JANUARY - MARCH 2015AN IMH QUARTERLY PUBLICATION
MCI (P) 119/12/2014
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Putting the Spotlight on Patient Safety
Celebrating Our Occupational Therapists
IMH Volunteers Make Life Beautiful
A strong safety culture is key in delivering quality healthcare services. At the annual Patient Safety Carnival held on 13 February 2015, staff had the opportunity to learn more about the various safety initiatives in IMH in a fun and interactive manner.
There were six booths, one of which was a mega booth, at the event this year focusing on areas such as fall prevention, infection control, medication safety and emergency preparedness. The booths were buzzing with exciting activities and games where staff – from administration to clinical – tested their knowledge on patient, staff and environmental safety and won great prizes.
Safety takes on a greater dimension in mental healthcare, where disturbed patients may turn aggressive, thus hurting themselves, other patients or staff. Over the years, IMH has designed safer systems and safety initiatives to reduce harmful incidents and ensure patients and staff are kept from harm.
Patient safety taskforces such as the Restraint Taskforce, Falls Taskforce, Suicide Taskforce and Assault Taskforce, led by Nursing with involvement from other departments, are an example. These taskforces regularly review and implement initiatives to reduce falls, assaults and suicides.
Another safety initiative is the Closed Loop Medication Management System (CLMS), which helps to reduce medication error by using barcode technology. With this system, nurses scan the corresponding barcodes of patients before medication is given to ensure that the right drug is administered to the right patient at the right time.
IMH also introduced the Activity Nurse programme in 2013, which involves nurses who are specially assigned to conduct activities in the wards to keep patients occupied. While this may not seem patient-safety motivated at first glance, it actually is as incidents tend to occur when patients have nothing to occupy them. Keeping patients engaged with meaningful and structured activities is one way to reduce restlessness and boredom, and chances of incidents occurring. The interaction and activities are also therapeutic for patients.
Putting the Spotlight on Patient SafetyBy Lalitha Naidu, Corporate Communications
One of the more recent safety-focused projects in IMH is the Safety Nurse. It was piloted in one of the wards last year due to an increase in the number of incidents in the ward. With this initiative, two nurses are assigned as dedicated safety officers to monitor high-risk patients in the ward. The nurses are given a list of high-risk patients, namely for fall risk as well as disturbed, aggressive and violent patients, at the beginning of their shift and must remain with their patients at all times. With the implementation of the project, incidents were reduced by more than half in the ward within six months. It also improved staff morale and confidence, and created a safer and more therapeutic environment for patients. The Safety Nurse will be rolled out to all wards this year.
While there are various initiatives in place that have helped keep our patients safe, we are constantly looking at ways we can do things better. Patient safety is an on-going effort!
Dr Chua Hong Choon, CEO, IMH, reads messages penned by staff and patients on what patient safety means to them.
Nurse Clinician Antonette Asuncion explains the Safety Nurse project at the Patient Safety Carnival.
The team behind the mega booth at the Patient Safety Carnival are all smiles after a day of knowledge sharing.
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Strategies for Effective Anger Management By Ng Si Jia, Corporate Communications
IMH launched a new book titled Effective Anger Management for Children and Youth on 25 November 2014. The manual and workbook are specially designed for teachers, counsellors, social workers, psychologists, and other mental health professionals who work with children who exhibit anger and aggression problems.
The manual and workbook are the 2nd edition of the previous manual and workbook, which were published in 2003. The ideas, materials, suggested activities and games included in this resource book are applicable to both primary and secondary school children.
This resource book provides practical strategies divided into 12 lessons that teachers and mental health professionals can implement to enhance children’s emotion management, problem-solving and social skills.
The manual and workbook are available for purchase at major bookstores and www.imh.com.sg/eShop and online at www.worldscientific.com.
(From left to right): Adj A/Prof Daniel Fung, Chairman, Medical Board, IMH; Dr Yoon Phaik Ooi, Research Scientist at University of Basel, Adjunct Asst Professor, Duke-NUS Graduate Medical School Singapore & Visiting Fellow, IMH; Assoc Prof Rebecca Ang Pei-Hui, Psychological Studies Academic Group, National Institute of Education, National Technological University at the book launch.
The Child and Adolescent Unit at IMH (Sunrise Wing) is the only ward in Singapore looking after young people with emotional, behavioural and mental health issues. It comprises 20 beds for children and youths aged up to 19 years. Its multidisciplinary team has been working on a series of interventions to reduce disruptive behaviour such as aggression towards self, others, property or environment and inappropriate behaviour.
Thanks to a generous gift of $10,000 from donor Ms Ana Dhoraisingam, the team was able to introduce two interventions recently: a cool-down room, named “The Iceberg,” and a gardening corner with a pond in the ward courtyard, named ‘The Green Place’.
‘The Iceberg’ provides young patients an alternative way to cope with stressors, under the supervision of trained nursing
Chilling Out @ Sunrise WingBy Cheong Yaun Marn, Corporate Communications
Selected items help children regulate their emotions and aggression in ‘The Iceberg’.
or allied health staff. It has been designed to help children de-escalate their stress, and regulate their emotions and aggression through the use of distress tolerance tools. Unlike a time-out room, it is stocked with selected items for distress tolerance, such as weighted toys, hammock, tent, self-help books, and art and craft materials to promote self-soothing. Patients are encouraged to practise self-directed behaviour to increase self-awareness and develop skills to cope with stress and dysregulation of their mood.
