Singapore is well-known for its efficient healthcare system. It consistently ranks high in global health indexes, with longer life expectancies and low infant mortality rates to show for it. However, Singapore’s healthcare system isn’t perfect. It fails to address one of the most prevalent medical conditions that plague mankind: mental illness.
The Institute of Mental Health (IMH) is the only statutory institution in which mental health patients can be admitted, detained, and discharged in accordance with the Mental Disorders and Treatment Act 1985 and the Criminal Procedure Code 1985 of Singapore. The services include assessment of accused persons suspected to be of unsound mind and the psychiatric treatment of offenders who are mentally unwell. Powers to detain people for treatment exist under the Mental Disorders and Treatment Act. There is currently no community treatment order or other provision to mandate the compulsory treatment of patients in the community.
Gaps in our mental healthcare system were brought up even before COVID-19 led to the circuit breaker period. Accessibility, affordability, and inclusiveness of professional services were particularly highlighted during the Parliamentary debate on the Ministry of Health’s budget in March 2020. According to the second Singapore Mental Health Study (SMHS) initiated in 2016, one in seven Singaporeans experiences a mood, anxiety, or alcohol use disorder within their lifetime. More troubling is the fact that after being diagnosed with a mental illness, less than a quarter of Singaporeans seek professional help. Those who do seek treatment do so after a considerable delay. People with obsessive-compulsive disorder, for example, only seek treatment after an average of 11 years. This is the longest treatment delay recorded among all disorders, followed by bipolar disorder and alcohol abuse, which have a treatment gap of four years.
Singapore also faces a lack of trained professionals. The national average of 4.4 psychiatrists and 8.3 psychologists for every 100,000 people in Singapore is lower than the 15 psychiatrists per 100,000 recorded by most OECD countries. The mental health support offered at the national level did not seem to keep up in tandem with the increasing numbers of those seeking help.
Singapore’s total expenditure on mental health made up only 3% of the Ministry of Health’s operating expenses for 2017, according to the latest data shared by the Health Minister in Parliament in 2019. The insufficient level of resources ploughed into mental health in the past could come back to haunt us. Neither the Resilience Budget nor the Solidarity Budget allocated any resources towards mental healthcare support or research.
It took three full weeks after the circuit breaker first started to declare allied health services-including private counseling and social work-as essential services, thus allowing them to remain open.
Mental health issues in Singapore have to first be more normalised.
For starters, we need to openly talk about the challenges we may be currently facing. Despite national campaigns to create mental health awareness, the stigma against mental health is still a large hindrance to tackling the issue. Various studies conducted in Singapore reveal a pervasive negative attitude towards mental health conditions.
According to a 2018 survey conducted by the National Council of Social Service (NCSS), six out of ten people believe such conditions are caused by a lack of self-discipline and willpower, and up to half of respondents would not hold people with mental health conditions responsible.
Unlike physical ailments, mental health conditions are not visible. What is visible—the behavioural manifestations of disorders leaning towards severity—tends to break established social norms. Even though Singapore is trying and making progress in the right direction, Singapore’s mental healthcare still has a long way to go.