Institute Of Mental Health /Woodbridge Hospital 75th Anniversary Psychiatric Conference And 2nd National Psychotherapy Conference

15 Feb 2003

By Dr Balaji Sadasivan

Venue: Institute Of Mental Health /Woodbridge Hospital

INTRODUCTION

Mental health is as important as physical health to the overall well-being of individuals. In fact, mental health is inseparable from health in general. This concept is captured in World Health Organisation's definition of health as - "A state of complete physical, mental, and social well-being not merely the absence of disease . . .". Dr Gro Brundtland, Director General of WHO gave the analogy that talking about health without mental health is a little like tuning an instrument and leaving a few discordant notes. In today's healthcare scenerio, consideration of health without the inclusion of mental health is therefore incomplete.

SIGNIFICANCE OF MENTAL ILLNESSES

Mental illness has an enormous impact on the individual, his family, the society and the world at large.

WHO estimates that one in 4 persons will be affected by a mental disorder sometime in their lifetime. Major depression is noted to be the leading cause of disability globally and ranks fourth in the ten leading causes of the global burden of disease. Globally, about 24 million people have schizophrenia, a million people commit suicide every year and between 10 and 20 million people attempt it.

In Singapore, a 1995 study on Mental Health estimated that about 10% of Singaporeans aged 21 to 55 years old have some form of mental ill health. Of this figure, about 5% have mild disorders and 5% moderate to severe disorders. The prevalence of schizophrenia in Singapore is estimated to be about 0.75%.

Mental illness can cause severe disruptions in the lives of those who are affected and their families. The affected patient's social interaction is altered, his work abilities may be affected and in some cases, they may either lose their jobs or be discriminated against at job interviews. The patient with mental illness often suffers silently. In addition to the direct morbidity from the illness, they have to face stigmatisation, shame, exclusion and fear. Their quality of life is definitely affected by the mental illness.

Mental illness can affect any age groups, any occupations, any social group and exists in all societies. On the community level, the impact includes that of the cost of providing care, loss of productivity and loss of the potentially productive years. The social and economic burden of mental illness is enormous, not only to the individual, his family, but also to society.

While mental illness can lead to physical disabilitiy, the converse is also true, that physical illness affects the mental health of individuals as well as their families. The reported figures on mental illnesses are therefore an underestimate of the real burden of mental disorders.

Fortunately, over the years, much progress has been made in the understanding and treatment of mental illnesses. These have resulted in better control of mental illnesses, reduced suffering for the patients and their families and improvements in their quality of life and productivity.

CHALLENGES AND PROGRAMMES FOR THE MENTALLY ILL

However, as you are aware, there are a number of major challenges to caring for the mentally ill. Let me highlight 3 key challenges and share how we are dealing with these challenges in Singapore.

(I) First, demystifying and destigmatising mental illness

Mental illnesses may manifest as socially unacceptable symptoms or behaviours that may be considered by others as 'strange'. Coupled with the general public's relatively poor understanding of mental illnesses this may result in the mentally ill person becoming rejected and discriminated against. The patients and their families may by themselves also isolate the mentally ill from social contacts. There is therefore a pressing need to educate patients, their families and the general public on mental illnesses, to allay their fears, increase their awareness of mental disorders, their treatability, the recovery process, and to solicit their acceptance of those who are mentally ill.

In 1993, the Review Committee on National Health Policies recommended that public education efforts on mental illnesses be intensified so as to reduce stigma and delay in seeking treatment. My Ministry had accepted this recommendation and initiated a mental health education programme, that aimed to: -

(i) firstly encourage adoption of lifestyles that will promote good mental health,

(ii) secondly educate the public about the common mental illnesses, their presenting symptoms, treatability and the services available for treatment,

(iii) and also to encourage the public to seek treatment early.

In 2001, this mental health education programme was expanded into a 10 year prevention programme for the control of major mental disorders. This expanded programme, called the "MIND YOUR MIND", was spearheaded by the Health Promotion Board and involves the Institute of Mental Health and the Department of Psychological Medicine NUH. The programme focuses on promotion of mental health, creating greater awareness about mental disorders, de-stigmatising mental disorders and improving the rate of early detection and treatment of depression, anxiety disorders and schizophrenia in Singapore. Educational sessions are organised for the public, health professionals and also in schools.

