JUNE-SEPTEMBER 2018 JUNE-SEPTEMBER 2018

A MAGAZINE ON MENTAL HEALTH

WEATHERING THE Storm WHY RESILIENCE MATTERS, AND WHAT YOU CAN DO TO CULTIVATE IT

MYTHS BUSTED! SETTING THE FACTS STRAIGHT ON PSYCHIATRIC BIPOLAR MEDICATION DISORDER: NAVIGATING THE UPS AND DOWNS

>> EXPRESSIONS: HARESH SHARMA’S OFF CENTRE AT 25 — KEEPING THE DIALOGUE ON MENTAL HEALTH OPEN 12 FamilyIndividual Counselling Matters for Family Members 22 Ask the experts Clinicians answer your questions Are you living with someone who has addiction issues?

For every person who has an addiction issue, at least four others close to him or her are impacted. It is challenging to care for someone with addiction problems. Families often feel stressed and helpless. Caregivers have their own needs and may suffer from physical and emotional problems. They require support too, especially when their loved ones with addiction issues are not ready to seek treatment. CON You do not have to feel alone. Our team of dedicated specialists is here to listen and support you in managing your situation better. TENTS FEATURES REGULARS JUNE - SEPTEMBER 2018 There is hhelpelp anandd hhope.ope. 8 FOCUS 3 MY SAY Why resilience is a vital Para-athlete Wong Zhi Wei Talk to us today. Call 6-RECOVER (6-7326837) for assistanceassistance.. quality to have, and how to on how having the right nurture it within ourselves. attitude has helped him 18 to succeed. 14 What we ought to know about bipolar disorder and 4 LIVE WELL how it can be managed. What’s new in mental health research, and 12 EXPRESSIONS tips on maintaining Playwright Haresh Sharma your mental well-being. looks back on his ground- breaking work on mental 22 ASK THE EXPERTS illness, Off Centre. IMH clinicians answer your questions. 20 INSIGHT Separating the 23 IMH SCENE myths from facts A round-up of news about psychiatric and events centred on medication. mental healthcare.

PROFILES LAST PAGE

17 I SERVE 24 BEAUTIFUL MIND 04 A GP talks about his While being happy can make experiences in dealing with you smile, smiling can make mental health issues in a you happy too! community setting.

18 A LIFE IN MY DAY 08 “IT IS DIFFICULT TO How journaling and PREDICT WHO IS family support helped a RESILIENT AND WHO IS woman with schizophrenia NOT UNTIL THEY ARE regain control of her life. TESTED BY CHALLENGING www.nams.sgams.sg CIRCUMSTANCES.” Associate Professor Daniel Fung, Chairman of IMH’s Medical Board and a child psychiatrist.

JUNE-SEPTEMBER I 1

CHAT ad for IMHAGINE FA.indd 3 6/8/18 11:54 AM EDITORIALnote interview I MY SAY

wimming started In class, I use a magnifying really important WHERE THERE’S as a hobby. I’ve camera so I can see to take charge of loved being in what’s written on the the mind in intense the water since whiteboard better. moments such I was four, and While some peers as these. It’s A resilient person I’ve always had can be hard on me also crucial to is someone who a will... an affinity for with their discouraging tune out other it. It de-stresses remarks, I also have distractions such demonstrates an t some point in our lives, most of us would Sand calms me. I started competitive many good friends who as your competitors. swimming when I was 13. Making it acceptance of the have had to deal with setbacks. These can are supportive. Navigating I find that if I stay to the winner’s podium at the 2017 extremely focused take various forms — injury, financial loss, the school blind in one eye is more reality of his situation ASIAN Youth Para Games in Dubai challenging, but it has made me — my mind at ease and A death of a loved one. Yet there is a great deal — I clinched three gold medals (see stronger. I am all the more motivated uncluttered — I am able to and that some things of variation in how individuals ultimately deal box), two silvers and a bronze — was to not rely on others for help in perform better. have changed beyond with adversity. Some buckle under the strain while others extremely satisfying. All the time and spite of my disability; it has made My main aim is to further improve his control. He shows ‘bounce back’ and even thrive in the face of it. A key factor effort spent in training before and me independent. my timing at the 2018 ASIAN Para a willingness to keep a at work here is resilience — a combination of thoughts, after school, eight times a week, The stress of competition can Games held in Jakarta this October. behaviours and actions that help individuals overcome felt worth the while. at times get to me, To win medals would be a bonus. balanced and hopeful hardships. And while it may seem that some people are Winning has made me Work hard and as it would most Ultimately, I hope to qualify for the perspective and the ‘naturally’ more resilient, it is in fact something that can be feel more confident of athletes — para 2020 Paralympic Games in Tokyo. ability to problem- learned and developed. Our latest cover story (page 8) looks what I am capable of focus on your or not. To manage That would be a dream come true. at this vital quality, and strategies each of us can adopt to in spite of my dream. Some this, I listen to pop To others aspiring to pursue their solve and improvise nurture it within ourselves. partial blindness. music pre-race. goals, here’s a piece of advice that sacrifices will solutions. He is This theme of resilience is echoed in our profiles this I’ve always attended I also visualise the I subscribe to: Work hard and focus also resourceful in issue — from visually-impaired para-swimmer Wong Zhi Wei a regular school. I’m have to be made race right down to on your dream. Some sacrifices will (page 3), who has pushed through obstacles to achieve his currently a Secondary along the way, the technicalities have to be made along the way, but tapping on his social sporting goals, to Sumaiyah Mohamed (page 18), who has 4 student at Catholic such as my strokes don’t ever give up. Push through no High School, where but don’t ever and breaths. It’s matter how big the obstacle in front support network.” not allowed her schizophrenia diagnosis from impeding her dreams of earning a university degree, getting married and I am on the Integrated give up. of you may seem.” MS CHERMAIN WONG, raising a family. Programme (IP) track. This means that I am Senior Clinical Psychologist and Deputy Also in this issue, we look at mental healthcare services Wong Zhi Wei was born blind in his right eye and has Head of IMH’s Mood Disorders Unit forgoing sitting for O-levels to available in the community. We put the spotlight on General 6/60 vision in his left. At the 2017 ASIAN Youth Para dovetail into the A-level curriculum. Games, Zhi Wei bagged gold in the Men’s 100m Freestyle Practitioners (GPs), who are often our first point of contact This gives me more time to participate S11-13, Men’s 400m Freestyle S11-13 and the Men’s when we are unwell. But not many of us are aware that in a broad-based curriculum that goes 100m Butterfly S11-13 categories. Para-swimming events GPs can help with our mental health needs too. We speak beyond just academic content while are classified according to disability levels. The S11, S12 to a family physician (page 17) who has partnered IMH I train for upcoming competitions. and S13 categories are for athletes with visual impairment, to provide mental healthcare in a convenient setting of a with S11 being the most severe. neighbourhood clinic. Ultimately, what we need to remember is that there’s no need to suffer in silence. Speak up, reach out and get help — the earlier you do, the smoother your road to recovery Visually-impaired para- will be! STAYING swimmer Wong Zhi Wei, Happy reading. 16, on pushing through to IN FOCUS overcome challenges, his the editorial team disability, as well as his nerves before and during a race. WONG ZHI WEI INTERVIEW FAIROZA MANSOR // PHOTO COURTESY A publication by Every care has been taken in the OF SINGAPORE DISABILITY SPORTS COUNCIL Editorial Team Singapore production of this magazine, but IMH the visually-impaired Lalitha Naidu publisher, and its employees assume no para swimmer Ting Mei See responsibility for any errors, inaccuracies or omission arising thereof. Opinions

