Speech by Minister for Health on the Integrated Resort

19 Apr 2005

By Mr Khaw Boon Wan, Minister for Health

Venue: Parliament

Mr Speaker, Sir

For many days, I agonised over this issue, whether to allow casinos or to maintain the ban.

This is not the first time I have had to face this question.

Dead Against Casino

For 7 years, as Permanent Secretary of MTI, I had taken a clear stand against casinos.  The Singapore Tourism Board pushed for this proposal periodically.  Each time, I would object to it.  I told them not to go for "easy options", but to think hard about how we could be special and still bring in the tourists without a casino.  They tried: Haw Par Villa, Volcano Land, remaking Sentosa and when it did not work, further remaking.  Meanwhile, our market share in tourism continued to shrink.

After I left MTI, I had to face this issue again during the Economic Review Committee's deliberations.  I chaired the Services Sub-Committee.  Mr Wee Ee Chao, as Chairman of STB and the Tourism Working Group, strongly recommended that we allow casinos in Singapore.  This time round, he was backed by a strong chorus of private entrepreneurs, both local and foreign.

I discouraged him.  When his Working Group finally submitted its recommendations to my Sub-Committee, I was quietly pleased that casinos did not feature in the report.

My reasons for objecting to casinos are similar to those already put up by many Singaporeans who had spoken against it.  So I won't repeat them.

Change of Mind

What finally changed my mind was the response to MTI's Request for Concept.  I was struck by the quality of the proposals, the strong interest expressed by these prospective investors and their multi-billion-dollar bids.  The economic benefit is huge and we cannot ignore the many, much needed, jobs that will be created for Singaporeans.

I particularly noted that they were prepared for more than one casino in Singapore.  They are not demanding any casino monopoly.  They are confident that the rising Asian market is large enough for more than one casino here.

It is not possible for two multi-billion dollar casinos to survive in our tiny domestic market.  It means that they are confident of drawing in a large number of foreign gamblers to make their huge investments viable.

What does this mean?  It means that while they are keen to set up in Singapore, they are likely to set up elsewhere in our neighbourhood if we say no to them.  Whatever our decision, they are going to be here, in our backyard.  It means that world-class casino resorts in Phuket, Bangkok and perhaps even Johor, springing up in the near future, are a distinct possibility.

Social Ills Not Avoidable

So even if we do not allow casinos here, the social problems brought about by casinos will be with us.  I would have still gone for the status quo, if we can be certain that our neighbours will also maintain the status quo.  But I will not bet on this.  Alternatively, if we can effectively isolate ourselves from the emerging regional casinos, then I will still go for the status quo.  Unfortunately, with easy and inexpensive access to these popular tourist destinations of Singaporeans, saying no to casinos here cannot isolate us from the social ills of gambling.  Hundreds of Singaporeans are already travelling to Genting and Batam and cruising to nowhere every day.  In reality the casinos are already available today.  Except now we have absolutely no control of these casinos.

It is this realisation which changed my mind about casinos.

If casino gambling by Singaporeans and the associated social ills cannot be avoided, then better that we have some influence over the operators, than to leave the situation completely to the mercy of the casinos in other countries.  And we can exert influence only if the casinos are in Singapore, within our jurisdiction.

Exerting Influence

By legalizing casino gaming in Singapore, we can impose the necessary social safeguards on the casino operators.  Yesterday, Minister Vivian Balakrishnan has outlined the social safeguards.  They are more stringent than in other jurisdictions.  This is reassuring to me.

Now that the Government has decided to lift the ban on casinos, on my part, my Ministry will step up our programme that deals with problem gambling, especially pathological gambling.

Pathological Gambling

Pathological gambling, more commonly known as gambling addiction, is a serious mental health disorder.  Patients become increasingly preoccupied with gambling and need to bet more frequently and with larger stakes.  They become restless and irritable when attempts are made to stop them from gambling, some sorts of withdrawal symptoms.  The result is a progressive increase in gambling activity over time, in spite of the harm caused to his or her personal and family life. 

It may be difficult for non-gamblers to understand this affliction, so let me share a few descriptions which some former addicts and their relatives have shared with our psychiatrists:

"I feel as though I am hypnotised when playing jackpot.  It helps me to relieve stress.  Also, I have a group of friends at the gaming room and we are very supportive of each other."

"My father used to gamble away the children's milk money. So our family used to eat one egg broken into broth, and served with rice."

