SINGAPORE - When general practitioner Radiah Salim was six, her 18-year-old sister was diagnosed with schizophrenia.
"I grew up watching her going in and out of the hospital," said Dr Radiah, now 49.
Her sister's condition today is stable and she is "happily married".
However, that childhood experience and her observation that not many Malay-Muslim patients have such positive outcomes because they do not get the help they need spurred Dr Radiah to form Club HEAL, a day rehabilitation service for individuals between the ages of 18 and 55 with mental illnesses.
Dr Radiah, who spent eight months as a medical officer at the Institute of Mental Health (IMH), said it was her personal observation that many Malay patients fight shy of using step-down care facilities such as psychiatric rehabilitation centres because they lack proper information about mental illness.
Those who do seek such services may have cultural or religious considerations like having halal food.
She formed Club HEAL in February this year to fill this gap. There is also a caregiver support group and public outreach activities.
"Club HEAL was formed to cater to the cultural needs of the community in the hope that more will come forward and benefit from its programmes," said Dr Radiah, who is the club's president.
Mental health experts and community leaders confirmed that Malay-Muslims and Asians in general tend to attribute mental illnesses to flaws in character or to the work of evil spirits, and so look to spiritual healers for a cure.
"There is quite a strong tendency in the (Malay-Muslim) community to seek out spiritual help first... I suspect also that spiritual explanations for these diseases are more prevalent," said Dr Habeebul Rahman of Tan Tock Seng Hospital's psychology department.
Madam Salmah (not her real name), 45, who was diagnosed with a bipolar disorder 14 years ago said her family turned to bomohs, or traditional healers, when she had her first mental breakdown.
"My mother-in-law witnessed it and called a bomoh. He put lime juice in my mouth and told me to take a bath with flowers," said the mother of two, who is now a participant at Club HEAL.
The freelance tutor sought help from bomohs for a few more years to little effect before finally getting a medical diagnosis.
"I realised later that the disease runs in the family - I have three other relatives who are bipolar," she said. Medication helped stabilise her condition.
Though Club HEAL was set up mainly for the Malay-Muslim community, it is open to everyone. The acronym stands for hope, empowerment, acceptance and love, which Dr Radiah says are "key ingredients to recovery".
Daily sessions at two mosques, Darul Aman in Eunos and Al-Khair in Choa Chu Kang, include lessons on writing, art and baking, and topics such as communication and medication management. Sessions began in May with four participants, but the number has since grown to 35.
"More than anything, the sessions are a place for them to make social connections so they know they're not the only ones going through this, and this is key to recovery," said veteran counsellor Hamidah Bahashwan, who is also the club's manager.
Other priorities are to educate the public about mental illnesses, said Dr Radiah.
While there is no research on how ethnic groups here regard treatment options, a study based on the results of the 2010 Singapore Mental Health Study (SMHS) found that religious and spiritual healers are a significant source of help for people with mental illness.
Of the 199 people who sought help from only one source, a "relatively substantial" 16.6 per cent went to religious and spiritual healers such as priests, imams, temple mediums and bomohs.
The SMHS, which surveyed 6,616 Singaporeans, found that one in 10 Singaporeans will develop a mental illness, showing a need for health care providers and religious and spiritual healers to work together to ensure better treatment for people with mental illnesses.
"We want to advocate a shared care module with patients seeking medical help while also engaging other sources of support," said IMH deputy director of research Mythily Subramaniam. "Counsellors and general practitioners do a terrific job and religious leaders also have an important role to play so we shouldn't dismiss any of them."
One such collaboration was a forum organised by Club HEAL in May on misconceptions about the disease which included Dr Habeebul and Ustaz Firdaus Yahya of the Darul Huffaz Learning Centre on the panel. They dispelled the commonly held belief of mental illnesses being the work of evil spirits.
Another misconception keeping people from medical treatment is that it is costly, said Ustaz Firdaus.
Minister of State for Social and Family Development Halimah Yacob also stressed the need for such groups on Saturday.
"The problem with Asians is we tend to feel things happen because of spirits, therefore we should go to a healer and get help to drive away these evil spirits," she said.
"It is only when the person's situation becomes worse that the family says, maybe it is time we get medical help."
Madam Halimah added that belief in the supernatural origins of mental illness cut across all races and could become an obstacle to seeking treatment early. Groups like Club HEAL could help by disseminating correct beliefs, thereby bridging the gap between traditional and evidence-based medicine.
"Traditional healing can co-exist with modern medicine because it gives psychological comfort but people must be educated that this is a medical condition and medical help is needed."
Madam Halimah was speaking on Saturday at the launch of Silver Ribbon (Singapore)'s new handbook, Mental Health Matters: Handbook For Employers And Employees.
The non-profit organisation said the book was published to raise awareness among bosses about mental illness, and to help workers who suffer from it cope better.
It is also targeted at their co-workers, so they can be more understanding of their condition.
Those who wish to get a copy of the book can call Silver Ribbon (Singapore) on 6386-1928.
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