Difference between revisions of "Mental Health"

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Different categories of mental disorders include substance-related disorders, mood disorders, anxiety disorders, sleep disorder, personality disorder and psychotic disorders (See the latest DSM-5) <ref>https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf</ref>
 
Different categories of mental disorders include substance-related disorders, mood disorders, anxiety disorders, sleep disorder, personality disorder and psychotic disorders (See the latest DSM-5) <ref>https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf</ref>
  
<small>[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 is to make sense of it to a lay person: What is the difference between a personality  and psychotic disorder?]</small>
+
<small>[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?]</small>
  
 
== Key Statistics & Figures ==
 
== Key Statistics & Figures ==
  
 
=== Prevalence of Mental Disorders - 13.9% ===
 
=== Prevalence of Mental Disorders - 13.9% ===
 +
<small>[Sense-make: How does this fare with other countries? Should we be worried or this is typical?]</small>
 +
 
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.
 
* 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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* Alcohol Abuse and Obsessive-Compulsive Disorder are highly common in Singapore.
 
* Alcohol Abuse and Obsessive-Compulsive Disorder are highly common in Singapore.
  
''[https://en.wikipedia.org/wiki/Suicide_in_Singapore Suicide in Singapore]''
+
=== Suicide Rate - Almost 400 a year ===
 +
<small>[Sense-make: 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>
 +
* Attempted suicide has been decriminalised in Singapore as of 1 Jan 2020.
 +
* ''See also wiki page on [https://en.wikipedia.org/wiki/Suicide_in_Singapore Suicide in Singapore]''
  
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>
+
=== 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.<ref name=":0" />
  
Attempted suicide has been decriminalised in Singapore as of 1 Jan 2020.
+
* 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>
 +
* 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" />
  
'''Patients / Clients'''
+
=== Size of Mental Health Professionals ===
 +
* 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" />
 +
<small>[Expand: How does this compare to other countries? What is an adequate number?]</small>
 +
* 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" />
  
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>
+
* 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" />
  
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" />
+
== Sub-pages ==
 +
Sub-pages are being worked on as part of ongoing [[Civic Experiment & Wiki Challenge|wiki challenge]]:
  
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" />
+
[[Mental Health/MH4|MH4]]
  
'''Professionals<ref name=":0" />'''
+
[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.]
  
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.
+
Substance-related disorders
 +
* Drug abuse
 +
* Alcohol abuse
 +
Mood disorders
 +
* OCD
 +
* Phobias
 +
Anxiety disorders
 +
* [insert?]
 +
* [insert?]
 +
Sleep disorder
  
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.
+
Personality disorder
 
+
* [insert?]
As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support
+
Psychotic disorders
 
+
* [insert?]
== Sub-pages ==
 
----
 
 
 
Sub-pages are being worked on as part of ongoing [[Civic Experiment & Wiki Challenge|wiki challenge]]:
 
 
 
[[Mental Health/MH4|MH4]]
 
  
 
== Policies & Legislation ==
 
== Policies & Legislation ==

Revision as of 11:33, 13 April 2020

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."

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

Overview

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

Priority Issues

  • [to insert]
  • to insert]

Actionable Opportunity Areas

  • [to insert]
  • [to insert]

Knowledge Gaps

  • [to insert]
  • [to insert]

Definition of Mental Health

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

[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]

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]

[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 include substance-related disorders, mood disorders, anxiety disorders, sleep disorder, personality disorder and psychotic disorders (See the latest DSM-5) [2]

[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 of Mental Disorders - 13.9%

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

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.[3]
  • 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.[4]
  • 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]
  • 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]

Size of Mental Health Professionals

  • 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.[4]

[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.[4]
  • As of March 2019, the Government has 41 community outreach teams and 21 allied health-led community intervention teams providing mental health support.[4]

Sub-pages

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

MH4

[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?]

Policies & Legislation

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

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

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:

- '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

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

- 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

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)

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

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)

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.[1]

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. [2]

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. [3]

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.” [4]

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.” [5]

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.” [6] “The cost of mental health issues in Singapore may go up to as high as $990 per month.” [7]

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. [8]

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.[9] 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. [10] Not to mention that seeking help from private hospitals would cost even more. [11]

Possible Solutions To Those Challenges


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.)

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

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

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

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

References