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OCTOBER - DECEMBER 2015AN IMH QUARTERLY PUBLICATION

MCI (P) 050/12/2015

Joining Hands for Addiction Awareness

Results of the Mind Matters Study

Education Hub: A Space to Learn

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Partnership and Education for Addiction Awareness

This year’s National Addictions Awareness Day (NAAD) was jointly organised by the National Addictions Management Service (NAMS), North West Community Development Council (NWCDC) and Khoo Teck Puat Hospital (KTPH). Held on 22 November at KTPH, the theme for NAAD was “Together for the Better” and focused on strengthening the community network through partnership and education to provide care and support for persons recovering from addiction. Dr Teo Ho Pin, Mayor of North West District, was the guest of honour.

The event acquainted residents in the north western side of Singapore to the different types of addiction, preventive measures and treatment as well as the various platforms to seek help. This annual community event, which had previously been held at south-west and south-east Singapore, is now into the third year since it was first initiated by NAMS. At the event, NAMS launched an education arm, the Addiction Recovery College (ARC), to provide workshops and training for the professionals as well as the public to help them or their loved ones better cope with stressors in life and manage their

By Penny Chua, Corporate Communications

behaviour before they spiral into serious addiction problems. By developing a culture of learning and recovery to engage the public on addiction prevention, treatment and wellness, ARC hopes to provide holistic care for persons with addictions and their families. “Recovery from addictions involves the individual’s determination to want to get well, treatment and counselling from medical professionals. Positive support and care from the family, employers, colleagues and friends are also important. By forging close partnerships with our partners and establishing the ARC, we hope to help and motivate more persons to overcome their addictions and work towards living a purposeful and meaningful life,” said Dr Christopher Cheok, Vice Chairman, Medical Board (NAMS).

Community partners such as the Central Narcotics Bureau, Health Promotion Board, National Council for Problem Gambling, Singapore Anti-Narcotics Association, Credit Counselling Singapore, WE CARE Community Services Limited, Thrive, Thye Hua Kwan Moral Society, and Touch Community Services put up interactive and informative booths showcasing various programmes and services. Participants also benefited from free talks on topics ranging from the types of addictions to financial management.

“Being closer to the ground enables the NWCDC to be a key connector of corporate and community organisations and volunteers, reinforcing community ties through a series of collaborative social exchanges. We are happy to be a part of National Addictions Awareness Day 2015, contributing to the efforts of raising awareness, providing support and care for persons recovering from addiction. Alone we can only do so little. However, with these collective efforts, we can help strengthen the social fabric and in turn, build a better home for all,” said Dr Teo Ho Pin, Mayor of NWCDC.

Mayor Teo Ho Pin (second from right) officially launching the ARC.

Collaboration with Community Partners NAMS counsellor at CCS Addictions services at Bukit Batok

• To bring addiction services closer to the community, NAMS teamed up with Credit Counselling Singapore (CCS) in August 2015 to station a counsellor onsite at CCS once a week to see clients who have indicated gambling or other forms of addiction as a factor of their financial debts. The clients see the NAMS counsellor as well as the CCS financial counsellors on the same day. This helps to screen and provide timely interventions to client’s addiction behaviour, which had contributed to their financial debts. Clients are referred back to NAMS to further manage their addictions when necessary.

• NAMS initiated a partnership with Club HEAL in September 2015 to develop community-based addictions care in the Bukit Batok neighbourhood. Club HEAL hosts a NAMS counsellor once a week to provide community-level care. The aim is to ensure easy accessibility to addiction care for residents in the western region of Singapore.

For courses and details about the Addiction Recovery Centre, please visit www.nams.sg

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Delivering Quality Care for Patients

Going the Extra Mile

IMH staff came together in September to celebrate the annual Quality Day with the theme “We Make It Possible”. Quality Day recognises those who have contributed significantly to work practices that have improved customer service or patient safety. Such events help in cultivating a learning culture in IMH and in enhancing quality of care.

Ms Karen Wong, Director (Healthcare Sector) in the Development Group of the Infocomm Development Authority of Singapore was invited to share how the healthcare industry can harness maximum value from technologies. Certificates and prizes were also presented to 10 teams that competed in the Quality Competition for innovative hospital improvement projects carried out from 2014 to 2015.

