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MENTAL
HEALTH
RESOURCE KIT
GUIDELINES FOR CASE WORKERS
Mental Health Communities of Practice supported by Social Service Institute
Mental
Health
resource kit
Mental
Health
resource kit
G U I D EL I NE S F O R C A S E W O R K E R S
Copyright © 2014
SSI Communities of Practice – Mental Health and Social Service Institute
Published by
SSI Communities of Practice – Mental Health and Social Service Institute
111 Somerset Road
TripleOne Somerset #04-01
Singapore 238164
Email: [email protected]
Website: www.socialserviceinstitute.sg
Supported by Social Service Institute, Singapore
Produced by Write Editions®
All rights reserved.
No part of this publication may be reproduced, stored in retrieval systems, or
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have used their best efforts in preparing this book, they make no representations or
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Contents correct at time of printing.
Printed in Singapore
ISBN 978-981-09-2275-7 (paperback)
ISBN 978-981-09-2276-4 (e-book)
National Library Board, Singapore Cataloguing-in-Publication Data
Mental health resource kit : guidelines for case workers. – Singapore :
SSI Communities of Practice – Mental Health and Social Service Institute :
Write Editions®, 2014
pages cm
ISBN : 978-981-09-2275-7 (paperback)
1. Mental health services – Singapore. 2. Mental illness. I. SSI Communities
of Practice – Mental Health Singapore, publisher.
HV3003
362.2095957 -- dc23
OCN890567382
Contents
Publisher’s Note
vii
About SSI Communities of Practice – Mental Health
ix
Acknowledgements
Foreword
CEO, National Council of Social Service
President, World Federation for Mental Health
xi
Introduction
Chapter 1
Common Mental Health Issues:
Onset, Signs and Symptoms
1.1 Depression
1.2 Bipolar Disorder
1.3 Generalised Anxiety Disorder
1.4 Obsessive Compulsive Disorder
1.5 Post-Traumatic Stress Disorder
1.6 Psychosis
1.7 Dementia
xiii
xv
xvii
1
2
6
9
11
13
16
18
Chapter 2
Risk and Protective Factors of Mental Health
Chapter 3
Recommendations and Guidelines
3.1 Managing Clients with Mental Health Issues
(Initial Contact)
3.2 Managing Clients in Distress
3.3 Managing Clients with Panic Attack
3.4 Managing Clients Feeling Agitated
3.5 Conducting Home Visits
3.6 Handling Phone Enquiries
3.7 Conducting Counselling Session
3.8 Working with Caregivers of Loved Ones
with Mental Health Issues
3.9 Assessment Tools
3.10 Details to be Included in a Referral Form
3.11 Display of Signage Against Abuse of Staff
21
27
28
29
29
30
31
34
40
41
42
43
44
Chapter 4
Resources: Mental Health Services
45
in Singapore
References
55
Publisher’s Note
The contents in this publication Mental Health Resource Kit
are guidelines and resources to help practitioners in Voluntary
Welfare Organisations (VWOs) manage clients with mental health
issues.
Inasmuch as adherence to these guidelines is advised,
understandably, it may not ensure successful outcome in every case.
These guidelines should neither be construed as including the best
practices, nor excluding other acceptable types of management.
Any mention of specific organisations or of certain mental
health programmes or services do not imply that they are endorsed
or recommended by the SSI CoP – Mental Health in preference to
others of a similar nature that are not mentioned. The responsibility
for interpretation and use of this publication lies with the reader.
In no event shall the SSI CoP – Mental Health be liable for any
damages from its use.
vii
ABOUT SSI Communities
of practice – mental health
WHO WE ARE
The SSI Communities of Practice – Mental Health is an initiative
of the Social Service Institute, the Human Capital Development
Group of the National Council of Social Service. It was officially set
up in January 2013. The SSI CoP – Mental Health brings together a
group of individuals and organisations focussed on providing mental
health services, where they share perspectives gleaned from their
experiences, problems they encounter and practices they adopt.
WHAT WE DO
The SSI CoP – Mental Health aspires to rally the mental health
community to reduce stigma associated with mental illness, and
retain staff in the social sector. It also seeks to raise standards
across the industry and improve client care. Finally, it serves as a
common platform for those in the mental health sector to share
concerns, exchange views and explore collaboration.
ix
WHAT WE FOCUS ON
1. Develop knowledge and resources related to mental health.
This is to help organisations and individuals to better care for
clients with mental illness.
2. Spur exchange of ideas, expertise and experiences across the
mental health sector, so that the community may learn from
one another and adopt the best practices.
3. Encourage creative collaboration so as to optimise strengths
and resources of respective organisations and individuals. This
is to ultimately bring the best possible care to clients.
4. Elicit support from key stakeholders to promote the SSI CoP
– Mental Health’s agenda – understanding the challenges
faced by people with mental illness; extending vital resources
to organisations/individuals working in the mental health
sector; galvanising the community to help restore the lives of
clients.
x
Acknowledgements
Mental Health Resource Kit is produced by the SSI Communities
of Practice – Mental Health with the support of Social Service
Institute and kind contributions of:
Facilitator:
MS PORSCHE POH
Silver Ribbon (Singapore)/World Federation for Mental Health
Co-facilitators:
MS PAMELA HEE
Pasir Ris Family Service Centre
MR WONG LIT SHOON
Sage Counselling Centre
Members:
MS AMY TAN
Care Corner Family Service Centre (Admiralty)
MS CLARA LOH
SPD (formerly known as Society for the Physically Disabled)
MS CLAUDIA MA
Silver Ribbon (Singapore)
MS JENNIFER YEO
Students Care Service
MS JENNIFER YONG
Care Corner Senior Activity Centre (Cluster Support/CREST)
MS VOON YEN SING
Singapore Association for Mental Health
MS WU RUOYI
Care Corner Family Service Centre (Toa Payoh)
xi
The publication of Mental Health Resource Kit is also made possible
by the generous and invaluable contribution of the following
individuals:
MS CECILIA CHNG MUI LEE
Senior Nurse Clinician/Advanced Practice Nurse
National University Health System
DR SWAPNA VERMA
Chief, Early Psychosis Intervention Programme/
Senior Consultant, Institute of Mental Health
DR SUREJ JOHN
Consultant, Department of Psychological Medicine
Khoo Teck Puat Hospital
DR CLARENCE GOH KAH HONG
Consultant, Department of Psychological Medicine
Khoo Teck Puat Hospital
DR ISHAAN GOSAI
Consultant, Department of Psychological Medicine
Khoo Teck Puat Hospital
xii
Foreword
Findings have shown one in 10 Singaporean adults is afflicted,
or is expected to be afflicted with mental illness in their lifetime.1
Apart from caregivers, the care for people with mental illness in
Singapore must also be shared by Voluntary Welfare Organisations
(VWOs) and specialised services in both the public and private
sectors. In this regard, I am pleased that a concerted effort, led
by the Social Service Institute (SSI) Communities of Practice
– Mental Health, has been made to collectively bring together
the expertise and experiences of mental health professionals, case
workers and advocates of public hospitals and VWOs to produce
the Mental Health Resource Kit. I congratulate all who are involved
in this purposeful project.
SSI, the Human Capital Development Group of the National
Council of Social Service, is an integrated learning hub for training,
practice, resource and career services for the social service sector.
