Mental Health
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."
Contents
Definitions
Mental Health
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
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.[1]
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
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:[2]
Theories of Mental Health
Policies & Legislation
Mental Health (Care and Treatment) Act 2008
Provides for the admission, detention, care and treatment of mentally disordered persons in designated psychiatric institutions.
Mental Capacity Act 2008
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 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
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.
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.
Specific Groups / Client Segments
Page to Youth with Mental Health Issues
Page to Adults with Mental Health Issues
Page to Addiction
Statistics
Prevalence of Disorders
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.
397 people committed suicide in 2018. The leading cause of death for those aged 10 to 29 years.[3]
Attempted suicide has been decriminalised in Singapore as of 1 Jan 2020.
Patients / Clients
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.[4]
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.[4]
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.[4]
Professionals[4]
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.
Within the public health sector, the number of psychiatrists and psychologists has increased by 8 per cent to 182 and 7 per cent to 171, respectively, from 2017-2019. No number on counsellors, especially because healthcare professionals and medical social workers do counselling as part of their everyday work.
As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support
Issues Faced by People with Mental Health Issues
Screening, Detection and Diagnosis
1. 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
2. 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
3. Need for public awareness and acceptance of people with mental illness
Existing Services and Communal Resources
Public Education Campaigns on mental illness:
- 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
4. 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
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
5. 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
6. 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
7. 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.
8. 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?
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 (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
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 (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)
11. 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
12. 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
13. 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
14. 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
15. 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
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.
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
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 (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
18. Need to address mental health issues in the community
(Case Study of COMIT run by O'Joy, by Murdoch Univeristy)
Resource Directory
Try Mental Connect, a service and events directory for users to browse first.
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 |
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 |
| 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.)
Fieldnotes of a Psychiatrist (2018)
A collection of commentaries on mental health by IMH psychiatrist Chong Siow Ann.
Stories
Holding The Hope (2019)
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.
An independent, not-for-profit website that champions mental health recovery through the power of story.
Our Grandfather Story
Mental Health Research in Singapore
Khoo Yi Feng's thesis
NAMS
IMH research repository
Quality of Life of PMHIs......
SG Exams - on mental health
SGH Eating Disorders Publication
Financial Support
The Zen Dylan Koh Fund - A fund that supports youths with mental health issues in need of therapy.
References
- ↑ https://www.samhealth.org.sg/understanding-mental-health/what-is-mental-illness/
- ↑ https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf
- ↑ https://www.sos.org.sg/learn-about-suicide/quick-facts
- ↑ 4.0 4.1 4.2 4.3 https://www.channelnewsasia.com/news/singapore/60-000-subsidised-outpatients-seek-treatment-mental-disorders-12240990