The Inter-agency Taskforce on Mental Health and Well-being has launched Singapore’s National Mental Health and Well-being Strategy. The Strategy aims to create an effective mental health ecosystem comprising accessible and good quality clinical care with a supportive community and society, where people with mental health needs can seek help early without stigma and be readily supported for their recovery.
2. The Taskforce is chaired by Dr Janil Puthucheary, Senior Minister of State, Ministry of Communications and Information & Ministry of Health. It is co-led by the Ministry of Health (MOH) and the Ministry of Social and Family Development (MSF), and comprises public sector agencies including the Ministry of Culture, Community and Youth (MCCY), Ministry of Education (MOE) and Ministry of Manpower (MOM), as well as private and people sector agencies.
3. To garner the views of stakeholders and the public on its interim recommendations, the Taskforce conducted a public consultation between May and August 2022, and received over 950 responses across the following areas:
i. Care integration between health and social services;
ii. Services and support for youth mental well-being;
iii. Support for mental well-being of employees and employability of individuals with mental health conditions; and
iv. Mental health literacy and stigma.
The Taskforce has incorporated relevant feedback in developing the National Mental Health and Well-being Strategy.
National Mental Health and Well-being Strategy
4. The Strategy covers four focus areas:
i. Expanding capacity of mental health services;
ii. Enhancing capabilities of service providers for early identification and intervention;
iii. Promoting mental health and well-being; and
iv. Improving workplace mental health and well-being.
5. A Tiered Care Model, accompanied by a Practice Guide, will be introduced to better organise mental health services across health and social sectors, according to the severity of individuals’ mental health needs. The Tiered Care Model will lay the foundation for further strategic enhancements to the mental health ecosystem. It will improve care access and facilitate effective interventions and care provision, while avoiding unwarranted medicalisation and stigma.
6. Mental health support will be tiered across four levels, ranging from community-led mental health promotion, self-help and peer support at Tier 1, to the most intensive level of care in hospitals and specialist clinics at Tier 4. (Please refer to the Annex.)
I) Expanding Capacity of Mental Health Services
7. To ensure we have adequate care capacity for those who require hospital care, MOH is working with acute hospitals on refining the care model for hospital-based mental health services and capacity planning. We will enhance inpatient psychiatric bed and rehabilitation capacity at the Institute of Mental Health (IMH). The redeveloped Alexandra Hospital (AH) will also offer expanded psychiatric services.
8. MOH will also develop more primary and community mental health services and long-term care facilities to enable individuals to seek help more easily. We will designate first-stop touchpoints, mainly in primary care and the community.
a) Today, 17 of the existing 24 polyclinics provide mental health services. We plan to extend the provision of mental health services to all new polyclinics by 2030.
b) Under the Mental Health General Practitioner Partnership (MHGPP) programme, there are currently over 400 GPs trained to provide mental health services. We will train and onboard more GPs through MHGPP to support mental health under Healthier SG. The GPs will be augmented by community mental health teams to provide counselling and psychological services.
c) We will increase long-term care facilities to meet future needs by developing two new psychiatric nursing homes and a psychiatric rehabilitation home by 2030.
9. Besides primary care, MOH will also develop other first-stop touchpoints such as a national mental health helpline and text service, and digital mental health platforms to allow more people to self-help or access help quickly.
10. Crisis support services remain a key feature and IMH is currently piloting a Crisis Response Team (CRT) to support police officers in managing suicidal cases. The CRT conducts rapid assessments and provides prompt support for individuals at risk of suicide.
11. Not all individuals with suicide risk have a mental health condition. At least half of the referrals for suicidal youths to IMH do not have any mental health conditions. Instead, triggers are usually related to psychosocial stressors such as difficult interpersonal relationships. An intermediate residential facility will be piloted for this group of youths to stabilise them in a safe and nurturing environment, while providing psycho-social interventions to address underlying triggers before discharge.
