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Mental health
- Thread starter LITTLEREDDOT
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Quote: "The 16-year-old was previously a patient at the Institute of Mental Health when he was a Sec 2 student as he had attempted to commit suicide."
Too much pressure at a top school?
River Valley High School death: Sec 4 student charged with murder; to be remanded for psychiatric assessment
By LOW YOUJIN
Published JULY 20, 2021
Raj Nadarajan / TODAY
Court documents said that the boy was allegedly killed between 11.16am and 11.45am at a level four toilet found within the school.
While it was not stated how the boy died, the police said on Monday that they had seized an axe as a case exhibit.
The 16-year-old, who is represented by Mr Peter Keith Fernando of the Leo Fernando Advocates & Solicitors law firm, will be remanded for psychiatric assessment and will return to court on Aug 10.
He attended the court hearing on Tuesday via a video link from remand. He was emotionless during the proceedings, and appeared tired and dishevelled.
His parents were not present during the hearing.
A police prosecutor said the 16-year-old was previously a patient at the Institute of Mental Health when he was a Sec 2 student as he had attempted to commit suicide.
Under the Children and Young Persons Act, which covers young persons under the age of 18, neither of the boys can be named.
The police had said in a statement on Monday that early investigations showed that the two boys did not know each other.
The had received a call for help at 6 Boon Lay Avenue, the address of River Valley High School, at about 11.40am on Monday.
When the officers arrived, they found the 13-year-old Singaporean boy lying motionless in a toilet at the school.
Murder, punishable under Section 302(1) of the Penal Code, typically carries the death penalty in Singapore.
However, offenders below 18 will be sentenced to life imprisonment instead, based on the Criminal Procedure Code.
Police investigations are underway.
ABOUT THE CASE
On Monday, the school said in a statement on the Ministry of Education's Parents' Gateway portal that a “serious incident” involving a Sec 1 student had taken place and that a Sec 4 male student was assisting in police investigations.
The school also urged parents not to speculate on the incident or post anything on social media.
When TODAY visited the school at around 3.20pm, several police cars and police officers were at the scene.
Photographs circulating on social media also showed ambulances at the school.
Some parents had turned up at the school in the afternoon, following the message on the portal, media reports and messages circulating on WhatsApp about the incident.
Students were also seen being released at about 3.30pm, after they were kept indoors for their safety.
They were ushered by school staff members and not allowed to speak to the media.
In a Facebook post on Monday afternoon, Education Minister Chan Chun Sing said that MOE is working closely with the police on the investigations and the police will share more details in due course.
At about 6.30pm, Mr Chan was seen at the school. He told the media that he had spoken to the principals, teachers and some students during his visit there.
He repeated the assurances made earlier in his Facebook post and appealed to the public not to speculate on the reasons and respect the affected families’ privacy. He did not take any questions from the media.
Too much pressure at a top school?
River Valley High School death: Sec 4 student charged with murder; to be remanded for psychiatric assessment
By LOW YOUJIN
Published JULY 20, 2021
Raj Nadarajan / TODAY
- Students of River Valley High School leaving the premises after Monday's incident.
- Follow us on Instagram and join our Telegram channel for the latest updates.
Court documents said that the boy was allegedly killed between 11.16am and 11.45am at a level four toilet found within the school.
While it was not stated how the boy died, the police said on Monday that they had seized an axe as a case exhibit.
The 16-year-old, who is represented by Mr Peter Keith Fernando of the Leo Fernando Advocates & Solicitors law firm, will be remanded for psychiatric assessment and will return to court on Aug 10.
He attended the court hearing on Tuesday via a video link from remand. He was emotionless during the proceedings, and appeared tired and dishevelled.
His parents were not present during the hearing.
A police prosecutor said the 16-year-old was previously a patient at the Institute of Mental Health when he was a Sec 2 student as he had attempted to commit suicide.
Under the Children and Young Persons Act, which covers young persons under the age of 18, neither of the boys can be named.
The police had said in a statement on Monday that early investigations showed that the two boys did not know each other.
The had received a call for help at 6 Boon Lay Avenue, the address of River Valley High School, at about 11.40am on Monday.
When the officers arrived, they found the 13-year-old Singaporean boy lying motionless in a toilet at the school.
Murder, punishable under Section 302(1) of the Penal Code, typically carries the death penalty in Singapore.
However, offenders below 18 will be sentenced to life imprisonment instead, based on the Criminal Procedure Code.
Police investigations are underway.
ABOUT THE CASE
On Monday, the school said in a statement on the Ministry of Education's Parents' Gateway portal that a “serious incident” involving a Sec 1 student had taken place and that a Sec 4 male student was assisting in police investigations.
The school also urged parents not to speculate on the incident or post anything on social media.
When TODAY visited the school at around 3.20pm, several police cars and police officers were at the scene.
Photographs circulating on social media also showed ambulances at the school.
Some parents had turned up at the school in the afternoon, following the message on the portal, media reports and messages circulating on WhatsApp about the incident.
Students were also seen being released at about 3.30pm, after they were kept indoors for their safety.
They were ushered by school staff members and not allowed to speak to the media.
In a Facebook post on Monday afternoon, Education Minister Chan Chun Sing said that MOE is working closely with the police on the investigations and the police will share more details in due course.
At about 6.30pm, Mr Chan was seen at the school. He told the media that he had spoken to the principals, teachers and some students during his visit there.
