Difference between revisions of "Mental Health"

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[[File:9395647476 66c4e40a9a z.jpg|thumb|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.|438x438px]]
 
[[File:9395647476 66c4e40a9a z.jpg|thumb|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.|438x438px]]
<br>
 
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.
 
  
From the National Mental Health Study 2011, it was found that 12% of the residential population (approximately 308 400 people) have a mental illness. "According to the latest mental health study, one in ten people in Singapore will be stricken by mental illness in their lifetime, and many are likely to face depression - the most common mental illness here."
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==Overview==
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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.
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===Priority Issues===
  
== Definitions ==
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*[to insert]
----'''Mental Health'''
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*to insert]
  
According to the [https://www.who.int/en/news-room/fact-sheets/detail/mental-health-strengthening-our-response WHO (2018)], mental health is a state of well-being in which every individual can:
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===Actionable Opportunity Areas===
* Realise his/her abilities
 
* Cope with the normal stresses of life
 
* Work productively
 
* Have the ability to contribute to the community
 
  
'''Mental Illness / Disorders'''
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*[to insert]
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*[to insert]
  
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.<ref>https://www.samhealth.org.sg/understanding-mental-health/what-is-mental-illness/</ref>
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===Knowledge Gaps===
  
According to the [https://en.wikipedia.org/wiki/DSM-5 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:
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*[to insert]
* Deviance : Serious deviation from social or cultural norms
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*[to insert]
* 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
 
Different categories of mental disorders include substance-related disorders, mood disorders, anxiety disorders, sleep disorder, personality disorder and psychotic disorders. The ambitious can consult the latest DSM-5 here:<ref>https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf</ref>
 
  
== Theories of Mental Health ==
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==Definition of Mental Health==
  
== Policies & Legislation ==
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===How Mental Health is Defined in Singapore===
[[File:82379081 10221149388475156 8435171063305863168 o.jpg|thumb|304x304px|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/[https://www.facebook.com/photo.php?fbid=10221149388395154&set=a.1324556964831&type=3&theater Tee Zhuo]]]'''Mental Health (Care and Treatment) Act 2008'''
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According to the [https://www.who.int/en/news-room/fact-sheets/detail/mental-health-strengthening-our-response WHO (2018)], mental health is a state of well-being in which every individual can:
  
Provides for the admission, detention, care and treatment  of mentally disordered persons in designated psychiatric institutions.
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*Realise his/her abilities
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*Cope with the normal stresses of life
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*Work productively
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*Have the ability to contribute to the community
  
'''Mental Capacity Act 2008'''
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[<u>Info gap</u>: 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]
  
Any person guilty of ill-treating a person who lacks capacity can be liable to a fine and/or jail term. Ill-treatment includes physical, sexual or emotional abuse, and wilful neglect or abandonment.
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===How Singapore Defines & Classifies Mental Illness / Disorders===
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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.
  
'''Vulnerable Adults Act'''
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<small>[<u>Clarification</u>: 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?]</small>
  
Empowers the sate 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 safe place
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According to the [https://en.wikipedia.org/wiki/DSM-5 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:
  
There are also specific legislations that matter in the course of specific mental disorders. For example, the Misuse of Drugs Act matters to persons with substance addiction.
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*Deviance : Serious deviation from social or cultural norms
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*Distress : Causes significant personal distress in social, occupational or other recreational activities
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*Dysfunction : Behaviour which interferes with the ability of a person to function effectively
  
'''Mental health declaration for job applicants'''
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<small>[<u>Clarification</u>: 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?]</small>
  
As of December 2019, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) has declared that [https://www.tal.sg/tafep/employment-practices/recruitment/job-application-forms "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.
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Different categories of mental disorders according to the DSM-5 are :
== Specific Groups / Client Segments ==
 
----
 
  
Page to [[Youth with mental health issues|Youth with Mental Health Issues]]
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#Neurodevelopmental Disorders, including:
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#*Intellectual Disabilities
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#*Communication Disorders
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#*Autism Spectrum Disorder
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#*Attention-Deficit Hyperactivity Disorder
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#*Motor Disorders (e.g., Tourette's Disorder)
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#Schizophrenia Spectrum and Other Psychotic Disorders
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#Bipolar and Related Disorders
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#Depressive Disorders
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#Anxiety Disorders
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#Obsessive-Compulsive and Related Disorders
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#Trauma- and Stressor-Related Disorders
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#Dissociative Disorders
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#Somatic Symptom and Related Disorders
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#Feeding and Eating Disorders
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#Elimination Disorders
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#Sleep-Wake Disorders
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#Sexual Dysfunctions
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#Gender Dysphoria
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#Disruptive, Impulse-Control, and Conduct Disorders
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#Substance-Related and Addictive Disorders
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#Neurocognitive Disorders
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#Personality Disorders
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#Paraphilic Disorders
  
Page to [[Adults with mental health issues|Adults with Mental Health Issues]]
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<small>[<u>Possible elaboration & sense-making</u>: 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?]</small>
  
Page to [[Addiction]]
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==Key Statistics & Figures==
  
== Statistics ==
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===Prevalence & Trend of Mental Disorders (13.9% or 1 in 7)===
----
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<small>[<u>Sense-make</u>: How does this fare with other countries? Should we be worried or this is typical?]</small>
  
'''Prevalence of''' '''Disorders'''
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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.<ref>IMH Media Release: https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf</ref>
  
 
Findings from the [https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf Singapore Mental Health Study (2016)]:
 
Findings from the [https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf 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.
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* 1 in 7 people in Singapore has experienced these disorders in their lifetime ( __% of the adult population 18y/o and above):
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*Comparing with the 2010 study, there was an increase in lifetime prevalence of mental illness from 12% in 2010 to 13.9% in 2016.
** '''Mood disorders:''' Major depressive disorder (6.3%), bipolar disorder (1.6%)
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*1 in 7 people in Singapore has experienced these disorders in their lifetime ( __% of the adult population 18y/o and above):
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**'''Mood disorders:''' Major depressive disorder (6.3%), bipolar disorder (1.6%)
 
**'''Anxiety disorders:''' Obsessive-compulsive disorder and generalised anxiety disorder (OCD+GAD = 4.8%)
 
**'''Anxiety disorders:''' Obsessive-compulsive disorder and generalised anxiety disorder (OCD+GAD = 4.8%)
** '''Alcohol use disorders:''' Alcohol abuse/dependence
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**'''Alcohol use disorders:''' Alcohol abuse/dependence
* Those aged 18 – 34 years, divorced or separated were more likely to have mood disorders
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*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.
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*Alcohol Abuse and Obsessive-Compulsive Disorder are highly common in Singapore.
  