‘The Green Place’ is a mini-garden with a fish pond. As part of their everyday schedule, patients feed fish and water plants to cultivate their nurturing side and reduce disruptive behaviour. The team has more improvement projects in the pipeline and looks forward to even better outcomes at the children’s ward.
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IMH commemorated Occupational Therapists’ Day (OT Day) on 9 January 2015 with a lunchtime celebration that brought together IMH senior management, stakeholders and some 58 OTs, Therapy Assistants (TAs) and OT administrative support staff.
The event got off to an interesting start as guests were asked to fold paper cranes. Much laughter ensued as everyone attempted to do so, and they certainly came to appreciate the effort and patience involved in the process. The crane was chosen as the symbol for the celebration, as it signifies hope and healing during challenging times. In line with this, Mr Julius Chan, Peer Support Specialist, IMH, shared his testimony of how IMH OTs helped him in his recovery from schizophrenia.
Dr Tan Bhing Leet, Head of the Occupational Therapy Department (OTD) in IMH since 2004, shared her sense of pride at having witnessed how OT services in IMH have evolved over the years to better meet the needs of patients and integrate them into the community. “This would not have been possible without the foundation that the previous generations of OTs have set, as well as the support from the other disciplines in IMH. I truly appreciate the work of our OTs on the ground.”
The changing healthcare landscape, however, means that the profession does face new challenges. Dr Tan revealed that there was a need to attract OTs to work in mental healthcare, amidst demand for OTs from other settings. To do so, IMH OTD is working on improving the quality of student supervision during internships to enhance budding OTs’ clinical education experience in IMH. As for Senior OTs, the focus is to groom them for advanced clinical practice, education and research leadership roles, and also to equip them with better supervision skills to mentor junior OTs.
Mr Kamaldin Ibrahim, Principal Occupational Therapist, first joined IMH in 1980, and is the longest-serving OT here. As a young OT, he initially felt quite daunted by the sheer size of the patient population, and the inherent needs. What kept him going all these years was the exemplary role models he had in his seniors. “We shared a common conviction that meaningful engagement in activities was immensely therapeutic. We explored creative pursuits like making drums, puppetry and hiking in Mandai Forest – all very ‘OT-type’ of activities,” he said.
Celebrating Our Occupational TherapistsBy Vera Soo, Corporate Communications
The newly renovated ECT Room with more units of monitoring devices (bottom) to enhance patients’ safety and a modesty panel to maintain privacy.
Interested in entering or switching to the healthcare industry by becoming a nurse or allied health professional? Scholarships and conversion programmes are available. For more information, log on to caretogobeyond.sg.
1,500 lovely paper cranes made by patients, staff, family and friends decorated the event hall.
Sharing by Mr Julius Chan, Peer Support Specialist, IMH.
Fun Facts about Occupational Therapy in IMH.....................................................................................
The Occupational Therapy Department in IMH was set up in Woodbridge Hospital in 1955 – which makes it 60 years old this year......................................................................................
Occupational therapy services and medical social work services were the first allied health professions to be established in IMH......................................................................................
Occupational Therapists’ Day in IMH was first celebrated in 2006, making this year’s celebration the 10th one.
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Once every week elderly patients with mild to moderate dementia at IMH’s Sunshine Wing can be found playing games on tablets as part of their therapy to slow memory loss and mental decline.
The games come under an app called the Cognitive Stimulation Programme (CSP). It was designed for older adults with mild to moderate cognitive impairment by occupational therapists and psychologists from IMH in collaboration with ITE College East. The games took about two years to develop.
“We previously used some games on a desktop computer, but it was not very user-friendly as patients had difficulty using
Patients coming for psychotherapy at IMH can now look forward to having their sessions in the new IMH Psychotherapy Centre. The Centre, which started operations on 1 December 2014, provides a cosy and private ambience for treatment.
Most hospitals which offer therapy services usually house these together with clinical consultations in their Specialist Outpatient Clinics (SOCs). This was previously the case in IMH as well. However, the setting of the SOCs was often noisy and hence disruptive to therapy sessions. In addition, bright lights and furnishing, such as the L-shaped table between the therapist and the patient in the consultation rooms hindered interaction.
The Centre marks a milestone in the history of IMH as it is a dedicated facility that integrates all psychotherapy services under one roof, and is purposefully designed to facilitate and enhance the therapeutic process. The comfortable and confidential environment created through dim lighting and soundproofing sets patients at ease to disclose intimate aspects of their lives
IMH and ITE Games Help Elderly Patients with Dementia By Lalitha Naidu, Corporate Communications
Bringing Psychotherapy Services Under One Roof By Vera Soo, Corporate Communications
the mouse and keyboard. Patients also could not relate to the games as they were not relevant to our local culture,” explained Ms Carmel Tso, Principal Occupational Therapist, IMH. “So, we decided to design games that are easier to access and are culturally and contextually relevant to older adults in Singapore.”
