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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 transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise without the prior written permission of the publisher. Limit of Liability/Disclaimer of Warranty: While the writers and the publisher have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties or fitness for a particular purpose. The writers and the publishers shall not be liable for any loss of profit or any other personal or commercial damages, including but not limited to special, incidental, consequential, or other damages. 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