''[https://en.wikipedia.org/wiki/Suicide_in_Singapore Suicide in Singapore]''
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===Suicide Rate (Almost 400 a year)===
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<small>[<u>Sense-mak</u>e: How does this fare with other countries? Should we be worried or this is typical?]</small>
  
397 people committed suicide in 2018. The leading cause of death for those aged 10 to 29 years.<ref>https://www.sos.org.sg/learn-about-suicide/quick-facts</ref>
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*397 people committed suicide in 2018. The leading cause of death for those aged 10 to 29 years.
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*Attempted suicide has been decriminalised in Singapore as of 1 Jan 2020.
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*''See also wiki page on [https://en.wikipedia.org/wiki/Suicide_in_Singapore Suicide in Singapore]''
  
Attempted suicide has been decriminalised in Singapore as of 1 Jan 2020.
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===Size & Profile of Mental Health Patients (60k outpatient, 6k inpatient)===
  
'''Patients / Clients'''
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*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.<ref name=":0" />
  
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.<ref name=":0">https://www.channelnewsasia.com/news/singapore/60-000-subsidised-outpatients-seek-treatment-mental-disorders-12240990</ref>
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*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.
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*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.<ref name=":0" />
  
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.<ref name=":0" />
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===Size of Mental Health Professionals (4.4 psychiatrists & 8.36 psychologists per 100,000)===
  
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.<ref name=":0" />
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*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.<ref name=":0" />
  
'''Professionals<ref name=":0" />'''
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<small>[<u>Expand</u>: How does this compare to other countries? What is an adequate number?]</small>
  
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.
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*According to a study in Ireland, there are different benchmarks that we can follow:
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**''Population-Based Estimates:''
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***“a  recommended  ratio  of  1 in 5,000 (Management Advisory Service, 1989; National Health Services  [NHS]  Education  for  Scotland, 2009)”
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***“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.
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**''Needs-Based Estimates:''
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***"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.
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**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.[https://www.researchgate.net/publication/277731214_How_many_psychologists_do_we_need]
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*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. [https://www.researchgate.net/publication/277731214_How_many_psychologists_do_we_need]
  
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.
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*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.<ref name=":0" />
  
As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support
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*As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.<ref name=":0" />
  
==Issues Faced by People with Mental Health Issues==
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==Overview of Key Issues & Areas of Needs==
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<big>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]</big>
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{| class="wikitable"
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|<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Prevention Prevention]'''</big>
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|<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Detection.2C_Diagnosis_.26_Referral Detection & Diagnosis]'''</big>
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Early_detection_and_screening Early Detection]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Information_and_Referral Information & Referral]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Help-Seeking_Behavior Help Seeking]
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|<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Treatment_and_Interventions Treatment]'''</big>
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Accessibility_and_affordability_of_treatment Accessibility & affordability]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Self-management_post-treatment Self-Management]
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*Rehab?
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|'''<big>↘</big>'''
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|'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Capability_.26_Capacity_of_Mental_Health_System Capability & Capacity of Mental Health System]'''
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Capacity_to_meet_demand Capacity to meet demand]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Professional_expertise_.26_knowledge Professional expertise & knowledge]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Integrated_service_system Integrated service system]
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|<big>'''↗'''</big>
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|<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Employment Employment]'''</big>
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Job_readiness Job readiness]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Employer_willingness_to_hire Employer willingness]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Workplace_support Workplace support]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Job_fit_and_matching Job matching]
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|'''<big>↘</big>'''
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| rowspan="5" |<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Social_Inclusion Social Inclusion]'''</big>
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*Public awareness & acceptance
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|<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Community_Integration Community Integration]'''</big>
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|<big>'''↗'''</big>
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|<big>'''[http://wiki.socialcollab.sg/index.php/Mental_Health#Caregivers Family & Caregivers]'''</big>
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Caregiving_knowledge_and_skills Caregiving knowledge & skills]
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*[http://wiki.socialcollab.sg/index.php/Mental_Health#Caregiver_wellbeing_and_social_support Caregiver wellbeing & social support]
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|<big>'''↗'''</big>
  
===Screening, Detection and Diagnosis===
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'''1. Need for preventive measures against mental health problems'''
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==Sub-pages==
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Current sub-pages are being worked on as part of ongoing [[Civic Experiment & Wiki Challenge|wiki challenge]]:
  
'''''Existing Services and Communal Resources'''''
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*[[Mental Health/MH4|MH4]]
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*Page to [[Youth with mental health issues|Youth with Mental Health Issues]]
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*Page to [[Adults with mental health issues|Adults with Mental Health Issues]]
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*Page to [[Addiction]]
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*Page to [[Dementia]]
  
SRS
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[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.]
  
Club Heal
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Substance-related disorders
  
HPB Working Minds Curriculum
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*Drug abuse
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*Alcohol abuse
  
Treasure your Mind
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Mood disorders
  
'''''Adequacy in meeting need'''''
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*OCD
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*Phobias
  
Not many HR departments in companies are aware of how to deal with people wiht mental illness, be it developed in the course of employment or before employment.
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Anxiety disorders
  
'''''Cause of Gap'''''
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*[insert?]
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*[insert?]
  
Not enough awareness and knowledge of the different mental illnesses
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Sleep disorder
  
Mental illness might still be considered a taboo.
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Personality disorder
  
'''''Potential Solutions'''''
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*[insert?]
  
Educate HR departments and develop resource toolkits
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Psychotic disorders
  
'''2. Need for early recognition and screening'''
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*[insert?]
----
 
  
'''''Existing Services and Communal Resources'''''
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==Legislation & Key Policies==
  
Community touchpoints: - Clarity Singapore - AIC - SAMH - Community Health Assessment Team (free mental health check for young persons aged 16 to 30 years) - Silver Ribbon
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*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.
  
Medical system: - GPs - 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
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'''<big>Mental Health (Care and Treatment) Act 2008</big>'''
  
'''''Adequacy in meeting need'''''
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Provides for the admission, detention, care and treatment  of mentally disordered persons in designated psychiatric institutions.
  
Not many HR departments in companies are aware of how to deal with people with mental illness
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See [https://sso.agc.gov.sg/Act/MHCTA2008 Mental Health (Care and Treatment) Act]
  
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 [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)]. More than 3,000 patients were helped through the Mental Health GP-partnership programme [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)].
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'''<big>Mental Capacity Act 2008</big>'''
  
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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)].
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Allows Singaporeans to appoint persons whom they can trust to make decisions on their behalf in the event that they are mentally incapacitated.  
  
Compared to young persons (26-28), older persons were less likely to recommend seeing a psychologist compared with talking to family or friends [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)]. Compared to Chinese, Indians were also less likely to recommend seeing a doctor or GP [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)].
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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.
  
'''''Cause of Gap'''''
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A person lacks mental capacity if he or she cannot do one or more of the following things:
  
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 [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.379.4271&rep=rep1&type=pdf (Corrigan et al., 2004)].
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*Understand the information relevant to that decision
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*Remember that information
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*Use or weigh that information as part of the decisionmaking process
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*Communicate that decision by any means; e.g. talking, using sign language, drawing, etc.
  
