S$25m research project to identify risk factors for schizophrenia
By Margaret Perry, Channel NewsAsia | Posted: 13 May 2008 2306 hrs

25m programme to identify genetic, biological and social risk factors relating to schizophrenia.


S$25m research project to identify risk factors for schizophrenia

SINGAPORE: As part of a S$25 million research programme, thousands of teenagers and young adults will be screened to see if they are at risk of schizophrenia.

Among the five leading causes of disability worldwide, schizophrenia affects one per cent of the population, and usually first shows up in the teens or early adulthood.

If not treated early, it can be difficult for schizophrenia patients to get their lives back on track.

Most schizophrenia patients in Singapore, however, only seek help 2.5 to three years after they first experience a psychotic symptom, such as hearing voices.

So the Institute of Mental Health (IMH) plans to screen thousands of 15- to 30-year-olds to identify those at high risk. Researchers will then track their progress and start treatment early, if necessary.

The institute will conduct screenings at tertiary institutions, the armed forces, the police and the Singapore Civil Defence Force. It will also liaise with school counsellors and general practitioners who see people that are at risk.

The researchers expect about 3,000 young people to be identified as high risk. Having a family history is not the only risk factor for schizophrenia.

Associate Professor Chong Siow Ann, vice chairman of IMH's medical board (research), said: "People who perhaps have some history of obstetric complications at the time of birth, and... people who use cannabis may also be at a greater risk of developing this illness."

The study is part of a S$25 million programme to identify genetic, biological and social risk factors for schizophrenia.

Other parts of the programme include identifying genes that cause schizophrenia and a drug trial on new treatment to improve patients' functional skills.

The study is one of two projects awarded the Translational and Clinical Research Flagship Programme this year.

The two research programmes were selected from eight submissions and were chosen based on their scientific merit, the strength of the research teams and their relevance to Singapore.

The other S$25 million project, led by the Singapore Eye Research Institute, focuses on glaucoma and corneal diseases - the leading causes of blindness in Singapore.

The Singapore National Eye Centre treats over 34,000 cases of glaucoma and 15,000 patients with corneal diseases every year.

Professor Donald Tan, director of Singapore Eye Research Institute, said: "We have very little understanding or ability to modulate wound healing. And for example, in glaucoma operations, in some cases, the failure rate could be as high as 30 to 40 per cent." - CNA/ac

Sketching out life anew, thanks to fund
Diana Othman
19 April 2008
Straits Times
English
(c) 2008 Singapore Press Holdings Limited

Mentally ill get sponsored help to manage illness and reintegrate into society

FOR almost a decade, William battled schizophrenia and its symptoms. The mental conditions made the 32-year-old deeply paranoid. He grew increasingly suspicious of his family and friends, and thought they were talking behind his back.

But William, who declined to reveal his full name, eventually overcame the illness and went on to earn a master's degree in civil engineering.

He is now working as a draughtsman and has been with the same company for over a year.

'I am able to apply my tertiary knowledge and my boss is very understanding,' said William, who added that he was pleased with his $2,000 salary.

He attributed a significant part of his success and well-being to the Woodbridge Hospital Endowment Fund, which helps rehabilitate mentally ill patients from the Institute of Mental Health/Woodbridge Hospital (IMH/WH).

It supported some of the activities during William's eight-week stay in the rehabilitative ward in 2006.

The fund even sponsored his participation in the 7th International Abilympics in Japan last year, where he competed with other physically and mentally challenged people in competitions that tested vocational skills. He won a bronze medal in the architectural design category.

Events such as the Abilympics help those with mental problems build the confidence needed to take care of themselves and succeed, he said.

First set up in 2001, the fund pools contributions and donations to provide welfare and medical care for patients of IMH/WH. They include about 1,200 long-term patients, some of whom suffer from chronic mental illness, and others who have been abandoned.

Dr Tan Chue Tin, the fund's acting non-executive chairman, said money also goes into several programmes open to all patients to help them manage mental illness and reintegrate into society.

He said the fund needs about $250,000 to $300,000 each year to provide subsidies for medical services for needy patients, such as helping children with learning, social and emotional problems.

Money from the fund is also used in several rehabilitation programmes. These include a 'work trial' programme in which the fund pays half of a patient's salary during the first two months of employment, capped at $350 a month.

This acts as an incentive for employers who might otherwise be reluctant to hire a person with a mental illness.

The fund raises money mainly through donations and events such as charity golf tournaments.

'I feel grateful...because if not for this fund, I may not have recovered so fast,' said William.

Dr Tan said other patients have also benefited from the fund's work. 'Beyond just medicine and nursing care, is...social, occupational and psychological rehabilitation. Some (patients) have the opportunity to go out into the community and start a new life.'

