Stigma No More: Greysteppenwolf's Singapore Mental Health blog

Illness Management and Recovery Program 2009

2009-07-06T22:13:00.000+08:00

ILLNESS MANAGEMENT AND RECOVERY (IMR) PROGRAM

Introduction

Adopting the manual developed by New Hampshire-Dartmouth Psychiatric Research & West Institute in USA, The Illness Management and Recovery Program consists of a series of 9 weekly sessions to help people who have experienced psychiatric symptoms to develop personalized strategies for managing their mental illness and moving forward in their lives.

Objectives

To improve knowledge and understanding of mental illness among the sufferers
To teach persons with mental illness to manage their symptoms and reduce relapses
To enhance the coping skills of persons with mental illness

How is the IMR run?

In the IMR sessions, the facilitator works collaboratively with participants, offering a variety of information, strategies, and skills that participants can use to further their own recovery. There is a strong emphasis on helping them put strategies into action in their everyday lives.

Topics for IMR Program

1 Recovery Strategies
2 Practical Facts about Schizophrenia, Depression & Bipolar
3 The Stress-Vulnerability Model and Treatment Strategies
4 Building Social support
5 Using Medication Effectively
6 Reducing Relapses
7 Coping with Stress
8 Coping with Problems and Symptoms
9 Getting Your Needs Met in the Mental Health System
2009 Programme Details: （1stcome 1st served basis）

9th Run: 12, 19 January, 9, 16, 23 February, 9, 16, 23, 30 March in English

10th Run: 13, 20, 27 April, 11, 18, 25 May, 8, 15, 22 June in English

11th Run: 13, 20, 27 July, 17, 24, 31 August, 7, 14, 28 September in English

12th Run: 12, 19, 26 October, 9, 23, 30 November, 14, 21, 28 December in Mandarin

Time : 7.00 p.m. to 9.00 p.m. (Light refreshment provided during tea break)

Venue : Central Singapore Club 3R
Blk 69 Toa Payoh Lorong 4
#01-365 S(310069)

Fee : $10 one time registration fee only

Who is eligible?
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Must be diagnosed with schizophrenia, depression or bipolar disorder and in stabilized condition

Able to attend all 9 sessions and complete the whole course

Able to read and speak either English or Mandarin for the respective English or Mandarin classes

Please obtain the registration form form Social Worker, Support Groups, Singapore Association for Mental Health Blk 69 Toa Payoh Lorong 4 #01-365 Singapore 310069 Fax No 62526834 Email: supportsvcs@samhealth.org.sg

For further enquiry, please call 1800 2837019 or email to the above email address.

Mum, I can't sleep

2009-07-04T22:39:00.003+08:00

Mum, I can't sleep

Hedy Khoo
Sun, Mar 23, 2008
The New Paper

THE loud noises prevented her from sleeping at night. But the problem was not one of noisy neighbours.

Nobody else could hear those voices except for the 15-year-old student.

Fortunately, her mother spotted signs of her mental disorder and sought help last October.

The teenager is not the only one among young Singaporeans having psychological issues and seeking help.

Some doctors say they are seeing more students seeking help for mental conditions.

Today, Audrey (not her real name) is still on medication, which keeps her mentally stable.

We are not naming her because she is a minor.

Initially, when Audrey complained of disturbed sleep because of people shouting at the void deck, her mother thought it was unruly teenagers hanging out late downstairs.

Their flat was on the fourth floor, so it was possible to hear people talking loudly downstairs.

Then, Audrey started to tell her that somebody was shouting her name at night and saying he was in love with her.

The mother, a 42-year-old housewife, decided to sleep with her daughter in her room for a week to see who the prankster was.

The mother recalled: 'I thought it was strange when I didn't hear anyone shouting at night, but my daughter kept complaining people were shouting at her, even though it was quiet.

'I even took her downstairs to see for herself that there was nobody there.'

Mrs Lim realised there was a problem when her daughter still insisted there were people shouting at her.

'She got upset at not being able to sleep. I got more worried when she started to shout and scold the people she heard. She also got angry with me, saying I refused to believe her.'

At first, her daughter was plagued by the voices only at night, but after a few days, she also heard voices during the day.

So her mother decided to take her to the Tze Hng Wellness Studio in Hougang for therapy.

Miss Porsche Poh, the executive director of the Wellness Studio, said: 'When Mrs Lim first took her daughter to our centre, I realised her condition needed medical care.

'She was unstable and was talking to herself. She said she wanted to kill someone, which was quite worrying.'

Miss Poh informed Audrey's mother of where to seek help, such as the Institute of Mental Health (IMH) and other private clinics.

Audrey was subsequently warded at the IMH last October for a week. Her mother did not want to say what sort of treatment she received or what her diagnosis was.

Audrey said: 'At first, I blamed my mother for sending me to the hospital.'

But she realised it was necessary during her counselling sessions later.

NOW, SHE HEARS JUST 1 'VOICE'...

The teenager is now determined to overcome her mental disorder. She could even joke.

'Now the only voice I hear is a real one - my mother telling me to mop the floor,' she said with a grin.

Mrs Lim, while relieved with her daughter's progress, regrets not seeking help sooner.

That was why she decided to share her story.

She said: 'I want to share with other parents to not take your children's feedback for granted.'

She said she had at first dismissed her daughter's complaints of problems at school as growing pains.

Audrey said that while her parents did not pressure her in her schoolwork, she had high expectations of herself, and irrational fears of her future.

She attributed a lot of her pressure to her secondary school, a neighbourhood school. She claimed that students were constantly reminded to aim for high grades.

She also had problems making friends, and had been bullied in primary school, and then in secondary school.

Her mother said: 'It is easy for parents to neglect a child, especially working parents. Children these days face a lot of pressure in school.'

She also said it was important for parents to accept that their child has a problem.

She said: 'Don't think that your child is mad. People must understand that mental disorders are treatable. It's like having a flu. One is physical, the other is mental. It is important to get early treatment.'

MORE STRESSED-OUT YOUNGSTERS SEEK HELP

MORE children and teenagers are under stress and seeking professional help for psychological conditions, some practitioners in the field said.

At the Child Guidance Clinic at the Institute of Mental Health (IMH), for example, the number of patients went up from between 2,000 and 2,500 children and adolescents eight years ago, to 3,000 patients last year.

However, Dr Ong Say How, the deputy chief of the department of child and adolescent psychiatry at the IMH, pointed out that the increase does not necessarily indicate an increased incidence of mental disorders.

'Some conditions are related to responses to stress in schools and homes, and not strictly mental disorders per se,' he said.

He noted that most of these cases involve children who have Attention Deficit Hyperactivity Disorder (ADHD), stress-related disorders, emotional disorders and conduct disorders.

Miss Porsche Poh, the executive director of the Tze Hng Wellness Studio, said that since her centre opened last October, she has seen more than 11 cases of people aged between 15 and 30.

One of them was a teen who was diagnosed with obsessive compulsive disorder with psychotic symptoms, and he was on medication.

The mother said he defecated around their flat.

Miss Poh told her to go back to his psychiatrist.

She noted: 'Some parents are reluctant to take their children directly to the IMH or private psychiatrists because of the stigma involved.'

At Dr Lionel Lim's clinic, 40 per cent of his patients comprise children and adolescents. He has also seen 2-year-olds.

He said: 'Parents these days are more educated... They are more exposed to the idea of seeking help for their children's psychological issues.

Dr Adrian Wang, 41, a psychiatrist in private practice, sees two to three more new young patients a month as compared to last year.

He said: 'Usually, the parents take their children here. There are also secondary and junior college students with childhood depression.'

This article was first published in The New Paper on Mar 23, 2008.

Crazy highs and lows

2009-06-29T11:17:00.001+08:00

June 25, 2009
Manic depression - Cover story
Crazy highs and lows
By June Cheong

How could feeling energetic and indestructible be part of a medical condition? But that's bipolar disorder. On its flipside, a patient can sink into deep depression and may even entertain thoughts of suicide

What do late American president Theodore Roosevelt, actress Carrie Fisher and pop star Britney Spears have in common?

They all suffer from bipolar disorder.

This mood disorder is characterised by recurrent bouts of extreme mood changes.

Dr Adrian Wang, a consultant psychiatrist at Dr Adrian Wang Psychiatric And Counselling Care, said: 'It's a brain disorder because it is caused by chemical imbalances.'

While the mood swings make it appear to be psychological, the cause is biological, he said.

Patients veer between two psychological states - mania and melancholia.

When manic, the patient may be in excessively high spirits, is sometimes irritable, needs less sleep with thoughts racing through his brain constantly, talks quickly and makes grand plans.

Symptoms of melancholia are a persistent feeling of sadness, hopelessness and lethargy. He may be unable to eat or sleep.