He repeated the assurances made earlier in his Facebook post and appealed to the public not to speculate on the reasons and respect the affected families’ privacy. He did not take any questions from the media.
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Man tasered, arrested after allegedly throwing chairs at coffee shop patrons, charging at cop near Lavender MRT
The man allegedly behaved aggressively towards police officers and people around him. PHOTOS: SCREENGRAB FROM DZAR ISMAIL/FACEBOOK
Ang Qing
JUL 17, 2021
SINGAPORE - A 41-year-old man was subdued using tasers and arrested by the police on Friday afternoon (July 16) after allegedly challenging officers to a fight at a coffee shop near Lavender MRT station.
The man had allegedly thrown chairs in the direction of other patrons at the coffee shop before the police arrived.
The police said on Friday night that they were alerted at around 1.50pm to a case of a man who had turned hostile towards paramedics and members of the public who were attending to him after he fell at a coffee shop at Block 802 French Road.
The man allegedly continued to behave aggressively towards police officers who arrived on the scene and people around him.
Said the police: "Despite repeated reminders to the man to comply with officers' instructions, the man allegedly challenged the officers to a fight and charged towards officers."
A video of the incident on Facebook shows the shirtless man shouting as he advances towards a police officer, who fends him off with a baton.
Another video on social media shows another officer firing a taser at the man, who is not wearing a mask, from behind.
The first officer then tasers the man as well, causing the man to slump against a food stall's counter and slide to the ground.
He was arrested for voluntarily causing hurt to deter a public servant from his duty, public nuisance, suspected drug-related offences and theft in dwelling. The man was allegedly involved in a case of theft at a pharmacy near the coffee shop.
The police said in their statement that they take into consideration multiple factors, including the safety of the target, before deciding whether to apply force.
"The police have zero tolerance towards acts of violence against public officers performing their duty and offenders will be dealt with firmly," they added.
Those convicted of voluntarily causing hurt to deter a public servant from discharging his duty can be jailed for up to seven years, and fined or caned.
The offence of public nuisance carries a fine of up to $2,000.If found guilty of theft in dwelling, the man can be jailed for up to seven years and fined.
Police investigations are ongoing.
20 years' jail for man behind chopper rampage in office
Warehouse worker hacked one boss to death, severely injured another, threatened a third
Yee Jing Man joined e-commerce company Jiji in March 2017, but from September 2018 his performance started to deteriorate. By February 2019, he began to visualise killing the company's three directors with a chopper. He decided to carry out his plan on March 11, 2019, when he was told he did not have to go back to work.PHOTO: SHIN MIN DAILY NEWS READER
Selina Lum
Law Correspondent
JUN 10, 2021
After he was fired from his job, a warehouse worker at an online retailer slashed two directors with a chopper - killing one and grievously hurting the other.
Yee Jing Man spared a third director but ordered him to eat a red packet containing $20 that the man had given him for Chinese New Year.
He barricaded the office and pointed the chopper and a knife at his colleagues to stop them from calling the police, before he stabbed and slashed himself.
The 24-year-old Malaysian was sentenced to 20 years' jail yesterday for the attack on March 11, 2019, at the office of e-commerce company Jiji in Sungei Kadut Loop.
He pleaded guilty to one count of culpable homicide for killing Mr Lin Xinjie, 29, and causing grievous hurt with a dangerous weapon by slashing Mr Li Mingqiao, 30.
Eight other charges were taken into consideration, including one of criminal intimidation for threatening the third director, Mr Ryan Pan Zai Xing, 29, and four of wrongful confinement.
After his arrest, Yee was assessed to be suffering from major depressive disorder, which significantly reduced his responsibility for his actions. The High Court heard that he started working for the company in March 2017, after his girlfriend, who was an employee, recommended him to Mr Lin.
Yee initially performed well at work. Mr Lin gave him a red packet with $999 for Chinese New Year in 2018, and offered to promote him to warehouse manager with a rise in salary from $1,700 to $2,000.
Yee rejected the offer as he did not want the additional workload and stress, the court heard.
From September 2018, his performance deteriorated. Court documents state that he was absent for 69 days starting from Dec 1, 2017. He felt that Mr Lin had scolded him unreasonably and that Mr Li was sarcastic to him.
By February 2019, Yee began to visualise killing the directors with a chopper, especially Mr Lin and Mr Li. He had a better relationship with Mr Pan, who helped him with his work, said prosecutors.
Yee decided he would take his own life after killing the trio. He did not want to be a fugitive and felt there was no purpose to life if he had to worry about work.
On Feb 12, 2019, after his girlfriend told him that Mr Lin wanted to fire him, Yee bought a chopper. But he changed his mind about killing Mr Lin.
Yee then took the rest of the month off and spent his time at home playing mobile games and searching online for ways to kill people efficiently. He returned to work on March 1, 2019, but stopped showing up by March 6.
On March 11, his girlfriend forwarded him a message from Mr Pan saying that Yee no longer needed to come to work. He decided to carry out his plan to attack the trio and headed for the office. At about 12.55pm, Yee walked to Mr Li, who was at his desk, and slashed his head and neck from the back. Yee swung the chopper at Mr Lin, slashing the back of his head, neck, right forearm and right index finger.
He threatened Mr Pan with the chopper and the director complied with Yee's demand to put the red packet in his mouth. One of the employees called the police.
