Deputy Prime Minister and Minister for Finance Heng Swee Keat's calls for strengthening resilience among Singaporeans are not possible without tackling mental health issues in Singapore, said Nominated Member of Parliament Anthea Ong in her Budget 2020 debate speech on Wednesday (Feb. 26).

In what she said was "likely [her] last Budget speech", Ong, a social entrepreneur, called on the government to improve the affordability, accessibility, and quality of mental healthcare in Singapore -- the same theme of her maiden speech in Parliament.

Resilience can't happen without supporting good mental health

Ong referenced Heng's Budget speech, which he gave on Tuesday, Feb. 18, in which he mentioned the word "resilience" multiple times.

While she thanked Heng and his MOF team for their hard work on a "generous" Budget, Ong said she was disappointed that mental health was not mentioned.

She added: "The ability to adapt to significant and adverse changes we call resilience is not happenstance -- it is enabled by good mental health."

She noted there had been a rise in the prevalence of mental illness in Singapore over the past two decades.

Ong and her team conducted a public consultation

Ong drew from over 400 responses that she and her team received in the public consultation on mental health they conducted earlier this year, the first done in Singapore.

Ong and her team will be sharing their findings from the public consultations online here.

Of the 400 responses, she said, 70 per cent were from people with lived experiences, while the remainder were from caregivers and mental healthcare professionals.

Improving affordability, accessibility, and quality of mental healthcare

Affordability:

66 per cent of the respondents said that mental healthcare costs were high, while others had stopped seeking treatment for financial reasons.

"How is it that our world-class healthcare system has denied so many people the mental healthcare that they need?", Ong asked.

She pointed out there is a significant difference between treating physical health as compared to mental health for the limits of Medisave and Medishield Life.

• Medisave: Inpatient claim limit of S$450 per day for physical health conditions, as compared to S$150 per day for psychiatric treatment.
• MediShield Life: Claim limit of S$700 per day for inpatient treatment of physical health conditions in a normal ward, versus the limit of S$100 a day for inpatient psychiatric treatment.

Ong called for the limits to be made equal for physical and mental health conditions, in order to remove the "entrenched stigma" surrounding mental health issues.

Accessibility:

In Singapore, there are 4.4 psychiatrists and 8.3 psychologists for every 100,000 people. The overall median waiting time for new subsidised appointments across public hospitals is 27 days to see a psychiatrist, and 28 days to see a psychologist.

71 respondents cited they did not seek help because of a lack of relevant and trusted information.

However, she said, she was encouraged by respondents who praised CHAT (Community Health Assessment Team), a public healthcare initiative by IMH located within the community.

CHAT provides free and confidential mental health check service and care navigation, including subsidised referral for public mental healthcare services if required.

Ong hoped that this could be expanded to support people of all ages, and not just youths at present.

Quality:

36 per cent of respondents explicitly mentioned the lack of empathy shown by the mental healthcare professionals they interacted with, as well as the "dismal environment" of the psychiatric wards in public hospitals.

Ong was not trying to imply that all mental healthcare professionals are "incompetent or without heart", and many respondents felt the poor quality could be due to "the excessive workload which strains both professionals and the system".

She emphasised the importance of feedback and public consultations with people with lived experiences and their caretakers when putting together plans such as the Community Mental Health Masterplan, launched by the Ministry of Health (MOH) in 2017.

She added that she would speak more about issues surrounding mental healthcare for vulnerable communities, such as LGBTQ+ people, migrant workers and the differently abled during the upcoming Committee of Supply Debates.

Necessary paradigm shifts

Ong also highlighted paradigm shifts needed to be made in order to "move beyond mental healthcare to total wellbeing for every Singaporean".

She mentioned considerations the government could make, such as treating mental health as a public health issue.

This could result in measures like conducting mental health screening for students, similar to physical health and dental checks.

In the workplace, employees could be allowed to use sick leave for mental health treatment or recovery.

Another shift would be to recognise that mental health is something that affects all of us, and that it is a "critical part of total well-being". Said Ong:

"Strong mental health support at schools and workplace directly impacts how we show up for our roles in our family and community - which contributes to how we support our children as parents, our elderly parents as caregivers, and how we build strong ties and connections with our friends, our colleagues and our neighbours."

Message to Singaporeans: it's not your fault

Ong noted that Singaporeans' mental wellbeing "forms the bedrock of our psychological resilience and social cohesion", said Ong.

She directly asked Heng what needs to happen for mental health to be a "national and budget priority" and called on the government to make quality mental healthcare accessible and affordable for all Singaporeans.

Ong closed her speech with a powerful message to Singaporeans:

"To Singaporeans, I invite you to remember that wherever you are on the mental health continuum is not solely a matter of personal agency but also largely determined by your social support structures, or lack of.

So if you are struggling right now, I hope you know it’s not a personal failing. We are all responsible for each other’s mental wellbeing, including the Government and institutions.

You have, in fact, shown us what true resilience is by fiercely living each day with less-than-adequate state support in mental healthcare whilst constantly dealing with structural stigma and discriminative behaviours."

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Top images via Parliament website and Tim Mossholder on Unsplash.