Speech by Dr Amy Khor, Senior Minister-of-State for Health, at the Singapore Mental Health Conference 2013, 27 Sep, at the Max Atria, Singapore Expo

Professor Chee Yam Cheng, Group CEO, National Healthcare Group

Associate Professor Chua Hong Choon, CEO, Institute of Mental Health

Associate Professor Swapna Verma, Chairman Organising Committee

Madam Halimah Yacob, my fellow parliamentary colleague

Distinguished guests, Ladies and gentlemen,

Introduction

            A very good afternoon.

2.         First of all, I would like to extend my congratulations to the Institute of Mental Health (IMH) as she commemorates 85 years as a healthcare institution. IMH has come a long way from providing custodial care to becoming the only tertiary institution in Singapore which specialises in the holistic management of psychiatric conditions. Beyond care provision, IMH is also a key organisation in mental health education for doctors and healthcare professionals, as well as in mental health research.

3.         I am very pleased to be here at the inaugural Singapore Mental Health Conference 2013. Let me also take the opportunity to welcome our overseas experts and guests to Singapore. I am glad that you have chosen to use this conference as a platform to explore solutions together with us. Through such exchanges, we can refine our approach together and find even better ways to bring about good care for our countries.

4.            The theme for this conference is titled ‘Evolving Mental Healthcare to Meet Changing Needs’. It is indeed timely to relook at the mental health landscape in Singapore and overseas, and identify how mental health capabilities can be further enhanced to cope with the changing needs.

Changing Needs and Evolving Landscape of Mental Health Care

5.            In the past few years, MOH started implementing the National Mental Health Blueprint and the Community Mental Health Master Plan. Taken together, these two plans focus on strengthening core mental health services for the detection, intervention and rehabilitation of mental health patients, especially in the community. While much still has to be done, we can safely say that we have achieved some progress in three key areas.

6.            First, on awareness and early detection. Together with the Health Promotion Board (HPB), programmes were developed to increase public awareness of mental well-being and strengthen mental resilience amongst Singaporeans. Targeted outreach efforts through mental health teams set up in the hospitals and community have helped to improve early detection. Examples include mental health teams in hospitals to screen for depression in obstetric wards, or amongst patients with chronic diseases.

7.            Second, we have expanded our capabilities for early intervention, for both patients and caregivers. For example, IMH’s multi-disciplinary Community Mental Health Team (CMHT) provides psycho-social rehabilitation and medical assessment for high-risk patients in their homes, allowing mental health professionals to detect problems and intervene early. To improve the clinical outcomes and quality of life of the frail elderly, the Community Psychogeriatric Programme (CPGP) pioneered by Changi General Hospital was also developed to provide home-based mental health services. These teams have been instrumental in providing support for patients and caregivers in times of crisis.

8.            Finally, there has been a specific impetus to integrate care with the community to make mental health help more accessible. We have taken steps forward in this regard through piloting the specialist-led Assessment and Shared Care Teams (ASCAT), which assesses and treats adults and elderly in the primary care setting, as well as allied-health teams called Community Mental Health Intervention Teams (COMIT) to support GPs through the provision of counselling and psychotherapy services. These teams form part of our efforts to create a continuum of care from hospital to community, helping patient transit from one care setting to another.

9.             However, our job is far from done. We should ride on this momentum to achieve more for patients and their caregivers. Let me share some areas which we should continue to be mindful of as we deal with the challenges in mental healthcare.

Better Integration Across Health and Social Sectors

10.         My parliamentary colleagues and I often hear from patients with mental illness, or their families, who approach us about the life issues they face. For example, patients would often require financial support as they are not well enough to go to work. Caregivers also face difficulties coping with the behavioural symptoms of persons with dementia and are unsure of what to do.

11.         Access to more holistic help can be achieved through better integration across the health and social services. This is because mental health illness and social issues are often inter-related. Recognising that social support plays an important role in the care for patients with mental health conditions, we are working with the Ministry of Family and Social Development (MSF) to set up four Community Resource Support and Engagement, or CREST, teams over the next two years. These teams will reach out to the at-risk adult and senior population, and help them and their families learn how to manage and live with conditions such as dementia and depression. We have also put in place a mental health helpline which community service providers can call when they encounter difficult situations. The helpline provides 24-hour support and is linked up with IMH’s Community Mental Health Teams who would conduct home visits if necessary to attend to people with mental health issues and their caregivers.

Optimising the roles of Mental Health Professionals

12.         Another challenge we face in caring for patients with mental health is the availability of mental health professionals. MOH has actively supporting more doctors, nurses and allied health professionals who are interested to pursue a career in this area. In the last five years, more than 200 postgraduate scholarships have been awarded to nurses, medical social workers, clinical psychologists and occupational therapists to further themselves in the area of mental health. I am glad to see that the mental healthcare teams developed under our blueprint and master plans are multi-disciplinary, comprising a range of healthcare professionals which would extend the range of services available to even more patients and allow patients to receive the specific type of care they need.

13.         By optimizing and maximising the role of each member of the team, we can reach out to provide better care then what each individual member can possibly achieve. Role revision to determine how skills may be best distributed among different healthcare professionals is also crucial in optimising the cost-effectiveness of health service delivery and to improve the quality of patient care.

Keeping costs affordable for patients

14.         We are mindful that the cost of mental health treatment is another major area of concern for patients, especially as this can be considerable if long-term treatment is required.

15.         We have taken steps to ensure that costs are kept affordable. Since 2009, patients were able to tap on their own or their family members’ Medisave under the Chronic Disease Management Programme (CDMP) to pay for the outpatient treatment costs for certain mental conditions such as schizophrenia, major depression, bipolar disorders and dementia. From 1 Jan 2014, anxiety disorders will also be included. In tandem, those who qualify for the Community Health Assist Scheme (CHAS) can also receive subsidies for the treatment cost of mental conditions under the CDMP at participating clinics. For those who require inpatient psychiatric care, MediShield has been extended to cover inpatient treatment with effect from 1 Mar this year, and will provide patients and their family members with greater peace of mind over their medical bills. We will continue our efforts to ensure that costs are kept affordable for mental health patients.

Efforts to Debunk Stigma

16.         Lastly, even as mental health professionals like all of you here try your very best, the stigma associated with mental illness unfortunately still remains. This is often a reason why many patients do not seek professional help. We hope that establishing more community-based services will facilitate greater acceptance of treatment and lower the stigma for mental illness. Coupled with early detection and intervention, our goal should be to continue supporting mental health patients to go on to live meaningful and productive lives.

Conclusion

17.          In closing, I applaud IMH and the many partners for organising this inaugural Singapore Mental Health Conference. The progress made on this front could not have been possible without the support of partners like IMH, psychiatric departments in hospitals, AIC, as well as our mental health professionals in the community. I would like to take this opportunity to acknowledge their contribution and also ask for their continued support.

18.         Continuous discussion and learning across all agencies involved in the delivery of mental healthcare is imperative so that we can adapt and improve to meet changing needs. As we continue to address and explore possible solutions for the challenges in mental healthcare, I am heartened to see that the mental health community is standing behind the same goal to help patients reintegrate into society and age in place with their loved ones.

19.         I wish everyone a fruitful conference ahead. Thank you.