Dr Ng Beng Yeong, the head of the department of psychiatry at Singapore General Hospital, said: 'In extreme forms (of mania), they may believe they are exceptionally gifted or rich or are important religious, political or famous people.

'The judgment of those with mania is often impaired because of grandiosity and failure to plan or consider the consequences of their actions.'

Mania often requires hospital admission as the manic patient's energy levels may be too much for their family or caregivers to take. The manic patient is also often prone then to excessive or dangerous but pleasurable behaviours like spending too much or sexual indiscretion.

While manic patients invariably sound like they have more fun, Dr Wang noted that depressive lows often last longer than manic highs.

Dr Chua Tze Ern, a registrar in the department of community psychiatry at the Institute of Mental Health, said: 'Different individuals will have different symptoms. One may be predominantly depressed and another may be predominantly manic.'

In between high and low episodes, patients feel well and normal - like everyone else.

The exact cause of bipolar disorder is unknown but doctors believe it is likely to be caused by a plethora of factors interacting with one another.

Dr Ng said: 'It often runs in families and there is a genetic component to the disorder.

'However, even though someone may have inherited the genes for bipolar disorder, there is no guarantee that he will develop it.'

As the brain controls moods, sense of perception and judgment, imbalances in certain brain chemicals like dopamine and serotonin may result in bipolar disorder. These may be destabilised due to genetics.

Beyond this genes factor, stressful or negative life events like losing a loved one and certain personality traits like being neurotic can also predispose someone to developing bipolar disorder.

A stressful event often triggers the first episode of bipolar disorder, so how one copes with stress and negative experiences influences one's susceptibility to the disorder.

Dr Wang said: 'The current economic crisis is stressful for everyone and stress can unmask underlying disorders.

'I've seen an increase in the number of patients with mood or anxiety problems.'

Asked if bipolar disorder can be prevented, Dr Ng said: 'Stay away from drugs, learn to manage stressful events better and give priority to sleep. Loss of sleep can contribute to the onset and recurrence of depression and mania.'

Although women are more prone to getting mood disorders like depression and anxiety, bipolar disorder seems 'neutral' to gender.

It is most common in people between the ages of 20 and 40 and 1 per cent of adults in Singapore have bipolar disorder.

Bipolar patients are also more susceptible to developing problems like substance abuse, anxiety disorders such as panic attacks and attention deficit hyperactivity disorder, or ADHD.

Dr Wang explained: 'There's an overlap in brain chemicals and functions. If one part of the brain is screwed, other parts may be too.'

Bipolar disorder can be difficult to diagnose for several reasons. One, it may be masked by other conditions like substance abuse or bulimia.

Two, the symptoms of bipolar depression are similar to normal depression and doctors can only confidently diagnose bipolar disorder if the patient does not respond as well to anti-depressant medication.

Like many illnesses, bipolar disorder can range from mild to severe. With regular psychiatric reviews and medication, patients with mild to moderate bipolar disorder can lead normal lives and maintain satisfying relationships.

In such cases, the mainstay of treatment is medication as well as counselling for the patient and his family. Different combinations of mood stabilisers, anti-depressants, anti-psychotic drugs and sedatives may be needed.

In severe cases, electroconvulsive therapy may be prescribed. The treatment is done in a hospital and a controlled electric shock is applied to the patient's head while he is medicated and under anaesthesia.

Asked if medication is more effective in treating bipolar disorder than counselling, Dr Chua said: 'Medication is often more effective as it can directly target the neurotransmitter abnormalities that cause the symptoms.

'Having said that, counselling plays an important role too in educating patients about their illness and in helping them to manage their stress levels.'

Dr Wang said: 'I get my patients to recognise certain dysfunctional thought patterns. For example, if they say their boss hates them, I show them how it's not true and to recognise their own faulty reasoning.

'It's more than thinking positive. I challenge my patients to change their behaviour. If they think no one likes them, I ask them to smile or go up to people first.'

As bipolar disorder is a long-running illness, continual consultation and treatment is necessary. Patients may experience long periods of feeling normal but the disorder may suddenly return.

Once diagnosed, patients usually require medication for at least a year to remain stable.

More than 90 per cent of patients with a single manic episode go on to have more. Between 5 and 15 per cent of patients have four or more episodes in a year while 10 to 15 per cent eventually commit suicide.

Bleak statistics aside, there is a positive aspect to having bipolar disorder - greater creative powers. Researchers have found a link between bipolar disorder and a higher level of creativity.

That explains why the ranks of bipolar disorder patients read like a who's who of the arts world, including American writer Ernest Hemingway, British novelist Virginia Woolf and American comedian Ben Stiller.

Dr Ng said: 'I often find myself marvelling at the intensity with which individuals with bipolar disorder experience life.

'Many patients with mild bipolar disorder enjoy their highs and prefer not to tell anybody. Once diagnosed, they are concerned that medication will take away the pleasurable states and their creativity.'

junec@sph.com.sg

Dreams interrupted

2009-06-29T11:12:00.003+08:00

June 25, 2009
Manic depression
Dreams interrupted

Her dream of becoming a university academic was blindsided by bipolar disorder.

Ms Choo Kah Ying, a freelance writer and editor, was diagnosed with the brain disorder when she was 19.

The 37-year-old said: 'I wanted to be an academic but I didn't go on to do that or get a PhD because of my bipolar disorder. My dreams were interrupted.'

She was in her second year of university in Australia when she found herself struggling with her studies and feeling insecure about her relationship with her then-boyfriend.

She said: 'The initial trigger was his going to Los Angeles. I panicked when he was out of reach.

'At school, I couldn't focus. I'd prided myself on being a good student.'

Things came to a head a few months later when she tried to hang herself at her then-boyfriend's place. She failed but he saw the rope marks on her neck and called her parents.

Ms Choo's parents then sent her to a psychiatrist who diagnosed her as bipolar and put her on lithium treatment, one of the most common drugs for bipolar disorder.

Lithium helps reduce the severity and frequency of mania as well as relieves bipolar depression.

Ms Choo did not respond well to the three-month treatment and experienced side effects like grogginess and a dry mouth.

She said: 'I was an uncooperative patient. I'd show up at the psychiatrist's and not say anything.'

She stopped taking lithium after three months as her mood swung towards mania.

Symptoms of manic states in bipolar patients include restlessness, increased energy, euphoric mood, racing thoughts and provocative behaviour.

Ms Choo described her manic episodes as feeling like James Brown's song, I Feel Good, all the time.

She said: 'That's the treachery of the condition. You mistake mania for recovery as the episode has semblance of health and liveliness.'

After graduation, she moved to Los Angeles. While there and under the influence of mania, she indulged in risky behaviour like having one-night stands, dancing all night at parties and clubs and shopping even when she was broke.

Then she found out she was pregnant. After giving birth to her son in 1996, she suffered severe post-partum depression.

Her mother flew over to Los Angeles to help her look after the baby and to persuade her to see a psychiatrist.

Ms Choo said: 'The psychiatrist told me 'I know you really want to take care of your baby but if you want to take care of him long-term, you should be on medication'.'

She was prescribed a cocktail of sleeping pills, anti-depressants and mood stabilisers.

The boy, now 12, is autistic. But he marked the turning point in Ms Choo's life.

She said: 'He was my anchor back then and he's still the reason I get out of bed regardless of how I feel.'

She started popping five mood stabilising pills every day until 2005. However, she began cutting back on her medication when she tried to buy health insurance and was told she was 'medically uninsurable'.

Later that year, she returned to Singapore with her son. By then, she had cut down her medication to half a pill every other day.

She said: 'Every time I cut down on my medication, I'd watch for symptoms. It's important not to do it alone and to enlist the help of loved ones.'

Keeping busy with work and settling back into Singapore led Ms Choo to forget her pills. Soon she had been off them for a year.

Meanwhile, she found time to pen a book about her experience entitled Five Little White Pills... And Then There Were None: A Journey From Manic Depression To Recovery.

Asked how she has managed to keep her condition under control without medication, she said: 'I don't take medicine anymore because I have a disciplined lifestyle.

'I exercise for an hour every day and I meditate.'

June Cheong

Survivor Obsessed with being thin

2009-06-21T22:14:00.001+08:00

Survivor
Obsessed with being thin

Home > Mind Your Body > In The Know > Story
June 11, 2009

Natalie Tan struggles with anorexia. The 21-year-old has been hospitalised twice and now copes by planning meals three days in advance. JUNE CHEONG reports

Food became a source of both pleasure and loathing for 21-year-old Natalie Tan a year ago.

Her battle is not fully over.

While the National University of Singapore undergraduate is now recovering from anorexia, she still struggles with her weight, which is now 38.3kg.

The 1.54m tall waif said of her conflicted relationship with food: 'I'd visit a lot of food blogs and stare at the pictures in them. I'd tell myself I'll eat when I've dropped 2kg. When I had got to that weight, I'd want to drop another 2kg.'

