Over the past year, the Institute of Mental Health saw a 3 per cent increase in outpatient referrals. Some of these referrals related to adjustment issues as well as anxiety and depressive symptoms secondary to the Covid-19 pandemic.

According to the Singapore Mental Health Study (SMHS) conducted in 2016, mental disorders are not uncommon and one in seven in Singapore has experienced a mental disorder in their lifetime, yet more than three-quarters did not seek any professional help.

Here, we suggest three ways to overcome barriers to mental health in Singapore, which we hope would improve the mental health landscape locally in the next few decades.

First, improve general perceptions and increase awareness on mental health through the mass media.

The World Health Organization (WHO) shared that positive portrayals of mental illness in film and television can reduce stigma and negative attitudes, while increasing understanding.

We have seen various mental health portrayals in the mass media, such as in award-winning movie A Beautiful Mind which depicted schizophrenia in Nobel Laureate John Nash, as well as the moving movie A Street Cat Named Bob which told the story of a recovering drug addict and his beloved cat.

However, closer to home, few mental health issues are adapted into local mass media such as film or television in an engaging and informative way.

In particular, three psychiatric conditions with high prevalence in Singapore are major depressive disorder, obsessive compulsive disorder and alcohol abuse.

Yet, few films or television series, fictional or biographical, have featured these mental conditions as a core theme for the masses.

It is our hope that the mass media, being entertaining and edifying, may bring mental health issues to the spotlight and improve attitudes toward mental health in an appealing way.

Second, increase awareness of less severe mental conditions among general practitioners as healthcare providers.

The SMHS revealed that among people who had a mental disorder in their lifetime and sought help, 20 per cent went to a general practitioner or family doctor.

We believe that general practitioners can play an important role in the early detection and treatment of mental disorders, before they progress in severity.

For instance, we came across a patient who had depression while going through a divorce, as well as caregiver stress when taking care of his elderly parents who had dementia.

He saw a general practitioner and was given a referral to a Caregiver Support Group and medications for his low mood.  

Subsequently, his condition improved and he has found close friends in the support group and his own interest group related to hiking. He continues to attend his general practitioner’s follow-up appointments for regular support.

Third, consider and improve remote therapy in the provision of mental health services.

According to the journal, the Lancet Psychiatry, the Covid-19 pandemic has led to telehealth being rapidly adopted.

Remote video or phone conferencing, online blended or coached therapies, and self-help therapies may be provided through apps.

Not only does remote therapy reduce travelling time and potentially reduce waiting times for patients, it may potentially be easier for patients to seek help at the click of a button.

For patients who are eligible, such as known patients with stable mental disorders or those who are in remission, telehealth can be a convenient and efficient option.

We may also consider a hybrid version of mental health services, where there are both remote and physical appointments.

For instance, patients may be offered the telehealth follow-up appointment if their condition has stabilised such that they no longer need psychiatric medications, and the patient goes for physical appointments only for counselling or psychotherapy.  

Yet, there may still be various issues related to using telehealth in mental health.

For example, lack of privacy when the patient does not have his own place for a private conversation, and lack of access to technology may inhibit the use of remote therapy.

Furthermore, there are also other issues on medico-legal liability, risk stratification of patients, to name a few.

For patients without their own place, computer booths in private rooms can be set up in places such as community centres, so that patients can access mental health services in a private and accessible way.

On privacy concerns, data security could be improved with a quality assurance in the apps used for teleconsultations. For other issues, more research and innovation may be necessary to overcome them.

These small steps toward increasing awareness and service access will lead to better mental health for Singaporeans.

ABOUT THE AUTHORS:

Associate Professor Lee Cheng is a senior consultant and vice-chairman of the medical board (clinical) at the Institute of Mental Health, where Dr Alvona Loh Zi Hui is a medical officer.