WOODBRIDGE HOSPITAL (Plans and programmes for discharged patients)

Mr S. Vasoo asked the Minister for Finance and Minister for Health (a) what is the progress in the development of Woodbridge Hospital; (b) what are the plans to strengthen day and community care programmes for discharged patients who have been treated for psychiatric illness; and (c) what efforts are being made to promote a mental health education programme.

Mr Yeo Cheow Tong (for the Minister for Finance and Minister for Health): Mr Deputy Speaker, Sir, the present Woodbridge Hospital was built in 1928. It was built at a time when the treatment of psychiatric patients was custodial with compulsory confinement in an institution isolated from the city centre. The many buildings which make up Woodbridge Hospital are spread over a very large area. They are old, out-moded, inefficient to manage and do not meet the needs of a modern psychiatric centre. As envisaged in the National Health Plan, the Ministry plans to demolish the present hospital and replace it with a new, compact and multistoreyed hospital complex that is in keeping with a modern centre for psychiatric treatment.

A Study Team comprising two Consultant Psychiatrists and two Architects recently visited new psychiatric hospitals in Hong Kong, Canada and the United States. A Planning Committee is being established to prepare a Master Plan for the redevelopment of Woodbridge Hospital. The team will be finalizing the plans to submit to the Ministry and the Ministry hopes to obtain approval for the building of the new Psychiatric Centre and to commence construction work in 1986. The project should be completed within three years.

The main thrust in modern psychiatric treatment is on non-institutional ambulatory or outpatient care. The Ministry's future plans for day and community care programmes for discharged patients will include the following:

(i) Increasing the number of Psychiatric Outpatient Clinics for the follow-up treatment of patients discharged from hospital and for those who do not require hospitalization because of the early or mild nature of their illness. At present, there are a number of Specialist Outpatient Clinics at Woodbridge Hospital. There are also five Psychiatric Outpatient Clinics at Maxwell, Bedok, Pegu, Bukit Merah and Lim Ah Pin Polyclinics/Outpatient Dispensaries. Additional Psychiatric Outpatient Clinics at Polyclinics to be developed at Woodlands South, Yishun and Bukit Batok are being planned for the next three to four years.

(ii) There are two Day Centres, namely, the Mandalay and Alexandra Day Centres. These centres have proved effective in rehabilitating discharged psychiatric patients and preparing them for return to the community. At these centres, patients undergo group therapy and are given training for simple job assignments in a sheltered environment. They are paid a token allowance based on their output. The maximum capacity of both Centres is 180 patients at any one time. In 1984, both Centres took in a total of 525 new cases and found employment in private firms for 99 patients. The Ministry is considering setting up a third Day Centre at the Lim Ah Pin Polyclinic.

(iii) The Ministry is considering developing psychiatric units in general hospitals for the less severe mentally disturbed cases. A ward in Tan Tock Seng Hospital will be converted to function as a psychiatric unit by the end of this year. Similar units will be established in Toa Payoh and Alexandra Hospitals to provide inpatient, outpatient and day treatment. This way we hope to treat the early or mild cases of psychiatric disorder within a general hospital rather than purely in Woodbridge Hospital.

The promotion of mental health will be a part of the Ministry's overall health education programme. This programme seeks to promote both the physical and mental health of school children, patients, the workforce and the community through healthy lifestyle. One of the priority activities in this programme is educating the public on stress management. This will be done through seminars, health fairs, talks and information materials. For example, a seminar on stress control was conducted for secondary school teachers last month. A stress management booth was included in the Health Fair held on World Health Day on 6th April this year.

In addition, Woodbridge Hospital will continue with its various educational activities such as the following:

(i) Educating patients and their relatives on the symptoms and treatment of mental illness, the need to seek medical advice and treatment early and regular follow up to ensure maximum success in treatment. Relatives will be taught to cope with patients after their discharge.

(ii) Staff will give talks on mental health to interested groups, for example, at schools and work places. Interviews, talks and articles will be given through the mass media. A series of articles on mental health contributed by the Hospital's Psychiatrists will be featured in the news media in the near future.

