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Mental Wellness during  #CBLite – Pushing Through The Phases

Mental Wellness during  #CBLite – Pushing Through The Phases

Written by: Joachim Lee, Senior Psychotherapist, Promises Healthcare

When the ‘circuit-breaker’ measures were put in place, there is no doubt that our lives have been drastically impacted. Even travelling to work or school – what was once considered a part of our daily routine – is no longer the same. Rules and regulations are put in place too, such as the wearing of a mask is now deemed mandatory and not being able to speak onboard public transports. With such increasing obstacles, it is unfair if we do not acknowledge the effort Singaporeans have put in to manage and cope with these disruptions to our daily routines. While we have moved into the phased circuit breaker emergence period, it may be still some time before we can resume our normal lives. 

To cope with being house-bound, some of us have chosen to take on a new hobby or to learn a new skill to pass time and keep ourselves engaged. Others have embarked on some self-reflection and have come to realise that they had taken their past freedom for granted. Whichever the case, we are all trying to keep ourselves mentally healthy in different ways, and this in itself is commendable. 

However, with the recent announcements of the circuit breaker emergence phases, this may have once again taken a toll on people’s mental health, with their sense of relief that it’s ending being diminished abruptly. In light of this, we need to help each other ride through these challenging times as circuit breaker measures continue on. Here are some simple tips to help you keep yourself sane, and to adjust to the new “norm”.  

First of all, start being grateful for your privileges in life. Gratitude will give you a sense of hope amidst these trying times, and that there is light at the end of the tunnel. There are many things to be grateful for, such as the increased connection and bonding with your friends and family. As they say, distance makes the heart grow fonder. Have you found yourself wanting to reach out to others more than ever, be it through the phone or video conferencing platforms? Do you appreciate that you are not just stuck at home, but that you have a home that provides comfort, safety and security? During these times, also be grateful and appreciate that you are in good health. For those of you who are feeling artsy, perhaps you can create a gratitude vision board. Whenever you are feeling down in the dumps, write notes of affirmation or gratitude and decorate your walls. Take a look at them and remind yourself of the little things in life that keep you whole.  

Another tip that is often overlooked is to set goals and a fixed routine. For some of us, staying at home is an excuse to idle, especially if you are not working from home or waiting for HBL to start. Contrary to what people think, that there is nothing much to do at home, there are in fact many activities that we can keep ourselves busy with. Make time for indoor exercise routines, do online crossword puzzles, read books, hang out with your friends on online platforms – you name it. Try setting weekly goals and track your progression too, and don’t forget to reward yourself for every milestone achieved. Believe it or not, stimulating your mind can definitely help reduce feelings of helplessness and to deal with cabin fever. 

Nonetheless, it is also important that you seek help whenever necessary. Consultations for psychological services are available at Promises during this period of time, with Teleconsultations as an option. You should never hesitate to seek help if things get hard.

Stay home, stay safe, stay happy!


Photo by Swapnil Bapat on Unsplash

Child Suicide is Preventable: How to handle suicidal ideation in children

Child Suicide is Preventable: How to handle suicidal ideation in children

Author : Joachim Lee, Senior Pscyhotherapist

The Samaritans of Singapore (SOS) reports that the number of suicides in Singapore rose 10 per cent in 2018, with suicides among boys aged 10 to 19 at a record high. Suicide mortality among youths and males is a “significant societal concern”, SOS said, highlighting that for every 10 suicides in 2018, at least 7 involved males. Among boys aged between 10 and 19 years old, there were 19 suicides last year – the highest since records began in 1991 and almost triple the seven cases recorded in 2017.

Suicide does affect children and adolescents, and avoiding the topic does nobody any favours – burying your head in the sand won’t help them learn how to get help if they find themselves needing it. One common misconception about the discussion of suicide is that talking about it plants the idea in people’s heads, causing children and adolescents to think about it. The simple truth is that parents won’t ever know if their child harbours suicidal thinking if they are too afraid to broach the topic. Suicidal behavior in children is complicated. It can be impulsive and associated with feelings of confusion, sadness, or anger. The so-called “red flags” people are cautioned to look for can be subtle in young children. While a young adult might say something along the lines of, “You’ll be better off when I’m gone,” in contrast, a child might say some something similar to, “No one cares if I’m here.”

Warning Signs

While the warning signs in children can be subtle, learning to identify potential red flags plays a crucial role in intervention.