The IMH is holding a charity concert tomorrow. The event, which will feature the Singapore Chinese Orchestra, is in aid of the Woodbridge Hospital Endowment Fund and also to mark the institute's 80th anniversary.

diothman@sph.com.sg

Charity facts

Name: Woodbridge Hospital Endowment Fund
Who it helps: Long-term patients and outpatients with mental disorders
Money it needs each year: $250,000 to $300,000
How it raises funds: Through fund-raising events and donations
Premises: Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View
How much in the kitty: $450,000
Size of staff: No paid staff. Its board has seven members who volunteer their time.
Number of volunteers: 250
Is it online?: Yes, at www.imh.com.sg [http://www.imh.com.sg]
Are its financial records online?: Yes
Why you should donate: To help patients reintegrate into society and live productive, meaningful lives

Mind Your Body
Married for 51 years
23 April 2008
Straits Times
English
(c) 2008 Singapore Press Holdings Limited

Tough love for the mentally ill

Every marriage has its ups and downs, as any couple will testify.

It is hard enough to sustain a romantic relationship if both parties are healthy and well. But it becomes even more difficult if one or both partners are ill.

'While in the past, counsellors and even parents did not encourage the mentally ill to get married, this is changing,' said Dr Lee Cheng, chief of the department of community psychiatry at the Institute of Mental Health (IMH).

'Nowadays, many patients with mild mental illnesses are married. Their partner is often a pillar of support and can even act like a co-therapist, reminding them to take their medication.'

IMH has just concluded a preliminary study of more than 2,000 of its own patients to analyse the needs of people with mental illness who have young children.

Of the respondents with young children, 30.9per cent said that they had difficulty getting emotional support from their spouses while 28.4per cent said that they had financial difficulties.

Other pertinent problems cited include difficulty in connecting emotionally with their children, as well as finding and keeping a job.

While the difficulties that these people face may not seem out of the ordinary, Dr Lee said their problems are amplified because of their illness.

Also, there are additional worries that are specific to such patients, like the genetic transfer of the illness.

Studies have shown that mental conditions such as depression and bipolar disorder have a genetic component, which would increase the likelihood of producing a mentally ill child.

Dr Lee said that he has yet to meet a couple who has avoided having children for this reason. But he has seen several cases in which a marriage involving one mentally ill spouse has produced a mentally ill child.

Also, there may be difficulties with the pregnancy.

'We usually advise the woman not to take medication during the first three months of her pregnancy as this is when most foetal development takes place,' said Dr Lee.

However, not taking medication to regulate a mental illness may put the woman at risk of a relapse during her pregnancy.

Dr Lee said that while medication can be useful in preventing a relapse, some patients choose not to take it for other reasons. In one case, he said, a married woman stopped her medication because it had the side-effect of weight gain and she feared that if she put on weight, her husband would no longer be attracted to her.

However, after she took her husband with her for a therapy session, she realised that her fears were unfounded. 'Now, her husband even reminds her to take her medication,' said Dr Lee.

While a marriage in which one or both parties suffer from mental illness may face unique difficulties, it by no means suggests that it cannot be a fulfilling and healthy marriage.

It is only after both parties fully know what they are dealing with that they work hand-in-hand to cope with the illness, Dr Lee said.

'Also, finding external support is as important as developing internal coping skills,' he added.

Lisabel Ting

THEIR LOVE WAS TESTED TO THE LIMIT

In 2004, Dr Rita Goh's husband, Mr Vincent Loy, returned from an overseas trip to find his wife behaving oddly.

In an e-mail interview, Dr Goh, 51, who founded and heads a company which provides counselling services for people with mental health issues, said: 'I was rolling about and pressing my head to the floor.'

Shocked and worried, Mr Loy immediately called an ambulance. What he did not know then was that his wife was suffering from schizophrenia, a severe and disabling brain disease which usually hits people in their teens and early 20s, and is often a life-long problem.

Dr Goh, who received a PhD in Business Administration just before her mental illness, was later also diagnosed with clinical depression.

Although her mental illness was eventually brought under control with medication and psychotherapy, her struggle highlights some of the unique challenges faced by marriages in which one or both parties suffer from a mental illness.

While the primary effects of a mental illness itself may be debilitating, this difficulty is exacerbated when both parties do not approach it with the same perspective.

'My husband felt that it was a spiritual issue and that medication was unnecessary. On the other hand, my belief was that it was a medical problem and treatment was key to my recovery. The contrast in our beliefs led to many arguments,' she said.

However, they eventually compromised and came to the understanding that in addition to religious beliefs, taking medication was vital to Dr Goh's health.

