Expand Powers under Mental Health Act to Allow for Intervention when Relatives Do Not Allow Patients To Receive Treatment

11 Mr Murali Pillai asked the Minister for Health whether the powers under the Mental Health (Care and Treatment) Act may be expanded to provide intervention for the benefit of mentally disordered persons under the care of relatives who do not allow these persons to receive psychiatric treatment even though these relatives do not ill-treat or neglect such persons within the meaning of section 8(1) of the Act.

The Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam) (for the Minister for Health): The Mental Health (Care and Treatment) Act or MHCTA allows for the state to intervene for persons with or suspected of having mental health conditions and who may be a risk to self or pose a danger to others. The Police can apprehend the person and take him or her to a doctor for an assessment or bring the person to a psychiatric institution for treatment. The processes that are empowered under MHCTA apply, even if the person declines to seek treatment on his or her own accord, or relatives refuse to bring the person to receive psychiatric treatment.

Nonetheless, MOH's approach is to intervene early and reach out to the persons who are facing mental health issues and their families to encourage them to seek help voluntarily, before there is a need to enforce mandatory psychiatric evaluation and treatment. MOH has worked with Agency for Integrated Care (AIC) to develop services to support persons with mental health conditions under the Community Mental Health Masterplan. AIC acts as a "first touchpoint" for agencies, service providers and members of the public to refer persons suspected to have mental health conditions and not receiving the treatment they need for further support. AIC, with the support of relevant stakeholders, could refer such persons to the appropriate medical and social services.

To actively reach out to community to provide early identification and community support for persons with mental health needs, AIC has set up 43 community outreach teams and trained over 24,000 frontline staff from Government agencies and community partners across Singapore as of end 2019. These teams have reached out to over 300,000 persons and provided assistance to more than 23,000 persons who were at risk of developing mental health conditions or dementia.

Nevertheless, MOH recognises that there is a need to better support persons with, or suspected with, mental health needs and displaying challenging behaviours in the community. MOH is currently reviewing the enablers for the community support required which include the current legislative levers.

We would like to urge Members and any member of the public that if they come across any person with mental health needs, to contact the Institute of Mental Health (IMH)’s 24-hour mental health helpline (6389 2222) or AIC’s Care-in-Mind (careinmind@aic.sg) for assistance.

Mr Murali Pillai (Bukit Batok): Mr Speaker, Sir, I thank the hon Parliamentary Secretary Ms Rahayu Mahzam for her comprehensive answer to my question. With your indulgence, Mr Speaker, Sir, on a point of elucidation, I wish to state that I filed this Parliamentary Question arising from my tracking of a case involving my resident and attended to by the AIC's Community Mental Health Division, Fei Yue's Community Intervention Team (COMIT), MOH's Mobile Crisis Team (MCT) and Adult Neuro-developmental Disorder Service (ANDS), MSF's Adult Protective Services (APS), HDB as well as my community leaders. The case involved a mentally disordered young man whose parents refused to allow him to be treated by IMH as they believe in religious and spiritual intervention.

The final report from AIC was that if the family refuses to cooperate, there cannot be any intervention under the current legislative landscape because he is physically well taken care of and he does not pose a safety risk. I was advised to tell the neighbours to file a complaint with the Community Dispute Resolution Tribunal (CDRT) as the young man screams very loudly in the middle of the night from time to time. Respectfully, I do not think this advice, though well-meant, is useful.

I am glad to note the hon Parliamentary Secretary has indicated that MOH is willing to review the legislative landscape. While waiting for the review, would MOH be prepared to direct its agencies to engage and work collaboratively with the spiritual and religious healers? And in this regard, I would like to offer that the researchers at IMH, led by Prof Chong Siow Ann, in 2012 and 2016, opined that there is a significant treatment gap in Singapore, with more than three quarters of mentally disordered persons not seeking professional help and 24% of people who seek some form of help go to religious and spiritual healers.

Ms Rahayu Mahzam: I thank the Member for the question as well as the extensive feedback and I am grateful for the acknowledgement given to all the different partners involved in resolving the particular issue that he was faced with. MOH is aware of the concerns that the Member has raised and, in particular, that case. We definitely need to look at how to better support persons with or suspected with mental health needs and displaying challenging behaviours in the community as well as the people around them.

Indeed, this is a work in progress. In 2012, MOH launched the Community Mental Health (CMH) Master Plan to further strengthen mental health care in the community and enable persons with mental health needs to be well supported. In 2017, we announced that the Government will be further enhancing and expanding mental health services over the next few years. So, it is work in progress.

AIC, as the Member has mentioned, has established Community Intervention Teams to support general practitioners, GP partners and service providers with allied health services, such as psychotherapy and counselling. As of end 2019, over 26,000 persons had been supported by these teams.

We have also started mental health and dementia services in more than half of our polyclinics and trained over 210 GP partners to diagnose and support persons with mental health conditions. So, a lot has been done and a lot will continue to have to be done. And it is, indeed, important to enhance these efforts.

I would just like to highlight that we have actually been working very closely with the health care institutions, community health partners, Government agencies like the Police, HDB and grassroots organisations to build up community networks to better support and manage persons with mental health conditions in the community.

So, the suggestion that the Member has raised about working with religious partners is something that we can definitely look into. And we definitely need to look into enhancing the awareness and support.

As I have mentioned, MOH is already reviewing the enablers for the community support. We will take the Member's feedback and input into consideration during this review and assess the appropriate approaches and recourse that we can take to address such cases in the community.

Ms Carrie Tan (Nee Soon): I thank the Parliamentary Secretary Rahayu Mahzam. I have further questions for MOH. Does the Ministry have any data about the recovery rates and outcomes of mental health patients currently receiving existing types of treatment through the methods employed by IMH? Second, will MOH consider exploring or supporting research into alternative treatments or rehabilitative care methods for mental health patients, including, possibly, TCM or other alternative medicines?

Ms Rahayu Mahzam: I thank the Member for the question. The details which the Member has asked for, I will need to check and, if the Member wishes, she can file another Parliamentary Question asking specifically for the data.

In respect of considering alternative treatment, this is work in progress. We are all still new at this and we are all looking at how to better address this situation as a community. With inputs from community partners and people in the sector, we can continue to build on this. I do not believe this is a closed option. But we definitely need to look and find out if the approaches that we are taking will actually meaningfully help address the situation. So, this is something that I can take back. But we hope to also get support from the community with the existing measures that we already have in place to help address the situation as we build towards strengthening the support that we are giving to the partners.