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JANUARY - MARCH 2016AN IMH QUARTERLY PUBLICATION
MCI (P) 050/12/2015
Inaugural Psychiatry Residency Day:A Visit to Gardens by the Bay
Frontiers in Mental Health Symposium
Patient Safety Matters at IMH
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A Journey Towards RecoveryBy Ng Si Jia, Corporate Communications
Patient Safety Matters at IMHBy Vera Soo, Corporate Communications
In line with its focus on patient-centred care, IMH strives to deliver care in the best interests of its patients. Patient safety is an integral component of patient-centred care. While safety initiatives are carried out throughout the year, the emphasis on patient safety is specially celebrated during the annual Patient Safety Carnival (PSC) to reinforce the importance of having such a culture.
This year’s PSC, held on 29 February, saw staff joining in the fun and games tailored for hands-on learning. The seven game booths focused on different aspects of patient safety, such as infection control, medication safety and emergency preparedness, revolving around the theme “Safety Culture: It Takes a TEAM”.
Invited speaker Adjunct A/Prof Tai Hwei Yee, Group Chief Quality Officer, National Healthcare Group, spoke on “Creating Effective Teams for Patient and Staff Safety” at the launch event, sharing her vast experience with the attendees. Also, a new resource, Handbook on Management of Aggressive and Violent Patients, was launched to equip staff with the knowledge and skills to protect themselves and their patients from psychological and physical trauma or injury. The handbook takes the form of an e-flipbook and is an easily accessible reference guide, being merely mouseclicks away on the IMH Intranet. It also includes videos to make the content more interactive.
As part of continual efforts to improve patient safety, a new Choking Prevention Taskforce was formed in late 2015. This is in addition to the four existing patient safety taskforces
looking into restraints, falls, suicides and assaults. Comprising multidisciplinary team members as well as administrative staff, the new taskforce is currently reviewing literature on choking prevention and developing plans to assess, prevent and manage choking incidents among IMH patients.
Dr Alex Su, Vice Chairman, Medical Board (Clinical Quality) and Chief Patient Safety Officer, IMH, who also chaired the PSC 2016 organising committee, commented, “At IMH, we are committed to providing high-quality care for our patients that is also safe. As patient safety is everyone’s responsibility, team efforts go a long way in sustaining such a culture. It is our hope that staff can be united in such a purpose to facilitate our patients’ recovery as they seek treatment.”
World Bipolar Day is celebrated each year on 30 March, the birthdate of Vincent Van Gogh, who was posthumously diagnosed as probably having bipolar disorder. A major misconception of bipolar disorder is that the term is just another name for mood swings. Bipolar disorder is a mood disorder characterised by two extremes of mood – depressed (‘low’) and manic (‘high’). A person with bipolar disorder will experience interference of daily functioning due to the extremes in the mood changes. According to the 2010 Singapore Mental Health Study spearheaded by IMH, 1.2 per cent of adult Singaporeans will suffer from the disorder during their lifetime.
Dr Mok Yee Ming, Chief, Department of General Psychiatry, and Head, Mood Disorders Unit, IMH, explains that depressive symptoms include feelings of hopelessness and excessive guilt, thoughts of negativity and suicide and disturbances in sleep and appetite. Symptoms of mania include reckless behaviour, being overly elated and energetic, easily irritable, and having racing thoughts. “If the disorder can be identified and treated quickly, its harmful effects can be reduced,” said Dr Mok. “Medication together with psychological therapy and family interventions can help sufferers stay in control of the illness. Helping the individual identify and work with stressors also forms a critical aspect of patient education.”
Mr Philibert Santhanaraj was 13 years old when he experienced his first episode of bipolar disorder. Once able to successfully juggle schoolwork with rugby practice, he started to feel burnt out and needed to take time away from school. “I was done both mentally and physically. I couldn’t do anything,” he recalls.
“But everybody just said it was stress, and I had no reason to disbelieve them.”
