Mental Health

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

Overview

This overview provides a synopsis of the current knowledge base. Having considered all the information in the disability pages: 1) What are the priority issues that deserve attention, 2) What are opportunity areas that community or voluntary organisations can already take action on, and 3) What knowledge gaps deserve further investigation.

Priority Issues

• [to insert]
• to insert]

Actionable Opportunity Areas

• [to insert]
• [to insert]

Knowledge Gaps

• [to insert]
• [to insert]

Definition of Mental Health

How Mental Health is Defined in Singapore

According to the WHO (2018), mental health is a state of well-being in which every individual can:

• Realise his/her abilities
• Cope with the normal stresses of life
• Work productively
• Have the ability to contribute to the community

[Info gap: What is Singapore's official definition; what is MOH, IMH, NCSS definition? These will have implications for access to services in terms of qualifying criteria]

How Singapore Defines & Classifies Mental Illness / Disorders

A mental illness is a disturbance of the mind that impairs the way we think, feel and behave. It affects our daily activities, as well as impact the lives of family members and friends.

[Clarification: is there a difference between calling it 'mental illness' (like the above) and 'mental disorder' (like below)? Or can we take it to be equivalent terms?]

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a mental disorder is characterised by clinically significant disturbances in a person’s behaviour, thinking or feeling that suggest dysfunction in psychological, biological or developmental processes underlying mental functioning.Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. As a rule of thumb, it satisfies three criteria:

• Deviance : Serious deviation from social or cultural norms
• Distress : Causes significant personal distress in social, occupational or other recreational activities
• Dysfunction : Behaviour which interferes with the ability of a person to function effectively

[Clarification: According to this rule of thumb, does it mean that if it satisfies only 1 or 2 out o the three, it typically does not qualify as a mental illness?]

Different categories of mental disorders according to the DSM-5 are :

1. Neurodevelopmental Disorders, including:
   • Intellectual Disabilities
   • Communication Disorders
   • Autism Spectrum Disorder
   • Attention-Deficit Hyperactivity Disorder
   • Motor Disorders (e.g., Tourette's Disorder)
2. Schizophrenia Spectrum and Other Psychotic Disorders
3. Bipolar and Related Disorders
4. Depressive Disorders
5. Anxiety Disorders
6. Obsessive-Compulsive and Related Disorders
7. Trauma- and Stressor-Related Disorders
8. Dissociative Disorders
9. Somatic Symptom and Related Disorders
10. Feeding and Eating Disorders
11. Elimination Disorders
12. Sleep-Wake Disorders
13. Sexual Dysfunctions
14. Gender Dysphoria
15. Disruptive, Impulse-Control, and Conduct Disorders
16. Substance-Related and Addictive Disorders
17. Neurocognitive Disorders
18. Personality Disorders
19. Paraphilic Disorders

[Possible elaboration & sense-making: It may be useful to lay out the broad differences between these disorders, even if merely just illustrating with examples. For example, what category of disorder is internet addiction or OCD? More challenging, but useful, is to make sense of some of these technical terms to a lay person: What is the difference between a personality and psychotic disorder?]

Key Statistics & Figures

Prevalence & Trend of Mental Disorders (13.9% or 1 in 7)

[Sense-make: How does this fare with other countries? Should we be worried or this is typical?]

In 2016, the Institute of Mental Health conducted a second Singapore Mental Health Study with 6126 Singaporeans and Permanent Residents aging from 18 years old and above. It has been found that 1 in 7 people in Singapore have experienced a mental disorder in their lifetime, an increase from roughly 1 in 8 when compared with the first Singapore Mental Health Study back in 2010. According to the study, the top 3 most common mental disorders are Major Depressive Disorder, Alcohol Abuse and Obsessive Compulsive Disorder.

Findings from the Singapore Mental Health Study (2016):

• Comparing with the 2010 study, there was an increase in lifetime prevalence of mental illness from 12% in 2010 to 13.9% in 2016.
• 1 in 7 people in Singapore has experienced these disorders in their lifetime ( __% of the adult population 18y/o and above):
  • Mood disorders: Major depressive disorder (6.3%), bipolar disorder (1.6%)
  • Anxiety disorders: Obsessive-compulsive disorder and generalised anxiety disorder (OCD+GAD = 4.8%)
  • Alcohol use disorders: Alcohol abuse/dependence
• Those aged 18 – 34 years, divorced or separated were more likely to have mood disorders
• Alcohol Abuse and Obsessive-Compulsive Disorder are highly common in Singapore.

Suicide Rate (Almost 400 a year)

[Sense-make: How does this fare with other countries? Should we be worried or this is typical?]

