Advancing Mental Health

Resumption of Debate on Question [6 February 2024],

That this House recognises the importance of mental health as a health, social and economic issue; affirms the importance of a robust national mental health ecosystem; and calls for a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being. – [Dr Wan Rizal].

Question again proposed.

Mr Speaker: Mr Vikram Nair.

11.59 am

Mr Vikram Nair (Sembawang): Mr Speaker, one of the grim figures that made me sit up last year was an article in July indicating that the suicide rate in Singapore for 2022 had risen to 476, the highest in 20 years and a more than 25% increase from the year before. It also indicated that the rise in suicide rates was highest amongst the elderly and the young. This was a perturbing figure and I have come across more than one case of residents affected by suicide.

Two teenagers were particularly sad. In one case, I spoke to the parents who were utterly devastated, saying they could not understand how their daughter who appeared to be a well-behaved and obedient child, suddenly decided to take her own life. In another case, I heard from a young resident whose best friend decided to take her own life. The friend was utterly devasted by this and had to deal with depression herself.

There are two related questions that arise. The first is whether these people had undetected mental health issues, including depression and/or the inability to deal with some difficult or stressful situation the person was facing. A United Nations (UN) study indicated that about 90% of the people who committed suicide had some underlying mental health concerns. The second is whether, even if such issues were detected, the interventions to deal with them were adequate.

In response to Parliamentary Questions that several other Members of Parliament and I filed on the topic, the Ministry of Health (MOH) indicated that the best interventions were to build mental resilience, spot early indicators, encourage help seeking and support those in crisis.

It highlighted several initiatives it had to address this, including Health Promotion Board (HPB)'s MindSG portal, movements by HPB and National Council of Social Services (NCSS) to encourage people to seek help, components in school curriculum to encourage children to get help and HPB’s campaigns for parents to train them to identify signs of mental health issues in their children, and then once people come forward, there are well-being centres in the community to help people, as well as mental health hotlines.

Based on the response provided by Senior Minister of State Janil Puthucheary at that time, it did seem like this was a matter that the Ministry was taking seriously. I do have some further clarifications and suggestions in this regard.

In relation to the clarifications, it will be helpful if the Government is able to share how it tracks the effectiveness of its outreach programmes. For example, do the HPB’s programmes targeted at parents reach all parents? Do the HPB and NCSS’ campaigns targeted at encouraging people to get help reach the intended audience? One way to gauge this would be if we can identify whether of the people who ultimately committed suicide, there was a way to track whether any of these programmes had reached them?

The second is to track the effectiveness of the interventions once people come forward to ask for help. For this, an important statistic would be tracking how many of those who had committed suicide had come forward to seek assistance and were therefore "known" cases.

I understand the main intervention for those seeking assistance now is administered by social service agencies at the community level. However, dealing with people with suicidal tendencies is a complex matter and where for example there may be underlying conditions such as depression, there may be a need for professional intervention from psychologists or psychiatrists.

In a supplementary question, I had asked at that time, I suggested the Government consider subsidising or providing such professional services under the ambit of MediSave or MediFund so that financial barriers to getting such assistance will also be reduced. This will be particularly important for say students or the elderly who may wish to seek assistance but may be concerned about whether they have the means to do so. A related aspect of this is to encourage insurance policies to cover or provide for mental health assistance as a rider.

While the largest increase in suicides was amongst the elderly and the young, the largest number is still amongst the working adult population. In this regard, I think in workplaces, it may also be useful to have such access to mental health assistance for employees as a benefit.

In many European countries and in the United States (US) for example, companies have an Employee Assistance Programme (EAP) where employees can seek assistance for mental health issues on a confidential basis. As this is provided by employers, the costs of doing this can generally be aggregated over a large pool of employees.

I should declare that my mother is a psychologist who currently does provide EAP services to several companies, and this is where I actually learnt about this service from. Her end customers are generally multi-national companies who offer EAP as an employee benefit. The consultations with the psychologists are confidential, so the employees do not have to worry about stigma in seeking assistance.

I understand that employees come forward with a wide range of issues, from dealing with family breakdowns to coping with the fear of retrenchment exercises when companies go through such exercises.

Both scenarios are generally traumatic for people and they also bring with them financial insecurity for the employees, which may make them reluctant to seek assistance privately. In these scenarios, having an employment benefit that gives them access to professional mental health assistance, in this case, trained psychologists or counsellors, can make a huge difference. Where it is provided by employers, there is no additional financial burden to the state, while if the employer is large, the cost of the service can be aggregated.

I understand that the provision of such programmes amongst local employers, particularly in the SME sector, which make up most of our local employers, is very low. So, I would suggest the Government consider the best practices in mental health programmes provided by employers in other countries and whether such programmes can be made more widely available in Singapore, say either through legislation, or through the tripartite framework. For example, if small employers may not be individually able to provide such a programme, it may be possible for NTUC to provide a programme, an umbrella programme that SMEs can sign up for and for which they can contribute to.

I think ultimately, an important aspect of mental healthcare is making access to professional mental health more affordable and accessible, and I think both the Government and employers can play an important part in this.

Mr Speaker: Ms Yeo Wan Ling.

12.06 pm

Ms Yeo Wan Ling (Pasir Ris-Punggol): Mr Speaker, I wholeheartedly affirm the Motion and believe the time is now, for each and every one of us, to be active stakeholders in building a robust and compassionate Singaporean mental health ecosystem.

Our Government with their national level programmes – Healthier SG, National Mental Health and Well-Being Strategy, ground mobilisation of more general practitioners (GPs), increasing capacity for medical psychiatric care – has indeed given importance and priority in this matter.

And yet, if our nation is a tapestry, mental health is the thread that weaves through every level of our nation – community, neighbourhoods, families, individuals. The heart of mental health matters, is not about unique issues, but about solutionings that are always nuanced and personal. I put it to the House that complementing our national initiatives, must be a network of localised support comprising of energised outreach, awareness and authentic friendships. Indeed, ground-up initiatives are invaluable as they address in a spot-on manner, mental health issues faced by real individuals whilst rallying the support and understanding of real-life neighbours in the communities we all live in.

In Punggol Shore, it was through home visits by our volunteers that we identified special needs adults, some in their 50s and 60s, who are undiagnosed and received no support for their conditions. They are out of the national system of care, as they were simply never registered in the system in the first place.

Some lead quiet isolated lives, depending on neighbours and Residents’ Committees to keep a discreet watch on their well-being. Some lead more colourful lives, and are called unkindly sometimes, as weird and strange. And yet there are some, who are fully dependent on their caregivers, many who are sole caregivers who have given up their lives and livelihoods to take care of their wards. These families living in our midst are often stressed, worried and financially challenged.

I met Mr Tan and his sister, not their real names, about two years ago, when there was a fire in their block. They are both in their 50s, and despite the fire, Ms Tan refused to be evacuated. Ms Tan later shared that she suspects that her brother has special needs and is a recluse as he refuses to leave their home. After the parents passed away, she stopped work and became his full-time caregiver. She is frustrated about the situation and worried about what is to become of her brother if something happens to her. She told me that she would rather die in the fire at home with her brother, than go through the trauma of forcing her brother to leave the house, climb down the stairs, wait at the fire refuge area with strangers while waiting for Singapore Civil Defence Force (SCDF) to give the all clear. While both the Tans were both physically unharmed in the fire, the state of their mental wellness calls for care and support.

We need to do more for families like the Tans and local support can certainly alleviate some of the stress and loneliness, be it the reassuring familiarity of neighbours checking in on you or participating in nearby community events. However, in order for local support to be effective and inclusive, the community needs awareness and specialised training.

In support of families like the Tans, Punggol Shore started a training and support programme for our grassroots leaders, in partnership with Caregivers Alliance, a non-profit organisation. Most of our Resident Networks now have a volunteer leader with higher awareness of mental health issues especially those faced by caregivers and their senior or special needs wards, and this has impacted the way we organise our community events and conduct our home visits. We hope to scale our local training, as we believe more volunteers and the community-at-large would benefit from such training and awareness.

In the same thread, livelihoods are a major contributor to mental wellness, and for caregivers, jobs in the community are always warmly welcomed for better work-life balance. Can more be done by our local merchants on local job creation? Can we encourage and equip our heartland merchants to embrace flexible work arrangements (FWA), especially with the upcoming Tripartite Guidelines for FWA requests? How about our local Community Development Councils (CDCs) promoting local job creation and FWAs with the heartland merchant networks that they have created so successfully with the CDC Voucher programmes? With tailwinds helping along in the creation of livelihood opportunities for our caregivers, let us seize the moment, and secure a peace of mind for our caregivers.

Support for the mental health of our caregivers is a multi-faceted one – providing support and respite in the care for their wards, creating caregiver support groups and the providence of local jobs. Local stakeholders and the organisation of our local stakeholders are critical in sustainable mental health support.

And indeed, this is where ground-level initiatives, like the Positivity Pizza Movement, become invaluable. Led by the youths for our youths in Punggol Shore, this movement promotes mental well-being in our youth community.

Mr Speaker, studies have shown that our youths had a challenging time during COVID-19, and coupled by stresses of school, a complicated social media landscape, our young ones are navigating a world that is complex and isolating beyond the one we grew up in. Through this movement, volunteers from across all communities in Punggol Shore, our seniors, youths, women groups, sports teams and our religious organisations have come together to sew pizza plushie keychains, with a common aim of making 20,000 pizzas to gift every single one of our youths in Punggol Shore. It is our community’s way of telling our youths that it is okay not to be okay, and the whole Punggol Shore Community has our youths' backs and the inspiration for the movement, it was at an encounter I had with a young Punggol resident, C, not her real name, came up to me when I was doing my regular rounds at a local mall.

I knew C when she was in primary school and was happy to note that she was in her secondary school uniform. I asked about her transition to Secondary 1 and to my dismay, she shared that she was having a really hard time and has considered self-harm and suicide. While we were speaking, C saw a keychain plushie I had on my bag and she said, "Ms Yeo, that's really very cute. May I have it so that I know that people care?" To C, if you are watching this, "Know that people do care and thank you for reaching out and trusting others with your burdens that day. You have started a movement."

Mr Speaker, in our modern world, where the pace of life seems only to accelerate and the digital landscape can create both connection and isolation, local communities stand as beacons of support and resilience. Localised strategies are effective at mobilising communities because they resonate with the unique fabric of each locality. When initiatives like the Positivity Pizza movement are driven by the people who care about and understand the dynamics of their own community, supported by the warmth of common shared spaces, there is a profound authenticity that connects with residents on a very personal level. These localised efforts tap into the values, traditions and shared experiences of the community, fostering a sense of belonging and collective responsibility.

While we continue to build the vital National-level infrastructure and systems, I remind and call on our Government to not forget the local level support, and to provide more resources to local networks to build strong local mental health advocates and stakeholders. Mr Speaker, I support the Motion.

Mr Speaker: Mr Shawn Huang.