Dr Mok explains that many teenage cases of bipolar disorder go undiagnosed as more extreme behaviour exhibited by teenagers may be viewed as part of a transitional stage of puberty. Mr Santhanaraj finally sought medical help in secondary three after a major episode of depression. Two years later at age 17, he learnt about bipolar disorder when watching an episode of The Oprah Winfrey Show. The experiences described by the people on the show resonated with him. He found the confidence to speak to his doctor about his feelings, and was diagnosed with bipolar disorder in 2009. Today, 23-year-old Mr Santhanaraj is in control of his illness. “Life is a lot brighter,” he said. “I have bipolar disorder, but that doesn’t define me – and I won’t let it.”
Staff learning about patient safety through a fun game.
Mr Santhanaraj has now successfully brought his condition under control and referees rugby matches as a way to de-stress. Ph
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A Vital LinkCase Management was introduced in IMH in 2000 with four case managers. The Case Management Unit has since grown in scope and number with 50 case managers, who serve as a link between the care team and the patient to ensure continuity of care and reduce defaults in follow-up treatment. They also ensure that patients receive the assistance they require with their day-to-day needs by linking them up to the various resources and services available to them. One of the recent additions to the team Ms Bhavani Devakaran tells us more about the role case managers play in a patient’s recovery.
How would you describe your role as a case manager? As a case manager, I wear many hats – from counsellor to friend and advocate. I work with every patient who enters my ward to identify his or her concerns and needs to provide care coordination and necessary interventions. A big part of my job is also to provide support and empower the patient as we work together to reach his or her optimum level of wellness and functional capability in the community.
What are some challenges you face in your work?
Establishing rapport with patients and caregivers is very important as they are then more open to talk about the issues they are facing and are also more receptive to suggestions. But this may not always be easy as when I meet patients they are often unwell and are not very forthcoming. I manage this by reminding myself to be patient and find the best way to reach out to them.
By Lalitha Naidu, Corporate Communications
Be it via phone, emails or in person, Ms Bhavani keeps in close touch with her patients.
“I work with every patient who enters my ward to identify his or her concerns and needs to provide care coordination and necessary interventions.”
– Ms Bhavani Devakaran, Case Manager
Describe a memorable case you handled.
Last year, a lady with schizophrenia, who had a history of defaulting follow-up treatment, was admitted to my ward. She was initially uncooperative as she was rather unwell. I gave her time and waited for her condition to stabilise before approaching her. I didn’t speak to her about her condition as it agitated her. Instead, I listened to her speak of her life and issues she faced. It took a while but she gradually warmed up to me and I could help her better understand her condition.After she was discharged, I maintained contact with her by calling her regularly and meeting with her when she came for her follow-up treatment. I also began to provide some psychoeducation to her on her condition and encouraged her to reflect on her past actions. She gained greater understanding of her illness and learnt to manage it better. These days, she calls me just to chat and tell me about her day. She recently told me that she is looking for a job. She has come a long way and being able to have helped her in her journey brings me great satisfaction.
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Schizophrenia and other psychotic disorders can be characterised by a pre-psychotic phase, during which low-grade psychotic symptoms, a decline in functioning and symptoms of mood and anxiety disorders can be experienced. Treatment during this phase might delay or even prevent the onset of a psychotic disorder, like schizophrenia.
However, the development of a psychotic disorder is not inevitable in all people having pre-psychotic symptoms; therefore, the term “at-risk of psychosis” was suggested instead. Later the term ultra-high risk of psychosis (UHR) was coined to include those between 14 and 29 years old who were at very high risk of psychosis in the near future. Risk factors include a family history of psychosis and decline in functioning.
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Impact of Psychiatric Comorbidity in Youths with Ultra-High Risk of Psychosis By Gurpreet Rekhi, Research Division
This study, a part of the Longitudinal Youth at Risk Study (LYRIKS) conducted at IMH, examined the prevalence of comorbid psychiatric disorders (mental illnesses co-existing with UHR symptoms) and their impact on symptoms, functioning, cognition and progression to psychosis in youths with UHR of psychosis. It involved 163 participants aged 14-29, who were followed up with over a two-year period.
