Dr Chua Hong Choon, Chief Executive Officer, Institute of Mental Health and Co-Chairperson of Singapore Mental Health Conference 2016 Advisory Committee
Dr Tan Weng Mooi, Chief, Community Mental Health Division, Agency for Integrated Care and Co-Chairperson of Singapore Mental Health Conference 2016 Advisory Committee
Mr Sim Gim Guan, Chief Executive Officer, National Council of Social Service
Dr Wong Kirk Chuan, Deputy Chief Executive Officer, Agency for Integrated Care
Ladies and Gentlemen
Good morning. I am very pleased to join all of you today for this year’s Singapore Mental Health Conference. This national conference is an important platform for us to share ideas and solutions about health and social support available for Singaporeans with mental care needs.
Mental health is an integral part of one’s overall wellbeing. Today, we face stresses at home, at school and in the workplace. These stresses can increase the risk of developing mental health conditions – such as depression or anxiety disorder. We have to be mindful about our mental wellbeing, and proactively learn about preventing mental health conditions. In fact, mental health conditions come as a package with intertwining medical and social issues. To deliver person-centred care for those with mental health conditions, these issues need to be addressed holistically. This will involve both my Ministry and the Ministry of Health, along with other social, health and community care agencies.
Building Environments that Promote Mental Resilience
This year’s conference theme, “Mind Matters, Family Matters”, resonates with me. It focuses on the role of the family in creating an environment that promotes mental health and wellbeing. And by “family”, I refer to both biological and “extended families” like the community and even workplaces. All of us can play a part. The empathy and emotional support from family, employers and the community are important in identifying and supporting the recovery of those with mental health conditions. It is even a source of comfort for their caregivers.
Families: Empowering Caregivers
Our family is the first line of support and care. Strong families and support each other through stresses in life, and this is especially important for those with mental health conditions as it can contribute significantly to the recovery process.
This is the case for Ms Sumaiyah Mohamed, who was diagnosed with schizophrenia and depression nine years ago. She was 19 years old and had a difficult time managing her university studies while trying to cope with her mental health conditions. Thankfully, her parents and friends rallied around her. Her mum brought her to see the doctor while her friends helped her with her school work. With their strong support, not only did Sumaiyah complete her studies, she secured a job and got married last year!
Caregivers play a very important role, and that is why there are opportunities for caregivers to learn how better care for and manage their loved ones’ conditions. One way is by going for training. The Caregivers Alliance Limited, offers a free 12-week education programme for caregivers to learn how to care for themselves and become empowered in their caregiving journey. To increase the accessibility of such services, the National Council of Social Service is working with Caregivers Alliance to scale up the services and increase the touch points for caregivers in the western and central parts of Singapore, over the next 3 years.
There are also many avenues for caregivers to seek advice and assistance on caregiving options. IMH and AIC both run help hotlines. Caregivers can also go online to search AIC’s Singapore Silver Pages or MOH and HPB’s HealthHub portal for mental health information. There are 47 Family Service Centres located island-wide to support families through their social and emotional challenges.
We should care for the caregivers too, with opportunities for respite so that they can go further in their caregiving journey. Respite care, such as elder-sitting services offered by the Alzheimer’s Disease Association and Thye Hua Kwan Moral Society, allow caregivers of persons with dementia to take short periods of break from their caregiving responsibilities with peace of mind, knowing their loved ones are being cared for by professionals.
But all this is happening against a backdrop of changing family structures. While extended families in the past tended to live together, sharing resources and responsibilities, the more common living arrangement today is that of the nuclear family. Nuclear families make up about half of all resident households in 2014. The number of singles and child-free couples is increasing. Many Singaporeans, particularly the elderly, are now living alone. In resident households with at least one member older than 65, 12% are one-person households as of 2014. We cannot allow these changes to dilute the level of support available to a person with mental health needs. Hence the community mental health safety net has become increasingly relevant.
Communities: Building Community Mental Health Capabilities
This brings us to the second “family” – the community. Those in the community are particularly well-placed to identify residents with mental health concerns early, and to help them access the necessary care needed.
To support the community in this role, we are building the capabilities of existing community partners to identify at-risk residents and to coordinate necessary care services for them. AIC works with the IMH, grassroots, government agencies and community partners to build the Local Community Support Networks for this purpose. Three such networks have been established in Macpherson, Taman Jurong and in my constituency of Kembangan-Chai Chee – allowing various agencies to come together and co-create solutions.
One of the cases that we encountered was 21 year-old Mike (not his real name) who had not stepped out of his room for a year. His elderly parents were unable to provide much support for him. Thankfully, Mike’s cousin alerted the Family Service Centre (FSC) which was a member of the network. The FSC then referred Mike’s case to AIC for case coordination, who in turn brought in Filos Community Services to assess the case. A befriender was introduced to Mike and discovered his interest in playing the guitar. After four months of guitar sessions, Filos built sufficient rapport to persuade Mike and his family to receive treatment from IMH. As of this January, Mike has been discharged and is currently supported at home by Filos and IMH’s Community Mental Health Team. Kudos to the team for their show of teamwork!
To further support the community in early identification and to support persons who may be at risk of having mental health issues, NCSS has developed a mental health resource booklet titled “Removing Barriers Series - Interacting with Persons with Mental Health Issues”. The booklet features everyday encounters with persons who may be experiencing mental health issues and suggest actions to help. Through its public education efforts, NCSS will also be encouraging persons with mental health issues to share their experiences so that the general public can better understand them provide them with the support they need to reintegrate to the society.
In addition to these support networks, AIC has partnered IMH to train over 1,000 grassroots volunteers and leaders in 36 constituencies to identify the signs and symptoms of mental health conditions. This has been encouraging, and it even inspired the development of Community Networks for Seniors. With more eyes on the ground, our grassroots can provide timelier interventions and support to those discovered to be at risk.
