Stigma No More: Greysteppenwolf's Singapore Mental Health blog 不再歧视：灰狼的新加坡心理卫生博客

Groggy MacGregor - "Conversation with..."

noreply@blogger.com (Grey Steppenwolf) — Tue, 31 Jan 2012 12:18:00 +0000

Silver Ribbon Singapore presents "Conversation with..." by Groggy MacGregor with his permission.

Groggy MacGregor has specially composed this song to show his gratitude for those who care about him while he is coping with his mental health condition.

http://www.youtube.com/watch?v=AqThnAPH-jU

Conference: Spirit Possession and Mental Health

noreply@blogger.com (Grey Steppenwolf) — Thu, 26 Jan 2012 11:42:00 +0000

Spirit Possession and Mental Health
http://bmehealth.org/
19http://bmehealth.org/th March 2012 / London

Spirit possession is recognised world wide across many cultures and by several religions. Spirit possession is often seen as an idiom of distress causing a change in behaviour and mental well being. Spirit possession is also included in the ICD 10 and DSM IV classifications of mental disorders, yet the extent to which it is recognised and / or discussed in clinical practice is less than we would expect, even in UK cities where there resides a diverse population.

This one day event will consider the critical themes and debates on spirit possession from an anthropological, social, psychological, medical and religious perspective using a range of illustrative case study, clinical practice, research and short film presentations.

Key questions including the following will be considered:

• Discuss possible definitions of and different kinds of spirit possession
• Debate the key elements which typify spirit possession
• Discuss who can make a diagnosis of spirit possession and how such a
diagnosis might be made
• Compare and contrast how spirit possession might be viewed by
clinicians, religious leaders, healers, the "patient", family
and community members
• Discuss the value of using the patient's explanatory model of
the illness
• Reflect upon the key issues associated with defining what is
"normal" and "abnormal"
• Discuss folk healing practices in different cultures and
"treatment" options including exorcism
• Consider whether there is a need to enhance joint working between
mental health professionals and traditional healers.

Programme of the day

9.00 - 9.30	Registration, Tea & Coffee
9.30 - 10.40	Introduction & Chair Spirit Possession and Mental Health Services Professor SASHI SASHIDHARAN
10.40 - 11.30	Anthropology, Cognition and Spirit Possession Dr. SIMON DEIN
11.30 - 11.45	Tea & Coffee
11.50 - 12.40	What happened to the Dybbuk? Spirit Possession in Judaism Professor KATE LOEWENTHAL
12.40 - 1.00	Morning session Q&A
1.00 - 2.00	Lunch & Networking
2.00 - 2.50	What is Jinn Possession? Case studies from Egypt: Lessons for the UK Dr. MOHAMMED ABOUELLEIL RASHED
2.50 - 3.40	Spirit Possession in Ladakh (North India, State of Jammu and Kashmir): Lessons for the UK Professor SOPHIE DAY
3.40 - 4.00	Afternoon Q&A
4.00 - 4.30	Plenary, Closure & Evaluation sheets

Who Should attend? This conference will be relevant to all interested in this field as well as all professionals, including those from Local Authorities and NHS trusts across the UK, Psychiatrists, GPs, Psychologists, Psychotherapists, Counsellors, Early Intervention Teams, CPN’s, OT’s, Social Workers, Chaplains, Community Faith Leaders & Healers, Equality Leads, CommunityDevelopment Workers, Service User Representatives, Charities, Third Sector, Educational Establishments, Academics and Policy makers.	Where? Oxford House, Derbyshire Street, Bethnal Green, London E2 6HG www.oxfordhouse.org.uk

Conference Contact Ahmed Qureshi (conference co-ordinator) tel. 07540 356 526 email us on: info@bmehealth.org or visit us on www.bmehealth.org

Yahoo Sg: Student at NTU found dead in hall of residence

noreply@blogger.com (Grey Steppenwolf) — Sun, 22 Jan 2012 08:37:00 +0000

Student at NTU found dead in hall of residence

http://sg.news.yahoo.com/ntu-student-found-dead-in-hall-of-residence.html

(UPDATED: 10:50pm, adding more details, statement from NTU)

A student attending a bridging programme at Nanyang Technological University (NTU) was found dead in one of its halls of residence late on Friday night.

Shin Min Daily News identified the student as 20-year-old Lan Xing Ye, who is from Fujian province in China. The paper reported that her roommate returned to the room they shared on the sixth floor of Hall 13 on Friday night to find her motionless on her bed, with a plastic bag over her head.

Police were alerted to the incident at 12:05am, and are currently investigating the case, which they have classified as an unnatural death.

In an email circulated to students in the late afternoon on Saturday, NTU president Bertil Andersson confirmed the incident, saying preliminary police investigations showed there was no sign of forced entry, and that Lan showed no other visible injuries.

He further added that NTU is extending all support and assistance to her family.

The paper also reported that Lan first came to Singapore to study slightly more than a year ago, in December 2010. She reportedly won a scholarship with the Ministry of Education (MOE) and was supposed to choose her major this year after her bridging course at the university, which she started after moving into its hostel a month ago.

The one-and-a-half year bridging programme acts as a preparatory course, which allows international students to take introductory courses in disciplines they may want to major in, and learn English as well.

Lan was also said to have given tuition in her spare time, advertising for students online, possibly for the payment of her school fees.

Her friends told Shin Min that she was cheerful, and showed no signs of any problems, although they added it was possible she may have been stressed from the pressure to do well academically. The paper also reported that Lan's roommate said she suffered from clinical depression.