The CSP app consists of nine cognitive training games, which are to be played on a touchscreen gadget. Each game has several levels that are progressively higher in difficulty. The games feature images and gameplay that relate to the everyday life of older adults in Singapore. For instance, ‘Tutti Frutti’ is a matching game designed to improve attention span. Users have to identify fruits or food items they were previously shown from a selection of similar looking items.
Another game called ‘Show Me the Money’, which is popular among patients, reinforces the concept of categorising by requiring users to pick out items that go together. ‘Unforgettable’, designed to improve memory, uses local scenes like Chinese opera and lion dance. Users are required to recall the arrangement, and put together pieces of the picture to re-create the scene. Therapists also invite users to share their thoughts on the picture as part of reminiscence therapy.
“The games are well received by patients,” shared Ms Tso. “They provide a less intimidating platform for patients to learn and practise cognitive techniques and complement practical scenarios to help link the concepts of the games to daily use.”
and minds during therapy. A suite of psychotherapy services, including Cognitive Behaviour Therapy, Psychodynamic Therapy and Systemic Therapy is offered at the Centre, which boasts 14 individual therapy rooms, an art therapy room and a family therapy room. At present, the Centre’s psychotherapists see about 150 new patients for psychotherapy each month. Referrals for psychotherapy are made by the patient’s attending doctor at IMH, based on an assessment for suitability and need.
Reception of the Psychotherapy Centre.
An elderly patient tries his hand at a matching game.
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When the IMH Research Division started in 2000, there were just three staff working from a small shared space with another department. Today, the division comprises 50 staff from multiple fields and disciplines, working on many different projects. To date, our team of researchers have garnered more than $63,120,899 million in extramural funding, published more than 532 papers in peer-reviewed journals, won awards, and forged extensive collaboration with local and overseas research centres.
One of the team’s significant achievements was the incorporation of the Early Psychosis Intervention Programme with a clinical initiative to verify the need for early detection in mental illnesses. The programme was recognised with the prestigious World Health Organization (WHO) State of Kuwait Prize for Research in Health Promotion in 2006, and the inaugural National Clinical Excellence Team Award in 2008. The Singapore Mental Health Studies conducted by the IMH research team in 2004 and 2010 also provided invaluable information for policy makers to transform mental healthcare to meet the needs of our local population.
Managing the many research projects is a complex and challenging task. Here’s where research administrator, Jenny Tay, plays an important role to support the division.
Jenny, an Assistant Manager, has been with the Research Division since 2007. She started as a Research Assistant working on her first mental health study “Pharmacognetics of Tardive Dyskinesia” led by Prof Chong Siow Ann, Vice Chairman, Medical Board (Research), IMH. Since then, she has been actively involved in coordinating various clinical trials and research projects.
As a research administrator, Jenny supports the division in her role as the central resource in providing critical information and administrative support to the Clinical Research Committee, Clinical Trial Unit and all investigators in the hospital who undertake clinical research projects or trials. She also acts as a liaison between various ethics committees, funding agencies, stakeholders and researchers. Another area of responsibility is to ensure that the grant for each research project is efficiently and prudently used.
“Research work is always changing. Every study requires a customised and unique kind of administration. I enjoy working on different kinds of research projects as it is challenging and definitely not mundane. To be with the team from the beginning till completion of each project and witness its fruition when the study is published in journals gives me a great sense of accomplishment and satisfaction. This is what motivates me in my job,” Jenny said on why she chose a career in research administration.
“I hope that in my own small ways I can contribute towards more research projects to further the study of mental health so as to better understand and improve treatment and care for those affected by mental illness,” she added.
Acknowledging the important role played by research administrators in the department, Adj Asst Prof Mythily Subramaniam, Director, Research Division said, “Usually the administrators who work quietly and diligently in the backroom and are not actively involved in research tend to be forgotten. However the proper and ethical conduct of research is made possible only with the work of these admin staff providing constant support in the background.”
Behind the Scene at the Research DivisionBy Penny Chua, Corporate Communications
On a Mission Dr Ho New Fei, Research Fellow, has been with the team since December 2013. Dr Ho’s main interest in research is in understanding the brain structure and function underlying various mental illnesses, using live imaging tools such as magnetic resonance imaging (MRI) and neuropsychological assessments.
Her Ph.D. was in Pharmacology, and for her thesis, she investigated the link between a growth protein and the boost in new brain cells caused by physical activity.She wanted to learn more about neuroimaging in the psychiatric populations and so for her postdoctoral training, she switched fields and did a four-year stint with the Massachusetts General Hospital / Harvard Medical School Psychiatric Neuroimaging and Schizophrenia Programs. Dr Ho has a keen interest in investigating how the brain reshapes itself with various therapeutic interventions and is currently involved in several studies in ADHD, bipolar disorder, schizophrenia and brief psychotic disorder.
Mental illnesses cause distress and disruption to the lives of the afflicted and their loved ones. However till today, there is no complete cure and no definite biomarker for mental illnesses. Dr Ho hopes that her research work will
Jenny, taking a moment off her busy schedule to pose for the camera.
