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.


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