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Mental Health Awareness Panel Discussion feat. Dr Rajesh Jacob & S C Anbarasu

Mental Health Awareness Panel Discussion feat. Dr Rajesh Jacob & S C Anbarasu

On May 16th 2020, Dr Rajesh Jacob, Senior Consultant Psychiatrist & S C Anbarasu, Senior Clinical Psychologist, were invited to be a part of a Public Education Talk: ‘Mental Health Awareness Panel Discussion’ by the ‘Migrant Workers Singapore’  group – a migrant workers community platform.

The discussion touched on a wide range of Mental Health conditions that they are concerned over; explained what they are and how one could cope or be a support.

We encourage you to hit the ‘play’ button to view the video.

 

Mental Health Awareness Panel Discussion

So if you feel anxious, depressed, stressed, or even suicidal? What can you do? Too many people suffer in silence and don’t seek help! Come join a conversation about mental health issues! Our experienced panel will consist of mental health professionals from various disciplines, a Senior Consultant Psychiatrist, Senior Clinical Psychologist from Promises Healthcare Clinic, and an Assistant Head of a Family Service Centre! The panel will be moderated by Casework Manager of SG Accident Help Jevon Ng, an advocate for mental health and wellbeing. Our panel members all have a lived experience of mental health and will be answering questions from the audience.audience participation is encouraged. Please click the link below to join the webinar: https://us02web.zoom.us/j/83397902082Date: Saturday, May 16 2020Time: 4:30 pm – 6:30 pmEvent Categories: Raise Awareness Organizer@Migrant workers Singapore Support by SGcare Physiotherapy Clinic

Posted by Migrant Workers Singapore on Saturday, 16 May 2020

Religion, Spirituality and Psychiatry

Religion, Spirituality and Psychiatry

Written by: Dr Rajesh Jacob, Senior Consultant Psychiatrist, Promises Healthcare

 

The basic characteristics of all religions are similar. There is a firm belief in a higher unseen power who is the supreme master.

 

Religion and Spirituality, Is There A Difference?

Religion Is an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality).

Spirituality is the personal quest for understanding answers to the ultimate questions about life, about meaning, and about the relationship with the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of a community. Spirituality is thus a more inclusive concept than religion.

 

Mental Illness In The Middle Ages

The idea that religion and psychiatry have always been in conflict is still very prevalent. Today, most people believe that in the medieval ages, most mental disorders were considered as witchcraft or demonic possession. People with mental disorders were recognized as different and treated in various ways. Early medicine men, considering such individuals to be possessed by demons, introduced a technique called trephination, which Involved drilling a hole in the head of the individual to let evil spirits out of the body. Many other civilizations independently developed such a procedure. For example, among the remains of the Incas in Peru are skulls with holes and trephination devices. The treatment of mental illness deteriorated in the late Middle Ages and remained poor through the eighteenth century. As the medieval years progressed, insanity became linked to witchcraft and demon possession. Those considered to be possessed with demons were exorcised. This ritual, performed by a priest, would call upon the demon to come out of the individual and to transfer itself into an animal or inanimate object. Both the Greeks and Romans thought that the mentally ill were capable of causing major social problems, as well as harm to themselves. They made provisions for guardians to take care of the insane. Realizing that these people could hurt themselves or others and could destroy life and property, laws were passed that set specific guidelines. Since there were no lunatic asylums, people with mental illness were a family responsibility. The seriously impaired were restrained at home, but others were permitted to wander in the hope that evil spirits might fly out of them.

Certain saints were thought to be more active in the domain of madness. In northern France, the shrines of Saint Mathurin at Larchant and Saint Acairus at Haspres were known for healing. In Flanders, now Belgium, citizens of Geel developed a shrine to Saint Dymphna that became a hospice to house the mentally ill. During the early years of the Middle Ages, the community took care of the mentally ill. Later, hospices, then asylums were developed to house them. London’s Bethlem asylum—better known as Bedlam—was founded in 1247, making it one of the oldest institutions of its kind. The term “bedlam” became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness at the time. It was only in the nineteenth century that scientists and society began to reconsider deviant behaviour from the perspective of mental illness rather than as a manifestation of evil spirits.

