Protection Against Suicides: By Raymond Anthony Fernando
It is so heartbreaking to read the report of a young soldier who had lost in his life in such a cruel manner as described in the report “Coroner: SAF regular shot himself while on guard duty” (The New Paper, Jan 20).
Make no mistake about it – Depression is a silent killer and if not properly managed, can lead to suicide; and this was sadly the case of the Singapore Armed Forces (SAF) regular, Pravinraj Selvaraj, 20, who shot himself in the head while on guard duty at Sembawang Camp on Nov 21, 2015.
At the Coroner's Inquiry on 19th January this year, State Coroner Marvin Bay ruled that Pravinraj's death was a deliberate act of suicide. He had been seeking treatment at the Institute of Mental Health (IMH) since 2011 when he was 16.
At the inquiry, it was revealed that Selvaraj had a history of depression and suicidal tendencies. In a farewell message before taking his life, he wrote that he didn't want his family involved after his death as they had abandoned him when he was 15 and he had been in pain for five years because he was all alone.
It was also revealed that Selvaraj was feeling stressed and frustrated by his parents' divorce and slept at staircases as he had a strained relationship with his family.
This tragedy is bound to have an adverse effect on those who was close to the soldier, one of whom is his girlfriend. Tears welled from my eyes when the full-time soldier spoke of his love for his girlfriend. Most certainly, she needs help to prevent her from falling into depression – for grief can take months, and even years to overcome.
Unfortunately, when patients are overwhelmed with family problems, they will mistakenly believe that there is no hope for them and in the worst-case scenario, will want to end their lives.
You do it once, you do it twice
It has been documented that those who attempt suicide are likely to do it again, and thus it is vital for caregivers, employers, friends, religious groups and the community at large to rally around those trying to cope with mental disorders.
But to be able to receive support, the sufferers must first of all come to terms with their condition and not be in denial. He/she must be willing to open up freely about their condition otherwise, it is impossible to secure help.
Even though the Ministry of Health (MOH) and her partners are doing their part to encourage people who have mental disorders to seek treatment, many patients do not do so due to the stigma which remains the biggest obstacle in getting the much-needed help.
Let us examine why people grappling with mental illness do not want to seek treatment.
(1) Is it fear or shameful?
In practically all cases, if a person has a mental illness and opens up, he is often labeled as ‘mad’, ‘crazy’, ‘trouble maker’ and ‘unproductive’. Such discriminatory labeling will have a negative impact as the sufferers fear that their career, education and life goals will be jeopardized. In the case of workers, they fear that whenever there is a retrenchment exercise, they will be the first to be axed.
(2) Lack of understanding of the illness
Patients, caregivers, and employers must have an understanding of mental disorders – at least some basic knowledge. But the more knowledge they possess, the better the condition can be managed. With life-long learning being encouraged by the Government, let us embrace mental health education as yet another step towards learning new things. Never dismiss or minimize mental illness as “No big deal, everyone of us gets stressed out” or “the condition is not that bad.” There is absolutely no harm getting professional advice.
It is often a mammoth task revealing personal details to a doctor or counselor, because of these professionals, in the eyes of the patient, are complete strangers. Added to this, what assurance has the patient got that the information given will be kept confidential.
(4) When all hope seems lost
There will be people grappling with depression or other more serious mental disorders who wrongly assume that there is no way out of their conditions and that nothing or no one can help them. In their troubled minds, they believe that they will ‘never get better.’
(5) Unable to find resources
The help schemes must be widely publicized and even though the press does from time to time publish the helpline phone numbers and the organizations where assistance can be provided, patients may not see them as not everyone can afford to buy the newspapers or they may be too depressed with their conditions that they lose interests in anything and everything.
(6) Payment for treatment
In some cases, though patients may want to get treated, they do not do so as they may not be able to afford to pay for their treatment and transport costs to commute between the clinics and their home. There are schemes in place to help them, but how many know about it?
Suggestions to help patients with their mental illness conditions
Our soldiers and men in blue protect Singapore and keep this country safe and free from crime. Parents must feel comfortable to know that the SAF and the police will take good care of their sons during national service.
(a) Declaration of mental illness under oath
When any servicemen join the army or police – either for national service or to sign up as a regular, to protect themselves, their peers and the community, the treating psychiatrist must send a full report to MINDEF or the police. This is not done to stigmatize any patient, but rather to ensure that treatment continues and supporting measures are put in place. It must be clearly made known to the affected servicemen and women that the authorities are there to help them cope with their illness.
To ensure that those called up for National Service(NS) do not feign mental illness to escape from doing NS, a detailed report from the treating doctor should be re-affirmed by the police or army doctors.
(b) Intensify public education on mental illness in all camps
On-going efforts to reduce or even eradicate stigma and discrimination are essential to send a very clear message that it’s perfectly ok to talk openly about mental health issues
Government agencies and the community at large need to have a clear understanding of mental health issues and given the tendency for those battling depressions to take the suicide route to put an end to the stresses in their lives, there must, first of all, be a staunch supporting system in place.
To this end, MINDEF and the police should encourage public education on mental illness by inviting speakers to give talks to all their servicemen and women at their centers/camps by adopting a holistic approach to these conditions.
A holistic approach means providing a comprehensive treatment plan that includes not just doctors prescribing medications, but also the necessary psychological and social support. For example, recovered patients can share their recovery while resilient caregivers and suicide survivors can talk about real life experiences. These efforts can motivate and inspire anyone who has a mental illness condition to readily come forward for treatment. People must see the recovery in its full glory and then only will seeking treatment be an easier option.
(c) Support groups vital in the recovery journey
This means that caregivers, as well as patients, must have support groups to take them through their journey and to a full recovery.
In the case of the army, MINDEF or the Police, with the assistance of their counselors can coordinate with the IMH, Silver Ribbon Singapore and the Singapore Association for Mental Health and other community mental health providers to encourage their servicemen or women who have mental illness to join such groups. Most of the meetings are held after office hours, but if it is held during office hours, all of them ought to be given time off to attend these useful sessions.
Another option is for MINDEF or the Police to form their own support groups within their camps with guidance from the experts.
With the formation of support groups within MINDEF or the police, the counselors can make periodic visits to the camps at specific periods to ensure that their servicemen and women are getting all the help they need.
(d) Dangerous to allow servicemen with mental illness to carry arms and perform guard duties
In the case of those in army or police, it is unwise to allow them to carry weapons and ammunition as they can not only harm themselves but others as well. Even policemen have killed themselves by using a revolver.
In addition, the effects of the psychiatric medications may make the patients feel drowsy so it would be far better if such soldiers/policemen are exempted from guard duty temporary as they try to cope with their mental illness.
( e ) Allow temporary accommodation in camps for servicemen with family problems
Having a good 8 hours’ rest is important for all of us to energize ourselves. Lack of sleep due to a poor environment is unhealthy and the wellness of the body and mind can be badly affected.
As Selvaraj had lots of family problems and due to disagreements, he chose to sleep at the staircase.
In such instances, servicemen like him could be offered temporary accommodation in the barracks until such time when their family issues are resolved.
It is understood that the proposed suggestions will entail more resources, time and effort, but I fervently believe that implementing the ideas is a good investment that will eventually help to alleviate further tragedies.
RAYMOND ANTHONY FERNANDO
Mental Health Advocate