The study found that a high proportion of UHR participants (80.4 per cent) had comorbid psychiatric disorders. Major depressive disorder and obsessive compulsive disorder were the most common mood and anxiety disorder. Participants with psychiatric comorbidity had more severe symptoms, reported higher levels of distress and lower functioning. However, presence of comorbid disorders had no effect on cognition and did not influence the risk of developing psychosis.
This study has important clinical implications. The results suggest that a large proportion of UHR individuals suffer from psychiatric disorders and should be assessed for comorbid disorders upon presentation. When appropriate, treatment that takes into account both conditions should be provided. This might help to reduce symptoms and distress in UHR individuals and improve their functioning.
This study was supported by the National Research Foundation Singapore under the National Medical Research Council Translational and Clinical Research Flagship Programme.
Exploring the Links between Mental Health and NeuroscienceBy Penny Chua, Corporate Communications
Senior management from IMH and LKCMedicine and invited speakers who participated in the two-day symposium.
More than 200 participants attended the first Frontiers in Mental Health Symposium which was jointly organised by IMH and the Lee Kong Chian School of Medicine (LKCMedicine) from 25-26 February.
The event brought together distinguished overseas speakers from Imperial College London, University of Oxford and Harvard Medical School as well as leading experts from LKCMedicine, Duke-NUS, National Institute of Education, Nanyang Technological University, National University Health System and IMH. They shared insights and latest research findings on topics ranging from the genetics of psychiatric disorders and trends in psychiatric neuroimaging to post-traumatic stress and developmental disorders.
“It is well accepted that in order to advance the management of medical disorders, we need to understand the cause and then target treatments accordingly and more specifically. The same should apply to mental disorders,” said A/Prof Chua Hong Choon, CEO, IMH. “Hence our interest at IMH is to not only understand the prevalence of psychosis such as schizophrenia, but also to examine the underlying biological determinants of these spectrum disorders with investigative modalities such
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Two IMH Studies Receive Grants of More Than S$200,000By Penny Chua, Corporate Communications
Health Services Research New Investigator Grant (HSR NIG)The HSR NIG, a Ministry of Health grant administered by the National Medical Research Council (NMRC), aims to help new health services researchers take initial steps towards obtaining their first independent national-level grants. Dr Edimansyah Bin Abdin, Senior Biostatistician, Research Division, IMH, received the grant for his study titled “A study of generic preference-based measures of health-related quality of life in patients with mental illness”.
Conducted over two years from December 2015 – December 2017, the study aims to identify the most appropriate generic questionnaire to measure health-related quality of life in patients diagnosed with depression, schizophrenia and other psychosis in Singapore. Three widely-used generic preference-based measures - EuroQol 5D (EQ-5D), Short Form Health Survey-36 (SF-36) and Health Utility Index Mark 3 (HUI3) will be included in the current study. The study will examine the performance of these questionnaires in terms of their applicability, validity and reliability.
It will provide yet-unavailable evidence to clinicians and researchers about the best choice of generic preference-based measures that can be used to assess health-related quality of life in patients with mental illnesses in Singapore.
Dr Attilio Rapisarda, Senior Research Fellow, Research Division, IMH, was recently awarded the Clinician Scientist (CS) – Individual Research Grant (IRG) – New Investigator Grant (NIG) for his study titled “Epigenetics of Psychotic Disorders: investigating the impact of early-life adversities on DNA methylation, white-matter connectivity and symptoms severity”. The CS-IRG-NIG is a sub category of the CS-IRG to cater for new clinical investigators who are applying for their first independent national level grant.
Traumatic experiences in childhood seem to be especially prevalent in individuals who develop psychiatric conditions during adulthood. A growing body of evidence documents the impact of quality of early life nurturing on the genetic expression of proteins involved in brain development. This study hypothesises that alterations in genetic expression may be associated with the hallucinations and delusions often observed in psychotic patients.