"I can't understand why I keep gambling. I always lose.  Once I pay my creditors back, I return to gambling... I can't understand it."

We have all read the tragic path of Mr Chia Teck Leng whose pathological gambling led him to criminal acts and finally into Changi Prison.  While his is an extreme case, there are many other cases, of lesser degree, but with equally devastating consequences to themselves and their families. 

In most countries, some 2 to 4% of the people develop gambling problems, while between 1 and 2.5% may become pathological gamblers. The latest MCYS study suggests a similar extent of incidence here.

Community Addictions Management Programme

To deal with this problem, the Institute of Mental Health runs a Community Addictions Management Programme (CAMP).  It is the main centre for addiction treatment, training and public education in Singapore.

CAMP is not narrowly focused on gambling addiction.  It also treats addiction to substances such as alcohol and drugs. But many addictions pertain to gambling addictions. 

It offers a range of clinical services, which include treatment, counseling and support for recovery. Last year, we saw about 100 patients for gambling addiction. They receive treatment under the care of a multidisciplinary team that includes psychiatrists, psychologists, counsellors, social workers and nurses.  12 of the professional staff are trained and certified as Gambling Addiction Counsellors, in accordance to international standards.  CAMP has a distinguished panel of international expert advisors.

Asia has lagged behind North America in the treatment and research of problem gambling.  Somehow, this has traditionally been neglected, despite the general observation that Asians seem particularly predisposed to gambling.

If the casino operators are correct about the huge appetite for casino gambling among Asians, it would mean a need for several major treatment centres in this region to serve the large number of addicts.

We have a modest set up in CAMP.  So I told IMH to step up its capabilities and acquire new expertise.  Let's not be half-hearted about it.

Benchmark Against the Best

I asked IMH to benchmark itself against the best in the world.  In the US, the state of Oregon is recognised as a leader in the field of problem gambling services.  Its strategy incorporates prevention, outreach and a comprehensive network of local treatment programmes.  In Canada, the Centre for Addiction and Mental Health in Toronto is its leading addiction and mental health hospital, with community locations throughout the province of Ontario.   It combines cutting-edge treatment with strong community support, education and prevention programmes.

These are world-class benchmarks which we should strive towards.  In particular, we should study the peculiarity of the Asian addicts.  Let's aim to be the among the top treatment centres in Asia. 

CAMP will be enhanced to develop such capabilities.   We cannot achieve this overnight, but we should progressively work towards this target. 

Priority Areas

Tentatively, we will focus on four key priority areas.

First, a strong focus on multi-disciplinary treatment, with clinical practices based on evidence-based research. 

As a one-stop tertiary treatment centre, we will provide the full range of services, including screening, assessment, individual and group therapy, structured relapse prevention, family therapy services as well as legal, credit and financial counselling, and employment advisory services.

Second, a strong focus on prevention programmes to avoid or reduce the problems of gambling.  One emphasis is in early detection and intervention, so that early gambling addiction can be nipped in the bud. 

We will work with MCYS to raise public awareness on unhealthy gambling behaviour, through mass media, seminars and public forums.

Third, we will invest in research and training.  Training programmes for family service centres, teachers and other outreach partners on screening and intervention skills will be expanded.  Research will be conducted on best treatment practices, taking into account factors that are unique to Asians.

Fourth, the Centre will work closely with our community partners such as the voluntary welfare organisations and strengthen community action against problem gambling.

To encourage such community involvement, we will provide convenient access for addicted individuals and their families to seek help and continue treatment.     

Mr Speaker, Sir

I am against gambling.  I don't encourage gambling.  But there will always be gamblers and there are millions of them here in our region.

When the integrated resorts are set up, Singaporeans may visit them.  But my advice is for them to stay away from the 5% gambling spot.  By all means go and watch the giant whale that Minister Lim Hng Kiang talked about yesterday.  But do not get near the "whales" that Chia Teck Leng wrote about, or follow them.   Remember Chia Teck Leng's advice: you cannot win against casinos.  That is why a tiny 5% can cross-subsidise the rest of the integrated resort, and still yield fat margins for the investors.

We hope not too many Singaporeans succumb to pathological gambling.  By regulating casinos here, it is my hope that we can then have a better handle over this undesirable activity.  Meanwhile, my Ministry will step up our efforts in managing gambling addictions and raise this to a higher level of competence.