Sunday, March 18, 2012

Young PAP (YP) activists provided excellent support for burnout caregiver

18th March 2012

Dr Vivian Balakrishnan

Dr Maliki Osman

cc: Deputy Prime Minister & Finance minister

Dear Ministers & MPs,

Young PAP (YP) activists provided excellent support for burnout  caregiver

It has never been easy for me to take care of my wife who has battled schizophrenia for 40 years.  As her sole caregiver, I have to write for a living to provide the necessary financial and social support for her. Matters have worsened after she was stricken with arthritis 7 years ago.

The severe knee problems which she faces makes it practically impossible for her to continue to help me carry my books and then sell it at selected churches and public forums.  My wife used to cry when she sees me struggling to carry 100 books as I have problems getting relatives and friends to help out.  But that’s the reality- when you are looking after a mentally ill person, you are all alone in this world cos’ most people will run away.

The thought of giving up writing completely though I am trying so hard to be self-reliant has crossed my mind one time too many, partly because I feel discouraged by the lack of caregiver support – an issue which I have raised in the media often.

But sometimes all it takes is for someone to believe in you and your cause, and you can bounce back once again.  This was when a female activist from the Young PAP (YP) Cashew branch and a member of the YP Executive Committee, Miss Elaina Olivia Chong and her  boyfriend - Ambassador (National Olympic Committee of Mongolia) , Albert Teo came to my rescue.  (Elaina helps out with the Meet –The – Peoples’ (MPS) sessions at the Cashew Branch).  They visited my wife and I in our home and went out of their way to help us, buying 20 copies of my recent book, linking me up with potential buyers and providing me with volunteers to help me market my books at a church last weekend.

The YP volunteers who gave me excellent support established good rapport with the parishioners, resulting in my marketing over 70 books, enabling me to put food on our table” and be well positioned to provide the recreational and medical needs for my wife.  These hardworking volunteers were out in the hot burning sun, raising awareness of mental illness and encouraging their readers to support caregivers like myself. 

The staff and priests were equally supportive, with one of them, Reverend Father Timothy Yeo, thanking the YP volunteers who rendered the much-needed support for me to carry on my caregiving journey. At the end of the book sale, Father Yeo spoke to the YP volunteers, who included caring Elaina, the tireless Daniel Huang & Jake Tan & his pretty girlfriend Alicia Qwek .  Impressed by their dedication and commitment to the mentally ill, Fr Yeo encouraged the volunteers to carry on their good work.  

I am deeply touched and motivated to carry on my writing career because of this wonderful structural support.

My perception of the PAP has been pleasantly enhanced by these YP volunteers who sacrificed their rest day to give hope, encouragement and support for those who sometimes feel that they are “left out in the cold.”  This is an excellent way for the PAP to boost its image because many Singaporeans feel that the Govt. does not give much attention to mental illness. Imagine if this kind of support can be rendered island –wide. You will not only get more people in such conditions being uplifted, but Singaporeans will be more supportive of the PAP because this will pave the way for a truly gracious, caring and inclusive society.

I am enclosing some photos that were taken at this event. Thank you & God Bless!


Raymond Anthony Fernando

Reply from Minister Dr Vivian Balakrishnan on 19th March 2012:

Dear Mr Fernando,

Thank you for your kind words – which I will convey to Elaina. I am sure they helped because you inspired them with your devotion and care for your wife.

Please send your wife my best wishes for her health too.

Warm regards,
Dr Vivian Balakrishnan

Friday, March 9, 2012

Rest days for maids, what about fulltime caregivers?  An open letter sent to Govt. ministers that include Deputy Prime Minister Tharman, Health Minister Gan Kim Young & a few others

“Loneliness and the feeling of being unwanted is the most terrible poverty.”

-Mother Teresa-
Minister of State for Manpower Tan Chuan-Jin announced in Parliament on 5 March 2012 that from January next year, all employers must give their foreign domestic workers (FDWs) a rest day every week.

It is encouraging that the welfare of our foreign maids has been looked into as it is impossible to work seven days a week without a break.

Even machines that work non-stop will break down.

But what about full-time caregivers who are citizens of this land looking after their sick loved ones suffering from chronic illnesses 24/7?  Don't they also require days off.

Caregiving, in many cases is a full-time job. Although looking after a loved one suffering from chronic illness – be in mental or physical can be very satisfying and rewarding, the work is never easy, and many caregivers experience sadness, depression, or anger.