In a statement, an NTU spokesperson said that professional counsellors with the school are assisting Lan's family, friends, coursemates and residents at Hall 13 who may need help coping with the emotional impact of the tragedy.

"Together with NTU’s President, the management, faculty, staff and students would like to express our deepest sympathies and condolences to the family of the deceased, her course mates and friends during this very trying time," he added.

P.S. From Silver Ribbon Singapore Facebook Group:

While everyone is busy preparing for CNY celebration, the NTU counsellors are assisting Lan's family, friends, coursemates and residents at Hall 13 who may need help coping with the emotional impact of the tragedy. Let's send our deepest condolences to the family of the deceased, her course mates and friends. If you know someone who is feeling suicidal, get help immediately or advise them to contact SOS at 1800-221 4444.

Asiaone: Female undergrad suffocates to death in school hostel

noreply@blogger.com (Grey Steppenwolf) — Sat, 21 Jan 2012 14:33:00 +0000

Female undergrad suffocates to death in school hostel

http://www.asiaone.com/News/Latest+News/Edvantage/Story/A1Story20120121-323294.html

Saturday, Jan 21, 2012

A female undergrad at Nanyang Technological University (NTU) was found dead early this morning in her dormitory room.

Miss Lum Xin Ye, 19, a Chinese national who resided on the sixth floor of NTU hostel hall 13 was found with a plastic bag around her head at around 12.05am, reported Shin Min Daily.

She was wearing a white shirt and black shorts when she was found unconscious on her bed by her roommate. There were no visible injuries on her body.

The Chinese daily reported that Miss Lum, who joined NTU last year as a scholarship recipient had been suffering from depression.

Before her death, she was attending bridging courses in preparation to choose a course to specialise in.

She also gave tuition part-time to earn extra money.

An NTU spokesperson has confirmed the death of a student at the school's hostel, and said that police investigations are ongoing.

There was no evidence of forced entry into the room.

The police have classified this as a case of unnatural death.

vtay@sph.com.sg

Halfway house planned for youngsters with mental disorders; First such facility here to help them return to living safely in society

noreply@blogger.com (Grey Steppenwolf) — Fri, 20 Jan 2012 14:20:00 +0000

Halfway house planned for youngsters with mental disorders;
First such facility here to help them return to living safely in society

The Straits Times Singapore

December 24, 2011 Saturday

BYLINE: Judith Tan

SECTION: SINGAPORE

LENGTH: 1288 words

A HALFWAY house will go a long way in helping children and young people with mental disorders get back to living safely in the community.

Such a residential facility is what the Singapore Association for Mental Health (SAMH) plans to set up.

It will be the first such facility in Singapore as existing ones cater only to people over 18 years old who have mental health issues.

The funding for this initiative comes from Temasek Cares, a non-profit philanthropic organisation.

Since April last year, it has committed $472,000 over two years towards SAMH's YouthReach programme.

SAMH acting head Ang Poh Hee said: 'With the money, we are able to develop resources like manpower to help the children and youth stay within the community.'

With the funding, SAMH is also adding mentorship and a 24-hour helpline under its YouthReach programme.

This will help reach out to more than 170 children and young people with mental disorders.

Volunteers are also needed for this, said SAMH president Daniel Fung, who is a child and adolescent psychiatrist.

'We are looking for young people to come on board as volunteers to support and guide those struggling with their disorders and to get back to the community,' he said.

He added that young people needing the most help are likely to be from the higher-risk groups such as school dropouts.

'While MCYS (Ministry of Community Development, Youth and Sports) is monitoring them, we still need concrete programmes to get them to a safe arena,' he said.

YouthReach was started in 2006 to address the lack of community-based support for children and young people with mental disorders. It is the first community-based support programme providing intensive case management strictly for those aged between 11 and 18 who are diagnosed with mental disorders.

But it was only in June last year that it expanded to include those at risk with serious psychological or emotional issues.

Mr Ang said that, as a result, YouthReach can now help more young people who have not been receiving proper mental intervention.

Some activities useful in this area include counselling, art therapy and sports.

Despite their afflictions, these children and young people can still develop to their maximum potential and reintegrate with their family and the community, added Dr Fung, who is also chairman of the medical board at the Institute of Mental Health.

The new halfway house will help such children and young people further develop social and functional life skills that will enable them to live safely within the community.

Ms Woon Saet Nyoon, general manager of Temasek Cares, said a National Mental Health Survey last month found that the number of young people with mental afflictions seems to be increasing.

'We at Temasek Cares want to help provide the financial means for early intervention programmes and equip these kids with life skills so they can get help and don't develop serious mental problems,' she said.

Dr Fung added that a residential programme would be ideal to help bridge the transition from hospitalisation to a return to society.

'It is often difficult for an adult with mental disorder to make the transition from being hospitalised to being back in society, let alone a child,' he said.

'Currently, there are no residential facilities for them and staying long term at the hospital will make it even harder to assimilate back.'

He said the challenge would be to make sure 'we have the support system to handle this and available resources are created within the community to carry it out'.

Indeed, the YouthReach programme has shown good results. Of the 140 children and young people helped between November last year and September, about 91 per cent or 127 stayed out of hospital or cut down on the time they were warded.

Dr Fung said that only about 1 per cent were deemed 'serious cases', which include major depression, schizophrenia and bipolar disorder.

juditht@sph.com.sg

Resume blogging

noreply@blogger.com (Grey Steppenwolf) — Tue, 17 Jan 2012 19:00:00 +0000

Dear readers,

I have contacted SPH and this is their reply:

"Hi Kelvin,

Thank you for your interest in hosting SPH-copyrighted articles on your blog where we notice it has no commercial interest. We will be glad for you to host our articles on your blog without licensing fees so long as there are no commercial interest on your blog. However, in the event that you decide to monetize your blog, the following licensing fees will apply."

