My intolerance with how mental health is treated is the straw that will one day, break my back. Even while doing my research, the inaction and lack of a sense of urgency continue to grind my gears. For an issue that affects one in twelve Singaporeans, we sure aren’t doing anything about it.
Surely We Can Do Better
For the 552,427 cars in Singapore (a nation of 5,612,300 people) – approximately one for ten Singaporeans – we can accurately collect $1.50 from 18:55 – 19:00, and immediately switch to collecting $1 from 19:00 – 19:55 on weekdays for each car that passes under this (exact one):
We can surely do better for our situation with mental health and those facing troubles with their mental health.
The State of Mental Health in Singapore (Unquote)
In order to be as subjective as possible, I’m going to quote Minister for Health, Mr Gan Kim Yong on the state of mental health in Singapore. This was a written answer to a question posed by Assoc Prof Daniel Goh Pei Siong, answered 6th November 2017.
“In 2010, the Institute of Mental Health (IMH) conducted the first Singapore Mental Health Study which concluded that 9.3% of Singapore Residents would have at least one mood or anxiety disorder at some point of their adult lifetime. Among the illnesses assessed, Major Depressive Disorder (MDD) and Obsessive Compulsive Disorder (OCD) were the most common mental health conditions in Singapore. MDD affected one in 17 Singapore Residents and OCD affected one in 33 Singapore Residents at some point in their lifetimes. The second Singapore Mental Health Study is currently underway. It will inform us how the mental health landscape has changed in the years since the first study and provide insights into other conditions such as schizophrenia and sleep disorders.
In addition, IMH has also conducted the Mental Health Literacy Study, which was completed in 2016. The study focused on social perceptions and stigmatisation of mental illness. The study suggested considerable stigma towards individuals with mental health conditions, which could hinder such individuals from seeking treatment.
Government agencies, healthcare providers and community partners have been working together on efforts to reduce the stigma of mental health conditions and encourage help-seeking. For example, the National Council of Social Services (NCSS) is embarking on a multi-year public education campaign to promote a more inclusive society for persons with mental health conditions. The enhanced Community Mental Health Masterplan announced in 2017 is being implemented to strengthen community-based care for persons with mental health conditions. These included initiatives to better outreach to individuals suffering from mental health conditions for early treatment, and enhancement of mental health services in the primary care sector.”
My Qualm With The Response
It is sad that most immediately, we only announced the enhanced Community Mental Health Masterplan in 2017. This is 52 years after we received independence as a nation. Surely, for us to take action only 50 years after an issue is known to be a bigger and bigger problem, must mean mental health stays low on the list of issues we are tackling. For it only takes a week for you to get penalised for not paying $1.50 for passing under the gantry shown above.
Alas, some action is better than no action. We are spending $160 million over the next five years for the enhanced Community Mental Health Masterplan.
Since 2012, MOH has partnered VWOs to set up 36 teams that provide outreach and allied health support in the community. Last year, MOH also launched Dementia Friendly Communities in Hong Kah North, MacPherson and Yishun. These communities are networks of residents, businesses and services trained to look out for and help those with symptoms of dementia.
I have never heard of these VWOs and how they are providing outreach and health support. This outreach might be short of enough.
So What Is This Masterplan?
First, front-line staff from selected Government agencies like the Housing and Development Board, National Environment Agency and Singapore Police Force will be trained to identify and respond to people with mental health issues in the community. This is to improve the early identification of mental health symptoms, said Dr Khor.
The Agency for Integrated Care will also be resourced to act as a “first responder” to mental health needs identified in the community, and coordinate care across the health and social sectors.
Mental health and dementia services will also be provided within polyclinics to make mental health services more accessible for citizens, she added. “Our target is for one in two polyclinics to implement mental health clinics by 2021,” she said.
MOH and the Ministry of Social and Family Development will also work together to strengthen integrated health and social care services in the community, she added. For example, MOH will increase the number of community outreach teams from 18 to 50 by 2021, to educate the public on mental health and reach out to those at risk.
Finally, “after-care” support for Institute of Mental Health (IMH) patients will be strengthened. “MOH will resource IMH to widen their case management support, so more IMH patients will be supported in the post-discharge period and transit well back home,” she said. “IMH expects to be able to support an additional 3,000 patients over the next five years, on top of the current 8,000 patients.”
I am fully for more first-responder-like help for those in need, whether it takes training more people or acquiring more resources for mental health first response. To increase mental health services at polyclinics is also a good move forward. But for a poly (many)-clinic, surely we must have missed out mental health, a pretty wide gap in our health system due to some error within the system.
However, I am strongly against how little action we are taking in the fourth and fifth paragraphs of the summary. A 270% increase in outreach teams might seem a lot, but to have an increase of 32 teams in the next 4 years seems starkly insufficient. That’s 10,000 residents for each team to educate. While we face our struggles as a small nation to increase infrastructure in our healthcare system, a 600 patient increase each year seems short of how mental health problems seem to be on the rise.
What Are We Lacking?
Despite this masterplan, I still feel that we are very lacking in mental health care for Singaporeans.
For instance, we are still severely lacking in education from an early age, teaching the future of our nation the importance of mental health and how their actions might negatively affect their mental health.
How about equal rights for those with mental health issues trying to look for stable work? Many are discriminated against despite how pristine our work laws are set up.
What about the lack of passionate people who are fighting for and with those with mental health issues? We are not, at any point, making mental health care something we should care about as part of our studies.
Maybe we should make financial subsidies available (at no extra liability) for those who are seeking treatment for mental health problems, like those we offer for physical health issues? Medicine and treatment (especially due to the trial-and-error method of treatment we experience) can compound to become financially straining for some.
What about talking about mental health? Maybe we should not stray away from addressing mental health problems on TV serial dramas or in news programmes. Maybe we should, perhaps, take people who struggle with mental health seriously. We have reached zero tolerance for public transport breakdowns but we still have some tolerance for discrimination against mental health.
I might sound passive aggressive about the inaction behind mental health in Singapore, and that is because I am. I am aggressively for action to make mental health part of our everyday lives.
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