Prioritising Mental Health Care and Support for Singaporeans

Mr Speaker, it has been almost a year since I raised my first Adjournment Motion on "Eradicating Mental Health Stigmatisation". During that speech, I shared the acronym L-A-S-T. Apparently, it was not my last Adjournment Motion. But, briefly, "L" stands for Literacy – to include mental health literacy in schoos and workplaces. "A" for Accessibility – to increase accessibility for people to come and seek help easier. "S" for Screening – like how we go for regular physical health screening, there should be one for mental health too. And "T" for Time-outs – to allow individuals to take a break and come back recharged.

Mr Speaker, we continue to see a lot of effort being rolled out by the Government, community partners and ground-up groups to destigmatise mental health issues. I would like to highlight that I am not the first to talk about this issue. PAP Members of Parliament have been championing it in Parliament long before I had. It dates back to the mental health blueprint in 2007.

From time to time, PAP Members of Parliament have risen in this House to ensure that policies on mental health are up to date and relevant. We have been consistent in our approach that progressive legislation can effectively promote access to mental healthcare and protect the rights of persons with mental health issues.

Therefore, I welcome recommendations put forth by the COVID-19 Mental Wellness Task force in August 2021 to provide a whole-of- Government strategy to address the psychosocial impact of the COVID-19 pandemic. Ground-up campaigns such as Beyond The Label, the Honest Cookie by Samaritans of Singapore and ThisConnect, to name a few, have not gone unnoticed.

Even among our own PAP Members of Parliament, we embarked on our own #452TooMany Campaign last month to bring together our community partners, volunteers and residents to discuss issues on mental health. Although discussions and engagements are still ongoing, I would like to share some of those findings and recommendations today.

Mr Speaker, the COVID-19 pandemic has amplified and made a significant impact on the mental health cases here in Singapore. Our suicide rate reached its all time high of 452, a 13% increase from 2019, with an increase across all age groups. If we picture a pyramid structure of mental health issues, certainly suicide is at its peak. What I want to bring forth today is not just the peak but the different ways we can come together to overcome issues surrounding mental health.

Mental health issues can affect anyone, from children to the elderly, students to teachers, workers to retirees. No one is spared in that manner.

Efforts to curtail the spread of the pandemic are necessary but unfortunately, have impacted the mental health of Singaporeans in different magnitudes. Measures to reduce social gatherings since the pandemic have increased stress and loneliness levels amongst our elderly and youths. This reduction of meaningful social engagement, coupled with stressors of the pandemic and adapting to technology and HBL, have understandably taken a toll on their mental well-being.

Another group of concern is our local Singaporean workers, our frontline healthcare professionals, teachers and public service officers have seen an increase in workload since the onset of the pandemic.

At its simplest form, those working from home faced the blurring of lines between work and personal time. For example, educators have had to adapt to the fluid COVID-19 situation tailoring their lesson plans and materials at short notice on top of the regular administrative duties, juggling various stakeholders' expectations and putting their students' first, always.

As an educator I feel overwhelmed, frustrated and of course, worried. So, I would like to take this opportunity to thank our teachers for their commitment, their dedication for being our fortress in such turbulent times.

On that note, I urge everyone as part of our “Whole of Society Approach” to change our mindset on how we view children's development, from daily school issues to major examinations.

It is about time we change this "Assessment of Learning", culture to a "Journey of Learning". If we can create a culture of appreciating the joy of learning and the challenges that such journey presents be it easy or difficult, whether we succeed or fail in something and accepting that there are multiple paths to achieve success, we can nurture an optimal mental health environment from the onset.

Hopefully, this would lead to a positive effect on the "parent-teacher-child" relationship and the positivity trickle down to our society.

Our Singaporean workers, from healthcare professionals to teachers to public service officers, need our continued care and support. Therefore, reviewing their workscope may be useful for a quality work life balance, but, most importantly, we must continue to create and upgrade channels for meaningful communication and this does not include the biannual staff appraisal.

Finally, we need to encourage and normalise mental health screening for all Singaporeans through key touchpoints like schools and IHLs, in workplaces and hospitals, and of course, the clinics. Anyone screened for being at risk or having symptoms of mental health issues should promptly be referred to a Mental Health Practitioner. We want to engage early, before mental health issues disrupts their lives and risks them doing something harmful.

Mr Speaker, my second point is regarding our mental health infrastructure to support mental health needs of our fellow Singaporeans.

Firstly, I call on the Government to expand our infrastructure by equipping all polyclinics, general practitioners (GPs) and social service agencies with the necessary expertise and resources. By expanding our community mental health touchpoints, we can make mental health screening accessible to more Singaporeans.

But beyond the hardware, it is the software that matters too. Diagnosing or sensing mental health issues takes time getting to know the patient, building trust and delving into the situation can make a difference. Therefore, it could be useful to consider and budget for longer consultation times in the future healthcare system.