Yee stabbed himself in the abdomen and slashed his wrist, uttering "I have no other way to go". Police arrived at about 1.05pm and restrained him after a struggle.
Mr Lin was pronounced dead at the scene by paramedics. Mr Li underwent emergency surgery and was discharged on March 16. He suffered significant scarring and still attends physiotherapy.
Care groups see spike in mental health crises in Singapore amid heightened alert curbs
The speed at which heightened alert measures came into effect made the situation difficult for many.PHOTO: ST FILE
Ng Wei Kai, Jessie Lim and Baey Zo-Er
JUN 15, 2021,
SINGAPORE - Calls to the Samaritans of Singapore's (SOS) mental health helpline spiked 40 per cent on May 16, the day Singapore started heightened alert restrictions.
Following the announcement of restrictions on May 4, SOS experienced a 12 per cent increase in the volume of calls that week compared with the week before, SOS chief executive Gasper Tan told The Straits Times (ST).
Seven out of 10 mental health organisations and professionals ST spoke to saw spikes of between 20 per cent and 60 per cent in queries and incidents like mental health crises because of the Covid-19 pandemic and the social restrictions that have been used to contain the virus' spread.
Those increased restrictions and the subsequent loss of support from outside the home compounded stress factors such as fears about the virus, difficult living situations, and fears about job loss and the future, say social workers.
Caregivers Alliance Limited (CAL), a non-profit organisation that helps the caregivers of those with mental health issues, said that it saw a "disturbing increase" in attempted and completed suicides between May last year and April this year among people being cared for.
CAL's head of communications, Ms Tricia Lee, said: "We have seen a rise in crisis cases as the mental health appointments or daycare programmes of caregivers' loved ones were halted. The social restrictions in some cases caused rising tension within families, increasing the risk of relapse (into a mental health crisis)."
Many students also found home-based learning stressful and missed the social interactions of schooling, support organisations said.
Mr Cho Ming Xiu, founder and executive director of Campus PSY, a mental health organisation for youth, said that it has seen a 40 per cent increase in the number of young people seeking emotional support via e-mail, and a 20 per cent to 30 per cent increase across various social media platforms.
Despite Singapore's experience with the circuit breaker last year, the speed at which heightened alert measures came into effect made the situation difficult for many.
"With the sudden limitations of movement, many of our callers found themselves struggling to adjust and adapt to the newly implemented restrictions," said SOS' Mr Tan.
"Many had to cancel their plans and return to working from home or home-based learning arrangements, which contribute to a state of loss and helplessness.
"The accumulation of these stressors may be overwhelming and with no one to speak to, they reach out to SOS."
However, the experience of last year's circuit breaker helped some organisations prepare for the sudden onset of restrictions, which included a ban on dining in eateries and reduced group sizes for social meetings from five to two.
To meet the intensified need for support, CAL has increased its number of helplines from one to six since April last year, as well as the frequency of its Caregivers-to-Caregivers programmes. These programmes provide fully funded training and support to caregivers of people with mental health issues, such as dementia.
Silver Ribbon Singapore, a charity that provides free counselling services, said it saw a 20 per cent increase in calls, but social worker Phay Yan Deng, 29, said the organisation was more prepared to provide support online this time round.The senior clinical executive said that during the circuit breaker period, it was "initially slightly overwhelmed as many things were quite new to us".
"In the past, we provided emotional support only face to face", whereas most of its work, from referral to actual sessions, is now done online, he said.
However, while organisations may be better prepared, Silver Ribbon's executive director, Ms Porsche Poh, said it is not helpful to assume that people should be able to cope with heightened alert restrictions just because they have been through it before.
"They might have limited social support, or face a new set of challenges during this phase," she said.
Helplines
National Care Hotline: 1800-202-6868Institute of Mental Health's Mental Health Helpline: 6389-2222
Samaritans of Singapore: 1800-221-4444
Touchline: 1800-377-2252
Care Corner Counselling Centre: 6353-1180
452 suicides reported in Singapore in 2020 amid Covid-19, highest since 2012
Non-profit suicide prevention centre Samaritans of Singapore said that the increase in suicide deaths was observed across all age groups.ST PHOTO: KELVIN CHNG
Ng Keng Gene
JUL 8, 2021
SINGAPORE - A total of 452 suicides were reported in Singapore last year, the highest figure since 2012.
In a statement on Thursday (July 8), non-profit suicide prevention centre Samaritans of Singapore (SOS) said this was a 13 per cent increase from 2019's 400 cases.
It added that the increase in suicide deaths was observed across all age groups. In particular, the number of suicide deaths among the elderly - aged 60 and above - hit 154, the highest recorded figure among this age group since 1991 and a 26 per cent increase from 2019.
SOS chief executive Gasper Tan said: "Covid-19 has severely affected the nation's economy, lifestyle and mental health. We are extremely worried about how our elderly are coping during this public health crisis.
"During the pandemic period, the elderly were more likely to face social isolation and financial worries. Difficulty in constantly adapting to changes as well as prolonged feelings of loneliness may be devastating."
While there was an increase in suicide deaths among the elderly in 2020 compared with 2019, SOS said its 24-hour hotline received fewer calls from them.
In its 2020 financial year from April 2020 to March 2021, 4,455 calls were made by the elderly, compared with 4,816 in the 2019 financial year.
