Screening for Mental Health Disorders among National Service Recruits

Mdm Speaker, the spectrum of mental health disorders within any given population can vary considerably in severity, and because our National Servicemen are drawn from the general population, this is also true for National Servicemen with mental health disorders. Further, for the affected individual, his condition may not be static and could worsen or improve over time. So, MINDEF's approach for National Servicemen with mental health disorders takes into account this variability; variability of conditions across different individuals, the variability of an individual who has the condition over time. And only those who are assessed professionally to be able to perform his National Service (NS) duties are enlisted.

Before enlistment, all pre-enlistees are screened by Medical Officers for psychiatric, behavioural and adjustment problems. The screening guidelines are established by the SAF Psychiatry Specialist Advisory Board, and this comprises senior psychiatrists drawn from private practice and public hospitals. Pre-enlistees with severe mental illnesses who are unable to perform NS duties are exempted from NS. And in the last three years, about 500 were exempted from NS because they had this condition, annually, due to mental health problems. Five hundred annually.

For those enlisted, we want to ensure that national servicemen with mental health disorders pose no risk to themselves and those around them. They are monitored while they are serving NS. To protect their medical confidentiality, only the Commanders and Medical Officers who monitor their progress are notified about their conditions. Should they require closer observation, these National Servicemen are seen regularly by psychiatrists at the Psychological Care Centre.

Any time there is doubt whether the National Servicemen can perform his duties or about safety risks, the individual is again assessed by the psychiatrist and could be redeployed to a more suitable vocation or excused from his NS duties.

I have spoken about a specific regime which the Member has asked for. But in addition to this specific regime for those with known mental health disorders, the SAF also educates trainees in Officer Cadet School and Specialist Cadet School. We give them basic counselling and mental health awareness programmes. This is to help our Commanders better identify fellow soldiers with mental health issues. Soldiers with mental health issues can be referred

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to the Psychological Care Centre. The Member also asked what other avenues there are. There is also a 24-hour SAF Counselling Hotline, which soldiers can call – whether they themselves or others for them – whenever they need help.

Our approach towards national servicemen with mental health disorders ensures that they are not discriminated against or stigmatised if they are able to perform NS safely. They are treated similarly with national servicemen who have other physical health disorders, where risks are also managed accordingly based on guidelines, again, developed by our Specialist Medical Boards. The risks from their medical conditions, whether physical or mental, will exist even when they are not performing NS.

Under our present regime, there have been many national servicemen with mental health disorders who have completed their NS duties well. MINDEF and the SAF will continue to periodically review and strengthen the mental health system, in consultation with the Psychiatry Specialist Advisory Board, to ensure that all National Servicemen with medical conditions receive good care during NS.

Assoc Prof Fatimah Lateef (Marine Parade): I thank the Minister for the response. Just two short supplementary questions. First, pertaining to fitness to perform, for example, if the recruit or NSman has already been diagnosed or is getting consultation from a private psychiatrist, is that also acceptable to the SAF?

Secondly, in the decision to downgrade for fitness to perform during National Service or in the SAF, is it required that a psychiatrist in a restructured hospital is consulted, or is it just the SAF psychiatrist who can make a decision? Also, for medication for the psychiatric conditions, which can be quite expensive for some, are there subsidies that these people can tap?

Madam, before I answer specifically, we treat psychiatric conditions similar to other medical conditions, with regard to whether the serviceman can be re-deployed or exempted from National Service altogether. The SAF makes no distinction between private and public medical specialists who have seen the serviceman and alert us to either the condition or if the condition has worsened. But the final decision on deployment and exemption or continuing of NS is made by a Specialist Board. We have a number of these Specialist Medical Boards. Rather than one person doing it, we draw them from both private and public sectors – as I had mentioned. We have a Psychiatrist Board that consists of specialists drawn from both private and public sectors, and they help us to assess any particular individual's condition.

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Our subsidy and treatment regimes fall under the general healthcare framework. If there are issues in terms of financial assistance, we have separate schemes but no, we do not have any particular scheme that addresses medical subsidies for National Servicemen with medical health conditions.