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Straits Times
7 days ago
- Health
- Straits Times
Community care: How one man managed his agoraphobia without hospital treatment
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.
Straits Times
7 days ago
- Health
- Straits Times
Singapore GPs step up to support those with mental health problems
Over 520 GPs had joined the Mental Health General Practitioner Partnership as at December 2024. ILLUSTRATION: LIM KAILI, ADOBE STOCK No health without mental health Singapore GPs step up to support those with mental health problems SINGAPORE - From excelling in a management position in a multinational corporation to bringing up two teenagers, Ms Lee has done it all. But after clinching her hard-won successes, the high-flier found herself in a deep state of emotional and physical exhaustion amid a hectic work period in 2022. Sleep and rest did not help. 'Everything started to feel heavy and I lost interest in things I used to love. 'I was like a functional wreck, still showing up, smiling and delivering results. But inside, I just constantly felt very disconnected and my mind was very foggy,' said Ms Lee, who declined to use her full name, nor provide her age . Overwhelmed, she decided to turn to family physician Lim Hong Shen at Bridgepoint Health, who had treated her and her family for minor illnesses over the years. 'I've developed that trust with him, and he was the first person who came to mind when I decided to seek help,' said Ms Lee, adding that she had never thought of going to a psychologist or counsellor because she was unfamiliar with mental health issues. She was grateful that Adjunct Assistant Professor Lim took a slow and tactful approach in assessing her over a few consultations. 'He did not even mention a word about mental health, and I think that was helpful for me because the moment he did, I would have been taken aback,' said Ms Lee. It was only on her third visit that Prof Lim gently broached the topic and referred her to a private therapist to manage her anxiety symptoms. He continued to stay in touch with Ms Lee through her therapy, even helping her find another therapist when she felt she could not click with the first. In 2023, Ms Lee was discharged by Prof Lim after mastering coping strategies and feeling energised by a new zest for life. Her experience inspired her to set up a women's help group in her company. Her recovery would not have been possible without Prof Lim, she said. 'He didn't just send me to a therapist, he was there throughout the entire journey,' said Ms Lee. While the treatment of mental conditions has always been part of what general practitioners (GPs) can do, they are now being asked to play a greater role in the national effort to have patients diagnosed early and treated in the community, rather than mainly in hospitals and specialist centres. According to latest figures from the Ministry of Health (MOH), more than 520 GPs had joined the Mental Health General Practitioner Partnership (MHGPP) as at December 2024. The initiative supports doctors in identifying, diagnosing and managing patients with mild to moderate mental health conditions. GPs on the MHGPP programme, which began in 2012, benefit from access to lower-cost psychiatric medicine and support from hospital-based psychiatrist-led teams. About 450 joined in March 2024. Prof Lim, who has been on the programme since 2018, said the clinic's Everton Park branch sees about 30 patients a month who need help with mental health. Most are regular patients of the clinic while others were previously seen at hospitals or by private specialists. The patients come from different walks of life, from students facing school stress to young adults who have relationship or work struggles and elderly folks who face isolation. Prof Lim believes that mental health conditions should, by and large, be treated in the community as the first line of defence. This is especially if the GP has had a long relationship with the patient. 'That trust component is huge… and that gives us an advantage over the touch-and-go or one-time encounter that a specialist may have with a patient,' said Prof Lim, adding that patients in such circumstances are more forthcoming about their struggles and receptive to treatment options. The common conditions seen at the clinic include depression and anxiety, and most are mild cases. GPs may also choose to refer patients who need more community support to social service agencies, and those with more severe and urgent mental health needs to specialists. The latter could be a patient who is suicidal, or has multiple mental health issues, said Prof Lim. 'We are like the master navigator for our patients,' he added. Dr Daryl Yeo, a GP and deputy primary care network clinical lead at Parkway Shenton, said family doctors can offer more integrated and holistic care for their patients. Dr Yeo has been on the MHGPP programme since 2022 and sees about one to two new mental health patients a week. He pointed out that many mental health patients, such as new mothers, have other health concerns. They can develop post-partum depression if they struggle with experiences like breastfeeding. 'As family doctors, what we can do is offer care on issues with breastfeeding and post-partum care, and at the same time manage their mental health conditions, which may actually go hand in hand with their breastfeeding issues,' said Dr Yeo. GPs can also notice red flags earlier. 'Patients who come in every month saying that they have headaches could trigger us to consider if there's an underlying issue of burnout, anxiety or depression,' said Dr Yeo. While the MHGPP programme allows GPs to prescribe lower-cost psychiatric medication to patients, sometimes the prescription is non-medical. Dr Yeo cited the example of a man who started suffering panic attacks because his wife feared he would cheat on her after witnessing infidelity in her friend's marriage. In cases like this, the social issues also need to be addressed. 'As primary care doctors, we are relatively familiar with community services. If there are couple or family issues that need resolution, we would try to get them to visit a family service centre,' said Dr Yeo. An MOH spokesperson said the ministry will continue to work with the Agency for Integrated Care, polyclinics, GPs and community mental health partners to expand and enhance mental health services in the community. With the launch of Healthier SG, which pairs those above 40 with a family doctor, MOH is developing care protocols for major depressive disorder and general anxiety disorder to be rolled out in 2026. These protocols will help more GPs integrate mental healthcare with chronic disease management. As more Healthier SG GPs become equipped to handle these conditions, MOH will be reviewing the MHGPP programme, with details to be shared in due course. Helplines Mental well-being Institute of Mental Health's Mental Health Helpline: 6389-2222 (24 hours) Samaritans of Singapore: 1-767 (24 hours) / 9151-1767 (24-hour CareText via WhatsApp) Singapore Association for Mental Health: 1800-283-7019 Silver Ribbon Singapore: 6386-1928 Tinkle Friend: 1800-274-4788 Chat, Centre of Excellence for Youth Mental Health: 6493-6500/1 Women's Helpline (Aware): 1800-777-5555 (weekdays, 10am to 6pm) Counselling Touchline (Counselling): 1800-377-2252 Touch Care Line (for caregivers): 6804-6555 Care Corner Counselling Centre: 6353-1180 Counselling and Care Centre: 6536-6366 We Care Community Services: 3165-8017 Clarity Singapore: 67577990 Online resources (for those aged 13 to 25) (for those aged 12 to 25) Join ST's WhatsApp Channel and get the latest news and must-reads.
