More children get early help with mental health issues

SINGAPORE - Eight-year-old Carmen Tow refused to speak to teachers, even during oral exams.

The Anderson Primary pupil avoided buying food from the canteen and asked friends to do so for her. But she was talkative at home.

"I couldn't figure out what was wrong. I was very eager to look for help," said her mother Angela Yap, 41, who is a housewife.

Help came in July last year after Carmen was put on the Institute of Mental Health's (IMH) Reach scheme, which set up a hotline for schools in 2007. Reach is short for Response, Early Intervention and Assessment in Community Mental Health.

The diagnosis from Reach's nurse clinicians was that Carmen suffered from selective mutism - a psychiatric disorder where someone who can speak normally cannot do so in specific situations.

The Reach team provided the school with materials such as worksheets for weekly sessions run by the school counsellor. It was through these sessions that her parents learnt that her fear of buying food stemmed from not knowing how to count money.

Carmen is not the only school-going child getting help. The Reach programme, which started in 2007 with 12 schools, now covers all mainstream primary and secondary schools as well as junior colleges.

Calls to the hotline rose from 306 in 2007 to 8,336 last year. The number of pupils referred from schools to Reach rose from 14 to 739 over the same period.

The Reach team assesses the child and comes up with treatment plans such as home visits.

Seven in 10 of these cases - for both calls and referrals - involved primary school children.

Half the time, school counsellors needed help to deal with attention deficit hyperactivity disorder (ADHD) - characterised by hyperactivity, impulsiveness and an inability to pay attention.

Others were concerned about oppositional defiant disorder, where pupils display hostile behaviour towards authority figures. Such behavioural problems made up one-third of cases for a one- year period from March last year.

Another one in five children exhibited signs of anxiety and mood disorders which include phobias.

Learning disabilities like dyslexia and developmental problems like autism were also picked up.

IMH said the rise in calls is more likely due to the helpline being extended to more schools, rather than a spike in psychiatric disorders in children. More school counsellors are also being trained to spot signs of trouble.

The roping in of 29 general practitioners (GPs) and six voluntary welfare organisations has also widened the support network. "What we have created is a community resource for help," said Associate Professor Daniel Fung, an IMH psychiatrist who is leading the Reach programme.

With schools better equipped to deal with cases, unnecessary referrals to specialist clinics or hospitals can be avoided, added the chairman of IMH's medical board.

The involvement of GPs also helps reduce the stigma that some parents fear if they take their child to a psychiatrist, said Dr Charity Low. The GP who runs a clinic at Woodlands sees up to five children with ADHD a month.

Next year, the Reach programme will be extended to all 20 special education schools here.

There are also plans to roll it out to pre-schools. Said Prof Fung: "What we realise from the current programme is that mental disorders tend to manifest early."

Already, IMH gets more than 600 referrals a year for children aged nine and under. Dr Low has also noted that some kids develop symptoms at a pre-school age.

However, as government funding for the Reach programme is running out, parents will have to pay for certain services. The first assessment will remain free.

Nurse clinician Kim Joo Hwee said the helpline also promotes awareness of mental health issues among the children who get to learn more about mental conditions when they or their friends get picked out for help. "Today's context is a more challenging one, with greater competition in schools, jobs and university placement," said Mr Kim, who is on the Reach team, adding that the provision of outlets for help can improve mental resilience.

Madam Yap said Carmen is now more comfortable with speaking up. "She is starting to order her own food at McDonald's and will even rush to pay for her items at the bookstore."

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