SOS added that elderly callers expressed difficulty coping with loneliness and inactivity due to isolation, psychological distress, and impaired social and family relationships - which were compounded by the pandemic.
The Institute of Mental Health's clinical director in the Office of Population Health, Adjunct Associate Professor Lee Cheng, said that the elderly who are living alone may lack support to deal with the pandemic.
"Those who are used to attending social activities outside on a regular basis will also likely feel socially isolated during this period," he added.
Said SOS' Mr Tan: "Since the pandemic, many in-person activities and initiatives for the elderly have moved digitally. Those with limited proficiency with technology may find themselves lost and helpless.
He added that given the uncertainty of how long more the pandemic will last, it is important to build on existing efforts and find new ways to support the mental health of the elderly.
Singapore University of Social Sciences' Associate Professor Helen Ko said it was important to find as many ways as possible to connect with the elderly who are lonely and socially isolated."Very often, most elderly persons want to hear a human voice and they long to hear the familiar voice of a loved one," she said.
"For those who are not digitally savvy, please be very patient as they may need more time to pick up digital skills."
From July 26, those who need emotional support may call SOS at its new four-digit hotline at 1-767. SOS said the shortened hotline will help make seeking help more convenient.
The old hotline number, 1800-221-4444, will remain operational even after the four-digit hotline is launched, and both numbers will be toll-free.
Helplines
Samaritans of Singapore: 1-767 (24 hours)Institute of Mental Health: 6389-2222 (24 hours)
Singapore Association for Mental Health: 1800 283-7019 (Mon to Fri, 9am to 6pm)
TOUCHline: 1800 377-2252 (Mon to Fri, 9am to 6pm)
Care Corner (Mandarin hotline): 1800-3535-800 (Daily, 10am to 10pm)
New mental health service launched to help young people cope amid Covid-19 pandemic
The service ResiL!ence aims to raise awareness of mental health issues among youth.ST PHOTO: KUA CHEE SIONG
Goh Ruoxue
JUL 17, 2021
SINGAPORE - Ms Danielle Grace Tan was 16 when she had her first panic attack, in the midst of studying for her O-level examinations.
However, conventional wisdom then was that young people do not require professional help, and three years went by before she finally got help.
She was eventually diagnosed with anxiety and depression.
When Ms Tan, now 25, heard last year about how a local charity had set up a team to help young people cope with mental health issues, she got in touch and signed up as a volunteer, as the aim of the unit resonated with her.
Shine Children and Youth Services' new youth community outreach team ResiL!ence began in October last year and was officially launched on Saturday (July 17), alongside Shine's new campaign, "It's the Mental Health for Me".
ResiL!ence aims to raise awareness of mental health issues among youth, promote early identification, facilitate the help-seeking process, and involve parents and peers in young people's recovery.
Mr Eric Sng, who heads the team, told The Straits Times that when the team started nine months ago, it realised that the need for such services was greater than what they imagined.
He said: "Because of the pandemic, some young people have become more socially isolated and reserved."
Many of their coping methods such as spending time with friends in person or engaging in interest-based activities, which may be therapeutic, are now compromised.
"They may feel alone and not know where to seek help," he said.
This is where outfits such as ResiL!ence can help.
The team offers services such as mental health screening, basic emotional support, the forming of interest groups for those aged between 12 and 25, as well as caregiver support for young people's caregivers.
Parliamentary Secretary for Culture, Community and Youth and Social and Family Development Eric Chua was the guest of honour at the launch held over Zoom.
In his opening remarks, he said: "Community-based programmes such as ResiL!ence, by Shine, are also key to our outreach to youths - they provide mental health services and encourage help-seeking behaviour while building mental resilience.
"We want to be an inclusive society where mental health is no longer stigmatised and help-seeking is normalised."
Ms Tan, a film-maker, said she is thankful that such a programme exists for youth today.
She said: "As I was growing up, I also wished that there were some of these services and resources available. It definitely would have helped with my struggles."
The virtual launch saw more than 170 participants, including social and youth workers, counsellors, school leaders, as well as young people and their caregivers.The campaign launch was followed by a virtual panel discussion about how a culture for youth to feel safe in seeking help for mental distress can be created.
Mr Chua said during the panel discussion that more can be done to support existing efforts to mitigate the impact of mental health conditions in the community such as the Community Health Assessment Team, a national outreach and mental health check programme under the Institute of Mental Health.
"There's plenty to be done, in terms of resources, the organisation of these resources, and having them better organised, so that the whole process of seeking out information and resources itself is not causing stress to the person who is seeking out help," he said.
Those interested can visit ResiL!ence's website, its Instagram page, and its Facebook page, for more information.
What a young patient with schizophrenia taught me about limits
When mental illness cannot be treated with medication or therapy, that is where kindness and compassion should step in
Chong Siow Ann
ST ILLUSTRATION: MIEL
AUG 13, 2019
When Mr L was in his 20s and studying for a business administration degree in an American university, he would observe certain strange happenings.
Sometimes, the books in his room would seem to be out of their usual places and the water had an unfamiliar bitter taste to it. The two students with whom he shared the apartment started leaving coded messages to each other in the different ways they arranged their books and notes on the dining table. Such little signs multiplied and became sinister portents.
Mr L was convinced that his housemates were trying to murder him by poisoning his drinking water, which had already addled his mind. This was why he found his thoughts getting increasingly muddled. And there was this voice that kept warning him of this, and of other webs of conspiracy that were closing in on him.
