Gone but not forgotten, IMH’s departed long-stay patients get annual memorial service

SINGAPORE — Her parents separated when she was very young, and Ms Sunita (not her real name) did not have much contact with her father or know his whereabouts after that.

She discovered only in January this year that he was a long-stay patient at the Institute of Mental Health (IMH) after her mother asked her to hand the hospital a letter requesting that IMH perform his last rites when he died.

When Ms Sunita reunited with her father, who was admitted to IMH in 2011, he was already very sick. The IMH declined to reveal what mental condition her father had.

“He was immobile already, he had dementia, couldn’t speak, said Ms Sunita, 31, a tech support executive who spoke on condition of anonymity.

“Most of the time, he didn’t recognise me anymore.”

She visited him three to four times a month before he died on July 1 at the age of 66.

Last month, Ms Sunita took leave from work and made her way to IMH’s function room for a memorial service organised by the hospital for her father, as well as 17 other long-stay patients who died this year.

The majority of the 50 attendees were staff of IMH, but there were also family members. Eulogies were given, and there was music, singing and food.

Ms Sunita, who spoke at the service, said: “I wanted to thank the people (at IMH). They looked after him for a way longer time.” She added that it was “something I really appreciate”.

Mooted by IMH chief executive Chua Hong Choon, the memorial service is an annual affair that began in 2015 to provide an opportunity for IMH staff and volunteers to bid farewell to long-stay patients. On average, about 20 long-stay patients die each year.

FINDING CLOSURE

Long-stay patients, who have conditions such as schizophrenia, are those who have stayed at the IMH for at least a year. Numbering about 1,000, they range in age from their 30s to 90s and most are in their 50s and 60s.

As some of the long-stay patients are transferred to other hospitals for medical treatment at the end of their lives, IMH staff do not always get to say goodbye.

“Many of our long-stay patients have been at IMH for a large part of their lives,” said Professor Chua.

“Our care staff spend a lot of time with them. So, they are very much a part of our lives and when they pass on, we feel a sense of loss too.

“It’s important to devote some time to acknowledge the poignant moments, find closure and bid our final farewell.”

Eulogies were delivered for most of the 18 long-stay patients remembered at the service on Nov 19.

Assistant nurse clinician Ang Siew Meng, 49, spoke about two of his patients.

One was a 57-year-old he had looked after for seven to eight years. The man had lived for more than 20 years at IMH.

He had aspired to return to the community, and was among those allowed to go to the IMH’s food court thrice a week. He would buy food such as coffee or nasi lemak for about 10 other patients each time, said Mr Ang.

“We’re like brothers,” said Mr Ang. “I build a lot of rapport with quite a lot of my long-stay patients. They not only see me as staff, they see me as a friend also.”

The other patient was a 59-year-old man who had other health conditions such as heart problems, in addition to his mental disorder. He lived in the long-stay ward for three to five years and had some difficulty in walking.

The man used to be a fortune teller in his neighbourhood and he would tell the fortunes of fellow IMH patients and staff by looking at their facial features and palms, recounted Mr Ang.

Long-stay patients tend to be quite mentally stable because the staff supervise their medication intake, said Mr Ang, who has worked at IMH for 23 years, of which eight were at its long-stay ward.

The staff said some patients become like family members.

For senior staff nurse Palanivel Vadivukkarasi, 39, who looked after Ms Sunita’s father for the final months of his life at the IMH’s medical ward, there was sadness but also the knowledge that her patient was no longer in pain.

He was unable to communicate with staff but “his eyes were very sharp”, said Ms Vadivukkarasi.

“When we feed him, we can feel he’s enjoying (the Indian minced meal),” she added. “Even though he’s not talking, we usually just talk to him (asking), ‘How do you feel, do you have any pain?’”

The nurses were all very happy when Ms Sunita was reunited with her father early this year, she added.

IMPROVING END-OF-LIFE CARE

Besides remembering long-stay patients who have died, the IMH has also taken steps in recent years to improve their quality of life and end-of-life care. Last year, The Straits Times reported efforts to help suitable long-stay patients regain their independence, improve their ability to care for themselves, learn new skills and eventually return home.

Many long-stayers are ageing and some may be diagnosed with terminal illnesses. They will need good end-of-life care to reduce their suffering and fulfill their final wishes.

A committee made up of doctors, nurses and allied health staff was formed in December 2016 to look into this.

At wards, doctors and nurses have started to discuss Advance Care Planning (ACP) at certain meetings. About 10 staff including doctors, nurses and case managers have been trained to be ACP facilitators by the Agency for Integrated Care. For patients without mental capacity, discussions may be held with family members.

End-of-life care is “something we simply cannot ignore”, said Prof Chua. “It’s also about respecting their wishes and maintaining their dignity as best as we can. We have gradually initiated conservations with patients in the last two years — to raise awareness and set them thinking about how they want to take this forward.”