Friday, February 28, 2014

Set up one-stop centre for those with suicidal tendencies - Raymond A Fernando's letter to The Straits Times

My letter appears on the Online Section of The Straits Times today, Friday 28th Feb 2014.

ASSOCIATE Professor Chong Siow Ann revealed some factors that push people to take their own lives ("Time to reconsider suicide law"; last Saturday).
People who are struggling with depression or other types of mental illness are prone to suicide because they often cannot bear the isolation and suffering. Those who are highly stressed or suicidal often think there is no way out, and this is compounded when their cries for help go unheeded.
Singapore's suicide rate has gone up by nearly 30 per cent; 467 cases were recorded in 2012 ("Suicide cases rise nearly 30% to hit 20-year high"; July 13, 2013).
Foreign workers who leave behind their families to work here and family members of foreigners, who have difficulty adjusting to life here, are among those who have attempted suicide.
We must help make foreigners feel welcome by organising activities to help them integrate into our society.
Developed countries like Britain have decriminalised suicide so that those who survive will not be prosecuted. Singapore should take this route.
Patients who seek help for their suicidal tendencies need more than medication and counselling.
To this end, I propose that a one-stop centre be set up so people can get the help they may not know even exists. This centre should make it convenient for the person and his family to secure temporary financial assistance, job opportunities and free counselling services.

Raymond Anthony Fernando


Thursday, February 27, 2014

Caregivers of the violent mentally ill need more help - Raymond A Fernando’s letter to the press

Do catch my letter to the press on the above matter- published in MediaCorp’s TODAY newspaper today, Thursday 27th Feb 2014.  
I refer to the report “Man gets eight years for fire that killed dad” (Feb 14).
The man is a psychiatric patient suffering from schizophrenia, and it seems that there are defects in our mental healthcare system that must be corrected to prevent the recurrence of such tragedies.
First, the police must be empowered to take mentally ill patients with violent tendencies to the Institute of Mental Health (IMH), on the request of carers who cannot manage them.
I know the man’s mother, and prior to his offence, she had approached the police to take him to IMH. But she was told that, since he did not commit any crime then, they could do nothing. It is a shame that IMH staff who care for violent patients can be rescued by pressing the emergency button in the ward, but carers who have the task of looking after loved ones with such conditions cannot protect themselves even after they approach the authorities.
Second, although IMH has a mobile crisis team, there is no ambulance service that can take violent patients to the hospital quickly when a crisis occurs. Instead, relatives must call for a private ambulance, which could cost up to S$400.
Third, halfway houses must be built to allow such patients to seek temporary treatment and support before they can return to the community.
Fourth, there are new, atypical antipsychotic drugs that can be used to treat schizophrenia. As these are costly, the Government can provide more subsidies for such medication.
Above all, carers need support, and if IMH cannot provide it, who can?
Raymond Anthony Fernando



Sunday, February 23, 2014

Raymond Anthony Fernando's letter to The Sunday Times: Appoint a Minister for Ageing

My letter to The Sunday Times on the above subject is published today, Sunday 23rd February  2014.

Managing editor Han Fook Kwang’s commentary (“Don’t stop at the pioneer generation”; last Sunday) certainly strikes a chord with many older Singaporeans.

I fully agree that Singapore needs a comprehensive national plan to tackle ageing issues, and that we should appoint a Minister for Ageing who can spearhead a new ministry.

We can learn a lot from a developed country like Australia, where support for the elderly and those with disabilities, including mental illness, is top-notch.

While there are advocates who champion the rights of persons with physical disabilities, people with mental illness do not get the same level of support because mental health issues make many people uncomfortable.

We need to establish a culture where our elderly and those with mental illnesses are not forgotten, because being mentally well is just as important as being physically healthy.  More so when many of our elderly folk are prone to developing chronic illnesses such as depression and dementia.

Currently, there is no MP or Nominated MP with a background in psychiatry who can speak up on mental health issues in Parliament.  It would be helpful to have such representatives in future.

Raymond Anthony Fernando




Wednesday, February 19, 2014

Correct defects in mental health-care to save and reclaim lives: An open letter to the Prime Minister, ministers and & MPs

Dear Prime Minister Lee, ministers and MPs,

Last week, a psychiatric patient who has a history of mental illness was sentenced to 8 years jail for burning down the family home; and in the process killing his pastor father.  The New Paper carried this somber tale on February 14th 2014 (Valentine's Day) in the report, “Brother’s plea: Please don’t make his sentence lighter.”  The irony of it all is that on Valentines’s Day when love is very much the focus and promoted, a tragic event grabs the headlines.

