OPENING ADDRESS BY MR ONG YE KUNG, MINISTER FOR HEALTH AT THE OFFICIAL OPENING OF STEPPING STONES REHABILITATION CENTRE AND SERENITY CENTRE, ON FRIDAY 6 OCTOBER 2023, AT THE INSTITUTE OF MENTAL HEALTH

Professor Philip Choo, Group CEO, National Healthcare Group

Adjunct Associate Professor Daniel Fung, Chief Executive Officer, Institute of Mental Health (IMH)

Distinguished guests, friends, colleagues

Ladies and Gentlemen

I am pleased to join all of you today to commemorate the opening of IMH’s Stepping Stones Rehabilitation Centre and Serenity Centre, which will serve as an addictions ward.

COVID-19 Situation

2   Before I start, I would like to seek the understanding of our organisers today to allow me to use this platform to provide an update on the current COVID-19 situation.

3   Singapore is now going through another COVID-19 infection wave. The estimated daily cases has risen from about 1,000 cases per day three weeks ago to 2,000 cases per day for the past two weeks. It is driven mostly by two variants, the EG.5 and HK.3, both of which are descendants of the XBB Omicron variant. Together, they account for over 75% of cases now.

4   This is the second COVID-19 infection wave we are going through this year. Like the last wave which occurred from March to May 2023, we have no plans to impose any social restrictions. We will treat this as an endemic disease, in line with our strategy and live with it. After all, there has been no evidence to suggest that the new variants are more likely to lead to severe illnesses compared to previous variants. All indications show that current vaccines continue to work well in protecting us against severe illness if infected by these new variants.

5   Notwithstanding, let us not lower our guard. In the coming weeks, we should expect more people to fall sick, and if so, hospitalisations will go up. Waiting times will go up. So if you are a senior, or medically vulnerable due to an underlying illness, please take the necessary precautions, such as wearing a mask in crowded areas.

6   Most importantly, seniors and vulnerable individuals are recommended to keep your vaccination up to date, which means taking a shot at least once a year. As I have said before, the COVID-19 virus has not become milder since the pandemic crisis. It is us who have gotten stronger and more resilient because of vaccinations and safe recovery from infection.

7   But like all protection, it will wane over time. Whatever protective walls we build, over time it will deteriorate and eventually crumble. Let me share an important finding from a recent Ministry of Health (MOH) study. We have calculated the incidence rate of severe illness recorded during the peak of our last infection wave, in April 2023, for various groups of individuals. These are the results:

- For those who are best protected, i.e. they have minimum protection of three mRNA shots plus a natural infection which they recovered from, all of which happening within the last 12 months, the severe illness incidence rate is about 10 per 100,000 population.

- For individuals who are least protected, i.e. no minimum protection and no recorded infection, the incidence rate is over 50 per 100,000 population. This means they are five times more likely than the well-protected individuals from falling very sick when infected with COVID-19.

- So far, nothing surprising. But the most important finding is the following: For individuals who are well-protected with three mRNA shots plus an infection, but these were all acquired more than 12 months ago, their incidence rate of severe illness is also about 50 per 100,000 population – not very different from those who have no vaccination or protection. It is a clear indication that protection wanes. And it happens at around the 12-month interval based on our study.

8   In other words, if you are a senior aged 60 and above or a medically vulnerable individual, you need to keep your vaccination up to date. If you do, and if you are infected during an infection wave like now, your symptoms are very likely to be mild and you will recover uneventfully. And the infection will give you protection against severe illness if you encounter another virus wave in the future. Before this protection wanes, if you take another jab, the protection gets renewed again.

9   However, if you are not up to date with your vaccination, and you allow your protection to completely wear off, an infection now can be as worrisome as when the pandemic first broke out and we had no vaccinations. That is why MOH continues to offer free COVID-19 vaccinations at our various vaccination centres. So do take them if you are a senior aged 60 and above or a medically vulnerable individual.

The Journey of IMH

10   Let me now go back to the topic of IMH.

11   IMH is Singapore’s only tertiary psychiatric hospital, and plays a pivotal role in providing psychiatric care and supporting the mental health needs of Singaporeans. Today’s official opening of the centres is significant because it also marks IMH’s 95^th anniversary this year.

12   IMH’s humble beginnings go back to 1928. Then, it was called “Woodbridge Hospital”, or 板桥医院 in Chinese. Facilities at the hospital were basic. The hospital also faced significant stigma and misconceptions and was even perceived as a place to avoid.