One of the teams that won the gold award was from Dietetics and Catering Services. The team revamped the central kitchen and implemented a centralised meal portioning and dishwashing system, which allowed these tasks to be carried out more efficiently in one main location. Previously, meals were sent to wards in large containers, which health attendants and healthcare assistants in the ward portioned and distributed to patients. The dishwashing was also done in the wards. Due to a shortage of health attendants, nurses often ended up with the tasks.

The NHG Excellence in Action Awards were presented in September this year to four staff and one team in IMH for consistently displaying qualities aligned with NHG’s CARE values of Confidence, Attentiveness, Respect and Empathy. Receiving the team award was the Adult Neurodevelopmental Service (ANDS).

About 40% of people with Intellectual Disability have a comorbid psychiatric disorder, such as problem behaviours. These patients often face greater social stigma and exclusion from both mental health and social (disability) sectors.

To improve the process, the team visited various hospitals and nursing homes to learn from their practices and systems. In addition, a kitchen consultant was roped in to plan the work flow and provide advice on the type of equipment that will be required. The kitchen revamp has resulted in increased productivity and better patient care. With the portioning of food and dishwashing managed in the central kitchen, staff in the ward now have more time to care for the patients.

Established in 2013, ANDS is the first in Singapore to cater for intellectually disabled people aged 19 to 64 with IQ levels of 70 or below and mental health conditions. The service is available in IMH and the Community Wellness Clinic in Queenstown.

A multidisciplinary team works closely together to identify the causes of a patient’s behaviour, as they are often complex in this group of patients, and implement care plans that address their mental health, behavioural and habitation needs. A study conducted by ANDS in 2014 showed that patients improved by more than 20% in behaviour and mental state, and saw 7% improvement in cognition and 8% in social functioning.

The team also supports caregivers and works with community agencies through case management, consultations, outreach and training to improve capabilities of service providers to care for this group of patients.

“The ANDS team has always gone the extra mile to care for our patients with developmental disabilities, who require more coordinated care,” said Dr Wei Ker-Chiah, Chief, Department of Community Psychiatry and Head, ANDS, IMH. “With them, I see the best of public healthcare ethos in action, and hope we can continue to make a big difference to the lives of this group of patients and their caregivers.”

By Ng Si Jia, Corporate Communications

By Christina Low, Department of Community Psychiatry

The ANDS team with Dr Chua Hong Choon, CEO, IMH (front row, left) and Dr Wei Ker-Chiah, Head, ANDS (front row, second from right).

Dietetics and Catering Services staff training at Tan Tock Seng Hospital in March 2015.

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More Awareness for Mental Disorders Needed in SingaporeBy Penny Chua, Corporate Communications

A two-year population-based study “Mind Matters: A Study of Mental Health Literacy” has found that across five common disorders – alcohol abuse, dementia, major depressive disorder (MDD), obsessive compulsive disorder (OCD) and schizophrenia – recognition was highest for dementia (66.3%), followed by alcohol abuse (57.1%) and MDD (55.2%). Recognition was poorer for OCD (28.7%) and schizophrenia (11.5%).

Mental health literacy has been described as the “knowledge and beliefs about mental disorders which can help in their recognition, management or prevention”. Previous studies suggest that the general public has a poor understanding of mental illness. They are unable to correctly identify mental disorders, do not understand causative factors and have incorrect beliefs about the effectiveness of treatment interventions. This failure to recognise signs and symptoms of mental disorders leads to delays in help-seeking or seeking help from inappropriate sources.

The Mind Matters study examines mental health literacy and how it correlates to the adult resident population as well as the extent of stigma and social distancing for specific mental disorders. Conducted by IMH’s researchers on residents aged 18-65 years in Singapore, the study found that age, gender, ethnicity and education were among the factors associated with recognition:

• Older age was significantly associated with poorer recognition. Those aged 35-65 years were less likely to recognise OCD symptoms compared to 18-34 year olds;

• Women were more likely to recognise depression and OCD compared to men;

• Indians were less likely to be able to recognise dementia and MDD compared to Chinese, while Malays were less likely to recognise dementia compared to Chinese;

• Those with less education (compared to those with tertiary education) were less likely to recognise alcohol abuse, dementia, depression and OCD.