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What Makes a Good Psychiatrist?By Penny Chua, Corporate Communications
Beyond being a good listener with a compassionate heart for patients, what are the attributes of a good psychiatrist?
Caregiver Ms Lina Lee, who has been taking care of her elderly father, shared her thoughts on this. “A good psychiatrist listens and values feedback from family members,” she said. “He works with his team to give the patient a 360-degree professional treatment towards recovery. He never gives up on the patient. Most important, I feel a good psychiatrist aside from being a good doctor, is a good human too. This makes the experience not only clinical as it is with a heart that further reassures the caregiver and the patient.”
An IMH study to examine the qualities of a good psychiatrist in Singapore has confirmed that patients and psychiatrists share similar ideas on what makes a good psychiatrist. According to Dr Tor Phern Chern, Consultant, Department of General Psychiatry, IMH and the study’s lead investigator, almost two thirds of qualities described by both patients and psychiatrists overlapped significantly but with different emphasis and unique viewpoints.
Patients required proof that the psychiatrist truly cared about them as well as demonstrations of diligence, clinical competence, and positive results for themselves. The gender and clinical reputation of the psychiatrist could matter to patients.
Interestingly, patients may also see Caucasian psychiatrists as being better than local psychiatrists because of their association with a culture that emphasises individualism and greater acceptance of people with mental illness.
Psychiatrists valued the ability to overcome adversity, be self-reflective and to apply wisdom as well as respecting the doctor-patient relationship and regulatory requirements such as adhering to the Hippocratic Oath as important attributes.
Joe, a patient in recovery from the Early Psychosis Intervention Programme (EPIP) said it aptly, “I have had good experiences with the psychiatrists from EPIP during my worst moments. To me, a good psychiatrist must believe recovery is possible, even in the worst situations, in order for his patients to believe that they can recover. Both the psychiatrist and patient must work closely together towards recovery and the psychiatrist must not see himself as higher than the patient, but as equal. It is important that he has compassion and sees his patients as individuals with potential despite their illness.”
Dr Tor shared that as far as he knew, similar research has not been done locally or internationally and further research to link such qualities to patient treatment outcomes would be of interest to the field.
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“Together with the research team in IMH, I aspire to one day identify signature biomarkers that allow us to better diagnose, monitor our mental health, and increase chances of more successful treatment.”
Dr Tor’s study shows that patients and psychiatrists share similar ideas on what makes a good psychiatrist.
Dr Ho hopes to change the way mental illness is diagnosed with her research work.
be able to bring mental health professionals closer to understanding the fundamental causes. She works closely with the research team, using quantitative biological measures to clarify the common and different features across various mental disorders.
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The 63-year-old Dr Yap also believes in life-long learning. “At first, I was a little worried about the course requirements, but I found it to be very manageable even with my busy schedule,” she said. “It is always good to upgrade yourself. I do hope more doctors will continue to upgrade in courses like mental health and have an open mind and heart to treat such patients.”
“Patients don’t often tell you outright that they are stressed or depressed. The training I received in the GDMH has helped me to be more aware of mental health issues and be confident in my ability to help patients. It equipped me with the skills to ask the right questions and look for early warning signs.”
Dr Gilbert Tan, a graduate of the GDMH programme
“Mental illness is a growing concern and we as GPs should be in a position to help our patients with mental health issues. I wanted to update myself on the medication available as well as other treatment options such as counselling, so I’m able to provide the best care I can for my patients.”
Dr Theresa Yap, one of the GPs in the latest GDMH intake
Enabling GPs to Handle Mental Health Problems in the CommunityBy Lalitha Naidu, Corporate Communications
When an 18-year old patient came to his clinic with chest pains and palpitations, Dr Gilbert Tan, who works at Geylang Polyclinic, sensed that there was a deeper issue. “I asked her a lot of questions,” he said. “It became apparent that she was facing great pressures at home and school and had anxiety-related symptoms.” Dr Tan started her on low dose anti-anxiety medication, and referred her to IMH for further management. While the patient was initially apprehensive, she came for her appointment and went on to receive treatment and counselling for anxiety disorder at IMH. She is now managing her condition well.
Dr Tan is one of the Family Physicians (FPs) in Singapore who have undergone the Graduate Diploma in Mental Health (GDMH). Launched in 2010 to enable General Practitioners (GPs) and FPs to provide basic mental health services in the community, the one-year diploma programme is jointly offered by IMH and the Division of Graduate Medical Studies, National University of Singapore. It provides comprehensive and structured training in community psychiatry and counselling to equip doctors with the knowledge and skills required to assess, identify and manage the various psychiatric conditions.
“Patients don’t often tell you outright that they are stressed or depressed,” said Dr Tan. “The training I received in the GDMH has helped me to be more aware of mental health issues and be confident in my ability to help patients. It equipped me with the skills to ask the right questions and look for early warning signs.”
As GPs are often the first point of contact for those who are unwell, they can play an important role in detecting and subsequently providing primary care services to those with mental illness. To date, 85 GPs have completed the GDMH programme. The fifth intake, which is the latest, saw 19 more GPs participate in the programme.