It aims to reinforce learning transfer from the classroom to the
workplace to facilitate Communities of Practice (CoP), where
practitioners collaborate and share industry best practices from
their working experience. Knowledge gained from these sharing
sessions is channelled to the resource hub for dissemination to
the social service sector and where relevant, incorporated into
SSI training.
1
Singapore Mental Health Study 2011, conducted by Institute of Mental Health.
xiii
I believe this Mental Health Resource Kit, to be used during SSI
training and across the mental health community, will empower
practitioners such as case managers and workers with critical
knowledge and guidelines, so they may serve clients better, and
more confidently.
SIM GIM GUAN
CEO
National Council of Social Service
xiv
Foreword
I have great pleasure in introducing the initiative for the provision
of more information on mental health issues to the case workers
in Singapore. I believe this initiative is timely and useful because
there is an increasing need for prevention and support for people
with mental health issues. Moreover, case workers play a vital role
in the provision of this help. Therefore the tool is addressed to the
appropriate recipients.
I congratulate the SSI Communities of Practice – Mental
Health team for their effort and wish them great success with
this much needed tool. I would be interested to learn how it will
be implemented and to what extent it helps case workers to carry
out their mission more effectively.
PROFESSOR GEORGE CHRISTODOULOU
President
World Federation for Mental Health
xv
Introduction
This Mental Health Resource Kit serves as a guide to aid the
mental health community to better serve clients with mental
conditions.
Chapter 1 covers the most common mental health issues,
and their respective onset, signs and symptoms. These include
depression, anxiety disorder and psychosis. Chapter 2 looks at the
risk and protective factors of mental health, and Chapter 3 outlines
key recommendations and guidelines for case workers in 11 areas,
ranging from establishing initial contact and managing clients with
panic attack, to conducting counselling session. Finally, Chapter
4 provides a list of available resources that extend mental health
services to both clients and caregivers.
Please note that the term ‘case workers’, used as a general term
throughout this book, refers to practitioners in Voluntary Welfare
Organisations. In some instances, the term ‘staff’ may also be used
if the term ‘case workers’ is not deemed to be appropriate.
xvii
Chapter 1
Common Mental Health Issues:
Onset, Signs and Symptoms
The following addresses some of the common mental disorders
such as depression, psychosis, and dementia.
Depression
Generalised
Anxiety Disorder
Bipolar Disorder
common
mental
health
issues
Obsessive
Compulsive Disorder
Psychosis
Post-Traumatic
Stress Disorder
Dementia
2 Mental Health Resource Kit
1.1 Depression
Everyone occasionally feels blue or sad. However, these feelings are
usually short-lived and pass within a couple of days. Depression,
on the other hand, interferes with daily life and causes pain for
both clients and those who care about them. Depression is a
common but serious illness.
Unfortunately, many people struck with depressive illness do
not seek treatment. They think that it is just another sad moment
in their lives. We need to realise that a majority of people with
depression, even those with the most severe depressive condition,
can get better with treatment. Medications, psychotherapies and
other methods can effectively treat people with depression. There
are several forms of depressive disorders.
Major Depression
The severe symptoms in major depression interfere with a person’s
ability to work, sleep, study, eat, socialise, and enjoy life. An episode
may occur only once in a person’s lifetime. However, it is likely
that a person will experience several episodes.
Persistent Depressive Disorder
On the average, the symptoms of this depressed mood lasts for
at least two years. A person diagnosed with persistent depressive
disorder may have episodes of major depression along with periods
of less severe symptoms. Some forms of depression are slightly
different, or they may develop under unique circumstances. They
include:
Common Mental Health Issues: Onset, Signs and Symptoms 3
Psychotic Depression
A person with psychotic depression is one with severe depression,
plus some form of psychosis, such as disturbing false beliefs, a
break with reality (delusions), or hearing/ seeing upsetting things
that others cannot hear/ see (e.g. hallucinations).
Postpartum Depression
Postpartum depression is much more serious than the ‘baby
blues’ that many women experience after giving birth. It is largely
attributed to hormonal and physical changes, and the daunting
new responsibility of caring for new-borns. It is estimated that
10 to 15 percent of women experience postpartum depression
after giving birth.
Who Gets It?
Major depressive disorder is one of the most common mental
problems and is faced by over 121 million people worldwide. In
Singapore, an estimated 5.6 percent of the population is affected
by depression during their lifetime. It is twice as common in
women as it is in men and usually begins in people aged between
20 and 40 years, although it can occur in children or older people.
Research has also shown that it is more common in people with
a family history of depression.
4 Mental Health Resource Kit
Signs and Symptoms of Depression
“It was really hard to get out of bed in the morning.
I just wanted to hide under the covers and not talk to
anyone. I did not feel much like eating and I lost a lot
of weight. Nothing seemed fun anymore. I was tired
all the time, and I was not sleeping well at night. But
I knew I had to keep going because I got kids and a
job. It just felt so impossible, like nothing was going to
change or get better.”
Not all people with depressive illnesses experience the
symptoms mentioned in the paragraph above. The severity,
frequency, and duration of symptoms vary in different
degrees, depending on the individual and his or her particular
illness. The common signs and symptoms include:
•
•
•
•
•
•
•
•
•
Persistently sad, anxious, or ‘empty’ feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability and restlessness
Loss of interest in activities or hobbies once considered
pleasurable, including sex
Fatigue and decreased energy
Difficulty in concentrating, remembering details, and
making decisions
Insomnia, early-morning wakefulness, or excessive
sleeping
Loss of appetite, or overeating
Common Mental Health Issues: Onset, Signs and Symptoms 5
• Thoughts of suicide and suicide attempts
• Aches or pains, headaches, cramps, or digestive problems
that do not ease even with treatment
6 Mental Health Resource Kit
1.2 Bipolar Disorder
Bipolar disorder is characterised by alternating episodes of mania
and depression. These episodes can vary in duration and intensity.
It affects a person’s ability to carry out daily tasks. More than just
a fleeting good or bad mood, the cycles of bipolar disorder can
last for days, weeks, or months.
During a manic episode, a person might impulsively quit a
job, charge up huge amount of expenses on credit cards, or feel
energetic even with only little sleep. During a depressive episode,
the same person might be too tired to get out of bed. He might
also be full of self-loathing and hopelessness over situations such as
being unemployed or in debt, which at times are the consequences
of what he has done during a manic episode.
Bipolar disorder is a chronic relapsing illness. If left untreated, it
may pose significant morbidity and suicide risks. Global estimates
suggest that between 1 to 2 percent of people may suffer from
bipolar disorder over their lifetimes, with 10 to 19 percent of
these individuals attempting suicide. About 1.2 percent of adult
Singaporeans have bipolar disorders and the average time taken
for them to seek help is nine years.
People with bipolar disorder also suffer from a notably
poorer quality of life. This is because most bipolar disorder cases
commence in a person’s late teen or early adult years, a life stage
that is arguably their most productive years. As a result, they
significantly lose out in terms of lack of focus and performance,
which impacts their academic and career pursuits.
Studies provide good evidence that bipolar disorder can be
effectively treated, and that people with bipolar disorder but who
are symptom-free, have a higher quality of life compared with
those who are not fully stable.
