No health without mental health

Who will care for caregivers?

Caregiving can be immensely rewarding, but the prolonged stress can lead to feelings of being overwhelmed, hopelessness and resentment. ST ILLUSTRATION: ADOBE STOCK, SOH HWEE YI

 and 

UPDATED Jun 30, 2025, 05:00 AM

Thanks for sharing!

SINGAPORE – As the mother of a son with a serious mental health condition, Mrs Evelyn Chng knows full well the challenges of caregiving, and the importance of having support.

Today, she works for social service agency Caregivers Alliance Limited (CAL), where she connects new caregivers with support in psychoeducation, training or counselling. CAL is the only social service agency focused on caregiving that has an outpost at the Institute of Mental Health (IMH).

Mrs Chng said caring for loved ones with mental health problems can lead to social isolation, financial difficulties and emotional turmoil. She can spot the negative emotions such as anger, aggression, frustration, low self-esteem, constant worry and feelings of helplessness. 

Her son was diagnosed with obsessive-compulsive disorder at 15. She and her husband learnt coping strategies and found support at a 12-week training programme run by CAL and conducted by other caregivers.

Yet, even after more than a decade of caring for her son, who is now 29, things have not become easier. He suffered a relapse that saw him admitted to IMH in January and March.

“People say: ‘You’re already a pro (at caregiving), why do you still face the same problem?’ I say it’s the same problem because it’s not easy,” she said.

Over the years, her son has developed psychosis, hearing voices telling him to harm himself.

Caregiving can be one of life’s most profound and challenging experiences. In particular, caregiving for someone with chronic mental health conditions comes with distinct challenges, due to the unpredictable nature of these conditions. 

There are more than 210,000 caregivers in Singapore, looking mostly after the elderly or people with disabilities.

Many sacrifice financial security, career opportunities and time to care for their loved ones, often putting their own physical and mental health at risk.

Given Singapore’s rapidly ageing population and finite healthcare resources, there is a need to bolster caregiver health through community-based care, experts said.

Prioritising caregivers’ health

Caregiving can be immensely rewarding, but the prolonged stress of caring for a loved one can lead to feelings of being overwhelmed, hopelessness and resentment. Depression is one of the common negative effects.

Dover Park Hospice medical social worker Michelle Lau cited a study in July 2023 that found that caregivers of stroke survivors who spent more than six hours a day caregiving were about 2.8 times more likely to develop depression than those who spent less than six hours a day caregiving.

Another study done between October 2022 and January 2023 involving 200 Dover Park Hospice caregivers found that about four in 10 were at risk of depression. 

“They are at higher risk of being socially isolated because most caregivers’ routines are overly focused on the care recipient’s needs,” said Ms Lau. 

“They also face emotional stressors like losing their identity because they may no longer hold their jobs, and they have to transition into a new role as a caregiver.”

More on this Topic

Telltale signs of burnout include poor diets and sleep, whether they have time for their personal hobbies, or if there is a lot of self-blame and guilt. 

She added that caring for patients debilitated by physical conditions such as cancer places considerable physical demands on caregivers.

“For patients with mental health conditions, it’s very hard to predict when the next mental breakdown would be, so it’s very crisis-driven. Most caregivers can be walking on eggshells,” said Ms Lau. 

Dr Shawn Goh Yong Shian from the Singapore Institute of Technology’s health and social sciences cluster published a study on caregivers of people with severe and enduring mental health conditions such as psychotic, bipolar and major mood disorders in 2024.

These conditions are particularly difficult to manage because of unpredictable behaviour, high relapse rates, communication and cognitive challenges, social stigma and employment discrimination. 

“There’s an underestimation of the emotional toll, including psychological distress, social isolation and even suicidal ideation that caregivers may experience. Many non-caregivers assume caregiving is limited to medication management and appointments, while overlooking the deep emotional labour involved,” said Dr Goh. 

He added that mental health caregivers frequently experience deeper social isolation, partly because the stigma associated with mental illness can deter them from seeking support or openly discussing their struggles .

