Mental health

According to World Health Organisation (WHO), mental illness is generally characterised by some combination of abnormal thoughts, emotions, behaviour and relationships with others. [1]

Different categories, according to Silver Ribbon (Singapore). These include substance-related disorders, mood disorders, anxiety disorders, sleep disorder, personality disorders, psychotic disorders, etc. [2]

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 epidemiologic 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."[3]

Landmark Reports/Studies

Singapore Mental Health Study (SMHS)[4]:

-aims to conduct a population-based survey to establish the prevalence of mental health disorders in the adult Singapore resident population including the elderly.

-aims to assess the spectrum of different types of mental illness across gender, ethnicity and age

-develop and validate a culturally valid instrument for assessing positive mental health and subsequently establish the level of positive mental health in the Singapore population

-describe the current level use of mental health services and the level of unmet need

-identify facilitators and barriers to mental health treatment

-evaluate the financial, personal, social costs associated with mental illness

Legislation

Mental Health (Care and Treatment) Act: to provide for the admission, detention, care and treatment of mentally disordered persons in designated psychiatric institutions

Mental Capacity Act: 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.

Vulnerable Adults Act: Empowers 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 safe place

Ecosystem

Service Providers

NCSS Directory of Mental Health Services https://gatherhere.jiveon.com/servlet/JiveServlet/downloadBody/1214-102-1-1274/Directory-on-Mental-Health-Services_Jan-2016.pdf

Support Groups

Other support groups

Caregiver support groups?

Information and other resources

Institute of Mental Health

SAMH

Silver ribbon

AA - Alcoholics Anonymous

NA - Narcotics Anonymous

Client Segments

Page to Youth with mental health issues

Areas of concern, Needs and Gaps

Screening, Detection and Diagnosis

Need for preventive measures against mental health problems

Existing Services and Communal Resources

SRS

Club Heal

HPB Working Minds Curriculum

Treasure your Mind

Adequacy in meeting need

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.

Cause of Gap

Not enough awareness and knowledge of the different mental illnesses

Mental illness might still be considered a taboo.

Potential Solutions

Educate HR departments and develop resource toolkits

Need for early recognition and screening

Existing Services and Communal Resources

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

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

Adequacy in meeting need

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

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).

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).

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).

Cause of Gap

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).

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)

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 (Picco, et al., 2016)

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).

Potential Solutions

Public education to tackle negative stereotypes of mental illness

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.

Further research exploring ethnic and cultural differences and preferences for mental health help seeking in Asian societies is needed.

Public Awareness, Information and Referral

Need for public awareness and acceptance of people with mental illness

Existing Services and Communal Resources

Public Education Campaigns on mental illness:

- 'NCSS ‘Speak Up’ Campaign

- World Mental Health Day, 10 October 2016

- 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)

World Mental Health Day in Singapore: Voice Out Concert in the Park

Adequacy in meeting need

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.

Cause of Gap

Stigma of mental illness needs to be first broken down.

Potential Solutions

Need for clients to have adequate information about how to manage their condition and support available.

Existing Services and Communal Resources

Information Services – Medical System:

-SAMH’s helpline

-IMH’s interactive information system

-IMH’s online resources

-Medical social workers

-GPs

Information Services – Community Touch Points:

-Clarity Singapore’s helpline

-Alzheimer’s Disease Association (ADA)’s helpline

-HPB’s Dementia InfoLine

-SOS’s helpline

Mental health literacy programmes

- MOH

- CGH

- SGH

- Silver Ribbon

Mental Health First Aid

Adequacy in meeting need

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

Family members may not reveal condition

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

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.

Family members want to cushion the impact on PMI.

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.

Treatment and Interventions

Need for timely access to medical intervention

Existing Services and Communal Resources

IMH

Private pyschiatrists

SRS

SACS CRSS

SAMH

Grassroots

HPB

Adequacy in meeting need

NMHS 2011: There are currently wide treatment gaps worldwide. Average treatment delay for mental illness is about 8 years.

Consequence: condition worsens, create stress for community, caregiver stress, other dysfunctions in life. Negative economic impact and high healthcare costs.

Cause of Gap

Many do not seek professional help due to finances, lack of insurance coverage, fear of discrimination and stigma. (Singapore Mental Health Study 2011)

Potential Solutions

Need for self-sustainable management of their conditions.

Existing Services and Communal Resources

Private psychiatrists

private counsellors/psychologists

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

Adequacy in meeting need

Cause of Gap

Potential Solutions

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

Existing Services and Communal Resources

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

Adequacy in meeting need

Cause of Gap

Potential Solutions

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.

Need for sustained employment as a means to financial independence.

Existing Services and Communal Resources

Open Door Fund (for 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?

Relapses in condition might make it hard for sustenance at jobs.

Cause of Gap

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

Potential Solutions

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?

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 (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)

Cause of Gap

Potential Solutions

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 (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 (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)

Need for fit between abilities and needs of the job seeker and employer requirements.

Existing Services and Communal Resources

Adequacy in meeting need

Cause of Gap

Potential Solutions

Need for flexible workplace accommodations and naturalised support

Existing Services and Communal Resources

Adequacy in meeting need

Cause of Gap

Potential Solutions

Client system support

Need for enlightened caregivers to support people with mental illness to go back to the workforce

Existing Services and Communal Resources

Adequacy in meeting need

Cause of Gap

Potential Solutions

Need for caregiver knowledge and skills

Existing Services and Communal Resources

Caregivers’ Association of the Mentally Ill

Caregiver Alliance Limited (CAL)

SAMH Insight Centre’s Family Link Programme

Adequacy in meeting need

Cause of Gap

Low awareness of available training services

Potential Solutions

Need for caregivers' psychological wellbeing and social support

Existing Services and Communal Resources

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

Adequacy in meeting need

Cause of Gap

Low awareness of existing services

Stigma associated with mental illness

Potential Solutions

Repeatedly offer caregivers and care recipients information and connection to supportive services

Capability Support

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.

Existing Services and Communal Resources

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

Adequacy in meeting need

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

Cause of Gap

Potential Solutions

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 (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

Need to address mental health issues in the community

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