Principal investigator Prof Chong Siow Ann, Vice Chairman, Medical Board (Research), IMH, said that the findings of the study show the need for more awareness of mental illness, especially among those with lower education and income levels as they were less able to recognise mental disorders. They were also more likely to view those with mental disorders as “weak,

not sick” or “unpredictable or dangerous”. “This may explain why the treatment gaps for some of these disorders are wide as well,” Prof Chong said. Treatment gap refers to the estimated percentage of persons with mental illness who are not seeking professional help.

The 2010 Singapore Mental Health Study found that while mental illness is quite common among the Singapore population, the treatment gap associated with common mental disorders is significant. However, critical information such as gender, education, religion, ethnicity, personal experience of mental illness, and how they would impact and shape mental health knowledge and attitudes are unknown. Also, the current state of knowledge on the ground about mental illness is unknown in Singapore. As such, the Mind Matters study was conducted to help bridge this knowledge gap, guide public health policies and formulate better educational programmes, which in turn can encourage early treatment and narrow the treatment gap.

This study cost $1 million and was funded by the Ministry of Health, Health Services Research Competitive Research Grant.

Other Findings from Mind MattersOn help seeking behaviour

• When asked about where someone with mental illness should seek help from, friends and family were the most common response for alcohol abuse (30.1%), MDD (54.2%) and schizophrenia (21.5%) while seeking help from a doctor or general practitioner was the most commonly reported source for dementia (53.8%) and OCD (26.8%).

• More than 88% of study participants said seeking help from a psychiatrist would be helpful for someone with a mental illness.

On stigma

• When participants were asked about their attitudes towards those with a mental illness, 89.4% of them felt that a person with a mental illness could get better if they wanted to, while 62.5% said that people with a mental illness are unpredictable. Among them, 50.8% said that a mental illness is a sign of personal weakness.

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About the Five Common ConditionsThe study assessed the recognition and beliefs pertaining to causes, treatment options and outcomes on five common mental disorders – alcohol abuse, dementia, major depressive disorder (MDD), obsessive compulsive disorder (OCD) and schizophrenia in Singapore. Here are some of the signs and symptoms of these mental disorders.

Major depressive disorder

• Sleeping difficulties and appetite problems.

• Poor concentration, feeling of hopelessness or having suicidal thoughts.

• Constant low mood and lack of interest in life.

• Downward spiral of self-esteem.

• Overwhelming sense of sadness, guilt, and unable to control mood.

Schizophrenia

• Delusions such as paranoid ideas about being followed or watched, and believing others are plotting to harm them.

• Hallucinations, such as hearing voices talking amongst themselves or commanding the person to do certain things; seeing, feeling, tasting or smelling things that are real to the person, but are not actually there.

• Thought disorder that interferes with the normal thinking process. The person’s speech may be difficult to follow, being disjointed or jumbled with no apparent logical connection.

• Lack of drive to engage in usual daily activities, such as working, cooking or doing other household chores.

• Social withdrawal, avoiding going out or interacting with people.

Obsessive compulsive disorder

• Recurrent intrusive and unpleasant thoughts or images known as “obsessions”, such as irrational fear of contamination, fear of hurting someone, distressing sexual or religious thoughts or a need for symmetry and exactness.

• Engaging in repetitive behaviour such as checking, cleaning, washing, counting, hoarding and mental ruminations to “neutralise” these obsessions which are often time consuming (usually taking more than an hour a day).

• Constant feelings of anxiety.

• Daily functioning such as school or work performance affected.

Dementia

• Memory loss specially related to recent events, messages and names as well as asking questions repetitively.

• Personality and mood change.

• Impaired judgement, facing difficulties with abstract thinking and finding the right words.

• Loss of communication skills.

• Disorientation to time and place and sometimes displaying inappropriate behaviour.

• Problems with gait, motor skills and balance.

• Neglecting self-care and safety.

• Hallucinations, paranoia, agitation or depression.

Alcohol abuse

• A strong and continuing compulsion or need to drink, despite persistent physical or psychological problems caused by alcohol.

• Need to drink increasing amounts of alcohol in order to “get high”.

• Withdrawal symptoms when a person stops drinking e.g. sweating, nausea and tremors.

• Loss of control of alcohol intake.

• Unsuccessful efforts to cut down or control alcohol use.

• Reduce social, occupational, or recreational activities because of alcohol use.

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Seven staff from IMH were recognised for their mental health research and care improvement projects at the Singapore Health and Biomedical Congress (SHBC) in October. Organised by the National Healthcare Group, SHBC is the largest healthcare and scientific congress in Singapore, where local and overseas healthcare delegates convene to network and exchange innovations and ideas to bring healthcare to greater heights.