Secondly, we need to develop our resources to respond to our community's increasing mental health needs and here, I offer two approaches. The first approach is to review expanding existing programmes or creating equivalent ones in IHLs so that more mental health professionals can be produced. The second, is to develop a community support network of trained staff and volunteers. They can be our first point of contact to attend distress calls and walk in consultations. Therefore, I welcome the Task force’s recommendation to develop a national mental health competency framework with a common set of training standards and clearly defined degrees of competencies expected of professionals and para professionals.

I hope this framework can be extended to students in IHLs as part of a module, so they too can be a ready-resource for the community support network. Similarly, I hope the training can also be extended to working professionals to develop their competencies and be their organisation's resource person at work.

Mr Speaker, lastly, I would like to touch on cost. For mental health patients seeking help, the financial costs of treatment, especially over a long period, can be prohibitive. For example, the annual Medisave limit is $700 a year from the year 2022. However, this may be fully used after a few consultations.

Perhaps the Government could explore increasing the Medisave claim limit for mental health consultations given that such consultations can be a bit more more regular for those who need more help. The Government could also provide greater subsidies for those who are under the Pioneer or Merdeka Generations, as well as those having CHAS cards.

Although insurance policy providers have started to offer insurance policies that provide coverage for mental health conditions, there are many other providers who have not begun. Thus, I am heartened to know when Senior Minister of State Janil previously told this House that there are ongoing efforts to make treatment more affordable and MOH is also working with insurance companies and other stakeholders to further optimise the coverage process. Mr Speaker, in Malay, please.

(In Malay): [Please refer to Vernacular Speech.] Mental health is a very critical issue faced by Singaporeans. Last year, our country recorded 452 suicide cases, and this is very worrying. In my English speech earlier, I suggested three broad aspects in our efforts to prioritise mental health in Singapore.

First, identify the most vulnerable groups and give them support as soon as possible.

Second, reviewing the mental health infrastructure.

And third, reducing the cost of mental healthcare.

So far, many activities and programmes are carried out to enhance awareness on mental health, and I personally support and welcome such efforts. However, our journey is still a long one.

My hope is that with this suggestion, Singaporeans who are suffering from mental health issues are no longer ashamed to come forward to get support, and also view mental health as no less important than physical health.

(In English): Mr Speaker, I have touched on three broad points as part of our efforts to prioritise mental healthcare and support for Singaporeans: identification, infrastructure and cost. We need to focus our efforts on identifying the vulnerable groups so that we can intervene quickly, review our current mental health infrastructure and explore how we can make mental health consultations affordable for those in need.

We need to take affirmative action now, beyond just performative activism and populist rhetorics. To this end, I would like to thank my fellow PAP Members of Parliament colleagues for joining me in the #452TooMany Campaign. A special thanks to our community partners, volunteers, residents, mental health practitioners and researchers, like Devan from Mental Act and Jonathan from Total Wellness Initiative, for contributing their ideas and suggestions to strengthen our resolve to support Singapore's mental health movement.

Special mention also goes out to four inspiring individuals: Xavierlyn, Athena, Afiqah and Devan who shared their experiences on mental health issues with me. I am heartened to hear their sharing and I believe that conversations like these must continue and so that we can destigmatise mental health.

This act of solidarity will not just end here. I am inviting Members of this House, community leaders, activists, influencers and the public to join me and my 18 Members of Parliament on 10 October in conjunction with World Mental Health Day. Let us post on our socials, this 10.10 at 10.10 am a message of hope and commitment with the hashtag #452TooMany to signify that we acknowledge and care about mental health in Singapore.

Mr Speaker, to those out there grappling with mental health, I would like to end with a n online quote that I have adapted:

"You are bent but not broken.

You are sad but not hopeless.

You are tired but not powerless.

You are depressed but not giving up."

We are not giving up and you are not alone. We  will stand by you. [Applause.]

Mr Speaker, I thank the Member for highlighting the importance of prioritising mental healthcare and support for Singaporeans. The Government is committed to do this.

The Member raised three points for our consideration: (a) identify vulnerable groups or persons who are at risk and provide proactive support; (b) review our mental health infrastructure and (c) review of the mental health consultation cost. I will address these points as I highlight the efforts which the Government has carried out and areas which we continue to build on.

The Government adopts a comprehensive and multi-pronged approach towards mental healthcare and support. The key strategies cover mental health promotion and upstream prevention, early detection and intervention, disease management, care integration and social support across different settings.

Over the years, the Government has been reviewing the range of mental health services and programmes available to the public on a regular basis to ensure that they meet the needs of the population.

In 2007, MOH developed the National Mental Health Blueprint to promote mental health, build resilience and reduce the impact of mental illness. Under the Blueprint, we began developing community capability, a key shift that entailed moving from an acute-centric institutionalised model to a community-based model. While acute care remains an important component of the system, only the acutely ill, disturbed or those with high risk of harm to self or others need to be hospitalised. For those whose conditions have stabilised, they should be discharged and allowed to recover and reintegrate back into the community.

