The Official Launch Of The Early Psychosis Intervention Programme (EPIP) Active Programme At Club EPIP

16 Feb 2005

By Dr Balaji Sadasivan, Senior Minister Of State For Information, Communications And The Arts and Health

Venue: Institute Of Mental Health

Speech By Dr Balaji Sadasivan, Senior Minister Of State For Information, Communications And The Arts & Health, At The Official Launch Of The Early Psychosis Intervention Programme (EPIP) Active Programme At Club EPIP, Institute Of Mental Health, On Wednesday, 16 February 2005 At 10:00 A.M.

Good Morning NHG CEO, Dr Lim Suet Wun; IMH CEO Mr Leong Yew Meng; A/Prof Chong Siow Ann, Chief of EPIP,

Distinguished Guests

Ladies and Gentlemen

It gives me great pleasure to be here today at the launch of the Early Psychosis Intervention Programme or EPIP's Active Programme.

Psychosis is a disorder of the brain. It gives rise to symptoms like hallucinations, delusions, and disorganization in thinking and behaviour. It is estimated that in the current population of 4.3 million Singaporeans, there are approximately 35,000 to 44,000 people with schizophrenia. Schizophrenia is a chronic disease with a high social and economic cost to society.

The feedback group on health 2005 highlighted the problem of chronic diseases in Singapore. Chronic diseases require a more holistic approach in their management. Part of the strategy in the management of chronic diseases is the implementation of preventive and early intervention programs. EPIP is a program that aims to do this - intervene early in a chronic disease.

The Ministry of Health initiated EPIP in April 2001 with the Institute of Mental Health. The aim of the programme is to ensure early detection and timely medical and psychosocial treatment for people who develop psychosis. The programme follows a three-pronged approach. First, at the societal level, the aim is to increase the awareness of the early signs and symptoms of psychosis and reduce stigma associated with psychosis. As most patients would initially seek treatment from the general practitioners and Traditional healers, the second step is to establish strong links to primary health care providers to work with them as "partners" on the detection and referral of potential EPIP clients. Thirdly, once diagnosis is confirmed, the programme aims to improve the outcome and quality of life through timely, cost effective and innovative, multidisciplinary treatment and rehabilitation. To date, EPIP has received 1,050 referrals and has accepted more than 700 of them into the programme.

Patients with chronic diseases, including chronic mental illnesses, are better looked after in the primary health setting. IMH should therefore aim to bring the treatment of mental illnesses as close to the community as possible. One option is to recruit general practitioners into the EPIP program so that they may continue the follow-up of EPIP patients once the treatment plan is initiated. This will reduce the load on the busy consultants at IMH, as well as reduce the cost of treatment for patients. Patients will then have to come to IMH only when they need more complicated treatments. Another option is for the psychiatrists to migrate to polyclinics to manage patients with well-controlled psychosis who are not likely to need complicated investigations and treatments.

A study commissioned by the feedback group on health 2005 found that the public preferred the polyclinic as the site for treatment because it was affordable and close to their homes. However, they were dissatisfied with the polyclinics because they felt that the medicines were not effective. They felt there was insufficient attention from the doctor. Perhaps, as a result of this impression, many patients still continue their follow-up at the specialist outpatient clinics in the restructured hospitals. The number of specialist outpatient visits in the restructured hospitals has risen sharply. In the 3rd quarter of 2003, there were 254,000 subsidized consultations. In the 3rd quarter of 2004, there were 301,000 subsidized consultations. This is an increase of 18%. This sharp increase will stress the quality of the specialist outpatient clinics in the public hospitals. Many of the subsidized specialist clinics are not staffed by specialist. They are staffed by medical officers under the supervision of specialists. The increase in the volume of cases will certainly stress the system and may reduce the quality of the supervision. Because restructured hospital specialist clinics are narrowly focused, patients with chronic illness who often have problems affecting multiple systems may end up being referred to multiple specialist clinics for their care resulting in high cost for patients.

One solution to the problem of increased volume in the specialist clinics is to improve the clinical services at the primary health care level. Patients who attend the polyclinic often complain that they see a different doctor at each visit and that they wished the doctor would spend more time explaining things. Currently our polyclinics provide a good standard of clinical medical care in an economically efficient way. But patients may sometimes want the confidence of a personalized service from a doctor whom they know and who knows them, because he is the same doctor at every visit. The polyclinics should consider how they can provide for this demand for better service levels.

One possibility is the creation of specialist family medicine clinics at the polyclinic. If these specialist family medicine clinics are staffed by family medicine specialist, patients who are followed up in these clinics may enjoy better management of their chronic disease. These clinics will certainly cost the patient less than if he were being followed up at the specialist clinics in the public hospitals. Specialist family medicine doctors are better qualified and more experienced than the hospital medical officers who staff many of the specialist clinics. They also have a holistic view of medicine and can treat the whole patient instead of a particular body system. Hence there will be less need for referrals to multiple clinics for minor complaints.

The two clusters are reviewing their outpatient services to better meet the public's expectations. If they can provide improved polyclinic services, the stress on the specialist clinics in the public hospitals will be reduced, leading to better overall healthcare. IMH should also review its services to see how it can work more effectively with the polyclinics to bring psychiatric treatment closer to the community in an effective way.

It is thus with pleasure that I now declare the EPIP Active Programme launched.