Changes in baseline behaviour:

Take note of behavioural changes that aren’t short-lived.  While suicidal behaviour is often associated with symptoms of depression, you might also notice the following changes in your child:

  • Changes in sleeping habits (too much, too little, insomnia)
  • Changes in eating habits (overeating or eating too little)
  • Withdrawing from family and friends (social isolation)
  • Psychosomatic symptoms: headaches, stomach-aches, other aches and pains that can’t be explained

Changes at school:

It’s perfectly normal for children to experience ups and downs during the learning process, but a pattern of negative change can be a red flag that a child needs help. Make a note of the following:

  • Drop in academic performance
  • Decreased interaction with teachers and kids at school
  • Lack of interest in school
  • Refusal to attend school
  • Loss of interest in normal daily activities (playing, sports, co-curricular activities)

Preoccupation with death:

It’s natural for children to think about death at times, particularly when they are coping with loss or hear about tragic events in the news. Preoccupation with death, researching ways to die, and/or talking about their own death can be red flags. Watch for the following warning signs that involve thoughts about death:

  • Frequent questions about or looking up ways to die
  • Statements about dying or what will happen if the child dies (Examples: “You won’t miss me when I die, I wish I was dead, I won’t bother you anymore when I’m gone.”)

Feelings of hopelessness:

Children who have suicidal thoughts might communicate feelings of hopelessness for the future. They might also make statements about helplessness. These kinds of statements indicate that the child feels as if there is nothing to be done to improve their outcome, and no one can help.

Child-sized wills:

Some children give away their favourite possessions or tell parents, siblings, or friends who should get their favourite possessions. While talk of dividing up possessions might seem like fantasy play to parents, it can signal thoughts of suicide when combined with other changes in behaviour.

Writing or drawing about death or suicide:

Young children often struggle to verbalize intense emotions, but they are likely to take to the diary or drawing block to explore these emotions. Poems, stories, or artwork depicting suicide or, frequent writings and drawings about death should be evaluated.

Significant changes in mood:

Kids experience changes in mood as they grow and work through stressors, but significant changes in mood signal a problem. If your child suddenly shifts from calm and relatively happy to aggressive, completely withdrawn, or very anxious, it’s important to get help.

In addition to the warning signs that a child might experience suicidal ideation, there are also certain factors that can elevate the risk.

  • Previous suicide attempt (regardless of how serious)
  • Experiencing a loss (this can include grief and the loss of a relationship due to divorce or family discord or break-up)
  • Chronic bullying
  • Family history of suicide or suicide attempts
  • Violence or witnessing violence
  • Impulsivity
  • Acute rejection
  • Feelings of hopelessness
  • Feeling like a burden

 

Communication Tips with your Child 

Any signs of suicidal ideation or behaviour should be taken seriously.

Parents should ask specific, direct questions about suicidal thoughts – “Are you thinking about hurting or killing yourself?”

Parents should also talk openly about depression by asking questions like, “Are you feeling depressed or very sad lately?” These questions show your child that you understand and that you care. Conveying empathy in a time of emotional crisis is crucial. You may be concerned about saying the “right” thing. But the truth is that just having an open and honest discussion with your child can provide them with much-needed support.

Keep the Talk Age-Appropriate

  • Make sure that your child understands what you are saying and is not confused or bored by the discussion.
  • Use words that your child can understand. Words such as “depression” or “emotional reaction” are probably too complex for a younger child but may be appropriate for an older child or adolescent.
  • Try comparing your child’s depression to something that your child is already familiar with like a physical illness such as the flu or an ear infection.

Keep the Conversation Positive

  • Depression is a serious illness that causes emotional and physical pain, but try to keep the conversation focused on the positive.
  • By maintaining a positive and hopeful outlook in your discussions, you will avoid unnecessarily alarming your child.

Prioritize the Positive

Another important way to prevent suicidal behaviour is to prioritize interacting with your child in positive ways. Sometimes we get into a sort of vicious cycle with a child. The child does something concerning; the parent gets critical; the kid does something more concerning; the parents get more upset. All interactions turn contentious. Interacting in positive ways means doing fun things together, hanging out and chatting about things that aren’t controversial, that aren’t difficult.