12. Good maternal health provides the best possible chance to optimise every child’s future physical, mental and socio-emotional outcomes. We are enhancing support for the mental health of women during and after their pregnancy through the introduction of a universal antenatal depression screening as part of routine care for pregnant women at KK Women's and Children's Hospital. The Perinatal Mental Health Guidelines have also been released this year to provide advice on perinatal depression and anxiety.
13. Community-based social service agencies that provide support for vulnerable families and individuals, such as Family Service Centres (FSCs) and counselling programmes, play an active role in supporting individuals experiencing distress, and the early detection and referral of individuals with mental health needs. Over 300 staff in FSCs have been trained to identify individuals with mental health needs, and to refer them to appropriate mental health services where necessary. These services include Community Outreach Teams (CREST)[1] and Community Intervention Teams (COMIT)[2]. Over 90 CREST and COMIT teams have been set up in various social service agencies island-wide. Similar teams known as CREST-Youth and Youth Integrated Teams (YIT) are set up to tailor community-based programmes to youths.
14. The MOH Office for Healthcare Transformation (MOHT) is also developing a platform to facilitate referrals of individuals between mental health service providers for better care coordination.
II) Enhancing Capabilities of Service Providers for Early Identification and Intervention
15. To deliver good mental health services, we need more trained service providers across various sectors. The National Mental Health Competency Training Framework will guide service providers in attaining the requisite competencies across each tier of care. Over 90,000 volunteers and frontline personnel from Government agencies, community partners, and mental health service providers have been trained in mental health awareness. In addition, these frontline personnel will be equipped with skills to provide psychological first aid where necessary. We aim to train about 10,000 more frontline personnel in the next two years, and upskill 1,500 frontline social service professionals.
III) Promoting Mental Health and Well-being
16. An effective healthcare strategy for mental health needs to be holistic. Rather than focusing attention on the treatment of mental disorders, at least equal emphasis should be placed on preventive care, aligned with the principles of the Healthier SG strategy. To achieve a mentally resilient population and prevent the onset of mental health conditions where possible, we are dedicating more effort and resources to promote mental well-being and encourage early help-seeking.
17. We need to normalise conversations surrounding mental health and well-being, improve mental health literacy, and reduce stigma towards individuals with mental health conditions. To achieve this, the Health Promotion Board (HPB) has run public education campaigns such as “It’s OKAY to Reach Out”. In addition, the National Council of Social Service (NCSS) introduced the ‘Beyond the Label’ (BTL) movement in 2018 to address mental health stigma and started the BTL Collective in 2022, in partnership with TOUCH Community Services, to rally partners from the public, private and people sectors to strengthen support for persons with mental health conditions. The Workplace Safety and Health Council also rolled out the ‘Take Time to Take Care’ campaign in 2021 to promote mental well-being at the workplace.
18. Improving mental health literacy and building mental resilience need to start at a young age. MOE has put in place education efforts in schools and Institutes of Higher Learning (IHLs) to build mental well-being and resilience of students. Initiatives to build mental and socio-emotional resilience in preschoolers will also be implemented. In addition, HPB conducts programmes for students at critical transition years. HPB also works with IHLs to establish peer support structures and provide training to students who volunteer to take up peer supporter roles.
19. Currently, the need for parental consent may affect children’s and youths’ access to mental health services as under common law, the age of consent is 21 years old and above. The Government will study overseas practices to see how best to address this.
20. Parents play a critical role in supporting their children’s mental health and well-being. To better support parents, HPB conducts mental well-being workshops for parents of children aged three to 17 years, to equip them with skills to help their children cope with their emotions, build resilience, and learn strategies to cope with stressors. MOE also regularly shares resources on practical tips and advice with parents and Parent Support Groups to support them in building their children’s resilience and strengthening their well-being.
21. As part of the Taskforce’s recommendations, a Parents’ Toolbox is being developed and is expected to be launched in phases from early 2024 to empower and equip parents with personalised knowledge and skills to build strong parent-child relationships and strengthen their children’s mental well-being and resilience.