 

Religion And Psychiatry

Persons with mental disorders can sometimes present with symptoms such as hyper-religiosity (manic episodes as part of bipolar disorder) or delusional beliefs such as possessing godly or religious powers. Rates of religious delusions in schizophrenia remain high. These symptoms and signs need to be carefully assessed by mental health professionals. Certain groups in Christianity such as Pentecostal Christians “speak in tongues”, which is not a symptom of mental illness, but an expression of their religious beliefs. “Speaking in tongues” is mentioned in the Bible. 

In the last two decades, rigorous scientific research has been done and published in mainstream medical and psychological journals. David B. Larson, Jeffrey S. Levin and Harold G. Koenig were some of the authors. They have conducted a series of studies looking at the relationship between religious involvement and mental health in mature adults, either living in the community or hospitalized with medical illness. Since then, many other researchers have produced a large body of research that has usually, but not always, shown a positive association between religious involvement and mental health.

According to the Harvard psychologist, Gordon Allport, a person’s religious orientation may be intrinsic and/or extrinsic.

  • Extrinsic Orientation
    Persons with this orientation are disposed to use religion for their own ends. Many find religion useful in a variety of ways – to provide security and solace, sociability and distraction, status and self-justification. 

 

  • Intrinsic Orientation
    Persons with this orientation find their master motive in religion.

    • Other needs, strong as they may be, are regarded as of less ultimate significance, and they are, so far as possible, brought in harmony with the religious beliefs. Having embraced a creed, the individual endeavours to internalize it and follow it fully. Usually, the intrinsic orientation is associated with healthier personality and mental status, while the extrinsic orientation is associated with the opposite. Extrinsic religiosity is associated with dogmatism, prejudice, fear of death, and anxiety, it “does a good job of measuring the sort of religion that gives religion a bad name.
    • Physical health:  Religiousness was related to decreased smoking and alcohol consumption. Religious commitment and participation seemed to affect longevity, as well, especially in men.
    • Suicide rates were consistently found to have a negative correlation with religiosity. In Hinduism, if you take your life prematurely, you have to suffer in the next birth. Most research findings support that religious affiliation, especially participation, lowers the rate of alcohol consumption. Being religious results in more hope and optimism and life satisfaction.

 

Belief Systems, Cognitive Framework

Beliefs and cognitive processes influence how people deal with stress, suffering and life issues.

Religious beliefs can provide support through the following ways: Enhancing acceptance, endurance, and resilience. They generate peace, self-confidence, purpose, forgiveness to the individual’s own failures, and positive self-image. On the other hand, they can sometimes bring guilt, doubts, anxiety and depression through an enhanced self-criticism. ‘Locus of control’ is an expression that arises from the social learning theory and tries to understand why people react in different ways even when facing the same problem. An internal ‘locus of control’ is usually associated with well-being and an external one with depression and anxiety. A religious belief can favour an internal ‘locus of control’ with an impact on mental health.

 

Religious practices

Public and private religious practices can help to maintain mental health and prevent mental diseases. They help to cope with anxiety, fears, frustration, anger, anomie, inferiority feelings, despondency and isolation. The most commonly studied religious practice is meditation. 

It has been reported that it can produce changes in personality, reduce tension and anxiety, diminish self-blame, stabilize emotional ups and downs, and improve self-knowledge. Improvement in panic attacks, generalized anxiety disorder, depression, insomnia, drug use, stress, chronic pain and other health problems have been reported. Follow-up studies have documented the effectiveness of these techniques.

 

Role of the Psychiatrist

During assessment, the psychiatrist should be able to determine whether the religion in the life of his patient is important, has a special meaning and is active or inactive. Four basic areas should be remembered when taking a spiritual history.

