Policy on psychiatric patients

24 Mar 2009

Question No:  927  

Question

Name of the Person: Dr Lily Neo

To ask the Minister for Health (a) whether the Ministry will review the policy of favouring psychiatric patients remaining in the community as much as possible; and (b) whether such a policy is suited to our densely populated city state where there is insufficient psychiatric community support.

Reply

Reply From MOH

1. How and where to treat a mentally ill patient is a decision for the attending psychiatrist to make.  There is a wide range of mental illnesses and many are treatable with prospects of a full recovery. Advances in medical science have led to the general conclusion that prolonged institutionalisation is the wrong approach for the vast majority of mentally ill patients. Instead, good community-based care can result in a better health outcome for the patient, besides rendering a higher quality of life and helping in reintegrating the patient back into society.

2. Community-based care for the mentally ill is a key recommendation of the World Health Organization and all developed countries, including cities, are moving in this direction.

3. In Singapore, there are about 25,000 patients with serious mental illness, principally schizophrenia.  10% of them are institutionalized at IMH (Institute of Mental Health) and psychiatric homes.  The rest continue their treatment in the community, often in partnership with the IMH.  

4 While the policy of community-based care is appropriate, successful implementation requires proper planning.  First, IMH has to carefully select the patients for discharge. They must (a) have responded positively to treatment, (b) have adequate family and/or social support, and (c) be assessed to pose minimal danger to themselves or to others.

5 Second, IMH will educate the patients and their families on the need to comply with medication and regular follow-up.  This is to avoid future relapses.

6. Third, IMH will formulate an appropriate post-discharge support plan for the patients.  Patients are categorized by the level of care, supervision and outpatient treatment needed.  Those with higher risk of relapses are followed up by Community Mental Health Teams led by IMH psychiatrists.  They keep in close contact with the patients by telephone and also through regular home visits. Case managers will monitor and alert the doctors if patients default follow-up.  If necessary, trained social workers and Community Psychiatry Nurses will make home visits to assess the need for re-admission. For lower risk cases, IMH runs several outpatient clinics across the island, and has several partnerships with trained GPs who are able to provide follow-up care nearer the patients’ homes. Patients are closely tracked to make sure they go for regular treatment and remain well.

7. Fourth, IMH runs a 24 hour Emergency Service and attends to patients who require immediate treatment. In addition, there is a crisis hotline and the IMH Mobile Crisis Team can make home visits if necessary.

8 Finally, under the Mental Disorders & Treatment Act (MDTA), the Police are empowered to bring mentally ill persons to IMH for assessment, if they are found or believed to be acting in a manner that is dangerous to themselves or to others.

9. Our community-based approach is not perfect and we will continue to enhance it in the light of experience.  In particular, we need the support and cooperation of family members and the community at large.

10. We will further strengthen the community support network.  We are devoting more resources to train community partners to support the patients.  Every year, more than 600 individuals are trained to increase their awareness of mental health issues and to facilitate early identification of at-risk individuals. Let us all work together to support the mentally ill, to help them get to terms with their illness, comply with the prescribed treatment and achieve early recovery, so that they can have a fresh start in life.