Another problem she faced was discrimination from friends and relatives. As some of them did not understand what schizophrenia was, they started to shun her.

'We try our best to educate people, telling them for example, that the majority of mentally ill people are not dangerous or violent,' she said.

Dr Goh said that although her mental illness was a trying period, her marriage was an invaluable source of encouragement and strength.

'Our love has been tested to the limit through many crises, but I'm glad to say that our relationship remains as strong as ever.'

STRAIN TENSION
Genevieve Jiang
16 April 2008
The New Paper
English
Copyright 2008, Singapore Press Holdings Limited

Man who heads caregivers' association says: Don't take my photo. My bosses and colleagues don't know And his daughter once said: Daddy, someone's telling me to kill myself

THOSE with mental illness are sometimes so difficult to care for that their family members give up on them.

These patients end up abandoned in mental hospitals and nursing homes, with no one to pick up the tab.

But for caregivers who stay by their mentally-ill family members, the emotional strain can take its toll.

It is telling when even the man who founded the first and only national association here for caregivers of the mentally ill declined to have his photograph published for this report.

His deputy in the association declined to be interviewed.

Mr Michael Pang, 58, head of the Caregivers Association of the MentallyIll (Cami), said: 'None of my colleagues and bosses knows of my involvement in Cami and my family members do not want too many people to know.

'It's not that we want to feel different, but people view the mentally ill differently.'

GROWING NEED FOR HELP

Such is the reality faced by a small group of caregivers here, and the numbers appear to be growing.

Starting with fewer than 10 members three years ago, Cami now has more than 80 members who are caregivers.

Cami, which has not had funding for the past three years, provides support and refers these caregivers to the various community services available here.

The association holds weekly support group meetings at the Simei Care Centre.

Last year, it started a hotline (6782-9371) that will refer caregivers to the relevant service providers.

Cami became a member of the National Council of Social Service on 1 Apr.

Providing support for those who care for their mentally-ill loved ones is a cause that Mr Pang, a civil servant, believes is worth fighting for.

He said: 'People used to suffer in silence, but now, they are more willing to come forward and seek help.

'And it is important because, without proper resources and guidance, caregivers, too, can snap.'

Mr Pang understands this strain well because he has a 31-year-old daughter with schizophrenia.

He said: 'It's hard. You first go through guilt, questioning whether you are to blame for your child's ailment.

'Then you hope against hope that your child's tantrums, and delusional and suicidal episodes will go away.

'As years go by, you never stop worrying about how your child will cope when you are gone.'

Mr Pang, who also has a 29-year-old daughter who is normal, did not realise his elder daughter was mentallyill until she was 18.

'When she was in primary school, teachers said she was slow in her learning. She was also extremely quiet and had very few friends.'

Mr Pang thought his daughter was just shy.

Teachers recommended that she see a psychologist as they suspected that she had a learning disorder, but specialists failed to detect anything.

In Secondary 2, she failed her exams and had to repeat the curriculum for the next two years.

At 16, she left school and took attended night classes to try and take the O levels as a private candidate, but stopped her studies after a year.

She then enrolled in an Institute of Technical Education, but dropped out after a week.

Mr Pang said: 'She was supposed to learn how to operate certain machines, but the instructor said she would just stare and appeared very afraid to go near the machines.'

He decided to let her stop school completely.

Later, she appeared depressed and withdrawn and had trouble sleeping.

Mr Pang said: 'One night, she gave me a fright when she came to me, quite hysterical, and said someone was telling her to kill herself.

'She kept saying that she couldn't take it anymore and that she had to jump.

'She wouldn't calm down and kept saying, 'I can hear voices telling me to jump,' he recalled.

Desperate, he took her to the emergency department of the National University Hospital (NUH), where she was hospitalised.

SEDATED AND TIED

That night, medical staff members had to sedate her and tie her down to the bed.

She spent the next month in hospital, where she was diagnosed with schizophrenia.

She was then in a rehabilitation centre for nine months.

A few months after she left rehab, she had a relapse, suffered bouts of depression and was hospitalised.

Since her discharge, she has been having monthly checkups at NUH, where she is given medication to control her illness.

And since 2005, she has been attending a day-care service at the Simei Care Centre, where she is taught simple working skills.

The centre has recommended her for jobs at fast-food outlets, but Mr Pang said: 'The last time she tried was two years ago. She lasted only about two weeks.

'The supervisor there told us that they found her too slow.'

She now helps to man a kiosk selling accessories at the centre.

It was during the time his daughter joined the Simei Care Centre that the idea of Cami was born.

Mr Pang said: 'The centre had a caregiver's network, but there were fewer than 10 of us. We realised that there was no organisation here catering to the needs of caregivers of the mentally ill.'

