SINGAPORE: The Ministry of Health (MOH) is reviewing the community support available for people with mental health conditions or suspected of having them, including “current legislative levers”.
It has been working with the Agency for Integrated Care (AIC) to develop such services but noted the need for better support.
“MOH recognises that there is a need to better support persons with or suspected with mental health needs and displaying challenging behaviours in the community,” Parliamentary Secretary at the ministry, Rahayu Mahzam, said in Parliament on Tuesday (Oct 6).
“MOH is currently reviewing the enablers for the community support required, which include the current legislative levers,” she added.
Currently, the Mental Health (Care and Treatment) Act (MHCTA) allows the state to intervene for persons with or suspected to have mental health illnesses, and who may be a risk to themselves or others.
The police can apprehend the person and take him or her to a doctor for an assessment or to a psychiatric institution for treatment.
The processes empowered under MHCTA apply even if treatment is declined by the person or the person’s relatives, said Mdm Rahayu.
MOH’s approach, however, is to “intervene early” before the need to enforce mandatory psychiatric evaluation and treatment, by reaching out to persons facing mental health issues and their families to encourage them to seek help voluntarily.
She said the ministry has worked with AIC to develop support services under the Community Mental Health Masterplan.
The agency has set up 43 community outreach teams as of end-2019. These teams have reached out to more than 300,000 persons and provided assistance to over 23,000 people at risk of developing mental health conditions or dementia, Mdm Rahayu told the House.
The AIC has also trained over 24,000 frontline staff from government agencies and community partners across Singapore, she added.
Mdm Rahayu was responding to a parliamentary question from People's Action Party (PAP) Member of Parliament Murali Pillai on whether the powers of MHCTA can be expanded to allow intervention when a mentally disordered person being cared for by relatives is not allowed psychiatric treatment even when there is no ill treatment or neglect.
Mr Murali, MP for Bukit Batok SMC, said he had filed the parliamentary question based on a case in his constituency.
“The case involved a mentally disordered young man whose parents refuse to allow him to be treated by IMH (Institute of Mental Health) as they believe in religious and spiritual intervention.
"The final report from AIC was that if the family refuses to cooperate, there cannot be any intervention under the current legislative landscape because he is physically well taken care of and he doesn't pose a safety risk,” said Mr Murali.
“I was advised to tell the neighbors to file a complaint with the Community Disputes Resolution Tribunal, as the young man screams very loudly in the middle of the night from time to time,” he added. “Respectfully, I don't think this advice … is useful.”
While he is glad to hear of a review, Mr Murali asked if MOH would be prepared to direct agencies to engage and work collaboratively with spiritual and religious healers in the meantime.
He cited previous researches done by the IMH, which noted “a significant treatment gap” in Singapore with more than three-quarter of mentally disordered people not seeking professional help. Among those who seek some form of help, 24 per cent turned to religious and spiritual healers.
Mdm Rahayu replied that MOH is aware of the case raised by Mr Murali.
She noted that improving support for people with mental health conditions in the community remains “a work in progress”, even though much has been done over the years.
The Community Mental Health Masterplan was launched in 2012. The Government also said in 2017 that it would further enhance and expand mental health services over the next few years.
Among the initiatives, mental health and dementia services have been made available in more than half of the polyclinics here. More than 210 General Practitioner partners have also been trained to diagnose and support persons with mental health conditions.
“A lot has been done and a lot will continue to have to be done, and it is indeed important to enhance these efforts,” said Mdm Rahayu, adding that MOH is also working closely with healthcare institutions, community health partners, other agencies like the Police, and grassroots organisations to build up community networks.
“So the suggestion that the member has raised – working with religious partners – is something that we can definitely look into.”
“As mentioned, MOH is already reviewing the enablers for the community support. We will take members’ feedback and input in consideration during this review and assess the appropriate approaches and recourse that we can take to address such cases in the community,” she added.
MENTAL WELL-BEING AT WORK
A separate parliamentary question from Radin Mas SMC PAP MP Melvin Yong wanted to know when the Tripartite Advisory on Mental Health will be published and whether it could be expedited to better support workers suffering from mental health related issues arising from the workplace.
The Ministry of Manpower (MOM) had said earlier this year during its Committee of Supply that an advisory will be issued to help employers improve mental well-being in the workplace.
The advisory will highlight initiatives companies should emulate, and that could include access to anonymised external counselling service, or training supervisors to identify mental health symptoms early.
Senior Minister of State for Manpower Zaqy Mohamad said on Tuesday that the ministry is “on track” to publish the advisory in the fourth quarter, with consultation ongoing with employers, unions, mental health professionals and civil society groups.
In the meantime, an inter-agency advisory published in April on how to support mental health well-being of workers under COVID-19 work arrangements can serve as a useful reference, he said.
The advisory has a list of external resources that employers can consider engaging to provide support for their workers’ mental health.
Employers can also initiate support to help their workers, said Mr Zaqy.
For instance, supervisors can check in regularly with their workers, talk to them to find out if they are facing any problems and refer them to external help if needed.