Be Honest

  • Don’t make promises you cannot keep.
  • Don’t go into detail about topics that you are not certain of.
  • Do tell your child what you do know.
  • Make a list of questions to discuss with your child’s mental health professional.

Be Compassionate

  • Your child needs to know that you recognize and respect their feelings.
  • Even if you do not quite understand their thoughts, don’t dismiss their feelings.
  • Avoid comments like “What do you have to be depressed about?” or “Don’t be ridiculous.”
  • Dismissive comments can cause a child to hide their feelings or become defensive.

It may seem obvious to you that you love your children, and that they know you love them. But when they’re having a hard time, children need to hear over and over again from you how much you love them, and how much you care about them. It’s not good enough to just say, “You know I love you.” You need to convey that in small and big ways. These days, we all have so many things we’re juggling that our children can end up unsure of where they fit in, and whether you really have time for them. Let them know how important they are to you.

Be a Good Listener

  • Allow your child to talk openly and express their opinions and thoughts.
  • Avoid interrupting, judging or punishing them for their feelings.
  • Listening demonstrates that they have someone they can confide in help to sort out their feelings.

If there are any safety concerns, do not provide judgment or discipline; simply remove your child from immediate danger, do not leave them alone, and get them immediate help.

Never dismiss suicidal thoughts in a child and any suicidal thought or behaviour should be brought to the attention of your mental health provider immediately. If needed, bring the child to an emergency room or call an ambulance.

If for some reason the above options are not available, make a referral to the Samaritans of Singapore (SOS) by writing to pat@sos.org.sg, or calling its 24-hour hotline at 1800-221 4444.

The author hopes that the suicide prevention/awareness workshops he conducts at schools and corporations are doing some good.

 

Bibliography

https://www.channelnewsasia.com/news/singapore/suicides-number-2018-teenagers-boys-highest-11761480

https://www.health.ny.gov/prevention/injury_prevention/children/fact_sheets/10-19_years/suicide_prevention_10-19_years.htm

https://www.psycom.net/children-and-suicide

https://www.verywellmind.com/suicidal-thoughts-and-depression-in-children-1066661

https://childmind.org/article/youre-worried-suicide/

https://www.sos.org.sg/get-help/helping-someone-in-crisis

 

Protecting your Mental Health During the COVID-19 Pandemic

Protecting your Mental Health During the COVID-19 Pandemic

by Joachim Lee, Senior Psychotherapist

Amidst the COVID-19 pandemic, there is evidently a growing sense of distress amongst the public – from panic-buying at supermarkets to wearing several layers of masks for fear of being infected. While ensuring our physical well-being is of great importance, we cannot deny that our mental health is also equally important – especially during the stress of a pandemic. The ever-changing situation can cast a shadow of uncertainty over us, creating feelings of vulnerability and helplessness. 

However, allowing coronavirus related fear to overcome us certainly isn’t the way to go. Let’s take a look at how we can help ourselves by avoiding the pitfalls of anxiety and depression.

CNN recently published an article on how to keep coronavirus fears from placing an undue burden on our mental well-being. In the same vein, we would like to emphasise the utmost importance of self-care during these trying times. 

In the context of this pandemic, what does self-care entail? By keeping our minds from straying into muddled uncertainty, we can avoid the toxicity of excessive worry – with the world already so volatile, it’s in our best interest to try to stay cool-headed to better make decisions. There’s no point expending precious processing power on unwarranted concerns. With the influx of information and ease of access to social media, it can be mentally exhausting if we choose to hang on every update. If you feel the urge to check your phones for up-to-date news constantly, learn to walk away. Know when to put away your phones if necessary.

Depending on the individual, the idea of self-care may vary, but ultimately, it is still a means of managing our stress and anxiety levels. 

During this period, some of you may well experience higher levels of mental stress. Worry over your own health and your loved ones’ may consume your mind, in turn leading to knock on effects such as – changes in sleep and eating habits; worsening of chronic illnesses; and increased substance usage. Needless to say, we would do well to guard against the deterioration of our mental health, to better cope with our negative emotions appropriately.

Connecting with our own feelings is a great place to start. It’s important to stay in touch with our feelings, taking care to identify our worries and concerns. Try naming your emotions. It sounds simple enough, but you’ll soon learn that there are nuances that set apart sensations, emotions and feelings. 