Stigma, which is manifested in bias, distrust, stereotyping, fear, embarrassment, anger and avoidance identified as a barrier to service use in Asian societies [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco, et al., 2016)].
+
See [https://sso.agc.gov.sg/Acts-Supp/22-2008/Published/20100331?DocDate=20081017 Mental Capacity Act 2008]
  
'''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 ([https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/treatment-gap-in-common-mental-disorders-the-singapore-perspective/A5389F32B49AC65C2A4E1794C8F99D44 Chong et al., 2012]; [https://www.ncbi.nlm.nih.gov/pubmed/11284613 Kua et al., 2000]; [https://www.researchgate.net/publication/282866787_Mental_Health_Literacy_and_the_Belief_in_the_Supernatural Lim et al., 2015]; [https://www.ncbi.nlm.nih.gov/pubmed/20938847 Ng, et al., 2011]).
+
'''<big>Vulnerable Adults Act 2018</big>'''
  
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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco, et al., 2016)]
+
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.
  
'''Poor awareness of existing services''' 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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco, et al., 2016)]
+
See [https://sso.agc.gov.sg/Act/VAA2018 Vulnerable Adults Act 2018]
  
'''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 ([http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2005.01456.x/full Hinshaw, 2005]; [https://link.springer.com/article/10.1023/A%3A1014551306288 Nicholson & Biebel, 2002)].
+
<big>'''National Mental Health Blueprint 2007'''</big>
  
'''''Potential Solutions'''''
+
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.
  
Public education to tackle negative stereotypes of mental illness
+
See IMH website for [https://www.imh.com.sg/uploadedFiles/Publications/IMH%20National%20Mental%20Health%20Blueprint.pdf National Mental Health Blueprint 2007-2012]
  
Targeted intervention strategies on help-seeking, treatment beliefs, and the effectiveness of treatments in Singapore [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)].
+
<big>'''Community Mental Health (CMH) Masterplan 2012, 2017'''</big>
  
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.
+
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.
  
Further research exploring ethnic and cultural differences and preferences for mental health help seeking in Asian societies is needed.
+
[Details of the Masterplans cannot be found currently.]
===Public Awareness, Information and Referral===
 
'''3. Need for public awareness and acceptance of people with mental illness'''
 
----
 
  
'''''Existing Services and Communal Resources'''''
+
'''<big>Mental health declaration for job applicants</big>'''
  
'''Public Education Campaigns on mental illness:'''
+
As of December 2019, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) has declared that [https://www.tal.sg/tafep/employment-practices/recruitment/job-application-forms "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==
 +
<big>[Read this templatised [[Template|guide]] on how to populate this section]</big>[[File:82379081 10221149388475156 8435171063305863168 o.jpg|thumb|304x304px|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/[https://www.facebook.com/photo.php?fbid=10221149388395154&set=a.1324556964831&type=3&theater Tee Zhuo]]]
  
- '[https://www.ncss.gov.sg/SpeakUp NCSS ‘Speak Up’ Campaign]
+
==='''Prevention'''===
  
- World Mental Health Day, 10 October 2016
+
*'''Desired Outcome''': [to insert]
 +
*'''Synopsis''': [to insert]
  
- Touch Community Services and Nanyang Polytechnic (NYP)’s campaign [http://www.straitstimes.com/singapore/campaign-on-track-to-raise-mental-health-awareness (Valluvar, 2017)]
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|SRS
  
- UNSAID – a student-led, socially-minded arts collective plans to organise an Artivist Fest on mental health [http://www.straitstimes.com/singapore/unsaid-helps-give-voice-to-an-unheard-problem (Tan, 2017)]
+
Club Heal
  
Silver Ribbon
+
HPB Working Minds Curriculum
  
Club HEAL
+
Treasure your Mind
 +
|
 +
Not enough awareness and knowledge of the different mental illnesses
  
Publications: Mental Health Issues - Handbook for Employers and Employees (by SRS)
+
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====
  
[http://www.who.int/mental_health/world-mental-health-day/en/ World Mental Health Day] in Singapore: [https://www.eventbrite.sg/e/world-mental-health-day-voice-out-concert-in-the-park-tickets-36466427065?aff=es2 Voice Out Concert in the Park]
+
*'''Desired Outcome''': [to insert]
 +
*'''Synopsis''': [to insert]
  
'''''Adequacy in meeting need'''''
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|[http://wiki.socialcollab.sg/index.php/Mental_Health#Community_Touchpoints Community Touchpoints]
 +
|
 +
|
 +
|-
 +
|Online platforms
 +
|
 +
|
 +
|-
 +
|[http://wiki.socialcollab.sg/index.php/Mental_Health#Medical_Touchpoints Medical Touchpoints]
 +
|
 +
|
 +
|-
 +
|Organisations
 +
<small><u>[Info gap</u>: How and where do HR depts equip themselves to deal with mental health issues of their employees?]</small>
 +
|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
  
Over 50,000 residents have been reached through various mental health awareness activities [https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/Media%20Release%20-%20Mental%20Health%20Awareness%20Walk-%20Final.pdf (Institute of Mental Health, 2015)]
+
Family members may not reveal condition; to cushion the impact on PMI
 +
|
 +
|}
 +
<u>Community Touchpoints</u>
  
Public awareness campaigns so far are about general mental wellness and mental health conditions. There are not many campaigns that are employment related.
+
*Clarity Singapore
 +
*AIC
 +
*SAMH
 +
*Community Health Assessment Team (free mental health check for young persons aged 16 to 30 years)
 +
*Silver Ribbon
  
'''''Cause of Gap'''''
+
<u>Online Platforms</u>
  
Stigma of mental illness needs to be first broken down.
+
*https://www.mindline.sg/home (AI powered chat line and informational and referral - joint initiative of MOHT, IMH, MSF, NCSS)
  
'''''Potential Solutions'''''
+
<u>Medical Touchpoints</u>
  
'''4. Need for clients to have adequate information about how to manage their condition and support available'''
+
*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 [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)]. More than 3,000 patients were helped through the Mental Health GP-partnership programme [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (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
  
'''''Existing Services and Communal Resources'''''
+
====Information and Referral====
  
'''Information Services – Medical System:'''
+
*'''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
  
-SAMH’s helpline
+
{| class="wikitable"
 
+
|-
-IMH’s interactive information system
+
| style="width: 33.3%;" |'''<big>Resources</big>'''
 
+
| style="width: 33.3%;" |'''<big>Gaps</big>'''
-IMH’s online resources
+
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 
+
|-
-Medical social workers
+
|Awareness of treatment services
 
+
|
-GPs
+
|
 
+
|-
'''Information Services – Community Touch Points:'''
+
|Understanding treatment efficacy
 
+
|
-Clarity Singapore’s helpline
+
|
 
+
|-
-Alzheimer’s Disease Association (ADA)’s helpline
+
|
 
+
|
-HPB’s Dementia InfoLine
+
|
 
+
|-
-SOS’s helpline
+
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
 +
<u>Information Services – Medical System</u>
  
'''Mental health literacy programmes'''
+
*SAMH’s helpline
 +
*IMH’s interactive information system
 +
*IMH’s online resources
 +
*Medical social workers
 +
*GPs
  
- [https://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2016/suicide-prevention.html MOH]
+
<u>Information Services – Community Touch Points</u>
  
