Mental Health in Singapore: A Quiet Revolution?

The financial coverage under the present healthcare system stresses on individual responsibility; it is based on a system of compulsory medical saving accounts and market forces. This system puts people with mental illness at a disadvantage and results in disparity of medical coverage. The causes of most mental illnesses like autism, schizophrenia, bipolar disorder, obsessive compulsive disorder are still unknown, so primary prevention is not possible. Some of these illnesses also strike early in one’s life – before the individual can join the workforce, and the resulting disabilities may lead to academic and vocational impairment with consequent chronic financial difficulties. Employers often discriminate against mentally ill people. Research has established that mentally ill people are at a significantly higher risk of having lower educational attainment, living in poverty and a lower socioeconomic status. 7 Many mentally ill people in Singapore do not have Medisave accounts, and Medishield excludes those with mental illnesses and personality disorders, leaving many to rely solely on Medifund (a default support mechanism). Not surprisingly, patients at the Institute of Mental Health, the only state mental institute and Singapore’s largest provider of mental healthcare, receive proportionately the most Medifund across all the restructured hospitals. To my knowledge, there is no private medical insurance company that provides cover for mental illness. There are a number of reasons for this sorry state. Throughout history, stigma has clung tenaciously to mental illness, and among its various consequences, it prevents people with mental illness from studying, working and socialising in their community. Stigma makes the public less willing to pay for mental healthcare. It makes the public fearful – many believing that all people with mental illness are dangerous and should be locked away. 8 This stigma also tinges the mental health professionals. As the pathogenesis and pathophysiology of many mental disorders are still unknown, it makes mental healthcare vulnerable to perception that it is “not so scientific”. We have yet to understand the biological substrates underlying