A new dream for IMH long-stayers

Mr H, 65, with advanced practice nurse Goh Ai Sze at the Institute of Mental Health. Mr H, who has schizophrenia and no family to turn to, is one of 1,128 long-stayers at the psychiatric hospital. Recently, he was given a job as a cleaner at the hosp
Mr H, 65, with advanced practice nurse Goh Ai Sze at the Institute of Mental Health. Mr H, who has schizophrenia and no family to turn to, is one of 1,128 long-stayers at the psychiatric hospital. Recently, he was given a job as a cleaner at the hospital as part of a programme to help him regain his independence.ST PHOTO: JONATHAN CHOO

'Slow stream' rehabilitation for some to reintegrate back into society

On the surface, Mr H leads a pretty ordinary life.

The 65-year-old works as a cleaner, likes popping into his usual foodcourt - for "soya milk, $1, and nasi lemak, $2.50", he said with a toothy grin about his favourite picks - and chatting with friends.

As evening descends, he returns to his block to wind down with dinner and perhaps a spot of television.

Except that the foodcourt he frequents is on the ground floor of a building at the Institute of Mental Health (IMH).

And his "block" is a nondescript six-floor structure at the psychiatric hospital - a place he has called home for the past 11 years.

Mr H, who has schizophrenia and no family to turn to, is one of 1,128 long-stayers at the 2,000-bed hospital. For stable patients like him, however, life at the institution recently took on renewed purpose.

Earlier this year, Mr H got to take a public bus to visit a temple in Punggol. It was something he had requested to do, and the first such trip he had made since he was admitted.

GOOD CHANCE TO GET OUT

Patients are very motivated; they work very hard because they know that this is a good chance to get out of IMH.

DR ALEX SU, vice-chairman of the medical board (clinical quality) at the Institute of Mental Health (IMH).


WHAT PATIENTS WANT

We spoke to them to find out their personal goals or wishes. Some told us they wanted to work. One had a simple wish of going to church on his own.

MS GOH AI SZE, an advanced practice nurse at IMH.

He was also given a job as a cleaner, mopping the floors of the wards, in addition to other chores, for which he receives a token sum.

The changes are part of a broad initiative started by IMH two years ago to help suitable long-stayers regain independence, improve their ability to care for themselves, learn new skills and eventually go home.

Dr Alex Su, vice-chairman of the medical board (clinical quality) at IMH, said most long-stay patients are in their 50s and 60s. A few centenarians are in the mix.

"Some have been here for 10, 20 years or longer, and probably have a bad... history - multiple relapses until their families were burnt out.

"They lead a simple lifestyle in the long-stay ward - sleep, wake up, eat, help with chores." Sometimes, volunteers visit them, added the senior consultant psychiatrist.

Long-stay patients are defined as those who have been hospitalised for at least a year. They are afflicted with conditions such as schizophrenia, intellectual disabilities and obsessive-compulsive disorder.

Many were abandoned by their families as the strain of caring for them took its toll. Some obtained court orders to stop the patient from returning home.

Other patients were transferred from nursing homes. Then there are some older folk, brought over from the old Woodbridge Hospital in 1993, who had been simply picked off the streets back in the day.

Said advanced practice nurse Goh Ai Sze: "Some of them believe that they will be with us for the longest time, or forever."

These patients may, therefore, be listless, unmotivated or have poor self-confidence, she explained.

While long-stay patients have been well cared for over the years, the side effect is that they become "institutionalised", said Dr Su.

"Everything is done for them such that they lose independence in their daily living tasks," he said.

To improve this, IMH regrouped them into six categories, from frail elderly to stable patients with potential for rehabilitation.

The stable group, which comprises 60 people including Mr H, are suitable to be discharged eventually, such as to a community rehabilitation facility or back home.

To achieve this, they undergo "slow stream" rehabilitation.

Said Ms Goh: "We spoke to them to find out their personal goals or wishes. Some told us they wanted to work. One had a simple wish of going to church on his own."

Several would like to go home.

Those deemed suitable to work receive training so they can take on simple jobs, such as helping out in the hospital kitchen.

Others are taught skills aligned with their goals, from personal grooming to washing their clothes and, if they wish to take public transport or go cycling, road safety.

Patients get help in setting up a bank account. Group outings are organised to familiarise them with modern society. Some, for instance, have never used an ez-link card.

Such changes at IMH did not take flight until recently, partly because staff have focused on providing care and ensuring patient safety.

"As hospitals, we are always a bit risk-averse, " said Dr Su.

MP Tin Pei Ling, who is on the Government Parliamentary Committee for Health, said reintegrating mental health patients into society will help boost their self-worth and dignity. "It can be quite sad to have to live the rest of their lives inside. If they are competent and stable, why not try to re-integrate (them back into society)?" she said.

So far, 10 patients have been discharged.They remain in touch with IMH. "Patients are very motivated; they work very hard because they know that this is a good chance to get out of IMH," said Dr Su.

But it is not always easy to make the transition. Some wanted to return to IMH and a few did, he said.

"They found it was too much of a change. Some were stressed and a couple of them relapsed," he added.

"We have to be realistic - after so long, it may take a couple of readmissions before they can adapt."

Ms Tan Li Li, executive director of the Singapore Association for Mental Health, said there is "an added layer of complexity" in assimilating patients who have been institutionalised.

Challenges include potential discrimination, self-stigmatisation and finding employment and retaining it. "All these require the community's support, without which it will be an uphill task," she said.

Mr H, whose full name cannot be revealed, said he likes living at IMH, though nobody visits him there.

He is stoic even though he has been diagnosed with lung cancer. What if he dies before he gets a shot at a new life "outside"? With a dismissive wave, the elderly bachelor said: "No girlfriend, no need to be sad."

A version of this article appeared in the print edition of The Sunday Times on October 01, 2017, with the headline 'A new dream for IMH long-stayers'. Print Edition | Subscribe