He stopped attending classes and withdrew into his room, emerging only late in the night for his meals. His paranoia and fear culminated in an assault on housemates late one evening. Bloodied, they managed to escape and called the police.
Mr L was later committed to a mental facility, where he was diagnosed to have paranoid schizophrenia. After months of treatment, his paranoia settled but he continued to have auditory hallucinations, though of a less frightening nature. His parents and sister flew to the United States and brought him back to Singapore.
In the subsequent years, he remained cloistered in the family house, at times wandering late at night, to the constant worry of his family. He didn't think he had an illness, but would passively take whatever medications he was told to take, despite having some bad side effects in the past.
Schizophrenia is one of the most severe mental illnesses. The author and professor of clinical psychology Andrew Solomon described schizophrenia in his 2012 book, Far From The Tree, as "an illness not of accrual but of replacement and deletion; rather than obscuring the previously known person, this disease to some degree eliminates the person".
The symptoms are varied and include hallucinations and delusions, which are known as positive symptoms; as well as negative symptoms which include profound loss of motivation, withdrawal and cognitive impairment such as difficulty in abstract thinking and concentration.
About a fifth of patients with schizophrenia show little or no therapeutic response, and Mr L is one such patient.
In the subsequent years of treatment, he was prescribed a wide range of antipsychotics - in increasing doses, in various forms and combinations, and augmented with other medications.
But none resulted in any significant resolution of his psychosis, and even after a few trials of electroconvulsive therapy, the symptoms remain recalcitrant.
Psychotherapy was tried, but he abandoned it. The numerous hospitalisations and months of inpatient rehabilitation did not bring about any significant improvement. His care team and family members felt that we were at the end of the road.
As with the rest of the medical specialities, the primary goal of psychiatry is to get our patients well and back on their feet, and on with their lives. But mental illnesses are intricately complex conditions with multiple causes interacting with one another in an unclear manner.
We have but rudimentary knowledge of the biological substrates of human thoughts and emotions. And we might never know all the murky secrets of childhood sexual and physical abuse, emotional neglect, parental losses, bullying and deprivation, and their terrible implications for mental health.
As psychiatrists, we often have to grapple with this sense of incompleteness - of the scientific understanding of the range of mental illnesses that confront us, of the areas of darkness within our patients and of what it takes to fully help them.
And we are so often reminded of this inadequacy by the substantial number of patients - those with chronic schizophrenia, resistant depression, debilitating obsessive-compulsive disorder, personality disorder with persistent self-harm, and severe anorexia nervosa - whose illnesses have remained intractably unremitting, despite our best efforts.
PALLIATIVE PSYCHIATRY
In other fields such as oncology, when doctors are faced with patients with end-stage cancer, this would have been the time to have a conversation about prognosis; about switching from a curative to a palliative approach, with its intent of reducing suffering, controlling pain and salvaging some reasonable quality of life until the imminent end.In line with this, there have been calls in recent years to adopt what is called "palliative psychiatry", with a therapeutic philosophy that explicitly acknowledges the limits of what can be done for those with severe persistent mental illness and eschewing more heroic attempts. The focus is on supporting the patient and family, reducing the harm that may come from aggressive treatment, but neither seeking to hasten nor to postpone death.
There are already a few case reports in the scientific literature where such a palliative approach was taken for patients with extreme anorexia nervosa. In their relentless pursuit of an unattainable ideal of thinness, they would starve themselves to death, which could be staved off only by forcing hospitalisation and feeding. This repetitive, seemingly endless life-and-death tussle with the medical team could easily be seen to be tiring and futile.
An article in the International Journal of Eating Disorders gave an account of a 30-year-old woman with chronic anorexia nervosa. After years of unsuccessful treatment, a clinical decision was made to forgo repeat hospitalisations, with their cycles of "forceful, intrusive, autonomy-depriving yet physical-life types of medical interventions" that she, the patient, experienced as personally unacceptable. She subsequently died - reportedly with the treatment team by her side.
COMPETENCE AND EGO
Imagining that deathbed scene is hard and uncomfortable. Most psychiatrists would baulk at the notion that there is ever a fatal mental illness, and that we could stand by and see a patient die before our eyes. Often, in the absence of certainty and persistence of suffering, patients and their families would want us to continue to push and not give up.And so we continue to push. We are ready to run through that armament of medications and procedures to find something that works. We might even be prepared to push medications over the limits of their recommended doses and beyond what the textbooks, evidence and treatment guidelines tell us. We will try whatever psychological and social interventions we can think of.
As doctors, we hew to that fundamental principle of assuming responsibility to restore the well-being of the patients under our charge, and we will use whatever effective means are available to do so. If there is none available, we will still think of something.
MIXED MOTIVES TO PUSH ON
The truth is that when we face conflict about what should be the right and best actions to take in such conundrums, we act out of a mixture of motivations.The first is the urge to help and relieve suffering, which is what we should do as doctors.
The second is possibly less noble and less obvious. It, too, has to do with our identity as doctors, tied to a hard-earned sense of competence and ability to solve difficult clinical problems.
We don't like to be confounded by a problem we cannot solve. It is an affront to our sense of competence, and so a decision to push on to continue treatment can too easily be driven more by ego than by a desire to relieve the patient's distress, or simply by a wish to do what is best for the patient. Such an urge can lead doctors to pursue aggressive treatment, with the risk of causing more harm to the patient.