Caregivers often feel frustrated and lonely because a large part of their social life is affected.

Research  has shown that  that caregivers who do not take a break:

·        Are more likely to be have symptoms of depression or anxiety

·        Are more likely to have a long-term medical problem, such as heart disease, cancer, diabetes, or arthritis

·        Have higher levels of stress hormones

·        Spend more days sick with an infectious disease

·        Have a weaker immune response to the influenza, or flu, vaccine

·        Have slower wound healing

·        Have higher levels of obesity

·        May be at higher risk for mental decline, including problems with memory and paying attention

These symptoms clearly indicate that over a period of time, caregivers will find their own physical and mental health breaking down.  Many of them are exhausted when they go off to bed. When this happens caregivers are bound to suffer burnout.

If steps have been taken to ensure that foreigners are treated well, why is it that our very own citizens, who are prepared to undertake the unenviable task of caregiving, cannot have a single rest day throughout the year?


I proposed to the govt to provide respite care for caregivers. I get the usual standard civil service reply from the Ministry of Manpower(MOM).
Reply from the Ministry of Manpower- received today, 13th March 2012:
Dear Mr Raymond,
We refer to your email of 9 March 2012.
Thank you for taking the time to write to us to share your views. Indeed, we do understand that caregiving obligations can be taxing, especially when a loved one has taken ill. For individuals who are employed as caregivers, they would be covered by employment laws governed by Ministry of Manpower. In the situation you have described where the caregiver is discharging caregiving obligations full-time but not as an employee, we would encourage such individuals to approach the Centre for Enabled Living (CEL) to explore possibilities of assistance according to individual needs. For more information on CEL, you may wish to refer to their website at
Thank you,
Yours sincerely,
Nicholas QUEK (Mr)
Head, Quality Service Management

Customer Responsiveness Department . Ministry of Manpower . Tel 1800-538-6930 . Email

And so, I have responded to day, as follows:
Dear Mr Quek & Ministers,
I beg to defer. CEL cannot help in this area. I’ve tried so many times (: What I’m asking for is some respite. You can go visit my blog to see what I written/have proposed. The... CEL & MCYS does not even want to recognize that mental illness is indeed a disability- a hidden disability. The Govt. has got to look into this area, and render us the support that we so badly need. Plain & simple!

Read this:

and finally this:


It is futile for citizens to put up proposals and everything is thrown out, simple because no one wants to do a little extra work.
Raymond Anthony Fernando

Wednesday, March 7, 2012

Taking care of the mentally ill- Make treatment compulsory

Former news anchor Joanne Lee goes public on being stalked for several years by a patient who suffers from schizophrenia. Concerned that the mentally ill will be further discriminated, Mental Health Activist Raymond Anthony Fernando writes to the press.

Raymond's letter to The New Paper: Taking care of the mentally ill

Make treatment compulsory

My letter to The New Paper (TNP) on the above matter is published today- Wednesday 7th March 2012 on page 19 of TNP.

I refer to the report, “Not hearing from stalker makes her even more anxious” (The New Paper, Mar 5.)

I fully empathise with the mental anguish that former news anchor Joanne Lee has gone through after being stalked for four years.

She had to give up her job, her privacy and worst of all, she ended up seeing a psychiatrist, having to live in fear.

I applaud Miss Lee for having the courage and conviction to share her traumatic experience publicly in an effort to raise more awareness about stalking. 

Indeed, there could be much more victims of stalking who suffer in silence.

However, the mentally ill should not be seen as nothing but trouble makers.

Many psychiatric patients who are willing to go for treatment have gone on to lead perfectly normal lives - mainly because they have good family and community support.

I would like to suggest that the Government introduces a compulsory treatment order for anyone who suffers from untreated mental disorder; including stalking.  

The police and the Institute of Mental Health (IMH) should be given powers not only to send people with mental illness for mandatory treatment but also to ensure that patients do not default on their medication and treatment.

Based on a psychiatric evaluation, a tribunal appointed by the government can decide whether the compulsory treatment order should be made, and if so, for how long. 

A care plan should be included in the order and a trained social worker must be on hand to advise the patients and their families of their rights and the programmes that will help them cope.


Monday, March 5, 2012

Greater transparency needed on Medishield payments

Every year the Central Provident Fund Board (CPF) sends out CPF statements to its account holders giving details of how much contributions have been made it through the Ordinary account, the Special account, the Medisave account and the Retirement account. 

