community services

Question 1

children and adolescent

Answer 1

School based:

• School counsellors
• Allied educators — ADHD, autism, special needs etc
• Peer Support Programme/Buddy systems
• REACH

Hospital based:

• Child Guidance Clinic: HPB, IMH
• Other hospitals/services: KKH, NUH, SGH (ED), EPIP (FEP), NAMS (gaming addictions etc)

Community based:
- Generally: Family Service Centre (FSC), Care and Corner Counselling, Club Heal, Singapore Children’s Society

• BEYOND Social Services (VWO that helps raise disadvantaged children and youths)
• Community Health Assessment Team (CHAT)
  National youth mental health outreach and assessment service for youth and young adults aged 16 to 30.
  Located in SCAPE, also provides video consultations
• REACH [Response, Early Intervention and Assessment in Community Mental Health]
  Consultation liaison service to schools and partnering with trained GP/family doctors and voluntary NGOs
• SAMH (Singapore Association for Mental Health) YouthReach
  Age 12-21
  Services: Counselling, case management, family psychoeducation, expressive therapies, psycho-social activities

SHINE (under MSF)
ResiL!ience: outreach/psychoeducation, mental health screening, basic emotional support, peer support, caregiver engagement
Educational Psychology — ID/learning difficulties

Tinkle Friend (under Singapore Children’s society)
Age 7-12
A toll-free helpline that provides support, advice and information to primary school children in distress, especially in situations when their parents or main caregivers are unavailable

TOUCH community services/ TOUCH Youth Intervention (TYI)
Individual assessment, support groups, family therapy, parenting courses
TYI runs Help123, the National Cyber Wellness one-stop service
DigitalMINDSET: 9mo programme for youths aged 12-21 for mental health issues from excessive gaming and device use
SPARKX: targets preventing children from engaging in delinquency behaviors in adolescence

Question 2

what is the president challenge this year?

Answer 2

The President’s Challenge-IMH programme will serve as an “important bridge” between hospitalisation and home-care for youths with mental health issues, she added.

its called Supporting Youth in Community
(SYiNC) programme

IMH will curate and provide a set of common training to the four SSAs (social service agencies) to equip them with the necessary skills to manage the referred youth cases from IMH

 Club HEAL (Youth Mental Health @ Club HEAL)
 Singapore Association for Mental Health (Youth X-Miles)
 Singapore Children’s Society (Oasis for Minds Services)
 TOUCH Community Services (Youth-Clusion)

The programme will serve youth with mental health conditions between 13 and 19 years old who sought help at the IMH emergency room but were not admitted although they may still require some community support. It will also support youths who were discharged from the psychiatric ward or were receiving follow-ups in the specialist clinics.

Question 3

How many people are lost to suicide in Singapore

How many are elderly

Answer 3

452 lives were lost to suicide in 2020

Among people aged 60 and above, a total of 154 took their own lives.

Question 4

The Interagency Taskforce on Mental Health and Well-being said there are 4 areas to target which are:

Answer 4

1) there is a need to strengthen family support and services for parents and youth.
2) mental health literacy among citizens must be improved
3) there is a need to provide and boost access to mental healthcare by integrating health and social services.
4) there is a necessity to provide employment support for those with mental health conditions

Question 5

ID/learning difficulties:

education support

Answer 5

-Early Intervention Programme for Infants and Children (EIPIC) centres
Aim: to increase developmental growth potential of the child, minimise the development of 2’ disabilities, and maximise integration in mainstream setting
Criteria: birth-6yo; assessed by a paediatrician to be at risk of a developmental, intellectual, sensory or physical disability, or a combination of disabilities

Specials education (ID: APSN Delta Senior School, AWWA, Grace Orchard, Metta School, MINDS, Rainbow Centre
ASD: mainstream, Eden, Pathlight or St Andrew’s Mission School
SPED school)
Vocational schools: Mountbatten

Question 6

ID/learning difficulties:

job support

Answer 6

• Courses: SGEnable, Skills Future
• Grants/subsidies: Mediacorp Enable Fund, SkillsFuture Credit, Workfare Skills Support (WSS) Scheme
• Job placement/matching SGEnable, Public Service Career Placement (PSCP)
• Employers: Open Door Programme (ODP) funding support for sending employees with disabilities for training
  Hospital-2-Work (H2W): CM support in gainful employment
  Discrimination? – MOM Employment Act/Workright Initiative, lodge report with the Tripartite Alliance for Fair Employment Practices (TAFEP)

Question 7

Other ID/LD community support

Answer 7

6mo-6yo: early intervention centre, learning/development support programmes, kindle garden
School-going: AWWA school (2 in SG), after school care, community integration programmes (SMILES)
Adults: adult disability homes and day activity centres, home personal care services, rehab, day care centres

Metta Welfare Organization
Children care, early intervention services
Vocational training and supported employment for youth
Day activity centre, respite and residential care for adults with ID

MINDS
Children: 4 SPED schools, aftercare, enrichment programmes
Adults: supported employment, social enterprise, training centres
Residential care: MINDSVille
MeToo!: to enhance social inclusion, build comm skills, ↑ inclusivity
Caregivers: workshops/training, respite care, Future Ready (care planning – coming soon)
Minds Clinic: health screening, MCA assessment for deputyship

Thye Hua Kwan
Home for Disabled (few locations), Children Therapy Centre, Early Intervention for Children (EIC), Autism Centre

Question 8

What are the trust and savings options for person with learning disabilities

Answer 8

Special Needs Trust Company (SNTC) is a non-profit trust company set up to provide trust services for persons with disabilities. SNTC will assist parents or caregivers to set up a Trust account to manage and disburse monies to meet the needs of their children with disability.

