SINGAPORE - Picking up mental health problems in people with intellectual disabilities may be the first step to helping them.
But equally crucial is the care they receive at home and in the community, which can make or break a treatment plan.
Many people with intellectual disabilities who are treated in hospital for psychiatric disorders quickly end up back in hospital again after they are discharged, said Dr Wei Ker-Chiah, deputy chief and consultant at the department of community psychiatry at the Institute of Mental Health (IMH).
The real problem: caregivers who do not understand the nature of the illness or cannot deal with the stress of looking after these patients.
Through a memorandum of understanding signed with the National Council of Social Service (NCSS) last year, IMH has started to plug this gap.
Since March last year, an IMH team has gone to four voluntary welfare organisations that run residential homes and day activity centres for intellectually disabled clients to equip staff there with the knowledge and skills to recognise and deal with mental health problems their clients may suffer from.
They are the Bishan Home for the Intellectually Disabled, Blue Cross Thong Kheng Home, Metta Home for the Intellectually Disabled and Moral Welfare Home for the Disabled.
Ms Ang Bee Lian, chief executive officer of NCSS, said the collaboration was a response to feedback from voluntary welfare organisations whose staff faced challenges working with clients exhibiting difficult behaviour.
The IMH team comprising a psychiatrist, a psychologist, an occupational therapist, a social worker and a nurse work with caregivers over two months to teach them about the common psychiatric conditions faced by people with intellectual disabilities and types of behaviour to look out for.
The IMH team also teaches them how to analyse patterns through observing the triggers and consequences of different types of behaviour.
Care is improved and stress is reduced when caregivers have a greater understanding of their clients.
Ms Ng Zhuo Wei, a senior occupational therapist at the IMH, cited an example of how an employee at a home realised a resident who cried a lot was not doing it to make his job harder but because she missed her home. Learning about this made the employee more sympathetic towards the resident.
The voluntary welfare organisations involved agreed that their collaboration with the IMH has helped staff understand their clients better.
Mr Steven Tan, an administrator at Blue Cross Thong Kheng Home, said employees there used to send a resident home each time he played with the fire extinguisher.
However, this simply perpetuated the behaviour, as he wanted to go home.
Now, he is no longer allowed to go on home leave for up to a few weeks if he did the same thing, but is allowed to if he puts on his best behaviour. His behaviour has since improved.
Besides the education sessions, staff from the IMH and the voluntary welfare organisations meet once every four months to discuss strategies to deal with difficult clients.
These sessions have helped staff at the Bishan Home for the Intellectually Disabled devise ways to teach a 33-year-old resident how to use the toilet.
For more than 10 years, the man, who has moderate intellectual disability and cannot speak, would urinate in different parts of the home, such as the multi-purpose hall and the common dining area.
Staff had to clean up after him as many as 10 times a day.
Using techniques taught to them by the IMH team, staff pasted a photo of his face on a picture of a man urinating into a toilet bowl and showed this to him each time he relieved himself, whether in the toilet or in an inappropriate place.
Each time they showed him the picture, they would tell him: "Pass urine."
Within a month, he got the message. The employees at the home clean up after him just once or twice a week now.
After the two months of training workshops, the IMH team comes back - once a week initially and then every fortnight - to watch how caregivers carry out care management plans and recommend tweaks.
Dr Wei said this close supervision beats having mental health professionals give verbal or written instructions to caregivers and relying on them to carry out the plan successfully.
An NCSS spokesman said after the training by the IMH, 74 per cent of the clients at the voluntary welfare organisations picked up for intensive consultation showed improvements in their social functioning, cognition and behaviour.
Dr Wei said there are plans to extend the outreach effort to another four voluntary welfare organisations, which may include autism centres, by next year.
At the Movement for the Intellectually Disabled of Singapore, clinical psychologist Hoili Lim said its staff know their clients well enough to detect any deviation from usual behaviour.
If this should happen, the client is first assessed by the in-house psychologist, who then decides if a referral to the psychiatrist at IMH is warranted.
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