Common Mental Health Issues: Onset, Signs and Symptoms 7
Who Gets It?
Bipolar disorder often develops at the ages between 15 and 19
years, followed by 20 and 24 years. At least half of all cases begin
before age 25. Some people have their first symptoms during
childhood, while others may develop symptoms later in life.
Signs and Symptoms of Bipolar Disorder
The manic phase is characterised by:
• Delusions (false beliefs) or hallucinations (false
perceptions)
• Hyperactivity
• Irritable mood
• Decreased need for sleep
• Exaggerated, puffed-up (inflated) self esteem
• Rapid or ‘pressured’ speech
• Rapid thoughts
• Poor attention span
• Recklessness
During a depressed period, symptoms may include:
•
•
•
•
•
Appearing slow or agitated
Fatigue and loss of energy
Feelings of worthlessness or guilt
Poor concentration
Indecisiveness
8 Mental Health Resource Kit
•
•
•
•
•
Low or irritable mood
Loss of interest
Increased or decreased weight and appetite
Increased or decreased sleep
Plans of death and suicide attempts
Common Mental Health Issues: Onset, Signs and Symptoms 9
1.3 Generalised Anxiety Disorder (GAD)
People feel anxious at times. Worries, doubts, and fears are a
normal part of life. For example, it is natural to be anxious about an
upcoming examination or to worry about finances after being hit
by unexpected bills. However, if worries and fears are so constant
that they interfere with the ability to function and relax, a person
may have Generalised Anxiety Disorder (GAD).
The symptoms a person with GAD manifests include incessant
anticipation of disaster and excessive worry about health, money,
family, or work. It is however hard to pinpoint the exact source
of the worry at times. Unlike a phobia, where a person has a fear
of specific thing or situation, the anxiety inherent in this disorder
is diffused. It generates a general feeling of dread and unease that
clouds the person’s whole life.
Treatment of GAD may involve using medications such as
selective serotonin reuptake inhibitors (SSRIs) and talking therapies
such as Cognitive Behavioural Therapy (CBT). People with GAD
may also find relaxation techniques helpful, such as progressive
muscle relaxation and deep breathing exercises. It is also advisable
to stop smoking or consumption of caffeinated drinks. Regular
exercise should also help to some extent in reducing the anxiety.
Who Gets It?
GAD tends to affect women more than men, with the most current
research showing that there is a 2:1 female/male ratio for GAD.2
1
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental
Disorders. Washington DC: American Psychiatric Association.
Barlow D.H. (Ed.)(2001). Clinical Handbook of Psychological Disorders (3rd Ed.). New
York: Guilford Press.
Wittchen, H.U. (2002). Generalized Anxiety Disorder: Prevalence, Burden, and Cost to
Society. Depression & Anxiety, 16, 162-171.
10 Mental Health Resource Kit
Separately, a recent German study has found that GAD affects
6.6 percent of women and 3.6 percent of men at some point
during their lifespan. This condition may be hereditary and tends
to develop usually in response to a stressor in major life changes
or events. Such stressors include adjusting to a new job, having
a child or even dealing with a physical illness. People who have
had traumatic childhoods may be at a higher risk of developing
this condition. Tobacco smoking has also been established as a
risk factor and caffeine tends to exaggerate the anxiety which the
person is already experiencing.
Signs and Symptoms of Generalised Anxiety Disorder
• Chronic, excessive, intrusive, and exaggerated worry and
tension
• Difficulty in tolerating uncertainty
• Pervasive sense of apprehension
• Put off things due to feelings of overwhelmingness
• Bodies feeling tight or tense, making it difficult to relax
or enjoy a quiet time
• Impaired concentration
• Restlessness and irritability
• Experience of palpitations, excessive sweating, and
trembling
• Difficulty in sleeping as one’s mind would not shut off
Common Mental Health Issues: Onset, Signs and Symptoms 11
1.4 Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is an anxiety disorder in
which excessive, time-consuming obsessions and compulsions take
over a person’s life, making it difficult to work or have a normal
social life.
Obsessions are recurrent and persistent thoughts, impulses, or
images that cause distressing emotions such as anxiety or disgust.
While people with OCD are aware that these thoughts are excessive
or unreasonable, they are unable to stop these obsessions.
Compulsions are repetitive behaviours that the person feels
driven to perform in response to an obsession. The behaviours are
aimed at preventing or reducing distress or a feared situation.
OCD is a treatable illness. Treatments include medication and/
or therapy such as Cognitive Behavioural Therapy.
Who Gets It?
OCD affects about 1 in 100 people. It often begins in childhood,
adolescence, or early adulthood. It is equally common in men
and women and transcends geographic, ethnic, and economic
boundaries. It can be hereditary. Research shows that OCD is
genetically transmitted in 30 to 50 percent of cases. It is also
believed to be related to group A streptococcal infection in some
cases.
12 Mental Health Resource Kit
Signs and Symptoms of OCD
• Spending excessive time with obsessions and/or
compulsions till they are unable to leave their home
• Excessive concerns about contamination or harm
• Need for symmetry or exactness
• Having forbidden sexual or religious thoughts
• Excessive cleaning, repeating, checking, ordering, and
hoarding
• Mental compulsions such as thinking silent prayer/
phrases
Common Mental Health Issues: Onset, Signs and Symptoms 13
1.5Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) is a mental illness
which can be very disturbing to an individual, with the person
experiencing great stress in their lives. It is characterised by the
experience of a trauma and anxiety symptoms even after two to
three weeks after the traumatic experience.
Like any other illness, PTSD can be treated. The earlier it is
recognised and treated, the better and faster the chances are of
full recovery. Early treatment may also prevent increased severity
of the illness and in some cases, suicide.
Who Gets It?
PTSD can happen to anyone who has experienced a traumatic
event. Examples of trauma include road traffic accidents, accidents
at work, domestic violence, sexual assault, and physical assault.
Traumatic experiences generally do not include death of a loved one
by natural causes. The traumatic event can either be experienced
by the person himself, or by the person observing the trauma of
someone close to them. Roughly 10 percent of women and 5
percent of men are diagnosed with PTSD in their lifetimes.
14 Mental Health Resource Kit
Signs and Symptoms of PTSD
Persistent re-experiencing with one or more of the
following:
• Recurrent nightmares or flashbacks
• Recurrent images or memories of the event, often
occurring without actively thinking about the event
• Intense distress of reminders of the trauma
• Physical reactions to triggers that symbolise or resemble
the event
Avoidance/numbness responses with three or more of the
following:
• Efforts to avoid feelings or triggers associated with the
trauma
• Avoidance of activities, places or people that remind the
person of the trauma
• Inability to recall an important aspect of the trauma
• Markedly diminished interest in activities
• Feelings of detachment or estrangement from others
• Restricted range of feelings
• Difficulty in thinking about one’s long-term future.
Sometimes this expresses itself by one’s failure to plan
for the future or risk-taking because he does not fully
believe or consider the possibility that he will live a
normal lifespan.
Common Mental Health Issues: Onset, Signs and Symptoms 15
Increased arousal with two or more of the following:
•
•
•
•
•
Difficulty in falling asleep or staying asleep
Outbursts of anger or irritability
Difficulty concentrating
Increased vigilance that may be maladaptive
Exaggerated startle response
16 Mental Health Resource Kit
1.6Psychosis
Psychosis is a mental illness which can be very disturbing to
both an individual experiencing it, and his loved ones. Its mental
disturbance causes one to lose touch with reality.