33-year-old Ho Wei Yi who suffers from schizophrenia could have been jailed for life or up to 20 years in jail, caned and fined.  But I commend Justice Tay Yong Kwang who showed compassion and lightened his sentence – despite the fact that Ho’s brother and his wife asked for Ho to be given a heavy sentence through a letter that was written and presented to the court by their MP Heng Chee How.  The reason given was that Ho’s brother and his wife were not able to support two mentally ill persons.

Caregivers often suffer in silence, and if anyone knows that, it has to be me as I struggle each day to care for my wife, Doris.  Family ties become strained when caregiving responisbilites are not equally shared. And when your are looking after a loved one suffering from mental illness, be prepared to walk alone because very few people will want to “take the road less travelled.”

There are many families here in Singapore who have more than one person suffering from mental illness, and the journey can be overwhelming – more so when there is very little support.  This particular case is the tip of the iceberg for I know of so many other cases where patients and caregivers are struggling to cope with the mental illness.  I try my best to help, but there is only so much I can do.

CLUB HEAL whose Patron is Halimah Yacob and its President Dr Radiah Salim have been doing excellent work.  Dr Radiah immediately went down to see Ho’s mother when I alerted her that she needed staunch emotional support.  CLUB HEAL uses the human element, the Singapore soul to help another human being.  This is the kind of care and support that is needed to tackle the growing problems of mental health issues that are coming on-stream– fast and furious.   IMH must learn from them.

Walking alongside caregivers to help them cope

I met the mother of Ho 5 years ago when I gave a talk on my wife’s schizophrenia battle and her amazing recovery at the Singapore Association for Mental Health.  She was encouraged by my motivational talk and I  gave her lots of encouragement.

Two years ago, I was shocked when Ho’s mother informed told me that her son had ended up in the Changi Medical Centre (CMC) after he was arrested for burning down their home and causing the death of her husband.  She was distraught and crying out for help.  She then asked me for help as her son was feeling very miserable having to sleep on a straw mat in CMC; and needed a bed to lie on.  Seeing that sufferers of this condition need more humane treatment, I wrote to her Member of Parliament – Heng Chee How, and Ho was later transferred to the forensic ward at the Institute of Mental Health (IMH).

Defects in our mental health care systems

There are defects in our mental health-care system that needs to be corrected to prevent recurrences of such tragedies.

First, the police needs to be empowered so that mentally ill patients who have violent tendencies can be brought to IMH on the request of caregivers who cannot manage them. Madam Ho told me that she approached the police twice to bring her son to IMH, but they told her that since Ho did not commit a crime at the time, they could do nothing.

It is a crying shame that health-care workers in IMH who care for violent patients can be rescued by pressing the emergency button in the ward, but caregivers who have the unenviable task of looking after loved ones with such a condition cannot protect themselves when they approach the authorities.

Second, even though IMH has a mobile crisis team in place, there is no ambulance service that can quickly bring violent patients to the hospital when a crisis takes place. Instead, relatives have to summon for a private ambulance which will cost them anything from $300 to $400.  How can you have a crisis team in place, but it is not tied in with an ambulance service that can help families in distress?  With caregivers struggling with financial problems, how are they going to meet out such hefty charges?

Third, half-way houses need to be built to allow such patients to seek treatment before they can go back into the community.  Here they can be temporarily housed, calmed down, learn a trade and be given advise on medication compliance.

Fourth, new atypical antipsychotic drugs can be used to treat schizophrenia, but as they are costly, the government could help to provide more subsidies for these medications.

Even though caregivers are crying out for help, they are not given the structural support that is clearly lacking.

Some caregivers try their best to remain positive in desolate times while they cling tightly to faith and hope.   But not every caregiver can do this till the end of time as some of them could be grappling with their own health issues – as with the case of Ho’s mother.  

I am sure the tragedgy that took place could have been prevented if somebody just cared. But no one did.

Mental illness – Educate, educate, educate

Sadly, the media sometimes presents people with mental illness as violent, criminal, dangerous, comical, incompetent and fundamentally different from the rest of us.  These inaccurate or incomplete images perpetuate unfavourable stereotypes, which can lead to the rejection and neglect of people with psychiatric disorders.

