rehabilitation for depression and anxiety · 2019-04-25 · 3. day rehab services •currently,...
TRANSCRIPT
Rehabilitation for
Depression and Anxiety
Dr Arthur ChernGroup CEOSt Andrew’s Mission Hospital &Singapore Anglican Community Services
Mental Health Landscape in Singapore
National Surveys On Mental Health
2010 & 2016
Lifetime Prevalence of Mental DisordersTop 3 Most Common Disorders
Major Depressive
Disorder
2010
1 in 17
(5.8%)
Alcohol Abuse Obsessive Compulsive
Disorder
2010
1 in 32
(3.1%)
2010
1 in 33
(3.0%)
2016
1 in 24
(4.1%)
2016
1 in 28
(3.6%)
2016
1 in 16
(6.3%)
Note : There was an increase in lifetime prevalence of mentalillness from 12% or 1 in 8 in 2010 to 13.9% or 1 in 7 in 2016 whohad experienced a mental disorder in their lifetime.
Mental Health Situation In Singapore
Where Do They Seek Help
26Years Old
Onset ofmental illness
Average No. of Years To Seek Treatment
Year Alcohol
Abuse
OCD Major Depressive
Disorder
2010 13 9 4
2016 4 11 1
Year Psychiatrist Counsellor General Practitioner
Religious / Spiritual
Healer
Psychologist
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
2. Depression
3. Bipolar
4. Anxiety
Affect:
• Thinking
• Feeling
• Behaviour
• Motivation
SACS Psychiatric Rehab Services
Anglican Care Centre (Pasir Ris)
Anglican Care Centre (Farrer Park)
Anglican Care Centre (Bukit Batok)
Anglican Care Centre (Yishun) Anglican Care Centre
(Hougang)
Anglican Care Centre (Simei) & Integrated Employment
Services (IES)
1614
1913 1956
2235 2267 2293
2013 2014 2015 2016 2017 2018
No. of Persons Served
Residential Rehab
(N=402)
Day Rehab
(N=238)
COMITs
(N=1,102)
Employment Support Services(N=305)
DIAGNOSIS NO. % NO. % NO. % NO. %
Schizophrenia 324 81% 175 74% 624 57% 162 53%
Mood Disorders
42 10% 36 15% 264 24% 99 32%
Anxiety Disorder
16 4% 12 5% 102 9% 41 13%
Others 20 5% 15 6% 112 10% 3 1%
Persons With Mood Disorders Under SACS Psy Rehab Services
Depression
1. Loss of sleep or sleep too much2. Loss of appetite / some may have big appetite3. Loss of social contact / withdrawal4. Loss of interest in usual activities5. Loss of concentration6. Loss of libido / sexual drive7. Loss of energy / easily tired8. Loss of movement / slowing downNote: 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 die3. Lethality of method (eg. Jumping, hanging, etc)4. Giving away precious things & suicide notes5. Feeling lonely, helpless and hopeless6. Inability to come to terms to grief and loss of
someone significant or something of significance7. Suffering from chronic depression and illness8. Family history of suicides9. Under the influence of drugs and alcohol
Bipolar (Manic Depression)Symptoms of Mania1. Feeling “high” and restless2. Irritable and easily agitated3. Talking very fast - jumping from one idea to
another, racing thoughts4. Easily distracted5. Grandiosity and religiosity6 Sleeping little8. 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• Muscle weakness and
tension• Fatigue• Nausea • Chest pain• Shortness of breath
• Headache• Stomach pain• Perspiration• Trembling• Restlessness• Insomnia
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.
Religious Affiliation
VWOs GP
HDB SSO
IMH
Residents Committee
School CAL
Hospital
Peer Support Specialists
Family
Relatives
Neighbours
Friends
Employer
Rehab Counsellor /Case Manager
Employment Specialist
Volunteers
Strengths-Based, Person-Eco Centric Holistic Care Model
SNAP
Bio-Psycho-Social-Spiritual
CaseManagement
&Counselling
CaregiverSupport
SkillsEquipping
WellnessManagement
PeerSupport
CommunityRe-integration
PastoralCare
Person with mental
health issues
Slow Stream Rehab
Residential Rehab
Psychiatric Sheltered Home
• Day Care• Community Intervention
& Outreach• Integrated Employment
Services
Long Term Nursing Care ------------------------------------------------ Living In The Community
Psychiatric Nursing Homes
Continuum of Psychiatric Rehab Services
1. 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 opportunities are aligned to members’ recovery goals under the Individualised Care Plan (ICP)
• The duration of stay depends on their progress. For positive discharges, they are encouraged to continue with COMIT for follow up in the community.
Annual No. of Clients Served is about 400.
Capacity : 156
Capacity : 170
2. Psychiatric Sheltered Home (PSH)
Anglican Care Centre (Farrer Park) was set up in Oct 2017 as aPsychiatric Sheltered Home (PSH) to provide temporaryaccommodation for PMHIs. It seeks to support them in theirrecovery and reintegration into the community. It has a capacity of80 beds; 60 for adult males and females and 20 for youths from16 to 20 years old
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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.
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.
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5. Integrated Employment Support Services
•Assess and match clients to relevant jobs
• Job training and internship opportunities
•Assist clients to secure and sustain in their jobs.
Social Enterprises (SE)
Employment Support Services (ESS)
Employment Training Services (ETC)
Employment Internship Programme (EIP)
Employee Assistance Programme+ (EAP+)
Choose Get Keep
• 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.
• Customised and generic items made by members and are sold at events and roadshows. MOSES is currently operated within the Sheltered Rehab Workshop at the ACC (Simei).
• 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.
5a. Social Enterprises (SE)
Members’ Own Social Enterprise & Services
Mother and Child
5b. Employment Support Services (ESS)
ESS provides employment services to help Persons withMental Health Issues (PMHIs) seek meaningful employment.Its goal is to empower PMHIs to achieve sustainableemployment with the view of reintegration into thecommunity. It also provides the business community withcomprehensive employment services to support them inintegrating PMHIs in the workplace.
5c. Employment Training Centre (ETC)ETC provides vocational training courses to PMIs with theappropriate knowledge and skills to prepare them for jobs inthe market. Each year, there are 3 runs with an intake of 20 to30 persons per run.
5d. Employment Internship Program (EIP)
EIP provides on-the-job training for PMHIs to prepare them foropen employment. The traineeship programme aims to enhancejob readiness and sustainability through on-the-job training inspecified industries, enhance knowledge and skills of employers insupporting PMHIs and showcase the employability of PMHIs
5e. Employee Assistance Program+ (EAP+)EAP+ aims to provide timely support to employees with or atrisk of having mental health issues and employers, co-workersthrough a multi-disciplinary team consisting of mental healthprofessionals and Peer Support Specialists so as to enhanceperformance of employees, mental well-being of employees andknowledge and skills of employers/co-workers in implementingworkplace support.
Thank You