A Day in the Life: Working with youth with mental illness
December 8, 2016
Interview with a Senior Social Worker
Ms Christine is a Senior Social Worker at YouthReach, SAMH. She works with youth who have psychological or emotional issues aged 12 to 21 years-old. Her clients live with a range mental illnesses, including depression and anxiety. Social workers like Christine work closely with the youth and their families, to reintegrate the youth back into the community. Read on to find out more about what working with the youth is like, the challenges they face and what YOU can do to help!
1) Tell me about a typical day in your job.
In the mornings, we will come in and do our usual paperwork (groans and laughs). Subsequently, we meet up with the youth for 1-on-1 sessions, go for home visits or accompany them on medical appointments. We try to keep updated on any medication changes and work with the family to get feedback on how the client is doing. Usually the family is quite busy, so these sessions are also our only opportunity to ‘psychoeducate’ the parents about the client’s condition and teach them about stress management. Other time is spent liaising with the school or the employer, or linking the older youth up with vocational institutes to find jobs.
We will stay with the same client throughout their journey at YouthReach, until we feel that they have reached their ‘goal’ (set by themselves) or that our services do not cater to their needs any more- then, we will discharge them. During my 5 years here, I have had some clients who have been with me the whole time. For us, building a good relationship and rapport with our client is very important, and we try to reach out to them on a regular basis.
2) What drew you to work with people with mental health conditions?
Before I came to YouthReach, I had worked for 2 years with the destitute and elderly with mental health conditions. It was by chance that I ended up working in mental health sector. I had started out as an architecture draftsman, but I felt that I wanted to do something more meaningful with my life and started looking for jobs with more of a ‘human touch’. I did not know anyone with mental illness before I started working at the elderly home, and most of what I knew came from the media.
“People with mental illness always seem to be featured only when they have done some crime or shown some aggression, so to be honest, I had that in the back of my mind. But I really wanted to try social work, so when the position opened up, I tried to come in with an open heart and wanted to learn more.”
What I found was that the elderly patients with mental illness were very caring, sweet and understanding people. It broke all thoughts of them being aggressive or violent. I started to see a change in my thoughts and perspectives and began to form strong bonds with them. Every day, my goal was to make them happy and to see them laugh and smile.
Similarly, when I came to YouthReach, I realized that these youth with mental health issues are very vulnerable. Unfortunately, the stigma in the community is still high, and I feel that they are often neglected. It awoke a passion in me to come and serve them. I hope that I can do my small part for these youths and their families.
Truthfully, sometimes the caregivers come to me exhausted and I am at a loss of how to help them- there isn’t always a solution to the problem… but I find that just letting them speak up and showing them that someone can relate to their problems, makes them feel better.
3) What do you love most about your work?
Paperwork makes me feel tired, but when I start speaking to my youth and brainstorming how to help them, I suddenly feel very energetic! (laughs and then sobers down) Seeing that my youth are moving slowly, but surely, forward-
“People forget that they are normal teenagers, just with an extra illness. They go through the same stages and problems as other teenagers- relationships, quarrels with their parents, puberty-often, a lot of things are going on for them at the same time. Yet, just because they have a mental illness, their options are often restricted.”
I want to reduce stigma and increase the opportunities available for them. Thankfully, I would say there are more things being done to help this group now, which is encouraging to see.
Otherwise, my work has also given me exposure to a whole different side of life. From my clients and their families, I have learnt a lot of things and it has made me more mature. It has helped me in my personal growth and changed my perspective a lot.
4) What is the most challenging part of your job?
(laughs) Wah got so many!
Sometimes, it can be frustrating when caregivers seem to “work against” the progress of the client. Either they get so protective that they don’t want us to push the youth, or they give up hope completely and label the youth as ‘he/she is always like that, don’t need to try’. It can be hard to motivate the client to find work or go back to school after that.
Other times, the youth ‘self-stigmatize’ themselves. They have a lot of self-doubt about whether people can accept them and whether they will be able to work etc. Small successes, like being able to hold down a job for a while, really helps to boost their confidence, but this confidence is fragile. From previous experiences, they have already pre-labeled themselves as ‘inferior’ and tend to look at the negative side of things. It’s a big problem because whatever they do, they will still feel like they haven’t achieved anything.
In addition, there can be prejudice and misunderstanding from the community. Once, one of my youth with schizophrenia was trying to apply for a course. During the interview, the interviewer suddenly turned to me and asked whether the client would turn violent or aggressive, since she had schizophrenia. I was so mad, I told the interviewer off.
“Just because someone has schizophrenia doesn't mean they will turn violent- you cannot label everyone like that.”
5) From your experience, what are the main difficulties your clients face?
Social skills are a really big issue. They lose a lot of their life skills from lack of communication with others.