She added: 'I didn't know how to get out of being anorexic. I just felt stuck and so obsessed with my weight I had no time to worry about anything else.'

Anorexia nervosa, or anorexia, is an eating and psychological disorder. An anorexic patient diets to lose weight and becomes obsessed with losing weight and gaining a sense of control over his or her body.

Miss Tan's wretched journey into anorexia started in February last year. Her then-boyfriend had joined a company selling slimming products. On a whim, she went through the firm's body analysis test.

One of the company's consultants then said she had too much body fat. Miss Tan was flabbergasted as she had always led a healthy lifestyle.

Among other things, she had avoided eating deep fried food, made sure she ate lots of fruit and vegetables at meal-times, jogged and did light weights training.

She recalled: 'After that test, I remember feeling disgusted with myself. I started feeling I was made up of only layers of fat within.'

Miss Tan began dieting, taking meal supplements and whittling down her portion sizes. Soon she became obsessed with counting calories and skipped meals.

By May last year, she was surviving on 200calories a day. The average woman aged between 18 and 29 years with a moderate activity level needs 2,100 calories.

When she attended a sports camp in July, her friends were shocked by how much weight she had lost.

She said: 'They couldn't recognise me. But every time I looked in the mirror, I thought I looked the same.'

Her retiree father, Mr Eric Tan, 53, said: 'It was scary for my wife and I as she just kept losing weight and was not eating.'

Miss Tan's low body weight meant that her body was unable to heal itself when she sustained injuries. A few light knocks she suffered while playing games at the sports camp left her with scars, scabs and bruises which took three weeks to heal.

Her condition also led to insomnia and she would often wake from a night of interrupted sleep with aching bones.

She knew something was wrong with her, yet she still would not eat.

At her lightest, she was 32.9kg. Now 38.3kg, she has a target weight of 43.8kg.

She said: 'When I didn't eat, I had a feeling of control, empowerment and self-discipline.'
When she visited her brother Aaron in Britain in July, she ate but then threw it up.

She said: 'With little body fat, I was freezing even with four to five layers of clothing.' It was summer then and although the weather was not hot, most people wore light jackets.

'I started eating because I was greatly tempted by the food there. Afterwards, I'd feel bad, go to the toilet and throw everything up.'

When she returned to Singapore in August, she deferred university for that semester and was admitted to Singapore General Hospital (SGH) as an anorexic patient for a month.

She had seen a psychologist before she left for Britain at the behest of her parents. The psychologist then referred her to an eating disorder consultant at SGH, who insisted on hospitalising her two weeks after her return to Singapore as she was unable to put on weight.

There, she attended seminars focusing on body image and acceptance of oneself and had sessions with occupational therapists, dietitians and psychologists. Its programme also included cooking sessions to help anorexic patients overcome their fear of food.

Miss Tan said: 'There was something safe about being in hospital. It was a challenge after my hospital discharge because when I ate out, different places served different portions and I didn't know how much oil was in the food served.'

Miss Tan then went back to eating very little. She was re-admitted to hospital for two weeks at her doctor's suggestion.

Emotionally drained

Leaving the hospital the second time, she was more determined to shake off her affliction.
Anorexia had left her with osteopaenia, a condition where the bone mineral density (BMD) is lower than normal peak BMD. She was also emotionally drained.

She said: 'I lost a lot of time and friendships.

'I became insensitive towards my then-boyfriend because I just felt numb to everything. We broke up eventually and the break-up became another excuse for me not to eat.'
Her road to recovery has not been easy. Miss Tan started skipping meals again when she returned to university in January.

She said: 'If people said I looked fatter and better, my mind couldn't process the word better, only the word fatter. It was overwhelming.'

But she managed to nudge herself back to normal eating habits, thanks to a strict meal schedule.

Now, she and her parents regularly sit down together to plan her meals - three days in advance - and her father acts as her 'minder'.

Even then, it was tough going for her and her parents.

Mr Tan said: 'If we missed a meal or she wanted extras and I told her not to take too much for fear of her bingeing, she'd fly into a tantrum like a spoilt child. She'd throw her food away or scrunch up her bread and stamp on it.'

The hiccups she experienced have led Miss Tan to appreciate her family and close friends even more.

She also started a blog about her journey towards health (http://nattietan.wordpress.com/).

She said: 'I want to eat like I used to. I know my relationship with food may never be the same.

'But I don't want to spend the next five years of my life with my weight yo-yo-ing.

'When you have anorexia, you're just existing. You don't enjoy life, people's company or gatherings. It's not living and I don't want that.'

junec@sph.com.sg

Dependence syndromes - The making of an addict

2009-06-21T22:08:00.003+08:00

Home > Mind Your Body > In The Know > Story
June 11, 2009
Dependence syndromes - Cover story
The making of an addict
Experts reveal why some are more vulnerable and that an addict should be cared for like the sick and not be labelled a bad person
By June Cheong

One is the loneliest - and scariest - number to an addict.

Just one 'hit' of an addict's personal manna, be it a cigarette puff, a swig from a beer bottle, or an hour on a computer game, will invariably lead to three or even 10.
Associate Professor Munidasa Winslow, a consultant psychiatrist at Raffles Hospital, said: 'Addictions develop when use of a substance or a behaviour starts to be a compulsion, such that the behaviour is continued despite adverse consequences and when it takes up more and more of your mental energy and time.'

Tolerance of the substance or behaviour comes next.

Professor Kua Ee Heok, a senior consultant in the department of psychological medicine at National University Hospital, said: 'An alcoholic may experience euphoria after drinking one glass of wine in the past but now he must drink two or three bottles to feel the same.'
An addict also shows withdrawal symptoms and his life is now controlled by whatever substance or behaviour he is dependent on.

Dr Tommy Tan, a psychiatrist at Tommy Tan Psychiatric Clinic at Novena Medical Centre, said an addict kept away from the substance or activity gets withdrawal symptoms such as dysphoria (an emotional state marked by anxiety, depression and restlessness), depression, irritability, anxiety and agitation.

Relief from such symptoms comes only when he takes the substance or performs the behaviour.

Addictions to drugs, alcohol and other substances are described as dependence syndromes while addictions to activities like gambling are called impulse control disorders.

These terms correspond to the two types: substance addiction and behavioural addiction.
People perceive addiction as something negative. Yet, Dr Kua said, many people drink beverages with caffeine, such as coffee. This is the most common addiction - or dependence syndrome.

One may be said to have developed a dependence on caffeine if more than three cups of coffee are needed a day.

Dr Tan said: 'Caffeine is one of the world's most used drugs. The stimulant is in our coffee, tea, energy drinks and various soft drinks.

'Many people start their day with a cuppa and continue to drink more through the day. If they don't, they will get irritable or be unable to concentrate and work.

'However, because caffeine is culturally accepted, most people don't see it as an addiction.'

The other common dependence syndromes involve smoking, alcohol and sleeping pills.
Dr Lee Kae Meng, an associate consultant and deputy chief of addictions at the Institute of Mental Health, said nicotine addiction (smoking) and alcohol use are the most common addictions here due to their easy availability.

The National Health Surveillance Survey 2007 revealed that nearly 14 per cent of Singapore residents aged 18 to 69 years smoked every day, compared to 13 per cent in 2004.

There are no official figures for the number of people dependent on alcohol or sleeping pills.

Asked who is most susceptible to developing dependence syndromes, psychiatrists Mind Your Body spoke to said that genetics, family history, culture, personal traits and environmental factors all play a part in the making of an addict.

For example, Indians and Chinese in Singapore are more susceptible to alcohol dependence while Malays are more susceptible to drug dependence.

In addition to socio-cultural factors, genetics may contribute to the formation of certain addictions.

Dr Winslow pointed out that a person is at four times greater risk of becoming an alcoholic if both his parents were or are alcoholics.

Impulse control disorders that are predominant here include gambling and Internet and sex addictions.

A Ministry of Community Development, Youth and Sports survey last year of 2,300 Singapore residents on gambling participation rates found that between 0.7 and 1.6 per cent of survey respondents may have a gambling addiction.

Probable pathological gamblers are more likely to fit the following profile - male, Chinese, aged between 30 and 59, with O level, ITE or VITB education, and has a monthly personal income of between $1,000 and $2,999.

While gambling addictions afflict older adults, Internet addiction is a symptom of this wired age.

A paper last year by Singapore's Academy of Medicine found that among 2,735 secondary school students surveyed, one in five admitted to being constantly online at least five hours a day, a usage the report said was 'compulsive'.

It is not known how many sex addicts there are in Singapore.

Dr Kua said families and friends of addicts should view addiction as an illness.
He said: 'If you see an addict as a sick person, you can care for him. If you see him as a bad person, you want to punish him.'