Mr Pang, who earns about $4,000 a month, pays Simei Care Centre $200 and spends another $80 on his daughter's medication, said: 'A major worry of caregivers is how our children will cope when we are dead.'

A government-backed trust fund for disabled children, where parents are allowed to set aside money that will go to their children after they die, is expected to be put in place later this year.

Mr Pang wants something similar for the mentally ill.

He said: 'We don't want our children to end up in a nursing home, and a burden to the state.'

Caregivers who need help can call Cami's hotline at 6782-9371.

They cut themselves to cope with hurt
22 March 2008
Straits Times
English
(c) 2008 Singapore Press Holdings Limited

Teenage girls are more likely than boys to practise self-mutilation, say counsellors

ALONE in her room, 15-year-old Stephanie searched for a clear landing between the livid, red scars criss-crossing her left forearm. There was none.

Sighing, she placed the blade of her penknife at the base of her elbow where a wound had barely healed and dug in.

Immediately, blood spurted out and numbness set in.

Stephanie cuts herself whenever she feels 'emotionally unstable', usually after quarrels with friends.

'When I forget to buy things which they've asked me to, they get angry with me and I feel frustrated. That makes me want to cut so that I can feel better,' said the Secondary 3 student from an all-girls school. Her parents divorced when she was five and she lives with her mother.

Sometimes, her body becomes her emotional canvas on which she carves words like 'angry', 'hurt' and 'frustrated' with her blade.

Like Stephanie, many teenage girls are using self-mutilation as an outlet to cope with emotions they cannot handle, said counsellors.

Besides cutting their skin with sharp objects, other popular ways of self-injury include pulling at the skin or hair, burning parts of the body with wax or bruising themselves.

Counsellors and social workers noted that the trend of self-mutilation is prevalent in all-girls schools.

Denise, 16, said that in her Normal (Academic) class of 42 girls, she knows of at least five others who cut themselves. Watching them in action piqued her curiosity.

She said she first cut herself in the classroom after being badmouthed by friends.

'I borrowed a penknife and cut a few lines,' she said, adding that she felt calmer afterwards.

No one tried to stop her.

A social worker at Denise's school confirmed this.

Out of every 10 students she has counselled there, about seven were practising self-mutilation, said Mrs Rachael Lim of Care Community Services Society.

'I suspected that many students were doing it. Almost every time I talked to a student, she would have issues about self-harm. It got a little scary,' she recalled.

The numbers dropped tremendously to about three out of every 10 troubled students last year after counsellors conducted sessions with the girls to discuss the dangers of self-mutilation.

'We helped them to explore alternatives to cutting and introduced more positive coping skills like music and sports,' she said.

Counsellors and social workers noted that more teenage girls than boys take to cutting themselves.

According to Ms Eileen Chua, assistant director of Lakeside Family Centre, this is because boys express themselves in other ways. They usually take out their hurt and frustration through sports or smoking and drinking.

Another reason is girls' susceptibility to peer pressure, said social worker Joyz Tan from Fei Yue Community Services.

'It used to be that when you had a problem, you'd share it with me, we'd talk about it and that'd be it,' she said.

'But now, when they know that their friends cut themselves and they see their scars, they think the way to cope with problems is to cut.'

Ms Melissa Lim, centre director of Students Care Service (Yishun), termed this group 'copy-cutters'.

One of them is Shuling, 15, who tried to emulate her fashionably dysfunctional friends, then got hooked.

'It's harmless fun. I like to see the blood flow. When my skin splits open, I feel like a paper being torn,' she said.

Many believe they are hurting no one but themselves. But there are instances when the cuts get too deep, the bleeding won't stop, or the wounds get infected and the girls end up in hospital.

Also, cutting to relieve tension can be addictive.

Consultant psychiatrist Daniel Fung, who is chief of child and adolescent psychiatry at the Institute of Mental Health, likens it to getting a runner's high.

'When there is pain, the body releases a natural anaesthetic agent called endorphins. These are hormones which reduce the pain and make you happy.

'If you keep cutting, you'll get addicted to the whole process,' he warned.

Doctors also warned that if girls are not taught healthier ways to vent their frustrations, they may continue to turn to self-mutilation as a coping mechanism even in adulthood.

'They feel so much pain on the inside that they need to feel it on the outside, so it ends up as physical wounds which they can see, feel and touch,' said Dr Geraldine Tan, a psychologist at Mount Elizabeth Medical Centre.

'It's a reminder that they're okay.'

Dr Tan added that teens who display their wounds are crying for attention and parents must act quickly. She advised parents to look out for tell-tale signs such as the frequent use of plasters and ointment.

Ultimately, the only way to help self-mutilators is to be there for them with a listening ear, she said.