- CGH
+
*Clarity Singapore’s helpline
 +
*Alzheimer’s Disease Association (ADA)’s helpline
 +
*HPB’s Dementia InfoLine
 +
*SOS’s helpline
  
- [https://www.sgh.com.sg/subsites/pgahi/Events/Workshops/Pages/mental-health-aid.aspx SGH]
+
<u>Mental health literacy programmes</u>
  
- [http://www.silverribbonsingapore.com/workshops.html Silver Ribbon]
+
*[https://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2016/suicide-prevention.html MOH]
 
+
*CGH
[http://www.mhfa.sg/ Mental Health First Aid]
+
*[https://www.sgh.com.sg/subsites/pgahi/Events/Workshops/Pages/mental-health-aid.aspx SGH]
 +
*[http://www.silverribbonsingapore.com/workshops.html Silver Ribbon]
 +
*[http://www.mhfa.sg/ Mental Health First Aid]
  
 
'''''Adequacy in meeting need'''''
 
'''''Adequacy in meeting need'''''
  
IMH psychiatrists do not communicate to patients abojut their diagnosis and how to manage their conditions.
+
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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco, et al., 2016)]
  
Family members may not reveal condition
+
IMH psychiatrists do not communicate to patients about their diagnosis and how to manage their conditions.
 
 
Many PMIs lack insight about their conditions/don't know where to seek  help
 
  
 
Not many HR departments in companies are aware of how to deal with people with mental illness
 
Not many HR departments in companies are aware of how to deal with people with mental illness
Line 257: Line 524:
  
 
IMH psychiatrists do not have time to share more about the diagnosis.
 
IMH psychiatrists do not have time to share more about the diagnosis.
 
Family members want to cushion the impact on PMI.
 
  
 
'''''Potential Solutions'''''
 
'''''Potential Solutions'''''
Line 266: Line 531:
 
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.
 
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.
  
'''Treatment and Interventions'''
+
====Help-Seeking Behavior====
  
'''5. Need for timely access to medical intervention'''
+
*'''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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)]. Compared to Chinese, Indians were also less likely to recommend seeing a doctor or GP [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (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 [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.379.4271&rep=rep1&type=pdf (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 [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (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 ([https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/treatment-gap-in-common-mental-disorders-the-singapore-perspective/A5389F32B49AC65C2A4E1794C8F99D44 Chong et al., 2012]; [https://www.ncbi.nlm.nih.gov/pubmed/11284613 Kua et al., 2000]; [https://www.researchgate.net/publication/282866787_Mental_Health_Literacy_and_the_Belief_in_the_Supernatural Lim et al., 2015]; [https://www.ncbi.nlm.nih.gov/pubmed/20938847 Ng, et al., 2011]).[<u>Knowledge Ga</u>p: 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 ([http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2005.01456.x/full Hinshaw, 2005]; [https://link.springer.com/article/10.1023/A%3A1014551306288 Nicholson & Biebel, 2002)].
  
'''''Existing Services and Communal Resources'''''
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|
 +
|
 +
|Targeted intervention strategies on help-seeking, treatment beliefs, and the effectiveness of treatments in Singapore [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (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.
 +
|}
  
IMH
+
==='''Capability & Capacity of Mental Health System'''===
  
Private pyschiatrists
+
====Capacity to meet demand====
  
SRS
+
*'''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.<ref name=":0" />
  
SACS CRSS
+
<small>[<u>Expand</u>: How does this compare to other countries? What is an adequate number?]</small>
  
SAMH
+
*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.<ref name=":0" />
  
Grassroots
+
*As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.<ref name=":0" />
  
HPB
+
====Professional expertise & knowledge====
  
'''''Adequacy in meeting need'''''
+
*'''Desired Outcome''': Professionals equipped with knowledge and skills to identify and treat mental illness
 +
*'''Synopsis''': [to insert]
  
NMHS 2011: There are currently wide treatment gaps worldwide. Average treatment delay for mental illness is about 8 years.
+
This includes healthcare professionals/workers; general health practitioners; and spiritual leaders/advisors.
  
Consequence: condition worsens, create stress for community, caregiver stress, other dysfunctions in life. Negative economic impact and high healthcare costs.
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''''Cause of Gap'''''
+
'''''Existing Services and Communal Resources'''''
  
Many do not seek professional help due to finances, lack of insurance coverage, fear of discrimination and stigma. (Singapore Mental Health Study 2011)
+
GPs are trained to spot and handle conditions under AIC’s Mental Health GP-partnership programme [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)][[File:Capture.jpg|thumb]]
  
'''''Potential Solutions'''''
+
'''''Adequacy in meeting need'''''
  
'''6. Need for self-sustainable management of their conditions'''
+
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 [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)]. More than 3,000 patients were helped through the Mental Health GP-partnership programme [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)]
----
 
  
'''''Existing Services and Communal Resources'''''
+
'''''Cause of Gap'''''
  
Private psychiatrists
+
'''''Potential Solutions'''''
  
private counsellors/psychologists
+
====Integrated service system====
  
SRS
+
*'''Desired Outcome''': Integrated network of community partners to provide seamless and timely support
 +
*'''Synopsis''': [to insert]
  
SACS CRSS
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}'''''Existing Services and Communal Resources'''''
  
SACS HCC
+
THRIVE – a regional platform for the North of Singapore to network mental health services, community-based social services, government agencies, VWOs and NGOs [https://search.informit.com.au/documentSummary;dn=752794801752608;res=IELHEA (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 [http://www.straitstimes.com/singapore/health/reaching-out-to-the-mentally-ill?login=true (Teo, 2015)]. THRIVES helps service partners to build their capabilities and skills by providing training and networking opportunities for cross-disciplinary learning and networking [https://www.ktph.com.sg/psychmed/thrive (Khoo Teck Puat Hospital, 2018)].
  
SACS SCC
+
'''''Adequacy in meeting need'''''
  
SAMH
+
'''''Cause of Gap'''''
  
Club HEAL
+
'''''Potential Solutions'''''
  
FSCs/Counselling Centres
+
==='''Treatment and Interventions'''===
  
Clarity
+
====Accessibility and affordability of treatment====
  
HPB Mental Welness Webpage
+
*'''Desired Outcome''': Treatments should be accessible, affordable and effective
 +
*'''Synopsis''': [to insert]
  
'''Medical Services'''
+
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.
  
