Mental Healthcare Access for All

Budget 2020, Committee of Supply Debates, Ministry of Health, 5 March 2020

We’ve come a long way in recognising mental health as an integral part of our total health, but still a long way to go in giving this priority and parity to physical health in our policies. Barriers to mental healthcare are significant issues facing many Singaporeans.

First, AFFORDABILITY. Through the public consultation on mental healthcare conducted by my team and I, more than 65% of the respondents felt that costs for mental healthcare was high, prompting some to stop treatment. One shared (1 quote), “I stopped my therapy at the hospital because I just couldn’t afford it even at $17 twice a month. It caused me to be more depressed instead.”[1]

There exists a significant disparity between claim and withdrawal limits under Medishield and Medisave for physical and mental health conditions,[2] which is incongruent with the increasing prevalence of mental illness. I am sure the Minstry wants to assure Singaporeans that there is no discrimination against those with mental health conditions. Could the Ministry please clarify when this overdue parity in Medishield and Medisave limits for physical and mental health treatments will be rectified?

OCD and Substance Abuse are currently excluded from the list of mental health conditions covered under the Chronic Disease Management Programme (CDMP) for Medisave withdrawals, despite the increasing and high prevalence of these two conditions according to the Singapore Mental Health Study 2016.[3] Will the Ministry consider including these conditions?

Given the high comorbidity between those suffering from chronic physical health conditions and those with mental health conditions,[4] how does the Ministry ensure this group of patients benefit from sufficient Medisave withdrawal limits for outpatient treatments?

In line with the spirit of the Community Mental Health Masterplan to shift mental healthcare from medical institutions into the community, would the Ministry consider allowing patients to tap on their Medisave for mental healthcare provided by community mental health services like Shan You Counselling Centre, Clarity, Counselling and Care Centre?

Lastly, to remove the first cost hurdle and encourage help-seeking behaviour, would the Ministry consider piloting programmes that provide free initial mental health consultations (with a psychiatrist or psychologist)?

Second, ACCESSIBILITY. We have 4.4 psychiatrists and 8.3 psychologists per 100k population, Overall median waiting time for new subsidised appointments is 27–28 days to see a psychiatrist or a psychologist. Can the Ministry clarify on what plans are in store to improve these numbers so as to increase accessibility?

71 respondents shared that lack of clear, trusted and consolidated information on how to seek help limited their help-seeking behaviour. There are more than 10 helplines available under NCSS’ Mental Health Services Resource Directory! Would the Ministry consider setting up a centralised helpline for e.g 991 to make it easier for a person in distress to call for help? These helplines could even be manned by peer supporters, given the many community efforts to promote peer support training.

Would the Ministry also consider a centralised platform for mental health services to include information about: (a) service providers and treatment options available (b) estimated costs of treatment and © available subsidies for treatment?

Building on the Ministry’s community outreach efforts, would the Ministry consider expanding the modes of referral for community mental healthcare, including text or web-chats, phone calls, walk-ins, referral by friends and family, and also self-referral? As subsidised referrals for public healthcare can only be made through public healthcare institutions, would the Ministry consider allowing professionals in community mental healthcare to make these subsidised referrals?

[1] SG Mental Health Matters Public Consultation — Respondent #303

[2] There exists a Medisave claim limit of $450/day for inpatient treatment of physical health conditions and $150/day for inpatient psychiatric treatment. There exists a MediShield Life claim limit of $700/day for inpatient treatment of physical health conditions (Normal Ward) and $100/day for inpatient psychiatric treatment.

[3] Singapore Mental Health Study 2016 indicates there is an “increase in the 12-month prevalence of OCD”. CNB arrested 11% more drug offenders in 2018 than 2017, with a 9% increase in first-time offenders. Singapore Mental Health Study 2016 indicates that more people are struggling with substance abuse, with 1 in 24 of the population doing so in 2016, in comparison to 1 in 32 in the previous 2010 study.

[4] In Singapore, in a study of 6616 respondents, “among those with chronic physical disorders, 14.3% also had a mental disorder, and among those with mental disorders, more than half (50.6%) had a medical disorder”. A comorbidity exists between mental and physical health conditions within Singapore’s employed population, at 2.4%. According to the WHO, high comorbidity rates of chronic diseases of diabetes, cardiovascular diseases, chronic respiratory diseases and cancer, exist with mental health conditions.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Anthea Ong is a Nominated Member of Parliament. (A Nominated Member of Parliament (NMP) is a Member of the Parliament of Singapore who is appointed by the President. They are not affiliated to any political party and do not represent any constituency. There are currently nine NMPs in Parliament.)

The multi-sector perspective that comes from her ground immersion of 12 years in different capacities helps her translate single-sector issues and ideas across boundaries without alienating any particular community/group. As an entrepreneur and with many years in business leadership, it is innate in her to discuss social issues with the intent of finding solutions, or at least of exploring possibilities. She champions mental health, diversity and inclusion — and climate change in Parliament.

She is also an impact entrepreneur/investor and a passionate mental health advocate, especially in workplace wellbeing. She started WorkWell Leaders Workgroup in May 2018 to bring together top leaders (CXOs, Heads of HR/CSR/D&I) of top employers in Singapore (both public and private) to share, discuss and co-create inclusive practices to promote workplace wellbeing. Anthea is also the founder of Hush TeaBar, Singapore’s 1st silent teabar and a social movement that aims to bring silence, self care and social inclusion into every workplace, every community — with a cup of tea. The Hush Experience is completely led by lovingly-trained Deaf facilitators, supported by a team of Persons with Mental Health Issues (PMHIs).

Follow Anthea Ong on her public page at www.facebook.com/antheaonglaytheng

A full-time human, and part-time everything else.