Strengthening Mental Health Care in the Community

01 Oct 2007

Of the additional $88 million committed towards building Singapore into a mentally resilient society, $40 million will be invested over the next 5 years to build community based capabilities and networks. Clinical services like counselling, social skills training and vocational rehabilitation will be expanded so that patients and their families can have ready access to such services within the community. Community partners such as General Practitioners (GPs), schools, institutes of higher learning, Community Development Councils (CDCs), Voluntary Welfare Organisations (VWOs) and other social sector agencies will be trained so that they can help detect mental problems early and reintegrate patients back into society. To better link up social care and medical support for patients, community networks among the key players will be developed and strengthened.

Integrating and Strengthening Community-Based Care

Community-based services, that are readily accessible and convenient, help in the early detection and treatment of mental health problems as well as the smooth reintegration of discharged patients into the community. Where problems can be detected and treated early, studies have shown that this can significantly improve chances of full recovery for patients.

Recognising the importance of community-based care and support,MOH has set up four multi-disciplinary programmes to integrate and strengthen the capabilities of community partners in the following areas:

Early detection and treatment of mental health problems – This will help to reduce the need for hospitalisation and increase the chances that patients can fully regain their mental health;

Reintegration and rehabilitation of patients with mental illnesses, and help them to live and work successfully within the community.

To provide a multi-disciplinary approach, each programme will have 20 to 50 professionals comprising psychiatrists, case managers, psychiatric nurses, social workers, psychologists, and occupational therapists.

Eachprogramme will cater for 4 different age-groups - Children, Youths, Adults and the Elderly - so that continued care is available for Singaporeans as they move through different life stages.

The Children Community Programme

Currently, there are efforts by various agencies such as schools, family service centres, VWOs and social agencies to support the social, emotional and mental development of children in different settings. To better synergise and strengthen these efforts, the children community programme, called Response, Early Intervention and Assessment in Community Mental Health(REACH), aims to do the following:

Build community capabilities. Provide training to GPs and school counsellors so that they can help in the early identification and management of behavioural and emotional problems among children. The children programme will also set up a helpline and provide intervention services via a mobile team, where necessary.

Build community networks. Develop an integrated network of community partners including GPs, school counsellors, VWOs and social agencies so that seamless and timely support can be provided to children and adolescents across all settings.

Starting with a pilot in one neighbourhood this year, the children programme intends to expand to all parts of Singapore in 5 years and train some 50 GPs and 350 counsellors. Overall, these efforts mean that children with behavioural or emotional problems will be able to receive more timely support and care in the community from counsellors and GPs, rather than seek treatment within the restructured hospitals. Timely intervention by mobile teams under the programme during a crisis will also help to reduce distress to families, schools and the community and alleviate the severity of situations and conditions.

The Youth Community Programme

Youth is not only the peak period for the onset of mental illness but also a complex phase in the psychological and social development of individuals. Recognising this, the youth community programme, also known as the Early Psychosis Intervention Programme (EPIP) was introduced in 2001 to provide early intervention for young adults, including tertiary students.

Given the effectiveness of its interventions, EPIP won the State of Kuwait Prize for Research in Health Promotion at the 59th World Health Assembly in 2006. Building on its success, the youth programme which has been piloted in 2001 in institutes such as NUS and Nanyang Polytechnic is being enhanced and expanded to reach out to youths in other institutes of higher learning.  The programme aims to:

Build community capabilities. Ramp up early detection capabilities in the community by systematically training counselors and staff in institutes of higher learning and GPs in early detection of psychosis, anxiety and mood disorders. A first-line detection tool will be developed so that at-risk individuals with potential mental health problems can be identified early and provided with timely help.

Build community networks.Build a close network between GPs, institutes of higher learning and VWOs to enable timely and continuing care for youth detected with mental health problems.

Over the next 5 years, EPIP plans to train over 700 counselors and staff in institutes of higher learning and GPs in early detection and intervention.

The Adult Community Programme

Community based care is generally recognised to be better than institutional care in providing persons with mental illness whose recovery has stabilised, with a better quality of life and improved acceptance of treatment. IMH currently has in place an adult community programme, also known as the Adult Community Mental Health Team (Adult CMHT) to help its discharged patients reintegrate back into the community. Where required, the programme keeps in contact with discharged patients to ensure compliance with medication and provides psychosocial support to the patient and family. Social workers also help patients source for jobs to support their reintegration. The Adult Community Programme will be extended to include more community partners, enlarge IMH’s community support roles and draw in other hospitals such that their discharged patients will also be provided with such rehabilitation support.

To further support the reintegration of patients, the adult programme will also engage community partners in the following ways so that they, too, can better support patients who are discharged:

Build community capabilities. Provide training and crisis intervention support to GPs and staff in VWOs and social agencies on ways to manage persons with mental illness.

Build community networks. Establish community networks between VWOs, GPs and mental health service providers to provide seamless medical and social care to patients in the community.

So far, over 20 training and networking sessions have been conducted with various community partners such as CDCs, CCs, Sheng Hong Family Service Centre (FSC), Ang Mo Kio (Seng Kang) FSC and Singapore Association for Mental Health (SAMH). Over the next 5 years, the adult programme plans to train over 80 care staff in the community. To support early detection and intervention for the wider majority of working adults, efforts at the workplace will be covered in the workplace mental health education programme, “Treasure your Mind”, to be launched on 10 Oct 2007.

The Elderly Community Programme

Psychiatric services for the elderly are currently available in restructured hospitals. However, access by the elderly is limited as there is a lack of awareness about mental health among the elderly and their caregivers. The elderly are also somewhat reluctant to access services in the hospitals.Thus, many elderly with mild mental health problems are not identified early, and their conditions remain undiagnosed until complications arise.

The elderly community programme, also known as the Community Psychogeriatric Programme (CPGP) will provide home-based clinical services to elderly who are unable to access hospital based services. It hopes to improve the early detection of mental problems among the elderly by undertaking 2 key activities:

Build community capabilities.Train GPs and staff in eldercare agencies on how torecognise common mental health problems such as dementia and depression, and specific skills such as counselling and grief work.

Build community networks. Create a networklinking eldercare agencies, GPs and hospitals. Where elders with mental health problems are detected by staff in eldercare agencies, the community programme will then assess whether to refer the patient to a GP or hospitals for care.

The elderly programme will begin its efforts with eldercare agencies such as neighbourhood links, day care centres, nursing homes, day dementia centres in the north east and south east zones. Training will begin in Nov 2007. Over the next 5 years, the elderly programme plans to extend its services to all other parts of Singapore and train some 850 care staff and volunteers.

Community plays a key role in mental health services

The community is where people of all ages spend the bulk of their time. It is where they live, work and play. Hence, community facilities and resources are the natural points where persons with mild or early mental health problems can first be identified and evaluated. For many people, this will meet their needs fully, and prevent their condition from deteriorating. For persons who require hospitalisation for their mental condition, strong community support will allow them to reintegrate back into society quickly, find a place to stay and to go back to work or to school.

Ms Yong Ying-I, Permanent Secretary (Health), says, “It is important that we have capabilities in the community to support people facing mental health difficulties.  This requires the involvement of many groups in the community.  I hope that our efforts in the community health programme, which draws in many partners with diverse skills and outreach, as well as fill the gaps in existing efforts, will be able to make a big difference.”