JUNE-SEPTEMBER 2018 JUNE-SEPTEMBER 2018 expressed by contributors are not Contributors necessarily those of IMH or the editorial A MAGAZINE ON MENTAL HEALTH Ronald Rajan, Dennis Yin, consultant, Mediacorp. The information Fairoza Mansor, Wanda Editorial consultant Mediacorp produced is for reference and educational : purposes only. As each person’s medical Tan, Kelvin Chia, Wilson condition is unique, you should not rely WEATHERING Pang, Jimmy Yap, on the information contained in this THE Storm magazine as a substitute for personal WHY RESILIENCE MATTERS, Koh Yuen Lin AND WHAT YOU CAN DO TO CULTIVATE IT Copyright © is held by the publishers. All rights medical attention, diagnosis or hands-on MYTHS BUSTED! treatment. If you are concerned about any SETTING THE FACTS STRAIGHT reserved. Reproduction in whole or in part without ON PSYCHIATRIC BIPOLAR MEDICATION DISORDER: Circulation Coordinator NAVIGATING health matter, please consult your family THE UPS AND permission is prohibited. Printed in Singapore by KHL DOWNS physician or healthcare professional. >> EXPRESSIONS:HARESH SHARMA’S OFF CENTRE AT 25 — KEEPING THE DIALOGUE ON MENTAL HEALTH OPEN Chris Ngiam Printing,www.khlprint.com.sg. MCI (P) 082/08/2017

FOR MORE INFORMATION // VISIT WWW.IMH.COM.SG OR WRITE TO US AT [email protected]

JUNE-SEPTEMBER I 3 STAYING ON TOP, MENTALLY COPING WITH Change affects all of us but some of us deal ● Expect a reaction Emotions will be stirred up. change with it better than others. If your feathers Let yourself laugh, cry or feel moody about it. have been ruffled by major life events, ● Break it up A large problem will seem less follow these tips to deal with them insurmountable when divided into little ones. more effectively: ● Know that it will end No matter how big or ● Don’t rush it Give yourself time to adjust difficult, change comes to an end when the and settle down. new circumstances become familiar. Look {LIVE WELL! forward to that day! CAFFEINE CALLING GET UP, GET You endure a throbbing headache until MOVING The ill-effects of a sedentary you have your morning kopi — if this lifestyle on one’s physical health situation sounds familiar to you, you are widely known. But a new might be caffeine-dependent. In study shows that the harmful small doses, the drug can have effects extend to one’s mental positive benefits on your health. GO EASY health as well. Researchers at the But take too much and you ON THE University of California recruited BREW 35 people aged between 45 and may become prone to anxiety, 65 and found out how many nervousness and restlessness. hours they spent sitting down a week. Wean off coffee by opting for these They then performed a brain alternative morning pick-me-ups: scan to study the participants’ medial temporal lobe, a part of ▲ Coconut water is rich in electrolytes and the brain crucial to the formation vitamins, while low in sugar and fat. Having of new memories. Researchers some in the morning keeps you hydrated found that those who reported and energised — just remember to choose sitting down more had thinner low-sugar varieties. structures. This can be an early sign of cognitive decline and ▲ Green tea isn’t exactly caffeine-free, but dementia in middle-aged and it does contain far less of this than coffee, older adults. making it perfect for when you’re weaning Researchers say that more off your Morning Joe. Plus, the antioxidants studies will need to be carried found in green tea make it one of nature’s out to determine a causal link best superdrinks. between a sedentary lifestyle and dementia, but suggest that ▲ Lemon water is a refreshing way to start adopting a more active lifestyle your day. And its high level of vitamin C could be a good way to reduce boosts your immune system as well. the risks of the condition. Their study was published in PLOS One. A University of Michigan SENSE OF SCENTS study found that the A recent study published on popular odds of being happy science news website ScienceDaily were 52 per cent higher PLANTS MATTER proved that any two brains will know to associate new similar odours with in active individuals each other — such as two different as compared to If you need an instant mood boost, already mature. Professor flowers — as long as both brains inactive ones. consider decorating your living and William Damon of Stanford #FACT have experienced even the smallest Its sinister name aside, overlap in odours during their working spaces with plants. The Utah University says that this the Mother-in-Law’s lifetimes. This study was conducted Statesman reports that plants not only helps fight what he calls Tongue is a hardy, easy-to-grow plant. It by a team of scientists from The serve as oxygen producers but also as a “self-absorption” issue. thrives in Singapore’s Zuckerman Institute at Columbia mental health boosters, quoting Dr Irina Prof Damon theorises climate and is perfect University in the United States of Wen of New York University’s Langone that caring for other for all living spaces. America. This essentially means that Medical Center. “(Nature) reduces living things, in this case two people need not have sniffed cognitive fatigue and stress and can be plants, can shift the focus beyond the every type of odour in the world helpful with depression and anxiety,” self, to finding a greater purpose that to come to an agreement about what they are smelling. Said the said Dr Wen. contributes to the world. Taking care of study’s first author Dr Evan Schaffer, For added benefit, consider growing plants is therefore one way to restore “As long as we have a little bit of plants instead of buying ones that are this sense of purpose. common experience, that’s enough.”

4 I IMAGINE JUNE – SEPTEMBER I 5 LIVEwell!

COLOUR ME SHARP TRY THIS: Say the colour you see, not the word that is written as fast as you can. Ready... go! > BLUE GREEN BROWN RELAX WITH A BRUSH RED At the end of a stressful day, some GREY of us may reach for a few glasses of WHITE wine or binge-watch television shows BLACK > A CHEERY GREETING to unwind. Both have shown to have According to the New York Post, the detrimental effect on sleep. Meanwhile, PINK average American checks their phone making art has long been reported to YELLOW 80 times a day. That number is likely help reduce stress — so why not pick Easier said than done? It turns out you’re under ‘The Stroop effect’: up a paintbrush and engage in a simple TAN a phenomenon that occurs when you must say the colour of a word to be as high in Singapore, which instead of the word itself.The task demonstrates the effect that creative project? Here are some simple PURPLE interference can have when it comes to reaction time. It was first ranks highest globally for smartphone described by US psychologist JR Stroop in the 1930s. penetration. So why not set an ideas to get you started: ORANGE encouraging message as your wallpaper to keep you motivated throughout the ∞ DRAW OUT YOUR EMOTIONS: day? These pithy sayings can make a Journaling is an easy way to express difference in how you your emotions. For a twist on view your life. “It was These pithy the classic habit, try drawing out a simple step towards how you feel. Begin by sketching self-love,” recalls a sayings pictures of a situation you have recently encountered. They may Happy pills copywriter to Imagine. can make a not be a Picasso or Monet, but Need a playlist for a joyous ♥ PHARRELL WILLIAMS “Every time I looked difference in all that matters is that they are a commute? Legendary British music Happy at my phone, I was reflection of how you feel during magazine NME has compiled a list ♥ REM how you view that moment. reminded to be kinder of the best happy songs. “These Shiny Happy People to myself.” your life. instant doses of sonic sunshine are ♥ NINA SIMONE ∞ RECORD LIFE’S BEAUTY: designed to left swipe the blues, Feeling Good Draw the faces of people you love, lift the spirits and give you an ♥ THE BEACH BOYS places that bring you peace, or endorphin boost,” it wrote. Good Vibrations objects that make you smile. This could be as simple as a bowl of fruit ♥ CHIC or flowers gifted to you by a Good Times special someone. ♥ CYNDI LAUPER Girls Just Want to Have Fun CYBERBULLYING: EVERYBODY HURTS ∞ COLOURS OF THE WORLD: ♥ Adult colouring books are an easy OASIS Young people under the age of 25 across 30 countries over a alternative for those who do not Live Forever who are victims of cyberbullying 21-year period. feel particularly artistic but still ♥ BLUR are more than twice as likely to The findings, published in want to harness the therapeutic The Universal power of art. self-harm and exhibit suicidal the Journal of Medical Internet ♥ THE WANNADIES behaviour, according to a UK study. Research, highlighted the major You and Me Song But new research suggests that impact that cyberbullying — both the bullies themselves also are at as bullies and victims — can have EXPRESS ♥ QUEEN higher risk of experiencing suicidal on young people. “Prevention of YOURSELF Don’t Stop Me Now thoughts and behaviours. The cyberbullying should be included ♥ MGMT study, led by Professor Ann John at in school anti-bullying policies,” Time to Pretend Swansea University Medical School said Prof John. The research also in collaboration with researchers found that cyberbullying victims ♥ OUTKAST from the Universities of Oxford and were less likely to report abuse and Hey Ya! Birmingham, looked at more than seek help than those victimised by 150,000 children and young people traditional means.