22. Recognising the need for whole-of-society involvement, the SG Mental Well-Being Network was launched in July 2022 to bring the public, private, and people sectors together to strengthen mental well-being outcomes. From this network, Well-Being Circles were formed in various neighborhoods to raise awareness of mental health and train volunteers to be peer supporters. So far, six Well-Being Circles have been set up with over 500 trained volunteers, and we plan to develop more. To augment this, HPB is running a national campaign “Supporters who listen, support better” this year to equip Singaporeans with relevant skills to support individuals with mental health needs.
23. Harmful online content is a prevailing concern, especially with the pervasive usage of online platforms among the youth. MOE has placed greater emphasis on cyber wellness to help students thrive in an interconnected, diverse and rapidly changing world. The Taskforce is also working with the Ministry of Communications and Information (MCI) to develop a positive use guide. This will guide the healthy and positive use of technology, and provide recommendations on how to mitigate its negative impact. Further measures to enhance online safety for users in Singapore have been introduced by MCI to empower users to protect themselves.
24. There is potential to leverage digital technologies to enable greater access to mental health resources with more privacy and less stigma. Currently, individuals with mental distress can go to HPB’s one-stop online portal MindSG for relevant e-resources. They can also use mindline.sg, a digital mental health and wellness platform for self-help developed by MOHT. This will be further enhanced to align with Healthier SG care protocols for anxiety and depression at later stages.
IV) Improving Workplace Mental Health and Well-being
25. Given the significant impact of the workplace on mental health, employers and workers play a key role in the national efforts to strengthen mental health and well-being. MOM, NCSS, Workplace Safety and Health Council and HPB are working to strengthen mental well-being support systems at workplaces. These are done through developing a community of Workplace Mental Well-being Champions, training employees to be peer supporters at the workplace, and recognising progressive employers who are committed to strengthening their employees’ mental well-being.
26. Employment support agencies play a key role by helping individuals with mental health conditions secure meaningful jobs which help regain their confidence and reintegrate them into society. Three key employment support agencies currently provide vocational training and employment support for individuals with mental health conditions. However, there is still scope for more employers to hire and support individuals with mental health conditions in recovery. MOM is strengthening its outreach efforts through tripartite partners and employer groups such as Singapore National Employers Federation (SNEF) to encourage more employers to step up. This is further augmented by efforts from NCSS and SkillsFuture Singapore (SSG) in providing relevant training and support for job readiness.
27. The Tripartite Committee on Workplace Fairness was formed in 2021 to review the options to strengthen workplace fairness. As part of the Committee’s recommendations, legislation on workplace fairness will be introduced, prohibiting workplace discrimination, including discrimination based on mental health conditions.
A Nationwide Effort to Improve Mental Well-being
28. To ensure continuity in our efforts for mental health and well-being, a National Mental Health Office, comprising officers from health, social and education sectors, will be established by 2025 to oversee the implementation of the Strategy and future mental health care developments.
29. The National Mental Health and Well-Being Strategy will tackle mental health issues coherently and holistically, from both preventive and curative perspectives, and through schools, community and workplaces. Ultimately, we need a whole-of-society approach to tackle mental health issues and improve the mental well-being of our population. The National Mental Health and Well-Being Strategy is available on the MOH website at https://go.gov.sg/mental-health-strategy.
MINISTRY OF HEALTH
MINISTRY OF SOCIAL AND FAMILY DEVELOPMENT
5 OCTOBER 2023
[1] Community Outreach Team (CREST) focuses on raising public awareness of mental health conditions, promoting early recognition of at-risk individuals, providing emotional support to individuals and their caregivers and linking individuals to relevant health and social care services when necessary.
[2] Community Intervention Team (COMIT) is an allied health led, multi-disciplinary team which provides assessment, counselling, therapy, case management and psychoeducation support for clients with mental health issues, and their caregivers.