In such situations, doctors should pause, rein in our feelings, temper our impulses, think of the patient and perhaps take heed of Sigmund Freud's modest expectation of the goal of treatment: to transform a patient's "hysterical misery" into "common unhappiness".
Having run out of ideas as to what else I could do to improve Mr L's symptoms and functioning, I admitted as much to him and his family, and suggested that they seek a second opinion.
But they chose not to do so. And so, together, we decided to just try to keep things on an even keel and to ensure that he stays as physically healthy as possible. He is still symptomatic and unable to work, but he is at least free of any side effects and has not been hospitalised for years. I continue to see him and his family on a regular basis and assure them that if anything untoward crops up, we will deal with it together.
Medicine, with all its stupendous and dazzling advances, will continue to have its limits. But there is always room - indeed, a need - for concern, kindness and compassion for us to fall back on when that limit is reached.
•Professor Chong Siow Ann, a psychiatrist, is vice-chairman of the medical board (research) at the Institute of Mental Health.
How achievement-oriented parents and schools stress out kids
Studies on the impact of school lockdowns on students unveiled interesting insights into the stress levels of teens, especially those with high-achieving parents
Emily Esfahani Smith
Studies on the impact of school lockdowns on students unveiled interesting insights into the stress levels of teens, especially those with high-achieving parents.PHOTO: REUTERS
MAY 7, 2021
(NYTIMES) When schools shut down last spring, Carson Roubison, a charter school student in Phoenix, Arizona, was initially relieved. There were some difficulties in those early days at home - when classes went online, Carson and his parents, both public school teachers, had to share the sole family computer. But Carson's stress levels fell as school became less demanding during the transition to distance learning.
"I wasn't aware of the giant impact the pandemic would have," he said, "so I was excited, to be honest, to have some time off school." But things changed in autumn. The academic load went back to pre-pandemic levels even though learning was still remote. Carson, a senior, struggled to stay motivated. His mental health suffered. He hoped to attend community college the following autumn, but grew increasingly "terrified" that the education he'd received in high school over the past year would leave him unprepared.
"I'm afraid I'm going to get to community college," he said, "and be held to the same standards as past students, and fail. That's the biggest source of my anxiety."
Carson's story is not unique. The coronavirus pandemic has taken a toll on the mental health of millions. But adolescents have been hit especially hard. According to a national poll in the United States conducted in January by the University of Michigan's C. S. Mott Children's Hospital, 46 per cent of parents say their teenagers' mental health has worsened during the pandemic. More alarmingly, a report by the US Centres for Disease Control and Prevention found that the proportion of 12- to 17-year-olds visiting emergency rooms for mental health reasons rose 31 per cent for most of last year compared with 2019. And this is all on top of an already existing mental health crisis among young people.
While many experts believe that the reason adolescents are struggling today is that they're away from friends and school, a closer look at the research reveals a more complicated picture.
According to psychologists who study adolescent resilience, one of the biggest threats to the well-being of today's teenagers is not social isolation but something else - the pressure to achieve, which has intensified over the past year.
Psychologists define resilience as the ability to adapt well to stress. For decades, they have studied why some children are more resilient in adversity than others. Dr Suniya Luthar, emerita professor of psychology at Columbia University's Teachers College and a leading resilience researcher, believes the pandemic is a "natural experiment" that can help answer that question: When you expose adolescents to an event that changes their lives significantly, how do they cope?
Dr Luthar began her career studying resilience among urban youth living in poverty in Connecticut in the 1990s. At the urging of one of her students at Yale University, where she was teaching, she also started studying teenagers living in middle- and upper middle-class suburbs like Westport, Connecticut, where many of the parents are high-achieving professionals who emphasise the value of status and achievement to their children.
Comparing these students with the poor, urban adolescents, she was shocked to discover that the suburban children were doing worse on drug and alcohol abuse. They also had higher rates of anxiety and depression compared with national norms. Researchers knew that social conditions were important determinants of resilience, but they hadn't known that living in success-oriented cultures was a risk factor.
In the years since, Dr Luthar and her colleagues at Authentic Connections, a research group that works to foster resilience in school communities, have studied tens of thousands of teenagers attending "high-achieving schools", which she defines as public and private institutions where students on average score in the top third on standardised tests. The students in these samples come from a variety of racial, regional and socioeconomic backgrounds.
In one group of students Dr Luthar studied, for example, one-third were members of ethnic and racial minorities and one-quarter came from homes where at least one parent did not attend college.
But regardless of these differences, many of them were struggling in the same way. In a paper published last year in the academic journal American Psychologist, Dr Luthar and her colleagues - psychological researchers Nina Kumar and Nicole Zillmer - reviewed three decades' worth of research findings showing that adolescents at high-achieving schools suffer from symptoms of clinical depression and anxiety at rates three to seven times higher than national norms for children their age.
What's driving their misery, the research shows, is the pressure to excel in multiple academic and extracurricular pursuits. The National Academies of Sciences, Engineering, and Medicine and the Robert Wood Johnson Foundation suggest children living in an achievement-oriented culture are at risk of adjustment problems, like those facing more predictable forms of adversity, such as poverty and trauma.