The Community Mental Health (CMH) Masterplan, launched in 2012, builds on the 2007 Blueprint and further strengthens mental health care in the community, to enable persons with mental health needs to be well supported in the community. Through establishing more community-based services, we hope to facilitate greater acceptance of treatment, lower the stigma of mental illness and increase community outreach for early identification of mental health needs. In 2017, we have committed a further $160 million to enhance and expand community mental health services over the next five years. These national mental health plans have expanded the community touch-points to promptly identify and assess at-risk persons with mental health needs and link them to relevant services. These efforts will address the Member’s concerns of ensuring that those who are most vulnerable or at-risk are identified early and interventions are in place to protect them from doing something harmful.

The Member had also called for an expansion of the infrastructure by equipping all polyclinics, General Practitioners and social service agencies with the necessary expertise and resources.

In this regard, I would highlight that under the CMH Masterplan, we have also increased the accessibility of mental health services in primary and community care sectors. As at end 2020, 14 polyclinics offer mental health and/ or dementia services and, over 220 General Practitioner (GP) partners are trained to diagnose and treat mental health conditions. They are supported in the community by our 21 community intervention teams, which comprise trained allied health professionals to provide psycho-social therapeutic interventions.

MOH will continue to work with the healthcare providers and social services agencies to expand and improve mental health services in the primary and community care settings, including training of frontline staff and community partners.

The Member also raised the issue of cost. MOH has put in place various support measures to ensure access to affordable mental health services. The Government provides up to 75% subsidies for outpatient treatment at polyclinics and public specialist outpatient clinics (SOCs). All Singaporeans regardless of income are also eligible for subsidies under the Community Health Assist Scheme (CHAS) for treatment of mental health conditions under the Chronic Disease Management Programme (CDMP) at participating private General Practitioner (GP) clinics. Pioneer and Merdeka Generation cardholders are eligible for additional subsidies at all polyclinics, public SOCs and CHAS GP clinics. Patients can also tap on their MediSave to pay for outpatient treatment of CDMP conditions.

Based on the latest available data, about three in 10 patients who utilised MediSave for the treatment of CDMP mental health conditions reached the yearly $500 MediSave withdrawal limit. Nevertheless, in recognition that patients with complex conditions may have higher needs, we increased the MediSave withdrawal limit to $700 for patients with complex chronic conditions in January 2021, in recognition that these patients have higher needs. The withdrawal limit for patients with simple chronic conditions remain at $500. Those who are 60 years old and above can additionally tap on the Flexi-MediSave scheme for outpatient expenses. The Flexi-MediSave annual withdrawal limit was also raised from $200 to $300 in June 2021.

To ensure that no Singaporean is denied access to appropriate treatment due to inability to pay, MediFund is available at public healthcare institutions as a safety net to assist Singaporeans who are unable to afford their mental health treatments despite Government subsidies, insurance and MediSave. MOH will continue to review the various financial schemes regularly to ensure that they meet the needs of Singaporeans with mental health needs.

The Government is aware that the COVID-19 pandemic has brought about unprecedented shifts in the way we live and work, and resulted in stressors that impact our mental well-being. It is in anticipation of the increase in mental health needs in our population that the Government and various agencies have expanded or newly introduced over 40 mental health-related initiatives last year. Besides targeting the general population, many of these initiatives are targeted at specific population segments such as parents and families; children and youth; workplaces and working population; and seniors.

It is indeed important for us to create awareness on these issues, or as the Member puts it, to enhance mental health literacy, in our community.

The COVID-19 Mental Wellness Task force (CoMWT), co-chaired by MOH and the Institute of Mental Health (IMH), was set up to address the psychosocial impact of the COVID-19 pandemic on the population. The task force has completed its work and announced its findings and recommendations. More details can be found in the task force report which has been published on the MOH website.

To better prepare for the future, MOH and MSF have also set up the new Inter-agency task force on Mental Health and Well-being, which will oversee mental health and well-being efforts, focusing on cross-cutting issues that require inter-agency collaborations. The new task force will form workgroups to review cross-cutting gaps and issues for example specific measures targeted at those that are more vulnerable or at risk, to identify potential solutions. We will develop an overarching National Mental Health and Well-being Strategy. The task force will engage the public on the development of this strategy through a public consultation exercise next year.

Notwithstanding the efforts by the Government and agencies, a whole of society approach is necessary to address the population’s mental well-being. Every one of us has a role to play. We can start by learning more about mental health and how we could support other in dealing with mental health challenges, reach out and do regular check-ins on the people we care about, and most importantly, practice self-care.

The Government is committed to supporting this. For example, to better reach out to youths, the Government has launched the Youth Mental Well-being Network in February 2020 to bring together the wider society to identify opportunities and gaps to work on to improve youth mental well-being. To date, there are over 1,500 passionate like-minded individuals including mental health professionals, practitioners, parents and youths in this Network. The network members have been working on over 20 projects to support youth mental health, ranging from enhancing youths’ emotional resilience to strengthening support among peers, and within the family, workplace and community. We look forward to seeing the fruits of their labour.

I thank the Member for sharing the findings of the #452TooMany Campaign’s mental health dialogues with the community. We will factor these findings into the work of the Taskforce and its supporting workgroups.

On this note, I urge my fellow Singaporeans to stand together and support one another, to ensure mental well-being and resilience especially in such unprecedented times.