Xiuping, 19, used to cut herself two years ago whenever she quarrelled with her boyfriend.

She stopped after being reassured that others care for her.

'Nowadays, I'd find friends to share my problems with. If they're busy, then I'd find something else to do, like read or do housework,' said the Institute of Technical Education student.

It has been three months since Stephanie last cut herself, but the scars on her forearm are still visible. She now knows that the relief from cutting is only temporary.

'Although I feel a bit better after cutting, I know the scars will remain there forever,' she said.

Names of the girls have been changed to protect their identities

SEEING THE HURT

"They feel so much pain on the inside that they need to feel it on the outside, so it ends up as physical wounds which they can see, feel and touch. It's a reminder that they're okay."

DR GERALDINE TAN, a psychologist at Mount Elizabeth Medical Centre

When happiness hurts one and all
22 March 2008
Business Times Singapore
English
(c) 2008 Singapore Press Holdings Limited

Bipolar disorder leads to mood swings that can be extremely disruptive to life, reports MELISSA HENG

HAPPINESS is a state that all of us aspire to, but unaccounted bouts of happiness or euphoria isn't normal and may be a warning sign that something's not quite right.

'When you mention depression, most people understand that's not normal, but seeking treatment for being extremely happy is something else,' says Adrian Wang, a consultant psychiatrist in private practice.

There exists a mental illness known as bipolar disorder, which leads to unexplained periods of manic euphoria, only to be followed by intense depression, he says.

'Bipolar disorder in simple terms is a mood disorder, characterised by dramatic swings of mood and varying degrees of energy at any given time,' explains Dr Wang.

A person suffering from bipolar disorder may be in the throes of depression for days or weeks, then suddenly flip over to a manic 'high' and feel exceedingly happy for no particular reason.

Such mood swings can be extremely disruptive to normal life and even to colleagues, friends and family.

And here's the scary part - about two in every 100 Singaporeans will be at risk of bipolar disorder at some point in their lives. It can strike at any age, but typically bipolar disorder rears its ugly head when a person is in his 20s or 30s, and women are as likely as men to suffer from it.

The causes of bipolar disorder are not fully understood. However, a combination of biological, genetic and environmental factors appear to trigger and perpetuate the chemical imbalances in the brain, says Heinz Grunze, professor of clinical psychiatry at the University of Newcastle upon Tyne in the United Kingdom.

According to Prof Grunze, bipolar disorder tends to run in families and the first-degree relatives of people with bipolar disorder have a 5-10 per cent lifetime risk of developing the illness. Bipolar disorder can also skip generations and take different forms in different individuals. Researchers are trying to find genes that may be involved in causing bipolar disorder, but some people with the illness have no history of it whatsoever in their family.

'Stress can be a mediating factor when it comes to the onset of mental illnesses. It acts as a trigger, often stimulating the patient during important periods of their lives,' notes Prof Grunze.

For example, a job change can bring about a lot of stress such as adapting to the new work environment or coping with the new job responsibilities. When these events occur, any person can feel under pressure to perform, leading to a lot of unwanted stress. Such bottled-up stress can lead to a breakdown and an onset of a bipolar episode.

So what tell-tale signs should one look for?

'The symptoms of bipolar disorder depend on whether the individual is experiencing a manic or a depressive episode. A bipolar mania episode usually shows symptoms such as inflated self-esteem, occasionally coupled with delusions of grandeur,' says Prof Grunze.

Patients facing a manic high set goals that are unrealistic, such as writing a novel within a day. They tend to speak very rapidly and incoherently, changing topics quickly and tend to also behave impulsively and take unusually high risks. In full-blown episodes, patients may also hallucinate and suffer from disordered thinking.

At the other extreme is bipolar depression, where the person experiences a persistent feeling of despair or sadness.

'Patients often come into the clinic complaining of a reduced appetite and sense of pleasure. Furthermore, they tend to have self-esteem issues and have problems sleeping. Lastly, patients suffering from depression tend to have suicidal thoughts too, and even attempt suicide,' warns Prof Grunze.

Depressive episodes usually last longer than manic episodes with most patients spending two-thirds of their illness in depressive episodes, according to Dr Wang. Diagnosis, unfortunately, isn't an exact science.

'There are no definitive scans like an MRI or X-ray. Also, there are a few other mental conditions that are similar to bipolar disorder. We usually call for a detailed history of the patient and cull information from caregivers,' says Dr Wang.

The other problem with diagnosis is the lack of awareness associated with the disorder, as with other mental health issues.

