Help mental health patients who wait ‘too long’ to see doctors in public sector, have trouble with insurance coverage: NMP
SINGAPORE — Access to mental healthcare in Singapore needs to be enhanced further, a Nominated Member of Parliament (NMP) said, adding that there are long waiting times to see a psychiatrist or psychologist in the public healthcare system.
During an adjournment motion on Tuesday (Oct 3), Dr Syed Harun Alhabsyi — in his first speech as NMP — also called on the Government to look into the struggles that people with mental conditions face with their health insurance coverage and claims.
Dr Syed is a consultant psychiatrist and honorary secretary of the Singapore Psychiatric Association.
In response, Ms Rahayu Mahzam, Parliamentary Secretary for Health, said that the Interagency Taskforce on Mental Health and Well-Being will be releasing a report on its strategy to improve the mental health of the population "in the next few days".
The task force under the Ministry of Health (MOH) was formed in July 2021 to oversee and coordinate mental health efforts across different sectors.
Ms Rahayu said that mental health is a pressing concern and that the Government has in place initiatives to address it.
These include the Health Promotion Board's MindSG portal, and setting up Well-being Circles to provide citizens with the skills to care for their own mental well-being and of those around them.
The Government also takes action to dispel stigma and misconception about mental health, such as through the Beyond the Label campaign by the National Council of Social Service.
THE AGONY OF WAITING
Dr Syed called on the Government to invest more in mental healthcare facilities and manpower in restructured hospitals, noting that the median waiting time to see a psychiatrist was 45 days and for a psychologist, 42.
By the time patients need to be referred by a learned general practitioner to see a psychiatrist or psychologist, it is likely the case that these patients are already struggling and are having marked difficulty in their lives.
He asked MOH for the mean waiting time, but added that a six- to eight-week wait is “much too long a wait to bear”.
“By the time patients need to be referred by a learned general practitioner to see a psychiatrist or psychologist, it is likely the case that these patients are already struggling and are having marked difficulty in their lives,” he said.
On the quality of mental healthcare, Dr Syed said that compared to the Institute of Mental Health, psychiatric departments in government restructured hospitals are smaller but still address equally challenging and complex cases.
"Not all restructured hospitals have dedicated infrastructure and a ward for psychiatric patients, and this makes managing patients who are of moderate risk sometimes difficult in a restructured hospital setting," he added. "We can do better."
He also said that more could be done to help ensure mental healthcare is delivered smoothly after a patient leaves a hospital.
This includes having all 32 polyclinics adopt mental healthcare as part of their "staple baseline services".
Some find it disproportionately more challenging to secure insurance coverage even for physical health conditions, even though the specific mental health condition they have (is not necessarily correlated) to a prospective risk of physical ailment per se.
In his speech, Dr Syed also noted that cultural, religious and social influences need to be considered more in administering care to patients with mental health conditions.
“When the practice of mental healthcare is devoid of this understanding, a diagnosis could be misinformed, treatment becomes sub-optimal, medication compliance becomes poor and a willingness for treatment is lost,” he said. “In fact, it can be a barrier to seeking help altogether.”
Dr Syed suggested that communities and religious organisations should play a part in mental healthcare but did not elaborate on how so.
WHAT NEEDS TO BE IMPROVED
For people with a history of mental health illnesses, procuring private insurance coverage for themselves can be a challenge, Dr Syed pointed out.
“For many of them, to search for alternatives beyond what is available in the public healthcare system remains both a rarity and at steep expense,” he said.
“Some find it disproportionately more challenging to secure insurance coverage even for physical health conditions, even though the specific mental health condition they have — or may have had in the past — does not necessarily bear a correlation to a prospective risk of physical ailment per se.”
Dr Syed called on the Government to study this problem and to take a deeper look at the evidence and reasons that insurance companies refuse to cover these patients, or when they charge more or make exclusions for insurance coverage relating to mental health conditions.
Even though he is “particularly optimistic” that the Workplace Fairness Legislation will protect employees from discrimination based on disability and mental health conditions, Dr Syed said that rehabilitative processes can be better handled.
Improving re-employment and re-integration of persons with mental health conditions is also an area that needs more work.
"While it is not part of accessibility of mental healthcare per se, a negative prospect of returning back to their home and livelihoods will feed into people's fears of seeking help early, thinking that they may never return to full function and that there are few opportunities for meaningful employment after a diagnosis of mental illness," he added.
WHAT KIND OF SUPPORT IS AVAILABLE
Ms Rahayu acknowledged that good mental health is "essential" for maintaining overall health. That is why, beyond expanding healthcare capacity and training healthcare workers, MOH takes prevention efforts as well.
"This move upstream means we can avoid over-medicalising mental health conditions and instead invest our resources in the promotion of well-being and early intervention," she said.
Private insurers selling these plans are expected to deal fairly with customers and not to indiscriminately reject an application solely based on declared personal information such as... medical condition, including mental health conditions.
Touching on several initiatives to enhance mental healthcare in Singapore, she said that the Government supports community mental health teams set up by social service agencies.
These teams provide mental health assessment and psycho-social help for persons in distress, most without charge.
In response to Dr Syed’s concerns about insurance coverage for individuals with mental health conditions, Ms Rahayu said that all Singaporeans are eligible for subsidies of up to 80 per cent in public healthcare institutions.
Singaporeans and permanent residents are also covered under the MediShield Life insurance scheme administered by the Central Provident Fund Board, regardless of their pre-existing conditions.
"Private insurers selling these plans are expected to deal fairly with customers and not to indiscriminately reject an application solely based on declared personal information such as occupation, income, disability or medical condition, including mental health conditions," Ms Rahayu said.
The Monetary Authority of Singapore (MAS) will take action against insurers whose practices are in breach of its regulations. Individuals may also appeal an underwriting decision through their insurer’s feedback channel or MAS.
Ms Rahayu added that the Ministry of Manpower, with the National Council of Social Service, is looking into improving the employment and employability of persons with health conditions and strengthening support for mental well-being in the workplace.
"More details on these will be released in the National Mental Health and Well-being Strategy," she said, calling on the public to review the report and make further suggestions for discussion.