  1. Does the patient use religion or spirituality to help cope with illness or is it a source of stress, and how?
  2. Is the patient a member of a supportive spiritual community?
  3. Does the patient have any troubling spiritual question or concerns?
  4. Does the patient have any spiritual beliefs that might influence medical care?

The clinician who truly wishes to consider the bio-psycho-social aspects of a patient needs to assess, understand, and respect his/her religious beliefs, like any other psychosocial dimension.

 


Photo by Jeremy Perkins on Unsplash

What is the Lasting Power of Attorney (LPA)?

What is the Lasting Power of Attorney (LPA)?

The idea of becoming mentally incapacitated is often so frightful that most people simply avoid the issue. Discounting the various other ways someone can lose control of their mental faculties, in Singapore, 1 in 10 people above 60 will succumb to dementia and 3.6% of people will suffer from obsessive-compulsive disorder, 1 in 50 people will experience a psychotic episode at some point in their lives, and 1% will suffer from schizophrenia, all conditions that might precipitate the loss of mental faculties. It’s a statistic that we’ve not brought up to alarm you, but simply to help you decide if you have someone in your life you trust to protect your interests, in the realm of your personal welfare, and property and affairs.

You simply have to be above the age of 21, by law in Singapore, to appoint one or more “donees”, who are people you trust “to make decisions on your behalf, in your best interests”. You, as the appointer of your donee(s), are known as the “donor”.

The Ministry of Social and Family Development suggests that it is beneficial to make an LPA as a protective measure against any untoward happenstance as it relates to your mental well-being. It is obviously best to decide what the best permutation for you is while you are capable of making rational decisions on your own behalf. Broadly, your appointed donee(s) will have control over one or both of the following aspects of your life: your personal welfare; and your property and affairs.

The LPA is designed to safeguard your interests, so it grants you the latitude of choice in deciding if: you want a single donee, whose powers are defined in Part IV of the Mental Capacity Act, or multiple donees. In the event that you decide that you would prefer multiple donees, you also have the power to decide if you will allow any one of them to act alone in making a decision on your behalf, or have them come to a consensus on undertaking a decision.

The difference between LPA Form 1 and LPA Form 2 is that LPA Form 2 allows you to appoint more than 2 donees, more than 1 replacement donee, or grant your donee(s) customised powers above the general powers with basic restrictions that donees are granted under LPA Form 1. LPA Form 2 requires the services of a lawyer.

After you have decided what’s best for you, and filling up LPA Form 1, or LPA Form 2, which you can do with the help of a lawyer, there is a “critical safeguard” in place to ensure that the LPA is not made under duress. This means that your LPA form will have to be witnessed and certified by an LPA certificate issuer, which can be:

  1. an Accredited Medical Practitioner;
  2. lawyer; or
  3. registered psychiatrist

As the writer of this article is none of the above, we recommend that you speak to your chosen LPA certificate issuer to fully understand the nuts and bolts of the LPA.

Nobody wishes to have the eventuality of an LPA come to pass, but we hope you will consider that “a stitch in time saves nine”. For Singapore citizens, the LPA Form 1 is free, until 31 August 2020.

Please refer to the MSF’s LPA FAQ for further details.

 


  1. Singapore Mental Health Study, 2016.
  2. Psychosis – Institute of Mental Health. https://www.imh.com.sg/clinical/page.aspx?id=258, accessed 8/6/20
  3. SA Chong, et al. A Risk Reduction Approach for Schizophrenia: The Early Psychosis Intervention Programme, Annals Academy of Medicine, Sep 2004 Vol 33 No. 5.
  4. Photo by Scott Graham on Unsplash
Wrap-Around HR Strategies That Could Increase Employee Sentiments & Mental Wellness

Wrap-Around HR Strategies That Could Increase Employee Sentiments & Mental Wellness

Singaporeans spend most of their time at their workplaces, and in some sense, their workplace is their second home, and now, their workplace could be their home. How do we consider our colleagues? Are they like family to us? Are we working in a supportive environment?  

