By Acmad Toquero Macarimbang
Culturally-appropriate tools and informal support networks are lacking here, with the medical scene overshadowed by Western psychiatry
While treating mental disorders is in itself a challenge, encouraging access to the treatments has proven to be the bigger challenge.
The reality is, a majority of those who suffer from mental disorders here do not seek or receive help – which is surprising for a country like Singapore, where modern mental health programmes, services and platforms are readily available.
There have been increased efforts to provide such services and programmes especially in light of the ageing population, and pressures from work and family. Such efforts, identified in the National Mental Health Blueprint for 2007-2012, include (among other things) public education, outreach in schools, workplaces, integrated programmes such as the Community Mental Health Team and Mental Health-General Practitioner Partnership, and mental health research.
Yet, a 2012 study on where those with mental disorders in Singapore go to for help found that only a minority actually access these services, while more than two-thirds of those with a lifetime mental disorder had not sought any help.
Contributing factors include low education, low income, cultural beliefs, shame, the inadequate number of culturally-competent mental health professionals, language barrier, value conflicts with service providers, non-familiarity with the Western mental health services, preference for informal social support, and negative attitudes toward seeking psychological help.
OF BOMOHS AND CULTURAL FACTORS
Take the case of Singaporean Malays for instance – they are significantly more likely to give a better rating of their mental health status, have a lower overall perceived prevalence of mental illness, and are less likely to be affected by stigma compared Chinese and Indians.
As such, the Malays are significantly less likely to report mental health problems or consult professionals (claiming they offer little help), and believe that medication does more harm than good.
Most also face financial constraints accessing health care services. Instead, as another study in 2000 found, many Malays still turn to spiritual or traditional approaches, particularly the bomohs (spiritual healers), which may be attributed to indigenous Malay belief in supernatural causes.
As such, it is important to understand the cultural background of patients. Unfortunately, culturally-appropriate instruments and informal or alternative support networks are lacking in Singapore, with the medical scene being overshadowed by biological psychiatry.
WHERE FRIENDS AND FAMILY COME IN
Experts have identified the role of friends, family and community as preferred sources of help when depressive symptoms are attributed to psychosocial factors. Family and friends are crucial support mechanisms – more so because the de-institutionalisation of care for people with mental health problems is a world-wide trend.
This decentralisation has seen a large number of patients with chronic mental disorders returning to their family, who do not complain despite the stresses of care. (One alarming fact is that more and more Singaporeans are developing mental health problems at a very young age.)
Religious and spiritual healers are a relatively important source of help. How an individual’s problems are perceived is influenced by social, cultural and religious factors. Particularly in Malay society, with the prevalent extended family system, most studies have observed that the strength of the social support, as well as relatives’ belief in supernatural causes of mental illness, are strongly associated with the decision to seek treatment with a bomoh rather than Western psychiatric treatment.
Cooperation among these groups is important: Bomohs should accept their limitations with regard to psychotic illness, and be aware of which cases are best managed by psychiatrists.
The authors of a 2010 study, ‘Perceived stigma and coping strategies among Asians with schizophrenia: The Singapore case’, state that without adequate community support and a mental health-friendly policy to complement professional help, patients may end up in social isolation, committing crimes and behaving antisocially, posing a social problem to the community.
Perhaps, among ourselves, a good start is to avoid stigmatising these patients. Prejudice and discrimination can have an extremely crippling effect on them, their family and friends. Most importantly, more credit and recognition should be given to mental health workers and patients’ families and friends.
Acmad Toquero Macarimbang is a Research Associate with the Centre for Research on Islamic and Malay Affairs. He visited Club HEAL, the only volunteer community organisation in Singapore that assists persons with mental disorders in the Malay/Muslim community towards reintegration.
This commentary was also published in TODAY online (13 October 2013).
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