Since I have no plans to monetize this blog in the near future, I can now put my articles back online. Thanks everyone for your patience.

A Belated Notice

noreply@blogger.com (Grey Steppenwolf) — Wed, 28 Dec 2011 07:07:00 +0000

Dear readers,

As you might have noticed, this blog has been shut down. Sorry for making the abrupt decision. As for the reason, it has to do with SPH suing Yahoo Singapore for copyright infringement. I have been harbouring a cavalier attitude towards copyright so far, reproducing entire SPH articles, albeit with attribution and link. One reader and even my psychiatrist have taken the trouble to warn me about the legal issues, but at first I so believed in my cause that they have fallen on deaf ears. I might not be sued or forced to take down the site but I think I shouldn’t take the chance. To forestall a situation where I am faced with a cul-de-sac, I have decided to shut down this blog temporarily.

I am not conversant in copyright law but I think there are two ways around this. One is to abbreviate the SPH content and provide a link. The other is to provide more original content.

Both present problems for me. First, is it OK if I quote the first paragraph? How much is OK? Secondly, it is even more likely that I’ll get into trouble if I voice my half-baked ideas and grievances on mental health issues, which I did a little of before but I took down some of it. I can be rather radical in my views and that can get me in trouble.

But if there is a need, I would go on providing mental health news in Singapore in the future. If you support me, please leave your thoughts and comments or contact me on how I can improve this blog. Much appreciated.

noreply@blogger.com (Grey Steppenwolf) — Sat, 03 Dec 2011 12:37:00 +0000

This blog is shut down until further notice. Thanks everyone....

noreply@blogger.com (Grey Steppenwolf) — Wed, 30 Nov 2011 10:15:00 +0000

ST THINK: You can't snap out of it

The Straits Times Singapore
www.straitstimes.com/

November 27, 2011 Sunday

When someone says he is depressed, it is not uncommon for friends and relatives to tell him, sometimes in exasperation, to 'snap out of it'. But as Dr Mok Yee Ming, deputy chief of the department of general psychiatry in the Institute of Health (IMH), pointed out in The Sunday Times last week, sufferers of clinical depression cannot just snap out of it or force themselves to recover. They must have proper treatment and medication. Misconceptions like this one - that the sufferer brings the problem upon himself and wallows in it rather than takes control of it - often surround mental illness, despite efforts by the Government over the years to educate the public about it.

The social stigma that attaches itself to mental illness has not gone away either. Which is why the IMH team that led a recently concluded study on mental illness in Singapore has made public education one of its chief recommendations in tackling the problem. But there must be inter-ministry effort, because previous campaigns have obviously not been effective enough.

The Singapore Mental Health Study, a three-year, $6.9 million nationwide study, found that more than one in 10 people will be stricken by mental illness in their lifetime. It identified depression, alcohol abuse and obsessive-compulsive disorder as the top three mental disorders. Alarming though the results were, there is a new generation of drugs, especially anti-depressants, developed in recent years that has proven very effective in treating depression and anxiety disorders.

Patients on the medication can often lead normal, productive lives. But they must seek medical attention in the first place. When they do not, they will be trapped in a vicious circle of emotional disturbances and physical decline and not be able to be integrated into society.

Ray of Light: Cat dumped in rubbish bin- Set up website so we can assess mental health

noreply@blogger.com (Grey Steppenwolf) — Wed, 30 Nov 2011 09:58:00 +0000

Ray of Light: Cat dumped in rubbish bin- Set up website so we can assess mental health

http://rayhope8.blogspot.com/2011/11/cat-dumped-in-rubbish-bin-set-up.html

Raymond’s letter to The New Paper is published today on page 21, Wed 30^th November 2011.

I refer to the report, “He’s still responsible” (The New Paper, Nov 26).

I’m not at all surprised at the way cat lovers and netizens on forums like Stomp have demanded that Madam Hamidah’s husband, Mr Michael who suffered a relapse of his bipolar condition, be taken to task for his actions.

But some of the comments on Stomp are far from kind. What is the point of showing love to animals, when we are so unkind to a human being who has fallen ill with a mental disorder that is so unpredictable? Bear in mind that the couple do love cats - otherwise they would not have adopted four cats, would they?

Given the findings of a study by the Institute of Mental Health which reveal that one person in 10 will suffer from some form of mental illness, it is imperative that we cast out nets wider to reach out to everyone in our society.

The key to tackling mental health issues is to secure a better understanding of the illnesses.

One way would be to set up a public funded website for people to do a self-assessment for potential mental health problems.

Confidential

Make the exercise confidential and available in the four main languages.

The questions asked can be designed to review one’s situation with regard to some of the more common mental health issues including, post-traumatic stress disorder, depression, anxiety, addiction and so on.

Such a screening will not provide a diagnosis, will but will give guidance as to where help can be sought.

It can be managed by experts who should be able to help the person doing the tests decide whether to go for treatment or not.

Grassroots leaders and the Community Development Councils should reach out to the lonely elderly, the vulnerable groups and those who do not have access to computers and carry out face-to-face assessment of residents.

For this, grassroots leaders should be trained in mental health.

There should also be a system in place to ensure that patients under psychiatric care do not default on treatment and medications.

Madam Hamidah is going to go through some challenging times, so let’s learn to rally around her, instead of giving her more stress.

