicidal patients within a safe and secure environment.

What differentiates this ward from the other wards within the Institute of Mental Health (IMH) is its stepped-up intensive care for the severely disturbed which includes close monitoring and frequent assessments of both emotional and physical states. With the use of higher doses of medication, care associated with higher doses of medication needs to be provided all within a safe and secure environment. And this is achieved through the intensive care implemented with a nurse-patient ratio of 1 nurse to 1 or 2 patients. With continuous monitoring, psychosocial interventions and health education on illness and treatment counselling sessions to patients and their families, HDPCU aims to achieve faster recovery therefore reducing patient hospitalisation days for this group of patients.

It has been demonstrated abroad in close-observation units in the UK, Canada and Australia since the 1970’s that such care leads to a decrease in staff and patient accidents, a decrease in constant observation and seclusion hours and a decrease in the number of nursing hours lost to injuries at work. Such consistency and control within the unit means that higher patient safety standards and shorter hospitalisation stay are possible. The following are the value-added features of the ward and its services:

Fully air-conditioned 10 beds separated into 2 rooms consisting of 6 beds for male patients and 4 beds for female patients. Nurses are able to view all beds from the Nurses’ Counter. Each male and female room is equipped with bedside medical equipment for prompt response to any medical emergency.

Recreational activities are used – with an emphasis on relaxation techniques such as music or art and craft activities using piped-in music; and board games which help refocus the individual’s mind, such as chess, scrabble, carom and physical exercise. An Activity Room with a 37-inch flat screen TV allows patients to catch up on the latest news or their favourite drama series. And, a cosy Visitors’ Room allows for private family sessions

Trained nurses in the management of psychiatric patients, encompassing de-escalation techniques which equip them with the skills and mental preparedness to assist when patients are aggressive as well as control and restraint techniques.

Inclusion and exclusion criteria to identify patients who will benefit most from HDPCU interventions. Patients from IMH’s other wards, Emergency services and Satellite Outpatient Clinics are reviewed by the HDPCU Specialists before transfer to HDPCU for treatment.

CCTV at strategic locations for close continuous monitoring, with all areas accessible only with the Staff Access Card. At least one nursing staff is in
each cubicle at all times. Each nurse carries a panic-alarm device that will
activate the same block wards as well as the hospital security personnel.......

FACT SHEET -THE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT (HDPCU)

Patient Demographics

HDPCU manages patients from ages 19 to 65 years who suffer from Schizophrenia, Bipolar Disorder, Major Depressive Disorder and Anxiety Disorders.

Ward charges

Because the HDPCU is a ‘classless’ ward, charges at HDPCU will vary depending on the
class of the wards the patients were staying prior to transfer to HDPCU.

List of charges applicable to Singapore residents in Singapore Dollars are as follows for each day of stay at the HDPCU:

Ward Stay costs per day Treatment Fee
A1 $325 $60
A2 $300 $60
B1 $245 $50
B2 $75 $20
C $40 $15

A1, A2 and B1 denote patients from private care. These patients would need to pay the full amount of the ward and treatment fees. B2 and C denote patients who are fully subsidised under the programme --these patients have undergone means testing to verify their income levels for suitability to receive subsidies.

HDPCU has been in operation since 15 December 2009 and the occupancy rates for the
10-bedded ward are:

Dec 08 Jan 09 Feb 09 Mar 09
Days in operation per month 17 31 28 31
Patient days (cumulative) 66 171 139 201
Occupancy rate 39% 55% 50% 65%

Who are on the team at HDPCU

Headed by Project Director, Dr Chua Hong Choon, IMH’s Vice Chairman of Medical Board
and Co-Project Director, Dr Prema K, Director of Nursing Administration, the medical and nursing teams consist of the following:

Medical team:
Dr Alex Su, Consultant and Acting Chief of General Psychiatry 1
Dr Thong Juinn Yew, Associate Consultant
Dr Habeebul Rahman, Registrar

Nursing leads:
Ms Soh Lee Choo, Senior Nurse Manager, Nursing
Administration
Mr Aziz Abdul Hamed, Nurse Clinician, Nursing Administration

Allied Health leads:
Ms Clare Yeo, Head and Principal Clinical Psychologist
Ms Chan Lay Lin, Principal Medical Social Worker

Veteran counsellor Anthony Yeo has lymphoma

(CNA) -- Veteran counsellor Anthony Yeo, 60, has been hospitalised with lymphoma, a cancer of a type of white blood cell that fights off infections in the body.
News of his illness was announced on Thursday on the website of the Counselling and Care Centre, where he is a consultant therapist.

