A Day in the Life: Reclaiming the identities of those with mental illness
April 23, 2017
Ms Linda Chua is the Senior Occupational Therapist who works at Creative Mindset, an activity centre that utilizes arts and crafts to encourage mental wellness - it is open to clients of SAMH as well as general members of the public who are interested in arts. Besides her role at Creative Mindset, she also works at Activity Hub @ Pelangi Village.
1) Tell me about a typical day in your job.
As an Occupational Therapist (OT), I conduct group and individual sessions. During group sessions, we use arts and craft to engage clients and let them explore.
Individual sessions are focused on identifying and working towards their individual goals - these are usually related to the roles that the person wants to do. For some, it can be going out to work, for others, returning back to school. My job is to help them identify what are the skills they need in order to do the daily activities required for that role, and then train them in those skills.
2) What drew you to work with people with mental health conditions?
I’ve been an OT for 7 years. Even before I entered OT school, I had an interest in human behaviors and psychology. It started from there. Then as an OT student, I was always excited about the mental illness case studies and modules. When I was finally posted to IMH and got my first ‘real’ interaction with the patients, it was a confirmation that this was what I wanted to pursue. But it was only after working for couple of years that I could appreciate the unique needs this group of people have.
3) What do you love most about your work?
Firstly, being an OT allows me to interact with people, which I love.
Secondly, I like seeing people go back to doing the things that make them happy - like hearing that the aunty with the stroke is able to go back to her house to do simple chores. It may seem small but people’s roles are their identity - when they get sick and lose their roles, they also lose their identity. As an OT, if I can help them, even a little bit, to reclaim that role or explore what they are now good at (post-illness), then I am happy because it empowers them to be who they really are.
Wall of expression at Creative Mindset
4) What is the most challenging part of your job?
There are service gaps in the system. For example, I once had a young client with a dual diagnosis. He ended up having to stay in a welfare home which has majority of the residents in middle age and above. Thus, he could not relate to most the residents and had few whom he could call friends. There were also much difficulties finding an alternative accommodation in view of his age and dual diagnosis, because there were strict selection criteria and other considerations from the various agencies.*
*most institutions and centres have strict selection criteria about the client profile they accept (specific mental conditions, age groups etc.). Patients who have complex cases, such as multiple diagnoses or social issues, often fall outside these system and have difficulty being accepted into programmes.
5) From your experience, what are the main difficulties your clients face?
A lot of my clients become ill in their late teens or early 20s. With mental illness in general, the earlier the onset, the worse the prognosis.
Imagine you are 15 years-old and in Secondary 3. Your brain development, cognition, social skills, understanding and living skills have only reached a certain level - then you get psychosis and your development is interrupted. This could be from deterioration because you are not using the skills or it may be you never had opportunity to experience certain things at all. You have spent your teens going in and out of hospital and are now in your 20s. You may not know how to cook your own meals or plan things. You’ve had no place to practice your social skills and you’ve lost touch with your academics. Your memory may have suffered because of the psychosis and as you get older, it just gets harder and harder to learn new skills.
Another challenge is finding suitable work for residents. First, there is the issue of opportunities. Nowadays it is better and people understand more about mental illness but it is still hard to find opportunities for people who are recovering. Many of them end up doing cleaning, F&B and clerical work. These are good, but there are a lot of other types of work they can actually do!
Other times, it is not just the limitations imposed by employers but it’s what the client wants and what they are capable of. Just like anyone else, we have to match the client’s interests, skills and salary expectations with the work that is available.
6) How do you work together with the clients to help them reclaim their lives?
First we do an assessment and identify the client’s goals. What is the role they want to return to and what are the skills they will need for that role? Then we do skills retraining or sometimes teach them from scratch.
For example, I had a client who missed school for 2 years because of his illness. His goal was to be able to support his single-mother when he became older. He realized that in order to get a job, he would need proper qualifications and so he decided he wanted to return to school. In this case, he wanted to go back to the role of a student so we had to train him on the skills of dressing appropriately and following a routine. After spending 2 years at home, his routine was messed up and he wore t-shirts and shorts to everything. For the dressing, I first had to educate him that there were different occasions that required different clothing choices. I showed him pictures and asked him what he thought was appropriate. After that, we usually bring the client out to buy what they need. We also knew that going back to school meant he would have to follow a schedule, so we tried to first establish a routine at home by doing Activity Scheduling.
Oftentimes, we work with the significant people in the client’s life to help educate them on the persons condition and get their help to reinforce what we have taught them. In this case, his mum played an important role to make sure he took what he was learning in the sessions and applied it to his home life and school.
Some of the Client’s works-in-progress at the art studio
7) How do you think we, as a community, can better support them?
Aside from obvious stigma, even those who try to be ‘accepting’ should be mindful. Some of these people have certain ideas about what clients with mental illnesses are like so they think ‘I must be accommodating, I cannot provoke them, I must accept them’. But even this is a stigma as you are still putting them in a box. A lot of people with mental illness are just struggling to find a place of where they belong or who they should be.
Just like physical disability, although we say we want to treat people with mental illness the same but the very fact is they are different. We should celebrate difference but still see them as a whole person and not just the illness. For example, if I dye my hair blue, my hair is different from yours. But my hair is just one part of me - I am also an OT, I work at creative mindset - there are so many other parts of me.
We can consider ‘Reasonable Accommodation’- it’s not giving special privileges but understanding the individual and modifying the environment a bit to give them a chance to perform better.For example, can we seat the client who has difficulty concentrating right at the front of class instead of in the middle, where he gets distracted. Work wise, can we work together to create a routine for the client trying to rehabilitate back into his job?
It is also important to introduce the concept of ‘recovery’ for mental illness. I always say mental illness is a bit like having Diabetes- your Diabetes cannot be cured but it can be managed and controlled. Mental illness is the same - it is an ongoing thing but it can be managed. There are times when things will go up and down but there are also times when you can bounce back to functioning. Peer specialists are living testimonies to how recovery is possible - they should be given the opportunity to share their stories with more people. Health professionals too can share their testimonies - we work with the clients and see the recovery journey first hand. We can provide another perspective to tell people that it is a process but that it is possible.
Finished works displayed proudly
8) On an individual level, what’s the best way to support someone you know with mental illness?
Get to know them as just another person first. If you think ‘how should I treat someone who has mental illness?’ then you are giving yourself too many things to consider. After you know someone, it will come naturally - what the best way is to interact or support the person.
Try to understand what stage the person is at and what the person needs. Different people are different. I have a friend who is still in the process of recovery. First, I let her know that I was here for her - that if she needed help, she could ask for it. She likes to cook so a couple of friends would cook together and engage with her that way. When she was comfortable enough to share with me about her medication, I would just ask how things were working out. And we know what her triggers are so we try to avoid them. But let’s say you don’t know what to do - then just try to be patient with the person. If they make mistakes here and there, be gracious about it. They may not know yet what they want or they may still be trying out new things in working to recovery. Observe what stage they are at. If they are really struggling or suffering a relapse, then seek help.
Thank you, Ms Linda, for your wonderful insights into the unique loses that client’s face during their illness and for explaining how occupational therapy helps them reclaim the roles that are so important to their identity!
Central workspace at Creative Mindset
If you would like to volunteer with Creative Mindset, previous volunteer sessions have included activities such as dance, photography, water color, piano and soap making sessions. They are open to suggestions so if you are passionate about creative expression and are keen to help teach a skill to our clients then please contact firstname.lastname@example.org at Insight Centre!
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!