There is also a notification to inform the account holder if he/she is covered by Medishield.

Since the inception of the Medishield scheme, I have been faithfully paying premiums every year for both myself and my wife for more than 10 years. Although Medishield deductions are made known annually in the CPF statement, account holders do not know how much they have paid over the years simply because there are no details documenting the accumulated premiums paid in the CPF statement. Why is this so?

Just as there are reflections of how much contributions have been made for CPF contributions, shouldn’t the same apply for Medishield payments? For example if an account holder has paid Medishield premiums at say, $100 per year, the total amount for 10 years standing at $1,000 should be stated for this scheme  in the annual CPF statement so that account holders are fully aware how much premiums has been paid to-date.

With the government encouraging Singaporeans to take up medical insurance, shouldn’t there be more transparency on Medishield premiums paid?

Another disturbing feature is that it is always so difficult to make a claim on Medishield when one is hospitalized.


Sunday, March 4, 2012

What does it take to build an inclusive society? An open report to DPM Tharman, MOS Health-Dr Amy Khor

“Most of the important things in the world have been accomplished by people who kept on trying when there seemed to be no hope at all.”
- Dale Carnegie -

In Parliament on Wednesday 29th February 2012, Dr Amy Khor, Minister of State for Health mentioned that everyone has a role to play in building an inclusive society. She went on to add that while government policies can redistribute resources to help the vulnerable, an inclusive society is also about individual wanting to be helped and to help themselves.   

An inclusive society is one:
(a) In which all persons are to be valued for themselves, not merely for what they contribute;

 (b) That all persons are entitled to quality of life, and to opportunities for growth, not hampered by unjust social or economic conditions, or by inequalities caused by prejudice.

According to the United Nations:  “An inclusive society must be based on respect for all human rights and fundamental freedoms, cultural and religious diversity, social justice and the special needs of vulnerable and disadvantaged groups, democratic participation and the rule of law.”

Social inclusion involves ensuring that all groups and individuals have equal opportunities for development and growth.  One group that has great difficulty in securing equal treatment is the mentally ill and their caregivers.

Yet, besides newly elected PAP MP Tin Pei Ling who had the courage and conviction to speak out in Parliament on 29th February 2012   about the mentally ill being left out of in the Budget 2012, how many of our other Members of Parliament (MPs) – opposition MPs included, are willing to raise the plight of the mentally ill in Parliament? Aren’t MPs elected to serve the people of Singapore - ALL people?

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.  

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.

People suffer from stress for various reasons.  It could be that they are unable to cope with the burden of caring for a sick relative.  It could be because they are worried sick about their jobs, exam stress or facing financial calamity.  Or maybe, it's because of the traffic and overcrowding. 

Mental illness is creeping into our schools, our homes, in the heartlands, in the offices and even in places of worship, like churches.  Just like we cannot avoid the problem of suicides and failed marriages, we also cannot avoid raising the plight of the mentally ill and their caregivers.  Let’s work together as a government and as a community to help save and reclaims lives.

Provide better care for the mentally ill in public hospitals
In IMH, the C class wards house 30 or more patients in one ward. In the A class 6-8. How can anyone get any rest and peace of mind with 30 or more patients- many of them very disturbed in one crowded ward?  Aren’t people who are ill supposed to go to a hospital to rest?   Can’t it be down- sized to about 10-15 in the C class wards, allowing for not only better supervision of the patients and giving the patients a chance to have some peace of mind.  
The government actively promotes medical tourism and yet securing a bed in hospitals for our own citizens is such a mammoth task.

Funds to support the mentally ill
I’m glad that the Government has come up with various schemes to help ex-prisoners get a second chance in life.  It is encouraging that a great deal of effort has been put in place to secure jobs for ex-prisoners under the Yellow Ribbon Project.  Some churches even have a prison ministry that looks after the welfare of prisoners and their families.  Funds are also raised for them through the Yellow Ribbon Project. Because the Yellow Ribbon Project has strong political support, it is much easier to raise money for them. If ex-prisoners are able to get a second chance in life, why aren’t the mentally ill given even a 1st chance in life?  

In Singapore, funds are raised on a national level for all kinds of illness, which includes cancer, heart diseases and kidney diseases, but nobody has found it in their hearts to raise funds on a national level for people with mental illness. Why is this so, especially when many of them cannot find jobs because of discrimination?

Caregivers & patients who are coping well can go on national TV and move the audience with their true stories.