'Many of my patients who suffer from bipolar disorder often have no idea that they have it and as such, don't consult a doctor. People with bipolar disorder cope with mood swings for years, and are unable to lead fulfilling and satisfactory lives. They suffer in silence, as do their loved ones, friends and families,' explains Prof Grunze.

According to doctors, the mainstay of treatment for the illness is pharmacological. Drugs used to treat bipolar disorder include mood stabilisers, anti-psychotics and anti-depressants. There is currently no cure for bipolar disorder.

'Even though bipolar disorder is a lifelong illness, suitable treatments are available. Such treatment methods usually involve both medication and counselling therapy. The drug Seroquel is the only drug in the market currently to effectively treat both bipolar depression and bipolar mania,' says Prof Grunze.

From the patients' point of view, this comes as a relief as they now only have one pill to take, instead of different pills for different stages of the disorder. Depending on the severity of the condition, a patient may need to be on Seroquel for at least a couple of years. Some could need lifelong medication, says Dr Wang.

But the drug does not come cheap. 'Seroquel is not currently a subsidised drug here, and in the private sector, the medication could cost between $5 and $10 a day,' says Dr Wang.

More troubled kids turning to IMH
Teo Cheng Wee
16 March 2008
Straits Times
(c) 2008 Singapore Press Holdings Limited

Mental institute says spike is due to greater awareness of illnesses and outreach programmes; others say stress and the Internet are to blame

A RECORD number of children and adolescents aged 19 and below have been seeking help at the Institute of Mental Health (IMH).

However, this does not necessarily mean that there has been a spike in mental illnesses among the young, the IMH said.

Instead, this could be due to an increased awareness of such illnesses and the greater number of outreach programmes.

Last year, the IMH's Child Guidance Clinic, which provides psychological and psychiatric services for those aged 19 and below, saw nearly 3,000 referrals.

By contrast, from 2000 to 2006, the IMH had between 2,000 and 2,500 annual referrals, mostly from schools or polyclinics.

It said that most of the new cases were children with attention deficit hyperactivity disorder (ADHD), learning disorders or emotional disorders such as excessive worry, fear and sadness.

The increase in the number of referrals did not necessarily indicate a higher incidence of mental illness among students, said Dr Ong Say How, the IMH's deputy chief of the department of child and adolescent psychiatry.

He pointed to better public knowledge of the IMH's services and programmes and more school counsellors who were 'more vigilant and ready to refer students to the IMH's clinics' as other possible reasons behind the rise.

The number of full-time school counsellors has risen from 270 last year to 360 now, in line with the Ministry of Education's plan to have a counsellor in every school by this year.

Just as importantly, the stigma of having a child referred to counsellors or psychiatrists has diminished, said one primary school counsellor.

'In the past, people thought it was a bad reflection of their parenting skills if they needed to bring in their child for help,' he said.

'But now, if you don't bring in your child to seek help, that is seen as bad parenting.'

There are also new initiatives such as the Response, Early Intervention and Assessment in Community Mental Health (Reach) scheme.

Launched in August last year, it aims to train some 50 general practitioners and 350 counsellors over the next five years in the early detection of childhood conditions such as ADHD, anxiety and depression.

Eight out of the 10 counsellors and psychiatrists interviewed also noticed an increase in the number of young people seeking help.

They partly agreed with Dr Ong, but felt that greater awareness may not be the only reason behind the higher numbers being treated.

These experts were concerned that, besides the higher stress faced by young people today, there seemed to be a greater lack of parent-child interaction.

Longer hours in school and at work meant that family members were spending less time together.

During interactions, parents inevitably asked about schoolwork and test scores rather than about their children's well-being, noted Ms Koh Wah Khoon, the director of family services at the Singapore Children's Society.

She has noticed a trend of children equating their self-worth with how far they had met their parents' expectations.

Today's children also have another thing vying for their attention: the Internet.

Ms Jessica Leong, a counsellor in private practice, said that more parents had problems getting their children to bed as their kids stayed online till early in the morning.

While the problem used to be limited to university or polytechnic students, she now has children as young as 11 brought to her.

When parents do not spend time to impart necessary life skills, their children may not be able to cope with crises when these happen, said Dr Ong.

Compounded with the fact that most children had fewer opportunities to experience major life events or adversity today, this generation may not be as resilient when coping with stress, he noted.

But doctors assured parents that there was no need to be alarmed by the new figures.

Said Dr Alex Su, the IMH's head of emergency services: 'They're seeking help rather than suffering in silence. That is a good sign.'

chengwee@sph.com.sg

Are you a troubled teen and would like to share your story? Please e-mail suntimes@sph.com.sg

Not alone Who to call for help:

Touchline: 1800-377-2252

Youth Challenge: 6336-3434

Tinkle Friend: 1800-274-4788

Befrienders of Youth: 6256-4440

SOS: 1800-221-4444

Parentline: 6289-8811

ST Mind Your Body – Wednesday, March 5, 2008

Sufferers of mental illness can now turn to a new form of support - the LiveJournal (LJ) community sg-mentalhealth (http://community.livejournal.com/sg_mentalhealth).

