Implementation of National Mental Health Blueprint

Ms Tin Pei Ling asked the Minister for Health (a) if he would provide an update on the implementation of the National Mental Health Blueprint that was proposed in 2007; (b) how are Singaporeans with mental health conditions (but not institutionalised) currently supported in the community; and (c) whether there are plans to further strengthen the network and structure of support in the community for Singaporeans with mental health conditions.

Dr Amy Khor Lean Suan (for the Minister for Health): The National Mental Health Blueprint (NMHBP) was developed in 2006. To date, about $178 million has been invested, and results have been encouraging.

One of the key thrusts of the Blueprint was to increase public awareness and education about mental health. The Health Promotion Board (HPB) has organised programmes in schools, workplaces and community settings to increase awareness of mental health issues and facilitate early detection and treatment. More than 40 initiatives and activities were organised last year, reaching out to some 170,000 students and members of the public.

Another key aspect of the Blueprint was to develop integrated mental health services. Hospital-based teams have been set up to provide integrated mental healthcare and physical intervention for patients with health problems such as those with stroke, diabetes or trauma who are also at risk of developing mental health problems. We have set up multi-disciplinary community mental health teams, comprising doctors, nurses and allied health professionals, to provide clinical services to patients in the community as well as urgent intervention in the case of crisis situations. We have also introduced programmes to train community health providers such as family physicians and counsellors to enable them to better manage mental health conditions. Going forward, we plan to scale up the successful programmes nationally.

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With regard to current community support for people with mental illnesses, the Institute of Mental Health (IMH) runs three off-site specialist outpatient clinics across Singapore and continues to develop links with the community and grassroots agencies to ensure that discharged patients have adequate family and social support. Currently, there are two Psychiatric Rehabilitation Homes, one Psychiatric Sheltered Home and eight Psychiatric Day Care Centres. These facilities provide transitional care and rehabilitation services for patients to assist their reintegration into the community.

Although we have made significant progress, there is much more that we can do to improve community support for persons with mental illness. We will be developing more medical and allied health teams in the community to further strengthen the delivery of mental healthcare in community settings. We will also be developing Intermediate and Long-Term Care services in the community for patients with mental illness. We will be sharing further details on our plans in the upcoming Committee of Supply (COS).

Ms Tin Pei Ling (Marine Parade): I thank the Minister of State for the reply and I look forward to further announcements in the COS. For now, I would like to ask this: given that there has been some decentralisation of the mental health services provided, for example, the three branches that IMH have in the polyclinic settings, what other community-based services are available that would be able to provide timely intervention for patients or people identified to be perhaps suffering from mental illnesses. The second question is that, so far, we have been talking about those who may have been captured in the current system, that means those who are aware of their conditions and have sought treatment, be it at the IMH or the branch clinics. What about those who have not been identified and not been captured in the system? One of the things, I think, we can do is to equip our grassroots leaders, the volunteers on the ground, not just in terms of raising the awareness, but by equipping them in terms of how they can possibly identify people with such vulnerabilities or already exhibiting such symptoms. How can they help to support and monitor such initiatives and the progress of the patients as well? Hopefully, the Minister of State could help to address the questions.

Dr Amy Khor Lean Suan: Firstly, I want to thank the Member for her very useful suggestions and views. Indeed, these are areas that we are looking to strengthen with respect to provision of care and support for patients that are suffering from mental illnesses that may have been discharged into the community. As regards the services, besides the three decentralised specialist clinics that IMH operates, basically, we have various programmes that are targeted to assist patients who may have been discharged into the community. They are assessed to be stable, so they are discharged into the community, and this is in line with our community-based psychiatric care model. Some of the other services available would be, for instance, adult community mental health team which manages patients with mental illness that have been discharged in their home through psycho-social rehabilitation and crisis intervention.

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There are also 24/7 helplines that the caregivers of these patients could call in crisis situations. They also have nurses that would go and follow up on these patients within the setting in the community. We also have a GP partnership programme which facilitates right siting of care for stabilised mental patients. So once they are discharged, they are referred to GPs under this programme who will follow up with the patients. And there are a variety of other programmes.