6 I IMAGINE JUNE – SEPTEMBER I 7 TRUE OR FALSE FOCUS > Resilient people do not struggle with difficulties or distressing emotions. ecently, tennis superstar demonstrates an acceptance of the reality FALSE. Being resilient does not Rafael Nadal became of his situation and that some things equate to a stress-free life. In fact, the top-ranked male have changed beyond his control. He it is only when faced with a tennis player for the shows a willingness to keep a balanced traumatic event that a person’s fifth time in his career, and hopeful perspective and the ability to resilience — or lack of it — comes to the fore. coming back from injury problem-solve and improvise solutions. yet again to dominate He is also resourceful in tapping on his > Everyone develops resilience his sport. But it is not social support network.” Conversely, a less just inspiring luminaries resilient person typically vacillates between in the same way. When the like him who display such fighting spirit. We denial and despair about their situation, FALSE. While there are resilience- R building principles that apply see it all around us — in a family member is unwilling to adjust their lives to pursue across the board, A/Prof Fung who recovers from depression or cancer, in a more realistic goals, and is socially isolated going gets notes, “Just as everyone responds friend who finally lands a job after a long and with no one to turn to. to stress differently, resilience has stressful job hunt, in news stories of people Whether getting over a breakup or to be developed in a personalised tough, being who survive war or violence. struggling with a chronic illness, being manner. It involves knowing How did they do it? How did these confronted with adversity is an unavoidable ourselves well, knowing what individuals manage to adapt and bounce part of life. By strengthening our resilience, drives us, and being aware of our resilient will back from adversity — and could we, if faced we can be ready for challenges that come own strengths and weaknesses.” with similarly tough odds? The good news is our way. keep you that we can. It is a matter of cultivating that intangible, indispensable quality: resilience. ROAD TO RESILIENCE going. Resilience can be learned at any age, but IT BEGINS WITH ACCEPTANCE it does not happen overnight. Rather, it is Resilience is not so much a trait as it is a an ongoing process requiring time and combination of thoughts, behaviours and effort, and involves a number of resilience- actions that collectively help individuals push building strategies: on and overcome hardships. Thus, resilience is not an innate characteristic that some • Build healthy social connections. people are lucky to be born with; it can be Surround yourself with people who learned and developed in anyone over time. help you feel good about yourself. What makes some people better at Lean on family and close friends for handling challenges than others? “It is encouragement, or if you need a difficult to predict who is resilient and who listening ear. “They can reach out to is not until they are tested by challenging you when you feel withdrawn, validate circumstances,” says Associate Professor Daniel your experiences and acknowledge “IT IS DIFFICULT TO Fung, Chairman, Medical Board, Institute of your successes,” says Ms Wong. Learn PREDICT WHO IS Mental Health (IMH) and a child psychiatrist. to accept help from those who care “But there are several protective factors that about you. Offering assistance to others RESILIENT AND can improve one’s resilience.” in their time of need can also increase a WHO IS NOT UNTIL TRUE sense of empowerment. These include: THEY ARE TESTED

▲ • Adopt a balanced perspective. BY CHALLENGING Higher cognitive function. Accept that change is a part of living. CIRCUMSTANCES, BUT People with better mental focus, Take a long-term view beyond the self-control and organisational and current crisis; do not think of it as an THERE ARE SEVERAL problem-solving skills are, by implication, insurmountable problem. Stay hopeful. PROTECTIVE FACTORS more resilient. Visualise what you want or where

▲ you want to be, rather than worrying THAT CAN IMPROVE Supportive environment. about what is fearful. Practise positive ONE’S RESILIENCE.” People who feel loved or cared for self-talk; think of yourself as a capable tend to have a stronger sense of self problem-solver. Associate Professor Daniel Fung, Chairman of IMH’s Medical Board and a child psychiatrist. and confidence in relying on their strengths as well as their social networks • Take committed action towards to tackle problems. your goals. Break down big goals into

▲ smaller, achievable steps. For example, TEXT BY WANDA TAN Physical fitness. if your aim is to return to a full-time GRIT Being physically healthy helps people job, plan to first write your CV and then deal with stress better. post it on job portals. Set a daily routine of waking up early and getting dressed, Ms Chermain Wong, Senior Clinical to help adjust to the working world. Psychologist and Deputy Head of IMH’s When an overwhelming situation arises Mood Disorders Unit, elaborates further: (e.g. speaking in public), face it head- “A resilient person is someone who on instead of avoiding it. Acknowledge

8 I IMAGINE JUNE-SEPTEMBER I 9 FOCUS

THE SOONER A PERSON LEARNS TO BE RESILIENT, PROVING HIS METTLE THE BETTER. AN OPPORTUNITY THUS EXISTS TO LAY A A full-time special education teacher, Mr Jeremy Goh, 39, SOLID FOUNDATION is also a husband and father. He has obsessive compulsive FOR RESILIENCE IN disorder and Tourette syndrome, a neurological condition CHILDREN AS YOUNG characterised by motor and vocal tics (involuntary movements AS PRESCHOOL and sounds). Diagnosed with Tourette’s at the age of 10, AGE THROUGH Mr Goh credits his family for helping him accept his condition CONSTRUCTIVE and overcome various challenges in pursuit of a rich, fulfilling life. EARLY CHILDHOOD EXPERIENCES.

y parents raised me the same each part of your progress and reward way they raised my two younger yourself for your effort, even if there is no sisters. I went to public school positive outcome. and had to perform household chores at home. I was also • Be reflective. Adversities can serve as M expected to look out for my siblings, opportunities for self-discovery. Think like any older brother would. The message from my about past challenges you have gone parents was loud and clear: ‘You have Tourette’s, through. What or who helped you cope but life goes on.’ In hindsight, their support was the with them? How did these struggles help most important factor in helping me get through life. you grow as a person? Knowing that you Because I did not receive any special treatment at have overcome past challenges can give home, I did not expect — or even want — to get it you the confidence to tackle new ones. from others. I set a benchmark for myself to live my life as normally as I could. • Find meaning and purpose in life. It has not been easy, though. My most painful Do something that you feel makes a memories were of being taunted and bullied by my difference and brings you joy, not just in solving problems. Children will then games or sports. That way, children secondary schoolmates. For example, they would in your personal life but also at work. blossom into independent, optimistic will realise that failure is not just okay throw chalk at me or shout at me to shut up when Being engaged in a meaningful activity individuals who perceive adversities not but inevitable, without knocking their my motor and vocal tics disrupted the class. It was will lead to greater willingness to as traumatic experiences to dwell on, but confidence or self-esteem. Give children frustrating, but I tried my best to put up with it. “THROUGH THE handle challenges. as opportunities to learn and grow. the space to learn from their mistakes I reminded myself that secondary school would not and overcome obstacles themselves, like last forever, and that I would eventually get out of DIFFICULT TIMES, • Practise self-care. Make sure both mind Parents and educators can follow if they have trouble remembering how there. However, graduating from school did not and body are in good shape. Stick to a these tips to inculcate resilience to tie their shoelaces. They will then mean that my challenges were over. I LEARNT THE healthy diet, get regular exercise, and in children: learn a lesson in perseverance, and feel In my mid-20s, I developed obsessive compulsive IMPORTANCE

set aside time for sufficient sleep and ▲ empowered to solve problems. disorder (OCD). Being let go from two jobs in a row

relaxation. Unplugging from technology Facilitate supportive adult–child ▲ within the same year, due to my Tourette’s, was once in a while is also beneficial for one’s relationships. “The caregiver must be Foster a sense of self-efficacy.Children another big blow. Most of all, I dreamt of starting a OF SEEING MYSELF FOR mental well-being. After completing a an attentive adult who is attuned to learn by watching and imitating adults, family, but I was worried whether I would ever find WHO I AM RATHER THAN particularly demanding task, give yourself the child’s experiences and helps the so be a positive role model. Display someone who could accept my condition. Things a break to unwind. Do something that you child feel protected,” says Ms Wong. a strong belief in your own capacity started to change for the better in 2004, when WHAT I SUFFER FROM. enjoy and that makes you feel energised. Through such secure attachments, to deal with challenging situations. I landed a job as a teacher at the Genesis School for It could be reading a book, playing a sport children develop a stronger sense Use verbal cues such as “Good job!” Special Education. In 2009, I met my now wife; our or going on a ‘staycation’ with loved ones. of self, and are better able to boost or “You did it!” when children show daughter Allymae just turned seven. And my OCD is Looking back on my life journey, it was tough but their cognitive development and resilience, to acknowledge and reinforce now under control. worthwhile, for it led me to where I am today. Through understand themselves as well as the their efforts. Right from the start of our relationship, my wife the difficult times, I learnt the importance of seeing

