SINGAPORE — As someone who has had depression since the age of 15, Raven (who did not want to be identified by her real name) would not have minded staying in a dedicated facility for youth prone to suicide risk or self-harm. This would have provided a respite from home, where she often felt very isolated, exacerbating her depression.
She added that with round-the-clock care and a good in-patient programme provided at such a place, it would have definitely speeded up her recovery as well.
Now 27, she was commenting after it was announced on Thursday (Oct 5) that such a facility catered to the youth is being planned as part of the National Mental Health and Well-being Strategy to improve mental healthcare for various segments of the population here.
Many details are still in the works, but the goal is for this intermediary care centre to serve as a rehabilitation centre where young people may seek refuge, free of stigma, in a safe environment for up to six months.
This is a live-in facility where a team of psychiatrists, psychologists, social workers, live-in staff members and nurses attend to youth with suicide risk who have received primary care, in order to address underlying triggers before they get home.
Raven said that having a home away from home would be really helpful, especially if young people do not have access to other mental healthcare.
However, she and some other young people, as well as mental health practitioners, told TODAY that they do have certain concerns about how such a place would be run and how it will ensure that the patients return to leading a normal life.
WHY IT IS A GOOD IDEA
Mr Ian, 27, who did not want to give his full name and is diagnosed with panic disorder, said that a care facility that promises a safe and stigma-free zone is beneficial for youth to develop some clarity on why they are feeling troubled.
Panic disorder is an anxiety disorder where people regularly have sudden attacks of panic or fear. Even though people can experience general anxiety or panic during stressful moments, people with panic disorder have frequent and unexpected panic attacks and spend long periods in constant fear of another attack.
“I didn’t fully understand what triggered my anxiety as soon as I was diagnosed, so to be in a facility with a team of professionals at the ready to immediately help you with what is troubling you, that would have been very beneficial and insightful,” the freelance creative director added.
He observed that at a young age, people often lack the vocabulary to articulate what they are going through, so to get a grasp on it and develop some understanding of their condition would be useful.
“I know at 20, I didn’t have the verbiage or the understanding of the world to comprehend what was causing me to be suicidal.”
As for 22-year-old Ashely Poo, a polytechnic student who is diagnosed with clinical depression and anxiety, she said: “I think it’s a great initiative for youths to have a safe space, especially when home isn’t one.”
Like Raven, she also said that being at home can be “triggering” because it intensifies feelings of isolation and can exacerbate mental illness.
Raven said: “If it is presented as an easily accessible option for teenagers, I do think it’s a great thing, because seeking avenues for help was something I struggled with as a teenager.”
Dr Jonathan Kuek, a mental health advocate, is co-founder of The Total Wellness Initiative Singapore, which seeks to encourage people to be more proactive with their well-being.
He said that having a facility like this is “a fantastic idea”.
He believes that the concept would be similar to crisis houses overseas, where care is provided in a residential setting instead of an overtly medical one such as a hospital.
They offer intensive, short-term support to help people manage mental health crises.
“A shift to rehabilitation means there can be a greater focus on more well-rounded care that targets the psychosocial and emotional challenges that youths may be facing, instead of a greater focus on managing the risk of harm and symptoms,” Dr Kuek added.
This move away from a hospital setting is vital for young people who might feel intimidated and hesitant to be admitted to one, a counsellor said.
Mr Thum Berfont, a senior rehabilitation counsellor from Anglican Care Centre (Pasir Ris), a non-profit organisation that offers counselling sessions, said: “The mixed profile of patients held in the general ward (in terms of age and diagnosis) could make the environment more challenging for youths who are grappling with acute stressors.”
He also said that being in the mixed environment of a psychiatric hospital with a range of patients consisting of adults undergoing mental health relapses can be intimidating and stressful for younger patients.
“It’s important to recognise that the approach required for managing acute stress reactions differs from the one used for chronic mental health conditions or relapses.”
These sentiments were shared by freelance creative director Ian, who was admitted to the Institute of Mental Health when he was 20, and he described the experience as “overwhelming”.
As a young person having a mental health crisis, facing a new strict daily routine with designated mealtimes as part of his in-patient programme, no access to the outdoors, unfamiliar faces around him, and coping with a new environment can be disorientating.
“I wanted someone to sit me down and take as much time as I needed to really comprehend what I was going through,” he recalled. “I hope that this facility gives space to the young, that they are given the attention they need for the length of time that they require.”
WHAT ARE THE POTENTIAL DOWNSIDES?
Having espoused the good of having an alternative healing space, the interviewees and the experts said that a facility of this sort will still not do much to eradicate the stigma associated with mental health.
It might even draw undue attention to suicide and its associated pains and repercussions, making youth-at-risk even more uncomfortable to step forward and seek help.
“I think it’s a double-edged sword, honestly,” Raven said, “as suicide risk is still a pretty serious issue, so I think having a programme dedicated to just that could be quite alienating since it singles out (those with suicide risk).”
To add to that, Ms Poo said that there is a fear of people finding out that you were admitted to such a facility. She also wondered if a stay in such a place would be reflected on official records and affect employment, for example.
Ms Ling Anne Hsieh, one of the founders of Project Green Ribbon, said that the facility is a “good option” to have but could be seen as a mere band-aid to the root cause of a troubled mind.
Project Green Ribbon is a non-profit organisation that takes in youth in crisis and provides refuge and support for them as they go through a transition and reintegrate into society.
Ms Ling also said: “Most of the time, when (young people) are having such troubles, a lot of it stems from childhood. Much of it stems from broken families, or even intact families but just dysfunctional.”
The focus should be on preventive and early care, she suggested.
Ms Ling believes that it would be hard to run away from the stigma that comes along with having to seek treatment for suicidal leanings, so the facility’s name and positioning must be a “careful” process because “every label that we put will give a certain image”.
Agreeing with Ms Ling, Dr Kuek said: “The devil’s in the details when it comes to execution.”
He added: “There is a real possibility that despite the best efforts of the facility, the root causes of (what the person is dealing with) may not be solved through their stay, and a strong continuity and community of care is necessary as well.
“If this is not done well and intentionally, it may lose its potential effectiveness.”
WHAT ELSE NEEDS TO BE CONSIDERED
Most of the interviewees brought up the matter of the healthcare costs of staying at such a care centre.
“Even for working adults, affording mental healthcare can be too costly, so I do hope it’s a programme that’s heavily subsidised or even free for teenagers,” Raven said.
Furthermore, it is unclear now how the stay would work around school and studies such that the residents do not fall too far behind the curriculum.
And looking at the capacity of the facility, Dr Kuek foresees that there will almost certainly be more people needing admission than there are spaces available, especially given that it will be the first of its kind.
“Identifying and selecting who gets to be placed in it will be tricky, and what happens after they leave will be an issue,” he said.
This is because, despite best efforts, the source of mental distress may not be solved through their stay.
Equal emphasis needs to be placed on the continuity of care after their stint at the facility, be it follow-ups from counsellors or community services. Dr Kuek warned, though, that this might then weigh heavy on manpower resources.
“With all these questions and concerns taken together, it is uncertain how many youths will be able to benefit from such an approach given its proposed initial scale,” he added.