OPENING REMARKS BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE PRESS CONFERENCE FOR THE LAUNCH OF THE NATIONAL MENTAL HEALTH AND WELL-BEING STRATEGY ON 05 OCTOBER 2023, 2.15PM – 3.30PM

         Thank you everybody for coming here this afternoon for the launch of the National Mental Health and Well-being Strategy.

2.                 I will begin by giving a sense of what we are trying to achieve. We want mental health care to be more accessible to all members of the public. There are members of the public who have mental health concerns or issues but they do not necessarily suffer from a disease. However, they need support. We want that care and support to be accessible. That means we need care and support to be available in the community where people are, such as their day-to-day work, studies, family lives and social activities. As a result, we need to make sure that the providers of these care and support services within the community have the requisite skills, competency, training and ability to deal with the concerns of the public around mental health and well-being.

3.             That does not mean we are not addressing the issues of those who have mental health issues that are actual diseases, pathologies and problems. We are dealing with issues of capacity and capability at the level of professional healthcare services as well. So it is not just either or. It is both. We want to increase the access and availability of services within the community, professionalism and competencies of the staff and personnel, volunteers, social service agencies in the community, as well as increase the capacity and capability of the professional healthcare services to deal with the entire spectrum of mental health and well-being.

4.             Putting all of this together and coordinating the work will require some effort. For that, we are developing a Tiered Care Model to provide a common language and framework and to make sure that everybody in this ecosystem understands how the ecosystem works. To coordinate all of that, eventually we will transition the work of the Inter-agency Taskforce on Mental Health and Well-being to the National Mental Health Office.

5.             Mental health is a pressing topic and we recognise it is a complex issue. It will take not only a whole-of-government, but also whole-of-society effort to strengthen the mental health and well-being for the entire population.

6.             The Interagency Taskforce on Mental Health and Well-being was set up in 2021 with members from over 30 organisations. We hope to use it to get insights and understanding of these very complicated issues from the public-private-people sectors, and ultimately to improve mental health for Singapore and Singaporeans. We have reviewed the landscape, studied the gaps and challenges, and developed recommendations to close these gaps. We put up a public consultation on some of these ideas and sought feedback through the public consultation process.

7.             Joining me today are my colleagues who have journeyed with me on the Taskforce in developing these recommendations. They represent a large number of people in all our different organisations and I want to put on record our thanks to the staff, volunteers, and the people who have represented very significantly diverse group of organisations that have come together for our Inter-agency Taskforce. In a way, it is representative of the kind of Whole-of-Society effort that we have had to put in place in order to identify the challenges. A similar Whole-of-Society effort will be needed to deal with the challenges. We have efforts on the  social space, education, workplace, and community. My colleagues will share more about the different aspects.

8.             The Taskforce’s recommendations have resulted in the National Mental Health and Well-being Strategy. I would note that this is not the first time we are doing something like this. We are not starting from ground zero or a blank slate. The details of some of our past efforts are in the report. We are building on those foundations, and we hope in this Strategy to create the foundations for the next bound of efforts that will come in the future. What we want to do is to improve the mental health support ecosystem in Singapore, where people live in a caring and inclusive society, can seek help without stigma, and are ready to support one another.

9.              It is a big and complicated endeavour that will take some time. We will need to bring together  services and programmes in these various sectors -  health, social, education, workplace and community. We have a  forward-looking strategy to guide the Government, public institutions, private organisations and  individuals on how to provide  mental health support. 

Tiered Care Model: Cornerstone of the Strategy

10.         Today, there are already many existing mental health services in the hospitals, primary care and community care sectors. How can we better organise these services and ensure that individuals in need can access the right services in a timely manner, and receive the appropriate level of intervention? Not every mental health issue needs to be addressed by a psychiatrist; not every medical issue needs to be seen by a specialist.

11.         The Tiered Care Model  organises our mental health services according to the severity of needs across the health, social and education settings. This is an important concept. We have, in the Tiered Care Model, one framework that all our different sectors and domains will use – whether you are a social service professional, educational professional or a healthcare professional. We use the same language, same model, same mental concepts in dealing with mental health issues. We want to make sure we use our resources and services appropriately, provide care and care access to all the clients, avoid over-medicalising mental health issues and ultimately reduce the stigma.

12.         Implementing any new care model is not going to be easy. We have worked with key stakeholders from the various sectors to develop a Practice Guide and we will continue this work through a number of working groups. We have implementation committees that will take practitioners, people who are working in the different sectors and organisations, and think about how the Tiered Care Model will result in practised change. That work has already started.

Ensuring Adequate Care Capacity for Mental Health Services

13.         Let me now touch on what the Ministry of Health (MOH) is doing. MOH is committed to ensure adequate care capacity to support individuals with mental health needs.