• 397 people committed suicide in 2018. The leading cause of death for those aged 10 to 29 years.
• Attempted suicide has been decriminalised in Singapore as of 1 Jan 2020.
• See also wiki page on Suicide in Singapore

Size & Profile of Mental Health Patients (60k outpatient, 6k inpatient)

• 60,000 outpatients were seen by public healthcare providers each year, from 2017-2019. The inpatient number stands at 6,000 from 2016-2018, with an average length of stay of 21 days per admission.

• The five most common mental health conditions seen at public hospitals were schizophrenia, depression, anxiety, bipolar disorder and substance abuse. Specifically at polyclinics, depression, anxiety and insomnia were the most common mental health conditions.
• In 2018, a new subsidised patient would have waited an average median time of 27 days to see a psychiatrist and 28 days to see a psychologist across the public hospitals.

Size of Mental Health Professionals (4.4 psychiatrists & 8.36 psychologists per 100,000)

• There are around 248 psychiatrists and 473 psychologists practising in Singapore, which translates into 4.4 psychiatrists and 8.36 psychologists per 100,000 population.

[Expand: How does this compare to other countries? What is an adequate number?]

• According to a study in Ireland, there are different benchmarks that we can follow:
  • Population-Based Estimates:
    • “a  recommended  ratio  of  1 in 5,000 (Management Advisory Service, 1989; National Health Services  [NHS]  Education  for  Scotland, 2009)”
    • “Carr based his recommendations for changes to service provision on what he described as a “conservative view” that only 10% of the area population required intervention and a further 10% required prevention services. Proposed service models in his review report requiring extra psychologists would have increased this ratio to 1 in 3,000 to 5,000.”
  • Needs-Based Estimates:
    • "The report concluded that 7,300 clinical psychologists and 1,200 counselling psychologists would be required to deliver adult mental health services based on the existing numbers requiring psychological intervention. This represented a recommended ratio of 1 in 5,781.”
  • We can follow the recommended 1 in 5,000 ratio by the Management Advisory Service (1989)  as it does not diverge significantly from the 1 in 5,781 ratio recommended by the BPS (2004) that was based on individual need across different service areas. Also, Popular-Based ratios are more applicable for providing a recommendation of how many staff are required for a given population size.[1]
• We can also encourage other healthcare workers to “be involved in providing the services currently carried out by clinical psychologists. These included health promotion officers, health psychologists, counsellors, primary care mental health workers, voluntary services coordinators, as well as assistant and associate psychologists.”. This way, the current workload of psychologists will be lesser and that would also improve the ratio as they are capable of helping more people. [2]

• Within the public health sector, the number of psychiatrists and psychologists has increased by 8 per cent to 182 and 7 per cent to 171, respectively, from 2017-2019. No number on counsellors, especially because healthcare professionals and medical social workers do counselling as part of their everyday work.

• As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.

Overview of Key Issues & Areas of Needs

Click the links below to go directly to specific areas of interest: [Not yet linked to the specific segments, or if we decide to have separate pages for them, then to the specific pages]

Prevention	↘
		Detection & Diagnosis Early Detection Information & Referral Help Seeking	↘
				Treatment Accessibility & affordability Self-Management Rehab?	↘
		Capability & Capacity of Mental Health System Capacity to meet demand Professional expertise & knowledge Integrated service system	↗
						Employment Job readiness Employer willingness Workplace support Job matching	↘	Social Inclusion Public awareness & acceptance
						Community Integration	↗
		Family & Caregivers Caregiving knowledge & skills Caregiver wellbeing & social support	↗ →				↗

Sub-pages

Current sub-pages are being worked on as part of ongoing wiki challenge:

• MH4
• Page to Youth with Mental Health Issues
• Page to Adults with Mental Health Issues
• Page to Addiction
• Page to Dementia

[Note to contributors on the below categories: It is not yet clear what is the best way to proceed with the catogories and sub-pages on specific disorders. If an issue is significant, then clearly a separate page of its own is justified. Possibly we could start with the bigger issue first, eg mood disorder being a separate page, which will include OCD and phobias etc. And then subsequently, if let's say OCD becomes a big enough issue, we can then split up and create one separate page for OCD itself.]

Substance-related disorders

• Drug abuse
• Alcohol abuse

Mood disorders

• OCD
• Phobias

Anxiety disorders

• [insert?]
• [insert?]

Sleep disorder

Personality disorder

• [insert?]

Psychotic disorders

• [insert?]

Legislation & Key Policies

• There is also specific legislation that matter in the course of specific mental disorders. For example, the Misuse of Drugs Act matters to persons with substance addiction.