IMH is taking the lead in this study, and will be collaborating with National University of Singapore and Duke NUS Medical School. The two-year study will start by mid-2016.
Clinician Scientist (CS) – Individual Research Grant (IRG) – New Investigator Grant (NIG)
as neuroimaging and genetics. Findings of brain anatomical changes and genetic signals not only allow us to better understand the biological changes but can potentially serve as biomarkers for treatment and prognosis.”
The participants included researchers, neuroscientists, clinicians and academics with a keen interest in mental health research, especially in the area of examining the biological causes for these conditions. They actively engaged in discussions on the implications of these studies on the practice of psychiatric care.
The symposium was an excellent platform for mental health professionals to learn and exchange expertise, network, collaborate and strengthen the link between research and practice.
“Our interest at IMH is to not only understand the prevalance of psychosis such as schizophrenia, but also to examine the underlying biological determinants of these spectrum disorders.”
– A/Prof Chua Hong Choon, CEO, IMH
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Capability Building in the CommunityBy Sharon Lai and Amelia Toh, Education Office
Ms Chan Lay Lin conducts a crisis training workshop for teachers.
Being PreparedTrainer Mr Desmond Ang, Senior Clinical Psychologist, IMH, shares pointers on how organisations can better support crisis preparedness at the workplace.
Share past experiences and incidents with staff
Companies such as the Singapore Airlines (SIA) share their experiences handling past incidents. This allows staff to understand that crisis training is not simply a table-top exercise, but a continuous effort.
Identify strength and weakness of staff
Not every staff is prepared or inclined to provide frontline crisis support, nor should the company expect every staff to do so. Crisis work is highly personal and emotionally draining as staff will be asked to provide more than the typical professional support. Staff should be given the chance to receive the appropriate training and through the training, discover their own strength and inclination. Although some individuals may not be able to contribute well as a frontline staff, they can still provide much needed logistical or administrative support during the crisis period.
Collaborate with partners
Companies such as SIA have not only focused on training their staff, but have also invested time and resources collaborating with other airlines and relevant authorities for better crisis preparedness. Regular joint exercises are carried out to simulate crisis and for the involved parties to synergise and test their readiness working across the various agencies and authorities.
When a crisis occurs at an organisation, employees are expected to intervene and help casualties, who are very often direct clients and their next-of-kin, regain control over their situations.
Taking a population approach to gear organisations to be crisis-ready, IMH clinical and allied health professionals have been working closely with corporate and government agencies from the aviation, tourism and educational industries to provide crisis management training.
As a first step to be prepared for managing crisis, it is important for organisations to set up operating structures and procedures to detail crisis activation and intervention processes, said Ms
Tracy Wee, Senior Medical Social Worker, IMH, who has been largely involved in training school teachers.
The curriculum for crisis management training is designed to help individuals and organisations manage various traumatic incidents unique to their industry, while minimising the psychological impact of these crises. It combines both theory and skills training with hands-on exercises and role-playing to provide a comprehensive understanding of dealing with crisis in the workplace. Ms Wee believes that it is essential to contextualise training components to meet the profile and needs of each client group and take into consideration the roles the participants are expected to undertake in the companies after the training.
To help participants learn better, the trainers also share their crisis-related experiences during these sessions. “Being exposed to emergency and crisis work in various hospitals and people who are often on the brink of life crises has taught me much, which I share with the participants,” said Ms Chan Lay Lin, Deputy Head, Medical Social Work, IMH, one of the crisis management trainers. “The participants also share their life and work narratives, enabling the learning experience to be mutually enriching for both trainers and participants.”
Ms Wee said that with proper and adequate training, participants would feel less fearful of managing crisis and would be more confident in understanding and recognising reactions to crisis as well as supporting people in crisis. Sharing what it takes to be able to provide appropriate intervention during a crisis aftermath, she said, “He or she would have had undergone effective and adequate training to be equipped with the skills and knowledge in managing crisis. He or she should preferably also have compassion for people in need and the capacity and resilience to manage challenging situations.”
