Intended Role of Community Mental Health Services within Singapore’s Care Continuum

Dr Hamid Razak asked the Coordinating Minister for Social Policies and Minister for Health (a) how does the Ministry define the intended role of community mental health services within Singapore’s care continuum; (b) whether community mental health services are primarily designed as (i) first-contact services (ii) post-hospital step-down care or (iii) both; and (c) how does this inform service design and resourcing.

Mr Speaker, my response will also address written Question No 9 filed by Dr Hamid Razak and filed in yesterday's Order Paper.

Community mental health teams include Community Outreach Teams (CREST) and Community Intervention Teams (COMIT). CREST is designated as one of the First Stops for Mental Health to improve access to screening, basic emotional support and other mental health resources. On the other hand, COMIT provides higher level psychosocial interventions, such as cognitive behavioural therapy, for individuals with moderate mental health needs. Both CREST and COMIT attend to patients referred for follow-up after undergoing treatment at the acute hospitals.

So, the short answer to his question today is, yes, both these resources are to cater as a first-stop and also, for follow-up in the community.

The Ministry of Health (MOH), together with the Agency for Integrated Care, monitors several indicators of these services. These include clinical and functional outcomes using tools such as the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and World Health Organization (WHO) Disability Assessment Schedule 2.0 (WHODAS 2.0). We also monitor the service utilisation and intensity of care needs of clients, including the referral sources. We use such data in our ongoing review and refinement of community mental health services, and to determine the resourcing for these services.

Thank you, Mr Speaker, and I thank the Senior Minister of State for his answer. My question really stems out of, when we look at a parallelism in terms of physical care. When we talk about community care in the aspect of physical health, we often look at step-down care in terms of intermediate and long-term care. So, this space of community mental health, since they are dual-purpose for both first touch as well as follow-up care, how does the Ministry ensure that our community mental care workers are adequately resourced and staffed so that the care itself is not compromised, as well as for the welfare of our community mental health workers?

Sir, the National Mental Health Office works closely with various agencies, including the Agency for Integrated Care, as well as touchpoints with our community partners that are delivering some of these care in the community. Through the regular interactions and structured meetings, we do get a sense of what the resourcing gaps might be. And right now, one of our measures is to push forth training resources and having some pocket guides to help the care providers right-site the clients to the right level of care so that they are not overburdened by those who need more care than they can provide. In these interactions and formalised meeting sessions, we will be able to get a sense of where the gaps might be and if need be, provide them with extra resources. It could be funding, could be training support to be able to deliver the services that they need to do in the community.