This is a locally-based cyber community whose message is: 'It's okay to be not okay'. Here, individuals coping with mental illness can find a safe haven to share their thoughts and emotions about what they are going through.

Its founder is Ms Yew Run Bin, 24, who launched the site on Oct 10, 2005 - World Mental Health Day. She is the moderator of the community and in charge of maintaining and organising posts from members.

Ms Yew herself is currently recovering from depression with psychotic features, borderline personality disorder and dissociative identity disorder.

The community is also open to mental health professionals, caregivers, and anyone else who is interested in mental health.

There are about 150 members. Aside from sharing their personal experiences, they are invited to post articles, videos, lyrics and even their own artwork.

Through the community, members can also seek advice from people who have been through similar experiences and find out more about the various help channels available.

Members can advise each other on treatment, which clinics to go to, or what numbers to call.
While most members are not professionals, most of them have had first hand experience in dealing with mental health issues and can share information.

Face-to-face support too

There are also face-to-face support sessions and information on local mental health-related events online.

Ms Yew, who did not want to be photographed, herself has struggled with various mental health issues since her teens.

In secondary school, she started cutting her wrists. The self-mutilation worsened to the point that she once needed a tourniquet, and was suspended from school for three weeks. Her principal feared that she would be a bad influence on her peers.

She was so angry and frustrated at being singled out and ostracised that her grades slipped, forcing her to repeat a year in Secondary 3.

After she finished secondary school, she did well enough to land a Ministry of Education scholarship to study Consumer Science and Technology at Temasek Polytechnic (TP), but once again mental health issues disrupted her studies.

She would flee from class whenever panic attacks or the urge to self-mutilate overtook her, and was eventually hospitalised. This constant disruption in her studies resulted in her breaking her scholarship bond, and leaving TP.

Although her mental condition made studying difficult, she eventually managed to earn a diploma in Mass Communications at the Management Development Institute of Singapore, while working odd jobs between classes. In 2006, she started a course in English and English Literature at the Singapore Institute of Management (SIM), but was forced to leave after three semesters as she had relapses and was hospitalised four times.

Ms Yew says that she had tried other avenues of support before founding this LJ community.

'I used to be in a support group at SMH (Singapore Association for Mental Health), and I really liked what I experienced there. But I wanted more spontaneity, so I decided to set this up,' she says.

Members of the community can also post about their personal issues without having to worry who may see their entries.

'On LJ there's a Friends Filter, so people have the choice to let only their friends see their posts,' says Ms Yew.

A Friends Filter allows a member to alter the security settings for any entry he may post so that only those with selected usernames are able to see the information.

Several community gatherings, at which members meet for casual chats, have been organised through the network.

On top of that, a group of about six or seven members have started visiting mental health patients who are warded in hospital, to provide support and to assure them that they are not alone.

'It feels a bit strange visiting someone you've never seen before, but after reading all the posts, you realise that there's something we all have in common,' says Ms Yew.

Psychologists agree that the singapore-mental health community is a positive move.

'Having a platform to share your struggles is good. Members will feel supported knowing that they are not alone, and that they are normal except for the fact that they have more to cope with than others. Sharing coping strategies and remedies is also helpful,' says Madam Christabel Hong, a counselling psychologist at Students Care Service (Clementi Centre).

'However, the flip side is that there are those who may create or amplify their 'sufferings' and draw pleasure from the sympathy they receive. That is reinforcing negative behaviour and is unhealthy,' she adds.

Managing the singapore-mental health LJ community has not been easy.

'I'm concerned that people may crash the community and and say nasty things,' says MsYew.

'On rare occasions we have had such comments, so I've had to delete them.'

Life hijacked by look-good urge

Ray (not his real name) dropped out of Anglo Chinese Junior College last year because the 19-year-old was too ill to continue.

A good-looking boy with a ready smile, Ray began battling a severe eating disorder three years ago.

It was around that time, at the end of 2005, that Ray's mother noticed he did not mix much with friends any more and that he barely ate any food.

He exercised obsessively, making a religion of his daily run and spending hours at the gym.

'I thought I was healthy. I wanted to look good and have that buff look,' he said.

But he could not look at food normally.

'I would look at something and think, 'Can I see someone who looks good eating it?' If I couldn't, then I would not eat it,' he said.

He became dangerously underweight and had to be admitted to hospital in December 2005.