The centre said it was unable to give more details on his condition, and his family has declined comment. An announcement on the centre's website said Mr Yeo, often referred to as the 'Father of Counselling' in Singapore, is not ready for visitors and would prefer to spend time with his family.

Those who would like to convey their get-well wishes may send their cards to the Counselling and Care Centre in Hong Lim Complex. Mr Yeo joined the centre fresh out of university in 1972, and rose to become its first local director in 1980. He was only 32 then.

He pioneered formal training for counsellors here and has trained close to 1,000 counsellors. An energetic speaker, he has always advocated paid sabbaticals for those in his profession and proper professional recognition in the form of licensing and registering of social workers.

Lymphoma is also what struck both Prime Minister Lee Hsien Loong and the late president Ong Teng Cheong in 1992. Mr Ong died in 2002 at the age of 66.

P.S. On 20 June 2009, Anthony Yeo passed away due to complications from Leukaemia, leaving behind his brother, wife and children. He was 60 years old.

S’pore gears up for SILVER TSUNAMI

From
http://www.ngejay.com/?p=2772

May 25, 2009 by admin

ST link

# 2,000 more nursing home beds in five years
# Eldersave, ElderShield, Elderfund being developed
# Manpower expansion and training in health care
By Salma Khalik

IN THE coming decade, Singapore’s health-care system will come under pressure from an ageing population coupled with an increase in mental ailments.

To cope, the Health Ministry will add more than 2,000 nursing home beds over the next five years - with about half devoted to the care of the mentally ill.

In the Health Addendum to the President’s Address at the opening of Parliament on Monday, Health Minister Khaw Boon Wan spoke of the need to prepare for a ’silver tsunami’.

The population here is ageing rapidly. The number of people who are over 65 years old is expected to treble to 900,000 by 2030 - from 300,000 today.

This is the driving force behind the development of a second heart and cancer centre, a new general hospital in Yishun and another in Jurong, and the expansion of the National University Health System’s dental centre.

‘We will increase our subventions to intermediate and long-term care facilities to help them meet growing patient needs,’ said Mr Khaw.

These include community hospitals, nursing homes and hospices. New rates for community hospitals will take effect on July 1, that will see total subsidy go up by 15 per cent.

Work on five new nursing homes will start within two years, including a 300-bed home for patients with psychiatric problems to be ready by 2012.

Dr Tan Weng Mooi, chief operating officer for the Institute of Mental Health (IMH) said such a home is an important part of integrated community care for patients suffering from schizophrenia, mental retardation or bipolar disorder.

She said: ‘IMH’s philosophy is that those with mental illness should be allowed to stay on their own or with their families for as long as possible.’

But there might come a time when they need full-time care, but because their conditions are stable, do not need to be warded at IMH.

There are now three nursing homes that cater to such patients.

Another two new homes, each with 250 beds, will be designed for people suffering from dementia.

These homes will also take in other elderly patients.

A Ministry of Health spokesman said there are now about 20,000 elderly people in Singapore with dementia.

‘This is estimated to increase to about 45,000 by 2020,’ she said.

People with dementia suffer from loss of memory to the point where they are no longer able to do simple things like dress themselves or even eat. If diagnosed early, there is medication that could slow the progression of the disease.

Nursing homes for them need to provide lots of cues - such as signs, colour code and even music - to connect particular rooms with certain activities.

The ministry will also be releasing two plots of land for the building of private nursing homes. And it will help two existing homes run by voluntary welfare organisations (VWO) to relocate to new and larger facilities.

To help patients pay for all these services, the ministry will develop the 3Es - Eldersave, ElderShield and Elderfund.

Elderfund, set up as Medifund Silver in 2007, helps the elderly poor pay their hospital bills, while ElderShield is insurance for severe disability.

Eldersave is a new concept to help young people set aside enough of the Central Provident Fund money to provide for their health-care needs when they are old.

With so much in the pipeline, the ministry says it will need to recruit 4,500 people over the next two years, with 2,000 job openings in the next 12 months.

‘Manpower expansion must precede infrastructure expansion,’ the minister explained.

Manpower training in health care will be given a boost when the third medical school at the National Technological University opens.

Mr Khaw also touched on palliative care or the management of pain, and the need to let the elderly sick die with dignity, a theme he has touched on several times this year.