Whether the dependence is psychological or physical or a treacherous combination of both, the brain has a vital role in maintaining the cycle of addiction
It is the limbic system in the brain that regulates emotional responses and reward systems.

Dr Nagaendran Kandiah, a consultant neurologist at the National Neuroscience Institute, said the neurotransmitter dopamine regulates the reward circuits in the brain. When a person takes an addictive substance like alcohol or marijuana, special neurons in the reward circuits release dopamine.
The dopamine binds to receptors in receiving neurons, providing a jolt of pleasure. Addictive substances increase dopamine's availability, deepening the feeling of pleasure.

Over time, the brain adapts to this increased dopamine by reducing the number of receptors. This results in the addict deriving less pleasure from each hit. He develops tolerance and needs stronger or more doses.

Mr Terrence Smith (not his real name), a retiree in his 60s and a recovering alcoholic, gives a graphical insight into what this neurological process does.
He said: 'I had to live within a whiskey bottle.

'As an alcoholic, you feel good for a few minutes after drinking but you drink more and more. You eventually black out, wet or soil yourself. But the obsession kicks in and you drink again.'

Asked whether it is easier to break a dependence syndrome or impulse control disorder, Dr Winslow said: 'The former are usually easier to treat as substance addicts usually know that they have a problem.

'A full blown behaviour addiction is easier to hide and the individual may fool himself into thinking he can manage or control it on his own.

'This may not be a true reflection of which is more dangerous though.'

Learning to say no - and staying motivated to say no - is key to conquering addiction.

Ms Tan Cin Yee, a certified Quit Smoking consultant and a senior pharmacist at the department of pharmacy at Tan Tock Seng Hospital, said of smokers wanting to quit: 'The smoker must have willpower and be committed to make a change in his current lifestyle and habits. He must also be personally motivated and want to kick the habit.'

While there is a range of cessation programmes, medicines and helplines available for common addictions, most people here do not knock on doctors' doors when they want to shrug off their dependencies.

A case in point: An independent street survey of 200 smokers here in 2007 found that only 15 per cent of them had sought help from medical professionals to quit lighting up.

If one is the loneliest number, then reaching out to others, be they family or the medical community, may lead to freedom from the lonely spiral of enslavement to an addictive substance or behaviour.

junec@sph.com.sg

IMH inmate caused death of fellow patient

2009-06-21T22:00:00.003+08:00

Dear readers,

This is a deadly incident that could have been avoided. Violence is culpable, but measures could have been in place.

IMH inmate caused death of fellow patient
By Khushwant Singh

AN INSULT sparked a fight between two long-term patients at the Institute of Mental Health (IMH) that turned fatal.

Mr Chow Wai Mun, then 41, died of severe head injuries several days after the incident. The coroner court yesterday said his death in June 2006 was caused by a fellow IMH patient Teo Kok Meng, 28.

The coroner classified the death as a culpable homicide not amounting to murder. Because Teo was found to be of unsound mind, he is unfit to stand trial for the crime.

Both patients suffer from schizophrenia. Mr Chow, a bachelor, had been in IMH since 1988 and Teo since 2004.

An IMH report indicated that because of his mental illness, Teo had lost control of his emotions and behaviour at the time of the offence.

He is now being confined in IMH at the discretion of the Law Minister.

A psychiatrist examines him at least once every six months to report on his mental state.

If Teo is eventually found fit to stand trial, he will be brought to court again for the case to resume.

He had admitted to a psychiatrist that he had attacked Mr Chow after the older man insulted him. The court was not told the exact nature of the insult.

On the night of June 20, 2006, both men were doing chores in the hospital and were seen quarrelling.

Ward attendant Simeon Kang told the police he saw Teo push Mr Chow, who fell backwards.

After punching and kicking the fallen man several times, Teo threw a wooden coffee table at Mr Chow.

The table, measuring 1m in diameter, landed on Mr Chow's head, causing his skull to fracture.

Mr Kang tried to intervene and was punched in the head by Teo.

Court papers disclosed that Teo then flung the table against a glass counter behind which Mr Kang was seeking refuge.

The ward attendant had to call for help to subdue Teo before they could get to MrChow.

Mr Chow was taken to Alexandra Hospital and transferred to the National University Hospital, where he died three days later.

Senior Station Inspector Zainal Abidin Ismail told the court that Teo had flung the table in the general direction of Mr Chow and had not aimed to hit the head.

State Coroner Victor Yeo said there was no evidence of bad blood between the two patients prior to the incident.

Although satisfied that Teo had voluntarily thrown the coffee table, the coroner ruled that it was culpable homicide not amounting to murder after considering Teo's state of mind and the circumstances surrounding the offence.

Coroner Yeo also noted that a psychiatric examination on March 16 had determined that Teo's schizophrenia had worsened and he remains incapable of following court proceedings.

Mr Chow's 42-year-old brother attended the inquiry but declined the chance to question Senior Station Insp Zainal Abidin, the only witness, about his brother's death.

Father of Counselling Anthony Yeo died yesterday from cancer complications

2009-06-21T19:02:00.005+08:00

Dear readers,

Another of our best left us. According to the Sunday Times 21 June 2009, Anthony Yeo died yesterday from cancer complications. I think it fit to publish below his compassionate thoughts on suicide and his contributions to Samaritans of Singapore.This is his Foreward to the book "Why? When Both My Parents Took Their Lives" by Yin.

"When someone dear to us dies through suicide, we are left with the agonising ordeal of having to survive the heartrending loss. It traumatises us and leaves us with a profound struggle to make sense of the suicide and learn to live again.

"Suicide survivors" are those who have been left behind after a suicide and their loss and grief tend to be misunderstood and, sometimes, inappropriately responded to by people who seek to offer comfort and support. There are those who want to help but instead of helping, they could be adding salt to injury, amplifying the pain and grief of suicide survivors.

It is also a struggle for suicide survivors themselves to acknowledge, appreciate and adapt to life after a suicide. Many tend to cope in silence and solitude, left with a sense of bewilderment as to what had happened.

Perhaps what is needed is to give voice to those who are suicide survivors and hear their arduous journey towards healing. This is Yin's attempt in offering us the opportunity to journey with her as she shares her story and that of others like her.

I count it a privilegde to be assocaited with Samaritans of Singapore and be offered the opportunity of experiencing this journey through Yin's account of her healing process. HEr cnadid disclosure of her struggles is most engaging, inviting me and you into the inner world of her experience in healing from the trauma as a survivor of her father's suicide.

This first-hand narration of Yin promises not only to enlighten, but also serves as a balm for those working through their own loss and grief.

I am grateful for Yin's contribution to SOS, and for the work of all others who offer a healing ahnd to those left behind in the aftermath of a suicide.

May you journey with Yin and others like her by sharing this books with fellow sojourners who may be experiencing loss and grief.

Anthony Yeo
Chariman and Consultant,
Samaritans of Singapore
Consultant Therapist,
Counseling and Care Centre"

Listen to Dr Alex Su sing

2009-06-14T22:29:00.001+08:00

Dear readers,

The IMH psychiatrist Dr Alex Su is also a professional singer. Hear him sing here:

http://www.tcrmusic.com/general/71.html

Mavis Hee walking tall circa Oct 2008

2009-06-13T23:02:00.001+08:00

许美静走出抑郁症阴霾积极筹备推出单曲

走出抑郁症的阴霾，本地歌手许美静重新回到音乐的跑道。除了写歌之外，她也正积极筹备推出下一张单曲专辑。不久后，她也将到中国参与歌唱演出。

　　许美静昨天在心理卫生学院主办的亚太精神康复会议的开幕仪式上，以一贯动人的歌声献唱成名曲《城里的月光》，赢得了观众热烈的掌声。从她的笑容可能看不出她是仍在吃药、复诊的抑郁症康复者。

　　许美静受访时透露，能在短时间内走出来，多亏自己及早到心理卫生学院接受治疗，也非常感激一直在身边支持她的家人和朋友。

　　2006年，许美静不知何故在本地一家酒店内向酒店访客吼叫，并以英语向他们说：“叫我上帝”。她在事件后进入心理卫生学院就医，被诊断出患有抑郁症，留院治疗一个月。她过后每个月复诊一次。她告诉记者，她向来乐观开朗，不把得失看得太重，为什么会忧郁，她也无法解释。

　　不过，许美静坦然面对自己是精神病人的事实，并依照医生的指示接受治疗。一路上，朋友和陌生人的支持，也给了她很大的推动力。回到工作跑道，虽然面对一些压力，但她尝试慢慢适应。中秋节时，她参与了中国中央电视台的中秋晚会。之前，也参与四川大地震的筹款演出。

　　她说：“我希望他们（其他的精神病人）可以尽快求医。有些人是知道自己病了但觉得不好受，所以不要求医；有些人不知道自己病了。我觉得这两者都可以尽快打电话求助。每个人都有康复的机会，越快求医，康复的机会就越大。期望朋友和家人可以更包容和关爱（精神病人）。”

