Rehabilitation for Depression and Anxiety - Dr Arthur Chern Group CEO St Andrew's Mission Hospital & Singapore Anglican Community Services ...
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Rehabilitation for
Depression and Anxiety
Dr Arthur Chern
Group CEO
St Andrew’s Mission Hospital &
Singapore Anglican Community Services
Mental Health Landscape
in Singapore
National Surveys On Mental Health
2010 & 2016
Lifetime Prevalence of Mental Disorders
Top 3 Most Common Disorders
2010 2010 2010
1 in 17 1 in 32 1 in 33
(5.8%) (3.1%) (3.0%)
2016 2016 2016
1 in 16 1 in 24 1 in 28
(6.3%) (4.1%) (3.6%)
Major Depressive Alcohol Abuse Obsessive Compulsive
Disorder Disorder
Note : There was an increase in lifetime prevalence of mental
illness from 12% or 1 in 8 in 2010 to 13.9% or 1 in 7 in 2016 who
had experienced a mental disorder in their lifetime.
Mental Health Situation In Singapore
Average No. of Years To Seek Treatment
26 Onset of
mental
Year Alcohol
Abuse
OCD Major Depressive
Disorder
Years Old illness
2010 13 9 4
2016 4 11 1
Where Do They Seek Help
Year Psychiatrist Counsellor General Religious Psychologist
Practitioner / Spiritual
Healer
2010 22.1 21.6% 18% 12% -
2016 42.3% 36.5% 20% - 26.2%
Reduction In Treatment Gap • In 2010, 84% did not have any treatment for their mental disorders. But in 2016, it was 78.4%. • For alcohol abuse, the treatment gap reduced from 96.9% to 80.6%.
Common Types of Mental Illness
1. Schizophrenia
Affect:
2. Depression • Thinking
• Feeling
3. Bipolar • Behaviour
• Motivation
4. Anxiety
SACS Psychiatric Rehab Services
Anglican Care Centre
(Yishun) Anglican Care Centre
Anglican Care Centre
(Bukit Batok) (Hougang)
Anglican Care Centre
(Pasir Ris)
Anglican Care Centre (Simei) &
Anglican Care Centre (Farrer Park) Integrated Employment
Services (IES)
No. of Persons Served
2235 2267 2293
1913 1956
1614
2013 2014 2015 2016 2017 2018
Persons With Mood Disorders Under SACS Psy Rehab Services
Employment
Residential Day COMITs
Support
Rehab Rehab
Services
(N=402) (N=238) (N=1,102)
(N=305)
DIAGNOSIS NO. % NO. % NO. % NO. %
Schizophrenia 324 81% 175 74% 624 57% 162 53%
Mood
42 10% 36 15% 264 24% 99 32%
Disorders
Anxiety
16 4% 12 5% 102 9% 41 13%
Disorder
Others 20 5% 15 6% 112 10% 3 1%
Depression 1. Loss of sleep or sleep too much 2. Loss of appetite / some may have big appetite 3. Loss of social contact / withdrawal 4. Loss of interest in usual activities 5. Loss of concentration 6. Loss of libido / sexual drive 7. Loss of energy / easily tired 8. Loss of movement / slowing down Note: Some may have suicidal thoughts which require suicide risk assessment.
Assessment on Risk of Suicide 1. Previous attempts (within 3 months) 2. Concrete plans to die 3. Lethality of method (eg. Jumping, hanging, etc) 4. Giving away precious things & suicide notes 5. Feeling lonely, helpless and hopeless 6. Inability to come to terms to grief and loss of someone significant or something of significance 7. Suffering from chronic depression and illness 8. Family history of suicides 9. Under the influence of drugs and alcohol
Bipolar (Manic Depression) Symptoms of Mania 1. Feeling “high” and restless 2. Irritable and easily agitated 3. Talking very fast - jumping from one idea to another, racing thoughts 4. Easily distracted 5. Grandiosity and religiosity 6 Sleeping little 8. Impulsive such as spending sprees, impulsive sex, gambling
Anxiety Disorders Anxiety takes several forms: phobia, panic attack, obsessive-compulsive, and post-traumatic stress. The physical effects of anxiety may include:- • Heart palpitations • Headache • Muscle weakness and • Stomach pain tension • Perspiration • Fatigue • Trembling • Nausea • Restlessness • Chest pain • Insomnia • Shortness of breath
Model of Care
1. Strengths-Based : Abilities, Talents,
Interests and Preferences
2. Holistic : Bio-Psychosocial Spiritual
Approach
3. Eco-Centric : Person in relation to
formal & informal support systems
4. Recovery Oriented : Working towards
personalized plans and to discover new
meaning and purpose in one’s recovery
journey.Strengths-Based, Person-Eco Centric
Holistic Care Model
IMH Hospital
Religious Affiliation
School CAL
Peer Support Specialists
Employer Family
VWOs Volunteers Rehab GP
Counsellor /
Friends Case Manager
SNAP
Employment
Neighbours
Specialist
Relatives
HDB Residents Committee SSOBio-Psycho-Social-Spiritual
Community
Case
Re-integration
Management
&
Counselling
Skills
Equipping
Wellness Person with
Management mental
health issues
Pastoral
Care
Peer
Support
Caregiver
Support• Day Care
• Community Intervention
Psychiatric & Outreach
Nursing Residential • Integrated Employment