RAISING RESILIENCE world around them. ▲ never judged me because of my condition; instead, myself for who I am rather than what I suffer from. That

The sooner a person learns to be resilient, ▲ Teach self-care. “Young children need she has always shown compassion and concern for is exactly what I tell my students with special needs, or the better. An opportunity thus exists to lay Give children the space to fail and structure to regulate their behaviour me. Allymae has also picked this up and, without our what I would say to anyone who is enduring some form a solid foundation for resilience in children as learn. Scaffold children’s learning by and manage their emotions,” says prompting, helps me now whenever my tics flare up. of hardship. Resilience, to me, means accepting that you young as preschool age through constructive allowing them to succeed in some Ms Wong. Set a regular routine for She will hold my hand and say, ‘It’s okay, relax,’ or have a challenge or disability, and then looking beyond early childhood experiences, such as providing things and fail in other, non-critical children that includes fixed mealtimes tell people staring at me, ‘My daddy has Tourette’s. that to focus on what you can do. Tap on your strengths a caring environment for kids to grow up in situations. For example, do not let and bedtimes, limited screen time and He makes noises, but that’s all. You have nothing to and abilities to reach your goals. Do not ever give up on and encouraging them to take the initiative them win all the time when playing adequate physical activity. worry about.’ yourself; if you do, others will give up on you.”

10 I IMAGINE JUNE-SEPTEMBER I 11 EXPRESSIONS I pushing the envelope

WHEN THEATRE

TACKLES Mr Sharma sees the play as a platform for facilitating dialogue on tough issues such truths as inclusivity The Necessary Stage’s 1993 play Off Centre offered a stark study of the complexities of mental health issues. Its playwright Haresh Sharma looks back — and forward — at our society’s attitudes in this area.

INTERVIEW FAIROZA MANSOR // PHOTOS KELVIN CHIA & COURTESY OF THE NECESSARY STAGE

he year is 1993. Vinod has clinical rely on preconceived notions of what mental illness is,” depression; Saloma has schizophrenia. explains Mr Sharma. TNS went ahead with Off Centre, They meet at Woodbridge Hospital and it was first staged in September 1993. (as the Institute of Mental Health was previously known). The duo become fast friends as they attempt to deal COMPASSIONATE OR COMPLICIT? with their mental health issues, and The term “off centre” is first used by the character the attitudes their friends and family Saloma, prompting Vinod to stop dead in his tracks and Singaporean play to be studied as an O-level Literature Thave towards their respective conditions. That in brief ask, “Where did you get that phrase?” Saloma responds, text. “This means that we can continue the dialogue is the premise of the play Off Centre, staged by theatre “Them,” pointing to the audience. The scene is one even among future generations. I feel privileged for this company The Necessary Stage (TNS) and written by of the many in which the characters would directly opportunity to continue talking about this play, and its Haresh Sharma. address the audience. The effect of this theatrical themes, considering that in Singapore, most plays get Off Centre kicked off as a commissioned piece, but technique is aligned with the play’s messaging. “It is staged once and are never brought up again,” he adds. the collaboration later fell through. However, Mr Sharma, our intention to put the audience in the spotlight and “At the end of the day, those of us who do not have then in his 20s, decided to continue with his vision for challenge them,” Mr Sharma says. “In a sense, we are mental illness are important stakeholders in this issue, the play. “I was adamant on showcasing the different asking them if they are willing to help and support and have an impact on those who do.” perceptions — the good, the bad and the ugly — that people with mental health issues, or are they, on the people have towards those with contrary, complicit in the stigma and mental illness,” says Mr Sharma, prejudice towards those who suffer from A PLACE FOR ALL now 53. “It was important to me a mental illness.” Off Centreis set to be restaged again in February 2019. to present the complexities of The conclusion of the play also seeks One of the play’s main themes — of embracing diversity mental illness. We believed in NOT to spur a stronger audience reaction. A scene within our midst — continues to remain relevant 25 our story, and in the research “The play does not sugarcoat nor close from the years on since it was first staged. “There is oftentimes we had done. We also believed ALONE with the happiest of endings, but by not inaugural a sense of distrust and caution towards those with a in the people we interviewed.” Off Centre seeks not only to having that, it can serve to move people staging of mental illness,” explains Mr Sharma. “Hollywood movies Off Centre Research — a common draw attention to the issues to change, or to play a bigger part in which sensationalise mental illness into something in 1993 devising process employed by surrounding mental illness, but rectifying the problems,” Mr Sharma tells that is to be feared, or even laughed at, do not help in also hopes to speak to anyone TNS — was indeed integral to IMAGINE. “Sometimes, when you wrap a shifting the conversation. They perpetuate stereotypes creating the play. Mr Sharma, who has been made to feel small when they are different story up too neatly, people tend to think that those with mental illness are often the cause of together with the director or less-abled. it’s no longer a problem that needs to be hurt — which is not true.” and actors, made several addressed.” TNS received many letters With its unflinching honesty,Off Centre seeks not visits to Woodbridge Hospital, OFF CENTRE BY HARESH then from audience members who had only to draw attention to the issues surrounding mental daycare centres, halfway SHARMA IS AVAILABLE AT ALL LEADING written in to say the play had made them AT THE END OF THE DAY, THOSE OF US illness, but also hopes to speak to anyone who has houses and even art therapy BOOKSTORES understand mental health issues better. been made to feel small when they are different or less- classes for patients. With no “It’s heartening to know that the play WHO DO NOT HAVE MENTAL ILLNESS ARE abled. In addition, it asks the rest of us: what will we do written script yet, the team was actually reaching out and making an when we encounter such people? Can we be a more interviewed patients in recovery, impact,” says Mr Sharma. IMPORTANT STAKEHOLDERS IN THIS ISSUE, accepting society? Stressing that these are the societal psychiatrists and social workers The conscious decision to remain AND HAVE AN IMPACT ON THOSE WHO DO.” issues we need to address, Mr Sharma says, “The health to get a better understanding of unfiltered in the play — unafraid to of a nation or a society is determined by the amount of their experience. “We wanted to tackle conflicts and explore the dark Haresh Sharma,53, Singaporean playwright diversity we have in our midst. We have to be inclusive, get candid, varied takes on the side of mental illness — ultimately paid not just in terms of gender and race, but also in terms issue as a whole, and not just off. In 2006,Off Centre became the first of abilities.”

12 I IMAGINE JUNE-SEPTEMBER I 13 FOCUS I bipolar disorder

WHAT IS BIPOLAR Getting back on track DISORDER? A mother of two, Ms Fauziah is determined to better IT IS CHARACTERISED BY EXTREME MOOD manage her condition and improve her quality of life for SWINGS OF EMOTIONAL HIGHS (MANIA) herself and her children. AND LOWS (DEPRESSION). THESE EPISODES OF MANIA AND DEPRESSION COULD LAST MONTHS IF s Fauziah was 23 when after the birth of her second child.

