Eleanor Yap
Mental illness is becoming a worrying trend in Singapore, where one in six suffer some form of it, with depression, alcohol abuse and obsessive compulsive disorders (OCD) being the most common.
In January, there was the 5th Singapore Mental Health Conference where this year’s theme was “Empowerment for Resilience and Recovery”. ProjectCare talks to Dr Julian Hong, a doctor from DTAP Clinic Group and alternative director of Resilience Collective, who was also a moderator at the Conference about caring for loved ones with mental health conditions, and how to safeguard caregivers’ own mental health:
Caring for loved ones with mental health:
Can you share more about the mental health situation in Singapore?
At the national level, the Singapore Mental Health study has found that more people in Singapore have experienced mental disorders at some point in their lives. The 2016 study found that one in seven people in Singapore (13.9 percent) had experienced specific mood, anxiety or alcohol use disorders in their lifetime. This proportion is an increase from roughly one in eight (12 percent) six years prior.
Among these conditions, depression was the most common mental disorder in Singapore, with one in 16 (6.3 percent) who had the condition at some point in their lives. Alcohol abuse and OCD rounded off the top three mental disorders in Singapore. One in 24 people had experienced alcohol abuse, while one in 28 people had suffered from OCD.
Can you give us an idea what types of mental health conditions that caregivers are caring for in their loved ones?
A 2017 report by Caregivers Alliance Limited, where a total of 6,715 caregivers were interviewed, found that the top three diagnosis of loved ones whom they cared for are: schizophrenia (27 percent), depression (21 percent) and dementia (17 percent).
What about taking care of loved ones with mental health issues? What are some signs of trouble that caregivers need to look out for?
Suicidal attempts: Every suicidal thought must be taken seriously. Stay with your loved ones and listen attentively to let them know you are very concerned. Let them speak about their suicidal thoughts; it does not increase their risk of committing suicide. Let them know they are not alone and later link them up to help such as the Samaritans of Singapore (SOS) (24-hour line) at 1800-221-4444. If they are however in immediate danger of harming themselves or others, you should call the police at 999 immediately.
Mood swings: Mood swings can swing to extremes from mania to depression. Observe and note the signs and symptoms; do not challenge the person’s behaviours and encourage him or her to seek professional help. If the person refuses to seek treatment, you can engage a community psychiatric assessment team who can visit the person at home.
Delusions: Not to argue or refute the person’s claims. Encourage loved ones around to bring the person to seek help from professionals or community partners near them. Again, if the person refuses to seek help, one can engage the community psychiatric assessment team to visit him or her at his or her home.
Caring for caregivers’ mental health:
Can you share a case of a caregiver who suffered from mental health issues due to his or her role?
The case is close to home and is about my own grandmother who recently suffered a fracture in her upper limb. The challenge however was faced by her caregiver, also a family member, who suffered feelings of guilt and sadness for not preventing the fall that resulted in the injury. Furthermore, the increased burden of care for my grandmother had significantly gone up as a result, adding further stress to the caregiver and possible burnout. According to a 2018 study done in the US examining the likelihood of depression in caregivers, a staggering 28.5 percent (nearly one in four) had developed depression!
It is important to recognise these signs of caregiver burnout and depression so that caregivers can seek help. Coping with negative emotions, coping with the emotional burden, learning to self-care as caregivers – all these featured in my personal encounter above.
Are there other mental health conditions that can occur as a result of caregiving?
Caregivers are also susceptible to any of the mental health challenges that all of us face. But more so for caregivers, they often face the stress of caring for their loved ones (unable to control the situation, unmet or unrealistic expectations, and emotionally and physically drained) and this can translate into caregiver stress or even burnout. When this stress or burnout takes its toll, mental health issues such as depression and even anxiety can set in.
How can caregivers take care of their own mental health?
In talking at the Singapore Mental Health Conference 2019, I shared the stage with five other distinguished panelists and we discussed the topic of empowered families. These panelists were caregivers themselves, and persons with mental health in recovery or serve as a service provider to caregivers. The platform sought to empower other caregivers as they journeyed in caring for their loved ones with mental health concerns.
These were three questions asked to the audience and the panelists, and I want to take this opportunity to share a few poignant statements which encapsulate the needs of caregivers and the challenges they face:
1) What does empowered families look like?
“Normalcy to go about their day-to-day lives.”
“Having the knowledge, information and equipped to support their loved ones.”
“To rationally understand their loved ones and not allow emotions cloud this understanding.”
“Family bonds and quality time are so important.”
2) What are the challenges to being empowered families or caregivers?
“Sometimes families and caregivers cannot get around the stigma that they are caring for a person with mental health needs and they do not want others to know. That makes it difficult for them to get help.”
“Your presence is important to be there for them and listen with your eyes, ears and heart.”
“Self-care is important, because as a caregiver, without proper self-care, you cannot care for your loved ones.”
3) Role of ecosystem in caregivers supporting caregivers
“Hope is important, to know that the journey is not taken alone.”
“Persons with mental health conditions all want to get well, they may not articulate this well, they may push you away but deep down, each one wants to get well. To be able to live a normal life without the fear of being taken over by the condition.”
I sum up these heartfelt sharings from the session into a short acronym COPE, adapted from the Agency for Integrated Care’s (AIC) dementia resource:
C – Care for yourself – exercise regularly, eat well and take time off for personal activities and relationships.
O – Open yourself to help – let your loved ones know when you need help with caregiving and accept help when offered.
P – Prepare yourself for caregiving – participate in support groups to exchange knowledge and tips with other caregivers.
E – Empower yourself – embrace your role as a caregiver, feel positive and focus on what you can control.
What are some people and/or resources that might be helpful to caregivers and their loved ones?
- Medical personnel such as afamily doctor or a psychiatrist
- Community partners – ClubHeal, Resilience Collective (peer-to-peer) and Caregivers Alliance (caregiver-to-caregiver)
- Emergency hotlines – Mental Health Helpline – 6389 2222 (24-hour)
Samaritans of Singapore (SOS) – 1800-221-4444 (24-hour)
Police – 999 (24-hour)
AIC also has fantastic resources and a helpline which provides a home assessment team to support the persons with mental health conditions or the caregivers themselves.
SilverPages hotline (by AIC) – 1800-650-6060 (office hours – Mondayto Saturday). There is also a battery of resources on the Silver Pages’ website, which shed light into respite care, financial assistance schemes, caregiver training, tools and other care services and programmes to support caregivers. I strongly recommend this resource – www.silverpages.sg/resource-library/Brochures.
Are drugs the best way in treating caregivers’ mental health issues?
Each of us have our own ways to COPE but the journey of being a caregiver is not one taken alone, and it is a community of doctors, nurses, counsellors, other caregivers, persons in recovery that journey together with the caregiver and his or her loved one.
Taking the first step to find support is important and knowing that other caregivers face the same challenges can somewhat empower them to know that they too can overcome these challenges.
Last but not least, if a caregiver discovers that his or her own mood has been affected – persistent negative emotions and sadness – please see a doctor about this for a thorough assessment, as depression is a real concern (28.5 percent of caregivers) and can be cured with medications, counselling and support. There also are many misconceptions surrounding depression and the taking of medications to cure this. But please speak to the doctor to address these doubts.
Remember, a baker who bakes the best bread in the world needs to be able to feed himself first, so that he can have the energy to continue baking wonderful bread for those around him!
** EDITOR’S NOTE: ProjectCare also has a peer-to-peer support group particularly for caregivers looking after loved ones with dementia. For more information, go HERE.