Mental Health (Care and Treatment) Act 2008

Provides for the admission, detention, care and treatment of mentally disordered persons in designated psychiatric institutions.

See Mental Health (Care and Treatment) Act

Mental Capacity Act 2008

Allows Singaporeans to appoint persons whom they can trust to make decisions on their behalf in the event that they are mentally incapacitated.

Under the MCA, a person is defined to lack capacity if he is unable to make a decision or take an action for himself at the time the decision or action needs to be made. This can be caused by the impairment of, or a disturbance in the functioning of the mind or brain. The impairment or disturbance could be permanent or temporary.

A person lacks mental capacity if he or she cannot do one or more of the following things:

• Understand the information relevant to that decision
• Remember that information
• Use or weigh that information as part of the decisionmaking process
• Communicate that decision by any means; e.g. talking, using sign language, drawing, etc.

See Mental Capacity Act 2008

Vulnerable Adults Act 2018

Empowers the state to intervene in high-risk cases of Vulnerable Adults (VA) abuse / neglect / self-neglect with victim consent (with mental capacity) and without victim consent (without mental capacity). Social workers have powers to: obtain info, enter private homes, conduct assessments of VAs, temporarily relocate VAs to a safe place.

See Vulnerable Adults Act 2018

National Mental Health Blueprint 2007

Singapore initiated it's first ever National Mental Health Blueprint and Policy in 2007. The blueprint proposed a population-based public-health model, focusing on epidemiological surveillance of the health of the population, on health promotion, and access to and evaluation of community-based services.

See IMH website for National Mental Health Blueprint 2007-2012

Community Mental Health (CMH) Masterplan 2012, 2017

Launched in 2012 to place more focus on mental health care in the community for persons to receive care closer to home. It was revised in 2017.

[Details of the Masterplans cannot be found currently.]

Mental health declaration for job applicants

As of December 2019, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) has declared that "all declarations on mental health condition should also be removed from the job application forms", unless there is a reason to do so - in which reasons should be stated clearly.

Areas of Need / Desired Outcomes

[Read this templatised guide on how to populate this section]

As of December 2019, it is now considered discriminatory by TAFEP for companies to ask for mental health declarations on job application forms. Image credit: Facebook/Tee Zhuo

Prevention

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Resources	Gaps	Ideas
SRS Club Heal HPB Working Minds Curriculum Treasure your Mind	Not enough awareness and knowledge of the different mental illnesses Mental illness might still be considered a taboo.
	Not many HR departments in companies are aware of how to deal with people with mental illness, be it developed in the course of employment or before employment

Detection, Diagnosis & Referral

Early detection and screening

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Resources	Gaps	Ideas
Community Touchpoints
Online platforms
Medical Touchpoints
Organisations [Info gap: How and where do HR depts equip themselves to deal with mental health issues of their employees?]	Not many HR departments in companies are aware of how to deal with people with mental illness	Educate HR departments and develop resource toolkits
Friends & Family	Many PMIs lack insight about their conditions/don't know where to seek help Family members may not reveal condition; to cushion the impact on PMI

Community Touchpoints

• Clarity Singapore
• AIC
• SAMH
• Community Health Assessment Team (free mental health check for young persons aged 16 to 30 years)
• Silver Ribbon

Online Platforms

• https://www.mindline.sg/home (AI powered chat line and informational and referral - joint initiative of MOHT, IMH, MSF, NCSS)

Medical Touchpoints

• Mental Health GP-Partnership Programme: Majority prefer to go to GPs as first point of contact when they experience ‘stress-related’ symptoms (Lum et al., 2008). With three GPs, doctors diagnosed 429 new cases of mental illness and potentially diverted about 1,000 appointments from hospitals (Boh & Oh, 2016). More than 3,000 patients were helped through the Mental Health GP-partnership programme (Boh & Oh, 2016).
• IMH (Child Guidance Clinic; Forensic Rehabilitation, Intervention, Evaluation & Network Development Services; Mood and Anxiety Clinic; Community Health Assessment Team)
• Khoo Teck Puat Hospital (Psychological Medicine Department)
• Alexandra Hospital (Psychology Services)
• NUH (Psychiatric Clinic)
• SGH (Department of Psychiatry)
• Tan Tock Seng Hospital (Department of Psychological Medicine)
• National Neuroscience Institute
• Changi General Hospital (Department of Psychological Medicine)
• KK Women and Children’s Hospital

Information and Referral

• Desired Outcome: PMI and their caregivers need to receive adequate information on support available, how to navigate the service system and understand how to manage their condition
• Synopsis:
  • Poor awareness of existing services

Resources	Gaps	Ideas
Awareness of treatment services
Understanding treatment efficacy