He said: ‘We will also build up capabilities on end-of-life care and expand the pool of palliative care specialists.’

salma@sph.com.sg

Don't grieve for me

From
http://www.straitstimes.com/Breaking%2BNews/Asia/Story/STIStory_380692.html

SEOUL - FORMER South Korean president Roh Moo-Hyun told his family not to grieve for him before plunging off a cliff early Saturday in an apparent suicide, news reports said.

'Please don't have sorrowful feelings. Aren't life and death one and the same?' YTN television quoted the note as saying.

'Please cremate my body. Please erect a small tombstone for me at the village.' An aide to the former leader, who held office from 2003-8, said Mr Roh had jumped from the cliff near his retirement village at Bongha close to the south-east coast.
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Mr Roh, 62, was questioned last month as a suspect in a multi-million dollar corruption case.

'It has been so tough,' the note reportedly said. 'I caused so much trouble to many people.'

Mr Roh had gone hiking with a bodyguard early on Saturday. He jumped while the guard's was distracted, according to Yonhap news agency.

He was taken to a nearby hospital in a very serious condition and moved again to Busan National University Hospital, where he was pronounced dead.

An official with the Busan University Hospital where Mr Roh's body was taken said at a televised news conference the cause of death was head injuries. 'Head injuries were the direct cause of his death. Many bones were broken, including ribs and pelvis.'

'Former President Roh left his house at 5.45am (2045 GMT, 4.45am Singapore time) and while hiking on the Ponghwa Mountain, appears to have jumped off a rock at around 6.40am (5.40am Singapore time),' Moon Jae-in, who was Mr Roh's presidential chief of staff, said in a nationally televised statement.

Police said they were investigating whether Mr Roh killed himself. -- AFP

P.S. If you're thinking of suicide, read this first
http://www.metanoia.org/suicide/

A life spent studying death

From
http://health.asiaone.com/Health/News/Story/A1Story20090423-137117.html

Fri, Apr 24, 2009
The Straits Times

DR CHIA Boon Hock, 73, is Singapore's resident suicidologist and a walking repository of research on the motivations, methods and meanings of suicide.

He has spent his life poring over coroner's reports, collecting data and trying to demystify what drives people over the edge.

He recently finished analysing hundreds of suicide letters left behind by Singaporeans between 2000 and 2004 for the renowned journal, Archives Of Suicide Research. He also contributed a chapter on Singapore to the 2008 book, Suicide In Asia.

In 1968, he became the first psychiatrist here to go into private practice. Besides a medical degree from Hong Kong University, he also has a doctorate on suicide from the University of Singapore.

He estimates that about 90 of his patients have killed themselves out of the 5,000 he has treated over a 20-year period.

Now semi-retired, he works an 11-hour week at his private practice, plays golf, practises the piano, learns Mandarin, does gardening, plays with his three grandchildren and analyses data on suicide as a hobby.

He is married to a housewife. They have two children who are both doctors.

a22

Tzu Chi volunteers' outreach

From
http://www.tzuchi.org.sg/en/News/2009/20090222.html

How will you spend your weekend morning? Will you be lazing in bed? Or still having hangover from the late night party the night before? Or will you be meeting friends to have a nice brunch?

On Feb 22 early morning, 10 volunteers including two young ones met in one of the pavilions in Circuit Road. After a short briefing by volunteer Wu Yu Chin, they came to a unit on the ground floor.

From the cordial greetings between the volunteers and Mr. Chan, the owner of the house, one can tell that they had known each other for a very long time and they have a very warm relationship. Volunteers brought along things like brooms and rugs and everyone started work right away. Some scrubbed the floor; some cleaned the toilet while others cleared the trash. There was also another volunteer there to give hair cut for the care recipients.

Sincerely caring for everyone

Both Mr. Chan and his mother are patients of the Institute of Mental Health (IMH). His mother’s condition is more serious – she would stare blankly and sit on the floor throughout the day. She cannot take care of her daily life and does not know how to use the toilet. Thus the house is always very messy and filthy. They are on long-term medication and require follow-up visits to the Institute of Mental Health. They depend on government subsidies for their living expenses. Chan's younger brother has a regular job, but he cannot manage the household while caring for his older brother and mother.

Tzu Chi took in the Chan family as care recipients in 2006. In the beginning, volunteers were shocked to find out about the piles of unused stuff and the very unhygienic environment in the house. Worrying it may cause a fire, they initiated a spring cleaning for the Chan family but it was turned down. However, with a lot of persuasion, care and concern shown to the Chan family over time, Mr. Chan finally agreed to let the volunteers to help clean up their house. This was also after the volunteers brought many bottles of soft drinks to him after knowing Mr. Chan loves soft drinks. Since then, volunteers have been helping in cleaning up the house on a periodic basis and they call Mr. Chan as the “Brother Soda”.