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Gearing Up for LKCMedicine StudentsBy Christine Tan, Education Office
The team from IMH and NHG involved in providing clinical training for LKCMedicine students with Dr Ong (middle, front row)
The first batch of students from Lee Kong Chian School of Medicine’s Bachelor of Medicine and Bachelor of Surgery (MBBS) degree programme, awarded jointly by the Imperial College London and Nanyang Technological University, will start coming through to IMH from January 2017 for their clinical training in psychiatry.
As part of preparations to support curriculum development and learning exchange, Imperial College London hosted a visit to London for representatives from IMH and the National Healthcare Group (NHG). In addition to site tours of Imperial College Medical School’s core teaching hospitals – Chelsea and Westminster, Charing Cross and West Middlesex – the team also had the opportunity to meet their counterparts in Imperial College to share experiences of clinical training in their respective contexts.
Dr James Warner, Director of Clinical Studies for Central North West London Foundation Trust, and Ms Annette McMayo, Undergraduate Medicine Teaching Coordinator, West London Mental Health NHS Trust and Imperial College London, provided valuable insight on the challenges and opportunities for teaching and training in psychiatry.
They shared that their psychiatry curriculum was designed to impart a balance of medical knowledge, clinical skills and professionalism to students. Key general skills such as interpersonal communication, leadership and life-long learning skills were also prioritised. Delivery through a breadth of methods including team-based learning, simulation, e-learning, lectures, seminars and apprenticeships were shared.
“The visit to Imperial College and various placement sites was useful,” said Adj A/Prof Ong Say How, Chief and Senior Consultant, Department of Child & Adolescent Psychiatry, IMH, who is IMH’s psychiatry lead with LKCMedicine. “I am responsible for the educational quality of our psychiatry curriculum and programme delivery during the clinical posting on-site. We want to ensure that IMH as a placement site will offer LKCMedicine students a well-coordinated, hands-on experience of our specialities supplemented by high-quality, outcome-focused teaching. We have an enthusiastic cadre of clinical teachers but they are facing ever increasing demands in terms of clinical workload and changes in service delivery. I am reassured that there is a genuine commitment to undergraduate education in IMH and NHG. I look forward to supporting our staff in their endeavour to ensure that our next generation of doctors receives excellent psychiatry training.”
Nurturing Lifelong LearnersBy Lalitha Naidu, Corporate Communications
Adj Asst. Prof Clare Yeo is one of over 100 staff in IMH involved in training the next generation of mental health professionals
More than 100 staff in IMH have teaching appointments or roles with academic partners in both pre-professional and post-graduate programmes. This dedicated pool of educators share their knowledge, experience and expertise with aspiring mental healthcare professionals to enable them to deliver quality care.
One such educator is Adjunct Asst. Prof Clare Yeo, Senior Principal Clinical Psychologist, who has been grooming psychology students transitioning from schools to the healthcare setting since 1997. As the Clinical Educator Lead for allied health (AH) in IMH, she also works with educational institutions to develop the curriculum for AH students coming to IMH for their clinical placements and ensures high standards of clinical training. “The aim is to synergise efforts and provide learners
with a holistic experience that would enable them to better meet the mental healthcare needs of patients,” she said.
In her years of teaching, she has seen some changes in the education landscape. “Learners today are encouraged to seek out knowledge and skills on their own, while guided by educators. As the pace of healthcare and patients’ needs are rapidly changing, this approach equips them to be lifelong learners,” she said. “Learning has also become more experiential to give future mental healthcare professionals a taste of real-life situations and equip them to provide the best care possible for patients.”
In addition to training psychology students who come to IMH for their clinical placement, she also teaches a module to undergraduate Psychology students in Nanyang Technological University, aimed at providing them with a taste of the roles and responsibilities of clinical psychologists, as well as the greater mental health landscape. She is heartened when those she has taught join the profession.