12.15 pm

Mr Shawn Huang Wei Zhong (Jurong): Mr Speaker, one out of seven adolescents experience mental disorder, whilst for younger children in the US, one out of six are diagnosed with a mental disorder, with anxiety and depression taking 40%, conduct disorder at 20%, Attention Deficit Hyperactivity Disorder at 19.5%.

This age group is particularly vulnerable as it accounts for 13% of the global burden.

In fact, based on the Mental Health Foundation, 10% of children and young people from age five to 16 have a clinically diagnosed mental problem. Yet, 70% of children and adolescents who experience mental health problems have not had appropriate interventions at a sufficiently early age.

What does it mean for Singapore? Even if we take a conservative approach and with all estimates, take a discount and assume one out of eight instead of one out of seven with an annual cohort of 35,000, from Primary 1 to tertiary education, we will have close to 57,000 students diagnosed with mental health disorders and this projection is based on undiagnosed figures. The number for those who are undiagnosed will be far greater. It would probably be one out of seven or one out of six, a value closer to those reporting countries. With these statistics, a secondary school with about 1,000 students will have over 120 students diagnosed with mental disorders and many more undiagnosed with developing conditions.

The global statistics for suicide amongst children and adolescents show that every year, 47,000 end their own lives. If assuming similar parameters, approximately 30 of such suicides would have occurred each year in Singapore. Suicide is the most tragic outcome of a mental health condition. However, anything short of that, the consequences of failing to address children and adolescents' mental health conditions will extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

The math is clear. This is the problem definition that we are facing. The question is: do we have the resources to manage mental health challenges?

So, how about the science of it? Gamma-aminobutyric acid (GABA) and dopamine are two critical neurotransmitters in the brain that play significant roles in regulating various physiological and psychological processes. GABA is the primary inhibitory neurotransmitter, which helps to calm down nerve activity, reducing neural excitability throughout the nervous system. Dopamine, on the other hand, is a neurotransmitter that is involved in reward, motivation, memory, attention and even regulating body movements. The levels of activity of these neurotransmitters can change over time due to various factors, including age, stress, environmental influences and hormonal changes.

So, to put it simply, if you are driving, you can view dopamine as the accelerator and GABA as the brakes, both essential and both countering and balancing the needs.

But as children approach puberty, it is marked by significant changes in hormones, including increases in estrogen and testosterone. These hormones have been shown to influence GABA neurotransmission. For example, estrogen can modulate GABA receptor expression and function, potentially altering the efficacy of GABAergic inhibition. Testosterone has been implicated in the modulation of GABA A receptors, which might inhibit signalling.

But this is not it. During puberty, the brain undergoes substantial restructuring and pruning of neural connections. The maturation of neural circuits, especially in the prefrontal cortex and limbic system, involves changes in the balance between excitatory and inhibitory neurotransmission. As the brain rewires itself for adult functioning, as part of puberty, the role and regulation of GABA may shift, leading to a temporal reduction in inhibitory effects on the neural circuits.

Members must be wondering why I am highlighting these evolving conditions. It is important because it is a critical period. It is a critical period because, at this juncture, puberty also coincides with the most critical period of neuroplasticity, where the brain is particularly sensitive to environmental inputs and experiences. The changes in GABA transmission during this time may reflect the brain's adaptation to these inputs, altering synaptic strength and connectivity in a way that requires modification of inhibitory signalling. This also means that the brain is developing, forming and setting the foundations of its neurochemical activity that may have long lasting impact throughout life.

So, imagine being a child or an adolescent having to manage these changes. It is made more difficult because the change is not overnight. It is a gradual but relatively rapid change, which requires a keen sense of self-awareness and learning how to self-manage and respond. It is a swirl of changing chaos for a young individual.

So, imagine those who grew up driving an automatic transmission all your life and, suddenly, in a short period of time, having to learn and drive a manual transmission, but with an additional complication that the sensitivity of the accelerator, brakes and clutch is constantly changing. Imagine how many times, the engine would have grinded to a halt and having to learn and restart again.

And given all these, we have yet to include the environmental influences and the genetic factors – adverse experiences, such as abuse, neglect, exposure to violence, exposure to adversity, pressure to conform with peers and the exploration of identity, quality of home life and relationships with peers, bullying, harsh parenting and socio-economic problems. This is no longer a simple scenario of travelling or driving along an expressway.

Imagine being caught in a traffic jam within the carpark at Plaza Singapura on a weekend. You are going up a spiral slope on the next level. You are a newly-minted driver, driving a manual transmission vehicle, with constantly changing accelerator and brakes and clutch, a sequence of clutch, brake, gear, brake, accelerator, clutch, accelerator, brake. It is a very difficult task; challenging. So, the Math is clear. The science is evolving with greater clarity.

We must be where the help is needed, where the children and adolescents are. We need better coordination and targeted resourcing.

Our Student Councillors are managing an overwhelming caseload. Our Student Welfare officers are working in parallel. Teachers trained in counselling are doing their level best, juggling the multiple hats and roles. REACH, our community-based health service, has received more than 1,500 referrals per year. But based on mathematical projections, over 5,000 per year will need help. That is a possible deficit of 3,500 per year.

Our child protective services caseloads will need more capacity. They are already prioritising severe cases. But we need to get the required help to those in the moderate and mild risk levels to prevent further escalation. Some are irreversible.

Family Service Centres (FSCs) with counsellors and psychologists are leaning forward and assisting schools and families in need. Guidance branch and psychological service branches are working hard on the cases. We need more trauma specialists. We need specialists that have deep skills to manage cases, such as the "Hidden Youth Syndrome", or known as Hikikomori.

In Singapore, the ratios of psychiatrists and psychologists to population are 4.6 and 9.7 per 100,000 respectively. These are much lower than OECD countries. It is not uncommon to wait for two to three months for a diagnosis, whilst the child continues to lose time in school, stacking on the challenges further.

Our methodology and the typical observe, orient, decide and act, or OODA, framework, though still relevant, will be less effective here. Each year, we are looking at a mass transition. All of our kids will be facing this. Some will face greater difficulty and others less. We should not leave it to chance because the transition is a 100% certainty of occurrence. But how it is navigated will have less certain outcome.

So, let us sharpen our emphasis and target resources on this specific transition to ensure that all our kids have a more certain outcome.

In the spirit of KidSTART, where we are rooted in the belief that every child deserves a strong start in life, regardless of their socio-economic background, this guiding principle is embodied in KidSTART's comprehensive approach to supporting early childhood development for children from low-income families. It is designed to ensure that these children have access to the same opportunities of healthy development as their peers, recognising the profound impact that the early years on a child's future health, well-being and educational achievement. KidSTART celebrates its 10th anniversary and, likewise, we should do the same for our children's mental health transition.

I suggest establishing a national mental health and transition programme for kids and adolescents. KidsSoar, a progamme that is dedicated and focused on mental health transitions for children and adolescents, which is a certainty, embodies a philosophy centred around understanding, supporting and nurturing emotional and psychological well-being of young individuals, to be pre-emptive, preventative and, if needed, resourced to support recovery.

This programme should be designed to acknowledge the importance of mental health as a critical component of overall health and to ensure that children and adolescents are equipped to navigate life's challenges with resilience, a programme that is compassionate and understanding, that empowers, through education and practice, inclusive and accessible and holistic in approach.

This will reflect the spirit of our unwavering commitment to the growth and healing of young minds. It acknowledges that the journey may be long and challenging but we believe in the potential for growth, for healing and positive change. We must do more and we must do more today.

In a world that often moves at an overwhelming pace, there are struggles of the mind that can be as debilitating as those of the body. There lies a group of unsung heroes dedicated to the art and science of healing not just the individual, but the very fabric of our society.

I would like to take this opportunity to pay homage to the mental health workers – psychiatrists, psychologists, counsellors, social workers, psychiatric nurses and all those who labour in the vast and complex network in the field of mental health. This tribute is a salute to your unwavering commitment, your compassion and the profound impact you have made on the lives of those you touch. Your work often goes beyond the call of duty. With every individual you help, you weave a stronger and more compassionate fabric for our society, ensuring that no one has to walk the path of mental challenges alone. You see beyond the stigma and the labels, reaching out to the person struggling in the shadows, offering them a lifeline, a listening ear and the promise of a brighter tomorrow. In times of crisis, your calm and steady presence provides the anchor many need to weather their personal storms. You remind us that it is okay to be not okay and that seeking help is a sign of strength, not weakness. Your work is a testament to the idea that mental health is an integral part of overall health, deserving of the same attention, care and respect.

Let this tribute be a reminder of the gratitude and respect that you so richly deserve. Your dedication, patience and compassion light the way forward for all of us, as we strive towards a future where mental wellness is prioritised and cherished. To those who are stuck in traffic on a slope with a manual transmission, fear not, we are here with you on this journey.

For me, with sincere appreciation and a grateful heart, I give thanks and tribute to all those who have taught me how to drive. May our children soar to greater heights to the moon and beyond and above all their mighty things. Mr Speaker, I support the Motion.

Mr Speaker: Deputy Prime Minister Lawrence Wong.

12.29 pm

The Deputy Prime Minister and Minister for Finance (Mr Lawrence Wong): Mr Speaker, I rise in support of the Motion, and I thank Dr Wan Rizal, Mr Edward Chia, Ms Mariam Jaafar, Dr Tan Wu Meng and Mr Yip Hon Weng for moving this Motion as well as all Members who have spoken passionately about the issue.

Mental health has grown in importance, both in Singapore and across the world. In the past, people dealt with mental health issues privately. It was always in the shadows, and not something we talk about publicly. In recent times, attitudes have shifted, for the better. People are more informed about mental health and more willing to talk about this openly.

COVID-19 also brought mental health issues to the forefront, because across the world, people had to cut back social interactions, and isolate themselves from family and friends. And this took a toll on mental health. It happened in Singapore too. After the circuit breaker was introduced, we observed an increase in the utilisation of mental health services, and more calls to the Institute of Mental Health (IMH)’s mental health helpline.

That is why we set up the COVID-19 Mental Wellness Taskforce, which later became the Interagency Taskforce on Mental Health and Well-being, chaired by Senior Minister of State Janil. The work of the Taskforce builds on previous national efforts to improve the quality and accessibility of mental health services in Singapore.

The Taskforce has published the National Mental Health and Well-being Strategy, which sets out concrete plans to plug existing gaps and to strengthen our mental health ecosystem. We will now translate these plans into action. Our plans are not static. We will continue to evolve and update them, including taking on board the many useful suggestions from Members in this debate. So let there be no doubt: the Government is making mental health and well-being a key priority in our national agenda.

To understand the approach in this new strategy, we must first appreciate the full range of mental health issues. On one end of the spectrum, are mental health issues that require medical treatment, like bipolar disorder and schizophrenia. These conditions can be debilitating – severely affecting a person’s ability to carry out important daily activities.