Psychosis is characterised by hallucinations, delusions, and/
or disorganised thinking and behaviour. Thankfully, like many
other illnesses, it can be treated. The earlier psychosis is recognised
and treated, the better and faster it is for the person to make full
recovery. Early treatment may also prevent increased severity of
the illness and in some cases, suicide.
Who Gets It?
Psychosis can happen to anyone but is more likely to occur in
young adults, in particularly those between 16 and 25 years old.
Around 1 in 50 people will experience a psychotic episode in their
lifetime. It is similarly distributed world-wide, and affects men
and women in equal ratio.
Common Mental Health Issues: Onset, Signs and Symptoms 17
Signs and Symptoms of Psychosis
Symptoms related to thinking and perception include:
• Thoughts of people being against him or talking about
him
• Receive ‘personal messages’ from the television or
radio
• Believe that one has special power
• Hear voices
• See visions or things that others cannot see
Symptoms related to feelings include:
•
•
•
•
•
Sadness or irritability
Feeling isolated
Feeling confused or puzzled
Distrustful towards others
Feeling of being watched
Symptoms related to behaviour include:
•
•
•
•
•
Difficulty in sleeping
Talk or smile to oneself
Neglect of one’s appearance
Avoid contact with people
Aggressive behaviour
18 Mental Health Resource Kit
1.7. Dementia
Dementia is a collection of symptoms caused by malfunctions
in the brain. It is not a part of normal ageing. Dementia affects
memory, behaviour, and the ability to function on a daily basis. As
dementia is a progressive and degenerative disease, its condition
is expected to worsen with time.
The two most common types of dementia are Alzheimer’s
Disease and Multi-Infarct Dementia (or Vascular Dementia, which
is caused by a series of strokes). When a person is suspected of
having dementia, it is vitally important for him to seek immediate
medical advice and verification. This is because there are other health
conditions that may manifest symptoms similar to dementia, for
examples, vitamin deficiency, tumour, depression, and infection.
With proper medical treatment, some of these conditions can be
cured, hence alleviating the person’s suffering.
Who Gets It?
People above the age of 65 years are at greater risk. It is a common
disease that afflicts people of all races, cultures and socio-economic
status.
Common Mental Health Issues: Onset, Signs and Symptoms 19
Signs and Symptoms of Dementia
• Short term memory loss (e.g. events that occurred in
the recent past)
• Confusion (e.g. inability to recognise familiar objects)
• Disorientation (e.g. inability to find one’s way home
from the market even though it is a route he has walked
many times in the past)
• Change in personality (e.g. a once loving husband
accuses his wife of stealing his things)
• Difficulty in learning and remembering new
information
Early Warning Signs of Dementia
• Difficulty in remembering recent events
• Difficulty with everyday tasks such as taking a bath and
preparing tea
• Getting lost in familiar places
• Forgetting common words
• Changes in personality
• Rapid changes in mood
• Tendency to misplace things
• Difficulty with calculations (e.g. how much change
should be received after making a purchase)
• Disorientation of time or/and day of the week
• Loss of motivation at work or at home
• Forgetfulness of performing common chores (e.g. turning
off the stove, closing windows, or locking doors)
Chapter 2
RISK AND PROTECTIVE FACTORS
OF MENTAL HEALTH
Research suggests that there are many factors that can beneficially
or detrimentally affect mental health. One should note that these
factors not only affect mental health discretely, but can also interact
with other factors to jointly affect mental health. It is also good to
note that while these risk and protective factors have been found
to be correlated, they are not necessarily causal factors, because
correlation does not prove causation.
In the following tables, the factors that are correlated with
mental health in general are grouped horizontally by developmental
life stages and vertically by the settings in which they affect the
individual. Some of these factors correlate more strongly with
certain disorders but not other disorders. It should also not be
assumed that any mental disorder is correlated with every single
one of these risks and protective factors.
Table 1.1 depicts the risk factors while Table 1.2 depicts the
protective factors of mental health.
22 Mental Health Resource Kit
TABLE 1.1 RISK FACTORS AGAINST MENTAL HEALTH
Culture
• Poverty
• Social inequalities
• Urban setting
• Poor academic performance
• Lack of control or mastery experiences
Community
• Peer rejection
• Low commitment to school
SETTING
• Marital conflict
• Family dysfunction
Family
• Unresponsive, cold parental care
• Negative life events
• Parental drug/alcohol use
• Insecure attachment, difficult temperament
•Child abuse/maltreatment
•Anxious and over controlling
childrearing
• Parental depression
Individual
•Social inhibition/hostility
•Irritability, fearfulness
•Motor, language and
cognitive impairments
Prenatal and early childhood
•Poor impulse control
•Self-reported psychotic
symptoms
Childhood
Adapted from:
1. National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and
behavioral disorders among young people: Progress and possibilities. Washington, DC: The
National Academies Press.
Risk and Protective Factors of Mental Health 23
•Decreased social support
in new social context
•Social adversity
•Social exclusion
•Bereavement
•Elder abuse
• School/neighbourhood violence
• Low/negative self-esteem and image
• Poor social and social problem-solving skills
• Shyness
• Extreme need for extensive approval and social support
•Female gender
•Early puberty
Adolescence
•Childhood history of
poor physical health,
anxiety, sleeping and
eating problems
Adulthood
• Chronic physical illness
Older Adulthood
LIFE STAGE
2. World Health Organization. (2012) Risks to mental health: an overview of vulnerabilities and risk
factors. Retrieved May 26, 2014, from http://www.who.int/mental_health/mhgap/risks_to_mental_
health_EN_27_08_12.pdf
24 Mental Health Resource Kit
TABLE 1.2 PROTECTIVE FACTORS FOR MENTAL HEALTH
Culture
Community
•High academic standards
•Support for early learning
•Low ratio of caregivers to children
•Regulatory systems that
support high quality of care
•Healthy peer groups
•School engagement
•Positive teacher expectations
•effective classroom
management and
school policies
SETTING
•Consistent discipline
•Extended family support
Family
•Reliable support and discipline
•Responsiveness
•Protection from harm and fear
•Opportunities to resolve conflict
•Adequate socioeconomic resources
•Language-based discipline
•Ability to make friends and get along with others
•Academic achievement
•Good coping skills
Individual
•Self regulation
•Secure attachment
•Mastery of communication
and language skills
Prenatal and early childhood
Childhood
Adapted from:
1. National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and
behavioral disorders among young people: Progress and possibilities. Washington, DC: The
National Academies Press.