“When did we start coming to help you clean up the house?” asked Cai, a volunteer.

“In 2006.” Mr. Chan replied immediately. He also remembered he was not so friendly towards the volunteers in the beginning.

Patience and tireless guidance pay off

In order to encourage the Chan family to participate in recycling and therefore reduce the amount of trash, Yu Chin made posters especially for the Chan family to explain and educate them about the different types of recyclables. She put the posters in a prominent place in the kitchen so that they are reminded everyday. Whenever volunteers come, they will patiently remind the Chan family to not create too much rubbish and improve the hygiene at home.

Since Mr. Chan loves to drink soft drinks, previously volunteers used to collect four big bags of empty, flattened soft drinks bottles whenever they came to do spring cleaning. However, this time they were pleasantly surprised to see that they did not even have a bag full of it. The amount of bottles has reduced almost 80 percent!

The kitchen sink used to be filled up with unwashed plates and bowls. But now they only found two used cups and one bowl. In the kitchen cabinet, they also did not find any empty cup noodles or Styrofoam boxes from the takeaways.

“Do you know why your house is so much cleaner now?”

“My younger brother takes out the rubbish and he also sweeps the floor.”

“Why isn’t there any of those disposable chopsticks anymore?”

“(It’s because) whenever I buy takeaways, I do not take disposable spoons and chopsticks no more.”

Yu Chin was touched to hear Mr. Chan’s replies. Very clearly, Mr. Chan has taken in the volunteers’ long-time advice. This is the result of three years of patience and continuous reminder and guidance. Till date, the volunteers have carried out more than 10 spring cleanings and through that, they have won over Mr. Chan and his family. Meanwhile, Mr. Chan, who used to take soft drink as water, has since drank green tea instead.

No fear in helping

“Yes!” a definite YES answer when asked if Mr. Chan like to see the volunteers.

Among the volunteers, there were a few who were participating for the very first time in home visits and helping out in spring cleaning. Thoo Moi Seng and Kan Chee Heng were among the first timers.

When both of them opened the refrigerator in Chan’s house, they were taken aback by the stench smell. It was filled with all kinds of things and looked as if it has never been cleaned before. Many of the food in it were already rotten. But they had no qualms and they patiently cleaned up everything.

Another volunteer, Yap Hui Kee, was also a first timer. Though Yap is very particular about hygiene, she quickly got the mop and cleaned the floor when she saw Mr. Chan’s mother soil the floor.

Though Yew Chui Fong has joined Tzu Chi for a few years already, this was her first time helping a care recipient with haircut. The Chans do not pay attention to their personal hygiene and therefore their hair was messy and dirty. This did not startle Yew but instead she happily gave them a fine and neat haircut. She even told Yu Chin later to not forget to ask her to come along in the next home visit.

When everyone finished cleaning up, they got Mr. Chan to help mop the floor. Upon seeing him wetting the ground, volunteer Wong Chong Wee quickly came forward and showed Mr. Chan how to clean it the proper way.

The continuous care and concern shown to the care recipients reflect well on Tzu Chi’s charity mission. Master Cheng Yen encourages the volunteers to reach out to public and help those in need. Meanwhile, through helping others, we learn to appreciate what we have and be contented. This is especially pertinent during this economic gloom period.

Tembusu Home for mentally unwell destitute

Tembusu Home at Pelangi Village
Dear readers,

Tembusu Home at Pelangi Village is a residential home for mentally unwell destitute.

From

http://www.4s.org.sg/ourprogrammes.html

Managed by 4S since June 2002, the Tembusu Home at Pelangi Village is a 7-storeyed Welfare Home set up by MCYS under the Destitute Persons Act. It is one of the six homes within Pelangi Village and has a bed capacity of 200. It provides shelter, care and rehabilitation for mentally incapacitated male destitute persons.

The Home is named after the Tembusu tree, which symbolises evergreen beauty, longevity and the ability to weather storms. The Home aims to emulate these qualities by providing a supportive environment for the maintenance and promotion of the physical, psychological and social well-being of the residents.

The Home’s programmes focus on training in social and independent living skills, with emphasis on personal grooming and hygiene, pursuit of religious persuasions, personal enrichment and social development