Community care: How one man managed his agoraphobia without hospital treatment

Straits Times

25-05-2025

Agoraphobia is a disorder characterised by symptoms of anxiety in situations where the person perceives their environment to be unsafe, with no easy way to escape. ILLUSTRATION: SOH HWEE YI, ADOBE STOCK
No health without mental health Community care: How one man managed his agoraphobia without hospital treatment
SINGAPORE - After working from home as a call centre operator for four months during the Covid-19 pandemic in 2021, Mr Mohamed Rashath Mohamed Riyad stepped out of his family's Housing Board flat to go to his workplace, and found himself breaking out in a cold sweat.
The sweating continued as he took the lift to the void deck and walked to the nearby MRT station. It left the young man, who is now 24, slightly confused as it was not a warm day.
While waiting for the train, he felt a little woozy. And the train, when it came, was packed.
'I was near the door and then, everything became blurry. I couldn't quite breathe,' he said.
He scrambled to get off at the next stop. His heart was racing, and he felt like he would pass out.
Mr Rashath, an only child, called his mother. They went to the polyclinic near their home in Kallang, thinking it might be long Covid, as he had had a recent bout of Covid-19. The doctor there gave him flu medication and told him to monitor his symptoms.
The next day, he took a cab to work, only to find the symptoms returning once he stepped out of the vehicle.
His company consented to him working from home, but it did not solve his problem. The rapid heartbeat, shortness of breath and cold sweat would return each time he tried to leave his home. It left him more and more unsettled and in low spirits.
'I love to drive, but I couldn't drive. I couldn't exercise, go out, bowl, cycle.'
After two months, he sought help again and was referred for a heart scan. When that came back clear, the polyclinic referred him to the Institute of Mental Health (IMH).
In April 2022, about five months after his symptoms first surfaced, an IMH psychiatrist diagnosed him with agoraphobia, a disorder characterised by symptoms of anxiety in situations where the person perceives their environment to be unsafe, with no easy way to escape.
'When I was first diagnosed with it, I was super depressed, I had no mood to do anything, no appetite. I didn't eat anything for two days,' he said.
'I was thinking: Why is life so difficult? What's going to happen to me? It took me a while to accept it as agoraphobia,' he said, adding that his mother, 59, an operations assistant, was 'shell-shocked'.
His father, 55, a supervisor, could not understand how his son was so affected.
But Mr Rashath was determined to do something about his condition. He stopped working to focus on his recovery.
IMH referred him to Viriya Community Services, a social service agency with a centre located in Potong Pasir, where he met Dr Timothy Singham, a clinical psychologist, in June 2022.
Over the next eight months or so, Dr Singham treated him using cognitive behavioural therapy – a proven type of psychotherapy that helps individuals manage their mental health difficulties through changing their thoughts and behaviour.
Their sessions took place mostly outdoors – in the HDB neighbourhood near Viriya's centre in Potong Pasir, at Potong Pasir MRT station, and at the bowling alley that Mr Rashath used to frequent.
At these outdoor therapy sessions, Dr Singham helped Mr Rashath understand why he experienced certain symptoms, and how exposing himself to situations that trigger fear would help him overcome them. He found the therapy so helpful that he was able to stop taking the antidepressant medication he had been prescribed by IMH.
Mr Mohamed Rashath Mohamed Riyad (left) with Dr Timothy Singham.
ST PHOTO: DESMOND FOO
Dr Singham said agoraphobia is an anxiety disorder that is often best treated in the spaces where the individual experiences feelings of being trapped, helpless or embarrassed.
But there is a shortage of trained clinical psychologists who can work with patients in the community using such evidence-based treatment methods, said Dr Singham, who had prior experience treating individuals with agoraphobia in Britain, where he was clinically trained.
That could change, as Singapore focuses efforts on improving community support for people with mental health issues. The pandemic shone a spotlight on mental health as an area that needed more attention.
The Ministry of Health (MOH) is expanding the community-based mental health support teams – Community Intervention Teams, and Community Resource, Engagement and Support Teams.
Social service agencies are also looking at new ways to help. One of them, Touch, has launched a suicide intervention app through which it engages clients to keep them safe. It also now offers marriage intervention for couples in marital difficulties or post-divorce.
And, in an unusual move for a social service agency, Touch is looking to hire a psychiatrist to help its clients, given the several months' wait at public institutions, as well as the high cost of private-sector services. It is also looking to hire two more clinical psychologists to add to its current team of three, said Ms Andrea Chan, group head of Touch Counselling and Psychological Services and deputy director of Touch Mental Wellness.
Ms Chan said community agencies have been getting funding to build up mental health services, and a national mental health strategy has established a structure that helps alleviate the hospital load.
However, she said, a central system needs to be created to link hospitals, primary care and social service agencies to make sure that patients get the care they need in a timely fashion.
A spokesperson for MOH told The Straits Times on May 13 that the ministry will continue to work with the Agency for Integrated Care, polyclinics, general practitioners and community mental health partners to expand and enhance mental health services in the community. It wants people to be able to seek help early and receive it close to home.
In Mr Rashath's case, receiving treatment close to home was a godsend, as he would have found it unnerving to travel to IMH.
It was night and day, he said. 'Going into IMH, I knew I was walking into a hospital that can treat severely ill mental health patients.'
In contrast, Viriya's Potong Pasir centre, located at an HDB void deck, offered a calming, normal and familiar environment, he added.
As Mr Rashath learnt more about his phobia, he became more adept at confronting his fears. After about six months, he decided to return to driving, which he had always enjoyed before.
He said his condition arose because he had developed an irregular heart rhythm during a Covid-19 episode.
'The heart healed, but the mind still thinks the heart can't handle it,' he said.
'When you go out, and you walk or climb stairs, your heartbeat goes up, and the mind kept trying to prevent the heart issue from worsening, lest a heart attack happened.'
Agoraphobia can develop as a complication of panic attacks. Most people who have agoraphobia develop it after having one or more panic attacks, leading them to worry about having another attack.
'He (Dr Singham) taught me about this hill of anxiety... Every time you conquer something, you can go down the hill and your anxiety will go down. This anxiety won't last forever.'
Mr Rashath rejoined the workforce in March 2023, after his treatment ended, and is now working as an operations manager for a medical equipment company.
If he had left his agoraphobia untreated, it could have badly affected his quality of life. Dr Singham said that some individuals with untreated agoraphobia remain unemployed and unable to leave the house for decades.
'Often, such conditions are strongly associated with shame, perhaps particularly so in our Asian culture, and therefore, greater efforts are needed to reduce the stigma, and increase the awareness and the accessibility to psychological interventions for such conditions,' he said.
For Mr Rashath, it has been a journey of recovery and understanding himself better. Should some form of anxiety return one day, he will be aware of the symptoms and know how to manage them.
He tells himself a phrase that he often repeated during his recovery.
'Failure isn't fatal, and it isn't final,' he said.
Success in life can be achieved, and if you never try, you will never know, he added.
Join ST's WhatsApp Channel and get the latest news and must-reads.