De-stigmatizing mental illness by adding a human touch

by Debbie Reyes-Coloma, portraits by Nick Tan

The journey for patients dealing with mental illness is a difficult one, as they and their family members struggle to understand and deal with the diagnosis and treatment of their condition. But it is made easier by the compassionate, caring and committed nurses who walk the treatment journey with them.

Age catches up with you faster than you think. This reality hit Kuganesh (Kugan) s/o Suppiah just over a decade ago when he decided to take up nursing after a friend broached the idea.

The thought of going back to school was daunting, as Kugan never liked books very much and was worried he would be exposing himself to jeers from friends. But he was pushing 30 then, and realized he wanted a more stable and secure future.

“I was doing a lot of odd jobs when I was younger. I was also quite temperamental, impatient and not gentle… and I thought that nursing was only for females… and what would my friends think?” Kugan smiles as he recounts the decision he had to make at life’s crossroad.

That was 11 years ago, and Kugan – now a Senior Staff Nurse (SSN) at the Institute of Mental Health (IMH) in Singapore – says pursuing a career in nursing was one decision he has not regretted, because it changed his life.

Making the most of Bangkok’s vibrant street food and nightlife with colleagues.

“Nursing provided me with structure and goals, and IMH is my second home. I am happy where I am now,” he says.

The road less travelled

The eldest of two sons, Kugan was simply coasting along for most of his youth. After completing National Service, he took on various jobs: rubbish collector, cleaner, magazine delivery man and dishwasher, later becoming a pest control officer and then working for a logistics firm.

“I had a lot of dream careers (in mind). I wanted to be an army officer. I wanted to be a flight steward,” says the 39-year-old registered psychiatric nurse. But those dreams did not quite pan out the way he imagined.

Kugan was 28 when he was sponsored by IMH to take a two-year course in nursing at ITE East College to be an enrolled nurse.

After graduating, he joined IMH as an assistant nurse and was posted to a ward to care for long-stay patients.

“I started enjoying the job towards the end of my ITE (programme). I learned a lot. When I saw patients whom I needed to nurse… I realized they were no different from my family members, like my late grandparents,” he says. “I slowly adapted and saw the need for nurses to care for such patients.”

A couple of years later, IMH provided him the opportunity to pursue a Diploma in Nursing at Parkway School of Health. It was challenging but he persevered.

The experience Kugan gained during his clinical attachments in various hospitals while he was a student was invaluable. He was determined to improve himself, and after receiving his Diploma in Nursing in 2011, IMH posted Kugan to its acute psychiatric ward, which became a pilot for the 40-bed Mood Disorders Unit (MDU) a year later. In the MDU, Kugan interacts with patients suffering from a range of conditions including mood disorders and co-morbid anxiety disorders, depression, obsessive-compulsive disorders, bipolar disorders, adjustment disorders and stress response syndrome.

Even though caring for such patients can often be challenging and unpredictable. Kugan feels gratified at the end of the day.

“As time went by, I started to understand that these patients were sick and needed help – that is why they were here. And when they got well, they come by for a visit, sometimes treat us to some snacks and they thank us for taking care of them,” he says. “I feel very good when that happens.”

Kugan (front row, far left) out with friends and enjoying a day at the zoo.

In 2013, Kugan was sponsored for an Advanced Diploma in the Mental Health Nursing Programme at Nanyang Polytechnic and was posted back to the MDU after graduation. Last year, he completed the BCLS (Basic Cardiac Life Support) instructor course. For someone who professes not to like studying, Kugan has accomplished much by attaining three qualifications in less than 10 years. And he is not done yet – he is currently pursuing a part-time Bachelor of Science (Nursing) degree with Queen Margaret University, and hopes to graduate this year.

The numerous professional upgrading courses have equipped Kugan with the necessary knowledge and skills to manage his challenging job of helping patients at IMH.

“It is natural,” he says. “Patients who are mentally ill are fragile and carry the stigma of being ‘different.’” Kugan also has to manage family members who feel helpless when they see their loved ones suffering. “That’s the most rewarding part of being a nurse.”

Kugan encourages young Singaporeans to consider nursing as a career: “If you have the patience, the drive and think you can or want to help people, nursing is a good job for you.”

Kugan points out that other medical professionals, including doctors, respect nurses’ opinions.

“Doctors are willing to accept our ideas and suggestions because we are the ones looking after a patient’s day-to-day health and welfare,” he says. In terms of professional development, there are opportunities available, like going for further studies and participating in outreach programmes, all of which will help make you a better nurse.

Personally, nursing has moulded Kugan’s character. Although his family teases him for still being “short tempered” occasionally, he feels he has more control over it now.

“That character is gone. I have not ‘erupted’ in a very long time. My work has changed me, and I have learnt a lot from my patients,” Kugan says. “Some are very hot-tempered and aggressive, but I realize they have bigger problems than me… and I learn how to cope, too, from them.”

With his wife of four years, Jocelyn. Nursing brought them together in 2008.

Outside the hospital wards, Kugan de-stresses by taking long walks, swimming, and exploring places like parks where he can have some peace.