One of the winning entries was “Assessment of physical health status of long-stay patients with severe mental illness in a tertiary care hospital” submitted by Ms Saleha Syafie from IMH’s Research Division. This project was part of a study led by Prof Chong Siow Ann, Vice Chairman, Medical Board (Research), IMH, to assess the physical health status of long-stay inpatients between the age of 25 and 90 with severe mental illness.

Conducted from July 2014 to April 2015, the study aimed to establish the prevalence of physical illness, such as diabetes and hypertension, the risk of osteoporosis, and frailty in long-stay patients. Patients with severe mental illness typically have shorter life expectancy of 13 to 30 years as they are known to have higher prevalence of diabetes and high cholesterol compared to the general population. However, proactive monitoring and management of these conditions through medication and lifestyle changes can help to reduce their risk for cardiovascular diseases.

Sharing Mental Health Expertise at SHBC 2015By Penny Chua, Corporate Communications

The study also indicated that there is a need to develop better medications with fewer side effects for patients with severe mental illness. Patients must be informed about the risks of comorbid physical conditions and motivated to be involved in their own care by regulating their diet and exercising to prevent physical illnesses. To this end, IMH’s care team conducts regular psycho education, which includes advice on good lifestyle and behavioural habits, for both outpatients and inpatients.

As the only tertiary psychiatric institution in Singapore, IMH’s role in educating the next generation of mental healthcare professionals is integral. Education forms one of IMH’s three strategic thrusts, in addition to Clinical Services and Research. Our goal is to provide quality education to support national mental health capability-building for the future.

With this in mind, the Education Hub was officially opened on 28 October 2015, at a ceremony graced by Madam Kay Kuok, Chairman, National Healthcare Group. With flexible spaces purpose-built for both didactic and interactive team-based styles of learning, locker facilities and a group study lounge, the Education Hub was designed to enhance the learning experience for post-graduate psychiatry residents and medical, nursing and allied health students who come

to IMH for their clinical training. The Education Hub adds to existing education infrastructure in IMH, namely the Duke-NUS Secretariat Office and the Centre for Mental Health Education, established in 2008 and 2010 respectively.

In the last financial year, nearly 2,300 medical, nursing, and allied health students passed through IMH’s doors for pre-professional training. These numbers are set to increase, as students from Lee Kong Chian School of Medicine start coming through from January 2017. As for postgraduate programmes, 77 residents are undergoing training in the psychiatric residency programme currently.

Putting things into perspective during his opening address, Dr Chua Hong Choon, Chief Executive Officer, IMH said, “We cannot simply focus on our clinical services because that is simply taking care of our patients today. Educating future mental health professionals ensures that we take care of the patients of tomorrow.”

Presently, some 111 IMH staff members from the medical, allied health and nursing professionals hold teaching appointments and/or roles with academic partners in both pre-professional and post-graduate programmes. IMH will continue to leverage its multidisciplinary expertise in training aspiring mental health practitioners to enable them to deliver compassionate, high-value, and safe patient care.

A Space to LearnBy Vera Soo, Corporate Communications

Winners with Dr Chua Hong Choon, CEO, IMH (centre) and Adj A/Prof Sim Kang (left), Chairman, SHBC 2015 Organising Committee.

Guest-of-honour, Madam Kay Kuok, Chairman, NHG (left) at the official opening of the Education Hub, with Clinical A/Prof Chiam Peak Chiang, Vice Chairman, Medical Board (Education), IMH and Dr Chua Hong Choon, CEO, IMH (right).

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A total of 34 medical, nursing and allied health staff from IMH received the NHG Teaching Excellence Award this year for their efforts in teaching and mentoring the next generation of mental healthcare professionals as well as contributing towards the professional development of staff. Some of the award winners share their thoughts on what it means to be an educator.

Leading By ExampleBy Lalitha Naidu, Corporate Communications

“Good teachers not only define and uphold the highest standards of ethics and professionalism in mental healthcare but they also inspire the greatest good in us as human beings. I have noticed that staff and students who have had the good fortune of receiving quality guidance from dedicated seniors and teachers tend to become willing mentors themselves subsequently to guide their juniors. This cycle of goodwill passes on to generations to come. This is perhaps part of what makes teaching a noble and beautiful pursuit.”