Risk and Protective Factors of Mental Health 25
•Positive norms
•Engagement in 2 or
more social contexts
•Presence of mentors
•Physical and
psychological safety
•Opportunities for
exploration in work
and school
•Connectedness to adults
outside of family
•Clear expectations
for behaviour
and values
•Balance of autonomy and
relatedness to family
•Behavioural and
emotional autonomy
•Positive physical
development
•High self-esteem
Adolescence
• Identity exploration
• Subjective sense of adult
status, self-sufficiency
and independence
• Future orientation
• Achievement motivation
Adulthood
•Strong social circle
•Financial security
•Independence in mobility
•Intact cognitive skills
Older Adulthood
LIFE STAGE
2. World Health Organization. (2012) Risks to mental health: an overview of vulnerabilities and risk
factors. Retrieved May 26, 2014, from http://www.who.int/mental_health/mhgap/risks_to_mental_
health_EN_27_08_12.pdf
Chapter 3
RECOMMENDATIONS
AND GUIDELINES
This chapter covers recommended guidelines for case workers in
managing clients and different scenarios. We start with a step-bystep guideline to help case workers through the process of initial
contact with clients.
28 Mental Health Resource Kit
3.1 MANAGING CLIENTS WITH MENTAL HEALTH ISSUES:
INITIAL CONTACT
Clients with potential
mental health issues
Suspected to have
mental health issues
Diagnosed to have
mental health issues
Conduct usual assessment of
needs, goals and priorities
(But include basic informal
screening for the suspected
mental health issue)
Conduct usual
assessment of needs,
goals and priorities
Discuss outcome of screening
with client and necessity of
referral to external parties
(Includes Psycho-education)
Find out client’s
personal signs of
relapse and assess
for relapse risk
If client has a relapse
If referral deemed
to be unnecessary
Provide continual
support and
appropriate
intervention
If referral deemed
to be necessary
Non-life threatening
Non-crisis
Crisis
Encourage client
to seek medical
attention
Call IMH mobile
crisis team if client
is known to IMH
(6389 2222). Otherwise,
call AIC Crest
team or CRSS
(6386 3911)
Life threatening
Contact client’s
next of kin and
call the police
Recommendations and Guidelines 29
Aside from the process of making initial contact with clients, case
workers may find the following guidelines useful in managing
their clients in different states.
3.2 MANAGING CLIENTS IN DISTRESS
In the case where clients are deemed to be in distress, case workers
should:
• Stay calm and appear confident.
• Show genuine concern and empathy.
To defuse or de-escalate anxiety in clients, case workers could:
• Offer them a safe and quiet place.
• Seat them down comfortably.
• Offer them a drink.
• Allow them to talk. The case worker is to listen attentively
without judgment and with minimal interruption.
3.3 MANAGING CLIENTS WITH PANIC ATTACK
If clients with known medical problem(s) display symptoms of
chest pain, profuse sweating and/or becoming less responsive, case
workers should seek medical attention or call for an ambulance.
If clients are seen to be unusually active and vocal, case workers
could:
• Seat them down comfortably.
• Attract their attention, make them keep eye contact with focus
on the case worker.
30 Mental Health Resource Kit
• Explain to clients that they are experiencing symptoms of a
panic attack and that panic attacks are not life threatening.
Further explain the concept of hyperventilation and guide
them to note that they might be breathing too quickly.
• Show and guide them to breathe slowly.
• Advise them to stop body scanning and listen to the case
worker’s instruction.
• Instruct them to relax the tense shoulder and neck muscles.
• Demonstrate breathing exercise and instruct them to repeat
the exercises for four to seven times until they are calm.
3.4 MANAGING CLIENTS FEELING AGITATED
To manage clients who feel agitated, and show seemingly volatile
agitation, case workers should:
• Remain calm and professional; alert colleague(s) who are
near them so that the colleagues can help to monitor the
situation.
• Keep an adequate distance from agitated clients (at least two
arms’ length) and remain close to the door.
• Adopt a passive, non-confrontational posture and attitude.
• Protect themselves and get their colleague(s) to help if the
agitation seems to be increasing or they themselves feel
threatened.
• Maintain appropriate eye contact. Loss of eye contact may
be interpreted as an expression of fear, lack of interest or
rejection. Excessive eye contact may be interpreted as a threat
or challenge.
Recommendations and Guidelines 31
To defuse or de-escalate agitation in clients, case workers could:
• Refrain from challenging or provoking the clients.
• Use a soft and soothing tone.
• Focus on their body language; try to stay still as much as
possible. Fidgeting could suggest to the clients that the case
workers are uncomfortable, which could in turn make agitated
clients increasingly anxious.
• Allow clients to ventilate their feelings and communicate what
is bothering them. A show of genuine concern and support
can sometimes diffuse a tense situation.
• Explain the limits and rules in an authoritative, firm, but
respectful tone. Where possible, give choices or alternatives
that are ‘safe’. For example, case worker could say, “Would you
like to continue our meeting calmly or would you prefer to
stop now and come back tomorrow when things can be more
relaxed?”
3.5 CONDUCTING HOME VISITS
While some untreated symptoms of mental illnesses may increase
the risk of violence, as a group, people with mental illnesses are no
more violent than the general population. However, as case workers
are often expected to conduct home visits, the recommendations
below seek to ensure the safety, comfort, and confidence of case
workers when conducting home visits.
a. Prepare a comprehensive assessment of the client prior to the
visit so that there is clarity about the purpose of the visit.
Include details such as the history (including any evidence of
32 Mental Health Resource Kit
violence), belief, culture, needs, and living circumstances of
the client.
b. Phone ahead of all appointments so that:
• The case worker can assess the client’s condition.
• The case worker can confirm the availability of the client
and, if necessary, the client’s family.
• The client knows what to expect of the visit.
c. Limit the amount of personal belongings and valuables
carried.
d. Wear ‘home visit’ clothing and shoes that are professional, do
not attract undue attention, and allow for mobility.
e. Make arrangement to travel in pairs.
f. During the visit, if the case worker and colleagues feel
uncomfortable, threatened, or that their safety might be
otherwise be jeopardised, they could consider the following
suggestions:
• Have a brief discussion at the corridor, void deck or
elsewhere.
• Postpone the visit and leave as calmly and quickly as possible
without revealing any awareness of a problem. After which,
report the concerns to the appropriate supervisor(s).
g. After entering the unit, be aware of the exit route. Where
possible, keep the exit route in sight.
Recommendations and Guidelines 33
h. Hygiene issues of client’s flat
• Be vigilant and always assess the flat’s physical
environment.
• If the client informs the case worker of bed bugs in the flat,
the case worker should take precautionary measures.
• If the case worker feels uncomfortable going into the flat,
have a brief discussion standing outside the flat.
• If the case worker does or intends to enter the flat, he
should:
– Wear light-coloured clothes
– Limit the amount of bags carried into the flat
– Try not to sit down or lean against the wall
– Refrain from going into the bedrooms if possible
• Even if the client does not mention bed bugs, it is always
good to stay vigilant during home visits. The case worker
should observe the physical surroundings for possible
manifestation of bed bugs such as trails of bed bugs/blood
stain on the bed and walls.
i. If food and/or drinks are served and the case workers do not
want to accept the offer, they may explain politely that they
have already taken their meal or have some food allergy. This
is to reduce the impact and likelihood of the client and/or
his family members viewing the refusal as a rejection of their
hospitality and having their feelings negatively affected.
j. If the client and/or the client’s family members are scantily
dressed, case workers may highlight their concern politely.
If the concern is being ignored, case workers may wish to
postpone the visit and leave as calmly and quickly as possible
before reporting their concerns to their supervisor.
34 Mental Health Resource Kit
3.6 HANDLING PHONE ENQUIRIES
The recommendations given below are based on some commonly
encountered situations. The objectives are to:
• Provide information that the caller (who may become a client)
requires.