“I’m more of a nature kind of guy, and I love to travel with my wife, who is also a nurse. Whenever we have a chance to do a short trip together, we take it, mostly to nearby countries,” he says. “We do about six or seven short trips a year.”

Kugan met his wife Jocelyn while they were both doing their diploma studies in 2008. They have been married for four years.

In Kugan’s story, we learn about the impact that nursing has made on him after he made the choice to turn his life around: “It has been 10 years since I started working here at IMH and I am still enjoying it.”

Another nurse’s story

Not all dreams come true. But even if they do not, the ending could still be just as happy. Siti Suhana Abd Rahman once dreamed of becoming a teacher. Instead, she studied to be a nurse… and she has never looked back.

Siti has her persuasive mother to thank, for nudging her towards this path. The obedient daughter, who counts several healthcare professionals among her relatives, now considers her career choice the correct one for her.

“My mother believed that nursing was a noble job, and she wanted to see one of her children in a healthcare profession. I was reluctant at first but I followed her wishes (and) enrolled in the School of Nursing at Outram, which used to be located near Singapore General Hospital, when I was 17,” recalls Siti.

Siti Suhana, at right, unwinding with colleagues during her break.

She grew to love nursing so much that she furthered her studies by taking advanced nursing diploma programmes.

“As a nurse, I’m helping other people. I become an adviser, advocate, caregiver and a teacher to my patients so I am able to do what I’ve always dreamed of,” says Siti, who is a Senior Staff Nurse at the acute female ward of the Institute of Mental Health (IMH) in Singapore, where she looks after women both young and old.

Graduates were assigned postings based on their residential location at that time, and Siti was assigned to IMH when she graduated in 2001.

“I never thought I would be working at IMH for long. But seeing the patients here, some without family care or support, it made me think, ‘If we nurses don’t stay, who will take care of them?’ So I stayed, and mental healthcare became my interest,” Siti says.

Now, the 34-year-old finds so much fulfilment in her work, especially when patients and their family members lean on her for counsel and support.

“It is a pleasant feeling when I see patients walking out of the ward mentally stable. I feel satisfied when patients are able to recognize me even after their discharge,” she smiles. “Some family members also appreciate the extra mile that I tried to go for them.”

People often forget that the patients had a normal life before they were diagnosed with a mental disorder – that they had a home, attended school and engaged in social activities, and that they have parents, spouses, children, and some even pets. To help her understand her patients better, Siti looks at each of them as a person first. Her approach makes it easier to break down walls, and it works; patients open up and let her in.

“It’s when I talk to patients that I learn more about them, like the things they did or their interests. I have seen some patients who were brought and just left here by their parents or by their children. They did not return to visit the patient,” she says. “Even when social workers try to reach the families, they couldn’t.”

Strong friendships are just one of the perks of the job.

Since she joined the acute female ward in 2014, Siti’s work has revolved around preventing, evaluating, diagnosing and treating mental and emotional disorders. Some of these conditions include schizophrenia, bipolar disorder, depression, psychosis, personality disorders and self-harm (suicidal tendencies), among others.

“Some patients will forget their activities of daily living and will be referred to the rehabilitation ward, which provides a comprehensive programme to assist persons with severe and persistent mental illness. These persons have deficits in social functions due to their cognitive impairment. The recovery process focuses on their ability to use alternative strategies to cope with their illnesses, to maintain social relationships and to be gainfully employed,” says Siti, whose particular unit has about 43 patients.

Siti’s hope is for her patients to recover and be discharged so they can return to their families and communities, or at least to a less restrictive environment like a home for the aged.

Outside work, Siti spends her free time with her three children, husband and mother. Once a year, Siti and her husband make time to go on a “honeymoon” trip to celebrate their wedding anniversary.

“Despite my shift work, I always manage to be with my family,” she says. When her children fall ill, her nursing skills come in handy. “I know how to manage them. There is no need for me to be anxious since I can monitor them and will know when it is time to seek treatment.”

If ice-cream makes you feel good, does that mean it’s good for mental health?

Siti applies the same tender loving care to her 61-year-old mother, who was diagnosed with an autoimmune disease last year. A few years ago, noticing that her mom had become lethargic and was losing weight, Siti brought her to see a few doctors. Initially, none of them could diagnose what was wrong.

Undeterred, Siti kept a dedicated watch on her mother for over a year. Her mother developed hyperpigmentation on her face and body and was eventually discovered to have autoimmune disease. (Autoimmune diseases are difficult to diagnose. They cause the immune system to attack healthy cells in the body by mistake and can affect almost any part of the body.) It was thanks to Siti’s close monitoring of her mother’s condition that she received medical attention early. The experience is one of the many reasons Siti feels that it was a wise choice to go into nursing.

“My husband and my mother are my best friends,” she says. “And my indulgences are my kids.”

Looking back, Siti does not regret following her mother’s wishes.

“I feel blessed to have a mother like her, who encouraged me to be a nurse,” says Siti, her voice trailing off as she tries to hold back the happy tears.

While she has fulfilled her mother’s desire for her to be a nurse, Siti’s passion in her work has also made her a shining beacon for others.