I have been very vocal about people struggling with mental illness because I have witnessed the devastation it has brought to my wife and others in her condition.  I have seen the tears of caregivers, I have heard their cries for help, and I have felt their pain.  Yet, many in our society still cannot accept that these citizens are also God’s children. 

This is why public education on mental illness is very useful in helping to reduce stigma.  People generally fear what they don’t understand. Patients and caregivers are the best people to educate the public on mental illness because they are “walking the journey.”  Policy makers, who understand the difficulties psychiatric patients and their caregivers face throughout their lives, can play an important supporting role. 

When people learn more about the mental illness and the struggles patients and their caregivers have to go through, they begin to show more empathy, understanding and support.  We can then change attitudes and change lives.  IMH needs to organize more public education on mental illness, bringing alongside caregivers who have overcome adversities. Yet, very few of these talks are organized. 

Above all, caregivers are in dire need of support, and if IMH cannot do it, then who will?


Footnote: This morning I wrote to PM Lee & his team:

PM Lee & health care ministers,
I have taken pains to highlight this issue with the Govt. and even made some suggestions on how our mental health-care system can be improved. So it is only proper and gracious to give me a reply. More so when the civil service is gearing up to improve on its image.


Friday, February 14, 2014

Pioneer Generation Package: Raymond's letter to The Straits Times: Consider special package for those who missed out

My letter to The Straits Times on the above matter was published on Friday 14th February 2014.

I am sure the 450,000 citizens aged 65 and older who will benefit from the Pioneer Generation Package will heave a sigh of relief (“PM Lee outlines health-care package for 450,000 pioneers”; Monday).

With rising health-care costs, citizens aged 55 to 64 who retired early also need to have peace of mind.  They have also contributed to nation building and worked with the first-generation leaders to help build Singapore’s vibrant economy.

There are several reasons why this particular group needs recognition and support.
First, some of them retired at 55 or 60 for health or family reasons, and not many are on the pensionable scheme and thus not covered by medical benefits for life.

Second, many of them have used most of their Central Provident Fund savings to buy property, which was not tightly controlled then.

Third, health-care costs have surged in recent years.  With modest Medisave funds and personal savings, many of these seniors are struggling to cope – not just with health-care costs but also daily living expenses.

Lastly, those within this age group have difficulty finding work due to age discrimination.

So I urge the Government to consider giving a special package to those aged 55 to 64, to mark Singapore’s 50th birthday next year.  It is a small gesture that will go a long way towards letting them know that the Government cares for their well-being.

Raymond Anthony Fernando


Tuesday, February 4, 2014

An open letter to Prime Minister Lee Hsien Loong and his cabinet: Family caregivers deserve recognition in the pioneer generation hongbao

Dear Prime Minister Lee Hsien Loong,
Your initiative to accord recognition to our pioneer generation through a pioneer generation hongbao will surely be well received by those who helped build the nation in the early years of independence (“PM promises pioneer generation a hongbao”; Thursday). It is a good move; and it will encourage more Singaporeans to stay loyal to the country.

Just as the pioneer generation has stayed loyal and committed to Singapore for decades, so have family caregivers who, with sheer determination, commitment and perseverance have not given up on their care recipients.  Moreover, many of these caregivers have, in their employable years, worked with the first generation leaders to help build Singapore’s vibrant economy.  But they are always forgotten.

Family caregivers need to be recognised for the simple reason that these individuals make lots of sacrifices as they tirelessly assist loved ones with a disability­–physical or mental, serious illness or the limitations of aging. 

Generally, caregivers would like to care for their sick relatives, but there are reasons – valid reasons, why some have little or no choice but to place them in nursing homes. We need to understand that.  

For decades, caregivers who are prepared to embrace caregiving as a noble job have not been given recognition for the commitment they make – practically every day of their lives.  This is not in keeping with your objective of ensuring that EVERY Singaporean will be well taken care of.   

In your Chinese New Year message, PM Lee, you once again stressed the importance of family support and taking care of the elderly.  This is exactly what our family caregivers have done.   With an ageing population coming on-stream, you can expect more and more of our citizens to become caregivers.  The question is how many will be able to take the road less travelled and, if they do, will they be to cope?   How many will be motivated to travel the long ardous journey?

It is therefore timely for the government to translate words into action and accord the long overdue recognition to our family caregivers through the pioneer generation hongbao.  And most certainly, this group is very much representative of an inclusive society.  Agreed, PM Lee?

Raymond Anthony Fernando

 An edited version of this suggestion appears in the TODAY Newspaper - Wed 5th Feb 2014: