Rehabilitation for

Depression and Anxiety

Dr Arthur ChernGroup CEOSt Andrew’s Mission Hospital &Singapore Anglican Community Services

Mental Health Landscape in Singapore

National Surveys On Mental Health

2010 & 2016

Lifetime Prevalence of Mental DisordersTop 3 Most Common Disorders

Major Depressive

Disorder

2010

1 in 17

(5.8%)

Alcohol Abuse Obsessive Compulsive

Disorder

2010

1 in 32

(3.1%)

2010

1 in 33

(3.0%)

2016

1 in 24

(4.1%)

2016

1 in 28

(3.6%)

2016

1 in 16

(6.3%)

Note : There was an increase in lifetime prevalence of mentalillness from 12% or 1 in 8 in 2010 to 13.9% or 1 in 7 in 2016 whohad experienced a mental disorder in their lifetime.

Mental Health Situation In Singapore

Where Do They Seek Help

26Years Old

Onset ofmental illness

Average No. of Years To Seek Treatment

Year Alcohol

Abuse

OCD Major Depressive

Disorder

2010 13 9 4

2016 4 11 1

Year Psychiatrist Counsellor General Practitioner

Religious / Spiritual

Healer

Psychologist

2010 22.1 21.6% 18% 12% -

2016 42.3% 36.5% 20% - 26.2%

Reduction In Treatment Gap

• In 2010, 84% did not have any treatment for their mental disorders. But in 2016, it was 78.4%.

• For alcohol abuse, the treatment gap reduced from 96.9% to 80.6%.

Common Types of Mental Illness

1. Schizophrenia

2. Depression

3. Bipolar

4. Anxiety

Affect:

• Thinking

• Feeling

• Behaviour

• Motivation

SACS Psychiatric Rehab Services

Anglican Care Centre (Pasir Ris)

Anglican Care Centre (Farrer Park)

Anglican Care Centre (Bukit Batok)

Anglican Care Centre (Yishun) Anglican Care Centre

(Hougang)

Anglican Care Centre (Simei) & Integrated Employment

Services (IES)

1614

1913 1956

2235 2267 2293

2013 2014 2015 2016 2017 2018

No. of Persons Served

Residential Rehab

(N=402)

Day Rehab

(N=238)

COMITs

(N=1,102)

Employment Support Services(N=305)

DIAGNOSIS NO. % NO. % NO. % NO. %

Schizophrenia 324 81% 175 74% 624 57% 162 53%

Mood Disorders

42 10% 36 15% 264 24% 99 32%

Anxiety Disorder

16 4% 12 5% 102 9% 41 13%

Others 20 5% 15 6% 112 10% 3 1%

Persons With Mood Disorders Under SACS Psy Rehab Services

Depression

1. Loss of sleep or sleep too much2. Loss of appetite / some may have big appetite3. Loss of social contact / withdrawal4. Loss of interest in usual activities5. Loss of concentration6. Loss of libido / sexual drive7. Loss of energy / easily tired8. Loss of movement / slowing downNote: Some may have suicidal thoughts which require suicide risk assessment.

Assessment on Risk of Suicide

1. Previous attempts (within 3 months)2. Concrete plans to die3. Lethality of method (eg. Jumping, hanging, etc)4. Giving away precious things & suicide notes5. Feeling lonely, helpless and hopeless6. Inability to come to terms to grief and loss of

someone significant or something of significance7. Suffering from chronic depression and illness8. Family history of suicides9. Under the influence of drugs and alcohol

Bipolar (Manic Depression)Symptoms of Mania1. Feeling “high” and restless2. Irritable and easily agitated3. Talking very fast - jumping from one idea to

another, racing thoughts4. Easily distracted5. Grandiosity and religiosity6 Sleeping little8. Impulsive such as spending sprees, impulsive sex,

gambling

Anxiety Disorders

Anxiety takes several forms: phobia, panic attack, obsessive-compulsive, and post-traumatic stress. The physical effects of anxiety may include:-

• Heart palpitations• Muscle weakness and

tension• Fatigue• Nausea • Chest pain• Shortness of breath

• Headache• Stomach pain• Perspiration• Trembling• Restlessness• Insomnia

Model of Care

1. Strengths-Based : Abilities, Talents,

Interests and Preferences

2. Holistic : Bio-Psychosocial Spiritual

Approach

3. Eco-Centric : Person in relation to

formal & informal support systems

4. Recovery Oriented : Working towards

personalized plans and to discover new

meaning and purpose in one’s recovery

journey.

