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Mr Devoted: Rainbows after the storm

Story contributed by: 

Desiree Ng

Institute of Mental Health

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Image by Yingchih

Prologue: Main Character 

Basic Information

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Supporting Characters

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Main Story

Mr Devoted was a fresh graduate with a Diploma from Ngee Ann Polytechnic when he was first diagnosed with Schizophrenia. He was well-supported by his mother and community case workers then. With the support of his job placement officer, he was also able to secure and sustain work relevant to his Diploma after a period of vocational training and remission of his psychotic symptoms. 

 

However, after his mother passed on, Mr Devoted began to steer away from his previously established routine. He gradually reduced his work term from full-time to part-time. Eventually, he was asked to leave due to poor work performance. He was having difficulties managing chores at home alone and items accumulated, filling up most of the floor space in the house. He became home bound for many months as he spent most of his time fending off bad spirits in his house. This eventually led to his admission to the psychiatric acute ward. 

 

During his admission, Mr Devoted was referred to an Occupational Therapist. He presented with visual and auditory hallucinations, accompanied with poor self-care, significant neglect, severe weight loss and  hoarding behaviour.

 

During his inpatient stay, Mr Devoted expressed wishes to regain control over his life and redirect his attention to what is important to him – his spiritual well-being and independence. He identified home management and work attainment as his top occupational priorities. 

 

On one occasion, he was granted home leave to extend his instrumental ADL skills training to his home environment. While engaged in home management, he found materials left behind by his late mother and brought it back to the ward for a craft activity (pictured below) with his peers during a group session. The entire process rekindled his love for crafting items while impelling him to re-organise his home.

 

On discharge, Mr Devoted redirected his devotion to appeasing the spirits in his house to building on his spiritual well-being and exploring leisure engagement while expanding his social network. He was more willing to explore outside of his home environment and resumed attending church services.

Synopsis

Participation Goal(s) of Client

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  • Secure employment and be financially independent

  • Join a cell-group to study the bible with church mates

  • Make friends

  • Re-organise his house to support leisure engagement

Facilitators to Participation

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  • Motivation to pursue valued roles – church member (son of God) and worker 

  • Intrinsic locus of control: Strong sense of spiritual well-being

  • Vocational support by community occupational therapist and case workers

  • Having a personal physical space (fully paid-for 3-room HDB flat left behind by late mother)

Barriers to Participation

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  • Residual symptoms (fixed delusional beliefs)

  • Fear of offending bad spirits in his house resulting in prolonged engagement in rituals to fend against them

  • Reduced self-efficacy at work due to past work terminations 

  • Limited family support due to strained relationship with sister for years

Strategies to overcome barriers and support participation by OT(s) and Stakeholders

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  • Expanding his social network in church. Gradual bonding with other church members through events and support from a church senior

  • Bolster his spiritual well-being to overcome his fears by praying with a church senior weekly, after church service.  

  • (Activity scheduling) Planning his time use ahead – to ensure occupational balance in his routine that supports independent living 

  • Use of alarm and calendar on mobile phone to remind him of appointments with others and to avoid getting entrenched in his rituals

  • Monthly reflections on work performance with supervisor at work and setting goals collaboratively with OT with feedback obtained

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