Information Services – Medical System

• SAMH’s helpline
• IMH’s interactive information system
• IMH’s online resources
• Medical social workers
• GPs

Information Services – Community Touch Points

• Clarity Singapore’s helpline
• Alzheimer’s Disease Association (ADA)’s helpline
• HPB’s Dementia InfoLine
• SOS’s helpline

Mental health literacy programmes

• MOH
• CGH
• SGH
• Silver Ribbon
• Mental Health First Aid

Adequacy in meeting need

Poor awareness of psychiatric services or lack of understanding of the types of effective treatments offered by professionals [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco, et al., 2016)

IMH psychiatrists do not communicate to patients about their diagnosis and how to manage their conditions.

Not many HR departments in companies are aware of how to deal with people with mental illness

Info gap: check whether medical social workers supposed to do this at IMH. Are all cases referred to the MSW?

Younger age psychiatric patients with higher education exhibit higher mental health literacy (Lim et al., 2015)

Informal help-seeking (e.g., friends and family) were most common source of help recommended for depression, whereas doctors and GPs were more commonly turned to for dementia (Picco et al., 2016)

Cause of Gap

IMH psychiatrists do not have time to share more about the diagnosis.

Potential Solutions

Mental health literacy programmes to target elderly psychiatric patients with lower education, and emphasise importance of seeking help from doctors and GPs regardless of type of mental health condition (e.g., including depression).

Future studies to cover wider range of mental disorders and specify areas of ignorance and knowledge – what people know or do not know – which can help to fine tune mental health literacy programmes.

Help-Seeking Behavior

• Desired Outcome:
• Synopsis: Many do not seek professional help due to finances, lack of insurance coverage, fear of discrimination and stigma. (Singapore Mental Health Study 2011)
• Seeking help from informal sources instead: Most respondents perceived seeking help from psychiatrist or psychologist as helpful. But the most commonly recommended source of help for persons with alchohol abuse, depression and schizophrenia vignettes is friends and family (Picco et al., 2016).
• People may be uncomfortable in explicitly acknowledging their mental health problems to a health professional and may thus choose to confide in family or friends (Picco, et al., 2016)
• Compared to young persons (26-28), older persons were less likely to recommend seeing a psychologist compared with talking to family or friends (Picco et al., 2016). Compared to Chinese, Indians were also less likely to recommend seeing a doctor or GP (Picco et al., 2016).
• Self-stigmatisation result in label avoidance – the individual is reluctant to be diagnosed with or seen as seeking treatment for a mental illness, resulting in delayed treatment seeking (Corrigan et al., 2004). Stigma, which is manifested in bias, distrust, stereotyping, fear, embarrassment, anger and avoidance identified as a barrier to service use in Asian societies (Picco, et al., 2016).
• Cultural factors Those who attribute the cause of mental illness to supernatural elements or spirit possession were more likely to seek help from spiritual healers than from professional mental health providers (Chong et al., 2012; Kua et al., 2000; Lim et al., 2015; Ng, et al., 2011).[Knowledge Gap: Further research exploring ethnic and cultural differences and preferences for mental health help seeking in Asian societies is needed.]
• Fear Parents may fear repercussions that their children might be taken away by Child Protection Services or they would be separated from their children by hospitalisations (Hinshaw, 2005; Nicholson & Biebel, 2002).

Resources	Gaps	Ideas
		Targeted intervention strategies on help-seeking, treatment beliefs, and the effectiveness of treatments in Singapore (Picco et al., 2016).
		Equip informal sources of help with adequate skills, knowledge, and mental health literacy to recognise mental health issues and to recommend professional sources of help when needed.

Capability & Capacity of Mental Health System

Capacity to meet demand

• Desired Outcome: [to insert]
• Synopsis: [to insert]
• There are around 248 psychiatrists and 473 psychologists practising in Singapore, which translates into 4.4 psychiatrists and 8.36 psychologists per 100,000 population.

[Expand: How does this compare to other countries? What is an adequate number?]

• Within the public health sector, the number of psychiatrists and psychologists has increased by 8 per cent to 182 and 7 per cent to 171, respectively, from 2017-2019. No number on counsellors, especially because healthcare professionals and medical social workers do counselling as part of their everyday work.

• As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.

Professional expertise & knowledge

• Desired Outcome: Professionals equipped with knowledge and skills to identify and treat mental illness
• Synopsis: [to insert]

This includes healthcare professionals/workers; general health practitioners; and spiritual leaders/advisors.