On the other end of the spectrum, are issues affecting mental well-being, like anxiety and stress. While these typically do not require medicalisation, it does not mean that we should take them lightly. If not addressed well, poor mental well-being can also affect our ability to lead our lives productively.

Because mental health issues lie on a spectrum, it means we need a broad suite of solutions. Not all mental health issues need to be treated in a specialist healthcare institution. It is the same when we have a physical ailment. We do not go to a specialist for treatment immediately when we experience some symptoms of ill-health. Instead, we first see our family doctor. If it is more serious, the matter gets referred to specialist care.

So, improving mental health is not just about hiring more psychiatrists or building more capacity at the IMH. We certainly will do that. But we also need to strengthen capabilities across our entire spectrum of care, including at our polyclinics and GPs, and across other settings like schools, workplaces and in the community, so that more timely support can be rendered to those in need.

In our strategy, we are redoubling our efforts to better understand the issues that young people face, something that many Members spoke about. It has never been easy to be a teenager. Teenage angst has always been part of the growing up process – teenagers have to learn about themselves, take on new responsibilities and prepare for adulthood.

But something has changed around the world, since around the early 2010s, because the current generation of young people are expressing more concerns about their mental health than previous cohorts. Many countries have reported increases in suicidal ideation, as well as mental health conditions like anxiety, and depression amongst their youths. Last year, the US Surgeon-General called the increasing mental health needs of US youth as the “defining public health crisis of our time”. Even the Nordic countries, consistently ranking high in global happiness and well-being surveys, they too, are reporting rises in youth anxiety, depression and a variety of mental illnesses.

So, we see a similar trend in Singapore. It is not at the same high levels as some other countries, where the mental health issues are conflated with other difficult issues like drug abuse, homelessness and street violence. But it is nevertheless a worrying trend, and we are taking it seriously. So, we are linking up with researchers from around the world to try and understand the root causes behind this recent surge in youth mental health issues.

Some think that heavy social media usage is a major cause. Indeed, the constant pressure to present a positive image online, the fear of missing out, the algorithms that flood news feeds with stories that are designed to spark outrage, and the issues of cyber-bullying – all these can take a toll on one's mental health. Furthermore, the more time spent on the Internet or social media means more sleep deprivation, less physical exercise, and less real live interactions – all of which are important for healthy brain development at a young age.

But other researchers think that there is more to it, that it is not just about more online safeguards, that we also need to loosen up in the real world and give our children more space for free play and autonomy. Because when children have less room to play and explore, or to interact and build social skills at an early age, they are also less likely to grow up with the sense of independence and confidence to take charge of their own lives.

The bottom line is that more work will need to be done to better understand what has changed globally in recent years. It is an area that requires further research and study – to identify the key causal factors are and the interplay between the factors, so that we can design and put in place appropriate interventions based on data and evidence to better help our young people.

These are some of the considerations behind our national strategies. Let me highlight quickly several key moves we will be making, with several targets we aim to achieve by 2030 or earlier.

We will increase capacity at the IMH and the redeveloped Alexandra Hospital for those that need specialist care. Capacity at long-term care facilities will also be increased to provide step-down care for those who need it.

We will increase the number of public sector psychiatrists and psychologists by about 30% and 40%, respectively.

We will introduce mental health services to all polyclinics and 900 more GP clinics.

We will equip and train an additional 28,000 frontline personnel and volunteers. They serve across our community and social service touchpoints, so they can identify people struggling with mental health and offer early assistance.

We will also redouble our existing efforts. The Ministry of Education (MOE) is on track to achieving its target of deploying more than 1,000 teacher-counsellors across our schools. This is on top of the basic counselling skills that all teachers will be trained in; as well as the one to two counsellors that every school will have to support students with more challenging social and emotional needs.

We will provide parents with resources to support their children’s mental health and well-being needs.

We will establish more peer support networks in the community, including in schools, Institutes of Higher Learning, workplaces and amongst our national servicemen. These networks will have trained peer leaders who can spread the message on the importance of mental health, and provide a first line of response to their friends or colleagues who need help.

My colleagues, Senior Parliamentary Secretaries Rahayu Mahzam and Eric Chua, Minister of State Gan Siow Huang and Senior Minister of State Janil Puthucheary will elaborate later on some of these areas. These are significant moves. They will require more coordinated efforts across the Government, more training, more people and ultimately more Government spending. But we will set aside the resources to advance this important agenda.

Through these moves, we aim to reduce waiting times, and make mental health services more accessible, and closer to where individuals are, be it at homes, schools or workplaces. We aim to keep mental health services affordable, and we will do so through our national healthcare financing framework of Government subsidies and the 3Ms, which will cover all cost-effective mental health treatments. Importantly, no one in Singapore will be denied access to appropriate care because of inability to pay.

Several Members also spoke about private insurance coverage outside of healthcare, including in areas like life insurance. Life insurers in Singapore have in fact offered coverage to persons with mental health conditions. But the underwriting of such persons can be a complex matter, as our own data is limited, and insurers here typically reference the underwriting guidelines of global life reinsurers. We will study and review how this coverage can be improved and ensure that financial institutions deal fairly with all their customers, including those with mental health conditions.

Importantly, we will have a bigger focus on preventive care, so that everyone can take proactive steps and take charge of their own mental health. We will start young in schools. We want our children to develop good cyber habits, so they learn to use the internet and social media safely and responsibly.

To be clear, our approach is not to remove all stress. That is not going to help our children. Instead, we want our children to learn to deal with stress at age-appropriate levels. We want them to develop self-belief and resilience, and grow up with the confidence to tackle challenges, stresses and demands that they will surely encounter later in life.

We will continue to integrate mental well-being into our Healthier SG and other preventive health programmes. We sometimes think of body and mind as separate entities, but they are closely linked, each affecting the other greatly. Staying active, exercising regularly, connecting with friends in person, not online, learning new skills, contributing to a larger purpose – all these sound like commonsensical advice, but they are not so easy to do. And they are foundational habits that will enable all of us to improve our overall well-being.

Sir, the Government is fully committed to doing more to improve mental health and well-being. But for all these plans to work, we also need to change our attitudes and mindsets.

We need to do more to destigmatise mental health conditions, so that people do not hesitate to seek help. Stigma reduces a complex and difficult problem into unhelpful labels and stereotypes. It opens people struggling with mental health to discrimination, such as in the job market. It may cause them to be socially ostracised. It makes them feel ashamed, isolated and stops them from seeking treatment. As I mentioned just now, we do see attitudes shifting. But the stigma remains and we can do much more to build a society where we help one another cope with life’s stressors, are considerate of others’ feelings and carve out safe spaces for them.

We also need to change our mindsets about what we consider success in life. It is good to have a culture in Singapore that values hard work, promotes excellence and encourages everyone to aspire and strive to do better. But we should not be unwittingly drawn into a rat race of hyper-competition and endless comparisons with one another just to get ahead of others, but end up worse off as a society.

In fact, this was one of the key points from our Forward SG engagements. The vast majority of Singaporeans wish to see a more inclusive Singapore Dream – one where we are not pressured to conform to narrow definitions of success; where we embrace excellence and talents across many different areas, and find meaning and purpose in what we do. The Government is making policy moves in this direction – by reviewing our education system, narrowing wage gaps and strengthening safety nets, so that everyone can be better assured of their basic needs at every life stage and can have the space to venture forth, and be the best version of ourselves. But we cannot make this happen through policy alone. Our attitudes, our mindsets must also change and align with our shared aspirations for a refreshed Singapore Dream.

Indeed, to achieve all of these goals, we must work together. There are many ground-up initiatives and community and social services organisations, already working in different ways to meet the mental health and well-being needs of Singaporeans. I know from personal experience, having served as Patron to the Samaritans of Singapore for more than 10 years. I have interacted with many of the volunteers there and seen first-hand their commitment and dedication to save lives.

We value the collaborations and partnerships with all of you. Through the SG Mental Well-being Network, we have been linking up with many groups and volunteers, to address the diverse needs of our people, be it befriending lonely seniors, or providing a safe space for youths to talk about their mental health struggles. The setting up of the National Mental Health Office will enable us to coordinate these partnership efforts more effectively, and to better synergise and maximise our efforts on the ground.

I call on all Singaporeans, who are passionate about this issue of mental health and well-being to join us in this national movement. We have lots to do and a full agenda ahead of us. The Government has set out clear plans and deliverables. But the issues are complex and we do not have all the answers. We want everyone on board, so we learn together and continue to fine-tune our strategies based on your feedback and ideas and our shared experiences and insights.

Together, let us build a Singapore where everyone matters, where everyone has a place and where everyone belongs. Together, hand-in-hand, let us improve the mental health and well-being of all Singaporeans. Mr Speaker, I support the Motion. [Applause.]

Mr Speaker: Senior Parliamentary Secretary Rahayu.

12.45 pm

The Senior Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam): Mr Speaker, Deputy Prime Minister Wong had explained the operating context that we are in and the approach we are taking, as we navigate the issues of mental health in our community. He highlighted an important starting point in our approach – that mental health issues lie on a spectrum and that, this means we need a broad suite of solutions. We also need to meaningfully organise the services and support available, so that people have access to the help they need, when they need it.

Allow me to build on this point. Let me start by sharing data that we have from the Singapore Youth Epidemiology and Resilience (YEAR) study, conducted by the National University of Singapore (NUS) in collaboration with MOE. This study showed that while 37% of respondents reported having internalising symptoms, like depression and anxiety, only 12% of respondents met the full criteria for at least one of the mental disorders. Furthermore, 6% of the respondents, who previously met the criteria for at least one mental disorder more than a year ago, no longer had the symptoms.

This means that while individuals may experience symptoms of poor mental health, they may be due to transient stressors and do not necessarily warrant the same intensity of interventions needed for individuals diagnosed with mental disorders. Receiving care in the community, as the first line of support, rather than at hospitals, is therefore, more appropriate.

The cornerstone of our National Mental Health and Well-Being Strategy, is the Tiered Care Model. It sets the foundation for how our mental health services should be organised, with different care levels, depending on the intensity of interventions needed. This, ultimately, helps us to provide the right care, at the right time, based on the individual's needs.

Right-siting of care to the community, is part of a much larger shift of mental health care. Countries, like Australia, Canada and the United Kingdom (UK), have implemented a similar model for their mental health care systems. Although more research studies are still being done, existing studies suggest that, a tiered model of mental health care delivery, where mental health care can be easily accessible in community settings is a better approach compared to concentrating services in the hospital settings. Senior Minister of State for Health will speak more on our tiered care model later.

For the tiered care model to be effective, we also need to encourage the right mindsets, allocate resources and build support within the community to empower people. I will, therefore, be addressing the mental health promotion efforts, community mental well-being initiatives, the affordability of mental health services as well as the manpower needs in providing mental health care.