LEFT UNTREATED. she had her first manic Between looking after two young M episode in 2004. It came children, she could not get enough sleep about after she had gone and was always drinking coffee to stay THE to a hospital for depression awake. Changing one’s sleep pattern is and was treated with antidepressants. a known trigger, and she had a relapse. She found herself walking from When Ms Fauziah is in her manic Bukit Batok East to Bukit Batok West in phase, she becomes very energetic. the early hours of the morning. Along “During my most recent relapse last G the way, she deliberately dropped all her year, I was cleaning the storeroom and STRUG LE personal belongings that she had with throwing away things in the wee hours her. "I felt an intense fear. I wanted to of the morning. At that time, I felt let go of everything that was with me." I didn't need them." Ms Fauziah found she could not Her mania would also manifest in sleep and just felt that she wanted to irrational beliefs. "I would think that WITHIN go on and on. She began developing God likes odd numbers, so I must do disruptive behaviour as well. "At my things in odd numbers like use three Understanding aunt's house, I was singing dikir barat ingredients when I'm cooking." (a type of rhythmic singing) at the top However, she is determined not the ups and of my voice." to let the illness wear her down. She Her family called the civil defence wants to manage her condition so that downs of bipolar and even an ustaz (religious teacher), she can be a better mother and get back disorder. but they could not help. She was to work again. eventually hospitalised and diagnosed Her advice to other people with with bipolar disorder. bipolar disorder is that they should Since then, Ms Fauziah, now 37, not let the condition get the upper has been trying to manage her hand. "If you feel down or are in a low condition. She has had relapses that she mood, don't beat yourself up. Talk to attributes to the stresses of life and to your doctor about it and be patient not taking medication regularly. with yourself. And if you are given The most recent incident occurred medication, take it," she says.

TEXT JIMMY ipolar disorder recently ingredients to cook for the party. You don't feel the need to sleep and putting a down-payment on a YAP // PHOTOS made the news when When her family found out and may spend days on end with little house or car they cannot afford, ISTOCKPHOTOS & pop star Mariah expressed concern, she got very sleep," says Dr Nisha Chandwani, driving dangerously, or having GETTY IMAGES Carey told People irritable, smashed plates and threw a consultant in the Department of unsafe sex," says Dr Chandwani. magazine that she has hot food at them. In another example, Mood and Anxiety at the Institute of In addition to manic episodes, the condition, which a man with the condition buys a Mental Health. people suffering from bipolar Bis characterised by extreme mood sports car whenever he suffers a The manic phase does not disorder also experience episodes swings of emotional highs (mania) relapse. When he is well again, he stop at merely feeling energetic. of depression. They experience and lows (depression). She had been will resell the vehicle, only to buy the Sometimes, when people are in extremely low moods, lose diagnosed in 2001 but only talked same make and model of car when this phase, they develop grandiose interest in things and aren’t about her condition this year. Carey he re-enters the manic phase. ideas that have little basis in reality, able to enjoy activities they used added that in her ‘manic phase’, such as feeling more important than to, and have difficulty thinking she would just keep working and BREAKING DOWN usual, or feeling invincible. One man, positively. Many become socially working until she “hit a wall”. BIPOLAR DISORDER in the manic phase, believed that he ACCORDING TO THE withdrawn and in severe cases, Bipolar disorder is not a In the manic phase, people with was a wealthy, award-winning chef SINGAPORE MENTAL they may feel that life is not HEALTH STUDY CONDUCTED mental disorder that is restricted to bipolar disorder experience euphoria who worked for various international IN 2010, SOME worth living. celebrities. In Singapore, a woman and, sometimes, extreme irritability. hotels. In reality, the man did not Bipolar disorder can be diagnosed with the condition "You feel very energetic, like everyone know how to cook, was unemployed classified into two types. In planned a huge Chinese New Year around you is slowed down. You have and was living in debt. type 1, people have episodes 1.2% party which she had not invited lots of exciting ideas, which makes “They may then act on their of adult Singaporeans of mania and depression. The anyone to attend, paid $1,000 as you talk very fast such that others beliefs and engage in reckless suffer from bipolar disorder episodes could last months if deposit for the venue, and bought sometimes cannot keep up with you. or dangerous behaviour, such as in their lifetime. left untreated. In type 2, people

14 I IMAGINE JUNE-SEPTEMBER I 15 gp partner I I SERVE FOCUS I bipolar disorder

issues, but put off getting help from a primarily experience depression, “WHILE BIPOLAR DISORDER psychiatrist due to the stigma of mental with some episodes of hypomania illness — when in fact there are other (a mild form of mania, marked IS A CHRONIC ILLNESS, IT avenues for help within the community, by elation and hyperactivity). such as through GPs. According to the Singapore DOESN'T DEFINE A PERSON. “As the fi rst touchpoint for Mental Health Study conducted in patients in the community, we are 2010, some 1.2 per cent of adult OFFER SUPPORT TO YOUR well-placed to identify at-risk persons Singaporeans suffer from bipolar who are vulnerable to mental illness disorder in their lifetime. LOVED ONES. TELL THEM and provide timely intervention,” says “There are no specific Dr Cheong. “Wellness is not just about 'I'M HERE FOR YOU' AND the absence of physical disease; rather, diagnostic tests for bipolar it encompasses biopsychosocial well- disorder,” says Dr Chandwani. REMIND THEM THAT THE being. Promoting mental wellness is “The main challenge is to a critical component of holistic care.” distinguish mood swings that are EPISODE WILL PASS.” That’s why, says Dr Cheong, he joined a part of normal experience Dr Nisha Chandwani, Consultant in the Department of Mood IMH’s Mental Health–GP Partnership from the extreme symptoms that and Anxiety at the Institute of Mental Health Programme (see sidebar) in 2015. characterise this disorder.” Furthermore, up to a third of people who present with control mood and judgement, For people living with A PROACTIVE APPROACH Dr Cheong estimates that about fi ve major depressive disorder may which is why medication can help bipolar disorder, mood-stabilising to 10 per cent of the patients he sees actually have bipolar disorder. And to control the symptoms of bipolar medication is the first line at his clinic have mental health issues. symptoms for the two conditions disorder. A relapse can be triggered of treatment, instead of While some are former IMH patients can overlap. People with depression by stressful experiences, changes in antidepressants. “If they do whose conditions have stabilised, most may be prescribed antidepressant sleep routine, and drug or alcohol not respond to the medication, JAMES are fi rst-time patients presenting with medication. However, for abuse. then electroconvulsive therapy CHEONG issues such as trouble sleeping or low FAMILY people with bipolar disorder, (ECT) may be used as a second PHYSICIAN mood. “We proactively screen for and antidepressants might trigger mania TREATING BIPOLAR or third line option,” says manage patients with mild to moderate or make a person more irritable DISORDER Dr Chandwani. ECT is a procedure mental health conditions including and edgy. While there is no cure for bipolar in which, while under anaesthesia, CARE IN THE adjustment disorders, depression Researchers are still trying disorder, it is a highly treatable a small electric current is passed Empathising and anxiety, prescribing medication if to fully understand the causes In addition to condition. "With a combination of through the brain, triggering a with patients needed. At the same time, we are able of bipolar disorder. What they manic episodes, medication and therapies, as well as brief seizure. This causes changes and instilling COMMUNITY to refer and coordinate early access to do know is that there is a strong people suffering learning how to minimise triggers, in brain chemistry that can specialist psychiatric care for patients from BIPOLAR hope in genetic component to the condition a person can manage the condition relieve symptoms. For Dr James Cheong, a GP partner who need it,” he says. DISORDER also them is a (it tends to run in families), and and significantly reduce his or her Apart from medication and From the patients’ perspective, experience positive fi rst with IMH, providing mental healthcare being treated at a GP clinic instead that there are likely abnormalities episodes of chances of a relapse," says ECT, there are also various types of a psychiatric hospital is more in certain areas of the brain that depression. Dr Chandwani. of therapies available, such as step in the is part and parcel of his job. cognitive behavioural therapy therapeutic convenient as it is closer to their home, INTERVIEW WANDA TAN// PHOTO EALBERT HO and it also carries less stigma. They are (CBT) and interpersonal and social relationship.” thus more likely to look for a GP to rhythm therapy (IPSRT). CBT r James Cheong, a family skills, and two months later her interpret their symptoms, help them helps people identify unhealthy physician, remembers mood symptoms improved and she understand what they are experiencing behaviours and beliefs that may FAMILY SUPPORT treating a middle-aged had a better handle on her work and and validate their emotions, which in trigger episodes and replace woman who visited family situation. many cases is enough to uplift their MATTERS them with more positive ones. his clinic multiple Such cases happen more often mood. “Empathising with patients and Family members of people living with IPSRT helps people learn how to times complaining of than one might think. Most people instilling hope in them is a positive fi rst regulate their biological and social D bipolar disorder have an important headaches and insomnia. “Upon visit a General Practitioner (GP) to seek step in the therapeutic relationship,” role to play. Dr Chandwani advises rhythms, set up regular routines probing further, I realised that she treatment for physical health problems says Dr Cheong. “I also give patients family members to: and develop strategies to manage had adjustment disorder caused by or chronic illnesses like diabetes, not psychoeducation, or information interpersonal stress. about their illness and treatment

