The stigma of mental illness is still a major obstacle in getting help to patients - and their children too, who may suffer as a result of their parents' illness.
A pilot programme offering support to children whose parents are mentally ill has had limited reach.
Project Orchid, run by the AMKFSC Community Services and funded by the National Council of Social Service, started seeing cases in November last year.
So far, 20 families have been referred by schools, family service centres and other agencies. But eight families have said no to the help offered.
AMKFSC's head of youth work department Tan Yi Ying said: "Not many people know we have started this project, but even if they know, it may be hard to convince them to join. The social stigma surrounding mental illness prevents them from seeking help due to 'face' issues."
They also worry that others will shun their children, if they find out about their parents' mental illness, she said.
The programme was started to get help early to the children, as some may find it hard to cope with their parents' illness or worse, are at a higher risk of developing a mental illness themselves.
Not many people know we have started this project, but even if they know, it may be hard to convince them to join. The social stigma surrounding mental illness prevents them from seeking help due to 'face' issues.
MS TAN YI YING, AMKFSC's head of youth work department.
This is because of genetic and other factors underlying mental illness, a host of overseas research has found, said Ms Voon Yen Sing, assistant director of clinical services at the Singapore Association for Mental Health. Parenting ability may also be affected by the illnesses, social workers said.
Ms Tan said: "Some parents suffer from depression, (and) may take it out on their kids unknowingly and this strains their relationship. Another worry is that the children learn their parents' unhealthy coping skills."
For example, a teenage boy whose mother suffered from obsessive compulsive disorder (OCD) began, over time, to wash his hands compulsively, aside from displaying other OCD symptoms, she said.
Another teenage girl mixed with bad company and ran away from home as she felt her depressed mother did not care for her.
The truth was, her mother was struggling to cope herself. Project Orchid's staff helped them to communicate with and understand each other better to improve ties.
Its social workers educate the children to understand their parents' illness and help parents understand how their illness affects their children. And they teach both sides how to cope with stress.
Like AMKFSC, the Institute of Mental Health (IMH), which has a similar initiative for children of patients called I'm A Resilient Kid, also finds it challenging to reach out to the children of its patients.
IMH senior medical social worker Michelle Shanthini Gunasilan said: "Some parents are apprehensive in letting their children know about their mental illness as they are unsure if it will undermine their role as a parent and affect their relationship with their child."
The IMH programme started in 2008 with group sessions where the children learn about mental illness, and receive support from social workers and other children in similar circumstances.
Last year, it also included individual sessions so children and families could have more attention, for example, through counselling, to help them cope.
And for those in situations where the parent may be suicidal or violent, the child is also taught how to seek help if he should feel unsafe. Over 200 children have gone through the programme since it was started in 2008.
Social workers welcome the Project Orchid initiative to support these children, given the multiple stresses they may face.
About one in eight adult Singaporeans or permanent residents has experienced a mental illness, according to the nationwide Singapore Mental Health Study in 2010.
Some children have had to care for their parents, reversing the parent-child role, said Ms Samantha Lim, deputy director of the Singapore Children's Society Family Service Centre (Yishun).
She had a few cases where a child skipped school to stay home to monitor depressed parents, afraid they would kill themselves.
"If we do not reach out to these children, they suffer in silence. So, Project Orchid (can help) look out for these children in need."
To get help from Project Orchid, call 6451-1553 or e-mail firstname.lastname@example.org