Is there anything specific about the situation that is heightening your stress level? Emotional awareness is often neglected, with some studies showing that only 1-in-3 people have the ability to correctly identify them. If you have reached a state of panic or hysteria regarding the virus, you might want to start considering how realistic your concerns are. There is a high chance that we often over-magnify our fears and underestimate our capacity to handle the situation. 

As mentioned, there is a need for us to remain cool-headed and not plagued by excessive worry in these trying times. Here are some tips that may help you to get through this difficult time, if you ever find yourself feeling overwhelmed with anxiety or fear.

Firstly, it is of great importance to consider if your worry is solvable. Is the problem within your control? In the case of the COVID-19, you may be constantly worrying about contracting the virus. However, if you are certain that you have done your part, such as washing your hands occasionally and not touching your face unnecessarily, does worrying excessively help in any way?

In some cases, excessive anxiety may cause one to hyperventilate – and this is where proper breathing techniques will come to your rescue. The 7/11 breathing technique is an exercise where one breathes in for a count of 7 seconds and exhales for a subsequent count of 11 seconds. This exercise is very simple, yet proven to be extremely effective in helping one regain his or her composure. Try this for approximately 5 minutes (or whatever duration that is best for you), and you’ll eventually feel calmer and be able to think more clearly.

Remember, while you may not have power over what happens to you, you are able to control how you react to it hence your state of mind. 

Avoidance and escapism from acknowledging the root of our uneasiness is not a healthy method of coping. Coming to terms with and recognising our concerns can in fact help us to better seek social support. Stay connected and start talking to the people you trust. Talk to them about your feelings and worries. Get them to share theirs too, and by the end of it, you’ll realise that you are not alone. Understanding others’ perspectives on the situation and recognising that they are most probably experiencing the same concerns will surely help to calm your nerves and help you feel less lonely and vulnerable.

It is also important that we spend more time with our families and friends. Taking a break from our busy lifestyles and hectic work schedules will benefit your mental health. Make sure to take time off to unwind, and to do activities that you enjoy. This could mean exercising, socialising, or some form of recreation in your spare time. 

Although socialising may be slightly more of a challenge due to the increased need for social distancing, it is still largely possible, especially with technological advancements. Now and then, you can opt to organise your own get-together through ‘Zoom’ or ‘Skype’, and perhaps have lunch with your friends over video-calls. Do you have something you’ve always wanted to learn, but could never find time for? Well, this might just be the right time for it too. In addition, some places of interest have started providing virtual tours. With this, one can explore and discover new areas whilst staying in the comforts of his/her home. With countless things to do on the internet, one can easily find various means to unwind and to de-stress. 

Doing things you love will help to ease the burden on your shoulders and distract you from your fears and concerns. Life goes on even with the COVID-19 situation, and constant worrying is in nobody’s interests.

One crucial thing to note is that you should never feel guilty or ashamed of your fears, and neither should you blame yourself for worrying. It is completely normal to worry, especially with uncertainty at every turn. After all, evolutionary biology dictates that it’s perfectly natural to feel threatened and afraid during a pandemic.

Do not hesitate to seek help and support when the going gets tough. If you ever find yourself barely treading water, there’s absolutely no shame in reaching for a helping hand. Stay safe! 

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Bibliography

https://edition.cnn.com/2020/03/14/health/coronavirus-fears-mental-health-wellness-trnd/index.html  (Retrieved 18/3/20)

https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fcoping.html (Retrieved 18/3/20)

https://www.apa.org/practice/programs/dmhi/research-information/pandemics?utm_source=linkedin&utm_medium=social&utm_campaign=apa-pandemics&utm_content=pandemics-resources (Retrieved 18/3/20)

Mental Health at the workplace: Making it count

Mental Health at the workplace: Making it count

by Joachim Lee, Senior Psychotherapist

Workplace mental health is becoming an attractive proposition for employees and employers alike. Having a mentally healthy environment can help employees become happier, more productive and motivated individuals. Yet, mental health issues are often swept under the rug, simply because they can be touchy subjects to handle. In Singapore, the Health Promotion Board (HPB) drew from data culled from 1000 respondents, and found that compared to an n representative of Singapore’s general population, the mental well-being of working adults was found listing – 13% more worse off, to be exact. In addition, another survey also found that 1-in-6 working adults experience “a relatively high level of stress”, compared to 1-in-10 non-working adults who expressed the same concerns. This stark contrast makes us wonder – Does working for ‘The Man’ make us miserable?  Does that mean we can curtly reply “Money”, when the interviewer wants to know why we want that job?