▲ stress at work and marital issues with knowing that their mental well-being find out more about the condition According to Dr Chandwani, it her spouse,” recalls Dr Cheong. He may have suffered. Others may be options, so that they feel empowered and its triggers is important to seek treatment early provided basic counselling and coping aware that they have mental health in their recovery.” ▲ and continue treatment regularly keep an open mind and be patient

▲ rather than intermittently. This is encourage their loved one to take the because some research suggests medication as prescribed that early treatment of bipolar ▲ A TWO-WAY PARTNERSHIP watch out for the early signs of relapse disorder may predict a better clinical ▲ course. “We do know that each Launched in 2013 under the National Mental arrange for easy referral back to IMH.” There are Dr Goh discuss with their loved one on the relapse affects the brain adversely, Health Blueprint, the Mental Health–GP (MH-GP) currently over 100 GPs under the programme. course of action to take in the event Yen Li, such that, those with multiple Partnership Programme enables “right-siting To provide comprehensive training in mental Director, of a relapse MH-GP

▲ relapses may have mild mood of care between IMH and primary healthcare healthcare, IMH also offers a one-year Graduate avoid being dismissive of his or her symptoms and problems thinking providers”, says IMH’s Dr Goh Yen Li, the Diploma in Mental Health in collaboration Partnership Programme challenges and concerns by using clearly even in between episodes. Programme Director. “Patients whose conditions with the Division of Graduate Medical Studies, words and phrases like "crazy" or They may also not respond as well have stabilised and who are well enough to National University of Singapore, and twice- "lazy", "just a mood swing", or "we to medication as those who sought live in the community can see GPs for follow- yearly Continuing Medical Education workshops had such high hopes for you” treatment early and have had fewer up appointments. If a patient relapses, the on a variety of mental health topics for relapses,” she says. GP can call us directly for advice or, if needed, participating GPs.

16 I IMAGINE JUNE – SEPTEMBER I 17

P17 i serveV2.indd 17 6/13/18 5:27 PM INTERVIEW I a life in my day

I was 19 when I was peer mentors so that they too can share their stories with others in a diagnosed with similar situation. I enjoy my work THE WRITE schizophrenia. It was 2007; as it enables me to help, meet and I was a first-year student at the interact with others. I’m a people National University of Singapore, person so this is the perfect job for where I was admitted to on a me. I hope to continue contributing APPROACH scholarship. I have always been to the mental health movement. HAVING A MENTAL driven and pushed myself to do well. Daily journaling and This, plus trying to adapt to a new ILLNESS DOESN’T phase of my life, put tremendous I first met my husband support from her loved DEFINE YOU AND stress on me. Once, I lost seven in NUS, where he studied NEED NOT STOP YOU days of sleep over essays I needed philosophy, but we weren’t friends ones help Sumaiyah at the time. After we graduated, a FROM ACHIEVING to complete for a module. Friends started noticing I wasn’t my usual mutual friend brought us together. Mohamed, 30, manage WHAT YOU WANT. “ self. I blamed myself for things that Our friend told him I had a problem with stress but he was not Sumaiyah Mohamed weren’t my fault and believed things schizophrenia. that weren’t true, like my parents discouraged from getting to know were disappointed in me. I felt lost me better. I’m not one to hide my and confused. At the end of the condition so I told him about it right term, I moved back home from from the beginning. We started INTERVIEW JIMMY YAP the hostel. My family realised dating in December 2013 and got CLUB HEAL HELPS // PHOTO WILSON PANG I wasn’t well and took action. married in 2015. We now have an PARTICIPANTS DEVELOP 18-month-old daughter. While we LIFE AND SOCIAL SKILLS were dating, he secretly bought a THROUGH THERAPEUTIC My parents brought me book on schizophrenia for family to the hospital where ACTIVITIES, SUCH AS ART SUMAIYAH members so he could understand AND CRAFT. MOHAMED,30 I spent two months in my condition better. He even met WANTS US TO KNOW the psychiatric ward. my psychiatrist. When I asked him THAT SCHIZOPHRENIA I was put on various medications but why he decided to go out with me, CAN BE MANAGED nothing quite worked. It was only he said it was because we have the after undergoing electro-convulsive same values — a shared faith and Part of my self-care therapy (ECT) that I started to get belief in volunteering our time to involves writing in my better. After a leave of absence, help others, as well as an interest I went back to school determined in personal development. One of journal every day before heading to complete the course. I knew the my goals this year is to improve my to work. This morning routine has challenges I faced previously were physical fitness, and we are working become extremely important to me, due to my illness so I paced myself on this together. Whether it is without which I will feel disoriented. this time and made sure not to work, personal interests or my Journaling calms me; it declutters my neglect my health. It took me five mental health condition, he is my mind and keeps me focused. I spend years to graduate with an honours in staunchest supporter. about an hour writing and reading Social Sciences (major in psychology) over breakfast. During this time, my in 2012. After that, I worked in the mum and my helper take care of my I’ve suffered one relapse daughter. However, I make sure to civil service for about four and a since; I was pregnant half years. spend time with her when I get home at the time. Worried that from work. the medication would affect my yet- These days, I work at to-be-born child, I stopped taking My advice to other Club HEAL which aims them without consulting my doctor. to help people with mental health Eight weeks after I gave birth, my people living with issues and their families. I coordinate symptoms re-appeared. I started schizophrenia is seek the daily rehabilitation sessions, having delusions. I would see signs professional help. Schizophrenia is which is one of our core services. from God in random things — like just another illness, which can be They help participants develop life a song I heard while in a cab or managed. Keep a close network and social skills through therapeutic a book I happened to take from of supportive friends and family activities like art and craft. During the shelf. A friend noticed I was members. My parents, brothers and the rehab sessions, I share what incessantly spamming our group my husband have been pivotal to my I’ve gone through with them, chats and sensed something was recovery. Remember also that you are hoping I can inspire them to look amiss when we met at a wedding. individuals with unique abilities and beyond their illness to focus on their She urged me to go back on my strengths. There’s a lot that you can strengths. Club HEAL has also rolled medication. I did and things returned do to contribute to society. Having a out a new programme, Our Healing to normal. I continue to see my mental illness doesn’t define you and Voice, which I am also coordinating. psychiatrist once every three to need not stop you from achieving We nurture recovered patients to be four months. what you want.

18 I IMAGINE JUNE-SEPTEMBER I 19 INSIGHT I psychiatric medication

accepts treatment, it is a sign of MYTHS his or her strength and commitment to get well.

#2 I will feel better immediately after taking BUSTED psychiatric medication Most psychiatric medications work slowly. For example, it may take Ms Emily Liew, a Principal Get the facts right on psychiatric medication. Pharmacist (Specialist) at the TEXT DENNIS YIN // PHOTOS ISTOCKPHOTOS & GETTYIMAGES someone on antidepressants up to Institute of Mental Health at least four to six weeks at the right dosage to see an improvement ▲ sychiatric medication Anti-anxiety / Sedatives in symptoms. #5 I can stop taking my plays an important for the short-term treatment Different people also respond medicine once I feel better role in managing of anxiety and insomnia differently to psychiatric medication; The length of treatment with mental disorders and some may experience a faster onset medication varies for different ▲ has helped many Mood stabilisers to prevent of effect than others. conditions and from person to people to improve or reduce the severity of mood It is important to continue taking person. For some conditions, like Ptheir quality of life. They work by swings in those with bipolar the medication regularly for it to be schizophrenia, medication may be acting on chemicals in the brain disorder, depression and other effective. Do not hesitate to talk to required for the long term. (neurotransmitters) that regulate mood disorders ? your doctor if you do not experience If you stop your medication too emotions and thought patterns. They any improvement after some weeks. early, your body may not be able to ▲ help to ease symptoms and stabilise Medication for addiction DESPITE ITS In some cases, adjustments may need adjust to the abrupt change, and the condition, so that one can make to reduce cravings and maintain to be made in terms of dosage or a relapse of your condition may lifestyle changes and participate more abstinence from addictive BENEFITS, SOME medication to find what works best occur. Depending on how severe readily in therapeutic activities. This substances for you. your symptoms are, and the risk of