14.         Today, all public acute hospitals provide psychiatric inpatient and outpatient services. We are working with the Institute of Mental Health (IMH) to enhance its capacity. There will also be expanded psychiatric services in the redeveloped Alexandra Hospital. Capacity expansion plans are in place for long-term care facilities to ensure sufficient community residential and day care capacity to meet our future needs.

15.         Even as we build up hospital capacity, we must keep in mind that individuals with mild to moderate mental health needs do not require tertiary care. They can be cared for in the primary and community care settings.

16.         Some of you may be familiar with the Singapore Youth Epidemiology and Resilience (YEAR) study by the National University of Singapore, in collaboration with the Ministry of Education. Some of it is referenced in the Strategy document. To use that as an illustration, when the study was conducted, and the respondents reported symptoms of anxiety, concerns around depression and behavioural issues, most of those who reported those symptoms did not actually have a diagnosed problem. Only a small proportion of those reporting those symptoms and concerns ended up having a diagnosis or pathology, which required intervention treatment such as psychiatrist and psychologist’s medication.

17.         What does this mean? It means that the bulk of the people who are concerned about mental health or who had mental health issues are persons who would be best served by our Tier 1, 2 or 3 type services. That is where the bulk of our efforts need to be. That is where the bulk of individuals need to be seen, in the community. Only a small number need the services of psychiatrists, psychologists and institutions. So, community care and primary care for mental health is going to be very important.

18.         Today, 17 polyclinics provide mental health services. MOH plans to extend mental health services to more polyclinics, including all new polyclinics, by 2030. 400 General Practitioners (GPs) have been trained to provide mental health assessment, diagnosis and support. We will expand the base of GPs providing mental health support under Healthier SG.

19.         Complementing the health primary care is the wide network of community-based mental health services. Over 90 CREST and COMIT teams have been implemented islandwide to reach out to and manage individuals with, or at risk of mental health needs through providing mental health education and resources, assessment and interventions. The CREST teams deal largely with outreach and education and the COMIT teams are much more focused on assessment and intervention. All of them have  linkages to other services to provide referrals and connections to the other services as appropriate. MOH will continue to work with the Agency for Integrated Care and Social Services Agencies to expand our  community mental health teams.

Strengthening Enablers to Support Mental Health Care

Uplifting mental health competency

20.         Another important aspect is the competencies and standards. We developed the National Mental Health Competency Training Framework, which will be released together with the Strategy. This cuts across all our sectors. It is a Competency Framework that the health, social and education sectors will use when it comes to mental health. It  seeks to guide practitioners in attaining the requisite knowledge, skills and competencies for each tier of care and it applies to all practitioners, from lay responders such as peer supporters, to mental health professionals including nurses, social workers, and counsellors, among many others.

21.         I would encourage all service providers and training providers to reference this framework, and look at it closely and make sure it is part of your organisation’s manpower development plans when it comes to mental health.

Leveraging digital technologies

22.         We have to  strengthen prevention, improve early detection and self-help in the community. One potential lever is to use digital technologies such as mental health mobile applications and web-based services. These can help with self-detection and self-help. There are plenty of existing digital resources such as MindSG and mindline.sg that provide resources for individuals to cope with stressors.

23.         Digital solutions are easily accessible and less stigmatising, but they are not all necessarily effective or safe. This is a relatively nascent and early area where more work needs to be done to evaluate these various mental health digital applications out there. MOH plans to look into this area in the future.

24.         On the point of self-help mechanisms, I would say that we need to take care to differentiate between mental health symptoms that are part of the normal stressors of life and how we have to develop resilience, peer support and social means of dealing with that. We also need a series of interventions around where people need the assurance that should they develop mental health issues, they will get the care and support they need under Tiers 1, 2 or 3.  For the small number that turn into real mental health issues, we have to make sure we have easy and good access to the healthcare professionals that need to intervene.

Closing

25.         Over the years, the Government, healthcare institutions, social service agencies, schools and many others have provided mental health support for those in need. But the Government cannot do it alone. All of us have a part to play. The Taskforce was very privileged to have many people come together and contribute their ideas. We hope that the spirit of collaboration will continue to improve the mental health and well-being landscape in Singapore.

26.         I thought I might also take the opportunity to summarise some numbers.

We will by 2025, have trained 100,000 frontline workers around various issues of mental health. The work has already started.

• We will also train 1,500 social service professionals, who deal with more complex issues.

• We have 200 touchpoints that give out information and connect people.

• We have 450 agencies and organisations that provide mental health support

• We have 90 CREST and COMIT teams.

• To date, we have trained 1,400 tertiary students to be peer supporters.

• We have six Well-Being Circles bringing together 30 organisations. They have trained 500 peer supporters.

• MindSG has engaged 1.4 million users so far, and mindline.sg engages 13,000 users per week.

27.         I will now hand over to my colleagues to share more on their respective areas.