Last Saturday (10 October) was World Mental Health Day. In Singapore, the first National Mental Health Week to raise awareness of mental illness and to reduce the stigma around it began in 1987.
Mental disorders can be a complex combination of both genetic and environmental or lifestyle factors. Early diagnosis and access to treatment are critical to managing the disorders. In terms of our awareness of mental illness, a recent survey showed that at least five in 10 people were able to identify the symptoms of dementia (66.3%), alcohol abuse (57.1%) and depression (55.2%).
The Mental Health Literacy study, conducted between March 2014 and March 2015 by the Institute of Mental Health (IMH), asked people about their perceptions of five common mental disorders. Besides the illnesses mentioned above, fewer people were able to identify symptoms associated with obsessive compulsive disorder (28.7%) and schizophrenia (11.5%).
While it is reassuring to know that two out of three of the 3,006 adults who participated in the IMH study were able to identify dementia occurrence, the recognition of symptoms does not necessarily imply that people understand the sickness.
Frequent misconceptions
A common misconception of dementia is that it is part of the natural ageing process. Age-related memory loss is often confused with dementia and there is a lack of clarity on when normal ageing-related changes are severe enough to indicate the possible onset of the disease.
Another common misconception is that nothing can be done to lower the risk of developing dementia. Studies have suggested that while some of the risk factors of dementia such as family history and age cannot be controlled, there are other lifestyle risk factors (such as high blood pressure, smoking, heavy alcohol consumption and high cholesterol) that are controllable.
It is worth noting that symptoms of dementia are not limited to forgetfulness and memory loss. It encompasses disturbance to higher order functioning — such as thinking, orientation, comprehension, calculation, learning capacity, language, and judgement — as well.
Recognising the symptoms
Dementia is a costly disease, with the World Alzheimer Report 2015 estimating the annual economic and societal worldwide cost at US$818 billion. Much of this can be attributed to formal and informal long-term care, medical costs, economic loss and social strain. In contrast, the amount of economic resources devoted to addressing mental illness related to dementia are severely lacking, in relation to the financial and personal impact of the disease.
Shifting demographic trends also highlight the need for greater recognition of the condition. Singapore is one of the fastest-ageing societies in the Asia-Pacific region, with one out of five people here expected to be aged 65 and above by 2030.
Currently, older adults aged 65 and above form 13.1 per cent of the population, up from 12.4 per cent in 2014. As this figure increases in the years ahead, it is likely that the number of people with dementia will correspondingly rise. The Ministry of Health estimates that there are currently 28,000 people with dementia in Singapore, and this is projected to jump to 80,000 in 2030.
Family and close friends are the first line of defence and are most likely among the first to spot warning signs. If they are able to recognise the symptoms, they can seek early intervention with the help of primary care professionals.
This can help to allay concerns, as having warning signs of dementia does not mean that someone has dementia. People with other conditions, such as depression, hormonal disorders, nutritional deficiencies and infection, may exhibit symptoms similar to dementia. Early diagnosis could lead to better management of the condition and allow people who have been diagnosed to plan for the future.
Furthermore, a lack of awareness could render the family less prepared with regards to caregiving arrangements and may increase the financial and legal vulnerability of the individual. This makes increasing awareness an even more urgent priority for society.
Doing more to raise awareness of dementia
In 2012, the World Health Organization highlighted dementia as a public health priority. In Singapore, the Health Promotion Board and voluntary welfare groups like the Alzheimer’s Disease Association in Singapore have been conducting workshops on understanding dementia and training caregivers to care for those with the disease.
However, from a policy standpoint, should dementia be a larger national health priority than it is now? Doing more to raise awareness and improve general knowledge on dementia will go a long way towards optimising healthcare resources and outcomes.
To complement that effort, more research can be done to find out the extent to which the public understands dementia. What is the profile of people who are least knowledgeable of dementia? In general, studies have shown that people with lower education and income levels tend to be less informed about dementia. Does that hold true for Singapore? Are there cultural stereotypes and stigma associated with the disease? If so, what are they? While international studies have been conducted, the multicultural context of Singapore warrants a domestic perspective on this debilitating disease.
Lastly, a systematic year-round public education programme can also be implemented. This can be in the form of providing handbooks on available resources, how to prevent deterioration, and the legal preparations to make, such as appointing a Lasting Power of Attorney.
In light of an increasingly greying society, our action or inaction now will have an impact on all of us and our loved ones.
Elaine Ho is a Research Analyst at IPS Social Lab, a centre for social indicators research at the National University of Singapore. She presented a paper at the Alzheimer Europe Conference in Ljubljana, Slovenia, 2-3 September 2015, on the interpretations and social constructions of dementia in Singapore.
Top photo from thinkstock.