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 14^th 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?

 

RAYMOND ANTHONY FERNANDO

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.

 

I await your response.

http://rayhope8.blogspot.sg/2013/10/letter-to-straits-times-govt.html

 

 

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 14^th 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

 

http://www.straitstimes.com/premium/forum-letters/story/consider-special-package-those-who-missed-out-20140214

 

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:
 

http://www.todayonline.com/voices/recognise-sacrifices-made-family-caregivers

 

 

 

 

 

Letter to The New Paper: UPROAR OVER ANTON CASEY”S FACEBOOK COMMENTS: Give him a second chance

My letter to The New Paper on the above matter is published today, Wednesday 29^thJanuary 2013.

Many people, including our politicians, Singaporeans and expats were understandably upset over Mr Anton Casey’s insulting remarks about our public transport users being “poor people” in the report, “You’re not superior because you’re got money” (The New Paper, Jan 24)

Initially, I was very upset by his insensitive comments. 

But I fervently believe that since Mr Casey has realised his grave mistake and is willing to make amends by offering to do community work, can we not find it in our hearts to forgive him and give him a second chance?

If prisoners are given a second chance, then I am sure we can accord the same kind gesture to Mr Casey.  

He has lost his job and friends, and he and his family will no doubt become isolated and lonely due to a wrong turn.

Only when we are in that same predicament do we realise what it feels like to be isolated.

VOLUNTEER

A good way for the former wealth manager to make amends for his mistakes is to volunteer his services to marginalised citizens who need love, understanding and support. 

Once Mr Casey has proven his sincerity with the concept of charity, I have every confidence that he can rebuild his life.  

RAYMOND ANTHONY FERNANDO

Raymond Anthony Fernando's letter to The New Paper: Doctors should have helped woman

My letter on the above matter was published in The New Paper today, Tuesday 21^st January 2014.

I have mixed feelings reading the report, “Why didn’t doctors come out to help?” (The New Paper, yesterday).

While I am heartened by the public spiritedness of 25-year-old customer service officer Janice Choy, who took pains to look for doctors to help the elderly woman who was lying on the road, I am troubled by the lack of support on the part of the two clinics. 

Public spiritedness does not always occur, but if we want to see such virtues spread widely, then those who are in a position to render assistance, as with the case of the doctors, must act decisively.  

At a time when our hospitals are facing a severe bed crunch with limited resources, it would have been far better if the doctors helped the elderly woman.  

Then, only if there was a need to call an ambulance, the clinic could have summoned one.  

RAYMOND ANTHONY FERNANDO

P.S: Doctors must understand that they are trained to save lives. Even if the doctors are busy seeing patients at their respective clinics, I am sure those waiting to see him would not mind waiting a little longer during an emergency.  Recently, the Prime Minister made an appeal for all our citizens to look out for one another. This lack of support for the eldery woman on the part of the clincs concerned is not in line with what the PM wants us to do.

Let us take lessons from the magnimous Janice Choy who should not allow this incident to deter her from wanting to reach out to those who need care and support – because you are making a difference, Janice .  

 

Raymond 's letter to the press: Expand support for the needy and elderly

My letter to The Straits Times on the above matter was published on Tuesday 14^th January 2014.

It is commendable that the authorities have taken a keen interest in helping needy people in Punggol East, through a community voucher programme that will help more than 400 households (“More shops accept vouchers from needy”; Dec 30).

Another report (“5 more estates get grant for features to help the elderly”; Dec 28) said five more estates have been awarded the $50,000 City for All Ages grant to enhance their elderly-friendly features.  Kembangan-Chai Chee now plans to work with the Institute of Mental Health (IMH) to help the elderly keep depression at bay.

Needy Singaporeans and elderly folk with mental issues are not confined to just a few districts in Singapore.  It is imperative that the Government reach out to everyone who needs help.

It would be helpful for more constituencies to collaborate with IMH. There is also an urgent need to intensify public education on mental illnesses, and make it an ongoing process.

It is only proper that needy Singaporeans and the elderly in every constituency benefit from government-driven help schemes.  Such programmes should not be restricted to a select few.

Raymond Anthony Fernando

 

Raymond Anthony Fernando's letter to the press: Adopt two-way appraisal system

My letter on the above subject was published in The Straits Times on Saturday 4^th January 2014.

One way to ensure good human resource practices is to introduce upward appraisals for staff performance (“Ranking employees against one another unhealthy” by Mr Tan Kin Lian; Thursday).

Upward appraisals are performance appraisals of managers and bosses which are usually written by the subordinate staff.

In organisations that use upward appraisals, the subordinates complete a questionnaire on how well their superiors manage them. This usually takes place after the superiors have had the opportunity to finish preparing and discussing the subordinates’ performance appraisals.

These upward appraisals will encourage supervisors to facilitate two-way performance communication with their staff.

With this scheme, the organisation will be able to identify areas of growth for their employees – either in their current positions or in preparation for more challening roles in a fair and non-discriminatory manner.

The civil service could lead the way in implementing such a system.

Raymond Anthony Fernando

http://www.straitstimes.com/premium/forum-letters/story/adopt-two-way-appraisal-system-20140104