Care Levels at Institute of Mental Health

Dr Intan Azura Mokhtar asked the Minister for Health (a) whether there are plans to upgrade and expand the Institute of Mental Health (IMH); and (b) whether the Ministry will consider increasing the ratio of caregiver to patient for IMH.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): Mdm Speaker, upgrading of IMH's infrastructure to offer better care to patients has been on-going to meet the needs of the population. Some of the new facilities at IMH include: (a) two dementia-friendly wards at IMH's campus built in 2014; and (b) a High Dependency Psychiatric Care Unit which was operational last year.

In addition, IMH has also upgraded its Specialist Outpatient Clinics at its Buangkok premises in 2013; and IMH's Community Wellness Clinics at Queenstown and Geylang Polyclinics in 2009 and 2013 respectively.

Currently, several IMH facilities are being upgraded to improve the inpatient care and these include:

(a) The expansion of the Mood Disorder Ward for patients with conditions such as depression and bipolar disorder; and

(b) Creation of an Early Psychosis Ward for patients with first-episode and early psychosis.

MOH regularly reviews the mental health services capacity in our system and when needed, new capacities and services will be added to meet the mental healthcare needs of our patients.

For manpower, IMH has about a thousand nursing staff today, with an adequate nursing staff to patient ratio as required by MOH's regulations. The nursing staff to patient ratio has improved from 1: 2.46 in 2010 to 1:1.68 in 2014. Over the years, the number of clinical and nursing staff at IMH has grown to keep pace with the gradual increase in patient numbers. The increase in manpower at IMH is as follows:

(a) The average number of doctors has increased from 98 in 2010 to 150 today;

(b) The average number of allied health professionals has increased from 328 in 2010 to 481 today; and

(c) The average number of nursing staff has increased from 862 in 2010 to 1,025 today.

IMH is continually innovating to provide holistic care for its patients. Other than traditional caregivers in the institute, IMH case managers ensure that patients are doing well after their discharge, through telephonic case management and home visits whenever required.

In addition, IMH also works on the development of community mental health to support persons with mental health problems in the community. For example, IMH has worked in collaboration with the Agency for Integrated Care to engage a pool of GP partners to help manage more stable patients in a primary care setting through the GP Partnership programme for Mental Health. These outreach efforts reduce the reliance on tertiary services and support better care management in the community.

Dr Intan Azura Mokhtar (Ang Mo Kio): Thank you, Senior Minister of State, for the answer. I am heartened to know that the ratio of caregivers to patients has increased over the years. The reason I am asking this question is because based on a couple of visits to IMH, some of the healthcare professionals shared with me that they have to turn away some patients because of a lack of space and they cannot have enough manpower to help patients.

Other than that, may I also ask a follow-up supplementary question? From what I understand, currently only the main caregivers of elderly persons aged 65 and above, and persons with disabilities are entitled to the caregiver training grant of $200. Would MOH consider (i) including mental illness under the caregiver training grant for caregivers of patients with mental illness; and (ii) increasing the caregiver training grant and allowing more than one main caregiver to be trained for each patient with mental illness, and understanding the challenges that come with giving care to patients with mental illness?

Dr Amy Khor Lean Suan: With regard to the Member's comments about bed capacity and inadequate staff, let me say that at IMH, for admissions into acute wards, IMH have consistently been able to admit patients within four hours from the decision to admit them. And what IMH does is, MOH, together with IMH, consistently review the mental services capacity within the system and if there is a need to create more services and capacity, we will do so when appropriate. One of the ways that MOH, together with IMH, has worked to reduce reliance on tertiary services, as I have said, and, therefore, less demand on tertiary beds, is to develop Community Mental Health. One of the ways really is to work with GPs, as I noted earlier, to manage the more stable patients within the community. In fact, in the community, they have also expanded memory clinics in the restructured hospitals and the capacities of memory clinics. They are also working on increasing the capabilities for dementia care in nursing homes, day care centres as well as in the community hospitals, St Luke's Hospital and St Andrew's Hospital.

In addition to that, IMH actually works to reorganise and remodel its model of care to provide targeted holistic help to specific groups of patients with varying patient acuity and mental conditions, so that care is more efficient and more targeted, with a view of improving their functioning so that they can eventually reintegrate back, where possible, into the community. And that helps them to work within the manpower currently available. As I said, we have actually increased the nursing staff to patient ratio over the years.

With regards to caregivers training, actually caregivers of mental patients are eligible for the caregiver training grant. But the caregiver training grant is given per recipient, to a care recipient per year. It is $200 per care recipient. So, you are right to say that it means that if you require two caregivers, you still get $200 per year. But having said that, if it is really necessary to have more than one caregiver, it is possible to tap on other sources of funds. For instance, for IMH, there is a Woodbridge Hospital Charity Fund that you can tap on for caregiving training and other activities. And I am sure that if it is needed, we will definitely be able to get the fund, the resources, to help support the caregivers.

Mdm Speaker: Mr Baey Yam Keng.

Mr Baey Yam Keng: Madam, I note the Ministry's approach to also welcome or encourage mental patients who do not need inpatient care to be integrated back into the community and to build the infrastructure to help them. But there will be patients - while they are not needed to be inpatient care - but they may not be socially acceptable by the community or being able to keep the jobs and appointments. Therefore, this would cause a strain on themselves as well as their family members. So, is MOH able to give a more supportive or definitive sort of endorsement of patients' mental condition, so that it gives them better access to assistance from Government, which could be financial assistance, public housing, or rental housing, for example.

Dr Amy Khor Lean Suan: I thank the Member for his supplementary questions. In fact, as I have said, IMH is reorganising and reviewing its nursing model of care. And in fact, they are re-categorising patients, including long-stay patients, medium-stay patients, and so on, according to their acuity and ability levels. So, for patients who may not need long-term institutional care and we do want to encourage as many to reintegrate back into the community as possible, there will be different levels of support and care for them, according to their needs. Even if they go back into the community, there is always a hotline available for either the patient or the caregiver to call these teams to get guidance. In fact, the teams can actually go for home visits and escort them back to IMH or to one of our satellite outpatient clinics if needed. So the idea really is to have a strong support network to care for the patients according to the levels of acuity. And IMH itself does have long-term patients too.

We are working with the community hospitals for say the shorter term stayers and we try as far as possible to improve their functioning to integrate back into the community. So, I agree with the Member that we need to do more in order to be able to provide targeted help to each of these groups of people.