　　心理卫生学院紧急部门主任苏心荃医生说，许美静目前在心理卫生学院做义工。他认为，许美静是许多精神病患者的最佳榜样，证明患上精神病跟其他病症没有两样，是可以医治的。他说：“人们需要减低对前来接受治疗的恐惧。很多时候，人们以为接受治疗意味着他的前途和事业就此断送，人生就好像有了污点。但这不是事实。精神病人在治疗后痊愈了，还是可以照常生活。”

　　苏心荃强调，虽然药物能有效控制因脑内化学物分泌的精神病导因，但还有一些精神病成因是社会环境造成的。病人定时复诊和服药固然重要，但要让病人重新融入社会，家人和朋友，甚至社会的谅解更不可少。许美静就获得身边友人的支持。

　　自心理卫生学院推出初期精神错乱治疗科（EPIP）以来，有越来越多人认识精神病，并及早治疗。不过，紧急入院病人当中仍有不少已多次入院，其中不少人可能由于不善沟通或情绪失控，让家人误以为他们又病发，而事实可能并非如此。

Dr Alex Su on Acceptance of the Mentally Ill 8 April 2009

2009-06-13T22:57:00.001+08:00

社会的关怀，精神病患的希望

2009-4-8 14:36:00 联合早报网新加坡精神病学科协会主席，叶琦保译

● 苏心荃
　　最近，《联合早报·交流站》（3月28日）发表了读者程玟喜的文章《正视精神病患对社会的威胁》，接着也引起言论版上对这个课题的讨论。

　　精神病虽然就像任何一种疾病，但却得面对更多的歧视。这种歧视通常是因为社会对精神病缺乏了解，产生误解和恐惧所造成的。它导致患病者没有及早寻求治疗，也让已经复原的病患很难重新融入社会。

大多数抑郁症都可康复

　　精神病往往是因为大脑里的生化不平衡，干扰一个人的情绪和思维所造成的。精神病的范围很广，包括轻微的焦虑和由压力引起的症状、抑郁症和精神分裂症等。每一种病症也有不同的严重程度，对治疗的反应也不尽相同。

　　一个全面的治疗方式除了药物之外，也包括给予病患和看护者社会心理支持。大多数患上焦虑和抑郁症的人都能够全面康复和过正常的生活。

　　不幸的是，精神分裂症因为病患可能显示的混乱思考和反常行为（如自言自语），一般会让他受到更严重的歧视。不过，如果及早治疗，大多数精神分裂症患者的病情也能好转。

　　好几个长期性研究显示，高达三分之二的精神分裂症患者取得重大的进展，只有三分之一或者更少的病患情况变得更差。这些研究结果驳斥了精神分裂症患者的病情只会越来越糟的传统观念。

　　很多研究也显示，由精神分裂症患者所造成的社会暴力事件并不多。事实上，精神分裂症患者通常比较离群和喜欢独处。

　　新闻报道往往会把精神病和犯罪暴力联在一起，研究却显示，除了那些在发病前已经有犯罪暴力纪录，或那些同时有滥用药物问题的人，患有精神分裂症的人并不会更具暴力倾向。

　　大多数暴力犯罪事件并不是精神分裂症患者犯下的，大多数精神分裂症患者也不会犯下暴力犯罪事件。

　　医药部门和社区都能提供帮助

　　作为专业的精神病医生，我们要强调，大多数寻求治疗并遵照治疗指示的病人，最终都能康复。在最近几个月造成伤害的例子，并不能准确地反映大多数进展良好的病人的情况。

　　精神病人应该在社区内受到照顾，是世界卫生组织的主要建议，所有发达国家（和城市）都朝这个方向发展。

　　医学的发展已经带来一个普遍的共识，即对大多数的精神病患，长期的关押是错误的做法。以社区为基础的良好照顾，不论是更好的生活素质或者重新融入社会，对病患的健康来说都会有更好的效果。

　　新加坡推出了很多供各种社区热心人士参与的新计划，让他们同病患和看护者接触。同样受到重视的计划包括：帮助人们认识精神病和伸出援手的公众教育；提高人们应对生活挑战的能力；加强社会人士（包括学校、宗教领袖和家庭医生等）的培训，以期及早发现精神病的症状。

　　所有综合医院的心理医药部门、心理卫生学院、私人医药服务和各社区服务（如家庭服务中心），都能为有需要的人提供全面的评估和帮助。由病患、看护者等发起的倡导组织，在提高认识方面也扮演重要角色。

　　然而，这些努力要取得成功，新加坡人必须表现出谅解、关怀和支持。在经济面对困难的这个时候，社会的谅解与关怀更形重要。有抑郁症的人必须尽早求医，不是因为害怕受到歧视而延迟看医生。

　　许多精神病专科人士选择把壮年时期奉献给照顾精神病人的工作。看到病人恢复健康并重返社会是我们最大的满足感。

编辑：李曼颖

Mental Capacity Act Focus Group

2009-06-05T23:22:00.004+08:00

Posted from my greysteppenwolf's mail

Dear members of the Caregivers Support Group

We've received a request from a IMH psychologist who is looking for
participants for his research study on Mental Health and the Law. Please
see the attachment for more information. If you're interested to
participate in the study, kindly contact him directly.

Wishing all of you a great weekend!

Regards
Yen Sing

What do you think of the new Mental Capacity Act?

Heard about the new Mental Capacity Act?

Have something to say about it?

Then please share your opinions in this research study on mental health and the law. We are recruiting volunteers for focus groups and your views may make a difference to law and policy makers who can improve mental health laws to benefit those afflicted with mental health challenges.

If you are 21 years old and above, have received mental health care or took care of someone who has, please contact Gwee Kenji at kenji_IMH@yahoo.com or 8176-8157 (mobile number active after 6 June) to participate.

Inconvenience fee will be given for the time taken to participate in this study. Further enquiries are welcome.

Version dated 23 Nov 2008

The High Dependency Psychiatric Care Unit IMH

2009-05-31T15:44:00.007+08:00

IMH Press Release 21 May 2009

THE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT: HOW INTENSIVE CARE AND
HEALTH EDUCATION TRANSLATE TO BETTER HEALTHCARE AT THE INSTITUTE OF
MENTAL HEALTH

HDPCU, the High Dependency Psychiatric Care Unit at Ward 31A officially opens on 21 May 2009. Funded by the Ministry of Health (MOH) as a Healthcare Service Development Plan (HSDP), its objectives are to provide close monitoring and management of acutely disturbed psychiatric and actively suicidal patients within a safe and secure environment.

What differentiates this ward from the other wards within the Institute of Mental Health (IMH) is its stepped-up intensive care for the severely disturbed which includes close monitoring and frequent assessments of both emotional and physical states. With the use of higher doses of medication, care associated with higher doses of medication needs to be provided all within a safe and secure environment. And this is achieved through the intensive care implemented with a nurse-patient ratio of 1 nurse to 1 or 2 patients. With continuous monitoring, psychosocial interventions and health education on illness and treatment counselling sessions to patients and their families, HDPCU aims to achieve faster recovery therefore reducing patient hospitalisation days for this group of patients.

It has been demonstrated abroad in close-observation units in the UK, Canada and Australia since the 1970’s that such care leads to a decrease in staff and patient accidents, a decrease in constant observation and seclusion hours and a decrease in the number of nursing hours lost to injuries at work. Such consistency and control within the unit means that higher patient safety standards and shorter hospitalisation stay are possible. The following are the value-added features of the ward and its services:

Fully air-conditioned 10 beds separated into 2 rooms consisting of 6 beds for male patients and 4 beds for female patients. Nurses are able to view all beds from the Nurses’ Counter. Each male and female room is equipped with bedside medical equipment for prompt response to any medical emergency.

Recreational activities are used – with an emphasis on relaxation techniques such as music or art and craft activities using piped-in music; and board games which help refocus the individual’s mind, such as chess, scrabble, carom and physical exercise. An Activity Room with a 37-inch flat screen TV allows patients to catch up on the latest news or their favourite drama series. And, a cosy Visitors’ Room allows for private family sessions

Trained nurses in the management of psychiatric patients, encompassing de-escalation techniques which equip them with the skills and mental preparedness to assist when patients are aggressive as well as control and restraint techniques.

Inclusion and exclusion criteria to identify patients who will benefit most from HDPCU interventions. Patients from IMH’s other wards, Emergency services and Satellite Outpatient Clinics are reviewed by the HDPCU Specialists before transfer to HDPCU for treatment.

CCTV at strategic locations for close continuous monitoring, with all areas accessible only with the Staff Access Card. At least one nursing staff is in
each cubicle at all times. Each nurse carries a panic-alarm device that will
activate the same block wards as well as the hospital security personnel.......