The pandemic offered a rare reprieve for students - at first. Since 2019, Dr Luthar and her colleagues have surveyed thousands of adolescents each year at public and private schools across the nation. Replicating findings of earlier research, these students reported suffering from anxiety and depression at higher rates than national norms before the pandemic.
But when schools closed last spring, something unexpected happened - the well-being of these students actually improved. As classes and exams were cancelled, grading moved to pass/fail and extracurricular activity ceased, they reported lower levels of stress, anxiety and depression compared with 2019.
But these improvements were short-lived. Dr Luthar and her colleagues found that, beginning in autumn last year, as school work was ramped back up, the mental health of adolescents returned to pre-pandemic levels or worse. According to research that will be published in Social Policy Report, a quarterly publication of the Society for Research in Child Development, the strongest predictor of depression among these students was perceived parental criticism and unreachable standards."Even though I'm trying my best, it never really goes the way I wished," a student Dr Luthar studied wrote, "and my mother adds stress because she is always saying that I need to have a 90 or higher averages in all my classes."
Other research supports these findings. In a nationally representative study conducted by NBC News and Challenge Success, a nonprofit affiliated with Stanford University's education school, researchers studied more than 10,000 high school students in autumn last year. Comparing the experience of these students with about 65,000 adolescents surveyed between 2018 and February last year, these researchers, too, found that many students reported feeling more stressed about school during autumn last year than before the pandemic. A chief cause of their stress: the pressure to achieve.
Nearly half of all students reported that the pressure to do well in school had increased since 2019, and more than half said their school-related stress overall had risen. Grades, workload, time management, lack of sleep and college fears were the most commonly cited sources of stress.
These findings held across socioeconomically diverse schools. At under-resourced schools, students were more likely to report being stressed about family finances, according to Dr Denise Pope, a founder of Challenge Success, but the top stressors were still grades, assessments and college.
"My school is giving too much work," a 10th-grader in this study wrote, "even though times are tough for everyone. At first, this was just a break from school, but now all I feel is stress, anxiety, and pain."Parents appear to play a big role in this phenomenon. Fifty-seven per cent of students said that their parents' expectations for their performance stayed the same during the pandemic, while 34 per cent said their expectations increased. The stereotype of the adolescent aloof from parental influence doesn't seem to apply to these students, who report feeling more stressed about family pressure than peer pressure.
When Dr Pope asks parents to define success, they inevitably say that they want their children to be happy and healthy, have loving relationships and give back to society. But when she asks children how they define success, many describe a narrow path: getting good grades, going to college and securing a high-paying job.
Dr Pope believes the gap is due in part to how parents praise their children. Many parents reward their children when they perform well, which sends a signal to them that the approval and love of their parents depends on how much they're achieving. So, inevitably, if they believe they are falling short of their parents' expectations, their sense of worth and well-being suffers.
Larger cultural forces are also pushing students to define success narrowly. As inequality rises and two major recessions in the past decade have left millions out of work, many students may feel compelled to climb the ladder to ensure their economic security as adults. College admissions at top-tiered schools have become more selective over the same period of time, leaving students competing harder for fewer spots - only to receive an education that will likely leave them or their parents in debt for many years to come.
If we want more resilient children coming out of the pandemic, then we need to heed a lesson of this past year - that the pressure to achieve is crushing the spirits of many young people and should be dialled back.
Parents can play a vital role here. They can help ease their children's anxiety by reminding them that where they attend college will not make or break them - and that getting Bs does not equal failure.They can encourage them to prioritise their health and well-being by getting enough sleep and making time for play and leisure. And, above all, they can teach their children that loss is an inevitable part of life by speaking to them about the grief of the past year.
This doesn't mean parents should necessarily lower their standards. But they might emphasise different benchmarks for achievement, like those they themselves claim to most value for their children - happiness, health and love.
• Emily Esfahani Smith is the author of The Power Of Meaning: Finding Fulfillment In A World Obsessed With Happiness.
These days I see schoolkids leaving school at around 3pm, and that's the 'norm'. I sometimes wonder what they're doing in school which necessitates spending such long hours there?
Let the kids have some free time before they hit adulthood.
let the kids play rugby, football or catch spiders, they wont have time to become wackos
our society too docile and smart for its own good....too timid and not streetwise, thats why the locals are all taken for a ride by CECAs and tiongs in business or work
a little bit of problem want to kill themselves
old fart still think he the smartest, got fucked in suchou but act tough in spore
You can have a wholesome date with her at the playground. Play on the slide, ride on the swing.
There are cases of mental problem that no medicines can cure and the only way to end is death KNN my uncle came across this kind of case and Very Kind Lady @ginfreely also belongs to this category KNN
this should be IMH theme song
This condition afflicts 61% of the population.
I do not believe Michelle Lai enjoys Hiking.
Good thing all stay highrise.
Instead of being used as a puppet to be a champion of women's rights, gender equality, Malay community, labour unions etc, Halimah should step forward and be a champion of mental health.
Society imposes high expectations on the young, particularly on those who seem to be doing well academically.PHOTO: ST FILE
Goh Yan Han
July 23, 2021
SINGAPORE - Parents, schools and society are ill equipped to deal with young people who are struggling with mental health issues, said President Halimah Yacob in a Facebook post on Friday (July 23), as she called for more to be done to support and understand the youth.
She noted that the impact of mental illness when the onset is at a very young age is usually a lot more severe than when someone gets it much later in life.