-IMH (Child Guidance Clinic; Forensic Rehabilitation, Intervention, Evaluation & Network Development Services; Mood and Anxiety Clinic; Community Health Assessment Team)
+
*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. [https://www.straitstimes.com/singapore/more-people-seeking-help-for-mental-illness-community-group-says]
 +
*'''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. [http://www.smj.org.sg/sites/default/files/4203/4203a4.pdf]
 +
*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.” [https://www.straitstimes.com/singapore/health/mental-health-issues-must-be-tackled-nmp]
 +
*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.” [https://www.straitstimes.com/singapore/health/urgent-need-to-improve-affordability-accessibility-and-quality-of-mental-healthcare]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.[https://www.straitstimes.com/singapore/health/urgent-need-to-improve-affordability-accessibility-and-quality-of-mental-healthcare]
 +
*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.” [https://www.theonlinecitizen.com/2019/04/17/what-is-the-state-of-mental-health-in-singapore/] “The cost of mental health issues in Singapore may go up to as high as $990 per month.” [https://blog.seedly.sg/mental-health-costs-subsidies-singapore/]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. [https://blog.seedly.sg/mental-health-costs-subsidies-singapore/] Not to mention that seeking help from private hospitals would cost even more. [https://www.theonlinecitizen.com/2019/04/17/what-is-the-state-of-mental-health-in-singapore/]
  
-Khoo Teck Puat Hospital (Psychological Medicine Department)
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|IMH
 +
|NMHS 2011: There are currently wide treatment gaps worldwide. Average treatment delay for mental illness is about 8 years.
 +
|
 +
|-
 +
|Private psychiatrists
  
-Alexandra Hospital (Psychology Services)
+
private counsellors/psychologists
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
-NUH (Psychiatric Clinic)
+
====Self-management post-treatment====
  
-SGH (Department of Psychiatry)
+
*'''Desired Outcome''': Patients should have ability to self-manage their illness post treatment in a sustained way
 +
*'''Synopsis''': [to insert]
  
-Tan Tock Seng Hospital (Department of Psychological Medicine)
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
 +
[Need meaningful categorisation]
  
-National Neuroscience Institute
+
*SRS
 +
*SACS CRSS
 +
*SACS HCC
 +
*SACS SCC
 +
*SAMH
 +
*Club HEAL
 +
*FSCs/Counselling Centres
 +
*Clarity
 +
*HPB Mental Welness Webpage
  
-Changi General Hospital (Department of Psychological Medicine)
+
'''Medical Services'''
  
-KK Women and Children’s Hospital
+
*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'''
 
'''Children and Youth Services'''
  
-IMH (Child Guidance Clinic; Forensic Rehabilitation, Intervention, Evaluation & Network Development Services; Mood and Anxiety Clinic)
+
*IMH (Child Guidance Clinic; Forensic Rehabilitation, Intervention, Evaluation & Network Development Services; Mood and Anxiety Clinic)
 
+
*SAMH YouthReach
-SAMH YouthReach
+
*WINGS Counselling Centre
 
 
-WINGS Counselling Centre
 
 
 
'''Adult Services''' -IMH (Community Mental Health Team; Early Psychosis  Intervention  Programme; Mood Disorder Clinic)
 
  
-SACS
+
'''Adult Services'''
  
-SAMH (Insight Centre; Creative Hub)
+
*IMH (Community Mental Health Team; Early Psychosis  Intervention  Programme; Mood Disorder Clinic)
 
+
*SACS
-Silver Ribbon
+
*SAMH (Insight Centre; Creative Hub)
 
+
*Silver Ribbon
-APRS (Association for Psychiatric Rehabilitation)
+
*APRS (Association for Psychiatric Rehabilitation)
  
 
'''Seniors'''
 
'''Seniors'''
  
-Changi General Hospital’s Community Psychogeriatric Programme
+
*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
  
-IMH (Aged Psychiatry Community Assessment & Treatment Service; Psychogeriatric Clinic; Memory Clinic)
+
====Rehabilitation for those who lack cognitive, social, communication, language, and motor skills====
 +
[<u>Clarification</u>: Is rehab different from treatment?]
  
-Community Intervention Team (COMIT) by O’Joy Care Services
+
*'''Desired Outcome''': [to insert]
 +
*'''Synopsis''': [to insert]
  
-Thye Hua Kwan Moral Charities (CREST; Goodlife!; Comfort Keepers)
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|Day Activity / Day Rehabilitation Centres
  
-Tsao Foundation (Hua Mei Counselling and Coaching)
+
-Club HEAL
  
-Counselling for Older Persons by O’Joy Care Services
+
-Friendship And Mind  Enrichment (FAME) Club by Bethesda C.A.R.E Centre
  
-Singapore Action Group of Elders (SAGE) Counselling Centre
+
-SASC (Hougang Care Centre; Simei Care Centre; Oasis Day Centre)
  
'''''Adequacy in meeting need'''''
+
-SAMH’s Club 3R
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''''Cause of Gap'''''
+
==='''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.
  
'''''Potential Solutions'''''
+
====Job readiness====
  
'''7. Need for rehabilitation for those who lack cognitive, social, communication, language, and motor skills'''
+
*'''Desired Outcome''': [to insert]
----'''''Existing Services and Communal Resources'''''
+
*'''Synopsis''': [to insert]
  
Day Activity / Day Rehabilitation Centres
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|<nowiki>-IMH’s Job Club – job training and placement programme</nowiki>
  
- Club HEAL
+
-SACS’ employment support services
  
- Friendship And Mind  Enrichment (FAME) Club by Bethesda C.A.R.E Centre
+
-SAMH’s employment placement services
 +
|IMH’s Job Club made 270 job placements each year; SAMH places about 150-200 clients each year [http://www.straitstimes.com/singapore/call-to-remove-mental-health-query-on-job-forms (Tai, 2016)]
  
- SASC (Hougang Care Centre; Simei Care Centre; Oasis Day Centre)
+
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 [http://www.straitstimes.com/politics/parliament-low-incidence-of-workplace-discrimination-based-on-medical-conditions (Yuen, 2018)]
 +
|
 +
|-
 +
|Vocational Training
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
- SAMH’s Club 3R
+
====Employer willingness to hire====
  
'''''Adequacy in meeting need'''''
+
*'''Desired Outcome''': [to insert]
 +
*'''Synopsis''': [to insert]
  
'''''Cause of Gap'''''
+
Patients who are clinically diagnosed admit that it is indeed difficult when they are trying to find a job. [http://www.smj.org.sg/sites/default/files/4203/4203a4.pdf]
 
+
{| class="wikitable"
'''''Potential Solutions'''''
+
|-
 
+
| style="width: 33.3%;" |'''<big>Resources</big>'''
===Employment===
+
| style="width: 33.3%;" |'''<big>Gaps</big>'''
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.
+
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 
+
|-
'''8. Need for sustained employment as a means to financial independence'''
+
|Open Door Fund (for PWDs only)
----
 
 
 
'''''Existing Services and Communal Resources'''''
 
 
 
Open Door Fund (for PWDs only)
 
  
 
SEC-WIS (extended to PWDS only)
 
SEC-WIS (extended to PWDS only)
 
+
|
'''''Adequacy in meeting need'''''
+
|
 
+
|-
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?
+
|
 +
|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.
 
Relapses in condition might make it hard for sustenance at jobs.
 