As shared by Dr Wan Rizal when he spoke on the importance of mental health literacy, raising awareness on mental health is crucial in shifting our societal values and attitudes towards making mental well-being, one of our priorities. We have made progress in this area as we see improvement in the public's attitudes towards individuals with mental health conditions. However, we recognise that stigma around mental health issues persist in our society.

Our efforts include encouraging help-seeking and reducing stigma and discrimination against people with mental health conditions, through public campaigns and targeted initiatives for youths, seniors, caregivers, women, persons with disabilities and minorities.

At the national level, HPB’s “It’s OKAY to Reach Out” campaign and the National Council of Social Service (NCSS)’s Beyond the Label movement, aim to normalise conversations around mental health and encourage help-seeking. These efforts are sustained through social media outreach and online portals.

In a post-campaign survey of 800 youths, HPB found that 78% of respondents were motivated to reach out for emotional support when they needed it. HPB's MindSG offers mental health resources, curated by professionals, including tools for users to assess their mental health risks and search for support or services, based on their needs. As of 31 December 2023, the portal has garnered more than 4 million page views, from over 2 million users since its launch in November 2021. The portal will be enhanced, progressively, to introduce more topics and features.

In schools, HPB offers training for students going through critical transition years, specifically, from Primary 6 to Secondary 1. These programmes are carried out in partnership with schools, to equip students with skills to better cope through these transitions. Additionally, in 2023, HPB has trained more than 2,200 students from Institutes of Higher Learning as peer supporters, equipping them with empathetic listening and basic mental health first-aid skills.

At workplaces, HPB trains management staff and conducts workshops, to enable people to better cope at work and support their colleagues. In 2023, more than 55,000 working adults have benefitted from HPB's mental wellness programmes. Besides HPB-led initiatives, the Workplace Safety and Health Council also launched the “Take Time to Take Care” campaign, to remind employees to look after their own and their colleagues' well-being.

In the community, Well-Being Circles have been established across various neighbourhoods to raise awareness on mental health and available resources and, to empower citizens with skills to look after their own mental well-being as well as that of others. We will continue to encourage the formation of more Well-Being Circles, so that more in the community will have access to the support when they need it.

Apart from community-wide efforts in mental health promotion, there are also several initiatives that target specific groups.

According to the 2022 National Population Health Survey, youths aged 18 to 29 years old formed the largest proportion of people with poor mental health in Singapore. Currently, we have community mental health teams, known as CREST-Youth and Youth Integrated Teams (YITs), dedicated to support youths with mental health needs. CREST-Youth, reaches out to youths and parents to promote early identification of mental health symptoms and provide basic emotional support. YITs, carry out mental health assessments and provide psychosocial interventions for youths who need more intensive support.

As of September 2023, we have four YITs that have supported over 3,000 youths and parents; and, eight CREST-Youth teams that have reached over 87,000 youths and parents. By 2030, we will be expanding to 15 YITs and CREST-Youth teams each, across the island.

In addition to these community mental health teams, the Response, Early Intervention and Assessment in Community Mental Health (REACH) teams work closely with schools to provide mental health assessments and interventions, for students aged six to 19 years old. CHAT, another mental health service which supports youths aged 16 to 30 years old, has assessed over 7,000 youths at risk of developing mental health conditions, as of September 2023.

To support youths at risk of suicide or severe self-harm, an intermediate residential facility will also be developed. Not all youths who present with suicidal behaviour, suffer from mental health conditions. Instead, they may have experienced social stressors, such as having difficulties coping with schoolwork and being bullied. Therefore, this facility will cater to this group of youths, aged 10 to 19 years old, to support them within a safe environment.

In the facility, youths will be supported by a multi-disciplinary team, consisting of psychiatrists, psychologists, social workers, nurses and live-in care staff. Services provided will include: identifying the needs of youths in crisis; providing psychosocial interventions, such as counselling and supportive medical attention, where necessary; and, facilitating the transition of youths with support from community partners before they are discharged.

In the course of supporting the mental health of our youths, there have been ground feedback on the need for parental consent for children and youths below 21 years old, which could hinder their access to mental health support. I thank the Members who have raised this issue earlier.

We recognise the importance of youths' continued access to mental health services and I appreciate Miss Rachel Ong's earlier suggestion, of having tiered guidelines for the requirement of parental consent on mental health services. In this regard, I would like to lay out several considerations that MOH is reviewing, as we navigate this issue. These include, balancing the need for youths' access to appropriate treatment; the involvement of the family and social support in youths' care journey; protection of the youths in view of the risks associated with treatments; and, the level of maturity and understanding of the child.

Above all, our priority, is to ensure that any approach taken is in the best interest of the child and that they can receive timely mental health care. We are studying this issue and exploring meaningful options to address it.

Several Members of Parliament, like Mr Yip Hon Weng and Ms Nadia Samdin, spoke about the need to do more to support our seniors with mental health needs. Currently, seniors are supported by the Community Outreach Teams (CREST), to identify their mental health needs and provide basic emotional support and referrals to appropriate service providers. In addition, Active Ageing Centres (AACs) work with CREST providers, in serving as community nodes, to conduct activities that engage and connect seniors within the community. We have 73 CREST teams islandwide, of which, 65 teams can support seniors at-risk of mental health needs.

We understand, that some seniors may be reluctant to seek help or accept support for their mental health needs, due to stigma. As part of their outreach efforts, Silver Generation Ambassadors, who come across these seniors, would also share about mental health resources in the community and encourage them to seek help. We are glad that there are also community initiatives, carried out by Members in their constituencies, that reach out to these seniors.

We are also looking at mental well-being issues of our seniors and tackling the social phenomenon of loneliness, as part of the holistic Age Well SG strategy, announced last November.

For caregivers, who have or are at risk of developing depression, anxiety and burnout, due to their caregiving role, there are Community Outreach Teams (CREST) that provide dedicated support. These teams support caregivers in self-care, stress management and future planning, such as making a Lasting Power of Attorney and Advanced Care Planning. Where necessary, they will also link caregivers with counselling services and peer support groups, like the Caregiver Support Network. As of September 2023, there are six Caregiver Community Outreach Teams and over 2,300 caregivers have been supported.

The Agency for Integrated Care (AIC) also administers the Caregiver Training Grant, which provides subsidies for caregiver training, including psychosocial management of behavioural issues.

For caregivers, who need short-term support to have their loved ones taken care of, some MOH-funded psychiatric nursing homes offer the Nursing Home Respite Care programme, which provides eligible clients with short periods of stay – typically ranging from a week to a month. Such arrangements, allow caregivers some time off, with the assurance that their loved ones are safely cared for in the nursing home.

I thank Ms Hazel Poa and Ms Hany Soh for their suggestions on support for postpartum women and their spouses. Several efforts are ongoing to support the mental health of women. For example, the National University Hospital (NUH) Women's Emotional Health Services (WEHS), provides both antenatal and postnatal mental health screening as well as individualised treatment interventions, for women who need more support. The NUH WEHS team, also works closely with community partners and social service providers to coordinate and provide continuity of care to those who need it. Similarly, the Postnatal Depression Intervention Programme in KK Women's and Children's Hospital (KKH), provides routine post-natal depression screening for all pregnant women; and, those with depressive symptoms, will be referred to the appropriate services available. Mental health services, including mental health screening for mothers, are also available in polyclinics.

To support fathers and spouses, NUH will be extending its mental health screening to support them. The programme allows for early intervention, case management and multi-disciplinary treatment.

In 2020, the KKH Psychosocial Trauma Support Service (PTSS) also began providing trauma-focused assessments and interventions to women experiencing psycho-emotional difficulties that arose from traumatic incidents.

I thank Ms Nadia Samdin for her suggestions on meeting the holistic health needs of persons with disabilities (PwDs). MOH is committed, to working with partners to deliver holistic care for PwDs. To address their healthcare needs, MOH works with community partners to provide the Home Personal Care service, which offers a range of services, including assistance with personal hygiene, housekeeping and simple maintenance exercises.

Over the past years, we have also collaborated with the College of Family Physicians Singapore to offer a Family Practice Skills Course to equip general practitioners in caring for persons with intellectual disabilities; and, piloted a Community Integrated Health Team, in partnership with a social service agency; as well as, a specialist outreach team from IMH, to offer home- or community-based care for persons with intellectual disabilities, who have complex health needs. We will continue to build these capabilities in the community to support more caregivers and families of PwDs.

In the Malay/Muslim community, we have organisations, like Club Heal, which has championed mental health issues for years. New initiatives are also in place. I lead M^3's Focus Area on Community Health, which was introduced last year. M³ is a collaboration, between the Islamic Religious Council of Singapore (MUIS), MENDAKI and MESRA. The newly introduced Focus Area on Community Health, aims to promote healthy lifestyles and empower residents to spearhead ground-up efforts, within their own community – including efforts on mental health and well-being. In towns, like M³@Jalan Besar, youth peer support groups have been set up and the community is rallied to co-create solutions. We will continue to roll out such initiatives, to enhance residents' mental well-being in the different towns. Mr Speaker, please allow me to say a few words in Malay.

(In Malay): [Please refer to Vernacular Speech.] There has been increasing awareness of mental health issues within the Malay-Muslim community. We are fortunate to have organisations like Club Heal which has championed this issue for many years. It is important that we continue to reinforce these efforts and garner more support from the community. As part of the National Mental Health and Well-Being Strategy, efforts are being undertaken to ensure that support and initiatives are readily available in our community.

I currently lead the M³ Focus Area on Community Health and Well-Being. It was introduced last year. This new Focus Area aims to promote a healthy lifestyle and empower residents to spearhead efforts in their own communities. One cornerstone of this endeavour is addressing mental health and mental well-being issues in our community.

I welcome efforts being done at the towns such as M³@Jalan Besar led by Dr Wan Rizal. Peer support groups for youths have been set up and the community is invited to co-create solutions. We will continue to implement such initiatives to improve the mental well-being of residents across Singapore.

(In English): Let me touch on the affordability of mental health services. In this regard, we have made efforts to reduce out-of-pocket costs through various schemes available.

For outpatient mental health treatment offered at polyclinics and public specialist outpatient clinics, eligible patients can receive subsidies of up to 75%. Additionally, individuals who hold Community Healthcare Assistance Scheme (CHAS), Pioneer Generation and Merdeka Generation cards are eligible for subsidies of up to $540 per year for mental health conditions including depression, anxiety disorders, bipolar disorder and schizophrenia under the Chronic Disease Management Programme. These subsidies are available at public specialist outpatient clinics, polyclinics and participating GP clinics. Patients can also use up to $500 or $700 from MediSave each year, depending on the complexity of their condition, at selected clinics. For patients aged 60 years and above, they can use an additional $300 each year from their Flexi-MediSave to offset out-of-pocket payments for their outpatient mental health treatment. Patients may also receive subsidised or free counselling services provided by various community service providers.