1) care plan
A Care Plan drawing up possible alternative care arrangements and the financial requirements are worked out for the person with disability in the event the primary caregiver is no longer able to provide the care and support.

2) SNTC trust

3) SNSS
The Special Needs Savings Scheme (SNSS) encourages parents of children with special needs to save up for their long-term care needs. Under this scheme, parents can nominate their children to receive monthly disbursements from the parent’s CPF savings after the parent’s demise.

Question 9

Dementia hospital support

Answer 9

Aged Psychiatry Community Assessment and Treatment Service (APCATS)
CARITAS Network: KTPH —? Not sure if still in place
Community Psychogeriatric Programme (CPGP) CGH
Geriatric Psychiatry Out-Reach Assessment Consultation and Enablement (G-RACE) NUH
Memory Clinics/PsychoG across various hospitals
Nursing home visits by psychogeriatricians

Question 10

Dementia community support

Answer 10

Generally: Agency for Integrated Care (AIC), COMIT, CREST

Alzheimer’s Disease Association — now renamed Dementia Singapore
Social activities, art/meal outings, self-advocacy groups
Daycare called New Horizon Centres (multiple locations)
Post Diagnostic Support (PDS): psychoeducation, individualised plan + comm support
Caregiver support groups and workshops
Apps (CARA, DementiaHub) — refer to articles below

Befriending services: AIC, Brahm Centre, Health Hub, Lion, REACH, TOUCH

Daycare — dementia vs non-dementia: AWWA (The Asian Women’s Welfare Association), Lions’ Home, OVNH, NTUC, St Luke’s Eldercare, The Salvation Army

DementiaHub.Sg
Online platform launched in Sept 2021 for those with dementia and their caregivers as well as a new app that helps with the early detection of pre-dementia symptoms

Funding
Assistive technology fund
EASE: for home modification
Eldershield: long-term care insurance scheme to help meet expenses for severe disability, especially during old age
Silver Support (SS) Scheme: quarterly cash supplement to seniors who had low incomes during their working years

Integrated Dementia (Home-based) Assisted Living
Launched in 2022, refer to article below for list of facilities
Includes activity room, telehealth services, assistive technology

Question 11

What are the funding support for elderly (3)

Answer 11

Funding
Assistive technology fund
EASE: for home modification
Eldershield: long-term care insurance scheme to help meet expenses for severe disability, especially during old age
Silver Support (SS) Scheme: quarterly cash supplement to seniors who had low incomes during their working years

Question 12

Support for HIV psych

Answer 12

Support for HIV psych
Primary +/- secondary:
Education, outreach at school and community-based levels (safe sex education, awareness campaigns eg World Aids Day, government organisation led advertisements/public service messages)
Sexual health screening and counselling for men and women eg at HPB, DSC clinic (anonymous testing), restructured hospitals
Anonymous and mobile testing services
PEP and PREP services at the abovementioned clinics
HIV Psychiatry service eg in TTSH – ID/Psychiatry within same clinic, encompasses MSW as well

Action for AIDS singapore
Anonymous and mobile testing service
Individual counselling, support groups
Outreach programmes (for heterosexuals, MSM), advocacy and fund-raising programmes
Blueprint to end transmission of HIV by 2030

Catholic AIDS Response Effort (CARE)
Spiritual, emotional, psychological support to people living with HIV/AIDS (PLWHA), financial support
Shelter home for male PLWHAs
Raising public awareness

Question 13

Hoarding , how to help

Answer 13

Community-based support:
Generally: FSCs, SAMH, Singapore Anglican Community Services (SACS) for home visits, persuade to seek psychiatric help
Habitat for Humanity – cleaning services

Government agencies:
Highlight to HDB, town council and grassroot leaders; limitation – requires the individual’s consent to intervene
SCDF only agency with legal power to intervene without individual’s consent to assess for fire hazards
NEA – for removal of animals/pets
Generally a mediatory approach preferred over forceful approach

Hoarding Task Force
Multiagency taskforce including all of the above, MOH, MSF, and IMH
Limitations: scope of taskforce remains unclear, not well known within the community, channels to report not well known, relatively limited powers for intervention within private property

Handling disputes between neighbours:
Community Mediation Centre
Community Dispute Resolution Tribunals: to resolve any dispute, but again limitation is all parties must be consent to allow for mediation of dispute