• Conduct a preliminary assessment on the caller’s needs and
inform him of suitable resources in the community.
• Encourage the caller to seek help if necessary.
The general guidelines are:
• The phone should be picked up after two or three rings and
answered in a neutral and non-threatening way. Greetings
should be brief and clear such that the caller knows that the
right place has been called.
• The caller’s purpose of calling should be explored.
• Time should be allowed for the caller to talk more in the initial
period such that the case worker can better assess the caller’s
needs. Case workers can use basic counselling skills to prompt
and clarify if necessary.
• Case workers should be non-judgmental, warm, empathic and
objective when handling phone inquiries.
– Some callers may not sound friendly. However, it could be
their way of verifying if the staff of the organisation accepts
them. It may also be the case that they call in a state of
frustration. For example, they could have been directed to
different places but are unable to get the information they
want.
Recommendations and Guidelines 35
– Using the right tone is important. For example, if the
caller is anxious or seems to be experiencing symptoms
such as hallucinations or delusions, the case worker should
speak slowly and calmly while using simple and direct
language.
• If some time is needed to retrieve information that the caller
requires, the case workers could offer to call the caller back.
• Case workers should be alert to the background noise and/or
when the caller appears to hesitate in his response. If a case
worker initiates a return call, the case worker should check
with the caller if it is a convenient time to talk by asking closed
ended questions.
• Case workers should summarise the purpose of the call and
what they can offer if the caller starts to divert away to other
topics.
Let’s look at some common ways to manage different situations
in call handling.
a.Managing caller who is experiencing hallucination and/or
delusions
• Avoid arguing with him or trying to convince him that his
experiences are just hallucinations and/or delusions.
• Listen to his emotions and reflect that back to his.
• Find out more about the other services he is currently
receiving.
• Encourage him to discuss his experiences with his healthcare
team.
• Encourage him to provide his contacts as well as his nextof-kin’s contacts to the case worker.
36 Mental Health Resource Kit
• Contact the caller’s next-of-kin to gather more information
about the caller, provide additional information to the
caregivers so that the caregivers can better support the caller,
or if the caller seems to suffer a relapse.
b.Managing caller who is anxious
• Speak slowly and calmly.
• Encourage and remind the caller to slow down while
talking.
• Try to get the caller to do deep breathing before assuming
conversation if necessary
• Pace the caller by paraphrasing and summarising what has
been said.
• Encourage the caller to focus on one issue at a time instead
of providing lots of information at one time to the case
worker.
c.Managing caller who is depressed
• Encourage the caller to seek help in managing the depression.
Ask him or her not to make any major decisions before
his or her condition stabilises. Explain to the caller that
depression can affect a person’s emotions, thoughts and
behaviours, and negatively impacts one’s ability to make
good decision.
• Offer realistic hope to the caller.
• Assess if there is any suicidal intent in the caller.
d.Managing caller who is angry
• Speak slowly and mildly.
• Listen not just for the content, but also the emotions;
respond to the emotions.
Recommendations and Guidelines 37
• Ask informational, non-judgmental questions to understand
why the caller is angry.
• Consider getting another staff to take over the phone if the
caller’s anger is directed at the staff who is answering the
phone and the level of anger is escalating.
e.Managing caller who talks a lot and is difficult to be
interrupted
• Take note of the caller’s issues and think through how they
as case workers would want to respond to the caller. Write
down the points if necessary. After which, listen intently
and when the caller pauses to breathe, ‘jump in’ to speak to
the caller regarding the noted points. Finally, try to direct
the caller to focus only on one specific issue at a time.
• Interrupt firmly and speak in a slower tone while the caller
is still talking. For example, the case worker could say “Mr
Tan, hold on please. Hold on. I would like to understand
what you’re going through, hold on, hold on, but I’m having
difficulties in doing so. I’ll need your help to slow down so
that I can hear what you’re saying. Would you mind taking
me back over to . . .”
f.Managing a ‘nuisance’ caller
The intention of a ‘nuisance’ caller varies. It may range from one
who wishes to test the services by causing annoyance, one who
feels bored or lonely, to one who does not know how to deal
with his own frustrations. However, in all cases, case workers
should:
• Maintain professionalism.
• Focus on the purpose of the call.
• Gently confront him if there is any incoherence observed,
38 Mental Health Resource Kit
for examples, giggling in the background while expressing
his sadness; when others can be heard in the background
giving ‘advice’ on what caller should say or respond.
g.Managing repeated and regular caller
Repeated and regular caller may sometimes use different names
and talk about the same issues to various staff. These are the
guidelines:
• Discuss individual caller cases with the team to fashion
consistent ways of managing the caller. This may include
strategies such as limiting the time spent on the phone with
the caller, as well as sharing what has been offered to the
caller along with the caller’s responses.
• Use the opportunity to get to know more about the caller
and listen for positive aspects in the caller’s life. This may
include information regarding the caller’s family background,
employment histories, hobbies, daily routine, relationship
with others and his views about certain issues.
• Avoid providing quick solution to the caller.
• Assign some homework for the caller to do before calling
again, and check on the homework when the caller makes
the next call.
• Maintain professional boundaries with the caller.
h.Managing sex callers
Sex callers use phone calls to satisfy their sexual needs. Many
of them are male and talk about sexual issues when they speak
to a female case worker. They tend to provide case workers
with explicit sexual content which is irrelevant or unnecessary.
Their breathing may also become heavier as the conversation
continues. Sex callers may also try to ‘lead’ case workers to
Recommendations and Guidelines 39
prompt them into talking about sex-related matters. The
content and profile of characters involved may change from
time to time as the sex callers may not be able to remember all
the details (which are usually fantasies and not real events) that
they have given. They would want to continue giving intimate
details even when told to stop, or they may digress to another
topic for a short period but will keep coming back to topic of
sex.
Note that people with mental illnesses may also talk about
sexual issues that they are facing, but usually only after rapport
is built. They are not sex callers if they do not abuse the service
to satisfy their sexual needs. They may summarise the sexual
issue faced without giving explicit details about how they
masturbated or what happened when they were at the brothels.
For example, they could say “I masturbated excessively the last
time when I was unwell, and kept going to the prostitutes.”
Even if they do give some unnecessary details, they will stop
when told to do so. Furthermore, they will also discuss about
other non-sexual issues that are bothering them.
In handling callers that may be sex callers, case workers
could:
• Identify the caller’s purpose of calling and let the caller
know whether the services provided at the case worker’s
organisations will be able to help him.
• Avoid going into explicit sexual content.
• Avoid promising that they, as case workers, will not disclose
any information to others and inform the caller of the limits
of confidentiality. Sex callers may try to get case workers
to promise that they will not disclose any information to
others, including the case workers’ supervisors.
40 Mental Health Resource Kit
• Inform the caller that his call will be returned and ask for the
caller’s contact details. Most sex callers will prefer to hang
up the phone or intentionally provide a wrong number.
• Maintain professionalism.
3.7 CONDUCTING COUNSELLING SESSION
Counselling room should reflect care and thoughtfulness not just
for the case workers but for the client as well. The recommendations
below seek to protect the safety of both case workers and clients
when conducting session in the counselling room.