FACT SHEET -THE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT (HDPCU)

Patient Demographics

HDPCU manages patients from ages 19 to 65 years who suffer from Schizophrenia, Bipolar Disorder, Major Depressive Disorder and Anxiety Disorders.

Ward charges

Because the HDPCU is a ‘classless’ ward, charges at HDPCU will vary depending on the
class of the wards the patients were staying prior to transfer to HDPCU.

List of charges applicable to Singapore residents in Singapore Dollars are as follows for each day of stay at the HDPCU:

Ward Stay costs per day Treatment Fee
A1 $325 $60
A2 $300 $60
B1 $245 $50
B2 $75 $20
C $40 $15

A1, A2 and B1 denote patients from private care. These patients would need to pay the full amount of the ward and treatment fees. B2 and C denote patients who are fully subsidised under the programme --these patients have undergone means testing to verify their income levels for suitability to receive subsidies.

HDPCU has been in operation since 15 December 2009 and the occupancy rates for the
10-bedded ward are:

Dec 08 Jan 09 Feb 09 Mar 09
Days in operation per month 17 31 28 31
Patient days (cumulative) 66 171 139 201
Occupancy rate 39% 55% 50% 65%

Who are on the team at HDPCU

Headed by Project Director, Dr Chua Hong Choon, IMH’s Vice Chairman of Medical Board
and Co-Project Director, Dr Prema K, Director of Nursing Administration, the medical and nursing teams consist of the following:

Medical team:
Dr Alex Su, Consultant and Acting Chief of General Psychiatry 1
Dr Thong Juinn Yew, Associate Consultant
Dr Habeebul Rahman, Registrar

Nursing leads:
Ms Soh Lee Choo, Senior Nurse Manager, Nursing
Administration
Mr Aziz Abdul Hamed, Nurse Clinician, Nursing Administration

Allied Health leads:
Ms Clare Yeo, Head and Principal Clinical Psychologist
Ms Chan Lay Lin, Principal Medical Social Worker

Veteran counsellor Anthony Yeo has lymphoma

2009-05-30T14:43:00.002+08:00

(CNA) -- Veteran counsellor Anthony Yeo, 60, has been hospitalised with lymphoma, a cancer of a type of white blood cell that fights off infections in the body.
News of his illness was announced on Thursday on the website of the Counselling and Care Centre, where he is a consultant therapist.

The centre said it was unable to give more details on his condition, and his family has declined comment. An announcement on the centre's website said Mr Yeo, often referred to as the 'Father of Counselling' in Singapore, is not ready for visitors and would prefer to spend time with his family.

Those who would like to convey their get-well wishes may send their cards to the Counselling and Care Centre in Hong Lim Complex. Mr Yeo joined the centre fresh out of university in 1972, and rose to become its first local director in 1980. He was only 32 then.

He pioneered formal training for counsellors here and has trained close to 1,000 counsellors. An energetic speaker, he has always advocated paid sabbaticals for those in his profession and proper professional recognition in the form of licensing and registering of social workers.

Lymphoma is also what struck both Prime Minister Lee Hsien Loong and the late president Ong Teng Cheong in 1992. Mr Ong died in 2002 at the age of 66.

S’pore gears up for SILVER TSUNAMI

2009-05-30T14:29:00.002+08:00

From
http://www.ngejay.com/?p=2772

May 25, 2009 by admin

ST link

# 2,000 more nursing home beds in five years
# Eldersave, ElderShield, Elderfund being developed
# Manpower expansion and training in health care
By Salma Khalik

IN THE coming decade, Singapore’s health-care system will come under pressure from an ageing population coupled with an increase in mental ailments.

To cope, the Health Ministry will add more than 2,000 nursing home beds over the next five years - with about half devoted to the care of the mentally ill.

In the Health Addendum to the President’s Address at the opening of Parliament on Monday, Health Minister Khaw Boon Wan spoke of the need to prepare for a ’silver tsunami’.

The population here is ageing rapidly. The number of people who are over 65 years old is expected to treble to 900,000 by 2030 - from 300,000 today.

This is the driving force behind the development of a second heart and cancer centre, a new general hospital in Yishun and another in Jurong, and the expansion of the National University Health System’s dental centre.

‘We will increase our subventions to intermediate and long-term care facilities to help them meet growing patient needs,’ said Mr Khaw.

These include community hospitals, nursing homes and hospices. New rates for community hospitals will take effect on July 1, that will see total subsidy go up by 15 per cent.

Work on five new nursing homes will start within two years, including a 300-bed home for patients with psychiatric problems to be ready by 2012.

Dr Tan Weng Mooi, chief operating officer for the Institute of Mental Health (IMH) said such a home is an important part of integrated community care for patients suffering from schizophrenia, mental retardation or bipolar disorder.

She said: ‘IMH’s philosophy is that those with mental illness should be allowed to stay on their own or with their families for as long as possible.’

But there might come a time when they need full-time care, but because their conditions are stable, do not need to be warded at IMH.

There are now three nursing homes that cater to such patients.

Another two new homes, each with 250 beds, will be designed for people suffering from dementia.

These homes will also take in other elderly patients.

A Ministry of Health spokesman said there are now about 20,000 elderly people in Singapore with dementia.

‘This is estimated to increase to about 45,000 by 2020,’ she said.

People with dementia suffer from loss of memory to the point where they are no longer able to do simple things like dress themselves or even eat. If diagnosed early, there is medication that could slow the progression of the disease.

Nursing homes for them need to provide lots of cues - such as signs, colour code and even music - to connect particular rooms with certain activities.

The ministry will also be releasing two plots of land for the building of private nursing homes. And it will help two existing homes run by voluntary welfare organisations (VWO) to relocate to new and larger facilities.

To help patients pay for all these services, the ministry will develop the 3Es - Eldersave, ElderShield and Elderfund.

Elderfund, set up as Medifund Silver in 2007, helps the elderly poor pay their hospital bills, while ElderShield is insurance for severe disability.

Eldersave is a new concept to help young people set aside enough of the Central Provident Fund money to provide for their health-care needs when they are old.

With so much in the pipeline, the ministry says it will need to recruit 4,500 people over the next two years, with 2,000 job openings in the next 12 months.

‘Manpower expansion must precede infrastructure expansion,’ the minister explained.

Manpower training in health care will be given a boost when the third medical school at the National Technological University opens.

Mr Khaw also touched on palliative care or the management of pain, and the need to let the elderly sick die with dignity, a theme he has touched on several times this year.

He said: ‘We will also build up capabilities on end-of-life care and expand the pool of palliative care specialists.’

salma@sph.com.sg

Don't grieve for me

2009-05-30T14:22:00.004+08:00

From
http://www.straitstimes.com/Breaking%2BNews/Asia/Story/STIStory_380692.html

SEOUL - FORMER South Korean president Roh Moo-Hyun told his family not to grieve for him before plunging off a cliff early Saturday in an apparent suicide, news reports said.

'Please don't have sorrowful feelings. Aren't life and death one and the same?' YTN television quoted the note as saying.

'Please cremate my body. Please erect a small tombstone for me at the village.' An aide to the former leader, who held office from 2003-8, said Mr Roh had jumped from the cliff near his retirement village at Bongha close to the south-east coast.
javascript:void(0)
Mr Roh, 62, was questioned last month as a suspect in a multi-million dollar corruption case.

'It has been so tough,' the note reportedly said. 'I caused so much trouble to many people.'

Mr Roh had gone hiking with a bodyguard early on Saturday. He jumped while the guard's was distracted, according to Yonhap news agency.

He was taken to a nearby hospital in a very serious condition and moved again to Busan National University Hospital, where he was pronounced dead.

An official with the Busan University Hospital where Mr Roh's body was taken said at a televised news conference the cause of death was head injuries. 'Head injuries were the direct cause of his death. Many bones were broken, including ribs and pelvis.'

'Former President Roh left his house at 5.45am (2045 GMT, 4.45am Singapore time) and while hiking on the Ponghwa Mountain, appears to have jumped off a rock at around 6.40am (5.40am Singapore time),' Moon Jae-in, who was Mr Roh's presidential chief of staff, said in a nationally televised statement.

Police said they were investigating whether Mr Roh killed himself. -- AFP

P.S. If you're thinking of suicide, read this first
http://www.metanoia.org/suicide/

A life spent studying death

2009-05-30T14:11:00.001+08:00

From
http://health.asiaone.com/Health/News/Story/A1Story20090423-137117.html

Fri, Apr 24, 2009
The Straits Times

DR CHIA Boon Hock, 73, is Singapore's resident suicidologist and a walking repository of research on the motivations, methods and meanings of suicide.

He has spent his life poring over coroner's reports, collecting data and trying to demystify what drives people over the edge.

He recently finished analysing hundreds of suicide letters left behind by Singaporeans between 2000 and 2004 for the renowned journal, Archives Of Suicide Research. He also contributed a chapter on Singapore to the 2008 book, Suicide In Asia.