 

Many a time, the workplace health and mental well-being of employees are compromised as business organisations focus on driving revenues and profits with little attention to safety, health and wellness of the staff. The impact of these is the negative effect on job-related attitude and job performance. In some instances, some workers may develop mental health issues such as anxiety or depression over time if they are too overwhelmed. As such, there is an increasing need for employers to acknowledge the positive correlation between having good mental health in their workers and the productivity and success of the business.  

Across all workplaces, we need to step up and start considering ‘wrap-around strategies’ to counter the negative effects of excessive work on employees’ mental health, one of which includes unhealthy stress levels especially when it’s so easy to blur the boundaries of work and personal time while we work from home. Organisations usually conduct one-off mental health awareness programmes as an attempt to spread awareness among employees in the hope of reducing the occurrence of mental health issues. However, by making these awareness programmes an annual occurrence, employees tend to find it a dread, and the messages no longer get through to them as effectively. On the other hand, how many employees would attend the programme if it were to be on a voluntary basis? Many companies are aware of this but are still trying to find the right balance between promoting mental wellbeing and business sustainability.

Employers and HR practitioners have to accept that mental health issues are more often than not deep-rooted, and cannot be solved easily with such band-aid solutions (as most people would expect). This calls for wrap-around strategies, which would mean tackling mental health issues at the fundamental level and preventing problems from cropping up in the first place. It is in no one’s interests to try tackling the situation only when things get out of hand. 

Having the right mindset and attitude is pivotal. We need to start thinking of our employees as our very own family members. If so, what can we do to make them happy? Do we have a framework for a healthy workplace? Are there plans in place to provide employees with the necessary support? For one, organisations can take the first step to introduce more flexibility into the workplace, with working from home being a mandatory option these days, it is the most opportune moment to reframe workflow processes for the longer term. This includes creating a flatter hierarchy, where there are fewer layers of management and less formal divisions between the higher-ups and the rest of the staff. Employees will thus be more involved in decision-making processes, creating a greater sense of ownership and accountability. The greater involvement of staff in the organisation will allow them to develop into more confident and capable workers, as well as enhance employee satisfaction. With greater employee satisfaction comes a greater sense of empowerment and motivation – factors that are crucial towards the productivity of the organisation. 

Do we need to start thinking of what are the overlooked essentials of employee wellbeing? In your organisation, what is the decision-making process (in terms of policies and other forms of red tape) like? At present, most workplaces have a ‘top-down’ approach, where decisions are made by the senior management of the organisation and information is then cascaded downwards to the lower levels. In such cases, the staff are not given a voice and have no contribution to any of the decision-making processes. In contrast, when employees are given a chance to contribute their ideas, this encourages employee engagement and motivates them to put in greater efforts to overcome challenges. In turn, employees will certainly gain a sense of accomplishment and satisfaction. Hence, while it is true that not all work-related decisions can be made by the middle or lower tier of the corporate hierarchy, organisations should allow employees some level of discretion and autonomy to provide feedback or inputs to the decision-making process where possible. Organisations that succeed at providing the autonomy, social connections and support to their employees are better able to foster physical and mental well-being.

Needless to say, a flatter organisation would be counter-productive if the supervisors or senior management are unwilling to let go of micro-management and to show care for their employees. Managers and supervisors should start making an effort to check in with their subordinates and to ensure that they are coping well with their workload. Moreover, this should occur frequently, rather than being a one-off occurrence. Perhaps the head of each department could act as a “Welfare Ambassador”, and check-in with the employees within the same department. Getting to know the people in the same team better will allow them to identify any mental health symptoms, no matter how small. One way to get it started would be to allocate mini bonding sessions daily, each lasting approximately 15 minutes (even if it is just a short video call check-in). During this time, take turns to talk about your day, or about any difficulties that you may be encountering.   relationships and social support with co-workers can improve emotional connections and ease any mental stress and burden. Such baby steps will help develop the camaraderie among teams and improve everyone’s overall well-being in the long-run. However, Managers do need to take note that they are not professional counsellors and would need to draw healthy boundaries for themselves so as to not be overwhelmed by the transference of emotional issues. Learn to, for your own safety of boundaries, to openly and healthily bring up the subject of steering an emotionally and/or mentally troubled employee to seek professional help. Remember, there is no shame in seeking help. 