• Counselling room is comfortable, ensuring safe distance
between the client and the case worker.
• The room should be clean, tidy and is free of hazard that could
cause harm to the clients and the case worker.
• Installation of panic button in the counselling room is advised.
This is to alert colleagues who are stationed outside, in case of
a dangerous situation arising in the counselling room.
• Installation of CCTV and door with fitted window in the
counselling room would be ideal. This serves to prevent
misconduct.
• Counselling room should not be locked during the session.
This is to ensure that should there be any emergency in the
room, colleagues will be able to access.
• Avoid working alone; case workers are advised not to see clients
if no one is around in the office.
Recommendations and Guidelines 41
3.8 WORKING WITH CAREGIVERS OF LOVED ONES WITH
MENTAL HEALTH ISSUES
In most cases, working with clients with mental health issues also
includes working with their caregivers. There is often a need to
strike a balance while working with caregivers. Besides getting
information from caregivers about their loved ones with illness,
case workers also need to be mindful that the caregivers are
also individuals who need support, especially in times of crisis.
Therefore, case workers are advised to consider the following:
• Identify who the caregivers are, especially the main caregiver
(who is often a female). This is because as the main caregiver,
he/she might be more at risk of caregiver burnout.
• Take initiative to ask how the caregivers are coping.
• Highlight the importance of self-care.
– Caregivers have the tendency to neglect their self-care; they
tend to also reason that they will focus on self-care only
when their loved ones have recovered.
– Encourage them to give themselves a break on a regular
basis. Discuss specifically what they can do to practise good
self-care. Follow up with them on the outcomes of the
discussions.
• Encourage the caregiver(s) to express their emotions and
manage these emotions constructively. Explain to them that
having intense emotions towards their loved ones may affect
their interaction. For example, a parent who constantly blames
herself for the illness of her child may tend to give in too much
to the client.
42 Mental Health Resource Kit
• Help caregivers adjust their expectations, with regard to their
loved ones’ condition, treatment outcome and abilities. This
includes helping them to understand that:
– Client may need more rest when he is recovering from a
relapse.
– When the client’s condition is stabilised, caregivers can
encourage the client to take baby steps to resume his
routine, instead of expecting the client to resume full-time
work immediately.
• Help caregivers to learn to differentiate between warning signs of
relapses and client’s ‘normal’ reaction to situation. For example,
a client who shouts in public may not be experiencing a relapse.
Instead, the client might just be angry at someone who had
just pushed the client and walked away without any apology.
• Help caregivers to calm down and relax when client’s condition
is stabilised, and lead them to continue to watch out for early
warning signs. While relapses may be sudden in some cases, it is
more common for clients to gradually show signs and symptoms
of relapses. On the other hand, caregivers may continue to be
in a hyper vigilant mode and constantly worrying that relapse
will suddenly occur again.
3.9ASSESSMENT TOOLS
Below are some of the commonly used assessment tools for mental
health clients:
•
•
•
•
Even Briefer Assessment Scale for Depression (EBAS DEP)
GHQ 12
Zung Self-Rating Anxiety Scale
GMHAT
Recommendations and Guidelines 43
3.10DETAILS TO BE INCLUDED IN A REFERRAL FORM
Below are some of the details found useful to be included in the
referral form:
•
•
•
•
•
•
•
•
Particulars of client
Language spoken
Particulars of next-of-kin
Reasons for referral
Presenting problems
Behaviours – suicidal, violent, others
Intervention before referral
Whether they are known to any other institutions or service
providers
• Status of referral
3.11 DISPLAY OF SIGNAGE AGAINST ABUSE OF STAFF
As a preventive measure, an organisation serving clients with
mental health issues may consider displaying a signage to help
protect staff from abusive clients. For example,
“Dear clients/visitors,
It is indeed our pleasure to serve you.
While our professional team is trying our best to assist you, we
would like to remind you that our staff deserves to be treated
with respect and any clients/visitors acting in a threatening or
abusive way will be reported.
Thank you and have a pleasant day.
<Name of Organisation>”
Chapter 4
RESOURCES:
Mental health services
in singapore
Alzheimer’s Disease Association (ADA)
– Caregiver Support Centre
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
46 Mental Health Resource Kit
✓
70 Bendemeer Road #03-02A Luzerne Building
Singapore 339940
Tel: +65 6389-5121
298 Tiong Bahru Road #03-01, Central Plaza
Singapore 168730
Tel: +65 6593-6440
http://www.alz.org.sg/caregivers/caregiver-supportgroup
Alzheimer’s Disease Association (ADA)
– New Horizon Centre
✓
157 Toa Payoh Lorong 1 #01-1195
Singapore 310157
Tel: +65 6353-8734
1 Jurong West Central 2 #04-04
Jurong Point Shopping Centre Singapore 648886
Tel: +65 6790-1650
511 Bukit Batok Street 52 #01-211
Singapore 650511
Tel: +65 6565-9958
362 Tampines Street 34 #01-377 Singapore 520362
Tel: +65 6786-5373
http://www.alz.org.sg/support-services/dementiaday-care-new-horizon-centres
Apex Harmony Lodge
✓
10 Pasir Ris Walk Singapore 518240
Tel: +65 6585-2265
http://www.apexharmony.org.sg
Caregivers Alliance Limited (CAL)
Blk 707 Yishun Avenue 5 #01-36 Singapore 760707
Tel: +65 6753-6578
http://www.cal.org.sg
✓
Caregiver’s Association of the Mentally Ill (CAMI)
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
Resources: Mental Health Ser vices in Singapore 47
✓
84 Riverina Crescent Singapore 518313
Tel: +65 6782-9371
http://www.cami.org.sg
CLARITY Singapore
✓
854 #01-3511 Yishun Ring Road Singapore 760854
Tel: +65 6757-7990 | +65 9710-3733
http://www.clarity-singapore.org/
Club HEAL
✓
✓
244 Bukit Batok East Ave 5 #01-02
Singapore 650244
Tel: +65 6899-3463 | +65 8400-6306
http://www.clubheal.org.sg
Darul Aman Mosque
✓
✓
1 Jalan Eunos Singapore 419493
Tel: +65 8400-6306 | +65 6899-3463
http://www.clubheal.org.sg
Early Psychosis Intervention Programme (EPIP)
✓
Institute of Mental Health
10 Buangkok View Singapore 539747
Tel: +65 6389-2972
http://www.epip.org.sg
Friendship And Mind Enrichment (FAME) Club
Blk 243 Hougang Street 22 #01-93
Singapore 530242
Tel: +65 6340-4164
http://www.bcare.org.sg/site/?m=100&f=120&p1=9