Jobs for those coping with mental illness
Just go take a look at any Govt. job application form and you will find a clause there which requires the applicant to declare if he/she has a history of mental illness.   Why is this requirement still in place? In the U.S. to ask this question, is illegal.  This clause handed down since the colonial time is clearly outdated, and has to be removed if we want to give equal opportunity for all Singaporeans to secure jobs and to encourage treatment if a person is going through depression or other types of mental illness, because the illness is treatable.   Is this in any way giving the mentally ill a chance to help themselves, DPM  Tharman , Dr Amy Khor?
 If the Govt. takes the lead, the private sector will most likely follow suit.

Grants to support talented psychiatric patients& their family members
Grants and sponsorship can help people coping well with mental illness and their caregivers to work from home, earn some money, have a sense of worthiness and become self-reliant. If they can write, such grants will enable them to contribute to the literary culture here in Singapore. 

In a report published in The New Paper (TNP) on June 4th 2010 – “Work Support Programme – Govt study to track impact of scheme”, it mentioned that the Government (MCYS) is willing to provide better support for low-income families including those with mental health issues.  Encouraged, I responded to that report in a forum letter to TNP dated 14th June 2010 – “More social support needed for the mentally ill”, urging the Government to consider awarding grants or sponsorship to psychiatric patients and their caregivers to work from home with the skills that they posses or could acquire. To-date, no one from the Government has followed through on this.
Health insurance
Another burning issue that demonstrates how the mentally ill are deprived of proper care is; health care insurance.  For several years, I have tried to buy a health care insurance for my wife for her physical illnesses, but this was rejected time and again because no insurance company wants to provide coverage for anyone suffering from mental illness, even though I have clearly stated that the medical insurance is for her physical illnesses. 

This issue was raised during the previous top management of the Ministry of Health, but to-date, no one has followed through on this pressing issue, leaving those who suffer from mental illness to be deprived of proper medical insurance and to struggle with skyrocketing medical expenses.  If this is not discrimination, then what is it?

Public transport at IMH
To raise caregiving to a higher level, we need to build the infrastructure. As such, the public bus companies should ply the grounds of IMH and pick up/drop off passengers at IMH. The present feeder bus service provided by a private company only operates during office hours.  I had written to the present transport minister and the previous one to consider this, but both have chosen to ignore this much-needed service.  How can caregiving – which is now a very much talked about issue and which the government and church is paying more attention to, be taken to a higher level when conditions such as proving the infrastructure is sorely lacking? It is little wonder that many of the patients at IMH take a longer time to recover because of this lack of strong emotional support- a key component that is vital in the recovering of the afflicted.
As Singapore journeys towards becoming an inclusive society and caring nation, it must bear in mind that there will always be people who may need more help.  And undoubtedly, the mentally challenged, the lonely elderly and their families are some of those who need a great deal of help. The mentally challenged, Dr Amy Khor are more than willing to help themselves, but it is roadblocks, lack of support  and discrimination that hampers their growth and development.

I await your response, DPM Tharman, Dr Amy Khor.


Footnote: DPM Tharman's office has replied today,
Dear Mr Fernando,

Thank you for your feedback and suggestions on helping the mentally ill.

I’m pleased to share with you that Dr Amy Khor, the Minister of State for Health has just announced the Government’s plan to develop a wide range of community-based mental health programmes over the next few years. Our goal is to enable more patients with moderate to mild mental conditions to receive appropriate care in the local community. These programmes include setting-up multi-disciplinary teams in the community to provide quick and convenient access of mental healthcare to patients, providing more resources to support caregivers to care for mentally ill family members, and expanding the capacity of mental healthcare institutions, such as special outpatient memory clinics and psychiatric nursing homes.

The Ministry of Health will also conduct public consultation soon, to gather feedback on the proposal to extend MediShield coverage for inpatient psychiatric treatment.

We also agree with you that it is critical to improve public awareness and understanding about mental illness. The public needs to treat patients with mental illness with understanding and compassion. To this end, the Health Promotion Board (HPB) has worked with schools, workplaces and community organisations to reach out to some 170,000 people last year, and will continue with these efforts this year. At the workplace, HPB has put in place a mental health promotion grant to build resilience and wellbeing of employees and facilitate early detection and support. From April this year, the maximum quantum of the grant will be raised from $2,000 to $5,000 to sustain and augment companies’ mental health promotion programmes.

Thank you.

Leela Pokkan (Mdm)
for Quality Service Manager
Ministry of Finance