'''''Cause of Gap'''''
 
  
 
Reluctant to hire due to perceived inability to perform
 
Reluctant to hire due to perceived inability to perform
Line 433: Line 877:
 
Neglect of management of condition by employees
 
Neglect of management of condition by employees
  
'''''Potential Solutions'''''
+
IMH Vice Chairman: Absence of legislation prohibiting discrimination [http://www.straitstimes.com/opinion/people-with-mental-illness-deserve-a-shot-at-work (Chong, 2017)]
  
Informal economy to reduce reliance on formal economy? (e.g. TaskRabbit)
+
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
 
Constultancy/training/funds to help companies on accommodation/internship projects for the hire of PMIs
Line 442: Line 887:
  
 
To introduce short term sheltered employment models to recovering PMIs who might not be able to take the full extent of open employment?
 
To introduce short term sheltered employment models to recovering PMIs who might not be able to take the full extent of open employment?
 
+
|-
'''9. Need to be job ready through basic education and specific vocational skills'''
+
|
----
+
|
 
+
|
'''''Existing Services and Communal Resources'''''
 
 
 
-IMH’s Job Club – job training and placement programme
 
 
 
-SACS’ employment support services
 
 
 
-SAMH’s employment placement services
 
 
 
'''''Adequacy in meeting need'''''
 
 
 
IMH’s Job Club made 270 job placements each year; SAMH places about 150-200 clients each year [http://www.straitstimes.com/singapore/call-to-remove-mental-health-query-on-job-forms (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 [http://www.straitstimes.com/politics/parliament-low-incidence-of-workplace-discrimination-based-on-medical-conditions (Yuen, 2018)]
 
 
 
'''''Cause of Gap'''''
 
 
 
'''''Potential Solutions'''''
 
 
 
'''10. Need for employers to be open to hiring people with mental illnesses.'''
 
 
 
'''''Existing Services and Communal Resources'''''
 
 
 
'''''Adequacy in meeting need'''''
 
 
 
'''''Cause of Gap'''''
 
 
 
IMH Vice Chairman: Absence of legislation prohibiting discrimination [http://www.straitstimes.com/opinion/people-with-mental-illness-deserve-a-shot-at-work (Chong, 2017)]
 
 
 
Stereotypes of persons with mental illness being ‘crazy’ and therefore incapable of work
 
 
 
'''''Potential Solutions'''''
 
 
 
 
Silver Ribbon: Remove mental health query on job forms to prevent job search discrimination [http://www.straitstimes.com/singapore/call-to-remove-mental-health-query-on-job-forms (Tai, 2016)]
 
Silver Ribbon: Remove mental health query on job forms to prevent job search discrimination [http://www.straitstimes.com/singapore/call-to-remove-mental-health-query-on-job-forms (Tai, 2016)]
  
Line 485: Line 898:
  
 
Routine assessment of quality of life in patients with mental illness should be conducted and monitored [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)]
 
Routine assessment of quality of life in patients with mental illness should be conducted and monitored [https://www.ncbi.nlm.nih.gov/pubmed/27524364 (Picco et al., 2016)]
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''11. Need for fit between abilities and needs of the job seeker and employer requirements'''
+
====Workplace support====
----
 
  
'''''Existing Services and Communal Resources'''''
+
*'''Desired Outcomes''': Flexible workplace accommodations and naturalised support
 +
*'''Synopsis''':
  
'''''Adequacy in meeting need'''''
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''''Cause of Gap'''''
+
====Job fit and matching====
  
'''''Potential Solutions'''''
+
*'''Desired Outcomes''': Fit between abilities and needs of the job seeker and employer requirements
 +
*'''Synopsis''':
  
'''12. Need for flexible workplace accommodations and naturalised support'''
+
{| class="wikitable"
----
+
|-
 
+
| style="width: 33.3%;" |'''<big>Resources</big>'''
'''''Existing Services and Communal Resources'''''
+
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|Vocational assessment
 +
|
 +
|
 +
|-
 +
|Placement services
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''''Adequacy in meeting need'''''
+
==='''Caregivers'''===
  
'''''Cause of Gap'''''
+
====Caregiving knowledge and skills====
  
'''''Potential Solutions'''''
+
{| class="wikitable"
 
+
|-
===Client system support===
+
| style="width: 33.3%;" |'''<big>Resources</big>'''
'''13. Need for enlightened caregivers to support people with mental illness to go back to the workforce'''
+
| style="width: 33.3%;" |'''<big>Gaps</big>'''
----
+
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 
+
|-
'''''Existing Services and Communal Resources'''''
+
|Caregivers’ Association of the Mentally Ill
 
 
'''''Adequacy in meeting need'''''
 
 
 
'''''Cause of Gap'''''
 
 
 
'''''Potential Solutions'''''
 
 
 
'''14. Need for caregiver knowledge and skills'''
 
----
 
 
 
'''''Existing Services and Communal Resources'''''
 
 
 
Caregivers’ Association of the Mentally Ill
 
  
 
Caregiver Alliance Limited (CAL)
 
Caregiver Alliance Limited (CAL)
  
 
SAMH Insight Centre’s Family Link Programme
 
SAMH Insight Centre’s Family Link Programme
 +
|Low awareness of available training services
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''''Adequacy in meeting need'''''
+
====Caregiver wellbeing and social support====
  
'''''Cause of Gap'''''
+
{| class="wikitable"
 
+
|-
Low awareness of available training services
+
| style="width: 33.3%;" |'''<big>Resources</big>'''
 
+
| style="width: 33.3%;" |'''<big>Gaps</big>'''
'''''Potential Solutions'''''
+
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 
+
|-
'''15. Need for caregivers' psychological wellbeing and social support'''
+
|AWWA Caregiver Service
----
 
 
 
'''''Existing Services and Communal Resources'''''
 
 
 
AWWA Caregiver Service
 
  
 
Caregiver Alliance Limited (CAL)
 
Caregiver Alliance Limited (CAL)
Line 555: Line 1,010:
  
 
Clarity Singapore’s support groups
 
Clarity Singapore’s support groups
 
+
|Low awareness of existing services
'''''Adequacy in meeting need'''''
 
 
 
'''''Cause of Gap'''''
 
 
 
Low awareness of existing services
 
  
 
Stigma associated with mental illness
 
Stigma associated with mental illness
 +
|Repeatedly offer caregivers and care recipients information and connection to supportive services
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}
  
'''''Potential Solutions'''''
+
==='''Community Integration'''===
  
Repeatedly offer caregivers and care recipients information and connection to supportive services
+
*'''Desired Outcome''': [to insert]
===Capability Support===
+
*'''Synopsis''': [to insert]
'''16. Need for professionals to be equipped with knowledge and skills to identify and treat mental illness'''
 
----
 
  
This includes healthcare professionals/workers; general health practitioners; and spiritual leaders/advisors.
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|}([http://www.toteboard.gov.sg/docs/default-source/module/case-studies/innovation-catalyst-for-the-community-mental-health-intervention-team-(comit)-and-the-ubk-health-oriented-ageing-(hoa)-community-ecosystem.pdf Case Study of COMIT run by O'Joy, by Murdoch Univeristy])
  
'''''Existing Services and Communal Resources'''''
+
==='''Social Inclusion'''===
  
GPs are trained to spot and handle conditions under AIC’s Mental Health GP-partnership programme [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)][[File:Capture.jpg|thumb]]
+
====Public awareness and acceptance====
  