“A few years ago, a student I taught came for an interview for a position at IMH. During that interview, she shared that I had sparked her interest in working with individuals with mental health issues. I subsequently had a hand in furthering her career development in working with older persons at IMH,” she said, “It is such encounters that spur me to better myself as an educator.”
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A Lasting LegacyBy Lalitha Naidu, Corporate Communications
Dr Leong Oil Ken (second from right) with fellow doctors at the IMH Doctors’ Night 2012 celebrations.
One of IMH’s longest serving psychiatrists retired last year after 39 years with the hospital. Dr Leong Oil Ken, Senior Consultant, Department of Community Psychiatry, IMH, joined Woodbridge Hospital as a medical officer in 1976 when there were very few psychiatrists in Singapore, and long-term custodial care was practised at Woodbridge Hospital.
“I hadn’t considered psychiatry when I graduated from medical school,” recalled Dr Leong, who had initially been interested in taking up internal medicine. “The posting to Woodbridge was my second choice at that time. It turned out to be the best experience I could have had.” As he contemplated specialising in psychiatry, a fellowship to study psychiatry in the UK opened up in 1978. “I applied for it, and lo and behold I was the only applicant,” he said. He later returned to the hospital with two postgraduate degrees in psychiatry.
Dr Leong made significant contributions to IMH during his tenure. He took on several leadership roles, which include serving as Head of Department of Adult Psychiatry 1 from 1996 to 2001 and Vice Chairman, Medical Board from 2002 to 2004 “He is efficient and quite decisive in his work and patient care,” said A/Prof Chiam Peak Chiang, Vice Chairman, Medical Board (Education). Dr Leong was also ahead of his time in embracing technology and complex systems to improve hospital processes and his department’s performance. “In the early days, there were no technicians and he’d be the one to approach to solve computer problems,” said Dr Chee Kuan Tsee, Emeritus Consultant, IMH. “He is also good at simplifying complex tasks.”
As a leader, he had a knack for knowing when to step in and help his staff with a problem, and when to give them the space
to work it out, said A/Prof Chua Hong Choon, CEO, IMH, who was a registrar when he first worked with Dr Leong in 1996. “When I was a young doctor, I had some issues dealing with a colleague in the ward,” he shared. “I decided to seek Dr Leong’s advice on this, and found that he already knew about it but hadn’t intervened. This incident personifies Dr Leong’s leadership style. It was something I took away with me.”
In recognition of his outstanding contributions, Dr Leong received the Public Service Medal in 2008. Last year, he was awarded the Distinguished Psychiatrist Award, which recognises psychiatrists for their clinical, academic, research and mentoring work, by the Singapore Psychiatric Association. “He gets quickly to the root of a problem and is generous in sharing his time and knowledge,” said Dr Cai Yiming, Emeritus Consultant, IMH, who joined the hospital with Dr Leong in the 1970s. This, plus his approachable nature made him a great mentor. “He is patient and rather unflappable, so it was easy for junior doctors to seek his advice,” added A/Prof Wong Kim Eng, Emeritus Consultant, IMH.
Dr Leong attributes the camaraderie among staff as they work together to help patients recover as key to his long and illustrious career at IMH. He believes that “one should be dedicated to his work, get along with all staff and pass on knowledge to the juniors who may one day become seniors.” Dr Lee Cheng, Vice Chairman, Medical Board (Clinical), IMH, is among the many Dr Leong mentored who have taken his lessons to heart. “Technical knowledge and skills can be picked up from books, unlike the soft skills,” he said. “I learnt the importance of personal touch and empathy from Dr Leong, through the way he interacts with patients as well as colleagues. He got along well with everyone.”
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IMH’s main lobby was abuzz on 30 January. A total of 31 patients from the long-stay wards had gathered decked in their brightly coloured caps, eagerly awaiting their afternoon excursion to Gardens by the Bay. Joining them were 25 psychiatry residents and nine nurses.
Organised by psychiatry residents, the outing kick-started the inaugural annual Psychiatry Residency Day, which aims to give residents an opportunity to give back to the community as well as to bond with each other through such activities.