Mr Ng Boon Tat, Principal Pharmacist, who received the NHG Education Leaders Award

“I believe knowledge, skills and a positive experience are necessary for the next generation of mental health professionals to grow. It provides the catalyst for them to improve the care provided to our patients as well as external customers.”

Mr Fredrick Varnum, Nurse Clinician, who received the NHG Nursing Preceptors Award

“The desire to teach stems from my own learning experience of picking up a new skill and being excited about how I can apply it to a clinical situation. Therefore, I feel a need to create interest in learning amongst students and young healthcare professionals. Many of them are keen to learn new things and it is a rewarding experience to see them grow as a practitioner. To meet the changing landscape of mental healthcare, we have to constantly relearn and guide younger professionals along the way. This will enable them to have a satisfying career in mental health. At the end of the day, our patients will benefit from better care.”

Dr Tan Bhing Leet, Head, Occupational Therapy, who received the NHG Allied Health Senior Educators Award

“Mental health is an integral part of healthcare. The mental health profession has come so far over the years and we need to maintain this by continuing to inspire future generation of mental health professionals. Engaging in educational work enables me to widen my circle of influence in this aspect.”

Dr Xie Huiting, Nurse Educator, who received the NHG Outstanding Nurse Teachers Award

“Teaching is both an honor and a commitment. Through teaching and contact with my fellow GPs, I hope to impart what I know, and at the same time learn from my colleagues. I wish that through learning from each other and with our mutual support, we will develop a team of primary care doctors to support mental healthcare in the community.”

Dr Alvin Lum, Deputy Director, MH-GP Partnership Programme, who received the NHG Outstanding Education Partners Award

Some of the IMH winners at the award ceremony.

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In a joint effort to raise awareness for depression and commemorate World Mental Health Day, IMH collaborated with community partner TOUCH Community Services (TCS) to make a difference through a race event on 10 October 2015. The M.A.D. (Make A Difference) Race held on Sentosa Island was graced by Ms Denise Phua, Mayor, Central Singapore Community Development Council and was supported by other mental health partners, such as the National Council of Social Service, Silver Ribbon Singapore and the Singapore Association for Mental Health. More than 70 IMH staff and 15 patients participated in the race, joining nearly 700 participants to fight stigma surrounding mental illness.

“We need more community partners to come onboard and take a stake in ensuring the mental well-being of our population. This run/walk is a fun and meaningful way to learn more about common mental health conditions and destigmatise mental illness,” said Dr Chua Hong Choon, Chief Executive Officer, IMH.

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IMH’s REACH* (North) team was part of a larger community team made up of partners Fernvale Primary School, Fernvale Gardens School, and Grace Orchard School, who received the PS21 Star Service Team Award. The award was presented to Fernvale Primary School and its partners for providing mental health care support to their students.

Winning Partnership

*REACH is a programme aimed at children and adolescents from six to 19 years old and is led by IMH working in collaboration with the Ministry of Education and voluntary welfare organisations.

In her final days, the late 94-year-old Madam Yuen was blind, deaf and bedridden. Her neighbour, Ms Rosy Tan, who had taken care of her in the last 20 years was desperate to contact Madam Yuen’s only son. Madam Yuen had lost touch with him a decade ago when she developed dementia. Her son was subsequently admitted to IMH for treatment and seeing him again was the old lady’s only dying wish.

With little or no information except for the son’s misspelt name, Ms Tan tried her luck by dropping IMH an email about Madam Yuen’s situation. The case was picked up by Ms Penny Chua, Assistant Director, Corporate Communications, IMH. “As a mother, I could understand Madam Yuen’s sentiments of wanting to know what became of her son after not knowing for 10 years,” said Ms Chua who is a mother of three. She was eager to help Madam Yuen.

Ms Chua spent almost half a year trying to track the son by working with the medical records department. He was found to be discharged to a social welfare home for destitute persons and still had some challenging behaviour. Ms Chua galvanised a team from IMH to stabilise his condition and together with Ms Tan made arrangements to reunite the mother and son – and Madam Yuen and her son finally met after 10 years of living apart.

For Ms Chua’s compassion and effort to help this family, she was conferred the PS21 Star Service Award on 15 October. The Award recognises public officers who have gone the extra mile to provide good service to the public.

