Chances are, you know somebody who’s struggling with depression, bipolar disorder or some other mental health issue. According to a 2010 study conducted by the Institute of Mental Health (IMH), one out of 10 people in Singapore will develop a mental health condition over the course of their life.
A sickness that creeps up on its victim
You might not recognise it at first. When my mother became depressed in 2016, it took my father, brothers and I weeks before we caught on. The first thing to go was her sleep.
Emerging from her bedroom in the mornings, she would carry dark bags beneath her eyes and a fog in her mind. Night after night, she confessed that she was lucky to get two hours of rest. We asked what was wrong, and mum said she was stressed because her work load in the new year was set to increase. “I don’t know how I’m going to manage,” she lamented.
The week before she was to start on her new work assignments, she still wasn’t getting any sleep. Once the perfectionist who kept the house in order, she started letting things slip. I discovered the mailbox was stuffed full because she stopped checking it. If the boys left their dirty dishes in the sink, they sat there the entire day. She started forgetting to feed the pet rabbit and water the plants. That’s when we knew something was wrong.
Mum was always an anxious person, but this time was different. She seemed to be shrinking into herself. Somewhere along the way, her movements had gotten slower. She stopped leaving the house, not even to go to church. This was shocking, since mum has always been devout. “I look so haggard, I don’t want anyone to see me,” was the excuse she expelled like a deep sigh. She lost her will to do anything. Getting her to eat required hours of cajoling. We set up a roster to make sure someone was always home to see to it that she had regular meals.
Spending time alone with her was incredibly draining. Her thoughts seemed to be delayed. And they were also darker, more sinister. “Why have I become this way?” She would whisper repeatedly to no one in particular.
Eyes glazed over, tugging at her hair with both hands. “It’s all my fault.” It isn’t your fault, we would tell her gently. But she never seemed to hear us.
We tried to get her to seek help, but she refused.
“I’m not crazy!” She cried weakly. So over the next few months, we took turns to hold her hand for hours as she sat slumped over on the sofa mumbling to herself.
Looking after that someone demands a huge reservoir of emotional energy, not to mention time and personal sacrifice. At the time, I was in my final year of university, and was falling behind on all my assignments and projects. In class, I was distracted, worrying about mum. At home, I was frustrated by her never-ending grievances and cries of hopelessness.
Avoid drastic action unless absolutely necessary
Mum resisted seeing a psychiatrist, and her condition got progressively worse. After a three-month tug-of-war, we hatched a plan to bring mum to the hospital.
On a warm Sunday afternoon, my father told her we just wanted to take her for a drive. Despite her feeble protests, namely that she hadn’t showered and looked horrible, we shepherded her into the car and drove off to the Institute of Mental Health (IMH).
With hindsight, this was not the best decision. The hospital environment, and IMH in particular, may be daunting and stressful. So unless your loved one is in an emergency situation, it’s better to bring them to a general practitioner (GP) who is trained in mental health.
These neighbourhood doctors are able to provide psychiatric consultation and specialist referrals. A list of more than 140 qualified GPs is available at silverpages.sg.
A GP may direct you to other resources within the community such as multidisciplinary healthcare teams. "There are Community Care teams that are trained to reach out, spot signs and symptoms early, conduct assessment, counselling, therapy and caregiver support,” said Dr Tan Weng Mooi, Chief of the Community Mental Health Division at Agency for Integrated Care. These teams in polyclinics and the community comprise of nurses, therapists and medical social workers to provide holistic care for persons with mental health conditions.
Mum would receive this kind of support, but not before enduring the harrowing ordeal of waiting in the IMH emergency ward where she listened to inpatients’ howls from down the stark hallways and watched others pace listlessly around her. “I’m not crazy,” she whimpered.
Learning to look after yourself
Taking care of someone with mental illness takes a toll. Each day was a marathon of muscle relaxation exercises between conversations that went round in circles and wrangling with mum to get her to take her medication. When you’re emotionally drained or overwhelmed with hopelessness, it’s important to have people who understand your struggle to fall back on.
Thankfully, I had a few close friends who either battled depression themselves or had previously done volunteer work with persons with mental illness. They helped me with my school work when it was too much to cope with, and listened whenever I needed to vent. Throughout the time that mum was unwell, I could rely on them to be my support system.
There are formal organisations to help too. Caregiver Alliance Limited (CAL) provides a free training programme to teach you about how to cope, as well as how to better care for the person with mental health issues. They also have on-going caregiver support groups with experienced facilitators who provide encouragement and are ready to lend a hand in day-to-day challenges that come your way.
It took many months of medication and care for mum to return to her normal self. Doctors avoid the term “recover”, because it’s impossible to say if depression will strike twice. We’re more sensitive to warning signs that point to heightened anxiety, so we can practise mindfulness meditation or relaxation exercises with her before the situation escalates.
The silver lining is that mum is now an advocate for greater mental health awareness. She uses her experience to demonstrate how depression can affect anyone, and that it isn’t something we should be ashamed to seek help for.
Take suicidal thoughts seriously
Don’t ignore or dismiss the person if they say they feel like killing themselves. Listen and let them know that you care (this won’t increase the risk of them actually committing suicide). If necessary, call the Samaritans of Singapore (SOS) 24-hour helpline at 1800-221-4444. If you think they might harm themselves at that very moment, call the police right away.
Be understanding, be supportive
The Agency for Integrated Care and more than 30 community partners are launching a Mental Health Awareness Learning Series 2018, as part of World Mental Health Day this year. The theme for this learning series is called “Be Understanding— Be Supportive”. It is happening from Oct 14-31.
For information on community mental health services and resources: visit www.dementiafriendly.sg, www.silverpages.sg, Dementia-Friendly Singapore Facebook page and Mental Health Awareness Singapore Facebook page. You can also call AIC’s Singapore Silver Line at 1800-650-6060 or email email@example.com.