Review of Singapore’s mental healthcare system underway, as MPs highlight existing gaps

SINGAPORE — There will be a whole-of-government review of Singapore’s mental healthcare system, Senior Minister of State for Health Amy Khor said, as various Members of Parliament (MPs) raised several concerns from high costs to the difficulties in obtaining relevant mental healthcare. 

Dr Khor was speaking on Thursday (March 5) during the debate in Parliament on the Ministry of Health’s budget, where she noted that the Government must strengthen its multi-pronged strategy to better address mental health even while it expands the available care services for those who have mental health conditions.

The following are some of the key issues raised by the MPs and the responses by Dr Khor.

ACCESSIBILITY

Nominated Member of Parliament (NMP) Anthea Ong raised the issue of long waiting times for those who seek mental healthcare, saying that the overall median waiting time for new subsidised appointments is about 27 days to see a psychiatrist or psychologist. 

Ms Ong and Non-Constituency MP Daniel Goh also highlighted that there are an average of 4.4 psychiatrists and 8.3 psychologists for every 100,000 people in Singapore.

Associate Professor Goh asked if MOH would consider making all mental wellness clinics at polyclinics open to consultation by appointment. These clinics that cater to mental health patients are attached to seven out of 18 polyclinics in Singapore.

At present, five of these seven polyclinics that offer mental health services only take in patients through referrals while the other two community wellness clinics that run by the the Institute of Mental Health (IMH) only see patients after an appointment is made. In other words, these clinics do not see walk-in patients 

Assoc Prof Goh also asked if the authorities will make mental wellness clinics available in all 18 polyclinics.

In response, Dr Khor said that MOH has set up 43 community outreach teams and has trained more than 24,000 frontline staff members from government agencies and community partners to identify persons with mental health needs and refer them to the appropriate channels.

She added that more than half of the polyclinics provide mental health services and 210 general practitioners have been trained to diagnose and support mental health conditions.

AFFORDABILITY

On the topic of affordability, Assoc Prof Goh asked if the authorities could raise the withdrawal limits for outpatient mental health treatments under the Central Provident Fund’s MediSave scheme from S$500 to S$1,000 a year. This is because the estimates for subsidised treatments ranged from S$220 to S$380 a month, he said.

Dr Khor said that MOH reviews the amount of financial support regularly to ensure that it is adequate.

Based on the latest data, 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, MOH has been reviewing the claim limits for MediShield Life and more announcements will be made in due course, she said.

MediSave is a national savings scheme which helps CPF members save for future medical expenses and may be used to pay for hospitalisations and selected costly outpatient treatments such as dialysis or chemotherapy as well as for treatment of chronic diseases such as diabetes and hypertension.

MediShield Life is a basic health insurance plan which helps patients to pay less using MediSave or cash for large hospital bills.

SUPPORTING VULNERABLE COMMUNITIES

1. LGBTQ community

Some lesbian, gay, bisexual, transgender and queer (LGBTQ) people have described experiencing a “double stigma” where they fear facing discrimination for both their mental health status as well as their sexuality or gender identity, Ms Ong said.

She added that research conducted by LGBTQ groups here have also reported that some LGBTQ individuals fear being discriminated by healthcare professionals.

Ms Ong asked if the authorities would consider a whole-of-government approach in ensuring mental healthcare workers are competent in handling LGBTQ issues.

Dr Khor said in a supplementary reply that all healthcare providers are trained to help people with mental health needs, regardless of sexuality and gender identity.

She added that in 2017, IMH opened the Gender Health Clinic to help persons experiencing emotional difficulties related to gender identity, and to provide psychiatric treatment and psychological counselling for those experiencing gender dysphoria, where they feel strongly that their gender does not match their biology.

2. Persons with disabilities

NMP Yip Pin Xiu talked about the challenges that persons with disabilities face when seeking mental health support. 

For example, deaf persons face specific challenges with seeking counselling support when such support is often offered through oral consultation.

Dr Khor said that counsellors will be provided with sign language translators if they are treating individuals with hearing loss.

MOH and the Agency for Integrated Care will also be engaging stakeholders over the next year to identify ways to improve mental health support for persons with disabilities, she added.