Besides enjoying the greenery and the colourful exhibitions on display for Chinese New Year at Gardens by the Bay, the residents and patients got to know each other better with plenty of laughter and stories shared.
“I discovered quite early that my buddy had an interesting quirk,” said Dr Zheng Shu Shan, Year 3 Psychiatry Resident. “She would need to be the first in line when we were waiting in our rows. She would gently but persistently make her way
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Keeping Fit with Uncle Tony
Flowers, Friendship and Festive Cheer
By Fiona Foo, Corporate Communications
By Dr Tan Rui Qi, Year 4 Psychiatry Resident
Catching Aerofit Club members before they start their Wednesday run with Uncle Tony (upper row, third from right).
Dr Zheng with her buddy.
to the front. When I discovered her reason for doing so, it truly humbled me. For the simple reason that she was very thankful to be on this trip, she tried to convey her appreciation by showing her utmost attention and cooperation. It wasn’t about her. It was about what she was trying to do for others. I felt surprised and touched.”
Aerofit Club, the in-house running club of IMH, celebrates its 10th anniversary this year. The club was founded by Mr Tony Lum, 63, Manager, Human Resource, IMH, with the objective of encouraging staff to maintain an active lifestyle. Fondly known as “Uncle Tony” among staff, he shares his fitness motto and formula to stay trim and fit.
What inspired the club’s name?
Always Exercise Regularly. Otherwise, Fats Increase Tremendously! I admit that I had used it as a scare-tactic a decade ago when I started the club. I knew there would be some buy-in from staff. For those who have stayed on, they have definitely maintained their weight.
Tell us about the training programme for new members.
As we have staff with different fitness levels and health concerns, I first ask them for their health objectives, fitness background and medical history before they join us on our regular jogs. Knowing their limits before pushing them is important. Every Wednesday, we cover about seven kilometres around the IMH campus. Once a month, we do “off-site” runs at places like
MacRitchie and Singapore Botanic Gardens. I teach beginners to pace themselves and correct their running techniques to achieve more with less effort.
It’s a wonder how you’re able to maintain the stamina of a 25-year-old man and look half your age. What’s your “secret”?
There is really no secret. Just know that we are what we eat. Exercise only helps to maintain our weight. Diet determines the rest when it comes to health and weight loss. I eat mainly fish and vegetables. For those who are trying to reduce weight, I would say cut back on carbs and load up on protein. I also sleep by 10pm. So, I’m not sure if looking more youthful is the result of having enough beauty rest!
How would you motivate staff to keep to a fitness regime?
There is no excuse for not exercising. Remember, health is life. When our health fails, our quality of life is compromised. It only takes 15 to 20 minutes of exercise three times a week to maintain good health. Besides, even our CEO Dr Chua Hong Choon makes time for the weekly runs. Would we still say we have no time? We should do it for ourselves and our health.
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ASK
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PERT Ask the Expert
– Self-Harm Among Teens
What is self-harm?
Self-harm refers to a spectrum of behaviour that people intentionally engage in to cause direct and immediate damage to their own bodily tissue, where the desire to die is usually not the primary motivation. Some self-harm behaviour includes:
• Scratching, puncturing or cutting one’s own skin• Taking toxic or corrosive substances (e.g. bleach, detergents),
overdosing on medications or vitamin pills, or swallowing sharp objects
• Hitting oneself against hard surfaces or using hard objects• Scalding oneself with hot fluids• Hair-pulling
Why do teens resort to self-harm?
The reasons for self-harm vary amongst individuals. Our experience working with these teenagers suggests that self-harm may be used to fulfill a number of functions:
• Relieve painful emotions, psychological distress or tension
• Self-punishment from the sense of guilt or shame resulting from past traumatic/abusive experiences
• Express emotional conflict or turmoil which the teenager has difficulty putting into words
• Communicate a need for support – a desperate cry for help• Regain a sense of control – especially for a teenager who
perceives that everything is out of control in his or her life except for “when, how, and how much I cut myself”
• Distract oneself from difficult life circumstances and situations – e.g. parental divorce, relationship problems and academic setbacks
What are the usual parts of the body that they self-harm?