Religious Affiliation

VWOs GP

HDB SSO

IMH

Residents Committee

School CAL

Hospital

Peer Support Specialists

Family

Relatives

Neighbours

Friends

Employer

Rehab Counsellor /Case Manager

Employment Specialist

Volunteers

Strengths-Based, Person-Eco Centric Holistic Care Model

SNAP

Bio-Psycho-Social-Spiritual

CaseManagement

&Counselling

CaregiverSupport

SkillsEquipping

WellnessManagement

PeerSupport

CommunityRe-integration

PastoralCare

Person with mental

health issues

Slow Stream Rehab

Residential Rehab

Psychiatric Sheltered Home

• Day Care• Community Intervention

& Outreach• Integrated Employment

Services

Long Term Nursing Care ------------------------------------------------ Living In The Community

Psychiatric Nursing Homes

Continuum of Psychiatric Rehab Services

1. Residential Rehab Services• It is a step down care to those

referred from acute wards and other agencies who require a period of psycho-social rehab. Programmes and work opportunities are aligned to members’ recovery goals under the Individualised Care Plan (ICP)

• The duration of stay depends on their progress. For positive discharges, they are encouraged to continue with COMIT for follow up in the community.

Annual No. of Clients Served is about 400.

Capacity : 156

Capacity : 170

2. Psychiatric Sheltered Home (PSH)

Anglican Care Centre (Farrer Park) was set up in Oct 2017 as aPsychiatric Sheltered Home (PSH) to provide temporaryaccommodation for PMHIs. It seeks to support them in theirrecovery and reintegration into the community. It has a capacity of80 beds; 60 for adult males and females and 20 for youths from16 to 20 years old

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3. Day Rehab Services• Currently, there are 5 Day Rehab Services located at

various part of Singapore. These Centres use the

adapted Clubhouse Model to involve members in various

programmes and activities based on their strengths,

interests and preference.

• It operates on week days from 9am to 5pm. The capacity

for Centre is as follows:- ACC (Simei) – 50; ACC

(Hougang) - 30; ACC (Bukit Batok) - 30 ; ACC (Yishun) -

30 and ACC (Pasir Ris) – 30. Total no. of clients served

per year about 240.

4. Community Intervention Teams (COMITs) @BUKIT BATOK • PASIR RIS • YISHUN

• The COMITs are mobile teams supported by AIC to reach out to PMHIs living in the community. The main thrust of the service is to provide various forms of support in knowledge and equipping of skills and linkages up with community resources to enhance meaningful participation and improve their quality of life.

• This helps to sustain their recovery in the community. Each COMIT Rehab Counsellor manages about 50 - 60 clients and the total no. of clients served per year is about 1,200.

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5. Integrated Employment Support Services

•Assess and match clients to relevant jobs

• Job training and internship opportunities

•Assist clients to secure and sustain in their jobs.

Social Enterprises (SE)

Employment Support Services (ESS)

Employment Training Services (ETC)

Employment Internship Programme (EIP)

Employee Assistance Programme+ (EAP+)

Choose Get Keep

• Sale of donated old and new items at seven outlets; 4 at Senior Activity Centres and at 3 psychiatric service centres to train members in retail and customer services.

• Customised and generic items made by members and are sold at events and roadshows. MOSES is currently operated within the Sheltered Rehab Workshop at the ACC (Simei).

• This project was started for women and children at the family crisis shelter. It became part of the social enterprises to support women who are not able to go out to work because of the need to care for their children at home.

5a. Social Enterprises (SE)

Members’ Own Social Enterprise & Services

Mother and Child

5b. Employment Support Services (ESS)

ESS provides employment services to help Persons withMental Health Issues (PMHIs) seek meaningful employment.Its goal is to empower PMHIs to achieve sustainableemployment with the view of reintegration into thecommunity. It also provides the business community withcomprehensive employment services to support them inintegrating PMHIs in the workplace.

5c. Employment Training Centre (ETC)ETC provides vocational training courses to PMIs with theappropriate knowledge and skills to prepare them for jobs inthe market. Each year, there are 3 runs with an intake of 20 to30 persons per run.

5d. Employment Internship Program (EIP)

EIP provides on-the-job training for PMHIs to prepare them foropen employment. The traineeship programme aims to enhancejob readiness and sustainability through on-the-job training inspecified industries, enhance knowledge and skills of employers insupporting PMHIs and showcase the employability of PMHIs

5e. Employee Assistance Program+ (EAP+)EAP+ aims to provide timely support to employees with or atrisk of having mental health issues and employers, co-workersthrough a multi-disciplinary team consisting of mental healthprofessionals and Peer Support Specialists so as to enhanceperformance of employees, mental well-being of employees andknowledge and skills of employers/co-workers in implementingworkplace support.

Thank You