'''''Adequacy in meeting need'''''
+
*'''Desired Outcome''': [to insert]
 +
*'''Synopsis''': [to insert]
  
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 [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)]. More than 3,000 patients were helped through the Mental Health GP-partnership programme [http://www.straitstimes.com/singapore/mental-health-issues-gps-can-help (Boh & Oh, 2016)]
+
{| class="wikitable"
 +
|-
 +
| style="width: 33.3%;" |'''<big>Resources</big>'''
 +
| style="width: 33.3%;" |'''<big>Gaps</big>'''
 +
| style="width: 33.3%;" |'''<big>Ideas</big>'''
 +
|-
 +
|Public Education Campaigns
 +
|Over 50,000 residents have been reached through various mental health awareness activities [https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/Media%20Release%20-%20Mental%20Health%20Awareness%20Walk-%20Final.pdf (Institute of Mental Health, 2015)]
  
'''''Cause of Gap'''''
+
Public awareness campaigns so far are about general mental wellness and mental health conditions. There are not many campaigns that are employment related.
 
+
|
'''''Potential Solutions'''''
+
|-
 
+
|
'''17. Need for integrated network of community partners to provide seamless and timely support'''
+
|
----
+
|
 
+
|-
'''''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 [https://search.informit.com.au/documentSummary;dn=752794801752608;res=IELHEA (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 [http://www.straitstimes.com/singapore/health/reaching-out-to-the-mentally-ill?login=true (Teo, 2015)]. THRIVES helps service partners to build their capabilities and skills by providing training and networking opportunities for cross-disciplinary learning and networking [https://www.ktph.com.sg/psychmed/thrive (Khoo Teck Puat Hospital, 2018)].
+
|
 
+
|-
'''''Adequacy in meeting need'''''
+
|
 
+
|
'''''Cause of Gap'''''
+
|
 
+
|}
'''''Potential Solutions'''''
+
Public Education Campaigns on mental illness
 
 
'''18. Need to address mental health issues in the community'''
 
 
 
'''19. Rising Trend of Mental Health Conditions in Singapore'''
 
----
 
 
 
'''''Abstract'''''
 
 
 
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. This report will identify the factors that contribute to the rise of mental health conditions in Singapore and ideas on how we may minimise or solve the problems.[https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf]
 
 
 
'''''Social Needs in Singapore'''''
 
 
 
In a modern society like Singapore, factors that can cause the increase of people with mental disorders are not just academics, but also social media and cyber-bullying. [https://www.straitstimes.com/singapore/more-people-seeking-help-for-mental-illness-community-group-says]
 
 
 
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. [http://www.smj.org.sg/sites/default/files/4203/4203a4.pdf]
 
 
 
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.” [https://www.straitstimes.com/singapore/health/mental-health-issues-must-be-tackled-nmp]
 
 
 
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.” [https://www.straitstimes.com/singapore/health/urgent-need-to-improve-affordability-accessibility-and-quality-of-mental-healthcare]
 
 
 
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.” [https://www.theonlinecitizen.com/2019/04/17/what-is-the-state-of-mental-health-in-singapore/] “The cost of mental health issues in Singapore may go up to as high as $990 per month.” [https://blog.seedly.sg/mental-health-costs-subsidies-singapore/]
 
 
 
'''''Existing Services and Communal Resources Available'''''
 
 
 
'''''Service or Policy Gaps and Their Causes'''''
 
 
 
The lack of professionals may be one of the reasons why people are not willing to seek help. With the lack of professionals, professionals may not perform well due to the overwhelming workload. [https://www.straitstimes.com/singapore/health/urgent-need-to-improve-affordability-accessibility-and-quality-of-mental-healthcare]
 
 
 
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.[https://www.straitstimes.com/singapore/health/urgent-need-to-improve-affordability-accessibility-and-quality-of-mental-healthcare] The long waiting time may be due to the lack of professionals too. However, that is just a hypothesis.
 
 
 
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. [https://blog.seedly.sg/mental-health-costs-subsidies-singapore/] Not to mention that seeking help from private hospitals would cost even more. [https://www.theonlinecitizen.com/2019/04/17/what-is-the-state-of-mental-health-in-singapore/]
 
 
 
'''''Possible Solutions To Those Challenges'''''
 
----
 
 
 
([http://www.toteboard.gov.sg/docs/default-source/module/case-studies/innovation-catalyst-for-the-community-mental-health-intervention-team-(comit)-and-the-ubk-health-oriented-ageing-(hoa)-community-ecosystem.pdf Case Study of COMIT run by O'Joy, by Murdoch Univeristy])
 
  
 +
*[https://www.ncss.gov.sg/Our-Initiatives/Beyond-The-Label 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.
 +
*'[https://www.ncss.gov.sg/SpeakUp NCSS ‘Speak Up’ Campaign]
 +
*[https://www.straitstimes.com/singapore/presidents-challenge-2019-to-focus-on-mental-health-issues 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; [http://www.who.int/mental_health/world-mental-health-day/en/ World Mental Health Day] in Singapore: [https://www.eventbrite.sg/e/world-mental-health-day-voice-out-concert-in-the-park-tickets-36466427065?aff=es2 Voice Out Concert in the Park]
 +
*Touch Community Services and Nanyang Polytechnic (NYP)’s campaign [http://www.straitstimes.com/singapore/campaign-on-track-to-raise-mental-health-awareness (Valluvar, 2017)]
 +
*UNSAID – a student-led, socially-minded arts collective plans to organise an Artivist Fest on mental health [http://www.straitstimes.com/singapore/unsaid-helps-give-voice-to-an-unheard-problem (Tan, 2017)]
 +
*Silver Ribbon
 +
*Club HEAL
 +
*Publications: Mental Health Issues - Handbook for Employers and Employees (by SRS)
  
 
==Resource Directory==
 
==Resource Directory==
----
+
See [https://mentalconnect.org/ Mental Connect], a service and events directory.
  
Try [https://mentalconnect.org/ Mental Connect], a service and events directory for users to browse first.
+
#[https://www.ncss.gov.sg/Press-Room/Publications/Detail-Page?id=Mental-Health-Resource-Directory NCSS Mental Health Resource Directory], [https://www.ncss.gov.sg/NCSS/media/NCSS-Documents-and-Forms/NCSS%20Internal%20Documents/Directory-on-Mental-Health-Services.pdf PDF version]
 +
#[https://www.ncss.gov.sg/NCSS/media/NCSS-Publications/Pdfdocument/Understanding-the-Quality-of-Life-of-Adults-with-Mental-Health-Issues.pdf Understanding the Quality of Life of Adults with Mental Health Issues]
  
=== Hotlines ===
+
===Hotlines===
 
{| class="wikitable sortable"
 