Based on clinical experience, one of the most common means of self-harm seen in our local teenagers is self-cutting. Self-cutting usually occurs on the wrists and forearms, often with multiple superficial cuts made each time.
Self-cutting may also occur on other “unusual” parts of the body concealed by clothing, such as the inner thighs, hips and even on the soles of the feet, to avoid detection.
Dr Donovan Lim Consultant Department of Child & Adolescent Psychiatry, IMH
Supporting a Child or Friend Who Self-HarmsBe vigilant to the tell-tale signs – such as insisting on wearing long sleeves or pants even in hot weather, having unexplained wounds or scars on the body and discovering sharp objects in the teenager’s bag.
Facilitate open communication, not secrecy – if you suspect self-harm, let the teenager know what you have noticed and express your concern in a caring, non-confrontational way.
Try to see things from the teenager’s perspectives – it helps you understand why the self-harm is happening in the first place.
Do not judge or criticise – Remember that the teenager may already be feeling ashamed and guilty. Avoid passing judgemental or critical comments, which may exacerbate bad feelings, possibly triggering another round of self-harm.
Encourage the teenager to undergo treatment and be an active player in your child’s treatment plans – Know the roles of the various mental health professionals caring for your child, understand the therapy goals and support your child in being compliant with treatment plans.
Work with the school – Your child spends a lot of time at school and it is only practical to share information about his condition with selected school personnel (e.g. form teacher or school counsellor). They can help look out for your child and keep you informed of any rising concerns.
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MY
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My name is Daryl and I am 30 years old. My roller coaster journey with bipolar disorder started when I was 18. I wasn’t doing my homework regularly, I skipped school and I was anti-social in class. There was an occasion when the lecture hall was very noisy and I shouted rude remarks to everyone out of frustration. I was in self-denial at that time. There was a lack of education on mental health and nobody referred me to a school counsellor.
I had depression, anxiety, and delusional thoughts. I felt powerful and invincible and that everything I did was right. I would exhaust myself and put myself in dangerous situations. I was caught by the police for a foolish public act and was referred to a hospital for rehabilitation.
While serving National Service, the environment, the routine and the support I got from my officers and my peers made me feel well. So I stopped seeing my psychiatrist and stopped taking my medication.
Once I left National Service, my support system was removed. My parents were going through a divorce and my father asked me to work for him. I relapsed. I started spending money excessively. I made irrational decisions and, before long, I was back in the hospital.
I was high and uncontrollable. I felt I had superpowers but I was of unsound mind and emotionally weak. I had to go for Electro-
convulsive Therapy.
For me, recovery has not been a straight line but a process of ups and downs. Every person has to figure out his or her own recovery formulae and to recover at one’s own pace. One thing I have learnt is the importance of discipline. For example, having a routine every day and exercising regularly.
After yet another re-admission to the hospital, I realised that I had to better manage myself. I learnt about the four pillars of support: Medication, Social Support, Coping Strategy and Lifestyle. I learnt illness self-management and recovery strategies and joined a peer support group.
I also received support from my occupational therapists. It helps me to know my symptoms when I’m stressed, such as having racing thoughts and irrational thoughts, and being easily agitated.
It is now my ambition to be a peer support specialist to assist mental health professionals to help others with mental health issues through sharing my lived experiences. I desire to find a solution for each client; for them to lead better lives and move ahead without being paralysed by their illness. I would like to be a role model for them, give them hope and encourage them to set goals for their future. Yes, we may have mental illness, but we can contribute to society.
Riding the Recovery Roller CoasterBy Daryl T
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EDITORIAL TEAM
Advisor Ting Mei See
Editor Lalitha Naidu
Circulation Coordinator Chris Ngiam
Committee MembersJamilah BeeviFiona FooPenny ChuaVera Soo
Cheong Yaun MarnHan Bing LingNg Si Jia
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