Homes Rehab Services
Continuum of Psychiatric Rehab Services
Long Term Nursing Care ------------------------------------------------ Living In The Community
Slow Stream Psychiatric
Rehab Sheltered Home1. Residential Rehab Services • It is a step down care to those referred from acute wards and other agencies who require a period of psycho-social rehab. Programmes and work Capacity : 156 opportunities are aligned to members’ recovery goals under Annual No. of Clients the Individualised Care Plan (ICP) Served is about 400. • The duration of stay depends on their progress. For positive discharges, they are encouraged to continue with COMIT for follow up in the community. Capacity : 170
2. Psychiatric Sheltered Home (PSH) Anglican Care Centre (Farrer Park) was set up in Oct 2017 as a Psychiatric Sheltered Home (PSH) to provide temporary accommodation for PMHIs. It seeks to support them in their recovery and reintegration into the community. It has a capacity of 80 beds; 60 for adult males and females and 20 for youths from 16 to 20 years old
3. Day Rehab Services • Currently, there are 5 Day Rehab Services located at various part of Singapore. These Centres use the adapted Clubhouse Model to involve members in various programmes and activities based on their strengths, interests and preference. • It operates on week days from 9am to 5pm. The capacity for Centre is as follows:- ACC (Simei) – 50; ACC (Hougang) - 30; ACC (Bukit Batok) - 30 ; ACC (Yishun) - 30 and ACC (Pasir Ris) – 30. Total no. of clients served per year about 240. 20
4. Community Intervention Teams (COMITs)
@BUKIT BATOK • PASIR RIS • YISHUN
• The COMITs are mobile teams supported by AIC to
reach out to PMHIs living in the community. The main
thrust of the service is to provide various forms of
support in knowledge and equipping of skills and
linkages up with community resources to enhance
meaningful participation and improve their quality of
life.
• This helps to sustain their recovery in the community.
Each COMIT Rehab Counsellor manages about 50 - 60
clients and the total no. of clients served per year is
about 1,200.5. Integrated Employment Support Services
Social Enterprises (SE)
Employment Support Services (ESS)
Employment Training Services (ETC)
Employment Internship Programme (EIP)
Employee Assistance Programme+ (EAP+)
• Assess and match clients to relevant jobs
• Job training and internship opportunities
• Assist clients to secure and sustain in their jobs.
Choose Get Keep
225a. Social Enterprises (SE)
• Sale of donated old and new items at seven
outlets; 4 at Senior Activity Centres and at 3
psychiatric service centres to train members in
retail and customer services.
Members’ Own Social • Customised and generic items made by members
Enterprise & Services and are sold at events and roadshows. MOSES is
currently operated within the Sheltered Rehab
Workshop at the ACC (Simei).
Mother and Child • This project was started for women and children
at the family crisis shelter. It became part of the
social enterprises to support women who are not
able to go out to work because of the need to
care for their children at home.5b. Employment Support Services (ESS) ESS provides employment services to help Persons with Mental Health Issues (PMHIs) seek meaningful employment. Its goal is to empower PMHIs to achieve sustainable employment with the view of reintegration into the community. It also provides the business community with comprehensive employment services to support them in integrating PMHIs in the workplace. 5c. Employment Training Centre (ETC) ETC provides vocational training courses to PMIs with the appropriate knowledge and skills to prepare them for jobs in the market. Each year, there are 3 runs with an intake of 20 to 30 persons per run.
5d. Employment Internship Program (EIP) EIP provides on-the-job training for PMHIs to prepare them for open employment. The traineeship programme aims to enhance job readiness and sustainability through on-the-job training in specified industries, enhance knowledge and skills of employers in supporting PMHIs and showcase the employability of PMHIs 5e. Employee Assistance Program+ (EAP+) EAP+ aims to provide timely support to employees with or at risk of having mental health issues and employers, co-workers through a multi-disciplinary team consisting of mental health professionals and Peer Support Specialists so as to enhance performance of employees, mental well-being of employees and knowledge and skills of employers/co-workers in implementing workplace support.
Thank You
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