(iii) Hospital staff will continue to work closely with the Singapore Mental Health Association in its mental health education programme and will promote activities that will benefit psychiatric patients.

Mr Jeyaretnam: Mr Deputy Speaker, Sir, may I know from the Minister of State the range of fees that are being charged at Woodbridge Hospital? I suppose there must be patients in this Hospital who have been there for a considerable length of time. Are they being charged at the rate that is being prescribed for short-term patients? Does the Ministry consider the hardship of families who may not be able to meet these fees?

Mr Yeo Cheow Tong: For long-term stay in the Hospital, no fees are charged if they are unable to pay. In fact, we have many patients who have been staying in the hospital for many years and who have not been paying a single cent. Most of them do not have to pay, mainly because they have been left there by their families who are unable to take them home. Therefore, we have not been charging most of such patients.

The fees for the outpatient clinics are also very minimal and if the Member wants to know, I can provide him with the whole range of the fees.

Mr Jeyaretnam: May I know further from the Minister of State the class of patients who have been exempted from payment of fees? Do they come from the public assistance cases only or do they range beyond that?

Mr Yeo Cheow Tong: They are not just restricted to those on the public assistance programme.

Mr Jeyaretnam: If I may move away from the fees to the question of patients who may not be too ill to be in the hospital but it may not be safe to keep at home. I understood from the Minister of State that the tendency is to try and keep them out of hospital. Two years ago, there was a suggestion that half-way homes might be set up. May I know whether any progress has been made in this direction?

Mr Yeo Cheow Tong: The present trend, on a world-wide basis, is to try and retain those who are less mentally ill in the home environment so that they are not fully isolated from a real-life situation. For those who are violent, for those who are unable to be restrained at home, they can be referred to the Woodbridge Hospital and most of those cases are retained at Woodbridge Hospital for observation, which normally stretches from between four and six weeks. If they are found to be suitable for release, they will then be released to their own homes where the home environment is more conducive to their recovery. However, they will be given the proper medication to ensure that they are under the correct treatment.

Mr Chiam See Tong (Potong Pasir): Mr Deputy Speaker, Sir, can the Minister of State please tell us the number of persons who are suffering from psychiatric illness and who are at the moment receiving attention at all the outpatient clinics?

Mr Yeo Cheow Tong: I am sorry I do not have the figures at hand. But if the hon. Member likes, I will arrange to send it to him.

Mr S. Vasoo (Bo Wen): Mr Deputy Speaker, Sir, in view of the high population centres and families are now relocated in various housing estates, would the Ministry be reviewing its outpatient services with a view to providing better support for discharged patients because it is a problem for patients to get access to the existing outpatient services?

Mr Yeo Cheow Tong: As I have stated earlier, we have current plans to expand the various outpatient clinics and specialist outpatient clinics. However, there is a limit as to how fast we can expand because of the availability of trained personnel. The hon. Member can be assured that we have a programme and we will be taking steps to implement the programme as stated.

Mr Jeyaretnam: Sir, I am sorry, but would the Minister of State be good enough to answer whether there is any plan to proceed with the setting up of halfway homes for people who are not too ill to be in hospital but who perhaps are not safe to be kept at home, especially where children are present?

Mr Yeo Cheow Tong: There are no plans at the moment. But it is still under study in terms of the overall health care services.

Mr Jeyaretnam: It was under study two years ago.

Dr Arthur Beng Kian Lam (Fengshan): Mr Deputy Speaker, Sir, there is a Unit in Woodbridge Hospital looking after the chronic sick. In the redevelopment plans of Woodbridge Hospital, will this Unit be retained or expanded?

Mr Yeo Cheow Tong: I understand the Unit looking after the chronic sick and the aged has been taken over by the Ministry of Community Development.

Mr S. Vasoo: Mr Deputy Speaker, Sir, what are the plans that are being currently undertaken to rehabilitate and reintegrate the chronic patients of Woodbridge Hospital into community life?

Mr Yeo Cheow Tong: The plan has always been to try to rehabilitate them and, for those who have been cured, to release them back to their families.