Also, many of them lack motivation and drive. They can tell you their goals but they tend to lose hope along the way. I have had clients tell me ‘I do so much for what? I have nothing ahead of me.’ Sometimes, it is because there is not enough encouragement coming from the important people in their lives, but other times, it can be the features of the illness itself. For example, in schizophrenia, part of the illness is a lack of motivational drive. For depression, there is a lot of negative thinking.
6) How do you work together with the client to overcome these challenges?
We conduct sessions to teach them about communication skills, where we act as role models, showing them how to interact with others. When they first start, a lot of them are in denial and don’t want to participate, but when they become more comfortable and feel safe, they begin to interact with the other youth.
“Some of them feel that they have nothing worth sharing and so don’t speak- we have to build up that confidence that what they have to say is worthwhile.”
We also work with the youth to set goals for themselves. A lot of them are still young, so for them their goals are mainly on the education part. Some of them have had to stop their education for years because of their illness and they have trouble getting back to school. For others, their illness may make it hard to concentrate during lessons. At the back of their mind, they know that Singapore places a lot of emphasis on education, so they want to sit for the ‘N’ levels or the ‘O’ levels. We try our best to work with them to make this happen.
When they get older, a lot of their goals become directed to ‘will I be able to work’. They become uncertain and we prepare them with job training at Singapore Association for Mental Health's (SAMH) Mindset Learning Hub. There is also the issue of ‘should I reveal that I have mental illness to my employer?’ because there are consequences either way. We work with the youth to discuss the pros and cons of revealing/not revealing and then let them decide. Sometimes we will work with the employer to help them understand the client’s condition better- this way, they can be more understanding and provide appropriate accommodation to the client. But we understand that the employers have their own targets and limitations so we also speak to our youth to make sure they understand the employer’s expectations. We have to educate both sides in a sense.
We also hold family sessions to discuss with the family what the youth’s goal is and to look at how to support them. We hold family workshops, where we get guest speakers to come in, or have family night, where there is dedicated time for the family to bond. We also have a caregiver support group under SAMH, where the caregivers have a venue to get support for themselves or learn new ways to care for their loved ones.
7) How do you think we, as a community, can better support youth with mental illness?
“We can spread the word about it.”
When I first tell people that I work in a mental health field, they ask ‘dangerous or not?’. If you know someone with mental illness, you should tell others what he/she is actually like. Social media now has a lot of good interviews and videos on mental illness, so if we can get more people to view these, it would be good.
“I think that if the community is willing to give them a chance, they would realize that the majority of people with mental health conditions are just like you and I- don’t just judge them based on the one or two people you read about in the newspaper who have done something bad. The most important thing is to open your heart.”
Also, language is important. For example, people call clients ‘schizophrenics’ and we need to remind them- they are not ‘schizophrenics’, they are ‘someone with schizophrenia’. It seems like a small thing, but it means they are an individual by themselves. Hopefully, if we can change the language, it will give the community an opportunity to know the individual before they judge the whole group.
I also think it would be good to put more focus on early intervention. For example, if more education was given to the public on what are the early signs and symptoms of mental illnesses, then friends and family would be able to look out for the youth and get the help that they need earlier.
8) On an individual level, what’s the best way to support someone you know with mental illness?
Be patient. We may ask what is happening but the person may not want to reveal it just yet. Assure them that you will always be there, and that when they are ready, you will be there to listen. If there are other family members or friends who may not understand why the person is behaving like that, speak up for the youth and explain to the others that the person needs more space and time to open up.
“Avoid trying to ‘fix’ the person. Believe in the client and give them the time to get better.”
If you are a caregiver, understand that it won’t get changed overnight, that medication takes time to work and that there is no point hopping from psychiatrist to psychiatrist, looking for a ‘quick fix’.
You may feel guilty that you didn’t spot the illness earlier or that you couldn’t do anything about it. Try not to get overprotective as this puts the youth in control of the dynamic, which is not good. Acknowledge your feelings of guilt, but then try to look forward.
“Think about how you can support the youth now, rather than look backwards at what could have been.”
As social workers, we don’t get to see the child as often as the caregivers. Ultimately, a lot of how much progress the youth makes comes down to how you decide to interact with the youth.
If you are a caregiver, make sure you take some time for yourself.Take care of yourself because if you fall ill, who will look after the youth? You are being a good role model to the youth too, when you practice good self-care.
Finally, if you pick up that something is really not right with the youth (especially if it involves safety or harming themselves), you need to take the initiative to get them the help that they need.
Thank you for sharing your experience with us!
YouthReach is currently the only center in Singapore that caters specifically to youth with mental illnesses. They have various opportunities available for volunteers who would like to make a difference in the youth’s lives, ranging from tuition services (to help the youth reach their educational goals), to helping facilitate/conduct skills workshops (like learning a musical instrument, baking, cooking etc). If you are interested, please drop an email to YouthReach at firstname.lastname@example.org or email@example.com.
Thank you for taking the time to learn more about mental illness- please help spread the word!
Team Mental Muscle
Let’s change the way we view mental illnesses today!