Making mental healthcare more affordable for Singaporeans

Cindy has been struggling with her mental health for the past six years, and has found it extremely difficult to afford the costs for her treatment. It broke my heart when she shared that she had to starve to afford therapy. She is not alone.

Many others, like her, continue to face significant barriers in affording mental healthcare in Singapore.

In a public consultation my team of volunteers and I conducted earlier this year for the Budget 2020 debates, two out of three of the 396 respondents indicated they faced issues in affording mental healthcare, even in public healthcare institutions. 

These responses are especially stark in a country with plenty and a world-class healthcare system. 

The recent recommendations by the MediShield Life Council to extend coverage for attempted suicide, self-inflicted injury, drug addiction and alcoholism are a step in the right direction but more needs to be done to enhance affordability of mental healthcare. 

LACK OF AFFORDABLE MENTAL HEALTHCARE

Within the public healthcare system, a subsidised counselling session costs around S$30 to S$50 per session. Psychiatric medication may cost upwards of S$100 for monthly prescriptions of more costly anti-depressants.

Coupled with the necessity of funding therapy and medication over a longer period of time, many Singaporeans, particularly young people and those from lower income groups, are unable to bear such a financial burden. 

The Singapore Mental Health Study 2016 found that 78.6 per cent of adults in Singapore with mental health conditions did not receive treatment in the past 12 months. 

More worryingly, it found that three out of four respondents not seeking treatment cited concerns with high costs of treatment as a deterrent. 

The same study found a 12-month prevalence of mental illness of 6.5 per cent among adult Singapore residents. 

With a population of 3.52 million Singaporeans, this potentially translates to a treatment gap of more than 130,000 citizens forgoing treatment due to cost concerns every single year.

This is equivalent to the population of an entire town like Toa Payoh. Surely this boggles the mind. 

LACK OF MENTAL HEALTH INSURANCE

Another aspect that contributes to the treatment gap is the lack of insurance cover for mental health conditions. 

Studies from the World Health Organization (WHO) have revealed that across countries, the lack of insurance cover constitutes a significant factor in delaying access to treatment.

On this, a few progressive employers from the WorkWell Leaders Workgroup — a ground-up community which champions workplace mental wellbeing — and I are exploring how we can move the needle as a collective for mental health conditions to be included in group insurance policies for employees. 

In the Committee of Supply debates in Parliament in March, I had suggested that the Ministry of Manpower work with insurance companies to ensure affordable premiums in mental health coverage for employees by pooling risks.

Apart from ensuring mental health coverage in insurance policies, claim limits should be established at appropriate rates to ensure bills can be paid for, especially given that mental health conditions are chronic in nature and require regular treatment sessions. 

Hence, I would argue that existing MediShield and MediSave claim limits do not go far enough in addressing the costs of mental healthcare. 

For example, the current MediSave claim limit for outpatient treatment of certain mental health conditions such as depression, anxiety and schizophrenia is S$500 per year. 

This will be increased to S$700 next year for those with complex chronic conditions. 

Yet this may not be sufficient for people like Colin, another respondent in the public consultation that my team conducted. 

Colin used up all of the S$500 available for treating his bipolar disorder in less than six months, and now faces the prospect of not being able to afford treatment for the rest of the year.

While the increase in limit to S$700 next year would help somewhat, it will still be a challenge for him.

WHO and experts recommend weekly therapy sessions (even a few times a week if in crisis) for the first four to six weeks, and regularly after, for a more effective care and treatment process. 

THE WAY FORWARD

In the coming months and years, it is expected that the need for mental health and psychosocial support will substantially increase as Singapore navigates the job losses and economic difficulties caused by Covid-19. 

I am therefore heartened that the Government has set up an inter-agency task force to provide a coordinated national response to Singaporeans’ mental health arising from the pandemic. 

For a start, I would suggest that the MediShield Life Council go further with its recent proposals to amend claim limits, and ensure parity between physical and mental health conditions. 

A disparity of five times continues to exist between the proposed revisions for claim limits, between S$160 per day for inpatient psychiatric care and S$800 per day for normal ward services. 

Ensuring parity will normalise mental health conditions and motivate those living with mental illnesses to step forward to seek help.

I would further suggest that the Ministry of Health (MOH) improve MediSave outpatient claim limits to at least S$1,000 per year for mental health conditions, to allow for all Singaporeans in need to attend their therapy sessions on a weekly basis as recommended by experts. 

In a parliamentary response to my question, MOH revealed that fewer than one in 10 subsidised patients exceed MediSave’s yearly withdrawal limit for inpatient psychiatric stays and fewer than three in 10 persons’ subsidised bills exceed MediSave’s daily withdrawal limit. 

However, I would argue that these numbers need to be further calibrated to take into account those two-thirds of persons with mental health conditions who do not seek help as mentioned above. 

Could these numbers be symptomatic of the low numbers of people coming forward to seek help because they do not think they can afford to, given the current subsidy levels?

Currently, the Community Health Assist Scheme (Chas) subsidises a maximum of S$125 per visit capped at S$500 per year under Chas Blue for anxiety, bipolar disorder, major depression and schizophrenia at certain clinics under the Mental Health General Practitioner Partnership Programme. 

There is room to expand this further not just in terms of quantum, but to more clinics and beyond these four specific conditions. This will ensure mental healthcare is not out of reach for our vulnerable communities.  

Increasing funding for and/or expanding the use of MediSave monies for consultation at government-funded community mental health agencies, such as Shan You Counselling, Silver Ribbon, Limitless and MindCare may be another area to look at. 

With just 4.4 psychiatrists and 8.3 psychologists for every 100,000 Singaporeans, doing so will help to lighten the load on our public healthcare institutions.

A NATIONAL PRIORITY

Health Minister Gan Kim Yong gave his assurance that “no Singaporeans will be denied health care because they cannot afford it”. 

I view this commitment to affordability as inclusive of mental healthcare, for there is no health without mental health.

However, if we are to walk the talk that affordable mental healthcare is a national priority, much more needs to be done. 

We must start by digging deeper into the low utilisation of MediSave withdrawals vis-a-vis the glaring treatment gap. 

We must ensure parity between claim limits for physical and mental health conditions, sending a strong signal to every Singaporean that their mental health is just as important. 

Mental health insurance must be part of the comprehensive and inclusive mental healthcare we strive for, just like the world-class healthcare system that we are known for. 

This year’s theme for World Mental Health Day on Oct 10 was Mental Health for All: Greater Investment, Greater Access. Everyone, everywhere. 

The Government has promised to “conduct a whole-of-government review of its mental health strategy in the coming months” in response to parliamentary questions by Members of Parliament and myself in March 2020. 

I share the same hope with Cindy that she will one day be able to see a specialist who will help her, and every other Singaporean in need, at a price that she can afford.

ABOUT THE AUTHOR: 

Anthea Ong is a former Nominated Member of Parliament, social entrepreneur (Hush TeaBar, A Good Space) and author of 50 Shades of Love. The names of the two persons with mental health conditions that she cited have been changed to protect their identities.