Resources	Gaps	Ideas

Existing Services and Communal Resources

GPs are trained to spot and handle conditions under AIC’s Mental Health GP-partnership programme (Boh & Oh, 2016)

Adequacy in meeting need

Majority prefer to go to GPs as first point of contact when they experience ‘stress-related’ symptoms (Lum et al., 2008). With three GPs, doctors diagnosed 429 new cases of mental illness and potentially diverted about 1,000 appointments from hospitals (Boh & Oh, 2016). More than 3,000 patients were helped through the Mental Health GP-partnership programme (Boh & Oh, 2016)

Cause of Gap

Potential Solutions

Integrated service system

• Desired Outcome: Integrated network of community partners to provide seamless and timely support
• Synopsis: [to insert]

Resources	Gaps	Ideas

Existing Services and Communal Resources

THRIVE – a regional platform for the North of Singapore to network mental health services, community-based social services, government agencies, VWOs and NGOs (Cheang & Cheok, 2015).THRIVE’s network of 18 agencies, including schools and VWOs, aims to help those with mild or moderate mental health symptoms seek and receive help in the community where they live (Teo, 2015). THRIVES helps service partners to build their capabilities and skills by providing training and networking opportunities for cross-disciplinary learning and networking (Khoo Teck Puat Hospital, 2018).

Adequacy in meeting need

Cause of Gap

Potential Solutions

Treatment and Interventions

Accessibility and affordability of treatment

• Desired Outcome: Treatments should be accessible, affordable and effective
• Synopsis: [to insert]

Consequence: if do not receive treatment, condition worsens, create stress for community, caregiver stress, other dysfunctions in life. Negative economic impact and high healthcare costs.

• In a modern society like Singapore, factors that can cause the increase of people with mental disorders are not just academic pressure, but also social media and cyber-bullying. [3]
• Stigma may be the reason why people are not willing to seek help as people are afraid that they would not be able to find a job. Patients who are clinically diagnosed admit that it is indeed difficult when they are trying to find a job. [4]
• The lack of professionals may be one of the reasons why people are not willing to seek help. “The Health Ministry had earlier revealed that there are around 250 psychiatrists and 470 psychologists practising in Singapore, which translates into 4.4 psychiatrists and 8.3 psychologists per 100,000 people here.” [5]
• The long waiting time to consult a professional may also be another reason why people are unwilling to seek help. “Across public hospitals, the median waiting time for a new appointment for subsidised consultation is 27 days to see a psychiatrist and 28 days to see a psychologist.” [6]The average time for a subsidised session is close to a month. This long period of waiting time may be another reason why people are not willing to seek help.[7]
• The high cost of seeking help can also turn away people who are not doing well financially. “The cost of 1-year inpatient treatment for those suffering from mental illness can be as high as S$200,000 at private hospitals.” [8] “The cost of mental health issues in Singapore may go up to as high as $990 per month.” [9]The cost associated with seeking professional help may be one of the reasons why people with mental disorders are not seeking professional help even if they are subsidised. [10] Not to mention that seeking help from private hospitals would cost even more. [11]

Resources	Gaps	Ideas
IMH	NMHS 2011: There are currently wide treatment gaps worldwide. Average treatment delay for mental illness is about 8 years.
Private psychiatrists private counsellors/psychologists

Self-management post-treatment

• Desired Outcome: Patients should have ability to self-manage their illness post treatment in a sustained way
• Synopsis: [to insert]

Resources	Gaps	Ideas

[Need meaningful categorisation]

• SRS
• SACS CRSS
• SACS HCC
• SACS SCC
• SAMH
• Club HEAL
• FSCs/Counselling Centres
• Clarity
• HPB Mental Welness Webpage

Medical Services

• IMH (Child Guidance Clinic; Forensic Rehabilitation, Intervention, Evaluation & Network Development Services; Mood and Anxiety Clinic; Community Health Assessment Team)
• Khoo Teck Puat Hospital (Psychological Medicine Department)
• Alexandra Hospital (Psychology Services)
• NUH (Psychiatric Clinic)
• SGH (Department of Psychiatry)
• Tan Tock Seng Hospital (Department of Psychological Medicine)
• National Neuroscience Institute
• Changi General Hospital (Department of Psychological Medicine)
• KK Women and Children’s Hospital

Children and Youth Services

• IMH (Child Guidance Clinic; Forensic Rehabilitation, Intervention, Evaluation & Network Development Services; Mood and Anxiety Clinic)
• SAMH YouthReach
• WINGS Counselling Centre

Adult Services

• IMH (Community Mental Health Team; Early Psychosis Intervention Programme; Mood Disorder Clinic)
• SACS
• SAMH (Insight Centre; Creative Hub)
• Silver Ribbon
• APRS (Association for Psychiatric Rehabilitation)

Seniors

• Changi General Hospital’s Community Psychogeriatric Programme
• IMH (Aged Psychiatry Community Assessment & Treatment Service; Psychogeriatric Clinic; Memory Clinic)
• Community Intervention Team (COMIT) by O’Joy Care Services
• Thye Hua Kwan Moral Charities (CREST; Goodlife!; Comfort Keepers)
• Tsao Foundation (Hua Mei Counselling and Coaching)
• Counselling for Older Persons by O’Joy Care Services
• Singapore Action Group of Elders (SAGE) Counselling Centre

Rehabilitation for those who lack cognitive, social, communication, language, and motor skills

[Clarification: Is rehab different from treatment?]

