IMH chief executive on tearing down
walls and dispelling misconceptions
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Profile of Assoc.
prof/Dr Chua Hong Choon , CEO of Institute of Mental Health (IMH) in the
observation ward of the emergency department.
Tuesday, Sep 03, 2013
The Straits Times
The Straits Times
SINGAPORE - In the main wing of the Institute of Mental Health
(IMH) at Buangkok View is a little heritage garden. It has a display of rusting
padlocks, metal grille doors and barred windows secured onto concrete slabs.
They are relics of the institute's past when it was set up in
1928 as an asylum to provide custodial care for the mentally ill.
They bear grim testament to a time when mental illness was
thought to be incurable and the best recourse was to house the afflicted in a
safe place where they would receive "humane" care.
Whenever IMH's Associate Professor Chua Hong Choon passes this
little walk down memory lane, he visibly recoils.
For the 48-year-old psychiatrist who joined IMH in 1993 - the
year it changed its name from Woodbridge Hospital - and has spent his entire
career there, it is all about breaking down walls.
On the 85th anniversary of IMH, he feels that it has come a long
way from being known as the xiao keng (mad house in Hokkien) of yore. But it
has a longer way to go to shed the stigma and exclusion associated with it.
Since he took on the chief executive job two years ago, he has
got rid of the perspex panels at its outpatient clinic service counters, where
patients once had to communicate with staff through a small hole. They are now
completely open, to "reduce the institutionalised feel".
IMH will soon have a new dementia wing, laid out like an
open-concept home with little nooks and colourful furniture, looking out at a
garden of lantana and lilies. The gentlest of slopes leads down a circular path
to a wooden pavilion.
Some might worry about elderly patients falling down on the
slope. But the CEO prefers to mitigate dangers where possible, but press forth
anyway, to let patients enjoy strolls and fresh air.
The specialist clinic reception, which sees 500 outpatients
daily, used to be encased in concrete. Now it is clad in see-through glass,
where life-size cut-outs of mental patients, who were persuaded to talk about
their illness, are hung up.
Although the stigma is
less now, rejection still awaits many of the 35,000 patients on its registry
upon discharge.
After they arrive
home, their family members sometimes get their MPs to write a letter, asking
why the hospital discharged them so soon.
"Imagine how you
would feel if you got home from hospital after surgery and people say: 'Why did
you come home so early? Who's going to look after you?' " he says.
Often, patients go
home to "mini asylums". Even as he tears down walls within IMH, many
more are built without.
Many are put on
Medifund and relegated to community homes or mollycoddled at home by their
families, exempt from all responsibilities and expectations. "You can
exclude someone with the best of intentions but it's still exclusion."
It is like a remaking
of the old concept of mental illness, he says, where people with mental illness
are seen as "very unfortunate, but since we don't blame them for it and
there's nothing we can do, we will put them in a special place where no harm
can come to them and exclude them from participating in work".
"So we don't
employ them and don't give them opportunity to go to school. Or we treat them
so special that they are completely excluded," he continues.
Wherever possible, he
feels the mentally ill should be included.
They should be
encouraged to integrate in the community and fulfil their maximum potential,
even as they continue with medication and treatment.
His view is inspired
by many of his patients over the last two decades. He darts to his desk to read
out loud a cherished e-mail from a long-time patient who struggled with
depression and mood swings throughout her teens.
She repeated many
years of secondary and tertiary education but never gave up. Finally, pushing
30, she won a statutory board scholarship to study abroad, earned a second
upper honours degree and is now engaged to be married.
He laughs in amusement
when he gets to the part where she admits her condition "didn't get
better" under his care, but "so what", he says, she learnt to
live life to its fullness in spite of her illness. She taught him that people
are capable of much more than they believe.
Patients at centre
Prof Chua started life
sickly and asthmatic but challenged himself to scuba dive and complete three
marathons.
The elder son of a
Malaysian general practitioner father and Singaporean teacher mother lived in
Malacca till he was 13 and came here to study at St Andrew's Secondary School.
He went on to Hwa
Chong Junior College, then read medicine at the National University of
Singapore and chose psychiatry as his speciality after he saw many patients
getting well and staying well.