79871749&p2=38&ty=1
✓
✓
Hua Mei Centre for Successful Aging
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
48 Mental Health Resource Kit
✓
298 Tiong Bahru Road #15-01/06, Central Plaza
Singapore 168730
Tel: +65 6593-9512
http://tsaofoundation.org
National University Hospital
✓
Department of Psychological Medicine
1E Kent Ridge Road Singapore 119228
Tel: +65 6772-4850
http://www.nuh.com.sg/umc/about-us/about-us/
department-of-psychological-medicine.html
O’Joy Care Services
✓
5 Upper Boon Keng Road #02-10
Singapore 380005
Tel: +65 6749-0190
http://www.ojoy.org
SAGE Counselling Centre
✓
1 Jurong West Central 2 #06-04,
Jurong Point Shopping Centre Singapore 648886
Tel: +65 6534-1191 | 1800-555-5555
http://www.sagecc.org.sg
Samaritans of Singapore
✓
10 Cantonment Close #01-01
(HDB Multi-storey Car park) Singapore 080010
Tel: 1800-221-4444
http://www.sos.org.sg
SASCO Day Activity Centre
30 Telok Blangah Rise #01-316 Singapore 090030
Tel: +65 6276-8713
http://www.sasco.org.sg
✓
Silver Ribbon (Singapore)
Complimentary Counselling Service
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
Resources: Mental Health Ser vices in Singapore 49
✓
Tze Hng Wellness Studio
616 Hougang Avenue 8 #01-386
Singapore 530616
Tel: +65 6386-1928
Raintree Sanctuary
550 Hougang Street 51 #01-169
Singapore 530550
Tel: +65 6385-3714
The Linkage
Geylang Serai Community Club,
99 Haig Road Singapore 438748
Tel: +65 6742-4190
The W.A.R.M. Corner
853 Woodlands Street 83 #01-132
Singapore 730853
Tel: +65 6386-1928
http://www.silverribbonsingapore.com
Singapore Anglican Community Service (SACS)
Community Rehabilitation & Support Service
267 Bukit Batok East Avenue 4 #01-206
Singapore 650267
Tel: +65 6562-4881
707 Yishun Avenue 5 #01-36
Singapore 760707
Tel: +65 6753-5311
534 Pasir Ris Drive 1 #01-266
Singapore 510534
Tel: +65 6584-4633
http://www.sacs.org.sg/crss.htm
✓
Singapore Anglican Community Service (SACS)
Employment Support Services
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
50 Mental Health Resource Kit
✓
534 Pasir Ris Drive 1 #01-266 Singapore 510534
Tel: +65 6586-1064
http://sacs.org.sg/employment.htm
Singapore Anglican Community Service (SACS)
Hougang Care Centre
✓
Buangkok Green Medical Park, IMH Block 4
20 Buangkok View Singapore 534194
Tel: +65 6386-9338
http://www.sacshcc.org.sg
Singapore Anglican Community Service (SACS)
Simei Care Centre
✓
10 Simei Street 3 Singapore 529897
Tel: +65 6781-8113
http://www.sacsscc.org.sg/index.php/services/
employment-services
Singapore Association for Mental Health (SAMH)
Bukit Gombak Group Homes (BGGH)
✓
239 Bukit Batok East Avenue 5 #01-165
Singapore 650239
Tel: +65 6564-7003
http://www.samhealth.org.sg/bukit-gombak-grouphomes
Singapore Association for Mental Health (SAMH)
– Club 3R
257 Jurong East Street 24 #01-405
Singapore 600257
Tel: +65 6665-9703
69 Lorong 4 Toa Payoh #01-365 Singapore 310069
Tel: +65 6255-3222
http://www.samhealth.org.sg/club-3r
✓
Singapore Association for Mental Health (SAMH)
Creative Hub
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
Resources: Mental Health Ser vices in Singapore 51
✓
90 Goodman Road Goodman Arts Centre
Block L #01-47 Singapore 439053
Tel: +65 6344-8451
http://www.samhealth.org.sg/creative-hub
Singapore Association for Mental Health (SAMH)
Insight Centre – Counselling Services
✓
139 Potong Pasir Avenue 3 #01-136
Singapore 350139
Tel: +65 6283-1576
http://www.samhealth.org.sg/counselling
Singapore Association for Mental Health (SAMH)
Oasis Day Centre
✓
139 Potong Pasir Avenue 3 #01-132
Singapore 350139
Tel: +65 6283-1576
http://www.samhealth.org.sg/oasis-day-centre
Singapore Association for Mental Health (SAMH)
Support Groups for Clients and Caregivers
✓
http://www.samhealth.org.sg/caregiver-support/
http://www.samhealth.org.sg/peer-support-peerspecialists/
http://www.samhealth.org.sg/support-for-eatingdisorders-singapore-seds/
Singapore Association for Mental Health (SAMH)
YouthReach
Social Service Hub @ Tiong Bahru
298 Tiong Bahru Road #03-03, Central Plaza
Singapore 168730
Tel: +65 6593-6424
http://www.samhealth.org.sg/youthreach
✓
St Andrew’s Nursing Home
✓
60 Buangkok View Singapore 534012
Tel: +65 6880-5330
http://www.samh.org.sg/sanh
Sunlove Home
✓
Buangkok Green Medical Park
70 Buangkok View Singapore 534190
Tel: +65 6387-3548
http://www.sunlovehome.org.sg/ourservices.php
Sunshine Welfare Action Mission (SWAMI) Home
✓
5 Sembawang Walk Singapore 757717
Tel: +65 6257-6117
http://www.swami.org.sg
Tai Pei Social Service
✓
10 Buangkok View
Block 5 Level 5 & 6 Singapore 539747
Tel: +65 6387-4728
http://www.dabei.org.sg/en_02_07_tpss.html
The Salvation Army Bedok Multi-Service Centre
✓
121 Bedok North Road #01-161 Singapore 460121
Tel: +65 6445-1630
http://www.salvationarmy.org.sg
Thong Teck Home for Senior Citizens
91 Geylang East Avenue 2 Singapore 389759
Tel: +65 6846-0069
http://www.thongteckhome.org
✓
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
52 Mental Health Resource Kit
Thrive
✓
Khoo Teck Puat Hospital,
Department of Psychological Medicine
90 Yishun Central Singapore 768828
Tel: +65 6555-8000
http://www.thrive.org.sg
Tinkle Friend
✓
Singapore Children’s Society,
Student Service Hub (Bukit Merah)
91 Henderson Road #01-112 Singapore 150091
Tel: 1800-274-4788
http://tinklefriend.com
Yong-En Care Centre
335A Smith Street #03-57 Singapore 051335
Tel: +65 6225-1002
http://www.yong-en.org.sg
Health &
Community
Elderly
Services
Family
Services
Organisations / Centres
Children &
Youth
Resources: Mental Health Ser vices in Singapore 53
✓
REFERENCES
1. National Research Council and Institute of Medicine (2009). Preventing
mental, emotional, and behavioral disorders among young people:
Progress and possibilities. Washington, DC: The National Academies
Press.
2. World Health Organization (2012). Risks to mental health: an overview
of vulnerabilities and risk factors. Retrieved May 26, 2014, from
http://www.who.int/mental_health/mhgap/risks_to_mental_health_
EN_27_08_12.pdf
Mental Health RESOURCE KIT
G U I D E L I N E S
F O R
C A S E
W O R K E R S
Mental Health Resource Kit serves as a guide to aid case workers
in the mental health community to better serve clients with mental
conditions. It covers essential areas such as:
• The most common mental health issues, and their respective
onset, signs and symptoms, such as depression, anxiety disorder
and psychosis.
• The risk and protective factors of mental health.
• Key recommendations and guidelines for case workers, ranging
from establishing initial contact and managing clients with panic
attack to conducting counselling sessions.
Mental Health/Social Work
Mental Health Communities of Practice supported by Social Service Institute