RAYMOND ANTHONY FERNANDO

Today: Suicides: Do more so those in need get help

noreply@blogger.com (Grey Steppenwolf) — Fri, 25 Nov 2011 05:37:00 +0000

Suicides: Do more so those in need get help

Today

Letter from Sivakkumaran Govindasamy

04:45 AM Nov 25, 2011

http://www.todayonline.com/Voices/EDC111125-0000028/Suicides--Do-more-so-those-in-need-get-help

THE report "Bedok Reservoir deaths reflect copycat behaviour: Balakrishnan" (Nov 22) brings attention to a bigger issue: The cost of and accessibility to trained professionals for those facing mental problems.

Stress levels in Singapore have increased. A 2010 survey by the Institute of Mental Health showed that one in 16 people have suffered from depression, the most common mental illness here, and it took an average of four years for a person to seek help for this.

Clearly, there is a problem here. The Ministry of Community Development, Youth and Sports and the Ministry of Health must do more than have annual campaigns to de-stigmatise mental illness and raise awareness.

They should be proactive in educating and identifying those at risk.

One option could be to encourage our general practitioners, who are most likely the first resort for many mental health patients, to be equipped with the skills to identify and refer patients to specialists.

After all, many people may be unaware that they have a mental problem and that they can go beyond GPs for professional help.

In that regard, we should decentralise accessibility by having more trained counsellors and psychiatrists at our community hospitals and polyclinics.

Anecdotal evidence suggests that we do not have enough of them, and I am curious to know what those numbers are (per capita) and how we compare to other developed cities. If there is a shortage, we should have a plan to rectify this.

Finally, not many people may be aware that they can use Medisave for psychiatric help.

I wonder, though, if the S$150 daily limit and S$5,000 annual limit is sufficient. Are there funding options for lower income groups, the elderly and recent residents, who, from anecdotal evidence, fall into the "high risk" category?

It is easy to blame the media for over-reporting suicides. However, I would rather that we, as a society, openly discuss mental problems instead of brushing them under the carpet.

We will never totally cut out suicides, but we could do more so that those in need get help as soon as possible. That is more likely to save lives than notice boards at reservoirs and "responsible" media coverage would.

ST: Every day, 4 or 5 people in Singapore attempt suicide

noreply@blogger.com (Grey Steppenwolf) — Fri, 25 Nov 2011 05:33:00 +0000

Every day, 4 or 5 people in Singapore attempt suicide

Problem that affected mainly elderly spreads to those in their 30s to 40s

http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_737096.html

Published on Nov 23, 2011

For people in their 30s and 40s who try to kill themselves, the trigger is often failed relationships and huge debts, said Ms Esther Lim of SGH. -- TNP FILE PHOTO

By Salma Khalik, Health Correspondent

Every day, four or five people in Singapore attempt suicide. At least one succeeds.

Doctors and medical social workers say those trying to kill themselves also appear to be getting younger.

The problem used to affect mainly the elderly, but in recent years it has spread to those in their 30s and 40s, said Ms Esther Lim, head of medical social services at the Singapore General Hospital (SGH).

For them, the trigger is often failed relationships and huge debts, she said. The rate of suicide attempts is based on information from hospitals. The bigger ones, such as SGH and the National University Hospital (NUH), say they deal with one case a day. Smaller ones such as Khoo Teck Puat Hospital have a case every other day.

ST: Tormented by demons, dogma and stigma

noreply@blogger.com (Grey Steppenwolf) — Fri, 25 Nov 2011 05:14:00 +0000

Tormented by demons, dogma and stigma

ST November 19, 2011 Saturday

Tormented by demons, dogma and stigma

BYLINE: Radha Basu, Senior Correspondent

SECTION: SATURDAY SPECIAL REPORT

LENGTH: 1087 words

FROM furniture to crockery, everything in Madam Fatimah Rahman's one-room home is made of plastic. She has two schizophrenic adult children who fling things in sudden fits of rage.

'The only glass object we had was my TV set which my son broke recently,' says the 61-year-old divorcee. 'Living with his anger can be scary.'

Her 24-year-old son is a polytechnic dropout. After brief stints in several jobs, including as a security guard and at a fast-food restaurant, he is jobless.

Her 22-year-old daughter lives in a home for recovering patients and works as a health-care attendant in a hospital.

Caregivers living with mental illness are often victims of violence.

Occasionally, the tables are turned and patients bear the brunt of their loved ones' frustrations.

Tormented by imaginary demons and driven by compulsions they cannot understand, many leave home for days, living in parks and drifting on the streets.

There is an acute need to build professional community care facilities for such people, says the Lien Centre report, which identifies the mentally ill as a vulnerable community.

'The mentally ill can be considered to be a subset of the disabled but its non-physical nature makes it even more difficult for sufferers and society to face the issue and take remedial steps,' says the report.

The scientific basis of many mental disorders is still unknown, it adds. This makes the public - and even professionals to a certain extent - fearful, believing that the mentally ill are dangerous and should be locked up.

Both Madam Fatimah's children have spent countless days away from home. 'I wanted to keep them locked at home, so they did not get into trouble,' she says. 'But perhaps that was wrong.'

Her daughter's repeated disappearing acts and history of family violence have landed her in a series of homes for troubled girls since 2003.

These days, she lives in a home run by the Singapore Association for Mental Health (SAMH).

'She is happier than before because she is not locked up,' says Madam Fatimah. 'She can come and go as she chooses.'

More such homes offering residents a degree of freedom would be a great help to families coping with mental illness, she says.

Ms Amy Tan (not her real name) could not agree more. The 52-year-old, who is single, suffers from acute anxiety and obsessive compulsive disorder.

