Improving elderly residents' health, from the ground-up

To help residents with mental health issues, 10 more estates will come under a multi-agency community support network by year-end. We go behind-the-scenes to find out how volunteers reach out to elderly residents.
By Sara Grosse, Channel NewsAsia, 17 May 2015

To help residents with mental health issues, 10 more estates will come under a multi-agency community support network by year-end.

There will also be more Community Resource, Engagement and Support (CREST) Teams to support elderly with dementia and depression in the central and western part of Singapore.

VOLUNTEERS HELP SUPPORT ELDERLY WITH DEMENTIA, DEPRESSION

A group of volunteers prepare for their weekly house visits, sometimes at 8.30 in the evening. They come from all walks of life, be it civil engineers, architects, students or retirees, but have banded together to help residents in the Kembangan-Chai Chee estate who may suffer from mental illnesses.

The area is one of the constituencies where a Local Community Support Network has been established.

The Support Network is a collaborative effort between the Agency for Integrated Care (AIC), Government agencies, healthcare institutions such as the Institute of Mental Health (IMH), grassroots and community partners. They all work together to identify healthcare needs of residents within each neighbourhood and refer cases if necessary. It is hoped that this network will raise awareness on mental health issues in the community to better support at risk residents.

Ms Eileen Teo, a multi-capacity Community Volunteer in the Kembangan-Chai Chee estate, said: “The prominence of the team going around the blocks, door to door, block to block, combing the area itself brings the awareness to the residents around – awareness like, for example, some of them they actually identify and let us know which are the units which are having a problem of this sort.”

“And a lot of it is through word of mouth, the residents convey the information to us that certain families or certain units of this block may need your assistance, may need the team to come in,” she added.

Since the network was established in Kembangan-Chai Chee in 2013, over 50 residents have been helped in this estate. The volunteers are trained by AIC and IMH to identify various kinds of mental illnesses.

IMH is one place where they are given this support. The institute provides basic and skills-based training to grassroots leaders and volunteers on how to communicate and manage a person who may be aggressive or suicidal.

Dr Lee Cheng, the Community Mental Health Team’s programme director at IMH, said: “The training is to equip them with better understanding and also a skills set to address some of these concerns. We do not want them to be treating them. After all, they are grassroots. So their role is to identify and make the necessary referral by maybe encouraging the family members, the residents, so that a person identified can get help earlier.”

To make the process easier, community partners of the Local Community Support Network can call IMH's 24 hour helpline once they identify a resident who needs assistance.

So far, more than 20 constituencies have joined the network. By 2017, there are plans to engage 50 areas, with 10 estates coming on board by the end of 2015. These include Hong Kah North, Tanjong Pagar-Tiong Bahru, Marsiling, Teck Ghee and Tampines. The estates are likely to have a higher concentration of elderly.

GREATEST CHALLENGE IS PERSUADING RESIDENTS TO SEEK TREATMENT: DR AMY KHOR

Senior Minister of State, Ministry of Health Dr Amy Khor said one of the greatest challenges is to persuade the residents, together with their caregivers or family, to be supported and to seek treatment.

“Another challenge that we have found would be in communication and sharing of information across the different stakeholders. That can be improved. And the Local Community Support Network is one useful platform to enhance communication and sharing of information among the different agencies, so when a case is surfaced, they are aware of the case, they can discuss how best to address and manage the case,” said Dr Khor.

In some ways, the network also helps to manage the demand on healthcare institutions by having grassroots leaders identify illnesses early. Dr Khor said: “They can refer them for appropriate care. They can refer them to community based care. For instance, to the general practitioners who have been trained to manage patients with mental illness for consultation, instead of going to the Specialist Outpatient Clinic."

The Government is also beefing up community support for residents facing dementia and depression.

Since 2012, Community Resource, Engagement and Support (CREST) Teams have been embedded in several estates to link residents to the appropriate mental health care networks. There are now eight CREST teams which are located in areas such as Bedok, Toa Payoh, Yishun and Chinatown.

By 2017, the Government hopes to triple this number – from eight to 24 – with 10 CREST teams set up by end-2015.

BEHIND-THE-SCENES WITH THE CREST TEAM

Senior social worker Mark Lin is in charge of the CREST team located at Marine Parade, where he conducts monthly house visits. During his visits, he typically asks seniors a series of questions, such as whether they can remember their home address or if they are able to count backwards easily. Their emotional state is also assessed.

If the resident is identified as being at-risk of dementia or depression, Mr Lin will refer him to a hospital or to relevant counselling services.

Mr Lim, who is also a Senior Social Worker with Goodlife!, Montfort Care, said it is less daunting on the resident when they think of seeking help as understanding themselves a bit better.

“Then (they may think) if I really cannot cope, then I know someone is there for me to link, at least they can help me to navigate the system so I can get the resources that I need,” he said.

In the past three years, 139 residents in Marine Parade have been identified as at risk of depression, and 57 with dementia.

Going forward, the community outreach team hopes to be able to expand its scope of identifying other types of psychiatric disorders, such as schizophrenia or even hoarding behaviour. It also hopes to strengthen its intervention methods by collaborating with other partners.

"We feel it is important for early identification of mental health conditions, dementia and depression, and other conditions. And for follow up, for support and for linkage to appropriate resources because many of these patients or even their caregivers, may not be able, or are unable to recognise early symptoms. And many may also not know where to seek help,” said Dr Khor.

RAISING AWARENESS ON PREVENTIVE HEALTH

Beyond support for mental health, there have also been efforts to raise awareness on preventive health.

Mdm Wong Kwan Wah, 70, recently enrolled in a wellness programme in her neighbourhood, where she attends health talks and also learns how to cook food which can help lower her high blood pressure.

“I have learned to cook some healthy food like porridge, vegetables, oats and fish, and I cannot eat oily food. So now when I visit the doctor, my blood pressure measurement is quite good,” she said.

The wellness programme is part of a partnership between the National Healthcare Group (NHG) Polyclinics and grassroots organisations of Nee Soon South constituency to provide services such as dietetics and clinical diagnosis to the elderly. The polyclinics regularly engage grassroots and community partners to understand and identify the health needs of residents.

The initiative has helped to reduce reliance on the acute care sector.

Dr Doraisamy Gowri, Family Physician, Senior Consultant, Regional Director, Primary Care, Transformation Office, NHG Polyclinics, said: “To have a patient come in who is engaged about taking care of his own health and is very much aware of what his health needs are and is proactive to do the right thing and has the knowledge of what health promotion is all about, when he steps foot into the polyclinic or hospital, you already have half your battle won, because he comes in well-informed.”

“And it will help to reduce our attendances, in the sense that when they do come in we know they are coming in for a real reason, and there is a real need for us to see them there because up to that point they have don't everything right to take care of themselves,” Dr Gowri added.

At the end of the day, healthcare professionals agree that a ground-up effort is needed to improve the health of residents. They said relying on the government and social service agencies alone is not enough as grassroots organisations, neighbours and caregivers are needed to access the community. Only then can the community effort be truly sustainable.