Mon, Mar 23, 2009
The Straits Times
By Lee Hui Chieh
THE national mental health hospital is looking at how it can
better track and care for its outpatients, especially those more
prone to violence.
The Institute of Mental Health (IMH) has set up a committee to
study this, after a former patient allegedly torched Member of
Parliament Seng Han Thong.
Questions about how IMH's more than 30,000 outpatients are
monitored surfaced after 70-year-old Ong Kah Chua, who has been in
and out of the hospital with a history of paranoid delusion,
allegedly set the MP for Yio Chu Kang on fire at a community event
in January.
Ong is now back in IMH, where he will remain until the Law
Minister decides otherwise, based on doctors' reports.
The Straits Times understands that one of the changes being
considered by IMH involves ensuring that patients at high risk of
hurting themselves or others, are followed up more closely if they
miss their appointments.
All patients are sent reminder letters, but those with suicidal
tendencies, aggressive behaviour, or a history of violence, will be
visited at home by nurses if they remain no-shows despite the
letters.
This had been done previously, but less systematically.
Doctors said that community care is the way to go, rather than
institutionalisation.
Dr Lee Cheng, the chief of IMH's department of community
psychiatry, said: 'The best indication of violence is a past
history of it. If a patient has no past history, is it justified to
keep him institutionalised forever?
'If we admit him by force, it's too extreme. At the end of the
day, no one would dare seek treatment because by doing so, you
would be deemed dangerous.'
To ensure chronic patients stick to treatment and prevent
relapses, IMH already runs two home-visit programmes, similar to
those in countries like the United States, Australia and
Britain.
Dr Joshua Kua, the chief of IMH's department of geriatric
psychiatry who heads the seniors' home-visit programme, noted: 'The
concept of having patients with mental illnesses going back to the
community, leading as normal a life as possible, is in line with
the international movement of psychiatry.'
The programmes have shown good results - patients have been
re-admitted fewer times, and have stayed for shorter periods when
hospitalised.
Retiree Amos Madina, 62, said of his father, who has dementia
and is on the seniors' home-visit scheme: 'He's so much better now.
He smiles at visitors, watches TV quietly, and doesn't spit and
scream.'
General practitioners (GPs) have been roped in for another
programme that lets stable patients get treated in their own
neighbourhoods, making it more convenient for them. It also reduces
the stigma that some still attach to visiting IMH.
The results so far show that GPs' care is 'not worse than
specialist care', said the programme's director, Dr Nelson Lee.
One GP, Dr Roy Ang, treats about 50 such patients, and has sent
only two back to IMH since joining the scheme in 2006.
'Most of them are very stable and compliant. In fact, they are
more compliant than my other patients with high blood pressure or
high cholesterol,' he said.
A 31-year-old woman who refused to seek medical help for
depression for five years before her mother convinced her to go,
has been well for the last six years.
She switched to seeing a GP in 2005 because she works and finds
it more convenient to see the doctor during weekends.
Her mother, who takes her to her monthly appointments, said: 'I
also make sure she takes her medication every day, as I don't want
her illness to come back.'
This article was first published in The Straits
Times.