In 1968, he became the first psychiatrist here to go into private practice. Besides a medical degree from Hong Kong University, he also has a doctorate on suicide from the University of Singapore.

He estimates that about 90 of his patients have killed themselves out of the 5,000 he has treated over a 20-year period.

Now semi-retired, he works an 11-hour week at his private practice, plays golf, practises the piano, learns Mandarin, does gardening, plays with his three grandchildren and analyses data on suicide as a hobby.

He is married to a housewife. They have two children who are both doctors.

a22

Tzu Chi volunteers' outreach

2009-05-12T21:55:00.003+08:00

From
http://www.tzuchi.org.sg/en/News/2009/20090222.html

How will you spend your weekend morning? Will you be lazing in bed? Or still having hangover from the late night party the night before? Or will you be meeting friends to have a nice brunch?

On Feb 22 early morning, 10 volunteers including two young ones met in one of the pavilions in Circuit Road. After a short briefing by volunteer Wu Yu Chin, they came to a unit on the ground floor.

From the cordial greetings between the volunteers and Mr. Chan, the owner of the house, one can tell that they had known each other for a very long time and they have a very warm relationship. Volunteers brought along things like brooms and rugs and everyone started work right away. Some scrubbed the floor; some cleaned the toilet while others cleared the trash. There was also another volunteer there to give hair cut for the care recipients.

Sincerely caring for everyone

Both Mr. Chan and his mother are patients of the Institute of Mental Health (IMH). His mother’s condition is more serious – she would stare blankly and sit on the floor throughout the day. She cannot take care of her daily life and does not know how to use the toilet. Thus the house is always very messy and filthy. They are on long-term medication and require follow-up visits to the Institute of Mental Health. They depend on government subsidies for their living expenses. Chan's younger brother has a regular job, but he cannot manage the household while caring for his older brother and mother.

Tzu Chi took in the Chan family as care recipients in 2006. In the beginning, volunteers were shocked to find out about the piles of unused stuff and the very unhygienic environment in the house. Worrying it may cause a fire, they initiated a spring cleaning for the Chan family but it was turned down. However, with a lot of persuasion, care and concern shown to the Chan family over time, Mr. Chan finally agreed to let the volunteers to help clean up their house. This was also after the volunteers brought many bottles of soft drinks to him after knowing Mr. Chan loves soft drinks. Since then, volunteers have been helping in cleaning up the house on a periodic basis and they call Mr. Chan as the “Brother Soda”.

“When did we start coming to help you clean up the house?” asked Cai, a volunteer.

“In 2006.” Mr. Chan replied immediately. He also remembered he was not so friendly towards the volunteers in the beginning.

Patience and tireless guidance pay off

In order to encourage the Chan family to participate in recycling and therefore reduce the amount of trash, Yu Chin made posters especially for the Chan family to explain and educate them about the different types of recyclables. She put the posters in a prominent place in the kitchen so that they are reminded everyday. Whenever volunteers come, they will patiently remind the Chan family to not create too much rubbish and improve the hygiene at home.

Since Mr. Chan loves to drink soft drinks, previously volunteers used to collect four big bags of empty, flattened soft drinks bottles whenever they came to do spring cleaning. However, this time they were pleasantly surprised to see that they did not even have a bag full of it. The amount of bottles has reduced almost 80 percent!

The kitchen sink used to be filled up with unwashed plates and bowls. But now they only found two used cups and one bowl. In the kitchen cabinet, they also did not find any empty cup noodles or Styrofoam boxes from the takeaways.

“Do you know why your house is so much cleaner now?”

“My younger brother takes out the rubbish and he also sweeps the floor.”

“Why isn’t there any of those disposable chopsticks anymore?”

“(It’s because) whenever I buy takeaways, I do not take disposable spoons and chopsticks no more.”

Yu Chin was touched to hear Mr. Chan’s replies. Very clearly, Mr. Chan has taken in the volunteers’ long-time advice. This is the result of three years of patience and continuous reminder and guidance. Till date, the volunteers have carried out more than 10 spring cleanings and through that, they have won over Mr. Chan and his family. Meanwhile, Mr. Chan, who used to take soft drink as water, has since drank green tea instead.

No fear in helping

“Yes!” a definite YES answer when asked if Mr. Chan like to see the volunteers.

Among the volunteers, there were a few who were participating for the very first time in home visits and helping out in spring cleaning. Thoo Moi Seng and Kan Chee Heng were among the first timers.

When both of them opened the refrigerator in Chan’s house, they were taken aback by the stench smell. It was filled with all kinds of things and looked as if it has never been cleaned before. Many of the food in it were already rotten. But they had no qualms and they patiently cleaned up everything.

Another volunteer, Yap Hui Kee, was also a first timer. Though Yap is very particular about hygiene, she quickly got the mop and cleaned the floor when she saw Mr. Chan’s mother soil the floor.

Though Yew Chui Fong has joined Tzu Chi for a few years already, this was her first time helping a care recipient with haircut. The Chans do not pay attention to their personal hygiene and therefore their hair was messy and dirty. This did not startle Yew but instead she happily gave them a fine and neat haircut. She even told Yu Chin later to not forget to ask her to come along in the next home visit.

When everyone finished cleaning up, they got Mr. Chan to help mop the floor. Upon seeing him wetting the ground, volunteer Wong Chong Wee quickly came forward and showed Mr. Chan how to clean it the proper way.

The continuous care and concern shown to the care recipients reflect well on Tzu Chi’s charity mission. Master Cheng Yen encourages the volunteers to reach out to public and help those in need. Meanwhile, through helping others, we learn to appreciate what we have and be contented. This is especially pertinent during this economic gloom period.

Tembusu Home for mentally unwell destitute

2009-05-11T15:01:00.003+08:00

Tembusu Home at Pelangi Village
Dear readers,

Tembusu Home at Pelangi Village is a residential home for mentally unwell destitute.

From

http://www.4s.org.sg/ourprogrammes.html

Managed by 4S since June 2002, the Tembusu Home at Pelangi Village is a 7-storeyed Welfare Home set up by MCYS under the Destitute Persons Act. It is one of the six homes within Pelangi Village and has a bed capacity of 200. It provides shelter, care and rehabilitation for mentally incapacitated male destitute persons.

The Home is named after the Tembusu tree, which symbolises evergreen beauty, longevity and the ability to weather storms. The Home aims to emulate these qualities by providing a supportive environment for the maintenance and promotion of the physical, psychological and social well-being of the residents.

The Home’s programmes focus on training in social and independent living skills, with emphasis on personal grooming and hygiene, pursuit of religious persuasions, personal enrichment and social development

Depression in Teenagers

2009-04-24T09:31:00.001+08:00

Posted by Possum on e-sangha.com in the thread "Depression Resources"

DEPRESSION IN TEENAGERS

These pages provide an introduction to the problems of depression in adolescence. In significant ways, teenage depression and its treatment differ from the experiences of adults.

“Teen Depression: A Guide for Parents and Teachers”

Teenage depression isn’t just bad moods and occasional melancholy. Depression is a serious problem that impacts every aspect of a teen’s life. Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. Fortunately, teenage depression can be treated, and as a concerned parent, teacher, or friend, there are many things you can do to help.

In This Article:

* Understanding teen depression
* Signs and symptoms
* Effects of teen depression
* Suicide warning signs in teenagers
* Helping a depressed teenager
* Risks of teenage antidepressant use
* Supporting a teen through treatment
* Taking care of the whole family
* References and resources

Caution: Please read the section “Risks of teenage antidepressant use” very carefully.

http://www.helpguide.org/mental/depression_teen.htm

“Teen Depression: Tips and Tools for Helping Yourself or a Friend”

The teenage years can be tough, and it’s perfectly normal to feel sad or irritable every now and then. But if these feelings don’t go away or become so intense that you can’t handle them, you may be suffering from depression. The good news is that you don’t have to feel this way. Help is available—all you have to do is ask. You also have more power over depression than you think. There are many things you can do to help yourself or a friend start feeling better.

In This Article:

* What depression feels like
* Dealing with suicidal thoughts
* What you can do to feel better
* Talking to your parents
* Helping a depressed friend
* Related links

http://www.helpguide.org/mental/depression...n_teenagers.htm

******

“Sober Coaching Your Teen”

This is a very detailed presentation, a website that offers information on substance abuse and a variety of links.

http://www.sobercoachingyourteen.com/

Music therapy cannot cure diseases, but can speed the healing process

2009-04-23T09:58:00.001+08:00

Music therapy cannot cure diseases, but can speed the healing process
(The Straits Times, Mind Your Body)
2 December 2007, Wednesday

BY WONG SHER MAINE

A visiting foreign national, who claimed to be a music therapist, recently sold CDs in Singapore priced between $400 and $1,000.