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Resources	Gaps	Ideas
Day Activity / Day Rehabilitation Centres -Club HEAL -Friendship And Mind Enrichment (FAME) Club by Bethesda C.A.R.E Centre -SASC (Hougang Care Centre; Simei Care Centre; Oasis Day Centre) -SAMH’s Club 3R

Employment

Employment can be both a cause and consequence of mental health problems. From a monetary aspect, the lack of income will ultimately have an impact on daily living. Psychologically, unemployment can lead to one feeling lose in social status, resulting in low self-esteem.

Job readiness

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Resources	Gaps	Ideas
-IMH’s Job Club – job training and placement programme -SACS’ employment support services -SAMH’s employment placement services	IMH’s Job Club made 270 job placements each year; SAMH places about 150-200 clients each year (Tai, 2016) MOM and TAFEP: 3 out of 2,100 complaints on unfair employment practices filed by employees with medical conditions. Further checks determined that no actual discrimination occurred (Yuen, 2018)
Vocational Training

Employer willingness to hire

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Patients who are clinically diagnosed admit that it is indeed difficult when they are trying to find a job. [12]

Resources	Gaps	Ideas
Open Door Fund (for PWDs only) SEC-WIS (extended to PWDS only)
	Many companies are still not open to hire PMIs: -Culture of flexible work arrangements not present? -Inability to get internships and foot through the door? Relapses in condition might make it hard for sustenance at jobs. Reluctant to hire due to perceived inability to perform Not aware of how to accommodate PMIs? Inflexibility in job, especially during 'low' moments in PMIs. Neglect of management of condition by employees IMH Vice Chairman: Absence of legislation prohibiting discrimination (Chong, 2017) Stereotypes of persons with mental illness being ‘crazy’ and therefore incapable of work	Informal economy to reduce reliance on formal economy? (e.g. TaskRabbit) Constultancy/training/funds to help companies on accommodation/internship projects for the hire of PMIs People with mental illnesses to be taught the importance of management of condition (though medication and lifestyle) in order to maintain jobs. To introduce short term sheltered employment models to recovering PMIs who might not be able to take the full extent of open employment?
		Silver Ribbon: Remove mental health query on job forms to prevent job search discrimination (Tai, 2016) Conduct mental health literacy talks at companies to change mindsets about PMHIs Implement an anti-discrimination law to penalise companies with discriminatory behaviour (e.g., sacking PMHIs without proper justification) Routine assessment of quality of life in patients with mental illness should be conducted and monitored (Picco et al., 2016)

Workplace support

• Desired Outcomes: Flexible workplace accommodations and naturalised support
• Synopsis:

Resources	Gaps	Ideas

Job fit and matching

• Desired Outcomes: Fit between abilities and needs of the job seeker and employer requirements
• Synopsis:

Resources	Gaps	Ideas
Vocational assessment
Placement services

Caregivers

Caregiving knowledge and skills

Resources	Gaps	Ideas
Caregivers’ Association of the Mentally Ill Caregiver Alliance Limited (CAL) SAMH Insight Centre’s Family Link Programme	Low awareness of available training services

Caregiver wellbeing and social support

Resources	Gaps	Ideas
AWWA Caregiver Service Caregiver Alliance Limited (CAL) Caregivers’ Association of the Mentally Ill Club HEAL SAMH Insight Centre’s Caregivers Support Group Clarity Singapore’s support groups	Low awareness of existing services Stigma associated with mental illness	Repeatedly offer caregivers and care recipients information and connection to supportive services

Community Integration

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Resources	Gaps	Ideas

(Case Study of COMIT run by O'Joy, by Murdoch Univeristy)

Social Inclusion

Public awareness and acceptance

• Desired Outcome: [to insert]
• Synopsis: [to insert]

Resources	Gaps	Ideas
Public Education Campaigns	Over 50,000 residents have been reached through various mental health awareness activities (Institute of Mental Health, 2015) Public awareness campaigns so far are about general mental wellness and mental health conditions. There are not many campaigns that are employment related.