For inpatient services, all Singaporeans and Permanent Residents are covered under MediShield Life, regardless of preexisting conditions. Patients who require inpatient mental health treatment can claim up to $160 per day, capped at 60 days per year, from MediShield Life, and up to $150 per day from MediSave, within an annual MediSave limit of $5,000. MediShield Life and MediSave claim limits are regularly refreshed to ensure that they remain sufficient to cover nine in 10 subsidised bills.

On top of MediShield Life, Integrated Shield Plans (IPs) and other private health insurance plans may provide additional coverage for mental health treatment.

Today, all IP insurers offer plans that cover in-patient mental health treatment and the amount of coverage is decided by the insurers.

For lower-income Singaporeans who require more financial assistance to pay for their remaining healthcare bills, they may apply for MediFund, which serves as a safety net for needy Singaporeans. No Singaporean will be denied access to appropriate healthcare due to their inability to pay.

I share Dr Tan Wu Meng’s concern regarding denied access to private insurance for persons with mental health conditions. Several other Members have also raised this concern. This should be considered within the larger context of our healthcare financing system where all Singaporeans are eligible for subsidies and are covered under MediShield Life which is a national risk pool that helps to ensure its sustainability.

On the other hand, IPs and other private health insurance products are optional. Private insurers may exclude pre-existing conditions from coverage upon underwriting, including mental health conditions, informed by actuarial and commercial considerations. Such a process allows insurers to ensure their risk pool remains sustainable, as they otherwise have to increase premiums for all policyholders. Depending on their underwriting assessment frameworks, insurers may still offer coverage to applicants with pre-existing conditions but with exclusions or higher premiums. It allows this group of applicants to still benefit from some coverage without adversely affecting other policyholders.

Notwithstanding, MOH and the Monetary Authority of Singapore (MAS) fully expect all insurers to deal fairly with their customers. Insurers are expected to carry out an objective assessment of every application based on reliable information or data relevant to the risks being insured. Insurers should not indiscriminately reject an application solely on the basis of declared personal information, including mental health conditions. Where an application is rejected or approved with higher premiums or additional conditions, insurers should properly explain to the customer the basis for the underwriting decision. MOH and MAS take this seriously, and MAS will take action against insurers whose practices are in breach of its regulations or guidance. MOH and MAS will review this issue and consider how insurance coverage for persons with mental health conditions can be improved.

I also thank Dr Tan for highlighting the Forum Letter by Ms Tan Hui In. MAS does not have records of her feedback in its complaints database. If Dr Tan has additional information to share about this specific case, he can share it with MAS and MAS can promptly look into it with the relevant insurers, if the complainant consents to it. Members of the public with similar feedback can also write to MAS and MAS will investigate accordingly.

On the feedback on long waiting times to access mental health treatment services, MOH will similarly look into the issue.

Let me move to the point on manpower for mental health care. One of the key considerations is the adequacy of mental health professionals, including psychiatrists and psychologists.

As of 2022, there were 203 registered psychiatrists and 212 psychologists in the public sector. To meet the anticipated increase in demand for mental health services, the Government aims to increase the number of psychiatrists by about 30% to 260 and the number of psychologists by about 40% to 300, in the public sector, by 2030. However, solely increasing the number of psychiatrists and psychologists will be insufficient and unsustainable to meet increasing demands for mental health services. This is also one of the reasons why we have developed the tiered care model.

With the tiered care model, more patients will receive timely care in the community, provided by appropriate mental health professionals such as counsellors. This will allow psychiatrists and psychologists to focus on patients with more complex mental health needs. We are thus committed to continue to raise the capability and capacity of our community service providers, while monitoring the changes in demand for mental health services to ensure continued adequacy of manpower required for mental health care.

Mr Speaker, issues surrounding mental health has garnered attention globally and in Singapore. I am encouraged by the efforts and progress we are making as a nation in tackling this extremely important and challenging area. In particular, we have made advancements in integrating various aspects of our social, education and health sectors.

To illustrate, let me share the story of Mr Chee Soon Weng. Mr Chee was an experienced teacher and managed students with challenging behavioural issues. This took a toll on his mental health and over time, he suffered from comorbid anxiety and depressive disorder. As a result, Mr Chee transited from a student-facing role to an administrative and research position at work. At home, he also encountered issues with his family due to his mood. He then approached the Methodist Welfare Service’s Family Service Centre under the Ministry of Social and Family Development (MSF), who identified his mental health needs and referred him to one of our COMIT Anglican Care Centre teams for support. Through weekly counselling and psychoeducation on symptoms and treatment plans, Mr Chee made significant progress in his mental health. Today, Mr Chee is coping well with his new position at work and his relationship with his family has also improved. Mr Chee’s story underscores the importance of integrating social service and health sectors to enhance mental health care for individuals.

In closing, I would like to record my gratitude to Members who have raised this Motion. It has given us the opportunity to highlight the mental health efforts that we have developed and implemented through the years, as well as hear various feedback and suggestions on how we can do more. I would also like to take this opportunity to thank all our community service providers for their unwavering dedication and their instrumental role in implementing these initiatives on the ground. The Government is committed to continue working with the healthcare clusters and community partners to develop and review our strategies to uplift the mental health of our nation. Mr Speaker, I support this Motion.

Mr Speaker: Senior Parliamentary Secretary Eric Chua.

1.09 pm

The Senior Parliamentary Secretary to the Minister for Social and Family Development (Mr Eric Chua): Mr Speaker, I support this Motion and thank my parliamentary colleagues for their continued advocacy and ideas to improve the mental health and well-being of our people. As mentioned by Senior Parliamentary Secretary Rahayu, the tiered care model is the foundation of our National Mental Health and Well-being Strategy. I will elaborate further on our initiatives to implement the tiered care model. We will (a) set up first-stop touchpoints to facilitate help-seeking; (b) train frontline social service professionals; and (c) develop a practice guide to enhance service integration between health and social service providers.

Mr Speaker, we have a vibrant and thriving mental health services landscape today, with over 200 different services available, including hotlines, websites and in-person services. These services target different levels of mental health needs, from community-led mental health promotion, self-help and peer support at Tier 1, to the most intensive level of care in hospitals and specialist clinics at Tier 4 of our tiered care model.

There are also many ground-up initiatives across sectors, such as those under the Beyond the Label Collective, to address the mental health and well-being needs of our people and reduce stigma. I thank all for your passion, determination and for rising to the occasion. These services and ground-up initiatives serve as the foundation of our work, building upon the larger National Mental Health and Well-being Strategy.

In spite of our vibrant mental health services landscape, we have heard feedback however that help seeking can be overwhelming as many do not know where, when and how to seek help. This is a key issue for us, as there remains a treatment gap – many who need help are not getting the help that they need, and far too many get help far later than they should. The complex web of services available can indeed have the unintended consequence of deterring help-seeking.

We want to make it easy for anyone to seek help. No going at it alone or figuring out your way by yourself. We will set up first-stop touchpoints; essentially "go-to places" for mental health support. Our first-stop touchpoints will identify their clients' mental health needs and provide the appropriate service. This can mean relevant information, immediate mental health support and intervention, or referrals. We want to make sure that individuals with mental health conditions are well supported, especially when they have taken the crucial first step to reach out for help.

Our first-stop touchpoints will include:

One, a number to call or text. We will set up a new National Mental Health Hotline and Text Service by 2025, that will connect callers and texters to the most appropriate support or services to meet their needs. For example, callers and texters with no or minimal mental health needs and want to learn well-being skills can be referred to Well-being Circles in the community. On the other end of the spectrum, those with suicidal tendencies may be connected to the Samaritans of Singapore (SOS)'s Hotline and Care Text for support.

Two, a digital platform, such as Mindline or MindSG. It does not matter which resource users visit first, since both link to each other. Both websites contain curated content by mental health experts, self-assessment tools and links to other resources, including our in-person touchpoints for mental health support. Mindline also has an online forum named "Ask a Therapist" where users can engage with verified professionals and a Wysa AI-enabled chatbot where users can share their emotions safely and anonymously without the fear of being judged, anywhere and anytime.

Third, a place to seek help. We will build up and promote in-person touchpoints, including community mental health teams such as the Community Outreach Teams as in-person first-stop touchpoints, so that the public knows where to seek help. With this move, we hope that the public will become more aware of the existence of the many social service agencies in our community providing psychotherapy and emotional support, and not just clinics and hospitals.

While first-stop touchpoints are more specialised in delivering mental health services, we also want to equip 1,500 frontline social service professionals with basic mental health capabilities. In the course of their work, social service professionals often encounter clients with unmet mental health needs. In fact, many may not themselves recognise that they are in need of mental health support. For our 500 frontline staff across our Social Service Offices (SSOs), we plan to train them in psychological first aid.

We also intend to train another 1,000 frontline social service professionals to be capable of identifying mental health concerns, provide casework and counselling and refer clients to appropriate services. These social service professionals will be trained by 2030.

Directing clients to appropriate services at the get-go does not mean the job is done. An individual's mental health needs can change over time. To provide a seamless care experience for clients, service providers across the social service and health sectors need to work ever closer together.

Today, different providers have different screening, assessment, collaboration, referral, IT and data-sharing practices. To provide a more seamless experience for those seeking mental health services, the task force brought together professionals from both social service and healthcare sectors to develop a practice guide, which we aim to launch by the end of this year.

The practice guide will standardise, one, common mental health screening and assessment tools, essentially, common language and tools to help service providers identify their clients' level of mental health needs; two, common collaboration and referral workflows, to guide service providers to determine which service provider to refer their client to, depending on their level of mental health needs and other factors, such as age and cost, and how they can collaborate to serve the best interests of the client; and three, common IT system and data sharing guidelines, to streamline referral processes while safeguarding and addressing clients' concerns about confidentiality.

The practice guide will help to better ensure that clients are referred to and receive mental health resources or interventions appropriate to their needs. When their needs change, the support for them can be adjusted accordingly, that is, stepped up to higher-intensity services or stepped down to lower-intensity services, as needed.

While there are good examples of collaboration and coordination across social service and healthcare sectors today, not all cases are handled in a systematic and consistent manner. To help raise overall practice standards and the experience for those seeking help, the practice guide will clearly lay out the kinds of services different agencies in the social and health sector should provide and how they should work with one another to serve clients with mental health needs. At the end of the day, it is all about serving individuals with mental health support needs better. Mr Speaker, in Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] Mr Speaker, we hope that any Singaporean in need of mental health support will not have to navigate their help-seeking journey alone and as a result, feel lost or afraid. Seeking help should not be a lonely experience.

To address this, we will establish first-stop touchpoints to help Singaporeans find appropriate mental health services. These include: first, a number to call or text; second, a comprehensive website for self-help; third, a place for Singaporeans to seek help.

Further, social service professionals often encounter individuals with mental health needs in the course of their work. Many of these individuals may not even be aware of their own mental health needs. To address this, we will provide basic mental health training for 1,500 social service professionals.

Finally, we will also develop a practice guide, so that both healthcare and social service professionals can collaborate more seamlessly in screening, assessment, referral, IT and data sharing practices. There is only one ultimate goal: to provide more comprehensive and client-centric services for Singaporeans with mental health needs.