He claimed the music on them could “cure” diseases and ailments.

Members of the newly formed Singapore Association of Music Therapy were quick to denounce him as a “mercenary charlatan”.

Music therapists pooh-pooh the notion that ills can be cured by putting on a generic CD of soothing music.

“This person is not a qualified music therapist,” said the association in a statement to the press.

“While passive listening to music is one of the many ways in which music is used, more often than not, active interventions are used, like playing instruments, singing, improvising, composing.”

Trained music therapists take pains to find out about their patient’s history, make a diagnosis of what would help the patient and then make a musical prescription.

In Singapore, there are few bona fide music therapists as music as a form of clinical therapy is not viewed seriously.

But the practice is gaining a foothold. The association, with 11 members, aims to increase public awareness and to serve as a contact point for local music therapists.

In January, the Singapore General Hospital (SGH) – where music therapist Dr Patsy Tan is based – started a music therapy programme for hearing-impaired children called Music To The Ears.

Apart from SGH, the small music therapy community here mostly operates outside hospitals and is centred on treating special-needs children in the special schools or at-risk youth.

It is a good start.

Music therapy can help to cut down medical costs. For instance, music can act as a substitute for pain relief medication.

According to a New York Times article published in 2001, United States scientists discovered that Muzak, piped into a New York City intensive care unit, seemed to help lower the mortality rate 8 per cent below the national average.

The same article describes how lullabies played in a neonatal nursery might have helped premature infants gain weight and speed their discharge from dependency units.

Rhythmic music with a strong beat has also proven powerful in treating those with neurological disorders like stroke, cerebral palsy and Parkinson’s disease.

Music can also address behavioural issues.

For the past two years, Ms Ng Wang Feng, 30, a freelance music therapist, has been helping at-risk youth at Beyond Social Services with their self-esteem, concentration abilities and listening skills, by getting them to sing in a choir.

“Unlike a music teacher, my focus is not on the music, but on using music as a means to achieve therapeutic goals,” said Ms Ng, who spends just as much time counselling the teenagers as she does singing songs like Imagine by John Lennon. She selects songs not only for the melodies but also for their meaningful lyrics.

She will soon start work with the National Cancer Centre, helping cancer patients with pain management.

However, music cannot replace conventional types of care.

Dr Tan stresses that it is crucial for music therapists to work in tandem with doctors as part of a team for best effects.

“Music therapy is not a cure,” she said. “If you have cancer or Alzheimer’s disease, music cannot cure you, but it can help you to adapt to the situation better.”

Find out more about music therapy at the Association for Music Therapy (Singapore) website at http://singaporemusictherapy.wordpress.com or by calling 8223-1736

Meditation provides hope for people with depression

2009-04-23T05:24:00.000+08:00

From
http://tech.groups.yahoo.com/group/psychiatry-research/

Meditation provides hope for people with depression
April 21st, 2009 in Medicine & Health / Psychology & Psychiatry
Meditation provides hope for people with depression

(PhysOrg.com) -- People with severe and recurrent depression could benefit from a new form of therapy that combines ancient forms of meditation with modern cognitive behaviour therapy, early-stage research by Oxford University psychologists suggests.

The results of a small-scale randomised trial of the approach, called mindfulness-based cognitive therapy (MBCT), in currently depressed patients are published in the journal Behaviour Research and Therapy.

28 people currently suffering from depression, having also had previous episodes of depression and thoughts of suicide, were randomly assigned into two groups. One received MBCT in addition to treatment as usual, while the other just received treatment as usual. Treatment with MBCT reduced the number of patients with major depression, while it remained the same in the other group.

MBCT brings together modern cognitive behaviour therapy with the ancient practice of mindfulness meditation. Participants are given classes that include meditation learning, education about depression, and advice on how best participants can look after themselves when their feelings threaten to overwhelm them. One way that the treatment benefits people is helping them to live more in the moment, rather than be caught up in upsetting memories from the past or worries about the future.

Professor Mark Williams and colleagues in the Department of Psychiatry at the University of Oxford will follow up the promising preliminary evidence from this small-scale study. They hope to do follow up work with patients to reveal whether MBCT can also help reduce the risk of relapse. The Oxford team are currently carrying out a larger study that will compare MBCT with a group form of cognitive therapy to pinpoint which elements of meditation or talking therapies can help which people.

The study coincides with National Depression Awareness Week. More than one in five people will become depressed at some point in their lives, and each year more than 5000 people in the UK die by suicide. Although depression is a common problem, there is still much to learn about the best ways to support and treat sufferers. Once a person has been depressed several times, their risk of becoming depressed again is high, without appropriate treatment and support, and many people live in fear of another episode.

Professor Williams, who developed the treatment and led this study, said: ‘We are on the brink of discovering really important things about how people can learn to stay well after depression. Our aim is to help people to find long-term freedom from the daily battle with their moods.’

People who would like to be involved in these studies can get more information at www.staying-well.org .

Provided by Oxford University (news : web)
http://www.physorg.com/news159550358.html

Posted by
Robert Karl Stonjek

SAMH Support Group Session on Manic Depression

2009-04-22T22:16:00.002+08:00

Dear members of the Caregiver Support Group,

We are pleased to invite you to attend our upcoming Caregiver Support
Group session for the month of April 2009. The details are as follow:

Topic: Sharing by Ms Choo Kah Ying
Author of Five Little White Pills...and Then There Were None:
A Journey from Manic Depression To Recovery
(The book costs SD$16.00)

About the Speaker:
Formerly an academic researcher in the U.S. for eight years, Ms Choo
is a writer/educator and a homeschooler of her 12-year-old autistic
son. She has also recovered from bipolar disorder after a challenging
15-year journey. Rising above the odds, Ms Choo has combined her
academic training and work with her life experiences into
inspirational and practical books and workshops.

Date: 30/04/2009 (Thursday)

Time: 7.00pm to 9.00pm

Venue: Toa Payoh Central Community Club
[Opposite Toa Payoh Library]
No 93 Toa Payoh Central Seminar Room #05-05
[Nearest MRT: Toa Payoh Station]

If you have any queries, please contact us via email or contact Ms
Christine Tan @6255 3222 on Monday and Thursday (12pm to 6pm).

Looking forward to seeing you.

Best Regards,
Voon Yen Sing (Ms)
Senior Counsellor
Singapore Assn for
Mental Health
Insight Centre

Suicide peak ahead

2009-04-22T22:14:00.000+08:00

April 22, 2009
ST.com News: Suicide peak ahead

IF THE downturn deepens, Singapore should brace itself for a rise in suicides. And it should do all it can to prevent the increase from starting now, warns Dr Chia Boon Hock.

Singapore's resident suicidologist, who has spent 40 years collecting and studying suicide data, says there have been four major suicide peaks here over the past 100 years.

Notably, three of these happened just after major recessions, when financial woes and unemployment took their toll. The other came in wartime.

The first was during the 1906 to 1910 Bankers' Panic financial crisis, which saw the suicide rate surge 71 per cent to 11.3 per 100,000 people.

The second peak was in the aftermath of the Great Depression, from 1936 to 1940, when the toll swelled to 15.8 per 100,000 people. ...

Click here for to read the full story.

Or cut and paste this URL in your browser:
http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_366891.html

Copyright © 2009 Singapore Press Holdings Ltd. Co.

Steve Pavlina, personal development guru, on depression

2009-04-18T06:59:00.001+08:00

Excerpts from the article:

Link: http://www.stevepavlina.com/blog/2006/06/overcoming-depression/

Depressed people often seem to have good reasons for feeling down, and from the outside looking in, those reasons may appear perfectly valid. If you’re dealing with financial scarcity, health problems, or other unwanted challenges, then any reasonable person might easily look at your situation and agree, “Yup, that’s depressing.”

I’m not going to insult your intelligence by saying your problems aren’t that bad. On the contrary I imagine that your situation may be downright awful, giving you every right to feel depressed. I can empathize with what you’re going through because I’ve been there myself. I know how horrible it is to feel bad most of the time, to have a life filled with negative results, and to feel powerless to change any of it. I’ll share a personal story about that later.

If you currently find yourself in such a situation, you have my compassion. But more importantly, I have a solution to share with you.

I think you’re smart enough to know that there’s no shallow quick fix for what you’re going through, but there is a workable solution. Your depression is by no means permanent.

This solution will work if you take the time to understand it and apply it, using whatever energy you’re still able to muster. This isn’t an all-or-nothing solution, so even a partial implementation will yield partial results. Best of all, you don’t even need to take any direct physical action. You can do the whole thing lying motionless on your bed.

The upside is that once you permanently overcome your depression, you’ll be able to use your experience to help many other people.

So as difficult as it may be to endure right now, there may come a day when you look back on these times as a tremendous gift. That has certainly been true for me.