Clinical Pathways Linking Schools and Primary Care to Emergency Departments for Adolescents at Risk of Self-harm

14 Dr Wan Rizal asked the Coordinating Minister for Social Policies and Minister for Health (a) what standard clinical pathways link schools and primary care to emergency departments for children and adolescents at imminent risk of self-harm; and (b) whether the Ministry will set coverage targets for gatekeeper training and pilot a 24/7 paediatric crisis line integrated with mobile crisis teams.

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Coordinating Minister for Social Policies and Minister for Health): Mr Speaker, my response will also address written Question No 17 in today's Order Paper and a similar Parliamentary Question filed by Dr Wan Rizal¹ for a subsequent Sitting. If the questions have been satisfactorily addressed, it may not be necessary for the Member to proceed with the question for future Sittings.

Sir, suicide is a complex phenomenon. Apart from warning signs, the assessment of suicide risk takes into account individuals' thoughts and behaviours. These are incorporated into the Practice Guide for the Tiered Care Model for Mental Health which guides mental health service providers on how to assess suicide risks and determine the appropriate follow-up actions.

Like other mental health service providers, school counsellors are trained to conduct suicide risk assessments. Students at imminent risk are directed to hospital emergency departments, while those with non-imminent risk are referred to the Response, Early intervention and Assessment in Community mental Health (REACH) teams for further assessment and intervention. The Ministry of Health (MOH) and Ministry of Education (MOE) do not currently track the data from school alert to first clinical contact.

The national mindline 1771 serves individuals of all age groups, including children and youths, by providing brief counselling and referrals to other mental health services where needed, including crisis response teams. Frontline personnel and volunteers in various sectors have access to basic mental health training to help identify individuals in psychological distress and refer them for further support. As of March 2025, about 140,000 frontliners have been trained.

MOH will continue to work with relevant agencies to work on ensuring timely support of individuals with suicide risks.

Mr Speaker: Dr Wan Rizal.

Dr Wan Rizal (Jalan Besar): Sir, I thank the Senior Minister of State for sharing on this issue with regard to suicide and the workflow. To be honest, I want to express my thanks to the counsellors, the school educators and of course, everyone involved in this mental health space because working with youths is really not easy. It is certainly complex and requires some dedication in that regard.

But having said that, I do believe that we need a national crisis pathway and in so, we need a key performance indicator (KPI) that will be distinctive enough for us to ensure that the timely intervention is set. Because right now, we do not have a particular KPI. May I suggest that the Ministry consider this and put this as part of our crisis pathway?

And having said that, will this pathway flowchart be issued and publicised so that it can be used across the different organisations, whether it is in schools, whether it be in the hospitals, whoever is doing the crisis intervention? We need to have the data to be properly accessed when an imminent risk occurs.

Dr Koh Poh Koon: Sir, I thank the Member for his concern on youth mental health and indeed, as he said, it is a complex issue and – as in my previous response to Member Vikram Nair as well – it is not something you can force onto the youths. They have to be encouraged to come forward and be open about sharing and discussion.

In terms of KPIs, based on what I have just explained about the complex process, about even getting someone to begin to seek help, it is therefore probably not very practical and it is difficult to set a downstream KPI. Because how soon the person is prepared to step in to receive care, how well they respond to that conversation with their counsellors or their doctors, it is really very much individualised. It will be quite difficult to set a KPI that artificially constrains what the counsellor or the interventionist needs in terms of having time to build a rapport, and build trust and understanding. So, it is a journey that must be taken between the counsellor and the patient or the youth.

What we have done is to make sure that at the very upstream, we want to make sure access to care is readily available and that there is no barrier to entry for any youth who is prepared to come forward and seek help. That is why this is the true value of our first stop for mental health, the national mindline 1771. It is meant to be something that can be anonymous so that it does not add that stigmatisation or the fear of the youths of having to see someone face-to-face which they may not be comfortable with. They can pick up a call, speak to a counsellor in a non-judgemental way and without asking them for their identity, to just seek very simple consultations and get counselled, to help them get through the immediate emotional distress that they may be feeling. And if they feel comfortable with the counsellor talking to them and they are prepared to look for a connection to a physical contact point with social services, this is where the counsellor can then try and link them up with someone that may then take the conversation and the relationship further in the physical space.

So, the whole idea is to create options that the youths can access. Those who may be more comfortable with using, say, text messaging and WhatsApp, can also use the WhatsApp function, the text messaging function on the mindline portal. We are just trying to provide a lot more access and options so that there is absolutely no reason why the youths who are prepared to step forward and seek help, will be deterred from it. That is something that we hold ourselves to, to try and provide and to do more in this area.

In terms of flowchart for assessment and escalation, in the practice guide, we actually graded our interventions into four different tiers, from tier one to tier four, from lower equity, those who are mentally well, that needed some education to tier four, where there is more of a crisis intervention at the acute care setting, for example, in the Institute of Mental Health (IMH). This entire practice guide also includes a flowchart, as the Member has asked for, that helps care providers, counsellors of different grades and across the whole spectrum of mental health interventions, to see at which point they need to escalate to the next level and to guide them on the appropriate pathway to take, including certain eligibility criteria, certain guides that they can follow so that there is some degree of standardisation and that also forms as a basis for communication across different care providers.

1.02 pm

Mr Speaker: Order. End of Question Time. Senior Minister of State Sun Xueling, do you have a clarification to make?

[Pursuant to Standing Order No 22(3), provided that Members had not asked for questions standing in their names to be postponed to a later Sitting day or withdrawn, written answers to questions not reached by the end of Question Time are reproduced in the Appendix.]