She says she has been living on the streets for more than a decade, ever since she broke her leg trying to escape from a locked room in a destitutes' home by jumping out the window.

She claims she was locked up after running away from the home. 'It was like a jail.'

For the past five years, she has been visiting the Waterloo Street office of the Catholic Welfare Services (CWS) on Mondays and Thursdays to wash up, change clothes and have two cups of hot Milo.

She has spent nights in void decks, carparks, parks and beaches and even on occasion in hotel lobbies and malls.

Her mother, who is 77, is full-time caregiver to two of her siblings who are also mentally ill.

As is common with families dealing with mental illness, mother and daughter do not get along.

'We always quarrel and I can't sleep at night,' says Ms Tan. 'So I'd rather live on the streets.'

Senior social worker Karl Koh, who has been working with Ms Tan since 2006, says people like her need residential care.

'What they would really like is their own HDB rental flat,' says Mr Koh.

But that is not always possible as, under HDB's joint singles schemes, single tenants need to find a partner with whom they can rent a flat.

'We have been trying to pair her up, but given her mental state, it is proving exceedingly difficult,' says Mr Koh.

The Government is trying to shore up services. Since 2007, the Ministry of Health has pumped $180 million into mental health care programmes, including some for early detection and to develop customised initiatives for the different age groups.

But the biggest barrier to 'transformative change' is also embedded within society's norms, says the Lien report.

It points out that long-stay patients in psychiatric wards find it difficult to assimilate into the community because of stigma and the 'cultural expectation that the mentally ill should be locked away'.

SAMH executive director K. Rajeswari says that while caregivers could do with more counselling and respite care services, drop-in centres for patients at the community level would also help.

'But stigma is still the biggest issue for people with mental illness, preventing them from studying, working and socialising in their community,' she says.

'That's what needs to change - and fast.'
radhab@sph.com.sg

The names of patients and caregivers in this article have been changed to protect their identities.

THE WAY FORWARD TO HELP THEM

o Train more mental health professionals: As of 2007, there were about 115 practising psychiatrists in Singapore, giving a psychiatrist- to-population ratio of about 2.6 per 100,000, which is low compared with other developed countries like the United States (13.7 per 100,000), Britain (11 per 100,000), and Australia (14 per 100,000). Singapore needs not just more psychiatrists but also allied mental health professionals like nurses and counsellors.

o Expand early detection programmes: As part of the National Mental Health Blueprint, the Government is already ramping up community schemes to detect mental health problems early in specific groups, such as the youth. Such programmes need to be expanded.

o Expand community outreach for families: Caregivers need more support, whether it is counselling or having centres that offer respite care, should they want a break from the daily burden of caregiving.

o Build more drop-in centres for patients: It is common for mentally ill people to disappear from home for days. Many drift on the roads, simply because they have nowhere to go. Increasing drop-in centres for such folk - so that they have a place to rest, take a shower, possibly even have a hot meal - is another way forward.

o Launch public campaigns that target stigma: Corporate sponsors or even the Government should step up initiatives to run advertising and other awareness campaigns that target the stigma that the mentally ill face, sometimes even from their own families. These campaigns could focus on how most forms of the illness are treatable, and that with timely intervention, patients can lead meaningful and productive lives.

ST: Clarion call for mental health awareness

noreply@blogger.com (Grey Steppenwolf) — Thu, 24 Nov 2011 01:58:00 +0000

Clarion call for mental health awareness; Mammoth study stresses need to know the how, where and who to seek for help

The Straits Times Singapore, November 20, 2011 Sunday, THINK, 1273 words, Chong Siow Ann, Mythilly Subramaniam, Janhavi Vaingankar

Here in one of the most medically advanced countries in the world, we had until recently a dearth of knowledge about the mental health status of the local population and on the nature of the problems faced by those with mental illness.
For that matter, we did not have accurate estimates of the number of people with mental disorders who were receiving treatment, nor had we identified the barriers to care, and we did not know what were the social and economic costs of these mental disorders - all of which is necessary for the rational allocation of limited resources and the shaping of better-informed policies.

It is heartening that in the last few years, there has been a growing awareness among policymakers of the importance of mental health and that 'there is no health without mental health'. In 2007, we launched our first National Mental Health Blueprint with a number of initiatives to tackle mental health issues and to build a more resilient population.

A component of this blueprint is the Singapore Mental Health Study. For policymakers, the eventual findings will provide a wealth of information that not only describes the mental health landscape but will also give that high-quality baseline data to track the trend of the mental health of the population over time, as well as to help evaluate some of the initiatives of the National Mental Health Blueprint.

The Singapore Mental Health Study was a household survey that was conducted among Singapore citizens and permanent residents who were aged 18 years and above. A representative sample was drawn which was used to estimate the characteristics of the total population. The collection of information was a mammoth task, with a legion of trained interviewers working tirelessly over one year to interview 6,616 people across the country.

The main findings of the study are that mental illnesses are not uncommon in the Singapore population, the onset of these illnesses is relatively early in life, the majority of individuals with mental illnesses do not seek help, and among those who seek help, there is a considerable delay before doing so.

Medical and mental disorders often co-exist, with one in two persons with mental illness having at least a chronic medical condition, and most of the mental illnesses in these people were not treated. The unemployment rate of those with mental illnesses is about twice that of those without mental illnesses; and even among those in the active workforce, there is a proportion of workers whose mental illnesses have a detrimental effect on their productivity.

There is no perfect study of this nature, so the findings of this study ought to be interpreted in the light of certain inherent limitations. The study was conducted by interviewers visiting households, which meant that people in nursing homes and prisons were excluded. About 24 per cent of people who are eligible for the study refused to participate in the study.