One of the GPs in the latest intake is Dr Theresa Yap, who has been practicing the last 30 years. Dr Yap decided to undertake the diploma to be able to provide more holistic care for her patients. “Mental illness is a growing concern and we as GPs should be in a position to help our patients with mental health issues,” she said. “I wanted to update myself on the medication available as well as other treatment options such as counselling, so I’m able to provide the best care I can for my patients.”
The GDMH is open for registration from 2 March 2015 – 3 July 2015. For more information, please contact Nirhana Binte Japar at 6389 2831/[email protected] or Helen Ong at 6389 2968/[email protected].
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Community Workers in Indonesia and China Receive TrainingBy Zhang Shuhui, Education Office
Discovering the Science of LearningBy Alicia Lee, Education Office
The community training phase of the “Temasek Foundation-IMH Disaster Mental Health Programme for Communities in Asia” for China and Indonesia successfully concluded in January 2015. This marks a milestone in the three-year project funded by Temasek Foundation, which saw IMH work with local partners to build capacities in mental health to support communities affected by disaster and crisis in China, Indonesia and Thailand.
A total of 80 master trainers, 40 from China and 40 from Indonesia, who were trained in mental health crisis assessment and management skills by IMH, delivered and cascaded training to community-based workers in their respective countries. In Indonesia, 200 workers in five provinces were trained, while 200 workers in various sites in Sichuan were trained in China. The training, contextualised by master trainers to meet local needs, was well received by the participants.
We all learn differently, and the way we learn simple tasks is different from how we learn difficult tasks. Prof. Jeroen van Merriënboer, visiting expert for the NHG Education Overseas Expert Programme (EOEP), was in town in January to share insight into how learning the science behind how we learn is the basis for teaching others new skills.
Prof. Jeroen van Merriënboer has published extensively on the topic of educational psychology and instructional design with his research focusing primarily on health sciences. In the early 1990s, he developed the four-component instructional design system (4C/ID model) in collaboration with other researchers for the design of training programmes for complex skills, which has been been widely used to guide educational innovations.
Themed ‘Innovations in Health Sciences Education’, the EOEP Programme comprised workshops, a lunchtime talk and dialogue session held from 12 to 15 January 2015 at IMH and Tan Tock Seng Hospital. Prof Jeroen shared the science of instructional strategies that help people learn, and the use of learning hierarchy
to organise different types of knowledge to easily accomplish a task. Educators had several takeaways from the workshop. One of them is that learning tasks should be planned first before the objectives when designing a blueprint for an educational programme. They also learnt to design and develop assessment tools for complex skills, which can be applied to real life problems. With the new knowledge and a better understanding of the 4C/ID instructional model, participants are now in a better position to optimise teaching methods and enhance the learning experience.
Graduation ceremony attended by IMH, Temasek Foundation, West China Hospital representatives, Beichuan Education Bureau ministry and master trainers.
Post-training Dialogue session held with leaders from the Banda Aceh provincial health ministry and disaster coordination units.
Prof. Jeroen van Merriënboer shares the science of instructional strategies to help people learn complex skills.
In December 2014, the IMH team represented by Dr Ong Say How, Chief, Department of Child and Adolescent Psychiatry, and Ms Christine Tan, Deputy Director, Education Office, attended a graduation ceremony in Banda Aceh, Indonesia, to recognise efforts by master trainers and faculty from Rumah Sakit Dr Cipto Mangunkusumo. The IMH team engaged leaders from the Banda Aceh provincial health ministry and disaster coordination units, who pledged support for the programme.
On a trip to Leigu, Sichuan in January 2015, the IMH team headed by Dr Lee Cheng, Vice Chairman, Medical Board (Clinical) accompanied by Mr Stanley Lee, Director of Programmes and Partnerships, Temasek Foundation, engaged local government and community-based stakeholders. A graduation ceremony was held to confer certificates of completion to all master trainers. The graduation ceremony also provided a platform for the master trainers to network and share outcomes of the community training.
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IMH Volunteers Make Life BeautifulBy Cheong Yaun Marn, Corporate Communications
IMH cares for more than 1,150 long-stay patients. For these patients, IMH is a place they call home and the staff and volunteers have become their surrogate families, playing important roles in their socialisation, rehabilitation, quality of life and sense of wellbeing.
Currently, more than 300 regular volunteers, who come from all walks of life, organise and conduct activities for patients and spend time with them. The longest serving volunteer groups are The Society of St Vincent de Paul (SSVP) and Living Waters Methodist Church, who started coming in the 1970s and in 2002, respectively.
There is at least one volunteer activity, be it art and craft, mobile library, dancing, karaoke or singing, conducted in the wards daily. For example, volunteer groups Yuan 2008 Services, Top Image, Braddell Heights Residents’ Committee and Hairlistic Team cut hair for hundreds of our patients on a regular basis.
