Regaining stability

PHOTO: Regaining stability

SINGAPORE - Radio DJ Glenn Ong sparked outrage when he remarked that the Institute of Mental Health (IMH) should keep the mentally ill locked up because of the danger they pose to others.

In contrast to Ong's rant, IMH's aim is to ensure that its discharged patients keep up with treatment and help them to reintegrate into society.

It has a case management department that follows up on these patients.

Case management has made a big difference in the life of Madam Lim (not her real name), 48, who has schizophrenia, a mental condition that often causes auditory hallucinations, delusions or disorganised speech and thinking.

Her son, John (not his real name), 21, who recently graduated with a diploma in nursing, said: "We spent years trying to coax her to take her medicine and have regular check-ups, but we had no success.

"About half a year back, she got a case manager, Gemma, who was able to bring about change after just a few months. Now she goes for her injection every two to three weeks, and every month or so, she will see the psychiatrist in a hospital near her home."

John was only seven when his mother suddenly left home because she was convinced that his father had cursed her.

"We had no idea where she went until a few weeks later, when my dad received a lawyer's letter where she asked for a divorce," said John. "It was a devastating time for me."

He added that his mum would get easily agitated and often scolded him for no reason, further straining their relationship.

Hurtful words

Hurtful things

"She would say I'm not her son, hurtful things like that," he said.

As Madam Lim had no insight into her own condition, she was frequently admitted to IMH over the years. Her most recent admission took place last year, when she was brought in by police for causing a ruckus at a hotel after accusing the staff of cheating her.

When case manager Gemma Fernandez, who is in her 40s, first met Madam Lim, she was irritable and uncooperative.

Miss Fernandez said: "Initially there were arguments, especially about her illness. But there were days when she could honestly tell me her feelings and frustrations.

"I always listen first. We are often very quick to ask why this or that was not done, but that's the last thing they want to hear."

Miss Fernandez persuaded Madam Lim to meet her for 10 minutes every day while she was in the ward.

Often, she would spend the time getting to know Madam Lim and not talk about the illness at all.

Eventually, Madam Lim admitted to having auditory hallucinations and was able to provide feedback on how much medication was helping her so that the side effects were minimal.

Miss Fernandez said: "Once there is acknowledgement of the condition, it's like half the battle is won."

After Madam Lim's discharge, Miss Fernandez kept in touch with her and John. Madam Lim is now working as an administrative officer and gives phone updates to Miss Fernandez voluntarily.

John is grateful for Miss Fernandez's patience as his mum's case manager. He said: "Through her case management, my mum is coping well and taking ownership of her condition. I have reconnected with her and I thank Gemma for that."

Miss Fernandez, who has been a case manager for two years, said her main motivation is seeing patients recover when they are empowered to care for themselves.

"The most challenging part of my job is when patients are in strong denial. Because of the stigma, no one likes to be perceived as having mental illness."

She credits her job for giving her a greater awareness about mental illness.

"Recently I saw someone wearing a T-shirt that said, 'I used to be schizo, but we get along well now'. There is a common misconception that schizophrenics have different personalities," said Miss Fernandez.

"In the past, I probably would have found the T-shirt funny. But I now understand what schizophrenics go through and if I see someone with that T-shirt now, I may well go and talk to them so they can reflect on what their T-shirt says."

This article was first published in The New Paper.