(In English): Mr Speaker, our mission at hand is one that is salient and pressing. Our national mental health strategy lays the foundation and gives us direction so that we can collectively get to a better place in terms of our mental health. Beyond plans, policies and programmes, perhaps, more importantly so, we need a further shift in mindsets surrounding mental health and people with mental health conditions. Much has been done, but more work remains.

With the help of Members of this Chamber from both sides of the aisle and beyond, I have every confidence that Singapore can be a paragon where stigma surrounding mental health is a thing of the past and where help-seeking is well-facilitated. With that, I support the Motion.

Mr Speaker: Minister of State Gan Siow Huang.

1.21 pm

The Minister of State for Manpower (Ms Gan Siow Huang): Mr Speaker, Sir, I rise in support of the Motion. Many adults spend substantial time at work and, sometimes, work can be stressful and affect one's mental well-being. It is thus important that we look at how workplaces can support mental well-being of employees and what each of us can do to create kinder, more inclusive workplaces.

I will, first, touch on the plans to support general mental well-being of employees. In November last year, the Workplace Safety and Health (WSH) Council launched the Well-being Champions Network. This is a community of practice for Well-being Champions to exchange best practices and access more resources and training.

Who are these Well-being Champions, you might ask? A Well-being Champion is typically a management-level employee or individual whom the company empowers to lead the well-being agenda and implement mental well-being measures in the company. One such Well-being Champion who has joined the Network is Mr Hon Lip Yung, General Manager of a local SME. The Network allows Mr Hon to learn from Well-being Champions of other companies on how they implement mental well-being initiatives. Mr Hon is now looking forward to attending training with other members in this Network, which is aligned to Tier 1 of the National Competency Training Framework. The training, worth $400 per person, is complimentary for one champion per company.

The Network now has 275 members from 145 companies with close to 175,000 employees. We will work closely with the various Government agencies, Tripartite Partners and Trade Associations to expand the network.

Peer support is another important part of strengthening workplace mental well-being support. The National Council of Social Service (NCSS) and Health Promotion Board (HPB) are working together to enhance training for peer supporters and develop a framework to support them. The peer supporters would be equipped to provide emotional support and lend a listening ear to colleagues at the workplace.

I agree with Mr Edward Chia's suggestion that every company should have a framework to support their employees' well-being. Employers may refer to the Playbook on Workplace Mental Well-being for step-by-step guidance to implement mental well-being initiatives.

HR leaders play an important role in this ecosystem. I encourage more HR professionals to join the Mental Well-being Champions Network.

The Institute of Human Resource Professionals (IHRP) has also established the Body of Competencies (BoC) for HR professionals which identifies the execution of employee benefits, including mental well-being initiatives, as an expected functional competency for HR professionals. The Ministry of Manpower (MOM) will continue to partner IHRP to equip and support the HR industry on this front.

I agree with Mr Mark Lee and other Members on the importance of both physical and mental health. This is why MOM and the Workplace Safety and Health (WSH) Council take a Total WSH approach to workers' well-being, focusing on both physical and mental health.

On Mr Ong Hua Han's interest in the support for SMEs, the Total WSH programme provides SMEs with free access to qualified consultants who can advise them on how to manage safety and health in an integrated way and provide intervention programmes, such as mental well-being workshops. We have streamlined the administrative overheads for SMEs to participate more easily and fully.

I agree with Mr Edward Chia that it is important for a company to measure the state of mental well-being of its employees. Companies can use MOM's iWorkHealth assessment tool, which is a free online, company-administered tool to better understand their employees' state of mental well-being, including the workplace stressors that the employees are facing.

We have taken in companies' feedback to leverage iWorkHealth as a pulse survey to monitor their employees' state of mental well-being on a more frequent basis. I am pleased to announce that we are launching the iWorkHealth Lite. iWorkHealth Lite is a dipstick survey for companies to gauge the employees' work stress and burnout and it can be completed in five minutes.

Mr Edward Chia also suggested harmonising the iWorkHealth tool with the Human Capital Diagnostic Tool. We will consider this. We need to balance between harmonising tools for ease and gaining an overview of the organisation's environment and workforce, while ensuring that the tools and surveys are kept functional, purposeful and at a reasonable length for the employees.

I thank Dr Wan Rizal for highlighting the need for one to set aside time to rest outside of working hours, and Assoc Prof Razwana Begum's that one has to have reasonable working hours.

Ms Carrie Tan and Mr Melvin Yong also suggested introducing the "Right to Disconnect", sometimes, known as after-hours work communication policy to people.

Guidance on how to implement such policy is in the Tripartite Advisory on Mental Health and Well-being at Workplaces. We will continue to work with our Tripartite Partners, including the National Trades Union Congress (NTUC) and Singapore National Employers' Federation (SNEF), to raise awareness of the importance of setting after-hours work communication policy while managing both employees' and business needs. At the same time, the Tripartite Partners are pushing for greater adoption of work-life harmony measures, such as health and wellness programmes and unrecorded time-off for personal and family matters.

I share Mr Melvin Yong, Mr Darryl David, Mr Vikram Nair and Mr Ong Hua Han's call in getting more companies to subscribe to Employee Assistance Programmes (EAP). Employers may refer to the refreshed EAP service providers list in the Tripartite Advisory, which includes EAP service providers offering subsidised rates and details of their offerings, such as indicative pricings and areas of specialisation.

Apart from EAP services, individuals experiencing mental distress or just need a listening ear, can tap on the new National Mental Health Hotline and Text Service from 2025. There are also free online resources, such as Belle the helpbot and Mindline.sg. Ms Jean See will be happy to note that self-employed individuals and freelancers can tap on such free resources, too.

I note Ms Hazel Poa and Assoc Prof Razwana Begum's suggestion for a four-day work week. Companies that find four-day work week feasible and workable for their business and employees are free to do so. However, as with any work arrangement, this may only work well for certain sectors and jobs. I encourage employers to proactively discuss with employees the types of flexible work arrangements that suit both their business context and their employees' specific needs, including for caregivers who might have special needs, as mentioned by Ms Yeo Wan Ling.

Supportive companies that demonstrate exemplary mental well-being practices can be recognised through the annual WSH Culture of Acceptance, Respect and Empathy (CARE) Award.

I acknowledge Ms Ng Ling Ling, Ms Mariam Jaafar and other Members' concern for the mental health of our young adults, especially for those adjusting to their first careers.

The National Youth Council's Mentoring SG Movement provides accessible mentoring programmes to support youths in managing life transitions. Young NTUC is one of our partners which has put in place several initiatives, such as career preparation workshops for youths.

I would like to assure Ms Carrie Tan that the Public Service Division (PSD) is taking the lead to strengthen mental well-being support of our civil servants. This includes providing a range of well-being programmes and resources to equip them with the skills and knowledge for self-care, joining the Well-being Champions Network, having a whole-of-Government confidential counselling services hotline for public officers to speak to trained counsellors, building a community of Wellness Ambassadors, who are trained peer supporters.

The Public Service will continue to strengthen support for our public officers' mental well-being.

I will now cover how we are supporting the employment and employability of individuals with mental health conditions who are on recovery.

Mr Keith Chua has suggested stronger support for individuals with mental health conditions who are looking for a job.

To drive inclusivity in training, SkillsFuture Singapore (SSG) is working with training providers to raise awareness of mental health and well-being in adult learners, develop customised training courses, and increase accessibility of some mainstream courses to cater to trainees with mental health conditions.

In relation to Mr Edward Chia and Ms Carrie Tan’s suggestions to equip Singaporeans with skills in psychological first aid and mental health literacy through SkillsFuture, SSG currently provides funding for more than 100 courses in the area of mental health including psychological first aid and mental health literacy.

For those who require customised employment support, agencies such as IMH, Singapore Anglican Community Services (SACS) and Singapore Association for Mental Health (SAMH) provide services to place them with suitable employers, advise employers on job task adaptations, and train supervisors to better support these employees.

One such company is Konica Minolta, which has partnered IMH Job Club since 2016 to recruit individuals in recovery. They are paired with a peer buddy and the company works closely with IMH to effect workplace adjustments, such as moderating their workload and tasks to a more suitable pace. Through the joint support by IMH and the employer, these individuals gain and sustain meaningful employment.

We are looking to help employment support agencies expand their partnerships with trade associations and chambers, to encourage more companies to come onboard to hire and retain employees recovering from mental health conditions.

On Mr Keith Chua’s and Ms Hazel Poa’s suggestion to look at some form of wage subsidies for employers that hire these individuals, I would like to say that mental health conditions vary in severity and fluctuate over time. It is difficult to calibrate salary support to cater to fluctuations in the conditions of the individual. Today, eligible individuals with mental health conditions are given training allowance as they work on equipping themselves with skills to return to employment.

Finally, I would like to speak on the stigma and potential workplace discrimination associated with mental health.

I share Ms Ng Ling Ling and Mr Sharael Taha’s concerns that individuals with mental health conditions require stronger support. And as highlighted by Mr Ong Hua Han, persons with disabilities need even greater help as they could be more vulnerable to mental health illnesses.

To this end, NCSS, together with the Beyond the Label Collective Workplace Workgroup members, is developing case studies and videos to increase awareness of best practices of inclusive employment and to guide employers on how to support employees when mental health issues arise. Employers may also refer to NCSS’ Mental Health Toolkit on adjustments they may make for their individuals with mental health conditions, including having a phased return-to-work programme and providing a buddy or mentor. NCSS is also working with employment support agencies to develop a common framework to refer, assess and support individuals with varying readiness to return to work.

On the issue of workplace discrimination as raised by Dr Wan Rizal and other Members, the upcoming Workplace Fairness Legislation sends a strong signal that there is no place for discrimination against employees and jobseekers with mental health conditions. Employees should be treated fairly and based on merit even if they have chosen to disclose their mental health conditions.

The Government is committed to working with employers to strengthen support for employees’ mental well-being. To the employers, we encourage you to tap on resources that are available. To employees, let us strive to show kindness, support and understanding to those around us. To those of you recovering from mental health conditions and other vulnerable groups seeking employment, you are not alone. We will support you in the pursuit of meaningful employment. Together, we can build a more inclusive society.

Mr Speaker: Senior Minister of State Dr Janil Puthucheary.

1.35 pm

The Senior Minister of State for Health (Dr Janil Puthucheary): Mr Speaker, I rise in support of the Motion. I want to thank Dr Wan Rizal, Mr Edward Chia, Ms Mariam Jaafar, Dr Tan Wu Meng and Mr Yip Hon Weng for putting forward this Motion on advancing mental health, and highlighting the need for a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being.

I would also like to thank my colleagues who had just spoken, sharing on efforts in the health, social, education, workplace and community sectors, and many Members of Parliament who have supported the various mental health initiatives and provided suggestions for improvements.