Her post comes after the alleged murder of a 13-year-old boy by a 16-year-old boy at River Valley High School on Monday.
It was revealed in court that the 16-year-old had been referred to the Institute of Mental Health two years ago because of a suicide attempt.
Said Madam Halimah: "Attempted suicides are a real cry for help. We don't know the full details, particularly whether he had continued to receive psychiatric help or medication in order to deal with his mental health after that episode.
"We also don't know whether it was due to school or there are other factors affecting him as the causes of mental breakdowns are numerous and sometimes there are more than one factor at play."
She added: "We do know however that parents, schools and our society are ill equipped to deal with this situation."
For parents, the great difficulty is in not knowing whether the child is perhaps going through a growth phase, as "all adolescents with growth hormones raging through their bodies sometimes act out", or whether it is because of something much deeper, she said.
For teachers, already overloaded with work, it is not possible to delve deeply into the issues affecting one child, which will require close monitoring, observation and engagement, said Madam Halimah, noting that there are school counsellors but they may not be well trained on issues affecting mental health.
She also pointed out that society imposes high expectations on the young, particularly on those who seem to be doing well academically.
"We expect to see a linear progression in their performance with no interruption whatsoever, like some well-oiled machinery. Parents compare all the time. We often say that a well-developed, healthy child is better than a troubled child who seems to be shooting all As but is suffering, but we actually send different signals to them," she said.
Sometimes, children with mental health issues may need some time off from school, but the dilemma for parents is what to do with the child at home for a whole year, she said.
She questioned if there were programmes to make it easier for parents to ensure that the child with mental health issues staying at home is meaningfully engaged and not just receiving psychiatric treatment or medication.
Madam Halimah also noted that parents fear the stigma that mental health attracts.
She said: "There is still so much ignorance, stereotype and prejudice in our society against people with mental health issues that parents fear doing more harm than good to their children's future by seeking treatment that they delay with disastrous consequences."
One way would be for them to partner social service agencies dealing with mental wellness, which could help to run programmes that educate students on mental well-being, she said.
"Some institutes of higher learning have also embedded programmes on mental health to support their students that are quite effective, and which they can share with schools. We could also study the experience of other countries with more developed systems of support for our reference," she said.
"It takes a tragedy like this to start us thinking deeply again about the mental health of our young. Most of our children can cope, are resilient and will grow up well. But not all children are the same. Some do need more help and not just from the school but from everyone."
More can be done for youth facing mental health issues: President Halimah
Society imposes high expectations on the young, particularly on those who seem to be doing well academically.PHOTO: ST FILE
Goh Yan Han
July 23, 2021
SINGAPORE - Parents, schools and society are ill equipped to deal with young people who are struggling with mental health issues, said President Halimah Yacob in a Facebook post on Friday (July 23), as she called for more to be done to support and understand the youth.
She noted that the impact of mental illness when the onset is at a very young age is usually a lot more severe than when someone gets it much later in life.
Her post comes after the alleged murder of a 13-year-old boy by a 16-year-old boy at River Valley High School on Monday.
It was revealed in court that the 16-year-old had been referred to the Institute of Mental Health two years ago because of a suicide attempt.
Said Madam Halimah: "Attempted suicides are a real cry for help. We don't know the full details, particularly whether he had continued to receive psychiatric help or medication in order to deal with his mental health after that episode.
"We also don't know whether it was due to school or there are other factors affecting him as the causes of mental breakdowns are numerous and sometimes there are more than one factor at play."
She added: "We do know however that parents, schools and our society are ill equipped to deal with this situation."
For parents, the great difficulty is in not knowing whether the child is perhaps going through a growth phase, as "all adolescents with growth hormones raging through their bodies sometimes act out", or whether it is because of something much deeper, she said.
For teachers, already overloaded with work, it is not possible to delve deeply into the issues affecting one child, which will require close monitoring, observation and engagement, said Madam Halimah, noting that there are school counsellors but they may not be well trained on issues affecting mental health.
She also pointed out that society imposes high expectations on the young, particularly on those who seem to be doing well academically.
"We expect to see a linear progression in their performance with no interruption whatsoever, like some well-oiled machinery. Parents compare all the time. We often say that a well-developed, healthy child is better than a troubled child who seems to be shooting all As but is suffering, but we actually send different signals to them," she said.
Sometimes, children with mental health issues may need some time off from school, but the dilemma for parents is what to do with the child at home for a whole year, she said.
She questioned if there were programmes to make it easier for parents to ensure that the child with mental health issues staying at home is meaningfully engaged and not just receiving psychiatric treatment or medication.
Madam Halimah also noted that parents fear the stigma that mental health attracts.
She said: "There is still so much ignorance, stereotype and prejudice in our society against people with mental health issues that parents fear doing more harm than good to their children's future by seeking treatment that they delay with disastrous consequences."
She also said schools need a lot more resources and support to help students with mental health issues.One way would be for them to partner social service agencies dealing with mental wellness, which could help to run programmes that educate students on mental well-being, she said.
"Some institutes of higher learning have also embedded programmes on mental health to support their students that are quite effective, and which they can share with schools. We could also study the experience of other countries with more developed systems of support for our reference," she said.
"It takes a tragedy like this to start us thinking deeply again about the mental health of our young. Most of our children can cope, are resilient and will grow up well. But not all children are the same. Some do need more help and not just from the school but from everyone."
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