MENTAL ILLNESS AMONG SINGAPOREANS

Dr Mohamad Maliki bin Osman asked the Minister for Health (a) what is the incidence of mental illness among Singaporeans over the last five years; (b) given the stigma related to mental illness, will the recent increase in charges by the Institute of Mental Health prevent Singaporeans, who are not eligible for Medifund, from seeking help for their illness; and (c) what measures are being taken to ensure that those who need help will continue to seek them and not be hindered by fee increases.

Dr Balaji Sadasivan (for the Minister for Health): Mr Speaker, Sir, the Member for Sembawang GRC asked about the incidence of mental illness among Singaporeans over the last five years. The 1995 NUS Study on Mental Health estimates that about 10% of Singaporeans aged 21 to 55 years old have some form of mental ill health. Of this figure, about 5% have mild disorders, while 5% have moderate to severe disorders. Major mental disorders are relatively uncommon. For example, the prevalence of schizophrenia in Singapore is estimated to be about 0.75%, comparable to world-wide figures which are in the region of 0.5% to 1%. The prevalence of certain common mental disorders will be updated when IMH and NUS conduct a National Mental Health Survey later this year.

The Member also raised his concern that Singaporeans who wish to seek help for mental illness may not do so because of the increase in charges at IMH. I would like to highlight that the fee charges for IMH are still very affordable, even after the fee revisions. For inpatient care, the average C Class bill size per day is only $13 while the average B2 Class bill size per day is $30. This works out to an average increase of only $1 for a C Class bill and $4 for a B2 Class bill, which is minimal. Patients can also use Medisave and MediShield to pay for these charges. For outpatient consultation, the average bill size after the fee revision is $25, an increase of only $2. Therefore, the increase in fees should not deter Singaporeans from seeking help for mental conditions if they need to.

Nonetheless, should patients be unable to afford the highly subsidised bills even after they have used Medisave and MediShield, Medifund is available to help them. I wish to reassure the Member that flexibility is given to the Medical Social Workers to extend Medifund assistance to Singaporeans who cannot afford to pay their bills.

Dr Mohamed Maliki bin Osman (Sembawang): Sir, I asked for the figures for the last five years. The Minister of State quoted the figures for 1995, which is way back. I wonder whether the Minister of State can highlight the figures based on the admissions into IMH as well as other psychiatric clinics over the last five years.

Dr Balaji Sadasivan: The inpatient admissions are: Year Admissions 1997 6,827 1998 6,687 1999 6,646 2000 6,607 2001 Not available, as we are still collating the data.

The SOC attendances are: Year Attendances 1997 146,485 1998 146,987 1999 144,982 2000 142,667 2001 134,131

Dr Mohamed Maliki bin Osman: Sir, can the Minister of State comment on the numbers in proportion to the population? How do the numbers stand with regard to other countries that we know of?

Dr Balaji Sadasivan: There are no significant differences in the rate of mental illness in Singapore versus other countries.

Mr Steve Chia Kiah Hong (Non-Constituency Member): Sir, what kind of professional training and specialist skills are the nurses and caregivers given in the mental institutes to provide for the care of mental patients?

Dr Balaji Sadasivan: Sir, there are three levels of caregivers. First, we have the doctors. The consultants are all psychiatrists. This is a medical sub-speciality. The nurses are given training in psychiatric nursing before they can work in IMH. And then we have the non-nursing medical staff like cleaners, etc, and they also have to be orientated to work in the hospital.

Mr Steve Chia Kiah Hong: What recourse do the ex-patients of a mental hospital have if they feel that they have been unduly treated by the nurses? If they try to complain, they are told that they are crazy, and so they are given a medical jab, etc.

Dr Balaji Sadasivan: They can write to the Ministry of Health and we will investigate the case.

Dr Mohamed Maliki bin Osman: Sir, given the recent economic crisis and stress, I would assume that the stress level would be going up. The manifestation of psychiatric conditions would be increasing, but the numbers seem to be showing a decreasing trend. I wonder if this decreasing trend means that people are coping better with psychiatric circumstances or whether it is because the medical fees are going up. Could the Minister of State also relate his answer to the last fee increases in terms of IMH fees and to comment on the reduction in the number?

Dr Balaji Sadasivan: Sir, with regard to the reduction in numbers, there is a tendency across all countries and also in Singapore for patients to seek psychiatric help at outpatient clinics and in private clinics, because there is still a certain amount of unease about going to a mental hospital to follow up on their outpatient psychiatric treatment. So we can expect that over the next 10 years, numbers will continue to decrease, and more and more outpatient care will be in settings that are not special psychiatric clinics, but you can see a psychiatrist who sees patients in an outpatient clinic.