Yuan 2008 Services and other volunteer groups, such as Firefly Missions and the Apex Club of Bukit Timah, also hold regular large-scale celebrations and parties for our patients during festive occasions. Volunteers from Retired Senior Volunteer Programme Singapore (RSVP) also run a mobile library for our patients; and a group of Filipino house helpers called Ladies in the Power of Service (LIPS) and Humanitarian Organisation for Migration Economics (HOMES) come on their off days to sing with and talk to our patients.
To thank our volunteers for their time and effort, IMH holds an annual Volunteers Appreciation Day on the first Saturday of December. The most recent event, held on 6 December 2014, included a sharing by retiree Mr Thomas Wee on his voluntary work for orphans in the Philippines, the inaugural launch of the IMH Volunteer Handbook, and maiden performances by IMH’s patient Drum Circle and patient choir “Hearts in Harmony.”
Xiang Lin, 57, self-employedA group of about 10 volunteers from Guan Zi Zai Buddhist Society and I started cutting hair for IMH patients in 2004. I chose IMH as I felt that fewer volunteers would be willing to help the mentally ill, compared to other needy groups. We have expanded into a team of 80-100 volunteers from Yuan 2008 Services, cutting hair every two months on Sunday mornings for approximately 600 IMH patients.
The Yuan 2008 Services volunteers also organise large-scale Autumn Festival and Christmas celebrations, karaoke, art and craft sessions and song performances. We also distribute moon cakes, Chinese New Year mandarin oranges and cookies to all the wards at IMH. I have packed boxes of goodies for the patients until midnight. I also collect goods, clothes, biscuits, chocolates, bedding and wheelchairs from factories to distribute to the patients.
Yong Kwon Seng, 28, primary school teacherI started volunteering at IMH in 2010. I had always wanted to help people with mental disorders, as I have relatives who are similarly stricken. I lead a group called The Achievers, consisting of working adults. We celebrated our 15th Anniversary last year.
We have adopted three wards and visit our special friends regularly on Saturdays from 3pm to 5pm. We organise activities, such as art and craft, games, Chinese New Year restaurant dinners and excursions. We have also sold second-hand clothes at IMH’s flea market (Macam Macam Market held on the first Sunday of each month) to raise almost a thousand dollars for the Woodbridge Hospital Charity Fund.
What keeps me going? It is my philosophy that this life is not just about ourselves. We shouldn’t ask the government to do everything but the people should also do our part. The good people I work with — Catherine Chua, Volunteer Programme Manager, IMH, and my fellow volunteers, also keep me going.
Our special friends are non-judgemental and all-embracing so I get upset when people pass negative comments about them. I find them fun, gentle, jovial and loving. They are no different from us.
Xiang Lin (holding the mike) and Mdm Catherine Chua with Dr Chua Hong Choon, CEO, IMH (left), at Yuan 2008 Services Christmas party 2014.
(Back row, second from left) Kwon Seng with some of the Achievers volunteers.
This Life is Not Just about OurselvesA few of our regular volunteers share what keeps them coming back to IMH.
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Two Choirs in ConcertBy Cheong Yaun Marn, Corporate Communications
The Very Special Outstanding Performers (VSOP) is a choir and dance programme supported by the Woodbridge Hospital Charity Fund (WHCF) that enables persons with psychiatric illnesses to benefit from the therapeutic effects of singing, dancing and performing. The programme also aims to train them for public performances to help de-stigmatise mental illness.
Once a year, the VSOP collaborates with external performers to bring de-stigmatisation and reintegration to a higher level and also to raise the standard and profile of the VSOP group. They have performed alongside the Singapore Management University Choir in 2013 and Coral Primary School (CPS) Choir in 2014.
VSOP choir mistress, Ms Angela Lee, who also coaches the CPS Choir, had the idea of having a joint lunch-time performance on 28 November 2014 at the IMH main lobby at Buangkok
Green Medical Park. The CPS teachers and parents supported this collaboration as it would help their children inculcate the school’s values of Resilience, Responsibility and Showing Care. “VSOP and the Coral Primary School Choir have actually sung together for three years. However, the performance in IMH was the first time they have performed in public together,” said Mrs King, a teacher at CPS. “It was a great opportunity to sing with the VSOP and the children were impressed by the VSOP singers. We look forward to performing together again.”
VSOP participants also enjoyed the experience. “I felt like I was back to my childhood days again,” commented VSOP singer Ann*. “I like singing with other groups as we need to work harder to prove others wrong because we are unique and different from others.” Another VSOP member said: “The Coral Primary School Choir sung well and harmoniously. It’s an encouragement for us to improve.”
(*pseudonym)
VSOP performing with Coral Primary School choir in IMH.
Xinying, front row second from left, jamming with her band.
Ms Deng Xinying, 26, PhD student in Mechanical EngineeringI started volunteering at IMH in 2007 when I was still studying at NUS. I have been visiting every Saturday from 3pm to 5pm with IMHope to do art and craft, play board games and celebrate festive seasons with the patients. We hold concerts during Chinese New Year and Christmas. We either invite Chinese orchestras from junior colleges or my rock band will play songs the patients like and remember, such as pop songs or evergreen getai sing-along hits in Mandarin or Hokkien.