{| class="wikitable sortable"
 
|'''Hotline / Helpline '''
 
|'''Hotline / Helpline '''
Line 757: Line 1,231:
 
|
 
|
 
|1800 283 7019
 
|1800 283 7019
 +
|-
 +
|[https://www.memc.com.sg/clinic/psychiatric-behavioural-medicine-clinic/ Mount Elizabeth Medical Centre Psychiatric & Behavioural Medicine Clinic]
 +
|Psychotherapy for children, adults and families
 +
|Mon – Fri
 +
Sat
 +
|9am – 5pm
 +
9am - 1pm
 +
|6737 3663
 +
|-
 +
|[https://www.tinklefriend.sg/ 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 ===
+
===Non-profit Organisations===
  
 
{| class="wikitable"
 
{| class="wikitable"
Line 783: Line 1,273:
 
|[https://www.limitless.sg/ Limitless]
 
|[https://www.limitless.sg/ 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 [https://www.limitless.sg/zen-dylan-koh-fund Zen Dylan Koh Fund]which offers financial support for youth to seek help for mental health issues
 
|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 [https://www.limitless.sg/zen-dylan-koh-fund Zen Dylan Koh Fund]which offers financial support for youth to seek help for mental health issues
 +
|-
 +
|[https://www.pleasestaymovement.com/ Please Stay Movement]
 +
|Advocacy group calling for unity and support to prevent suicide among young people
 
|-
 
|-
 
|[https://www.psaltcare.com/ PSALT Care]
 
|[https://www.psaltcare.com/ PSALT Care]
Line 800: Line 1,293:
 
|-
 
|-
 
|[http://www.wecare.org.sg/ WE CARE Community Services]
 
|[http://www.wecare.org.sg/ WE CARE Community Services]
|Persons in recovery from addictions - substance or behaviour-based, and their caregivers.  
+
|Persons in recovery from addictions - substance or behaviour-based, and their caregivers.
 
|}
 
|}
  
=== Newslinks (Articles, op-eds, commentaries, letters to the editor etc.) ===
+
===Newslinks (Articles, op-eds, commentaries, letters to the editor etc.)===
 
{| class="wikitable"
 
{| class="wikitable"
 
|'''Date'''
 
|'''Date'''
Line 839: Line 1,332:
 
|11 December 2018
 
|11 December 2018
 
|TODAY article on the Singapore Mental Health Study 2018:
 
|TODAY article on the Singapore Mental Health Study 2018:
[https://www.todayonline.com/singapore/mental-illness-more-prevalent-among-young-adults-ocd-one-of-top-disorders-spore "Mental illness more prevalent among young adults, OCD one of top disorders in S’pore"]  
+
[https://www.todayonline.com/singapore/mental-illness-more-prevalent-among-young-adults-ocd-one-of-top-disorders-spore "Mental illness more prevalent among young adults, OCD one of top disorders in S’pore"]
 
|-
 
|-
 
|11 December 2018
 
|11 December 2018
Line 852: Line 1,345:
 
|-
 
|-
 
|08 March 2019
 
|08 March 2019
|[https://www.todayonline.com/commentary/how-make-mental-health-national-priority TODAY commentary by Anthea Ong to make mental health a national priority]  
+
|[https://www.todayonline.com/commentary/how-make-mental-health-national-priority TODAY commentary by Anthea Ong to make mental health a national priority]
 
|-
 
|-
 
|10 March 2019
 
|10 March 2019
Line 861: Line 1,354:
 
|-
 
|-
 
|11 July 2019
 
|11 July 2019
|[https://www.todayonline.com/singapore/hikikomori-singapore-recluses-hidden-view-and-loss-help TODAY article on hikikomori in Singapore]  
+
|[https://www.todayonline.com/singapore/hikikomori-singapore-recluses-hidden-view-and-loss-help TODAY article on hikikomori in Singapore]
 
|-
 
|-
 
|29 July 2019
 
|29 July 2019
Line 871: Line 1,364:
 
|12 October 2019
 
|12 October 2019
 
|TODAY spread on mental health among youth together with the National Youth Council:
 
|TODAY spread on mental health among youth together with the National Youth Council:
[https://www.todayonline.com/big-read/big-read-youths-more-open-about-mental-health-its-time-others-learn-listen "The Big Read: With youths more open about mental health, it’s time others learn to listen"]  
+
[https://www.todayonline.com/big-read/big-read-youths-more-open-about-mental-health-its-time-others-learn-listen "The Big Read: With youths more open about mental health, it’s time others learn to listen"]
 
|-
 
|-
 
|13 October 2019
 
|13 October 2019
Line 892: Line 1,385:
 
A collection of commentaries on mental health by IMH psychiatrist Chong Siow Ann.
 
A collection of commentaries on mental health by IMH psychiatrist Chong Siow Ann.
  
=== Stories ===
+
===Stories===
 
''Holding The Hope (2019)''
 
''Holding The Hope (2019)''
  
Line 907: Line 1,400:
 
[https://www.ourbetterworld.org/ Our Better World]
 
[https://www.ourbetterworld.org/ Our Better World]
  
=== Mental Health Research in Singapore ===
+
===Mental Health Research in Singapore===
Khoo Yi Feng's thesis
+
[to insert research landscape]<ref>Wikipedia testing</ref>
 
 
NAMS
 
 
 
IMH research repository
 
  
Quality of Life of PMHIs......
+
[https://www.nams.sg/research/Pages/default.aspx Research by NAMS]
  
SG Exams - on mental health
+
[https://www.imh.com.sg/research/ IMH research repository]
  
 
SGH Eating Disorders Publication
 
SGH Eating Disorders Publication
  
=== Financial Support ===
+
===Financial Support===
[[File:43042962 10217790148325761 8614600782454456320 n.jpg|thumb|Zen Dylan Koh and his mother, Elaine Lek. Elaine was featured in a [https://www.straitstimes.com/lifestyle/breaking-the-silence-on-suicide-a-mother-opens-up-about-the-loss-of-her-teenage-son news article] here.]]
+
[https://www.limitless.sg/zen-dylan-koh-fund The Zen Dylan Koh Fund] - A fund that supports youths with mental health issues in need of therapy.[[File:43042962 10217790148325761 8614600782454456320 n.jpg|thumb|Zen Dylan Koh and his mother, Elaine Lek. Elaine was featured in a [https://www.straitstimes.com/lifestyle/breaking-the-silence-on-suicide-a-mother-opens-up-about-the-loss-of-her-teenage-son news article] here.]]
[https://www.limitless.sg/zen-dylan-koh-fund The Zen Dylan Koh Fund] - A fund that supports youths with mental health issues in need of therapy.
 
  
=== References ===
+
===References===
 
<references />
 
<references />

Latest revision as of 02:54, 18 June 2021

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.

Contents

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.[1]

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.[2]
  • 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.[2]

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.[2]

[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.[2]
  • As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.[2]

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
Treatment
Capability & Capacity of Mental Health System
Employment Social Inclusion
  • Public awareness & acceptance
Community Integration
Family & Caregivers

Sub-pages

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

[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

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

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.[2]

[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.[2]
  • As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.[2]

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)

Capture.jpg

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][3]

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.

References

  1. IMH Media Release: https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Cite error: Invalid <ref> tag; no text was provided for refs named :0
  3. Wikipedia testing