As regards her second question of what we can do for early detection and hence treatment of people who may have mental issues, including dementia, let me say, firstly, that our Ministry recognises that we need to develop a system of comprehensive management and safe discharge of patients recovering within the community. In addition to that, we also need to strengthen our community outreach programmes to help grassroots, community partners, people who are volunteers, or counsellors, people who are working in the VWOs to identify potential cases. IMH, for instance, has developed links with community rehabilitation and support teams run by VWOs generally as well as grassroots agencies to ensure that, firstly, discharged patients have family and social support. They also do training of grassroots leaders on mental health awareness as well as on early identification of such potential patients. They have been training at least 420 grassroots leaders annually on basic mental health awareness and identification skills.

At the hospitals, as I have noted earlier, there are hospital-based multi-disciplinary teams that would cater to patients with health problems, whether it is diabetes or trauma cases, who are also at potential risk of suffering from depression, and so on.

Dr Lam Pin Min (Sengkang West): Sir, I would like to thank MOH for its efforts in strengthening the community support for patients with mental illness. Besides community support, we need to look into financial support as well. As such, I would like to ask the Minister of State if MOH would consider MediShield coverage for patients diagnosed with mental illnesses. In fact, these patients are most in need of medical insurance coverage as many may have difficulty gaining meaningful employment upon diagnosis. If MOH decides not to, would the Minister of State share the reasons for excluding mental illnesses?

Dr Amy Khor Lean Suan: Firstly, patients with mental illnesses now can use Medisave for their outpatient treatment, and this includes illnesses such as schizophrenia and major depression since October 2009. Since November last year, they can also use Medisave for dementia and bipolar disorder. The basis for MediShield is to cater to acute hospitalisation cases which generally would have larger bill sizes. But we will continue to review our MediShield coverage. We need to note also that as we review MediShield coverage, and if we do expand the scope of coverage, what it inevitably means is that there will be an increase in MediShield premiums. We have to balance needs versus affordability.

Mr Desmond Lee (Jurong): I am glad to note the many programmes that are put in place by MOH to bring mental health and well-being into the community. I would like to ask the Minister of State about the capacity of our professions to do so. In October 2007, the Academy of Medicine reported that there were about 115 practising clinical psychiatrists in Singapore with the psychiatrist to population ratio of just 2.6 per 100,000, and this is contrasted with 13.7 per 100,000 in the US, 11 per 100,000 in UK, 14 per 100,000 in Australia, and also a shortage across a whole slew of mental health professionals, such as psychiatric nurses, clinical psychologists, and so on. Can I ask the Minister of State what is the situation now and do we have the capacity to roll out all these programmes effectively in the community?

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Dr Amy Khor Lean Suan: Mr Speaker, Sir, I thank the Member for highlighting the manpower issues with regard to the healthcare sector. We are ramping up the manpower in the healthcare sector in all areas from doctors, nurses, allied health professionals, healthcare support staff in various sectors, including in the psychiatric care sector. Overall, what we are trying to do, of course, is to increase and expand the intake of our medical professionals – doctors, nurses and allied health professionals. We are also looking into attracting more of our foreign-trained Singaporean health professionals back to Singapore.

In addition, in the short to medium term we will need to continue to augment this with foreign workforce. In fact, even in the longer term there will always be some need to augment this with the foreign workforce. These are some of the ways we are ramping up manpower capacity. We are also ramping up the infrastructure, as the Member has rightly noted, and we will need to continue to train and attract more professionals into this segment of the healthcare sector.

Mr Speaker: Ms Tin Pei Ling. Last question.

Ms Tin Pei Ling: Sir, I thank the Minister of State for the clarification and addressing the issues. Talking about manpower, locally there is no shortage of young people taking an interest in psychology as well as psychiatry. I understand that in recent years, the universities have started to offer clinical psychology programmes. I am wondering if MOH would consider expanding such programmes so that aspiring young people who are interested in this field can take on this kind of training, so as to augment the lack of manpower that we observe now.

Dr Amy Khor Lean Suan: Mr Speaker, Sir, as I have noted earlier, we are looking into expanding the intake for the various healthcare professionals. Certainly, we are in talks with the university to expand the capacity.