Shortly after he
arrived at IMH as a 28-year-old medical officer, he discharged a patient who
jumped to his death upon reaching home. He became convinced psychiatry was a
"serious business", very much about "saving lives".
Twenty years on, he is
focused on putting mental patients at the centre of their own care. He is hard
at work trying to reduce IMH's re-admission rates, shorten hospitalisation
stays and ensure new patients do not turn into long-stayers.
IMH has a bed capacity
of 2,000, with about 1,700 patients warded at any time. Two-thirds are
long-term residents who cannot be discharged because of the severity of their
condition or loss of all social contact.
About a fifth of these
long-stayers are above 70, largely "inherited" from the hospital's
asylum era and who have known no other life outside. A handful are above 90 and
will likely die within its walls.
But he wants to debunk
the conventional thinking that mental patients are "different from other
patients" and "can't possibly know what they want".
"If we see our
patients who suffer from mental illness as different from other people who
suffer from other illness, it's a wrong start. I always believe that you see
what you want to see. At the root of it, they want nothing different from
anybody else. They want to have security, healthy relationships, a meaningful
existence."
On a one-on-one basis,
he says most of his 2,200 staff connect with their patients as individuals. But
when they organise themselves to deliver a service, he feels not enough room is
made for patients to have a voice.
So he is changing that.
He has stepped up
focus groups to get feedback from patients and their families. Beyond asking
about the state of facilities, he makes it a point to ask what patients hope to
see in their own recovery.
"The focus is not
about what can we do better but what we can do to help you do better," he
says.
Next month, IMH is
organising its first Singapore Mental Health Conference, together with the
National Healthcare Group, that will see public and private sector
psychiatrists, voluntary organisations and policymakers, as well as patients,
giving talks.
In December, the IMH
is also putting up a play written, performed and produced by volunteers, staff
and patients, in celebration of mental health care. It also has a 15-strong
patients' choir - a third of the singers are long-stayers - called the VSOP
(Very Special Outstanding Performers), which regularly performs at civic
events.
Inclusion advocate
Beyond making hardware
changes, he is also working on changing IMH's software and the way it works to
deliver more customised care.
To prevent discharged
patients from feeling lost between appointments, he has explored ways to keep
in touch by getting a case manager to call them at home, a community nurse or
volunteers to visit, or linking them up with community agencies to provide
support to their families.
To make it easier for
the mentally ill to seek help early, IMH is training neighbourhood GPs and
polyclinic doctors to diagnose and treat common mental health problems. Over 50
GPs have since seen 1,300 of its more stable patients.
He is also working at
turning on its head the "doc-patient" relationship of old, where the
doctor was the "know-all, be-all, end-all of everything" and decided
everything.
He is now setting up
smaller, multi-disciplinary teams centred on each patient, led not necessarily
by the doctor, but often the nurse, case manager or patient himself.
For example, he
launched the Mood Disorder Clinic in 2011 for those suffering from depression,
bipolar disorder and anxiety.
Patients now receive
more coordinated care from a team of psychiatrists, case managers,
psychologists, medical social workers, pharmacists and occupational therapists,
who meet weekly to discuss and review their cases.
The end goal he is
trying to achieve, he describes, is when "patients are actively
participating in their own care, in the way we organise our services and
sitting on some of our committees".
He wants IMH to be a
leading centre for mental health care, doing teaching and its own research,
providing the latest treatments and trying the newest ways of delivering care.
Former schoolmate
Adrian Wang, 47, a consultant psychiatrist at Gleneagles Medical Centre,
believes he will get there. "I have always known him to be a determined
person with a sense of mission. Once he sets a target for himself, he aligns
everything around him to make it happen.
"He is neat and
meticulous, to the point that we used to joke that he was almost OCD-like
(obsessive-compulsive disorder), with his pens and pencils placed neatly in a
colour-coordinated row.
"It is this
attention to detail that makes him good at what he does. He thinks through the
problem from all angles. He is able to see things from both an analytical and
emotional perspective."
So it is with Prof
Chua's unswerving conviction that "all are capable of change, even in the
most difficult and unlikely circumstances", that he presses on, following
his patients' lead.
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