I would also like to record my thanks to all the members of the task force, political office holders, people that we have consulted, community representatives, the Civil Service officers as well as the professionals that have contributed to not just the development of the strategy, but so much of what we have done since we launched the strategy to implement these programmes into action.

What is it that we are trying to do? What is it that we are trying to achieve?

As many colleagues have emphasised, mental health exists on a spectrum and requires a comprehensive approach involving the entire government and society. Instead of managing mental disorders only or solely, largely in hospital-based settings, the aim is to bring mental health support closer to individuals’ everyday environment, their homes, their workplaces, their social circles. By integrating care within the community, mental health support can be seamlessly delivered within natural social settings such as schools and workplaces, and leveraging existing social and support networks, such as families, friends and coworkers.

The National Population Health Survey in 2022 reported that our residents are more willing to seek help informally from their social circles than formally from healthcare professionals. By shifting the focus of our efforts, the centre of gravity into the community, by broadening the number of professions and processes that can be involved in mental health and by engaging larger and larger circles of the community, we are hoping to do a number of things in terms of changing what we do for mental health in Singapore.

The first of many, I will just highlight three, but the first is increasing access to our mental health services ecosystem. We want to be able to make it easy for people to find the help that they need and access the touchpoints that will provide them the interventions that they will find useful.

The second is to make sure that we make these interventions effective and certainly for persons with mild mental health concerns, or mental health conditions that are mild, care in the community, where they are able to continue to interact with their social circles, with their friends, with their family, with their workplace, have that normal routine of life, interventions in those settings may be more effective than removing the person from the natural rhythm of their life, institutionalising them and providing a very clinical response.

The third reason is that by involving a much wider variety of partners and more and more members of the community, we hope to be able to drive that shift in attitude that so many Members of this House have spoken about as being key to changing our approach towards mental health here in Singapore.

That is what we are trying to achieve and why we are trying to do this. How we are doing so, I will go on to explain some of the details, and in particular, the tiered care model.

This has been brought up by Senior Parliamentary of State Rahayu Mahzam, it has been a central part of the strategy and it has been discussed. I will highlight that this tiered care model is not something that we need members of the public to internalise or use as a guide to how they seek services. Someone with mental health concerns does not need to look at the strategy and ask, "Am I a Tier 1?" That is not the point. The tiered care model is an internal way of organising our services. It is an internal way of thinking how we will invest the development of our services, shift the development of our professional capacity and capability and integrate the various parts of our system with each other. But the reason we explain it and I will now explain it, is to really make the point that we are very serious about what we want to do. We are very serious about reorganising how we deliver our services and how we develop our capacity and our capability.

So, in explaining the breadth and depth of what we are doing, I will need to explain a little bit about how the tiered care model will be developed and implemented. It will guide the delivery of our mental health services according to the severity of mental health needs and apply across a variety of settings. It serves as a framework, a foundation for strategic enhancements to our mental health ecosystem, and our overall goal is to improve access to care and mitigate unwarranted medicalisation and to reduce stigma.

Because not every mental health issue needs to be addressed by a psychiatrist, just as not every medical condition needs to be treated as an inpatient by a specialist. So, as has been discussed, there will be four levels of mental health support, from mental health promotion, self-help and peer support at Tier 1, to the most intensive level of care in hospitals and by specialist clinics at Tier 4.

Based on the severity of symptoms, individuals can tailor care according to their needs. Individuals with severe symptoms of mental health conditions will benefit from hospital-based psychiatric and medical treatment. Those with mild to moderate symptoms are best supported by mental health practitioners in primary care and community settings. The majority of individuals, who may experience mental distress periodically without mental illness, could be best supported by peer supporters in schools or workplaces, as well as using self-help resources, including online. Overall, we aim to ensure that individuals with mental health needs receive the right support at the right time. This reflects a more nuanced and responsive approach to mental health.

Senior Parliamentary Secretary Eric Chua shared about the Practice Guide that is being developed by the Interagency Taskforce on Mental Health and Well-Being together with key stakeholders from the health, social and education sectors. This will translate the core concepts into practical steps to help practitioners effectively apply this tiered approach, make the framework work for their clients and for their patients, enhance the integration and coordination of our mental health support system. We have already put in place implementation teams, working groups and committees to execute our various plans and strategies. The processes in this Practice Guide will be piloted with some of the service providers and fine-tuned before being disseminated to mental health practitioners across our ecosystem by the end of the year.

GP clinics and polyclinics are important touchpoints for all of us, especially for individuals with mental health needs. They are community-based, they are easily accessible and we know that there is a strong association between physical and mental health conditions. So, the primary care service, the primary care doctor, the primary care clinic, is ideally placed to treat the patient’s physical and mental health conditions simultaneously and holistically.

Today, 19 out of the existing 25 polyclinics provide mental health services. These services at polyclinics are helmed by multi-disciplinary teams with family physicians, psychologists, medical social workers and nurses. In addition, over 450 GPs in GP clinics are trained to support persons with mental health needs under the Mental Health General Practitioner Partnership (MHGPP).

To ensure that more patients with common mental health conditions, such as anxiety and depression, have access to mental health services in a primary care setting, we aim to make these services available in all polyclinics and 1,350 HealthierSG GP clinics by 2030.

Expanding mental health support in the community beyond healthcare settings is essential. Today, 73 Community Outreach Teams (CREST) work tirelessly to raise awareness, to detect and to refer individuals with mental health needs to the appropriate services. Eight of these teams currently cater to youths. By 2030, we will expand the number of outreach teams to 90 and we will have 15 teams that cater to youths.

The CREST teams work on awareness, detection and referrals. We have another set of teams, which are the Community Intervention Teams (COMIT). They provide mental health assessments and psychosocial interventions. Today, we have 29 of such teams, and four of them cater to youths. By 2030, we will expand the number of these teams as well to have 50 COMIT teams, with 15 catering to youths. MOH is working with the AIC to publicise these services as well, so that more people can benefit from access to these community-based mental health services.

Other than expanding mental health services in primary and community care settings, we must also continue to ensure the safety and quality of services. I thank Dr Syed Harun, Ms He Ting Ru, Ms Rachel Ong and Ms Razwana Begum for their suggestion to introduce regulatory frameworks for psychologists and other professionals. I would point out that this space is not entirely a vacuum today. There are, indeed, some regulatory processes and frameworks in place.

Today, services provided by clinical psychologists in healthcare institutions are subjected to the clinical governance framework of these healthcare institutions and existing healthcare legislations, such as the Healthcare Services Act. In a non-healthcare setting, such as MSF-funded early intervention programmes, the operators do, indeed, employ mental health professionals, including clinical psychologists, to provide therapy services. And these funding agreements for these services specify the minimum qualifications and training required, before staff can be deployed to provide such services.

So, there are some regulatory frameworks in place, but Members have made the point that perhaps it is insufficient for our situation today, and potentially insufficient for the outcome of the shift that our national mental health strategy will engender.

Psychology practice is evolving and already encompasses diverse fields with their own unique safety concerns. So, MOH has been working already with agencies, service providers and professional associations to update the risk assessment – and that updating of the risk assessment will have to take into account then what developments occur in the field in the near future; review and study these findings; and study the possible need to regulate clinical psychologists.

So, I thank Members for their suggestions. There is, I think, not a consensus among the suggestions within the House from which professions need what type of regulation. So, we will study all the suggestions that are being made very seriously and look at these possibilities.

But beyond the regulation of clinical psychologists, building the competencies of other mental health practitioners and the community to effectively support individuals with mental health needs is another critical component of our strategy. So, we have introduced the National Mental Health Competency Training Framework to enhance the capabilities of practitioners across the various tiers of care, and this framework will complement existing professional standards for mental health professionals, such as psychologists and counsellors. It provides guidance to service providers in acquiring the necessary competencies which will then be aligned with the Tiered Care Model.

And importantly, this national mental health competency training framework is designed to be inclusive, and it encompasses all practitioners and individuals involved in mental health support. So, one single, national mental health competency training framework – from lay responders like peer supporters to mental health professionals like psychologists and counsellors.

As we step up our capability building efforts, a substantial pool of peer supporters and service providers across Tiers 1, 2 and 3 will have the necessary baseline competencies to support individuals with mental health needs over the next two years. So, we will equip a wide spectrum of practitioners, enhance the overall capability of the community to provide effective support for individuals with mental health needs.

But we will also engage peer supporters and frontline personnel that are not within the healthcare and social space. They will be trained to identify mental health needs and provide psychological first aid if needed. And so, the term is appropriate. Just as you do not need to be a healthcare worker to provide first aid, it is something that all of us can do. We want to train people to be able to provide psychological first aid, even if they are not a healthcare worker or a care professional.

Today, over 48,000 frontline personnel, including school teachers and officers from agencies, such as the Singapore Police Force (SPF), Housing and Development Board (HDB), Central Narcotics Bureau (CNB), Social Service Offices (SSOs) and Family Service Centres (FSCs), have been trained, together with 54,000 volunteers, to recognise and provide basic emotional support to individuals in need and to refer these individuals for further support as needed. The eventual goal is to extend this training approach to over 130,000 frontline personnel and volunteers by 2030. So, to have a broad network of support and individuals for mental health needs.

We have created the learning modules. AIC has worked on this and put it online; awareness of the signs and symptoms of mental health conditions, how to support individuals. They are accessible, they are open to the public. And there are courses that you can go for psychological first aid. So, caregivers for individuals with mental health needs may also find it beneficial to participate in these courses and enhance their ability to care for their loved ones, the care recipients.

The issue here is supporting individuals with mild symptoms of mental health conditions – how to identify the individuals, prevent an escalation of their symptoms and de-escalate a mental health crisis, formulating a safety plan for individuals with suicide risk.

Next to this, we have plans around what to do to support individuals with moderate symptoms of mental health conditions. For that, service providers are trained to conduct mental health assessments and provide psychotherapy. So, we distinguish those 130,000 frontline personnel and volunteers focused on mental health needs of people with mild conditions and then a separate tier of interventions for individuals who can support people with mental health needs that are moderate in nature, with moderate symptoms – providing assessments, psychotherapy to reduce the severity of their symptoms.

To raise the capabilities of these practitioners, MOH and the Ministry of Social and Family Development (MSF) are collaborating with NUS, Nanyang Technological University (NTU) and Singapore University of Social Sciences (SUSS) to develop an onboarding course for practitioners providing Tier 3 support to equip participants with skills to provide Cognitive Behavioural Therapy (CBT) for a range of common mental health conditions, including depressive and anxiety disorders, schizophrenia, obsessive compulsive disorders and insomnia. We aim to upskill 80 practitioners a year through these courses starting from this year. This is part of our commitment to proactively upskill practitioners in the community to effectively support individuals with diverse mental health needs.