The residents keep me going. I would feel strange if I don’t come. Because of the social stigma, my family, friends and colleagues are surprised when they hear that I’m volunteering at IMH. I encourage them to come with an open mind, as the residents really appreciate our time. Every week there will be someone waiting for us.
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Painting HopeBy Ng Si Jia, Corporate Communications
Bringing Festive Cheer to Our Long Stay PatientsBy Penny Chua, Corporate Communications
A team of National University of Singapore students came to IMH in December 2014 to repaint the walls in Sunrise Wing, a ward for children and adolescents. The team worked hard for several days to create an environment that would be bright and inviting for the young patients.
Since then, the repainted walls (right) have received admiration and compliments from visitors, and brought joy to patients. The nurses also feel that the different environment makes working in the ward more enjoyable for them. One of the nurses said, “When I enter the ward now, I feel more motivated to work.” We would like to thank the NUS team for creating a warm and hopeful environment for the patients!
“The NUS team worked hard to create an environment that is bright and inviting for young patients.”
Every year, IMH staff and volunteers ensure that the more than 1,000 long-stay patients in IMH are not left out of the various festive celebrations such as Christmas, Chinese New Year, Hari Raya and Deepavali.
Over the Christmas season last year, more than 120 of our long-stay patients, as well as 30 patients from Hougang Care Centre and Tai Pei Social Service, had an afternoon of games and music at the annual Christmas carnival held on 19 December 2014. Some 14 student volunteers from ITE College East packed goodie bags, decorated the hall, manned a photo booth and performed for the patients. IMH staff set up games booth where our patients played old school games such as kuti-kuti (animal-shaped plastic tokens), five stones, fishing games and dunking cans. These games are not only fun but also help to improve the participants’ hand-eye coordination and their social and communication skills. The patients were also treated to kopi-o and kaya bread, compliments from Killiney Kopitiam.
During the Lunar New Year celebrations in February 2015, IMH’s senior management contributed to the annual louhei for our patients. This annual event sees the management team, led by Dr Chua Hong Choon, CEO, IMH, visiting the wards to wish patients a healthy and happy lunar new year. Gathering round the table, patients get to toss the yusheng while heartily shouting auspicious Chinese greetings, creating a festive mood and feeling the warmth of fellowship.
We take this opportunity to wish one and all a healthy, prosperous and joyful year ahead!
Hit the cans and win a prize! The games stall by staff from the Early Psychosis Intervention Programme (EPIP).
Best wishes for the New Year! Our senior management tossing the prosperity yusheng with our patients from the long-stay ward.
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IMH’s Dr Alex Su, Vice Chairman, Medical Board (Clinical Quality) and Chief, General Psychiatry and Head of Emergency Services, was among six winners presented with the Family Violence Dialogue Group Appreciation Award on 15 January 2015 at the National Family Violence Networking Symposium, which was jointly organised by the Ministry of Social and Family Development and the Singapore Police Force. The award recognises individuals and teams for their contributions and collaborative efforts towards family protection work.
Dr Su, who has served the hospital for the last 22 years, is an advocate for inter-agency collaboration in the management of family violence cases. As a psychiatrist looking after many patients who are in dire need of social support, Dr Su strongly believes that agencies must work together to be effective in their effort to support families afflicted with family violence, especially when there are patients with mental health needs involved.
Committed to helping patients in the community, he often goes beyond the call of duty to safeguard the interests of vulnerable families by enlisting the support of multiple agencies and being actively involved in their case discussions.
“The needs of our patients are evolving and we constantly need to review systems and processes that might have worked in the past but may not be as effective today,” he said. “Holistic care is important. As no one party can fully provide all aspects of care, inter-agency partnership is what makes providing holistic
Doctor with a Big Heart Bags MSF AwardBy Fiona Foo, Corporate Communications
“Holistic care is important. As no one party can fully provide all aspects of care, inter-agency partnership is what makes providing holistic quality care possible. We should strive to build more of such safety nets to support the community, especially those who tend to fall through the gap.”
Dr Alex Su, Vice Chairman, Medical Board (Clinical Quality) and Chief, General Psychiatry and Head of Emergency Services.
quality care possible. We should strive to build more of such safety nets to support the community, especially those who tend to fall through the gap.”
Dr Su once facilitated the admission of two of three elderly sisters after their situation was brought to his attention. Besides living in an unsanitary environment, all three women had mental and physical health issues, which needed immediate attention. Dr Su personally attended to the sisters and coordinated the care of their medical needs as one of the sisters was suffering from severe leg infections. Because of Dr Su’s professionalism and kind help, the quality of life of the three sisters has improved by leaps and bounds. Today, the sisters have settled well in a nursing home.
Dr Alex Su receiving the award from Mr Chan Chun Sing, Minister for Social and Family Development at the National Family Violence Networking Symposium.
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Is hoarding behaviour treatable? Is there a need to treat such behaviour?
The treatability depends on whether the behaviour is caused by an underlying mental illness. If it is, the illness could be managed with therapy or medication, which in turn can help to control the hoarding behaviour. However, not all hoarding cases are caused by an underlying mental illness. Sometimes, the management of the underlying mental illness also may not help the hoarding behaviour.
