Madness 3

angry doc nearly missed this letter from Prof Lee, published last week:


Don't be too harsh on families who abandon kin

THE article, 'Long-stay mental patients strain IMH' (ST, June 11), highlighting the plight of patients at the Institute of Mental Health who have been abandoned by their family, paints a sad story, placing the blame on irresponsible relatives and society in general.

Little does the reporter or the lay public know the burden of looking after a patient with chronic mental illness.

Mr Raymond Anthony Fernando's letter, 'Govt support needed to care for the mentally ill' (ST, June 22), is atypical only because he has chosen to shoulder his burden instead of dumping his wife at IMH.

By doing so, he sacrificed a significant portion of his life. His is not the worst-case scenario because his wife has recovered. For the families of mentally-ill patients who do not achieve a remission, the burden can be overwhelming.

While I do not condone the families abandoning their relatives at IMH, I can understand why they do so.

I would like to praise IMH for doing a great job in keeping these mentally-ill patients off the streets and giving them a decent quality of life. The alternative would be to deinstitutionalise these patients, as is the politically-correct policy in Western countries. This would result in many of the patients ending up as vagrants or bag-people, with maybe a few ending up in prison.

We need more chronic stay facilities, not just for chronic psychiatric patients but also adult patients with mental retardation and other handicaps who are now physically too big for their elderly parents to look after; likewise for demented patients who may be difficult to nurse at home.

While we would like the families to take on the care-giving responsibility, as a neurologist I have seen the lives of all the family members ruined by one ill relative, through no fault of their own.

Let's be realistic: If we find ourselves in the situation of these families, what would we do? If I were a patient, I would certainly not wish to burden my family or society. But as a 'First World' society, we owe our less-fortunate members a minimum quality of life with dignity.

Assoc Prof Lee Wei Ling


You can read the article mentioned in the letter here (archived at this site, which aims to 'promote mental illness awareness and fight the mental illness stigma in Singapore).

We've looked at the issue of 'home care' before. As much as we would like to think that a patient is best cared for at his own home by his own family, angry doc believes that in some cases, home care is beyond the expertise and finances of the family.

Is having more chronic stay facilities the solution? Certainly it has to be part of the solution, but angry doc thinks that more importantly, we need to change our perception of what placing a relative into a chronic stay facility means.

If we see placement of relatives not as 'abandonment' or 'dumping', but a means to ensure that they receive adequate care and supervision while the other members of the family can carry on with the other tasks of their lives, it will probably reduce the sense of guilt and resentment experienced by all parties concerned. Placement does not have to mean abandonment, and family members can still visit or even bring the patient (or should I say resident) for home leave when the demands of life are lighter. Options like daycare or home-visitation programmes can also be explored.

It might take a while for us to get there, but when you come to think about it, daytime childcare is already almost universal here.