Organisational structure aside, it is also important to ensure that the workplace has a conducive environment – one that fosters overall well-being of the staff. All work and no play will eventually take a toll on the employees’ health, both mentally and physically. If space constraint is not a problem, try allocating a room for staff to take short mental breaks. In other words, have a “chill” room! Do take note that this should be a separate space from the staff pantry, where employees usually have their meals or to grab a quick drink. Mental-break rooms, on the other hand, can be used for socialising or for employees to take a short rest. Such a room can be decorated in an informal style, with more comfortable furniture. There is absolutely no harm in placing a few beanbags or some sort for employees to relax on whenever they feel overwhelmed by their hectic schedules. For those working at home, perhaps remind them to take mental health breaks. HR could schedule it into company calendars as a reminder and these small steps could foster greater trust between employees and the company. Trust that their welfare is being considered in decisions and that they are not just a tool or a means to the company’s bottom line, but a life that they now also have a responsibility to steward.  

In short, mental well-being is important for a productive workforce and a healthy workplace. We need to create an environment where employees feel welcomed and safe. Workplace mental health is not – and should not be – an issue that we sweep under the rug. We need to acknowledge that providing support to the colleagues around us holds great importance and that we cannot simply cast them aside, leaving them to deal with their troubles alone. Ultimately, assisting your employees and ensuring they have the best mental health support will go a long way. 


Photo by Mimi Thian on Unsplash

An interview about Psychosis on Vasantham’s En Ullae S2 with Dr Rajesh Jacob

An interview about Psychosis on Vasantham’s En Ullae S2 with Dr Rajesh Jacob

Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Consultant Psychiatrist, Dr Rajesh Jacob, in the name of bringing greater mental health awareness to the Indian community in Singapore.

This episode of En Ullae touches on psychosis. This case study was about a man who had developed schizophrenia and became obsessed with the ‘spiritual safety’ of his partner. The building tension served to demonstrate the dangers of ignoring the symptoms of psychosis, which his partner was predisposed to do, in her untoward position as the long-suffering partner in a dangerously unstable relationship. Dr Jacob characterised psychosis as rooted in an unshakeable belief in false delusions – people who suffer from the condition are often willfully blind to reason, which he cautions against trying to impose on them when the time is inclement. 

Prem, the unfortunate man with all the symptoms of hallucinatory schizophrenia, began to cast an evermore imposing spectre in the relationship, causing much distress to Rani. His delusions began to take such a toll on their relationship, with even the good tidings of a baby in the oven twisted into a string of abortion by Rani, afraid that he would bring harm to her and any prospective child she would bequeath upon them – he professed to see the child as a harbinger of doom, as the embodiment of the devil. Midway through the episode, the viewer is treated to the appearance of two ambiguous personalities – a man and a woman, whose blue lanyard faintly conveyed some sense of authority. We are left uncertain as to their actual responsibilities – they are at times quizzical, unwilling to manifest the “good cop, bad cop” trope. No matter, it is not the point of the episode to further entangle the convoluted plotlines – they serve as plot devices which encourage Prem’s own narrative to unfold – to the end, he remains stolidly convinced that his stabbing of Rani had taken her to a better place, the expression on his face almost beatific at times. 

Dr Jacob, at this point, sees fit to caution the viewer against harshly attributing homicidal tendencies to persons with psychosis. He presents the statistic that even less than 15% of homicides are perpetrated by people mentally unsound. Noting the prevalence of drug use and antisocial tendencies that colour this 15%, he confidently steers the viewer away from making too quick a conclusion – it is in everyone’s best interest to step back and evaluate statistics grounded in good science, instead of leaping to the easy conclusion that Prem was beyond rehabilitation.

 

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep6/952940 )