Monday, May 23, 2011

Time to re-look the bridge to mental health and provide better support for caregivers

23rd May 2011

Major- General Chan Chun Sing

Ag Minister – MCYS

Madam Halimah Yacob

MOS- MCYS

Mr Gan Kim Yong

Health Minister

Dr Amy Khor

MOS- Health Ministry

cc: Mr Heng Chee How- Senior MOS(PMO's Office)

Dear Ministers & Ministers of States,

I refer to the above matter.

I am encouraged that Major-General Chan Chun Sing is keen to help needy families (CNA report- Sunday 22nd May 2011). Undoubtedly one group that needs much help and support are the mentally ill and their caregivers who have been neglected for decades. They definitely fall into the needy families category. The parting message from former MM Lee Kuan Yew and Emeritus Senior Minister Goh Chok Tong was that “we must not forget the older generation”.


Isolation; depression; shame; guilt; loneliness. Mental illness can bring about these emotions. Stigmatisation can cause discrimination in the workplace, unnecessary violence and inappropriate hospitalisation. Sufferers will lose self-esteem, self-worth and even hope altogether. In extreme cases, the effects of social stigma can lead to suicide.

Russian-born American writer Elie Wiesel, the 1986 Nobel Peace Prize Laureate, once said: “The opposite of love is not hate; it’s indifference.” Many people in society, even educated ones, are still indifferent to the mentally ill. A large number of people choose to remain indifferent because of fear. Their fear and lack of understanding of mental illness often leave the afflicted shunned and discriminated against. This fear, when left unchecked, will continue to obstruct moves toward a more compassionate society, in which we care more humanely for the mentally ill within our community.

At this juncture, permit me to give you a little background as to why I am making a call to all of you to provide this marginalised community with the support that we so desperately and urgently need since some of you are new on the jobs.

I am a caregiver to my wife, Doris Lau who was stricken with schizophrenia and depression at the tender age of 17, and my journey in caring for her all by myself for 37 years has been extremely difficult and exhausting, mainly because the support mechanism for citizens like us are non-existent. I have suffered burnout countless times! She has a total of 6 chronic illnesses and is seeing 7 doctors.

During our 37 years of marriage, my wife has suffered 12 nervous breakdowns. Her recent relapse last month has once again seen me suffer all alone. The Institute of Mental Health(IMH) of which I am a volunteer has a vision to be the leading mental health care provider in Asia by 2012. But how can this be realised when the support mechanism for caregivers like us is clearly lacking?



Many a time when my wife suffers a relapse of her mental illness, I am left to bear the enormous pain, hardships and suffering all alone. I have not chosen to place my wife in a nursing home or in IMH, but will continue to care and love her to my last dying breath. What is clearly lacking here in Singapore is love for another human being who, by no choice of their own, are made to suffer horrifically from the ravages of schizophrenia.
During the SARS period, I was denied access to see my wife for 30 days when she suffered a relapse of her mental illness. Yet emotional support is vital to the recovery of mental patients. Any psychiatrist in the world will testify that 50% of their recovery comes from strong emotional support. For one solid month, I suffered all alone.  It was only my Christian  faith in Jesus that helped pull me through this most difficult period.
My wife has to take 44 tablets a day - half of which is for her psychiatric condition. Medication  compliance alone is a big headache. If you disbelieve me, take a look at the list of medications provided for in the attached document. Her drugs are so complex that during the period when my wife underwent knee surgery in a restructured hospital a few years ago, the nurse almost gave her the wrong dosage of her psychiatric drugs. Fortunately, I noticed the mistake and decided that I should counter-check all the medications that she was taking 3 times a day.

This resulted in my having to make 2 trips a day for a week to counter-check the medications that was given by the nurses. I was exhausted and collapsed when I reached home on the 3rd day. Lack of sleep, deep set worries caused me to suffer burnout. Any wrong dosage - either overdose or underdose will see a relapse of her mental illness because my wife's mind is very fragile. She can so easily snap. Once that happens, my wife's full recovery will take as long as a year. My wife will have to go for another knee surgery in a few months time. Will the same mistake occur? I really don't know, but I will not take any chances.
One of the cruellest aspects of the disease (schizophrenia) is that the sufferers so easily alienate those closest to them before anyone knows that they are ill. It effectively robs them of the love and support that are vital in dealing with the devastation wrought by mental illness. Relationships are torn apart, home and families are lost, and anticipated futures evaporate. Respect is eroded and a person is often left with nothing and no one — and at a point in their lives when they are the least capable of helping themselves.
If they are fortunate, there will be at least one person who doesn't give up, one person who does not retreat in the face of a mind in chaos. But trusting that person is another matter. When delusions and hallucinations implicate their loved ones in sinister conspiracies, the mentally ill feel alone in the most fundamental of ways.
Singapore has done well in meeting the basic needs of its citizens such as a good education system, health and housing needs, and a safe and clean environment. However, there is still an urgent and dire need to facilitate the inclusion of marginalised communities that include the mentally ill, the disabled and the lonely elderly who do not have the same sense of belonging in a society that is bent on economic excellence.
Our health care system needs improvement. If you read the postings on my blog , and it includes a plea to our Prime Minister, you will find that I am not exaggerating when I say this.
Many people , even doctors do not fully understand the difficulties we face everyday in our lives. An example is noise pollution. Excessive noise , such as lift upgrading and other types of renovation will also adversely affect my wife. People with mental illness cannot take excessive noise pollution. Everytime there is noise pollution, I have to search high and low for alternative accomodation, because no day care centre in Singapore will take in people suffering from mental illness. Must we be like gypsies or nomads running from place to place when there is little or no consideration for the sick?
Bear in mind that I do support upgrading programmes, but shouldn't the HDB show more compassion and allow us to rent an affordable flat during such periods?
Everyday for me is a relentless pursuit to find the means/places that can provide a safe haven for my beloved Doris.
I have sat on the MCYS focus groups for 3 years, contributing ideas and useful suggestions. I have given up this role as a volunteer because I was unappreciated. If you read my advocacy book- “A Choice, A Voice, A cause-: One man's advocacy on social issues”, you will find very useful suggestions on how we can improve the lives of all Singaporeans. Heng Chee How has purchased 5 copies. He will bear testimony to this. I am willing to re-volunteer my services to MCYS if the government is keen to listen and accept bold and new ideas.
Despite the enormous obstacles and adversities I have faced, and will continue to face, I will continue to care and love my wife, taking a leaf from my Christian marriage vows which says, “I will love my wife in sickness and in health, for better or worse, so help me God...” for Doris is a beautiful human being, who like anyone of us, needs love, understanding and compassion.
In closing, I have taken time and effort to write to you, ministers so I hope that I will be able to secure a reply or at least an acknowledgement that my feedback is receiving attention. Often Singaporeans get upset when government agencies or even office holders do not make the effort to respond to genuine feedback. It can create the impression that the government does not care.
This 2nd “cry for help” goes onto my blog.
I am copying this letter to Mr Heng Chee How because he is one man that really cares and he has always rallied around us during moments when I needed assistance. God Bless you, Heng Chee How! Our marginalised communities need more leaders like you.
Thank you for your time and I look forward to a reply. You may now visit my website and blogs to understand and empathise with our dire straits. I am not just speaking for myself, but for the thousands out there who are suffering in silence. I want to believe that the government cares.

Sincerely,

Raymond Anthony Fernando

Website (RAY OF HOPE) : www.rayofhope.per.sg/

Blog (RAY OF LIGHT): http://rayhope8.blogspot.com/




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