More on this Topic

Ms Jacinta Phoon, head of psychosocial support services at Assisi Hospice, said caring for a loved one with palliative care needs can span months to years, and caregivers have to pick up relevant medical and nursing knowledge.

The hospice connects caregivers to social workers, pastoral care counsellors and therapists as needed, and they also have access to art and music therapy, she added.

To better support caregivers of those with mental health conditions, Ms Lau suggested extending to them the Home Caregiving Grant, which offers a means-tested monthly cash payout of up to $400. 

Currently, those looking after loved ones requiring assistance with at least three self-care tasks or activities of daily living (ADL) and have a monthly per capita household income (PCHI) of $3,600 or less are eligible for the grant.

From April 2026, the grant quantum will be raised to up to $600, and the coverage expanded to households with a monthly PCHI of between $3,600 and $4,800. But the three-ADL criterion remains – the activities refer to one’s ability to feed oneself, dress, go to the toilet, shower, walk or transfer oneself.

“Those with mental health conditions may be still functional but their condition may make it difficult for them to have a daily routine,” said Ms Lau. The financial support by the Government would help to offset treatment expenses, she added. 

More on this Topic

Preparing individuals for caregiving in the long haul

One way of lessening caregivers’ stress is to prepare them early for the role. Mrs Chng said CAL’s caregiver-to-caregiver psychoeducation programme helped her see that she is not alone, and understand why her son engages in his rituals.

“If caregivers lack the knowledge and understanding of the mental health issues that their loved ones are facing, they can’t really support them,” she added.

“They may say: ‘Don’t keep thinking about it, just go out and make friends, find a job or just go to school’.”

In her nine years at CAL, she has seen many caregivers suffer burnout. One of them, who was taking care of two children with autism spectrum disorder and who were acting out aggressively, became suicidal.

Another woman was taking care of a daughter who had depression and was self-harming, but she did not disclose this to her family. Her siblings, thinking that she had time to spare as a full-time homemaker, asked her to take over the care of their mother, who lives alone and has mild depression.

“She was so stressed but didn’t want to see a doctor (as she was afraid of) how her siblings would view her, and she felt guilty if she wasn’t able to take care of her mother,” said Mrs Chng.

“She eventually sought help at IMH and became a patient.”

IMH chief executive Daniel Fung said families need planned breaks from caregiving, and not just support when the situation reaches breaking point.

They must be better supported so that they do not feel like the only option is to institutionalise someone when caregiving becomes difficult.

He noted that there is a shortage of standardised training courses for caregivers of people with mental health conditions, and training is currently fragmented and ad hoc.

When it comes to caring for those with dementia, challenges are often compounded by the progressive and non-linear nature of dementia and the need for increasingly intensive care coordination as the condition advances over time, said Dr Philip Yap,  who is a senior consultant in geriatric medicine at Khoo Teck Puat Hospital. He is also chairman of Dementia Singapore.

“Time-limited training or support does not adequately attend to the dynamic nature of dementia care, where caregivers must continuously adapt their strategies and approaches as cognitive and neuropsychiatric symptoms evolve over time.”

There are caregiver support groups for specific diseases at the hospitals, and caregiver support at social service agencies such as Care Corner Singapore and Touch.

Dementia Singapore, for instance, runs a support group for family caregivers of people with dementia.

CAL focuses exclusively on supporting caregivers of people with mental health conditions as well as those who have developed mental health issues due to caregiving.

Besides CAL, two other social service agencies – Club Heal and Dementia Singapore – have a community outreach team to support caregivers. Free group activities such as art, music or yoga classes are offered to caregivers through which they can connect with one another.

Experts said the need for caregiving will rise with an ageing population and more support will be needed to empower caregivers, particularly as the country focuses its attention on community care.

“We don’t need the professionals to come in all the time.” Dr Fung said. “The real professional is the caregiver themselves.”

More on this Topic

Join  ST's WhatsApp Channel and get the latest news and must-reads.

Thanks for sharing!