Man stayed in IMH ward for 2½ years, but now works part time as a cleaner

SINGAPORE - He is now jovial and even a bit of an extrovert, belying how much he once suffered from mental illness.

Diagnosed with schizophrenia in 2013 and obsessive compulsive disorder in 2014, RZ – he did not want to give his real name – called the Institute of Mental Health (IMH) home until July.

The 40-year-old was one of around 1,000 long-stay patients at IMH – patients who have stayed there for at least one year and exhausted all possible discharge options.

RZ spent nearly 2½ years in the long-stay ward, starting from February 2021.

But after taking part in a programme to rehabilitate long-stayers and prepare them for life outside IMH, RZ is among 140 patients who have been discharged into the community and now have a chance to rebuild their lives.

He is staying at a step-down facility in the community and works as a part-time cleaner.

The rehabilitation programme helps patients take on employment and rebuild their ability to live life independently.

A sudden descent

RZ’s mind was suddenly fractured after a religious mission abroad in 2013.

The devout Christian, who once enjoyed going to church on weekends and found joy in reading and music, became a shadow of his former self.

He started behaving erratically, withdrawing from people and sleeping throughout the day.

His younger sister, who wanted to be known only as WQ, said: “He was hunched over, walking in and out of the toilet and wincing his face... I had not seen him like that before, so I knew something was wrong. He wouldn’t respond to us, it was like he was in his own world.”

Recalling his frazzled state of mind then, RZ said: “I remember trying to play with the lights using my eyes and trying to put the lights together... I also thought that my shower head was a cobra, and it felt like I was in a demonic realm.”

He was first admitted to IMH in 2013 after he started throwing things at the TV.

Following that period, RZ was in and out of the mental institution for months at a time as an acute patient.

Acute care is provided when a patient is treated for a brief but severe episode of mental illness.

This was partly because he had trouble complying with his medication regime, which caused him to relapse.

“One day I had the flu, and I was so paranoid that every two steps I took, I used antibacterial wipes to clean the floor,” said RZ.

He also described feeling an irresistible urge to push someone in public, and had police and security officers called on him on multiple occasions.

He would also throw his personal items such as keys, wallet and mobile phone into lagoons and over MRT tracks, and was unable to explain why he did so.

He was helping his sister with her business at the time, and started having difficulty doing his job, needing constant supervision.

His sister, who was also the main caregiver for two other old and sickly family members, was at the end of her rope.

“Things got heavier; he was the toughest one to take care of, and he really challenged me physically and mentally,” said WQ, 37.

After RZ threatened to hurt WQ’s son, he was admitted to IMH as an acute patient in 2018, for the final time, as it turned out.

When his condition stabilised, RZ was moved to IMH’s long-stay ward.

Patient services

On average, long-stay patients make up about two-thirds of IMH’s 1,700 patients, said Dr Alex Su, a senior consultant in the department of recovery care at IMH.

More than half of the long-stayers have schizophrenia.

Others suffer from major depressive disorder or anxiety disorder, have intellectual disabilities or dementia – conditions that stop them from living independently or integrating well in the community.

In 2015, IMH reorganised patient services into five groups to better cater to the specific needs of different long-stayers, said Dr Su.

These include the elderly, the intellectually disabled who have other mental health conditions or behavioural challenges, and those who concurrently suffer from terminal medical conditions like cancer.

There are also those whose conditions are stable, yet they are not suitable to undergo rehabilitation as they tend to be socially withdrawn and passive when it comes to engaging in rehabilitative activities.

Lastly, there are those on slow-stream rehabilitation. Patients on this programme are given help to improve their functioning and to regain skills such as personal grooming and medication management, said Dr Su, adding that they also undergo vocational training.

“The aim is to restore their independence and prepare them for discharge, so that they can reintegrate into society,” he said.

Ms Cheryl Goh, an advanced practice nurse at IMH and a member of the pioneer team who set up the slow-stream rehabilitation ward, said ensuring patients take their medication is key.

Some do not because they reject their diagnosis, afraid of the stigma attached. Others are afraid of side effects.

Ms Goh said she would remind such patients that with medication, they can do more things in their lives.

“Some patients also (take their medicine) because they have developed trust in us,” she noted.

RZ was found to have rehabilitative potential in July 2022 and put on the slow-stream programme.

He was given the role of recovery ambassador at the slow-stream rehabilitation ward because of his amicable personality.

His job was to help newcomers ease into ward life during their first few weeks, and to orientate visitors to the programme.

A music lover, RZ mooted the idea of using music to engage his peers.

He was also involved in meaningful activities like the packing of hydroponic vegetables grown at IMH, as well as retail sales events held at the hospital and at external venues.

He also took on an ad-hoc job as a cleaner within the hospital’s premises, wiping down consultation rooms and toilets three times a week.

He did well enough for the cleaning company to hire him part time for four-hour shifts, five times a week.

The ability to earn some money gave him a sense of accomplishment and boosted his confidence, said RZ.

WQ soon noticed that her brother had improved.

“I became more hopeful about my brother’s future and ability to become independent,” she said.

“I am thankful to the IMH team for the opportunities, because if they didn’t fight for him, he’d just stay in the hospital... Who doesn’t want a second chance?”

Caring for long-stayers

While RZ is on a journey of rehabilitation, some long-stayers face hard times.

This is particularly true of those who have little to no social support in the community, said Dr Su.

In an IMH survey done in January involving some 200 patients, it was found that about 10 per cent had no next of kin.

For those who did have immediate family, 60 per cent either did not receive regular visits, or were not visited at all.

About 80 per cent of IMH long-stay patients are aged 50 and above, and the institution’s longest-staying patient has been there for 53 years.

“Their own parents would have passed on or be too old to look after them. Their siblings or the younger generation may not be too familiar with them... They really have nowhere to go, and we can’t discharge them onto the streets,” said Dr Su.

But that does not mean IMH gives up on them.

“We have become their family and friends, but we also don’t want them to become institutionalised, so we put in programmes to help them have daily activities and pick up some work in the ward to look after each other,” said Dr Su, adding that such activities help them build their confidence and regain independent living skills.

He acknowledged that there is a small group of elderly patients whose mental condition are so chronic that they cannot look after themselves.

The hospital will look after them till the end of their lives or until they are moved to nursing homes.

Patients at IMH receive regular visits from volunteers who plan festive celebrations and outings to places of interest to keep them connected and engaged.

Said Dr Su: “Many people think, how can these patients survive outside? But many of them who are in their 50s and 60s feel that this is their last shot.

“So they participate in programmes and learn skills and share their problems.

“Everyone still has a chance.”