Commentary: Don't rush in calling for those with mental health issues to be institutionalised
For patients with psychiatric illnesses, a viral photo or video of their most vulnerable moments live on in perpetuity on the Internet. Be accountable for your actions, says the chief of IMH’s department of emergency and crisis care.
SINGAPORE: I first saw the video clip on my TikTok feed sometime in June this year. It showed a woman wearing a skincare face mask having a seemingly bizarre interaction with two livestreamers.
This video was not an isolated incident, and it doesn’t happen only in Singapore. There are tons of viral videos and photos online shaming and flaming people who seemingly misbehave or act differently.
Many of the comments accompanying those social media posts are disheartening to read; some are outright cruel.
Almost anyone who owns a camera phone can be a “news reporter” these days. When they upload a video of someone doing something unusual in public, their aim is to get as many viewers, "likes" and comments as possible. As such, the unwitting subjects in the videos are often dramatic, distorted, or comical and lack context.
People could argue that the subjects in the videos were being themselves. There was no exaggeration or dramatisation; there was also no wrongful portrayal per se. However, the emphasis of those clips is frequently about dangerousness, unpredictability, and seemingly "odd" behaviours.
VIRAL VIDEOS CAPTURE PATIENTS AT MOST VULNERABLE MOMENTS
We need to recognise that for many patients with psychiatric illnesses, that snapshot or video clip captures them at their most vulnerable moments.
See a lady at a hawker centre talking to herself, gesturing to no one in particular? This person could be experiencing auditory hallucinations or hearing "voices", as it is more commonly known. See an unkempt man demanding that you switch off your camera phone? This person could have paranoid delusions and firmly believes you are trying to hurt him. Notice a person standing at the edge of a busy road? He may actually be having suicidal thoughts.
Instead of whipping out your camera phone, or doubling down and making further recordings, show empathy and offer a reassuring word. Ask how you can help, or call the police for assistance. Most of all, try your best not to aggravate the person even more - not everything is an argument that needs to be won.
A person's mental health does not exist in a binary state. There's no internal mechanism that switches between "well"' and "unwell". It can be terrifying when a patient develops symptoms of psychiatric illnesses, whether from a "first break" or a relapse.
Imagine hearing voices or seeing images that no one else experiences. Imagine feeling as though insects were crawling under your skin. Imagine thinking that there are no longer any reasons to live.
Worst still, these patients may not have insight into their conditions, believing that what they are experiencing is real.
IS INSTITUTIONALISED CARE THE SOLUTION?
I have read comments linked to such video clips about how patients with psychiatric illnesses should be detained in hospital for "a long time".
Generally, patients are only admitted to the hospital when they become extremely unwell or in crisis. They may pose a risk to themselves or others, or be so psychiatrically impaired that they are at risk of self-neglect.
Some patients admit themselves voluntarily as they recognise that they need help, while others are involuntarily admitted as they do not have insight into their need for hospitalisation and treatment.
During the admission, care and treatment of the underlying psychiatric illnesses are provided for all patients. Discharge planning also takes place, taking into account the patient’s condition, the risk issues, and the level of support at home and in the community. Once their conditions improve, patients are discharged, and follow-up reviews are arranged for them at outpatient clinics.
To encourage their recovery, patients are treated in the least restrictive setting, in environments that preserve their dignity, rights and freedom as much as possible.
WHAT IS SELF-STIGMA?
For patients recovering from psychiatric illnesses, realising that video clips depicting their odd behaviour are circulating in perpetuity on the Internet can be destabilising. Patients may have little recollection of what happened, and even if they did, they might be unable to explain why the incident occurred.
It's not merely the videos and images. Patients read for themselves the negative reactions, which include fear, rejection and ridicule. Labels such as "crazy" and mad" do a great disservice to people who must live with their condition every day.
Self-stigma occurs when people with psychiatric illnesses internalise negative stereotypes about their conditions. This leads to many negative consequences: I have had patients who avoided seeking treatment as they did not want to be labelled as mentally ill. Some avoid close personal relationships or do not apply for certain jobs and insurance out of fear that they must reveal their mental health diagnoses.
It is easy to see how the delay in seeking help, and social isolation may lead to worsening symptoms, some of which can cause behavioral disruptions – a self-fulfilling prophecy then.
WHAT CAN WE DO?
We can be more conscious of the words we use when talking to and about persons with psychiatric illnesses. We must be accountable for our actions. Do we forward the videos and images and use them as memes? Or do we respond to the misperceptions and negative comments by using facts?
When we see someone that we know or suspect is struggling with psychiatric illness, take a leaf from the book of psychological first aid. First, check if there are any concerns about the risk of harm to self or others. If necessary, activate emergency services that may be better equipped to help. Second, listen without judgment or shame and see if any help can be offered. Avoid using words like "crazy", "siao", or flippant phrases such as "Are you OCD?" or “Did you take your medicine today?".
When faced with someone in great distress, do not take their behaviour personally and definitely do not argue or aggravate the situation. The sight of recording devices can quickly turn things confrontational, usually with threats or ultimatums. If you are unable to control or contain yourselves, consider walking away. Hopefully, with a rise in mental health literacy, we will all be more aware of the avenues of help available to individuals in distress.
Above all, we can all do with more kindness. To others and to ourselves.
Dr Jared Ng is a senior consultant and chief of the department of emergency and crisis care at the Institute of Mental Health.