Studies carried out elsewhere have suggested that the rates of mental illnesses might be higher among institutionalised people and those who refused to be interviewed. We could not assess all the myriad mental illnesses, choosing instead to focus on a number of key illnesses.

These limitations notwithstanding - they would also imply that the overall rate of mental illnesses is likely to be higher than what we have reported - the study has used the latest advancements in epidemiological survey methods and has generated a wealth of information for policymakers and care providers.
The findings are also a clarion call for action.

First, there is a need to get people who are not well to seek help. Help-seeking behaviour is influenced by many factors, such as the individual's perception and understanding of the problems, the prevailing attitude of family and friends, economic factors like financial resources and the availability of insurance coverage, and the fear
(real and perceived) of discrimination and stigma.

Measures to address these issues would be those that increase mental health literacy. The public should be educated to recognise the manifestations of common mental disorders and the how, where and who to seek for help. Needed, too, is the continued battle to lessen the stigma of mental disorders, although it is something that is unlikely to disappear any time soon.

So, other innovative ways to access help ought to be considered. This would include the use of Internet and telephone-delivered therapy, which has the advantage of alleviating fear of loss of privacy and confidentiality, but more research is needed to evaluate the efficacy and effectiveness of such non- face-to-face therapies in the local population.

Second, the professionals in the primary health-care sector are major players. Our study did not examine the degree of collaboration or conversely, the extent of fragmentation of the whole process of care from start to end. Fragmentation of care, unfortunately, is a common situation across health-care systems almost everywhere in the world.

Efforts are already in place to pull GPs and mental health specialists together, although less so with other care providers, like counsellors and social workers in the family service centres.

This process of working together is often more challenging in practice. It requires skilful negotiation and a high degree of commitment of time and resources for ongoing training and supervision, quality checks and support, including the appropriate financial incentives.

Third, the common co-existence of medical and mental health problems means people with chronic physical disorders ought to be screened for mental problems and, by the same token, mental health specialists should routinely assess their patients for physical health problems; and a close collaboration between these groups of health professionals is necessary.

Lastly, loss of productivity caused by common mental disorders is considerable. Employers should understand that untreated mental health problems among their employees will have an economic impact and there are programmes in which they can invest. The returns in terms of improved productivity would more than offset the cost of such interventions as shown by some studies.

Employees often fail to seek treatment because they fear exposing their condition and risk stigmatisation and possible job loss. Workplace health policies need to incorporate more than the usual programmes to deal with workplace stress: forums to talk fearlessly about common mental disorders, and the importance of timely treatment coupled with the genuine intent to obliterate discriminatory employment policies are needed.

Some time ago, an editorial in The New York Times (May 1, 2007) opined that rather than a resolvedly determined way of just looking at the good things and successes, a healthy dose of negative thinking - though painful, as it 'involves finding and exposing your inadequacies, which can be overwhelming' - may be much better when it comes to health care, because it makes us strive to fix the wrongs and do even better.

The Singapore Mental Health Study has shown that while the rates of most of the mental illnesses are substantially lower than in Western societies, we ought not to fall into a self-congratulatory, complacent state. The study has also highlighted gaps and inadequacies and it is through the identification and description of the problems that we could work out the solutions.

The writers are from the Research Division of the Institute of Mental Health and investigators of the Singapore Mental Health Study.

ST: The Darkness Within

noreply@blogger.com (Grey Steppenwolf) — Thu, 24 Nov 2011 01:51:00 +0000

the darkness within

The Straits Times Singapore, November 20, 2011 Sunday, NEWS, 1274 words

More than one in 10 people living in Singapore will suffer some form of mental illness in their lifetime. And while the onset occurs in most while they are in their 20s, two in three never seek help. This is what the Singapore Mental Health Study - the first-ever nationwide mental health census here - has found. The survey, led by the Institute of Mental Health, studied more than 6,500 residents above the age of 18. Sunday Times correspondent Judith Tan finds out what the four most common mental disorders in Singapore are.

Major depressive disorder (MDD)

What it is: A combination of being depressed, profoundly sad and feeling empty, worthless and hopeless which interferes with a sufferer's ability to work, sleep, study, eat and enjoy once-pleasurable activities.

Dr Mok Yee Ming, deputy chief of the department of general psychiatry at the Institute of Mental Health (IMH), said the 'real and complex disorder' affects mental processes, hormonal cycles and even the outcome of many medical disorders.

Lifetime prevalence: 6.3 per cent

Who are more prone: Indians, women and those who are divorced or separated

Age of onset: Although the median age at which the first symptoms appear was found to be 25 years, Dr Mok said it affects all ages, even children.

Different stages; warning signs: It is associated with depressed moods, anhedonia (inability to enjoy life), sleep difficulties such as sleeping too much or not being able to sleep, appetite issues such as bingeing or not eating, poor concentration, low energy, hopelessness and thoughts of suicide.

In severe cases, there may be psychosis like hearing voices.

Help: Events such as a break-up, loss of a loved one or setback at work can cause depression. For many, sadness caused by such an event passes. But when the depression drags on for weeks, affecting family, friends and work, it is time to seek help.

Help can be found at the family doctor, who may refer the patient to a psychiatrist if necessary.

Not getting treatment would worsen the condition, Dr Mok said.

Percentage that do not seek help: 59.6

Treatment options: MDD can be treated with anti-depressants. But as this medication needs between one and two weeks to take effect, sedatives (sleeping pills) can be used to help with sleep.

Psychotherapy has been shown to help.

Dr Mok said: 'Sufferers cannot just snap out of it or force themselves to recover. Caregivers must ensure they are compliant with their treatment.'

