Covid-19: Impact on mental health under the spotlight, as MOH clarifies stance on treatment amid 'circuit breaker'

SINGAPORE — The mental well-being of Singaporeans as they cope with the Covid-19 crisis came under the spotlight in Parliament on Monday (April 6), with some members of the House emphasising the importance of providing services to support those with mental and emotional health issues. 

There was already some confusion among mental health service providers and the related community over whether psychological treatment is considered an essential service and is thus allowed to continue despite state-imposed closures of workplaces providing non-essential services from April 7 to May 4. 

The Ministry of Health (MOH) listed on its website that “outpatient rehab/therapy services and other allied health services such as dietetics, counselling, social work, psychologist (and) podiatry” were non-essential. 

The Ministry of Trade and Industry (MTI), on the other hand, listed psychological treatments under essential health and social services on its website.

The Singapore Psychological Society put up a notice on its Facebook page on Monday saying that it had pushed for psychological services to be made essential during this time of need, and had succeeded in doing so on Sunday.

However, in response to queries from TODAY, MOH confirmed on Monday that psychological treatments would be still considered as non-essential services, but with some exceptions. 

“We understand that there might be patients who have unstable mental health conditions, including those who might be in danger of harming themselves or others, should there be a disruption in their care,” the ministry said. 

“For such patients, teleconsultations may not be suitable, and face-to-face consultations would be allowed during this period of very high safe-distancing measures.” 

MOH added that most outpatient psychological services can be delivered through teleconsultation, to reduce the risk of potential exposure of patients to the coronavirus causing Covid-19.

Last Friday, the Government announced that there would be “circuit-breaker” measures kicking in this Tuesday, when most workplaces would have to shut down, except for those providing essential services or are in key economic sectors. This is to control the spread of Covid-19. 

COVID-19 COULD INFLICT ‘PSYCHOLOGICAL CARNAGE’ 

The topic of mental health was brought up by MPs on several occasions during Parliament on Monday. 

Nominated Member of Parliament (NMP) Anthea Ong said that she was alarmed that the Resilience Budget does not allocate any funding and resources to mental healthcare, support and research for this period.

She said that pandemics can inflict “psychological carnage” and can trigger new psychiatric symptoms even in the healthy. 

“Safe distancing, constant fear and anxiety, the loss of loved ones, job losses, industrial failures… will wear down our national psyche,” Ms Ong said. “Now, more than ever, we must prioritise mental-health support.”

She added that The Association of Women for Action and Research (Aware) has received 33 per cent more calls related to family violence than usual on its Women’s Hotline in the last month, and relapses among those with mental illnesses have become more commonplace recently. As community activities cease, senior citizens may be “left to battle loneliness”.

Mr Alex Yam, MP for the Marsiling-Yew Tee Group Representation Constituency, said that one could not ignore the “long-term impact on the mental health of Singaporeans.

He added that even after Singapore was declared free of the severe acute respiratory syndrome (Sars) outbreak that occurred in 2003, there was a “higher prevalence of post-traumatic stress (disorder)”. 

FACE-TO-FACE CONSULTATIONS PREFERRED

Psychotherapists approached by TODAY said that the conflicting information on whether psychological treatment was an essential service was confusing to them, but they accepted that patients marked as severe cases would get the chance to have face-to-face consultations. 

Psychologist Yeo Ke Xin, whose clients are mainly young children and teenagers, said that the confusion and sudden nature of the announcements had resulted in many parents flooding her with calls and emails. Some of them had made a case for why their children should continue going for consultations at the clinic. 

Ms Yeo, who practises at The Therapy Room, said that such consultations will be decided based on “clinical judgement” and those who have self-harm tendencies or who are aggressive towards others will be considered. 

Dr Simon Neo, a psychotherapist at The Psychotherapy Clinic, said that face-to-face appointments for severe cases are important, because video-conferencing makes it harder to observe paralinguistics — aspects of spoken communication that do not involve words.

“(We don’t know) whether they are moved, whether they are shaking or crying, for example, we don’t know what are their surroundings,” Dr Neo said. “The clinic is (still) going to be the most conducive place.” 

On the other hand, Dr Joel Yang, a clinical psychologist from Mind What Matters, said that he will take up teleconsultations, because he sees the potential in online engagement.  

“It is easier for some clients to engage with us online, especially digital natives who are very comfortable with this mode,” he said. “Sometimes they find it easier to type things out than say it, so the online platform allows for that.”

For patients who prefer meeting their therapists to having teleconsultations, they said that it was a more empathetic experience.

A patient who declined to be named said that she felt the shift towards telemedicine is “not optimal for this kind of care”. 

The 25-year-old, who works in marketing, said that she would be declining teleconsultations during the period when the “circuit-breaker” measures are in place, and will return to the clinic when the measures are eased. “Unless I had an emergency, then I would be open to remote consultations,” she said. 

Another patient who did not want to be named said that the pandemic has caused her mental health to further deteriorate. 

The 24-year-old, who is about to graduate from university, said that the shaky job market has been giving her more stress when finding work. This is on top of having to deal with her pre-existing anxiety and attention deficit hyperactive disorder. 

“The symptoms associated with my anxiety are more pronounced, such as insomnia and nervousness, and I find myself unable to sleep or rest and constantly over-worrying about the future. 

“It is difficult for me to keep my anxiety levels at a healthy level with this global scale of uncertainty.”

If you or someone you know needs help for mental health-related issues, here are some helplines:

• Samaritans of Singapore (24-hour hotline) – 1800-221-4444

• Community Health Assessment Team – 6493 6500 or 6493 6501, or click on the webchat icon at chat.mentalhealth.sg

• Singapore Association for Mental Health helpline – 1800-283-7019