(II) The second challenge is to improve accessibility to care

Adequate and appropriately placed services are important for easily accessible care.

In line with this, psychiatric care is being developed in the primary healthcare sector. A wide range of training programmes are organised to improve the ability of family physicians and other primary care workers to better detect and manage mental health problems in their patients. Acute care hospitals also collaborate with the primary care physicians through shared psychiatric care clinics. In addition, psychiatrists from Woodbridge Hospital/IMH provide consultations at clinics outside the hospital setting, for e.g. in the polyclinics. Community outreach teams are also formed to provide care to the patients within the community.

(III) The third challenge is to improve effectiveness and efficiency of care

We recognise that our desired outcomes can only be achieved if the system of care is efficient and effective treatment are used. In line with this, we have continued to invest in training, research and continuing service development. Currently we have 99 accredited psychiatrists, and each year we offer about 7 traineeship places for psychiatry. We will continue to support training at all levels. We also have in place, a number of streams of funding to support research. Through research, we look to better understandings of mental disorders, break-throughs in treatments and more effective treatment.

NATIONAL DISEASE CONTROL PLAN FOR MENTAL DISORDERS

To coordinate all these activities at a national level, my Ministry developed a National Disease Control Plan For Mental Disorders. This was initiated in the year 2000, with the targets to:-

(i) reduce the prevalence rate of depression from 8.6% in 1995 to 8% in 2010,

(ii) reduce anxiety disorders from 9.3% in 1998 to less than 9% in 2010

(iii) reduce suicide rates from 59 per 100,000 in elderly Chinese Singaporean in 1991 to 40 per 100,0000 in 2010; and,

(iv) to pick up schizophrenia earlier and reduce the need for institutionalized care.

IMH plays a key role in this plan and IMH works with other agencies to implement the strategies under this programme. This comprehensive plan has various primary, secondary and tertiary prevention programmes targeted at different age groups. The programmes include training for professionals, educationists, carers and the public; shared care programmes between the institutions and the primary care professionals; satellite specialist clinics, day programmes and outreach teams for schizophrenics and the setting up of support groups and counselling sessions in the community.

I would just highlight one of these programmes here. The Early Psychosis Intervention Programme, also call the EPIP, was started in 2001 and is specifically targeted for people with first episode psychosis, and those at high risk of developing psychosis. We hope to reduce delays in detection and treatment of such patients, and to improve outcomes through the integrated treatment approach in EPIP. EPIP works through a multidisciplinary team consisting of psychiatrists, psychologists, social workers, nurses and occupational therapists. Patients are treated at satellite specialist clinics. In the year 2002, a total of 1222 patients were seen at the EPIP satellite clinics and of these 234 were new patients.

CONCLUSION

A key focus of modern-day Psychiatry is early detection and treatment of mental illness, and community based care. Over the last 75 years, care for the mentally ill in Singapore has made impressive advances. The history of psychiatry care in Singapore is closely linked to the evolution and developments in Woodbridge Hospital/IMH. WH/IMH has grown from strength to strength and there is much for the dedicated doctors and staff of Woodbridge Hospital/IMH to be proud of.

While much has been achieved, more can and needs to be done. It is evident that good and appropriate prevention and management of mental disorders will make a big difference to the lives of patients and their families. It will also make a big difference to the society. The burden of mental and behavioural disorders can be reduced. I therefore encourage all healthcare staff, particularly those in the psychiatry, to take on this challenge to make the difference, to enable this difference to become a reality.

On this note, I would like to wish IMH/Woodbridge Hospital a meaningful 75th Anniversary celebration.

I would also like to wish all delegates a fruitful and stimulating time at this Conference. Have a good time at the conference, and do take some time to look around Singapore.

It gives me great pleasure to now declare the Institute of Mental Health/Woodbridge Hospital 75th Anniversary Psychiatric Conference and 2nd National Psychotherapy Conference open.