SINGAPORE: To prioritise mental health care and support for Singaporeans, mental health infrastructure and mental health consultation costs should be reviewed.
These reviews were called for by Member of Parliament (MP) Wan Rizal Wan Zakariah (PAP - Jalan Besar) in Parliament on Monday (Oct 4).
Speaking during an adjournment motion, Dr Wan Rizal also highlighted the need to earlier detect people who are at risk or have symptoms of mental health issues.
These calls come about a year after he spoke about eradicating mental health stigmatisation during his first adjournment motion on Oct 15, 2020.
‘SOFTWARE’, EXPERTISE AND RESOURCES IMPORTANT
To improve Singapore's mental health infrastructure, Dr Wan Rizal called on the Government to address the importance of “software” in the country’s mental health infrastructure aside from the “hardware”, which includes resources.
“Diagnosing or sensing mental health issues takes time — getting to know the patient, building trust, and delving into the situation can make a difference. Therefore, it could be useful to consider and budget for longer consultation times in the future healthcare system,” he said.
Dr Wan Rizal also called for equipping all polyclinics, general practitioners and social service agencies with the “necessary expertise and resources” to make mental health screening more accessible to Singaporeans.
Dr Wan Rizal expressed support for the COVID-19 Mental Wellness Task Force’s recommendation to develop a national mental health competency framework.
This framework would include a common set of training standards and “clearly defined degrees of competencies” expected of professionals and para-professionals.
“I hope this framework can be extended to students in Institutes of Higher Learning (IHLs) as part of a module. So they too can be a ready resource for the community support network,” he said.
He suggested “expanding existing programmes or creating equivalent ones in IHLs” to nurture more mental health professionals.
“Similarly, I hope the training can also be extended to working professionals to develop their competencies and be their organisation's resource person at work.”
He also suggested developing a “community support network” of trained staff and volunteers. These people can be the first point of contact to attend to “distress calls and walk-in consultations”.
INCREASE MEDISAVE CLAIM LIMIT
Dr Wan Rizal also called for a review of mental health consultation costs.
The financial costs of seeking treatment, especially over a long period, can be “prohibitive” for mental health patients getting help, he said.
For example, he said, the annual MediSave limit is S$700 a year from 2022, but this amount may be fully used up after a few consultations.
“Perhaps the Government could explore increasing the MediSave claim limit for mental health consultations, given that such consultations can be a bit more regular for those who need more help,” he said.
“The Government could also provide greater subsidies for those who are under the Pioneer or Merdeka Generation, as well as those having CHAS (Community Health Assist Scheme) cards.”
Dr Wan Rizal noted that some insurance policy providers have started to offer insurance policies that provide coverage for mental health conditions, but there are other providers who have not.
“I am heartened ... when Senior Minister of State Janil (Puthucheary) previously told this house that there are ongoing efforts to make treatment more affordable, and MOH is also working with insurance companies and other stakeholders to further optimise the coverage process,” he said.
‘ENGAGE EARLY’ TO SPOT MENTAL ILLNESS
Finally, Dr Wan Rizal urged to normalise mental health screening for all Singaporeans in order to intervene early and quickly once mental health issues are detected.
This can be done through “key touchpoints”, such as schools and IHLs, workplaces, hospitals, GP clinics, paediatrics clinics, and gynaecological clinics.
Once people are screened for being at risk or have symptoms of mental health issues, they can then be referred promptly to a mental health practitioner, he added.
“We want to engage early, before mental health issues disrupt their lives and risk them doing something harmful.”
Dr Wan Rizal’s call for proactive mental health support comes amid the shadow of the COVID-19 pandemic, which saw an “all-time high” suicide rate of 452 individuals last year. This was a 13 per cent increase from 2019, with an increase across all age groups, he said.
He pointed to several groups whose mental health was impacted by the pandemic.
First, elderly and youth have experienced increased stress and loneliness due to a reduction of social gatherings and meaningful social engagement, he said. This is coupled with the stressors of the pandemic and adapting to home-based learning.
Second, he noted that Singaporean workers have been affected by an increase in workload since the start of the pandemic, such as through a “blurring of lines between work and personal time” for those working from home.
Among these workers are educators.
“Educators have had to adapt to the fluid COVID-19 situation, tailoring lesson plans and materials at short notice, on top of their regular administrative duties, juggling various stakeholders' expectations and putting their students first always,” he said.
“As an educator, I feel overwhelmed, frustrated and of course, worried.”
Dr Wan Rizal, who is also a senior lecturer at Republic Polytechnic, urged Singaporeans to “change our mindset on how we view children’s development”, from daily school issues to major examinations.
“If we can create a culture of appreciating the joy of learning and the challenges such a journey presents — be it easy or difficult, success or failure — and accepting that there are multiple paths to achieve success, we can nurture an optimal mental health environment from the onset,” he said.
“Hopefully, this would lead to a positive effect on the ‘parent-teacher-child’ relationship and the positivity (would) trickle down to our society.”
Dr Wan Rizal added that workers, from healthcare professionals to teachers to public service officers, need “continued care and support”.
“Reviewing their work scope may be useful for a quality work-life balance, but most importantly, we must continue to create and upgrade channels for meaningful communication. And this does not include just the bi-annual staff appraisal,” he said.
Acknowledging efforts by various players, such as community partners and ground-up groups, to lessen the stigma around mental health issues thus far, Dr Wan Rizal welcomed recommendations by the task force to “address the psychosocial impact” of the pandemic.
“We need to take affirmative action now, beyond just performative activism and populist rhetorics,” he said.
'WHOLE OF SOCIETY' APPROACH NECESSARY
In response to Dr Wan Rizal, Parliamentary Secretary for Health Rahayu Mahzam said the Government adopts a "comprehensive and multi-pronged approach" towards mental health care and support.
"The key strategies cover mental health promotion and upstream prevention, early detection and intervention, disease management, care integration, and social support across different settings," she said.
Ms Rahayu illustrated this with a few examples, including a National Mental Health Blueprint that the Ministry of Health (MOH) developed in 2007 to promote mental health, build resilience and reduce the impact of mental illness, and a Community Mental Health (CMH) Masterplan launched in 2012 that builds on the Blueprint.
She also highlighted that under the CMH Masterplan, there were 14 polyclinics offering mental health and/or dementia services and more than 220 General Practitioner partners trained to diagnose and treat mental health conditions, as of the end of 2020.
Regarding the issue of cost for mental health treatments, Ms Rahayu said the Government currently provides up to 75 per cent subsidy for outpatient treatment at polyclinics and public specialist outpatient clinics.
"All Singaporeans, regardless of income, are also eligible for subsidies under CHAS for treatment of mental health conditions under the Chronic Disease Management Programme at participating private General Practitioner clinics," she said.
The four listed conditions under this programme are schizophrenia, major depression, bipolar disorder and anxiety.
"Pioneer and Merdeka Generation cardholders are eligible for additional subsidies. Patients can also tap on their MediSave to pay for outpatient treatment of (these) conditions," she added.
Ms Rahayu also acknowledged the impact of the pandemic on the population's mental health, adding that the Government and various agencies have expanded or introduced more than 40 mental health related initiatives in 2020. Many of these initiatives are targeted at specific segments, such as parents and families, children and youth, workplaces and the working population, and seniors.
"Notwithstanding the efforts by the Government and agencies, a whole-of-society approach is necessary to address the population’s mental well-being. Every one of us has a role to play," she said.
"We can start by learning more about mental health and how we could support other in dealing with mental health challenges, reach out and do regular check-ins on people we care about, and most importantly, practise self-care."