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Commentary: Time is a crucial factor in Singapore’s mental health well-being

SINGAPORE: The recent National Population Health Survey has unveiled a paradox, casting a spotlight on the state of mental health in Singapore. On one hand, there is a heartening increase in the willingness of individuals to seek professional help for mental health issues. On the other, the prevalence of poor mental health increased from 13.4 per cent in 2020 to 17 per cent in 2022.

These findings, collected from more than 15,000 adults, paint a grim picture, particularly when juxtaposed with an alarming 26 per cent spike in the number of suicides in Singapore last year.

This raises some urgent questions: Is Singapore’s mental healthcare infrastructure adequately prepared to handle this surge in demand? How will patients afford the mental healthcare they need?

WHEN SOMEONE IS IN DESPAIR, TIME IS OF ESSENCE

As the former chief of emergency and crisis care at the Institute of Mental Health and now a private practitioner, I have witnessed first-hand the despair felt by patients and their families who have highlighted waits of up to two to three months for an outpatient appointment in the public sector.

When someone is teetering on the edge, every day counts. Every day they wait is a day where their despair deepens.

These waiting times are not just an inconvenience; they have a direct and significant impact on the emotional well-being of individuals who are already in a vulnerable state. 

The increasing willingness among the public to seek mental health assistance is a promising development, and can be attributed, in part, to ongoing efforts in the country to improve mental health literacy and reduce stigma.

The recently launched National Mental Health and Well-Being Strategy further underscores that this is a focus area for the nation. Mental health services will be included in Singapore’s national preventive care programme Healthier SG in the coming two years, and individuals will be able to receive help from more hospitals, polyclinics and general practitioners.

But while these initiatives are crucial for societal progress, they inadvertently place an additional burden on Singapore’s already stretched public mental health system. Are our community services, clinics and public hospitals adequately equipped to handle this surge in demand?

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NEW FOUR-TIERED MODEL A STEP IN THE RIGHT DIRECTION

The new four-tiered model – which tailors mental health services to an individual’s severity of needs – may go some way in improving accessibility, but it is not without its own set of challenges that need careful consideration.

From community-led mental health promotion and peer support at the lowest tier, to specialised clinical interventions at the highest, the model offers a diverse range of care options. 

But one pressing concern is the potential for patients to be pushed towards higher tiers of care, particularly if community and primary care providers lack the necessary experience, capabilities or confidence to manage mental health issues. This could result in an initial overburdening of specialised services, leading to longer waiting times and potentially reduced quality of care.

To address this, the model has been accompanied by the National Mental Health Competency Training Framework, designed to guide mental health practitioners in attaining the requisite knowledge, skills and competencies commensurate with each tier of care.

This is a step in the right direction, but it is crucial to balance paper qualifications with real-world experience. A competency framework that overly emphasises academic qualifications risks overlooking the nuanced skills and empathetic understanding that come from hands-on experience.

Though it was not explicitly covered in the National Strategy, supervision must be included to support mental health care workers at all tiers. The complexities of mental health care often require a level of expertise that can only be gained through real-world experience and mentorship.

Introducing a robust supervisory structure could empower practitioners to manage complex cases more effectively, thereby enhancing the quality of care. This would not only provide an additional layer of support but also contribute to the professional growth and confidence of mental health care workers.

Another concern is that the model could inadvertently create a “two-tier” system where those who can afford paying higher fees skip the lower tiers for more immediate, specialised care, thereby exacerbating inequalities in access and outcomes. This could lead to a situation where public services are possibly overwhelmed with complex cases, while simpler cases that could be managed effectively at lower tiers are siphoned off to private mental health services for faster treatment.

One question to ask then is whether a more robust insurance framework and employer-sponsored benefits would make private mental health services a viable option?

MENTAL HEALTH COVERAGE IN INSURANCE

The growing focus on mental health presents an opportunity for stakeholders to collaborate and innovate in creating sustainable financial models that can make mental health care more universally accessible.

Currently, government subsidies and initiatives like the Community Health Assist Scheme (CHAS) offer some financial relief but fall short of providing universal access to mental health services.

The high costs associated with private sector treatment remain a significant barrier for many, leading to an overreliance on public sector resources and, consequently, straining them.

Insurance companies are uniquely positioned to step into this gap. By incorporating comprehensive mental health coverage into their standard insurance plans, they can make these essential services both more accessible and affordable.

There’s also room for improvement concerning the denial of insurance coverage based on a past mental health diagnosis. Addressing this issue would not only reduce the existing stigma around mental health but also remove a significant obstacle for those in need of continuous care and support.

On the corporate front, more companies are prioritising the mental health of employees and incorporating mental health benefits in their insurance coverage. Yet, there’s more that can be done.

Employers can make a significant impact by integrating mental health coverage as a fundamental component of their standard employee benefits packages. This not only makes mental health services more accessible but also fosters a work environment that genuinely values the mental well-being of its employees.

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A HOLISTIC APPROACH

The mental health landscape in Singapore is at a critical juncture. While we celebrate the strides made in reducing stigma and increasing mental health literacy, we must also confront the gaps in service availability, financing and systemic preparedness.

It is not difficult to see that as the demand for mental health services rises, our current infrastructure may not be fully equipped to meet this demand.

The journey to a robust mental healthcare infrastructure is a long one; efforts will take decades before their full impact is realised. Creating a people-public-private partnership is key to addressing these challenges effectively.

Dr Jared Ng is Senior Consultant and Medical Director at Connections MindHealth. He was previously chief of the department of emergency and crisis care at the Institute of Mental Health.

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