holistic approach has seen many ▲ STIGMA STILL relapse, your doctor may consider people with mental health issues Stimulant medication #3 I can take my medicine reducing the dosage slowly over manage their condition better and go to treat attention-deficit SURROUNDS whenever I feel like it a period of time while closely on to lead productive lives. hyperactivity disorder Most psychiatric medications should monitoring your condition. You be taken regularly as prescribed in should not make any changes to ▲ THE TAKING OF Anticholinergics which refer order to ensure their effectiveness your dosage or schedule without A RANGE OF REMEDIES to medication taken to manage PSYCHIATRIC and a steady concentration of the consulting your doctor. Today, a wide assortment of safe some of the side effects from drug in the body. If the medication and effective psychiatric medication taking antipsychotics MEDICATION, AND is meant to be taken on a “when #6 They are addictive

is available through prescription and ▲ necessary” basis, such as those Most psychiatric medications are can be broadly categorised into Dementia medication to treat THIS MAY DETER to help with sleep issues, it will not addictive and do not result in the following: symptoms of this condition be stated on the label. Taking cravings associated with addiction. medication on and off can lead to However, the long-term use of ▲ PEOPLE FROM Antipsychotics to treat and uncomfortable symptoms due to certain sleeping pills may lead to prevent the recurrence of Despite its benefits, some stigma GETTING THE HELP fluctuations in the level of the drug dependence; hence they are usually symptoms such as hallucinations, still surrounds the taking of in the body and increase the risk prescribed for short-term use only. disorganised or unreal thoughts psychiatric medication, and this THEY NEED. of relapse. While it is possible for some people may deter people from getting to experience temporary symptoms ▲ Antidepressants to treat the help they need. #4 They have very bad side such as dizziness, headache, symptoms of depression and Ms Emily Liew, a Principal effectsAs with all medication, restlessness, tiredness, nausea and some anxiety disorders Pharmacist (Specialist) at the psychiatric medication can have side insomnia when certain psychiatric effects. How these are experienced medications are stopped, these and their severity, however, varies symptoms usually resolve within from person to person. It is more a week as the body adjusts to common to experience side effects the change. TAKE any queries regarding the check with your doctor Institute of Mental Health, dispels when starting a medication or when YOUR MEDS medication. or pharmacist. some common misconceptions and the dosage is increased, as the body #7 Psychiatric medication • • myths associated with the use and is still adjusting to it. If the side effects will change my personality Always inform your doctor Store your medication CORRECTLY efficacy of psychiatric medication. persist or become bothersome, you One’s personality is not affected

• or pharmacist about the according to the instruction Read the medication labels various medications or on the labels. If they are should inform your doctor at the by medication. When you are carefully, and follow the dietary supplements that not properly stored, their #1 Taking psychiatric earliest opportunity. unwell, you may display irritable instructions as printed. you are taking, as there shelf life may be shortened medication means I am Side effects are usually minimised behaviour or behave differently Inform your doctor or may be adverse drug and effectiveness may weak-minded Generally in health- by starting the medication at a lower than usual. When your sleep and pharmacist if you have interactions. be affected. been missing doses of care, medication is prescribed for a dose and titrating it according to mood improve, you will feel less • your medication. Note the expiry dates of • Do not stop your medication wide range of conditions — this how your body responds. If you feel irritable, be more focused and the medication. If you includes mental disorders. Taking very uncomfortable about a particular have a clearer mind to pursue your

• abruptly or adjust your Get advice from your doctor are unsure where the dosage without consulting antipsychotics for schizophrenia or side effect — such as feeling drowsy interests. Taking medication as or pharmacist if you have information is printed, your doctor. antidepressants for depression does in the daytime — the doctor may prescribed can help you manage not mean one is weak-minded. switch to a less-sedating medication your condition and get you back When a person sees a doctor and or adjust the time to take it. to your original self. 20 I IMAGINE JUNE-SEPTEMBER I 21 news & events I IMH SCENE

ASK THE A round-up of news and events centred on mental healthcare.

EXPERTS UP AND IMH clinicians answer your questions. A MULTIDISCIPLINARY COMING APPROACH TO STUB MENTAL HEALTH A DRINKING PROBLEM FESTIVAL 2018 A friend of mine, who is in his early OUT SMOKING When: 8 September, 40s, is a binge drinker. He holds a 9.30am to 3pm Where: IMH, Buangkok steady job, has a stable family, and claims that Smoking is the largest cause of preventable deaths in the world, yet it Green Medical Park, he doesn’t have a problem with alcohol. But 10 Buangkok View takes time to quit smoking because I have noticed that his binges are becoming the nicotine in cigarette smoke is Join us to celebrate more frequent. What can I do to help him? addictive. To help smokers kick the IMH’s 90th anniversary habit, nicotine replacement therapy at the Mental Health Binge drinking refers to drinking five or more standard (NRT) is usually offered in smoking Festival 2018, held drinks for men, and four or more standard drinks for cessation services. Medical products on IMH campus in This outpatient service is women, over two hours. It is common for someone to HELPING MUM FEEL SOCIABLE AGAIN that supply controlled doses of Buangkok Green. available to IMH clients as well as deny binge drinking as a problem when he is able to I noticed that my 70-year-old mother, who was nicotine are prescribed to patients Highlights include hold a job and fulfil family responsibilities. However, to help reduce craving and ease the the general public. forums on bipolar once a lively person, has become withdrawn. They can be referred binge drinking is very damaging to one’s health and symptoms of nicotine withdrawal. KNOW THIS disorder and obsessive could lead to alcohol addiction. She claims that because of her ill health, socialising has by any doctor, or become difficult. But even when put in a social situation Since March 2017, the National Every day, compulsive disorder, Before approaching your friend, learn more about Addictions Management Service can call the All about 7 mindfulness workshops alcohol-use disorder so that you can provide accurate with people familiar to her, she is quiet and feels that she (NAMS) has begun using a Addictions Helpline Singaporeans for adults and children, information when you speak with him — and do so in a hinders their enjoyment. What can I do to reassure her and die prema- multidisciplinary approach to at 6-RECOVER turely from creative expression non-judgemental manner. You may also engage your boost her self-esteem? help smokers overcome nicotine (6-7326837; 8am to smoking- activities, craft booths, friend in activities that do not involve alcohol, dependence. The method combines 11pm daily) for an related tour of facilities, or encourage him to seek professional help. For Physical decline is part of ageing. her efforts (not how well she does) diseases. appointment. This and more. A public more information, call the addictions helpline at As such, some seniors may find and boost her confidence. the use of medication and/or NRT with counselling over several service is available at education campaign 6-RECOVER (6-7326837). previous interests challenging when If your mother continues to be NAMS Clinic in IMH the demands of those activities withdrawn, appears to experience sessions as required to help with to reduce stigma and the Community Wellness Clinic MS TAN MING HUI, Counsellor, National Addictions exceed their physical capacities. low mood and loses interest in most behavioural change, which is surrounding mental Management Service They may then feel shame and activities persistently for more than often the most difficult aspect of (Queenstown Polyclinic). For more health issues will also be embarrassment when put in a social two weeks, accompany her to see a overcoming an addiction. information, visit www.nams.sg. launched at the festival. situation with familiar people who doctor, as these symptoms may be expect them to perform at the signs of depression. same level. You may need to first spend time MS LIM SI HUAN, Senior Clinical Psychologist, Department of at IMH, he has helped numerous with your mother to understand STORIES OF Geriatric Psychiatry FURTHERING patients’ transition back into society. what is making it difficult for her to EXCEPTIONAL socialise. Then, have a discussion RESEARCH DEDICATION AND ● MS SAMANTHA ONG has looked HAVE QUESTIONS REGARDING ISTOCKPHOTOS and plan activities that she finds In collaboration with the DRIVE Mr Yong after patients for 31 manageable and enjoys doing. Offer MENTAL HEALTH? Email them to Lee Kong Chian School of Kwon years. While she is her praises consistently to validate [email protected] Medicine (LKCMedicine), Three IMH staff and a Seng PHOTOS now Chief Nurse, IMH organised the second volunteer were lauded she still makes for displaying altruism Frontiers in Mental Health time to work in the above and beyond their Symposium (FMHS) on 6 March wards alongside call of duty at the 15th charges if your father If hospital admission is 2018. Themed “Advancing Ms the staff. This Healthcare Humanity Samantha PAYMENT WOES is suffering from any of required, Medisave can also Research in Depression and has helped her Psychosis”, the event brought Awards on 26 April Mr Ong My father recently the conditions under be used to pay for those Roger understand ground 2018. received a referral the Chronic Disease bills. There is a withdrawal together some 200 researchers, Tan issues and implement from the polyclinic Management Programme. limit of $150 per day and a neuroscientists, clinicians and ● MR YONG solutions to improve to seek specialist These include major maximum of $5,000 per year. academics to share research KWON SENG, patient care and work help for a mental illness. depression, schizophrenia, In addition, if your father is on the two conditions to help a volunteer conditions. bipolar disorder, anxiety a Singapore Citizen or PR, improve treatment, outcomes, with IMH for seven Mr Gemma However, he is hesitant to Angela do so because of financial and dementia. he is likely to be covered and quality of life for patients years, received “Honourable Fernandez ● MS GEMMA concerns. Can he use his He can use up to $400 by Medishield Life, which and their caregivers. Mention” for faithfully spending ANGELA FERNANDEZ, Medisave to pay for his per year from his own provides protection against time with long-stay patients every Senior Case Manager, medical bills? If need be, Medisave or his family large hospital bills. Sir Philip Campbell, weekend and even on public supports patients with can I use my Medisave for member’s account (up to However, should your Editor-in-Chief of holidays, despite his postgraduate complex social needs after they 10 accounts can be used). father and family experience Nature and Nature studies and work as a teacher. his treatment too? Research, was the are discharged, and ensures their Each claim is subject to a difficulties with payment, do keynote speaker reintegration into the community It is important to seek 15% co-payment. If he is not hesitate to speak with the at the event. ● MR ROGER TAN BOON MENG, through an Aftercare Programme. professional help, as that 65 years old and above, he Medical Social Workers at the a Principal Medical Social Worker, Outside of work, she also helps will help your father get can tap on an additional clinic/hospital for assistance. was recognised for his commitment to deliver groceries to patients, better and remain well. $200 per year from his towards psychiatric patients under refurbish their homes and Medisave can be used Medisave to pay for the MR DAMIEN LIEW, Senior the Mandatory Treatment Order seek sponsorship for household to cover most outpatient 15% co-payment. Manager, Business Office programme. Over his 13-year career items.