Alcohol abuse & dependence
What it is: Alcohol abuse is drinking too much, to the extent that it causes problems in or disrupts everyday life. The key features of alcohol dependence are physical tolerance, withdrawal symptoms and a loss of control over drinking.

Lifetime prevalence: Alcohol abuse: 3.5 per cent

Alcohol dependence: 0.5 per cent

Who is more prone: Indians, men and those who are divorced or separated.

Age of onset: International studies have shown that young adults with disposable income often fall prey. Dr Gomathinayagam Kandasami, acting head of the Addiction Medicine Department at the Institute of Mental Health, said it can start during the teen years or late adulthood.

'Men usually develop drinking problems in their 20s and 30s, while women often seek treatment later,' he said.

Different stages: Dr Gomathinayagam said it is not easy to predict how someone can become a victim of severe alcohol-related difficulties as it is 'determined by a complex of biological, psychological and social factors'.

Warning signs: Early warning signs are similar to those seen in other addictions - lying to hide alcohol-seeking behaviour, neglect in physical appearance and day-to-day activities, sleep-related difficulties, and frequent emotional arguments with family and friends.

Health may also worsen, starting with minor ailments such as gastritis, and progressing to serious ones like hypertension and cancer. There may also be signs of short-term memory difficulties.

Help: When a person shows the warning signs, a doctor should be consulted.

If treatment is not sought, long-term effects include fatty liver, hypertension, diabetes, psychosis and cancer.

Percentage that do not seek help:
Alcohol abuse: 96.2

Alcohol dependence: 88.3

Treatment option: Detoxification is the first stage of recovery. Patients may need to take medication during this period. Follow-up treatment includes counselling.

Dr Gomathinayagam said that for recovering alcoholics, maintaining sobriety is a major hurdle. Here, self-help groups such as Alcoholics Anonymous and halfway houses can help prevent relapse.

Obsessive-compulsive disorder (OCD)
What it is: An anxiety disorder where the sufferer has thoughts, feelings, ideas or fears that drive him to do something repeatedly. This compulsion is time-consuming.

Lifetime prevalence: 3 per cent (US: 2.3 per cent; Europe: 1.1 per cent).

Who is more prone: Malays and Indians, women, and those who are divorced or separated.

Age of onset: Usually in adolescence or early adulthood.

Different stages: Intrusive and unpleasant thoughts that recur. A common example of this is the fear of contamination or dirt.

This results in anxiety. To neutralise the thoughts, sufferers engage in repetitive behaviour such as constant hand-washing.

Warning signs: Often, family members of the patient notice the compulsive behaviour for a few weeks before treatment is sought, said Dr Chai Suet Bin from the Department of General Psychiatry at IMH.

The common types seen include excessive hand-washing, constant checking, counting behaviour and hoarding. If these become severe, it hampers the patient's day-to-day living, Dr Chai said.

Many children and young people have compulsive- obsessive behaviour, usually brought on by stress of an upcoming examination or relationship problems. The behaviour is, however, transient and will go away after a few weeks.

Help: When a person notices himself or family members having obsessive-compulsive behaviour for two weeks or more, then a psychiatrist should be consulted.

Early treatment is essential to prevent further worsening of the condition.

If left untreated for too long, Dr Chai said, OCD may develop into depression, which can in turn lead to suicide.

Percentage that do not seek help: 89.8

Treatment option: Medication and psychotherapy. A psychiatrist needs to confirm the diagnosis to plan the necessary treatment.

Nicotine dependence
What it is: Not being able to stop smoking even though it is causing harm.

Nicotine dependence is a complex brain disease characterised by compulsive, at times uncontrollable craving, seeking, and use, despite devastating consequences.

Overall prevalence: 4.5 per cent.

Who is more prone: Malays, men and widowed persons.

Age of onset: According to the Mayo Clinic, most people begin smoking during childhood or adolescence.

But Ms Kng Kwee Keng, Senior Pharmacist (Clinical) and Certified Quit Smoking Consultant at Tan Tock Seng Hospital, said there is no specific age at which people start smoking. 'They can be as young as seven years or as old as in late adulthood.'

Different stages:

'The initial high from the first puff will draw the smoker in. Wanting that same 'high' will make the smoker continue smoking,' Ms Kng explained.

Warning signs: They are similar to other addictive behaviour.

'First there is the craving for a puff, then the constant obsession with smoking cigarettes.

'When the smoker does not have any, withdrawal symptoms set in, resulting in frustration and irritability,' Ms Kng said.

Health may also worsen, starting with a cough, and progressing to premature ageing and more serious illnesses such as hypertension, chronic obstructive pulmonary disease and lung cancer.

Treatment option: There are several ways to stop smoking. Some stop 'cold turkey', but it is hard for a larger percentage to stop on their own without some type of help.

There are products available that can ease cravings and calm withdrawal symptoms.

Some are medication such as Zyban and Champix, nicotine blockers which are prescription drugs.

Others include nicotine replacement therapy such as gums, inhalers or patches.

A support group can also help break the habit.

ST: '1 in 10 will suffer from mental illness'

noreply@blogger.com (Grey Steppenwolf) — Thu, 24 Nov 2011 01:43:00 +0000

'1 in 10 will suffer from mental illness'

Common disorders include depression and alcohol abuse: Study

By Chang Ai-Lien, The Straits Times, 19 Nov 2011

MORE than one in 10 people in Singapore will be stricken by mental illness in their lifetime, according to a large, new study here.

Many are likely to face depression, the commonest mental illness here. It is projected to affect 170,000 adults, with more women affected than men.