Public Education Campaigns on mental illness

• Beyond the Label
  • Launched on 8 September 2018 as a five-year public education effort funded by the Tote Board Mental Health Strategic Initiative.
  • Influence public’s perception towards persons with mental health conditions. Aims to encourage the public to go beyond the label of a mental health diagnosis, to view and regard persons with mental health conditions for who they are.
  • Raise awareness of the stigma towards persons with mental health conditions.
  • Celebrate the resilience, strength and contributions of persons in recovery from mental health conditions.
  • Educate and equip the public with tips and knowledge to interact and support persons in recovery.
  • Facilitate more conversations on mental health.
  • Encourage more balanced reporting and portrayal of persons with mental health conditions in the news and media.
• 'NCSS ‘Speak Up’ Campaign
• President's Challenge 2019
  • Emphasised on indiviuduals with mental health issues. Raised awareness of their needs and better support them in their recovery process and reintegration into the community.
  • Voluntary Welfare Organisations supporting people with mental health conditions were able to apply for Empowering For Life Fund (2019 edition) that helps enable employment for vulnerable groups.
• World Mental Health Day, 10 October 2016; World Mental Health Day in Singapore: Voice Out Concert in the Park
• Touch Community Services and Nanyang Polytechnic (NYP)’s campaign (Valluvar, 2017)
• UNSAID – a student-led, socially-minded arts collective plans to organise an Artivist Fest on mental health (Tan, 2017)
• Silver Ribbon
• Club HEAL
• Publications: Mental Health Issues - Handbook for Employers and Employees (by SRS)

Resource Directory

See Mental Connect, a service and events directory.

1. NCSS Mental Health Resource Directory, PDF version
2. Understanding the Quality of Life of Adults with Mental Health Issues

Hotlines

Hotline / Helpline	Who is it for?	Day	Times	Telephone
Samaritans of Singapore (SOS)	Anybody in crisis and the suicidal.	Daily	24 hours	1800 – 2214444
Mental Health Helpline	Those suffering from psychological and psychiatric problems	Daily	24 hours	6389-2222
SAMH Helpline	For people who have psychological, psychiatric or social problem and others who need information on services for such persons	Mon – Fri	9am – 5pm	1800 – 2837019
Hotline 800	Mandarin speaking community with family marital and personal problem	Mon – Sun	10am – 9pm	1800 - 3535800
AMP Hotline	Malay / Muslim families in crisis or those who need help	Mon – Fri	10am – 5pm	6416-3960
Club HEAL	For Malay / Muslim individuals or families  who require assistance with or support for mental health concerns	Mon – Fri	9am – 5pm	6899-3463
Singapore Indian Development Association (SINDA)	Indian families in need of assistance or counselling	Mon – Fri  Sat	9am – 5pm 9am – 1pm	1800-295-4554
AWARE Helpline	Women with a variety of concerns	Mon – Fri	3pm – 9.30pm	1800-774-5935
Counselling & Care Centre	For individuals, couple and families experiencing psychological, marital or family problems	Mon – Fri	8.30am – 5pm	65-65366366
Oogachaga Hotline, Whatsapp and Email Counselling	For LGBTQ individuals - visit website for more specific details	Tuesdays, Wednesdays, Thursdays: 7pm – 10pm; Saturdays: 2pm – 5pm.		Hotline: 6226 2002 Whatsapp: 8592 0609
Brave Helpline	Lesbian, bisexual, transgender, queer and intersex (LBTQI) women in Singapore.	Mon – Fri	10am – 6pm	87888817
Limitless Helpline	Youth experiencing mental health concerns. Can chat on the phone, through text or Whatsapp.	Check the weblink!
CHAT (Community Health Assessment Team)	Youth aged 16-30 experiencing mental health concerns. Offers an online mental health assessment service called WebChat as well for those who wish to stay anonymous.			6493-6500 6493-6501
Fei Yue eCounselling Centre	Youth aged 13-25
Singapore Anti-Narcotics Association Online Counselling for Drug-Related Issues		Check the weblink!
Silver Ribbon (Singapore)				6386 1928
Singapore Association for Mental Health (SAMH)				1800 283 7019
Mount Elizabeth Medical Centre Psychiatric & Behavioural Medicine Clinic	Psychotherapy for children, adults and families	Mon – Fri Sat	9am – 5pm 9am - 1pm	6737 3663
Tinkle Friend (Singapore Children’s Society)	Online chat service for children that provides support, advice, and information.	Mon - Thurs Fri	2:30pm - 7pm 2:30pm - 5pm