“I’m very proud of Penny for winning this award. She has shown us that we should always go the extra mile for our patients as nothing is impossible if you really make the effort,” said Dr Alex Su, Vice Chairman, Medical Board (Clinical Quality), IMH, who nominated Ms Chua for the award and was also involved in the reunion.

MediaCorp actress, Ms Eelyn Kok, shared that she went through a rough time when depression hit her a decade ago, but she managed to pick herself up with treatment.

Participants walking with colourful umbrellas in a successful attempt to break the Singapore Book of Records for the largest number of mass walkers with umbrellas.

IMH Staff Reunites Dying Woman and Long-lost SonBy Fiona Foo, Corporate Communications

A Race with a Touch of HopeBy Fiona Foo, Corporate Communications

Ms Penny Chua sharing her joy of winning the award with Dr Alex Su.

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Imagine having pertinent information such as patient’s sleep patterns, mood changes and compliance to medication at your fingertips for timely diagnosis and decision-making. That’s the basis of the idea from Dr Richard Goveas, Consultant, Department of Geriatric Psychiatry, IMH, for an app called Caregiver. The idea won the top prize at the inaugural Massachusetts Institute of Technology (MIT) Hacking Medicine @ SG held in July this year.

With the theme “ageing-in-place”, the event saw healthcare professionals, entrepreneurs, engineers, designers and programmers work together to tackle healthcare challenges. As elderly patients generally rely on their caregivers to convey information to doctors, Dr Goveas and his team of four looked at improving communication between doctors and caregivers through technology.

“Caregivers of elderly patients have access to information, which they may not realise is useful to doctors or may have difficulties sharing due to language barriers,” he explained. “We wanted to create a simple, intuitive app, where doctors can input prompts and monitoring questions to a caregiver’s phone to gather relevant information and obtain faster feedback. We hope that this app, once developed, will enable doctors to provide better care for their patients.”

A group of unsung heroes received the NHG Exemplary Patient and Caregiver Awards in September for their unwavering support and significant contribution towards healthcare service delivery. Two outstanding mental health advocates of IMH were among those honoured:

Brother took leap of faith when sister plunged into depressionMr Jared Ng, 50, was a high-flying executive in a large multinational IT firm until his sister, who had been battling depression for 15 years, had a relapse and became suicidal in 2013. To add to Mr Ng’s woes, his elderly mum was also frail. Mr Ng then made the difficult decision to leave his job to look after his family full time. Determined to play the role of a caregiver well, Mr Ng began to attend caregiving training courses and joined caregiver support groups. Today, he gives back to the community by providing the support that he had once needed to other caregivers through his daily work as a Volunteer and Administrative Manager with the Caregivers Alliance Limited (CAL).

From manic to inspirationalMs Mahita Vas, 53, was diagnosed with bipolar disorder 11 years ago. Ms Mahita, who often went into a manic state previously and at one point tried to kill herself, is now an inspiration to others. In an effort to reach out to sufferers and their loved ones, who may be silently crying for help, Ms Mahita wrote the book Praying to the Goddess of Mercy, which offers insight into bipolar disorder. Ms Mahita also openly shares her experience and opinions on various public platforms. She hopes to create more awareness, reduce the stigma and nurture the community to be more accepting and tolerant towards persons with mental health issues.

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Our Journey with Exemplary Patients and CaregiversBy Fiona Foo, Corporate Communications

Winning Ideas for the Old and YoungBy Lalitha Naidu, Corporate Communications

Another innovative idea by IMH staff was recognised at the Serious Games Conference 2015 in August. Dr Lambert Low, Associate Consultant, National Addictions Management Service, IMH, was part of Team Free Agent, which came up with a game to promote healthy eating habits in lower primary school kids. Titled Couching Tigers, Hidden Gluttons, it tells the story of a medieval emperor who was found dead by his daughter who then goes on a quest to uncover the conspiracy behind his death. The game, which won the Health Promotion category, teaches essential concepts related to healthy food choices and calorie intake.

Dr Richard Goveas (third from left) and his team receive the first prize from Dr Vivian Balakrishnan, Minister for Foreign Affairs (second from left).

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Ask the Expert- ADHD in Adults

What is adult ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is not just a childhood problem and some could continue to have symptoms of ADHD as an adult. ADHD sufferers have difficulty maintaining attention. They could have hyperactivity and could act impulsively.