22 I IMAGINE JUNE – SEPTEMBER I 23 Science has shown that the act of BEAUTIFUL smiling can lift your mood, lower stress, boost your immunity and possibly prolong your life — even M when you are faking it. A smile spurs a chemical RESOURCES AND ind reaction in the brain, releasing hormones such as dopamine and serotonin. Thus, smiling can trick USEFUL INFO your brain into believing you’re happy — which can then trigger real feelings of elation. This phenonmenon was first noted by Charles Darwin in HELP IS A PHONE CALL AWAY 1872. “The free expression by outward signs of an GRIN AND WIN emotion intensifies it,” he wrote. Mental Health Helpline Samaritans of Singapore (SOS) Say ‘cheese’ and feast on Manned by trained counsellors from Provides confi dential emotional HAPPY FACE IMH for those requiring advice on support for those in crisis, thinking of Because botox injections have the effect of mental health issues. suicide or aff ected by suicide. the health benefits it offers ‘freezing’ facial muscles, recipients often end up being less able to frown — but this may Tel: 6389 2222 (24 hours) Tel: 1800-221 4444 (24 hours) yield unforeseen benefits. University of Cardiff researchers surveyed 25 females — half of whom National Addictions information to primary school had received botox injections — to gauge their Singapore Association children in distress, especially emotions. The botox recipients reported feeling Management Service (NAMS) in situations when their happier, but not more attractive. This suggests for Mental Health that the treatment’s cosmetic nature wasn’t what (SAMH) Helpline All Addictions Helpline parents or main caregivers provided this psychological boost. are unavailable. Provides information and assistance Provides a range of services to Tel: 1800-274 4788 on mental health matters and assist people who are dealing with (Monday to Friday; 2.30pm to 5pm) psychosocial issues. addiction problems. Tel: 1800-283 7019 Tel: 6732 6837 (Monday to Friday; 8.30am to 6pm) (Monday to Friday; 9am to 6pm) Club HEAL Helps persons with mental health Dementia Helpline by National Council on Problem issues to reintegrate back into the Gambling (NCPG) Helpline community. Alzheimer’s Disease Association Tel: 6899 3463 Provides information and help for Provides information and (Monday to Friday; 9am to 5pm) problem gamblers and their families. assistance on caring for a person with dementia. Tel: 1800-666 8668 (24 hours) Tel: 6377 0700 Silver Ribbon (Monday to Friday; 9am to 6pm) Touchline by Touch Supports persons with mental health issues and Youth Services their families. Dementia InfoLine by Renders emotional support Tel: 6386 1928 Health Promotion Board and practical advice to youth. (Monday to Friday; 9am to 5pm) For advice and information Tel: 1800-377 2252 (Monday to Friday; on dementia-related queries 9am to 6pm) (available in all 4 languages Caregivers Alliance Limited – English, Chinese, Malay and Tamil). Supports caregivers of persons with Tinkle Friend Helpline by mental health issues. Tel: 1800-223 1123 (Monday to Friday; 8.30am to 5pm and Singapore Children’s Society Tel: 6460 4400 (main line); 6388 2686 Saturday; 8.30am to 1pm) Provides support, advice and (Caregivers Support Centre)

IMH SERVICE DIRECTORY

INSTITUTE OF MENTAL HEALTH Monday to Thursday 8am to 5.30pm Wednesday 8am to 12.30pm Buangkok Green Medical Park Friday 8am to 5pm Friday 8am to 5pm THERE ARE MORE 10 Buangkok View REASONS TO SMILE. Singapore 539747 CLINIC B COMMUNITY WELLNESS General Enquiries 6389 2000 IMH, Level 1 CLINIC, GEYLANG Researchers at the University (24-hour hotline) Monday to Thursday 8am to 5.30pm of Kansas found that smiling 21 Geylang East Central, Level 4 Appointment Line 6389 2200 Friday 8am to 5pm Singapore 389707 reduces the body’s response (Monday to Friday; 8am – 6pm) to stress; another study Monday, Tuesday, Thursday, Email: [email protected] linked smiling to lower SAYANG WELLNESS CENTRE CLINIC Friday 8am to 5pm blood pressure, while a third (for non-subsidised patients) Wednesday 8am to 12.30pm suggests that smiling leads to CHILD GUIDANCE CLINIC IMH, Level 2 longevity. Also, a study from SUNRISE WING Monday to Thursday 8am to 5.30pm NATIONAL ADDICTIONS Penn State University found IMH, Block 3, Basement Friday 8am to 5pm MANAGEMENT SERVICE that people who smile appear Monday to Thursday 8am to 5.30pm (NAMS) CLINIC more likeable, courteous Friday 8am to 5pm and competent. COMMUNITY WELLNESS IMH, Block 9 Basement CLINIC, QUEENSTOWN Monday to Thursday CHILD GUIDANCE CLINIC 580 Stirling Road, Level 4, 8am to 5.30pm HEALTH PROMOTION BOARD BUILDING Singapore 148958 Friday 8am to 5pm 3 Second Hospital Avenue #03-01 Monday, Tuesday, Thursday Singapore 168937 8am to 5.30pm

24 I IMAGINE

IBC Services.indd 1 6/13/18 5:32 PM mental health festival ad for IMAGINE.pdf 1 7/6/2018 5:12:48 PM

C

M

Y

CM

MY

CY

CMY

K