Furthermore, AIC has embedded 11 allied health-led intervention teams to develop capabilities within the community to provide direct care interventions for those with mental health conditions. Comprising counsellors, occupational therapists, psychologists, nurses and programme coordinators, these teams provide counselling, psycho-education and caregiver training services for clients with mental health conditions, and support their caregivers to cope with caregiving. They also work closely with mental health trained General Practitioners (GPs) so that their clients can visit a clinic near home for their consultations and treatments. These GPs have also been referring new cases to the intervention teams for monitoring of their conditions or to link up care support needed. Over 1,300 clients and caregivers have been helped so far.
On this note, I am happy to share that doctors in polyclinics are now also able to attend to patients with mental health needs. This is thanks to the collaboration between AIC and National Healthcare Group (NHG) to up-skill family physicians to co-manage clients with physical and healthcare needs.
There is also a Mental Health GP-partnership programme where GPs are roped in to diagnose and manage clients in the primary care setting. They work closely with AIC, specialists at IMH as well as practitioners in the restructured hospitals. Currently, there over 100 GPs on this programme. This move will help meet the 2017 target of 150 mental health trained GPs in the community, greatly strengthening our community’s ability to care residents with mental health conditions.
I also mentioned last month during MSF's Committee of Supply debate that NCSS will provide more support to voluntary welfare organisations in building up volunteer management capabilities. The approach would be to help social service agencies recruit, train and work with volunteers. NCSS will also work with VWOs in redesigning their programmes, to carve out roles that volunteers can perform, so that the paid professionals and full time staff can be freed up to do more complex and client oriented work. This will in turn help raise overall capacity of VWOs in the social service sector.
And what is a community if it does not look out and support the vulnerable within its midst? Persons with dementia and their families are one such group. MOH, together with AIC, started the dementia friendly movement to create dementia friendly communities (DFC) earlier this year. DFCs are neighbourhoods where its residents, students, businesses and neighbours are aware of dementia, empathise with persons with dementia and their caregivers, and understand how they can be supported.
At the heart of a DFC is a support network of dementia-aware volunteers. These volunteers are trained to recognise common signs and symptoms of dementia and how to communicate with persons with dementia. A safe return system will also be piloted with community partners forming a network of four to five “Go-To Points" to help such persons who are lost to return safely to their family and caregivers. Over 7,000 volunteers across Singapore have been trained. DFCs have been rolled out in Chong Pang, Hong Kah North and MacPherson to date, and we hope to have more DFC in other parts of Singapore.
Workplaces: Being supportive employers
Lastly, I come to the third “family” – the workplace. Employment plays an integral role in mental health recovery as it enables persons with mental health issues to be financially independent and attain positive feelings about themselves. How can this “family” play a part? One way to do so is to offer more employment opportunities for those seeking re-employment, and to create a supportive environment for them to integrate into their workforce.
NCSS started Project H.I.R.E. in 2014 to encourage acceptance and inclusion of persons with mental health issues, and create pathways for them to contribute to their fullest potential. Another initiative is the Employment Internship Programme, a partnership by NCSS and the Singapore Anglican Community Services to provide on-the-job training. The programme not only enhances the job readiness of persons with mental health issues but also increases the knowledge and skills of employers on how to support them in the workplace.
Another way employers can play a part is to partner non-profit organisations, such as the Singapore Anglican Community Services, the Singapore Association for Mental Health and the IMH Job Club, to hire and support more persons in recovery in finding re-employment. In fact, we need more employers to be our ambassadors in encouraging companies to hire persons with mental health issues. At this point, I would like to commend Jardine Matheson Group, for implementing initiatives through The MINDSET Care Limited to conduct awareness talks, fund raising campaigns and employment initiatives such as the Back to the Workforce Programme, which provides six to nine-month transitional employment for persons with mental health issues to enhance their employability.
It is important for employers to nurture work environments that are supportive, so that employees who may have difficulties coping at work can seek help when necessary. Workplaces can highlight support resources to employees, such as the Health Promotion Board’s “Talk2Us” Hotline, which provides free, anonymous telephone counselling from a trained professional. In addition, employers can conduct programmes to build mental wellbeing for employees, so that they can pick up skills on managing stress and developing resilience.
For someone who has recovered from mental health issues, he can extend a helping hand to his peers as well. He also has the potential to alter attitudes and break down stigma associated to mental health issues by sharing his lived experiences. IMH, NCSS and voluntary welfare organisations will thus be co-developing a framework to enable such ‘Peer Specialists’ to support persons with mental health issues.
The different ‘families’ in our lives have roles to play in supporting and influencing our mental, psychological and emotional wellbeing. Therefore, I urge all of you to spread the word and tell your family, friends, and colleagues to take greater interest about mental health. By knowing more about it, we can seek help from the existing available community resources. And if we are an empathetic and accepting “family”, we can build a more inclusive society where all of us can live and age well together in the community.
I leave you with the inspiring true story of Mr Vijay Pratap Rai. Vijay was diagnosed with psychosis in 2010. The key elements in his recovery were strong support by family, friends and his medical team, as well as willingness to face his fears, worries and social stigma. As part of his recovery journey, Vijay started participating in activities under IMH’s Early Psychosis Intervention Programme. With his positive attitude, he was roped in to provide peer support and given a platform to share his experiences to inspire his peers through support groups.
Today, Vijay has not only recovered and reintegrated in the community, but he has gone on to help more people with such conditions too. His story embodies the vision of a mental health-resilient and friendly Singapore that we are striving towards. And all of us present here today play critical roles in making that happen.
On that note, I wish all a rewarding conference ahead. Thank you.