Mr Keith Chua, Ms Mariam Jaafar, Mr Yip Hon Weng and Mr Vikram Nair highlighted concerns about persons with suicide risk. The causes of suicide are multifaceted and it requires a holistic, multi-agency approach to address them. For example, in schools and Institutes of Higher Learning (IHLs), students at risk of suicide are supported by school counsellors, referred to the Response, Early Intervention and Assessment in Community Mental Health (REACH), Community Health Assessment Team (CHAT) or emergency services in hospitals. CareLine, a 24/7 social support hotline, provides tele-befriending as well as emergency response services to seniors in distress and it is operated by staff who can speak various dialects.

Those in crisis can access crisis helplines, such as the Samaritans of Singapore (SOS)’s Hotline and Care Text and IMH’s Mental Health helpline. Under the National Mental Health Competency Training Framework, service providers in the community would be equipped with suicide risk assessment and intervention skills, so that individuals with suicide risk can be detected early and be provided with the relevant interventions. But we will continue to work on this and find ways to do what we do better and to make sure that every individual who needs help can find it.

As a safety net to meet the care needs of individuals with severe and chronic mental health conditions, MOH will be expanding our hospital and our long-term care capacity, and this will be supported by plans to expand the pool of psychiatrists and psychologists in our public healthcare institutions (PHIs), as has already been shared.

So, the balance of that capacity increase will be different, depending on whether we are talking about inpatient psychiatric beds at places like IMH and the redeveloped Alexandra Hospital, and compared to, for example, long-term psychiatric care capacity. We hope that with all the things that we are doing with our mental health strategy, while we will increase inpatient acute psychiatric capacity, the need for that will not be so significant because of the things that we are doing upstream in the population and in the community. But we will continue to need some increase in facilities in long-term psychiatric care capacity.

Today, we have almost 1,000 acute psychiatric beds. By 2030, this will be 1,070. Today, we have 3,000 step-down residential care beds – long-term psychiatric care facilities – and by 2030, we will have 3,500 of such beds. So, the balance is on the long-term residential psychiatric care.

So, even though we are expanding our capacity to provide mental health support for persons with severe mental health needs, it does not mean that we are adopting a purely medicalised approach towards mental health. There is room for non-medical interventions, such as art-based interventions, to play a bigger part in promoting mental well-being. To cultivate mental wellness, we need to live healthily. That means having friends, having adequate sleep, a healthy diet, taking part in sports, arts and volunteer work. These are not medical interventions, but they make a huge difference to an individual’s life and a huge difference to an individual's health.

The National Mental Health and Well-Being Strategy puts forth a comprehensive and holistic approach to addressing mental health issues across many different facets of society. It encompasses a preventive component as well as curative perspectives. We want to tackle the whole continuum of mental health issues coherently, with an emphasis on community, schools and workplace settings. We want to foster a whole-of-society approach, uniting efforts across different sectors to build a mentally healthy and resilient population.

After we launched the strategy last year, in late 2023, we have continued to engage with professionals and stakeholders in the space and we have sought their feedback on the strategy and how the implementation was going. All of them supported the strategy recommendations, but consistently, all of them – professionals working in the mental healthcare space, whether they are healthcare workers or they are social workers in the community and within institutions – consistently raised concerns about persistent stigma and the need for stronger partnerships; the need for stronger partnerships between clients and providers, but also partnerships across different service providers. It is very important that we must not forget these fundamentals even as we talk about all the other things that we are doing around the implementation of the strategy. And we will continue to address these issues as we go forward.

There are many initiatives rolled out by the various Ministries and agencies to support individuals with mental health needs. Ms Carrie Tan asked about the need to transition the current interagency task force to a permanent national well-being committee. We have a plan for a whole-of-Government coordination, which is the National Mental Health Office, which we will establish by 2025 with officers from the health, social and the education sectors to oversee the implementation of the strategy to ensure cohesive alignment of policies and programmes at the national level, and to track the progress and impact of the strategy.

Actually, these teams and these officers have already begun work. They began work in supporting the work of the Inter-Ministry Taskforce, they are the ones that worked together to put the strategy in place and they are already working together to implement our various programmes and recommendations. So, the work will continue, and the work is not done. Members have highlighted issues that we have to continue to study, whether it is about the regulation of some professionals, issues to do with how insurance is made available, issues to do with stigma and access. So, we are quite clear that the work is not done and there is need for continued work in this space.

And I would like to thank all the Ministries and agency officers who have come together to better support and advance the mental health and well-being of our population. The collective dedication and commitment of our Government agencies and the whole of our society are instrumental in driving positive change and fostering better mental health for all. [Applause.]

Mr Speaker: I would like to invite Dr Wan Rizal to make his closing speech.

1.58 pm

Dr Wan Rizal (Jalan Besar): Mr Speaker, on behalf of the Government Parliamentary Committee for Health, Dr Tan Wu Meng, Ms Mariam Jaafar, Mr Yip Hon Weng and Mr Edward Chia, I extend our profound appreciation to all Members who have actively participated in this pivotal debate.

I was deeply moved by the stories and struggles shared in this Chamber. In fact, I was crying when one of the stories was being shared about suicide. Over the years, I have heard many, many stories, but to hear from you, from all of you, shows how much we care for the communities we serve. Thirty-one Members of the House took part in this Motion, including Deputy Prime Minister Lawrence Wong, showcasing the undeniable importance of mental health in our lives and society.

The voices of the Nominated Members of Parliament, with their unique insights and connections to the communities they serve, have been particularly striking. Their contributions have not only enriched our debate but have also underscored the urgency of addressing mental health with compassion and action.

Mental health is everyone's business, and I am glad that everyone agrees that business as usual is no longer acceptable. The diversity of topics discussed, spanning different sectors and age groups, has highlighted our collective understanding that mental well-being cannot be compartmentalised. In our spirited discussions over the last two days, we have delved deep into the myriad aspects of mental health, from increasing understanding and literacy to tackling the practicalities of cost, insurance and the critical support for caregivers.

Yet, amidst all these important conversations, one subject has notably stood out, touching the core of our humanity – shared by Dr Janil Puthucheary too earlier – which is the stigma surrounding mental health. It is not just a societal issue. It is profoundly personal, affecting individuals and families in every corner of our community. The stigma mutes voices that need to be heard. It isolates those who feel alone in their struggle and deepens the wounds of those silently suffering.

The story shared in our debate have underscored the urgent necessity to breakdown these walls of silence and isolation and our mission is clear to foster a society where conversations about mental health are met with open arms and understanding hearts, not judgment. We need to cultivate an environment that encourages everyone to seek help about fear to talk openly without shame. The mission spans across every facet of our society, from our schools to our workplaces, from our healthcare institutions to the very fabric of our communities.

Sir, as I speak about stigma, we cannot overlook the heroes often in the shadows too – the caregivers. Their journey of is one of love, resilience and sometimes, silent struggle. They face their own set of challenges, bearing emotional and financial burdens all the while navigating the stigma associated with mental health. In one of my many conversations I had with the community, the caregivers often come forth and shared their challenges and really hope that through this strategy, our efforts would support them further.

Sir, mental health is an issue that touches all aspects of life, requiring a united, inclusive approach. The Government's response, led by Deputy Prime Minister Lawrence Wong, no less, is deeply appreciative and highly encouraging.

I would like to thank Senior Minister of State Dr Janil Puthucheary, Minister of State Gan Siow Huang, Senior Parliamentary Secretary Rahayu Mahzam and Senior Parliamentary Secretary Eric Chua, for their comprehensive reply. It is a testament to our Government’s unwavering commitment to advancing mental health care in Singapore.

But more than policies and plans, the debate that we had, has been a powerful reminder of why we do what we do. It is about people we serve, the lives we hope to improve and the community we wish to build, a Singapore where mental health is a priority for everyone.

The strategy that has been laid out is just the beginning. It is a promise of action, a roadmap towards a future where every Singaporean knows they are not alone in their struggles. As we move forward, let us remember that our efforts today are for the long term. The impact of our work might not be immediately visible, but we are planting seeds for a future where mental health is openly discussed, supported and prioritised.

As we look ahead, I invite every Member of this House to stand with us in this commitment. This is more than just a Motion. It is a pledge to our fellow Singaporeans that their well-being is our priority. The journey may be long and challenging, but it is a journey worth taking together.

By supporting this Motion, we are choosing to be part of a compassionate community that recognises the importance of mental health and well-being. I can assure you, as members of the Government Parliamentary Committee of Health, we will continue to pursue this effort on mental health, ensure that the strategy is being implemented. We are committing to a future where everyone feels supported, valued and understood.

Let us seize the opportunity to make a lasting difference in the lives of our people. I urge you, Members of this House, to support this Motion, not just for the health of our nation but for the well-being of every individual who calls Singapore home. May our commitment and sustained efforts towards mental health lasts. Together, we can and we will make mental health and well-being a reality for all. We will take action. [Applause.]

Mr Speaker: Are there any clarifications for Dr Wan Rizal? Ms Usha Chandradas.

2.05 pm

Ms Usha Chandradas (Nominated Member): Mr Speaker, I have a clarification for Senior Minister of State Janil Puthucheary if I may?

Mr Speaker: Go ahead.

Ms Usha Chandradas: Senior Minister of State Dr Janil Puthucheary, I would like to clarify what is MOH's position on the regulation of art psychotherapists. The Senior Minister of State have acknowledged that art interventions are an important part of our mental health and wellness strategies. But I would like to clarify: will the Ministry be engaging with arts wellness practitioners as well as our arts therapies communities to further this strategy?

Dr Janil Puthucheary: Mr Speaker, I thank Ms Usha Chandradas for the question. We will be very happy to follow up with her and other practitioners to look to see how we will engage with the practitioners, provide for an appropriate level of access, depending on the effectiveness of the various components of the intervention.

As has been brought up in the House, actually, Members have differing views as to how far regulation should go – which professions should be regulated, which interventions should be regulated, which settings should be regulated. It is something that we are studying and we will be very happy to study it together with the professionals involved in the space.

Mr Speaker: I am sorry I missed your hand just now, Ms Usha Chandradas. Any other Member has any clarifications? Yes, Ms Carrie Tan.

Ms Carrie Tan (Nee Soon): Speaker, I would like to seek clarification from Deputy Prime Minister Lawrence Wong. When he articulated that the National Mental Health Office will continue to drive this effort, may I ask whether it will residing with MOH and if so, how will how will the Prime Minister's Office (PMO) ensure that the well-being initiatives and policies are well-coordinated across Ministries? Because, for example, education policies will have an impact on manpower and manpower policies can have an impact on family life – and all these contribute to the levels of stress and bandwidth and all that.

Mr Speaker: Deputy Prime Minister Lawrence Wong.

Mr Lawrence Wong: Mr Speaker, it still resides in MOH. The coordination office and function is in MOH. But rest assured that it will be empowered to effectively coordinate across the whole-of-Government.

2.08 pm

Mr Speaker: Any other clarifications from any Member? No.

Question put, and agreed to.

Resolved, "That this House recognises the importance of mental health as a health, social and economic issue; affirms the importance of a robust national mental health ecosystem; and calls for a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being."