Strategic roadmap to build up a mentally resilient society

23 Sep 2007

The Government is committing an additional $88 million over the next 5 years (2007 – 2011) towards building Singapore into an emotionally resilient society with good access to effective mental health services. Another $17 million every year thereafter will be committed to promote mental wellbeing.  The investments will be in 4 key areas:

a. Increasing public awareness and education about mental wellbeing;

b. Piloting community-based mental health teams that will train community partners in schools, social agencies and GPs on ways to support mental wellbeing of others and early detection of mental health problems;

c. Strengthening mental health manpower; and

d. Mental health research.

The additional resources for the expanded efforts underscore the importance of mental health which is as crucial as physical health to the overall well-being of individuals. Singapore is not alone in this effort. The World Health Organisation (WHO) has similarly called for countries to invest more in mental health in a recent WHO news release dated 3 September 2007.

Mental Health Situation in Singapore

Health refers to the physical, mental, and social well-being of a person and is not merely the absence of disease. Mental health is an integral component of health.

The National Mental Health Survey conducted in Singapore in 2004 suggested that a lifetime prevalence of depression in adults of 5.6% and a lifetime prevalence of anxiety disorders of 3.4% in Singapore. The proportion of adults suffering some form of mental health problem (other than anxiety and depression, problems such as phobias and mild depression) that affect their effectiveness and well-being is 15.7%.  In addition,

a. 12.5% of our children (aged 6 to 12) have emotional / behavioural problems such as depression, anxiety and social withdrawal;

b. 5.2% of those above 60 suffer from dementia.

Although the statistics are much lower than those in other developed countries, as our population ages, family sizes shrink and economic pressures grow, we can expect that strains on the mental wellbeing of Singaporeans will rise.  Hence, the government has decided to adopt a pro-active approach in improving the mental well-being of our nation.

Cost of Mental Health Problems

Mental health problems affect not only the individual but also impose indirect costs on families, society and the economy.  While we do not have figures for Singapore, the World Health Organisation (WHO) estimated that poor mental health costs some 2.5%-4% of Gross National Product (GNP) in US and Europe.  Of this, lost productivity (i.e. absenteeism and unemployment) accounts for half of the total cost of mental health problems. Studies have also suggested that unresolved mental health problems in childhood can lead to greater downstream societal problems (e.g. crime) in adulthood.  Hence, a key strategy is to build emotional resilience among our young and prepare them for the various challenges ahead.

Strengthening Partnerships for a Holistic, Community-based Effort

Given that mental wellbeing is shaped by many socio-cultural factors and the environments that we live in, a committee headed by PS (Health) with representatives from MOE, MOM, MCYS, MHA, MINDEF, NTUC, SNEF and PA, was set up in Feb 2007 to synergise and build on various agencies’ existing efforts.  These existing efforts include MCYS’ Active Aging initiatives, MOE’s Social and Emotional Learning approaches, MOM’s Work-life Works (WOW!) initiatives and PA’s Modern Living courses as well as lifestyle interest and sports groups (See details in Annex A).

The workgroup has structured its work around 3 key population groups – Children & Youth, Adults and Elderly.  A strategic roadmap has been drawn up to integrate existing efforts, identify gaps and drive new strategies to strengthen support at all stages of mental health, i.e.

a. Education & prevention for the mentally well;

b. Early detection and treatment for those at-risk or facing minor mental difficulties; and

c. Reintegration of the mentally ill.

As many of studies have shown that acting early to building mental resilience can prevent the onslaught of mental illness or improve chances of recovery, a central focus of the workgroup’s efforts is on working with community partners to bring mental health education and early treatment to Singaporeans in the community. Some of these efforts will be piloted in the coming months as the workgroup fleshes out its plans.

Expanding Resources for a Mentally Stronger Society

While plans on mental health education and community-based teams are still being worked out with community partners, it is recognised that manpower development requires a longer lead time. Hence, concurrent efforts are underway to expand our pipeline of mental health manpower:-

a. Starting from FY2008, 15 new Health Manpower Development Plan (HMDP) fellowships will be offered every year for allied health professionals to pursue skills upgrading or postgraduate training in clinical psychology, occupational therapy and other mental health areas;

b. 10 new HMDP scholarships will be awarded this year for nurses to gain clinical expertise overseas or pursue specialisation in Psychiatric Nursing, with further 15 scholarships to be awarded yearly; and

c. Specialist trainee numbers in psychiatry have been increased so that we can double the number of psychiatrists in Singapore from the current 111 to about 200 by 2015.

Apart from training more psychiatrists, mental health care training for GPs will be codified in a new Graduate Diploma in Psychiatry for GPs to help strengthen services at the primary level. The Family Medicine training programme, which prepares our young doctors to become GPs, will now include a core posting in psychiatry. NUS will also be offering a Masters in Clinical Psychology starting from 2008.

To enhance access to psychological services and improve early diagnosis, we will be piloting integrated medical-psychological teams in hospitals to assess and treat patients in an integrated, holistic manner.  We will start with two teams – one in CGH for adults and one in KKH for children suffering from trauma. Next year, another team in KKH will address the needs of women suffering from postnatal blues.  We will subsequently consider expanding these teams to other disciplines.

The expanded resources and our efforts at strengthening partnerships in the community will complement our existing efforts and put us in good stead to raise the overall wellbeing our Singaporeans and our society. However, how successful we are ultimately, will require the joint efforts of the community – all Singaporeans must put into practice, life-skills to enhance mental wellbeing and create a supportive environment for themselves and their families.