Others may be affected by alcohol abuse or obsessive-compulsive disorder (OCD), an anxiety affliction characterised by obsessions, compulsive rituals, as well as intrusive thoughts and impulses.

These were the top three mental disorders to surface in the $6.9 million Singapore Mental Health Study, in which 6,616 people were interviewed extensively last year.

The problem is a serious one, said Institute of Mental Health (IMH) experts who released the results yesterday. Mental illness can strike at a young age, and most people do not seek help.

'This is of great concern,' said Associate Professor Chong Siow Ann, vice-chairman of the IMH's medical board (research), who led the mammoth exercise.

'Mental illness often occurs at the prime of life, and goes undetected and untreated, resulting in decades wasted and having a profound impact on health, well-being and productivity.'

The information from the study, including treatment gaps, will go towards developing new mental health services and policies, and refining current ones, he said.

He hopes the results will include less stigma in the community, better care for patients, and more awareness all round.

In the study, depression emerged as the most pervasive mental illness here. Characterised by profound feelings of sadness, worthlessness and hopelessness, the debilitating condition is projected by the World Health Organisation to become the second-leading cause of disability worldwide by 2020.

In Singapore, it will strike 6.3 per cent of the adult population at some stage of their life. This amounts to 110,000 women and 60,000 men, half of whom will also suffer from a chronic physical illness.

Alcohol abuse and OCD are the next most common mental disorders.

Mental illness trends here generally follow global trends.

A surprising finding, however, is that Singapore has the highest rate for OCD, which hits 3 per cent of people here. The figure for the United States is 2.3 per cent, while in Europe it is 1.1 per cent.

Said Dr Mythily Subramaniam, deputy director of IMH's research division: 'This is the first and only disorder where we bucked the trend.'

The reasons are not yet clear, but the disease itself is affected by both genetic and environmental factors such as developmental upbringing and even illness.

Prof Chong said: 'This study has identified the problems. Now we can work out the solutions and how to do better.'

The study is an integral part of the National Mental Health Blueprint. The blueprint was launched in 2007 with a number of initiatives to promote mental health, help prevent the development of mental health problems, and reduce their impact.

Another important finding is that while the onset of mental illness occurred in most people while they were in their 20s, two in three never sought help.

Even those who eventually did took years to do so.

On top of that, mental illness also occurred alongside chronic conditions such as cancer, diabetes and heart problems.

Half of those with mental illness also had chronic physical ailments.

Dr Chua Hong Choon, IMH's chief executive officer, said that there are many efforts to narrow these gaps, such as working with schools and elder-care centres to spot and treat mental illness.

More general practitioners are also being roped in to care for patients. The first batch of 20 GPs has completed a graduate diploma in mental health, he said, adding that another 50 GPs have been trained to manage mental illnesses.

This will give them better skills in treating such patients, and hopefully encourage more sufferers to come forward to get help, he said.

Associate Professor Kwok Kian Woon, associate provost of student life at Nanyang Technological University and a co-investigator in the study, added: 'We should not underestimate the need for community awareness in the home, at work, and at school.'

He said that the study made a good case for counselling as an avenue for identifying and even preventing mental illness.

'The point is to prevent the normal downs that we expect in life from becoming an impairment or even making someone non-functional,' said Prof Kwok, head of the division of sociology at NTU's school of humanities and social sciences.

Added Prof Chong: 'This is an example of how research is not just about sexy findings and breakthroughs. Other, more pedestrian results can translate into more immediate benefits.'

Most sufferers do not seek help

It strikes young. The majority of mental illnesses occurred by 29 years of age.

Most sufferers do not seek help. Fewer than one in three approach people such as psychiatrists, care givers, counsellors, GPs or religious or spiritual healers.

Those who do seek help take a long time to do so. The average time taken ranges from four years for people with depression, to 13 years for those with alcohol abuse.

Mental and chronic physical illness such as cancer, heart conditions, diabetes and high blood pressure often go hand in hand. Over 14 per cent of people with chronic physical illness also have a mental illness. Among those with mental illness, over half have a chronic physical illness.

Over one in 10 people here will suffer from a mental illness in their lifetime. Depression, alcohol abuse and obsessive compulsive disorder are the three most common disorders.

Loss of productivity: Mental illness results in over six working days lost, and about 10 days where work quality is compromised per person. This amounts to 267,418 days lost and 425,238 workdays cut-back on among employees here.

The unemployment rate of those with mental illnesses is about twice that of those without such ailments.

The figures for mental illness here are in line with global trends but lower than those of Western countries, and less than half the world average - where one in four is estimated to suffer from mental illness in their lifetime.

CNA: North West district to raise awareness of mental illness

noreply@blogger.com (Grey Steppenwolf) — Thu, 24 Nov 2011 01:37:00 +0000

North West district to raise awareness of mental illness
Posted: 21 November 2011 0011 hrs

http://www.channelnewsasia.com/stories/singaporelocalnews/view/1166607/1/.html

SINGAPORE: North West district mayor Teo Ho Pin says he is concerned about the incidence of mental illness in Singapore.

And he plans to increase the number of interest groups in his district to raise awareness of the issue.

One in 10 people in Singapore will be stricken by mental illness in their lifetime, according to a recent study.

Dr Teo was speaking at a carnival to spread the message of active ageing on Sunday.

The number of social clubs in North West district has gone up from 66 in 2002 to 207 today.

Membership has also grown from 8,000 to over 50,000.

And it's not just the seniors taking part.

Dr Teo said some activities, such as brisk-walking, have found fans among younger residents too.

- CNA/ir