13   A key reason was that people were unable to seek treatment on a voluntary basis. Most cases who were sent to then Woodbridge Hospital were either through the Police or Court system. Indeed, the care provided was custodial in nature, with patients housed in a secured environment until they were stable for discharge. Woodbridge was therefore seen as a place for “detainees” in a psychiatric institution.

14   As a personal anecdote, my parents moved from Toa Payoh to the Yio Chu Kang area when I was in primary school in the 1970’s. When they told friends and relatives where we were moving to, one of the disapproving reactions was “Isn’t that near Woodbridge hospital?”.

15   In 1973, the Mental Disorders and Treatment Act was amended. It specifically sought a change in the perception of persons with mental health conditions. From being “detainees”, they are recognised legally as patients seeking treatment. Nevertheless, perception takes time to shift, and people still stayed away from Woodbridge Hospital because of the stigma. They ended up seeking help at a much later stage, when their mental health condition had become serious or chronic. This was unsatisfactory.

16   In 1984, MOH unfolded plans to shift away from institutional isolation of mental health patients, towards prevention, early intervention, and rehabilitation of patients within the community. To better understand mental health, we also expanded the role of research, training and education in mental health.

17   These objectives should be carried out by a new psychiatric hospital. It was eventually realised in 1993, when Woodbridge Hospital moved from Yio Chu Kang to its new, purpose-built premises here in Buangkok, and renamed the Institute of Mental Health.

18   Since then, IMH has evolved into a tertiary institution that offers sub-specialty clinical services and drives impactful research to better understand mental conditions and develop more effective treatments. IMH also trains future mental health professionals, builds capability among community partners, and raises mental health literacy amongst our population.

19   IMH has come a very long way in 95 years. I want to thank IMH for shouldering this immense responsibility and the bold transition over the decades. Today, you take care of about 52,000 outpatients each year across seven clinics located in IMH and in the community. Every day, you attend to 1,800 inpatients on average.

20   Many of your patients are long stayers. The long stayers in IMH are far longer than those in the regional hospitals, staying years or even decades. For those used to running regional hospitals, we describe those staying a few weeks as long stayers. IMH’s long stayers have been with you for years, even decades. This is really a result of your history of custodial care for mental health patients. For many of these long-staying patients, IMH has become their home, and the staff their family.

21   Some months ago, I attended one of IMH’s memorial services. You hold this annually for long-stay patients who have passed away. The service provides an opportunity for staff and volunteers to bid farewell to these individuals who were very much a part of the IMH family. It was a very poignant and memorable event, for a segment of the Singapore population who has easily been forgotten. But IMH made sure they are not forgotten, and gave them the sending off they deserved.

Inclusive Care for Mental Health Patients

22   Today, the understanding of mental health has become even more matured. The younger generation especially has a keen interest in it, as to them, good mental health is the path towards a happy, fulfilling and balanced life.

23   Hence care for mental health today has to be holistic and person-centric. One key aspect in advancing the standard of care is to be able to combine expertise with empathy. This is the main motivation behind IMH adopting a recovery-focused care approach, at this new Stepping Stones Rehabilitation Centre.

24   With a recovery-focused care approach, the multidisciplinary team focuses on the patients’ individual strengths, interests and abilities to build their confidence for independent living. The Stepping Stones Rehabilitation Centre provides the setting for the delivery of recovery-focused care, through its thoughtful design to encourage rehabilitation and reintegration of patients into the society.

25   The Centre has features that simulate real living environments in our society, such as a living room, kitchen and laundry room. Patients participate in communal living with each other and are encouraged to undertake responsibilities for themselves and other patients.

26   This is a very good development. From a little boy living in Yio Chu Kang to now opening the Centre as Minister for Health, psychiatric care in Singapore has really come a long way. They remind us that, just like other chronic diseases, mental illness can be prevented, treated and managed, when we provide the right support and set up the right ecosystem.

27   Further, beyond the healthcare system, as a society, we can all help break down stereotypes and reduce stigma related to mental health. There can be more open conversations in schools, workplaces and communities to reduce discrimination and give stronger support to those who are struggling with mental illness to help them overcome their personal challenges.

Closing

28   Let me end by congratulating the IMH management and staff on your 95^th anniversary. I am confident that IMH, as a thought leader in mental health, will continue to be a driving force of change and improvement, working alongside community partners to further improve the mental health landscape in Singapore.

29   The mental health patients of the past had to live in the hospital and end their life journey in the companionship of healthcare workers. We will strive for the great majority of future mental health patients to work and live in the community, and enjoy the full company of family members and friends. Thank you.