Adults with ADHD tend to have more inattention and impulsivity leading to problems at the workplace in terms of organisational skills, time management and their ability to hold their jobs. Adults with ADHD may also suffer from other difficulties such as low self-esteem and personality difficulties. They are also more likely to suffer substance abuse problems and depression.

Can adults suddenly develop the condition?

ADHD is a developmental disorder and in most of the cases the symptoms start before the age of 12. This can continue into adulthood. Hence, it is unlikely for symptoms to suddenly appear in adulthood.

Can a person with ADHD recover from this condition?

Symptoms of ADHD, in particular hyperactivity, is less seen in adults. Difficulty maintaining attention is more common in adults. It is likely that some of the symptoms of ADHD do improve as a person gets older (about 10% reduction of symptoms every decade) and with appropriate intervention and treatment plan.

What are the treatment options for adult ADHD?

Treatment for adult ADHD consists of medications, psychotherapy and also managing other mood symptoms and self-esteem issues. Some patients may need coaching to improve their life skills such as organisation skills, time management and interpersonal skills.

Dr Ganesh Kunjithapatham Consultant Department of General Psychiatry, IMH

Coping with ADHDADHD sufferers tend to forget their appointments and need some help with lifestyle management. They can make lists, keep diaries, stick reminders and set aside some time to plan what they need to do if they find it hard to stay organised.

Smart phones are also useful in integrating many organisation tasks and often have the advantage that they can be synchronised with desktop computers. These devices can also be used as electronic reminders to help with remembering medications and appointments.

ADHD sufferers are more prone to anger, hence they can let off steam by exercising regularly and finding ways to help them relax, such as listening to music or learning relaxation techniques.

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My name is Sumaiyah and I am 27 years old. I love to write. I love walking. I love to volunteer my time and I love being with my family and friends. I am a person with dreams, hopes and aspirations. I have strengths and flaws. I am just like anyone else.

However, I faced one significant challenge in my life. When I was 19 years old, I was diagnosed with schizophrenia and depression. I was in university then, and I thought that I had a bright future ahead of me. I had placed much pressure on myself to do well for my essays and examinations and was obsessed with my studies. In fact, there was a time when I did not sleep for an entire week, trying to get my essay right. Slowly, I started to lose interest in my hobbies and spending time with my friends and family. I became worried and anxious most of the time.

My parents and friends became concerned and tried to help me. My mother took me to a General Practitioner, who prescribed sleeping pills. My friends tried to help me with my school work. They were there for me. However, the idea of me developing a mental illness was far from everyone’s mind. 

Things did not get better. Eventually, a friend brought me to see a counsellor at the university who gave me a referral to see a psychologist in a month’s time.

Unfortunately, this referral had come too late. By then it was the end of the semester, and I had completely lost it and had developed psychosis. My parents decided then that I had to seek treatment immediately and I was warded in hospital for two months, given medication and, soon after, electroconvulsive therapy.

I recovered and took a leave of absence for one semester to rest and get fully well before returning to university. I managed to graduate and I am working now.

My parents and my friends played a very significant role in my recovery. They helped me when I was down, they rationalised with me when I had paranoid or depressive thoughts, and they encouraged me in many ways.

I recently got married. My husband and I were introduced by a mutual friend, who told him upfront about my history of mental illness. As he had previously had a friend who had also suffered from mental illness, my husband was not prejudiced against me but instead sympathetic. Secretly, during our courtship, he even bought a guide book on schizophrenia for family members so that he could understand my condition better. He was very supportive and even accompanied me during my regular check-up at the hospital. 

My current challenge is to adapt to married life and to be more independent, so that my husband can lean on me, just as I lean on him.

It has been eight years since my first episode of mental illness. Thanks to God, I have not had a relapse since. My doctor always reminds me that medication is important. However, other than sticking to my medication routine, I also practise “personal medication”. My “personal medication” is taking care of myself, helping others, writing, seeking comfort in my faith, resting in the knowledge that my illness does not define me, and spending time with my loved ones.

My Recipe for RecoveryBy Ms Sumaiyah Mohamed

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EDITORIAL TEAM

Advisor Ting Mei See

Editor Lalitha Naidu

Circulation Coordinator Chris Ngiam

Committee MembersJamilah BeeviFiona FooPenny ChuaVera Soo

Cheong Yaun MarnHan Bing LingNg Si Jia

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