'The strange thing is that I felt normal. I thought the people around me were overreacting,' Ray said.

His perspective was in fact typical of people with eating disorders: Ray thought he was just being healthy, not realising that he was endangering his life. He thought his parents were trying to fatten him up.

As soon as he was discharged from hospital, he started the cycle of exercising and starving himself again.

'If my friends wanted to meet me for dinner, I would cancel that because it clashed with my exercise schedule,' he said.

In March 2006, Ray was hospitalised again. Once his weight stabilised, he was admitted to the Institute of Mental Health (IMH) for two months as he was also dangerously depressed. He was miserable and tried to run away from there.

After several admissions to the hospital and IMH, Ray realised that the desire to look good had hijacked his life.

'I just wanted to be happy,' he said.

Turning point
In March 2007, he told senior psychiatrist Dr Lee Ee Lian, who heads the Eating Disorders Programme at SGH, that he wanted to change his lifestyle.

He started attending the day programme for people with eating disorders at the Life Centre, when it opened in October last year.

He goes to the centre every day now, where along with other teenagers like him, he is taught to eat normally and encouraged to re-examine how he looks at himself.

Ray said coming to the centre has helped him accept all parts of himself and to stop the obsessive scrutiny to which he subjected himself.

In the presence of psychologist Evelyn Foo, Ray said he has learnt to think of the person with the distorted thoughts as Rex.

'It's like fighting an opponent. You look in the mirror and it's an evil version of you. Rex is the me I don't want to be,' he said.

Ray wants to be happy and successful and he has come to realise that he had equated 'being good looking' with these things. This was particularly fuelled by the fact that he was fat as a child and felt that the only way to be popular was to be good-looking. These are the feelings he identified and is working through with a psychologist.

When he is at the Life Centre, he sometimes visits the wards so he can talk to other patients with eating disorders.

'I like it here. All of us are kind of going through the same thing,' he said.

Ray said the one thing that has kept him coming back is the concern shown by SGH's Eating Disorders Team.

'They stuck with me. Even when I was in IMH, Dr Lee told me they would accept me back in the programme any time I was ready,' Ray said.

He plans to continue in the programme for a few more months and find a job.

'I hope I find something that's fun,' he said.

This story was first published in The Mind Your Body supplement on Feb 20, 2008

The article has been taken from
http://health.asiaone.com/Health/News/Story/A1Story20080226-51463.html

Discover Eating Disorders
25 February - 1 March 2008

The Singapore General Hospital's Lifestyle Improvement & Fitness Enchancement or LIFE Centre is a hospital-based centre that provides integrated and holistic care for patients with lifestyle-related medical conditions,in particular patients with eating disorders and obesity.

The Eating Disorders Programme at LIFE Centre is a dedicated treatment programme for the management of eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disoder. Eating disorders are complex psychological problems with potentially serious medical complications. Eating disorders are not only about food and weight, but are frequently symtomatic of deeper, more complex psychological and biological issues.

Date : 25 Feb 08
Time : 11:30am-12:30pm
Venue : Healing Garden. Life Centre Bowyer Block A level 1, SGH
Event : Launch Signing of Seventeen body Peace Treaty.

Date : 26 Feb 08
Time : 12:00pm-2:00pm
Venue : Healing Garden (same as above)
Event : Size Free T-shirt Design
Join us in designing a t-shirt to encourage positive body-image

Date : 27 feb 08 - 29 Mar 08
Time : 9:00am-5:00pm
Venue : LIFE Centre, Bowyer Block A Level 1 SGH
Event : The Great Jeans Give Away
Did you buy a pair of jeans that was a little too snug but you are hoping to lose a few kilos to fit into it? Give them away and celebrate your natural size!
Donated jeans will be given to Red Cross

Date : 01 Mar 08
Time : 10:00am-12:00pm
Venue : Void Deck, Blk 6 level 9, SGH Registration fee $10*
Contact person : Nana 63265400 9am-5pm
Event : Public Forum - "Help Your Teenager Beat An Eating Disorder"
9:30am Registration
10:00am Welcome and introduction.
Dr Lee Huei Yen, Consultant
Department of Psychiatry - SGH
10:05am "Help Your Teenager Beat An Eating Disorder"
Professor James Lock,
Director, Eating Disorder Programme and Clinic Standford Unversity School of Medicine
10:25am "Practical Tips and Resource"
Ms Esther Chan, Medical Social Worker - SGH
11:05am Q&A
11:35am End

Time : 1:00pm
Venue : LIFE Centre, Bowyer Block A, Level 1, SGH
Contact : 17mag@sph.com.sg
Event : Seventeen Perfect Fit workshop
Anyone can look good! Get advice from sylists from Seventeen Singapore