Many persons who hoard will not seek help as they do not see it as a problem. The majority of patients come to our attention because they are highlighted by our community partners such as Housing & Development Board, grassroots organisations or were brought in by their family. These are cases where a person’s hoarding habits have encroached into common areas and are affecting other residents.
How does IMH help neighbours or families affected by someone who hoards?
The team manning the Mental Health Helpline (MHH) regularly engages community partners such as grassroots leaders, constituencies and agencies to better understand the hoarding cases that they encounter. It also provides mental health training to increase their understanding of mental illness and advice on treatment options so that they may help their residents. IMH has regular multi-agency case conferences with interested stakeholders to discuss further management of challenging cases.
A study “Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life” was conducted by IMH’s Research Division as part of the 2010 Singapore Mental Health Study. Two per cent of our adult population has a lifetime prevalence of hoarding, which is lower than the 4 per cent reported in studies done elsewhere. Hoarding is also less prevalent as compared to two other common mental illnesses among the Singapore population – major depressive disorder (5.8 per cent of the adult population) and obsessive compulsive disorder (OCD) (3 per cent of the adult population).
Why does one hoard?
People hoard for a variety of reasons, and not all of them are caused by mental illness. Some mental illness can have hoarding as one of the presenting symptoms. For instance, a person with schizophrenia may hear voices or hallucinations commanding him or her to collect items. However, most of the time, there is no identifiable underlying mental illness that causes hoarding.
When does hoarding become a problem that requires one to seek treatment?
According to the classification in the DSM 5, a person with Hoarding Disorder :
• Has great difficulty discarding or parting with possessions, regardless of their actual value
• Experiences distress when discarding the items due to the perceived need to save the items
• Accumulates items until they congest and clutter living areas
• Shows significant social and occupational impairment, a lack of self-care and increasingly unable to cope with daily living which inevitably affects self and others
When hoarding affects the person’s functioning, it warrants intervention.
Dr Kelvin Ng Associate Consultant, Department of Community Psychiatry, IMH
Ask the Expert- Hoarding
One in 50 people in Singapore will display hoarding behaviour in their lifetime, a recent study conducted by the Research Division in IMH has found out. The study also found that 0.8 per cent of the 6,616 respondents surveyed had displayed hoarding behaviour in the past 12 months. Dr Kelvin Ng, Associate Consultant, Department of Community Psychiatry, IMH shares his expert advice on hoarding and explains when it becomes a problem that warrants treatment.
If you know someone who may have a hoarding problem, you can approach the town council for assistance. Alternatively, you can call the Mental Health Helpline at 6389 2222 for advice if you know the person in need may have mental health issues.
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Recently, several arts projects have been successfully completed by people with mental health issues in Singapore. Some examples are books such as Mind this Voice: The Write to Recovery (2011), Rainbow Voices: An Anthology of Creative Writings (2014), and my own personal and philosophical account of psychosis, A Philosopher’s Madness (2012).
No doubt, the writing of such books serves a therapeutic function, and can be a way of coping with mental illness. The question, however, is whether this is sufficient to constitute art? Can non-professional artists, including people with mental health issues, make art? Should we?
My short reply to this question is ‘yes’. Make art, define it for yourself. Even if the art project is an amateur attempt, there is still great value in doing it.
The arts should be for everyone, and should occupy a central place in their hearts and minds. For engagement in the arts leads to emotional, intellectual and spiritual fulfilment, which is what living a good life is about.
People with mental illness, by virtue of being a marginalised group, see the world differently and are therefore able to offer perspectives and insights that can be an eye-opener for the majority of society. So, their writings should not be dismissed as simple navel-gazing accounts of suffering and recovery but understood as explorations of the self in encountering illness.
An uncommon life makes for uncommon art
I have often been told that my story is heartfelt, honest and authentic; that there is strong emotional truth in my writing. This is a trait prized by artists, since good art must speak truth in some way. And, while this may not be a consequence of my
mental health condition, speaking about my mental health condition has certainly been a way for me to be honest and open with others.
So, it seems to me that people with mental health issues have real potential to produce work that lives up to what we would conventionally associate with art – originality, individualism, authenticity and truth. In the area of the literary arts, people with mental health issues have fascinating stories to share, stories that speak of a search for happiness, an attempt to overcome difficulty, the saddest emotions, and the wish to find love.
Such stories display both the diversity and the common ground of humanity. Such stories make for compelling reading and appeal to all ages and backgrounds. And so, I would like to encourage all my peers to have a shot at making art.
Leaving aside the well-discussed question of whether or not mental illness is linked to creativity, I believe that the energy that is needed to experience life differently – to have hallucinations, delusions, mood swings, and behavioural problems – can definitely be channelled into creative energy and to bring forth novel ideas and concepts.
There is a potential artist in all of us. And it is up to us to activate it and to develop it.
Making Art by Chan Lishan, Mental Health Advocate
Lishan’s personal and philosophical account of schizophrenia is available from Ethos Books.
Mental health advocate Lishan speaking at the Psychosis Symposium 2013, held at IMH.
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EDITORIAL TEAM
Advisor Ting Mei See
Editors Lalitha Naidu Vera Soo
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