Non-profit Organisations

Organisation/Service	Who is this for?
AMKFSC - Psychological Services Unit (PSU)
AMKFSC - MindCare
AWARE	Provides counselling for women over a range of issues, here.
Club HEAL	Individuals or families  who require assistance with or support for mental health concerns
Clarity Singapore	Individuals in need of social support / support groups -> OCD, youth
Limitless	Youth-centred, offers free and paid subsidised counselling for youth above 12 years old to address issues of relationships, trauma, mental health, self-image and behavioural challenges. Also holds the Zen Dylan Koh Fundwhich offers financial support for youth to seek help for mental health issues
Please Stay Movement	Advocacy group calling for unity and support to prevent suicide among young people
PSALT Care
Samaritans of Singapore	Persons with suicidal thoughts
Silver Ribbon
Singapore Association for Mental Health
Singapore Anti-Narcotics Association	Persons in recovery from narcotic abuse
WE CARE Community Services	Persons in recovery from addictions - substance or behaviour-based, and their caregivers.

Newslinks (Articles, op-eds, commentaries, letters to the editor etc.)

Date	Description
27 March 2012	Straits Times special feature on OCD, featuring the disorder and stories of persons in recovery
07 February 2017	Straits Times Op-ed by IMH psychiatrist Chong Siow Ann on OCD
07 April 2017	CNA commentary by IMH psychiatrist Daniel Fung on depression, to commemorate World Mental Health Day in 2017
24 November 2017	Coverage on the Hikikomori – Hidden Youth Syndrome Symposium 2017 organised by the Department of Psychological Medicine
10 October 2018	TODAY article on high-functioning depression among professionals
14 October 2018	TODAY commentary by reporter Louisa Tang on depression
22 February 2018	Straits Times article on polyclinics offering mental health services
20 April 2018	"Surprise! Reddit is actually helping people battle mental illness"
02 December 2018	TODAY commentary by student Tan Yu Jia on caring for her mum with mental illness
11 December 2018	TODAY article on the Singapore Mental Health Study 2018: "Mental illness more prevalent among young adults, OCD one of top disorders in S’pore"
11 December 2018	TODAY article on the Singapore Mental Health Study 2018: "More people in Singapore have experienced a mental disorder in their lifetime, study finds"
21 January 2019	TODAY article on the Singapore Youth Epidemiology and Resilience (Year) Study, to be done by NUS together with MOE and IMH
22 February 2019	TODAY article on SCDF full-time national serviceman who allegedly committed suicide
08 March 2019	TODAY commentary by Anthea Ong to make mental health a national priority
10 March 2019	Millennials of SG feature on hikikomori in Singapore
08 July 2019	TODAY commentary by Anthea Ong to make mental health education mandatory in SG schools
11 July 2019	TODAY article on hikikomori in Singapore
29 July 2019	TODAY article on the spike in male teen suicides in 2018, based on statistics from the Samaritans of Singapore (SOS)
16 September 2019	TODAY commentary by CHAT mental health advocate Khoo Yi Feng on dealing with mental health issues from the ground-up
12 October 2019	TODAY spread on mental health among youth together with the National Youth Council: "The Big Read: With youths more open about mental health, it’s time others learn to listen"
13 October 2019	TODAY commentary by reporter Louisa Tang on fighting depression
15 October 2019	TODAY forum letter: "Enhance suicide preventive measures in the SAF and Home Team"
21 October 2019	Reply to TODAY forum letter on 15 Oct by SAF
03 November 2019	S’porean lyricist who wrote songs for Stefanie Sun & JJ Lin runs 11km every day to stave off depression
29 February 2020	Straits Times op-ed by Tommy Koh on "Time to put mental health high on list of national priorities"

Fieldnotes of a Psychiatrist (2018)

A collection of commentaries on mental health by IMH psychiatrist Chong Siow Ann.

Stories

Holding The Hope (2019)

Speaking Your Mind (2020)

Published in Singapore in 2020 by NUS Yong Loo Lin School of Medicine. Featuring stories by individuals related to the mental health sector, Speaking Your Mind is an inter-professional project inspired by students from different faculties of the National University of Singapore (NUS). It was initiated to raise awareness, and to correct and challenge the status quo of society’s perception on mental health.

The Tapestry Project

An independent, not-for-profit website that champions mental health recovery through the power of story.

Our Grandfather Story

Our Better World

Mental Health Research in Singapore

[to insert research landscape]

Research by NAMS

IMH research repository

SGH Eating Disorders Publication

Financial Support

The Zen Dylan Koh Fund - A fund that supports youths with mental health issues in need of therapy.

Zen Dylan Koh and his mother, Elaine Lek. Elaine was featured in a news article here.