Gemma Fernandez
Senior Case Manager
Institute of Mental Health

I first met Anna, who was diagnosed with bipolar disorder, over a series of admissions between 2011 and 2012. However, it was only during her admission in March 2013 that I got to know her better.

During her 2013 admission, she was having a lot of difficulties managing her condition. Whenever Anna experienced the “high” or manic phase of her condition, she would seek her ex-fiancé’s company. She would have delusions that she was pregnant with triplets and that she was going to marry him without her parents’ consent. During one of her stays at the Institute of Mental Health (IMH), she started planning her “wedding” with a fellow patient, who offered to help out with the ceremony.

During the first few days of her admission, Anna was highly agitated and I experienced the brunt of it as her Case Manager. She would often scold me and told me “to get lost”. I gave her the time and space to settle down before approaching her again, and she slowly started warming up to me.

Anna had several unresolved issues – her battle with bipolar disorder, her anger towards her mother, and her relationship problems with her ex-fiancé. I was objective and respectful towards all her relationships, and I even met her ex-fiancé to have a better understanding of the situation. I encouraged Anna to see her situation in a different light and we worked together to address the issues one at a time. Over time, Anna’s resentment towards her mother diminished. It dawned on Anna that her mother’s actions stemmed from her instinctual protectiveness, both as a caregiver and the maternal figure who shaped her value system. This was a crucial turning point in Anna’s recovery. She was able to appreciate her mother’s feelings and viewpoints, and was able to empathise with her mother’s pain.

Anna is currently working at a wellness centre as an advocate for people with mental health issues, and has recently published a book about her experiences. To date, I am still in contact with Anna, and she knows that I am only a phone call away. She would call me when her mood starts to dip, or when she’s “high”. I will listen to her and guide her along her decision-making process.

I have been blessed to have Anna as a client because she has taught me a lot in my own journey with other patients, and has enriched my experience as a Case Manager.

Key Learning Points:

The crux of Case Management is:

  1. To ensure that the patient recovers optimally during the hospital stay and there is continuity of care post-discharge.
  2. To genuinely care for the patient and treat him or her as a person; to empathise and guide the patient in his or her journey towards mental wellness and quality of life.
  3. To work through the patient’s issues together with the patient, one at a time, and to help him or her see things from a different point of view.