Singapore is notorious for a fast pace of living, a country where your career helps to define you. With career advancement already firmly ensconced within our list of priorities (for the average Singaporean, at least), many tend to devote a good part of their waking hours to work, with less and less time being set apart for leisure and recreation. It makes sense then, that we should look to the workplace as a concept just as deeply implicated in our happiness (or lack thereof) as home and family.

Employers who pay scant attention to the mental health issues of their employees will soon find that such a business model doesn’t pay long-term dividends. In fact, it may end up costing them – there are countless studies out there detailing and actually quantifying the monetary costs of poorly managing workplace mental health. Intuitively, we’ve already known this without having to be told – if the only free time you’re allotted for a restroom break has to be taken during your 10-minute lunch, then you’ve probably seen fit to leave your bootstraps in the toilet. Employers, too, know the sting of cynical, burned out employees making full use of paid medical leave.

In this case, not only does the organisation have to pony up the employee’s sick leave entitlement, they also have to incur the opportunity cost of the work the employee would have contributed if they were present and productive. The organisation thus suffers financially. Moreover, mental health issues can precipitate workplace bullying and harassment. Employees may start feeling disempowered, demotivated and dissatisfied with their jobs. The overall workplace morale takes a plunge.

In light of this, we have to acknowledge that we, more often than not, overlook an extremely important factor which makes or breaks the mental well-being of employees in the workplace.

I am reminded of the movement of person-centered decision making in the workplace by the pithy saying: “Nothing About Me Without Me”.¹ It serves to remind people that even though individuals with mental health issues may be deprived of 100% lucidity and perspicacious decision making abilities, others should, as a principle, accord them the same respect, and not make any decisions without consulting with them. This is especially so if these potential choices might affect the employee’s quality of life. When making considerations which may impinge on another’s life, it’s only good manners to make sure that everyone affected is a stakeholder.

Mental health issues tend to attract the kind of hushed conversations that we want to avoid. It’s simply improper to gossip about such deeply personal issues. Conversations regarding the affected individual shouldn’t take place without their “blessing”, either. If I were to take a charitable interpretation of such water-cooler talk, I might say, after all, people may not know the right approach to handle these situations, or they may simply be misguided in their good intentions!

Some useful guidelines for professionalism at the workplace. If you are, for example, a HR-manager and suspect that an employee of yours requires help with a personal mental health issue, do not:

  • Apprise superiors of his condition without seeking his permission first
  • Try to “ease his burden” by lessening his workload in an attempt to “help” him cope with his condition without consulting him beforehand

Instead, as soon as any discussion is started about the individual, he should be brought into the fray and  not be left in the dark. The point here is about giving back control to the person in question, and allowing him to understand that he is still equally respected regardless of his mental health.

What happens if these pointers are neglected? Unfortunately, diminishing the employee’s workload without consulting him first may chip away at his sense of self-worth, since he is stripped of the ability to demonstrate his capabilities. Moreover, having your superiors talk about you behind your back can in some ways, make you feel discriminated against for having a mental disorder. This breeds a sense of distrust amongst colleagues, which erodes the fabric of work cooperation. Not respecting someone’s dignity and right to make decisions can also hinder his/her mental recovery process. Needless to say, such workplace environments are deeply unprofessional outfits which detract from productivity and dignity.

We should thus focus on what we can do to make our workspaces better places, and mentally healthier ones. We should start taking “Nothing About Me Without Me” seriouusly. We need to start recognising its importance to a well-oiled outfit and how it helps foster pride and dignity. In fact, we should help this principle take root at the organisational level, such as including people with past experiences of mental health issues in the development and expansion of workplace mental health policies, or seeking their input when it comes to planning activities in service of mental well-being. Policies centered on transparency and proper communication should also be developed as adjuncts to ensure that the organisation is committed to making sure employees’ voices are heard when it comes to issues of mental health and their careers. If more organisations are willing to take these steps, there’s no doubt our workplaces will slowly become more conducive and nurturing environments. How is your company contributing towards making your workplace a mentally healthier one? Share your thoughts in the comment section below, so we’re all better off for having heard these ideas.

¹ Golding, E. and Diaz, P. (2020) Mental Wealth. New York: Morgan James Publishing.