Question 14

LGBTQ service

Answer 14

Community based support
Oogachaga: counselling, outreach work
Pink Dot: annual event advocating for LGBTQ rights, spreading acceptance
Project X: advocacy group for transgenders working in sex industry
The T Project: for transgenders – counselling, shelter
TRANS Befrienders – peer support service
Kopitiam brothers for transmen for social support
The purple alliance, agourp that aim to empower LGBTQ folks

Hospital based support
Gender Care Clinic – IMH – Dr, psychologist assessments
Dr Tsoi WF private clinic – pioneer in transgender psychiatry, does hormone reassignment therapy
Endocrine clinics across RHs – gender reassignment, hormone therapy etc

Question 15

Suicide support

Answer 15

Hotlines: Samaritans of Singapore (SOS), IMH crisis hotline
Bereavement support groups – SOS, Healing Bridge, Grief Matters
Outreach to suicide survivors – SOS (calls/emails/care cards)

Question 16

Violence in family support

Answer 16

Hotlines: National Anti-Violence and Sexual Harassment Hotline (NAVH), AWARE, 999- call the police!

Association of Women for Action & Research (AWARE)
Case management, counselling, legal advice, Befriending and assistance to women in need, research, advocacy for women rights

PAVE Family Violence Specialist Centre
One-stop integrated community-based service for individuals and families experiencing violence
Scope: PPO assistance, casework/counselling

Other FVSCs: TRANS SAFE, Care Corner Project StART

Big Love Child Protection Specialist Centre
Help families with child protection concerns and for families to improve their functioning & resilience
Case work, risk assessment, home-based parenting, family bonding events

Crisis shelter homes for victims – approach FSC or police for this, temporary relocation

Ministry level: Ministry of Social and Family Development (MSF)
Working with FSCs on marriage counselling, parenthood preparation, anger/conflict management, financial support
Adult and Child Protection Services
Community Guardian App (CGA) – for trained grassroot leaders/volunteers to quickly find first responders to investigate alleged abuse
Training of professionals in community setting (eg teachers, social service staff) to manage reports of suspected abuse
Outreach, eg Break the Silence Campaign – encourage public to report instances of family violence

Question 17

Migrant workers

Answer 17

COVID-19 Migrant Support Coalition (CMSC), under Ray of Hope
Ground-engagement activities within dormitories – keep them company, ensure adequate meals and supplies
Education – eg posters on COVID-19 vaccinations, mental health issues
Legal and casework, raising awareness re safety issues at workplace
Ground/policy feedback & community awareness – collecting feedback from migrant workers to share with relevant authorities

Healthserve
Subsidised medical and dental services for migrant workers
Mental health & counselling done in native languages: mass psychoeducation at workplace, formal skills workshops for employers, 24 hour crisis hotline, face to face native-speaking qualified counsellors
Case work + social services: work injury claims, legal/criminal/employment related issues, accompanying to TCUs, financial assistance for unemployed migrant workers

Humanitarian Organisation for Migrants Economics (HOME)
Welfare: legal/financial/psychological recourse, shelter for victims of abuse/exploitation, subsidised medical treatment
Empowerment: educational and vocational training programmes
Advocacy: public education, campaigns on migrant worker rights, research

Migrant Workers Centre
2 main aims: fair employment practices and migrant worker wellbeing
Temporary shelters, soup kitchen for the unemployed/those awaiting settlement

Transient Workers Count Too (TWC2)
Direct services: social work, medical/healthcare for injured workers, food/housing/transport related assistance, outreach to migrant workers
Advocacy: public engagement with schools/policy makers/media, research

Legally:
Ministry of Manpower — to lodge any complaints wrt abuse/exploitation
Employment of Foreign Manpower Act: covers offences and infringements for work pass holders (eg salary, off days (AL/sick leave), hours of work/rest days/overtime)
Foreign Employees Dormitory Act: regulate housing standards

Question 18

youth at risk support

Answer 18

Enhance Step Up is a 12-month support programme provided by Integrated Service Providers (ISPs) for students at risk of dropping out of school and youth who are out of school.

Youth GO! Programme
A community-based outreach programme for youths aged 12-21 who are out of school and not working. The programme focuses on youths and their families and aims to coordinate assistance and services at the community level.

Boys’ Town
Interest Based Sports Groupwork with Family Workshops

“Youth Guidance Outreach Services (YGOS)”

TOUCH Community Services

Guidance Programme (GP): 6-month pre-court diversionary programme for youth offenders who have committed minor offences 🡪 given a warning in lieu of court prosecution

Youth Enhanced Supervision (YES): youth <21yo arrested for drug consumption, to complement the urine supervision regime with casework and counselling interventions

Prison Youth Outreach Programme: StepbyStep (for reoffending youths in RTC), Prison Befrienders, Aftercare group coaching

Question 19

Youth with difficult family support

Answer 19

Safe and Strong by MSF (strengthen families with child protection concerns.), PAVE child violence specialist centre

Ministry of Social and Family Development (MSF) launched the Community Link (ComLink) COMLINK greater support to families with children living in rental housing so that they can achieve stability, self-reliance and social mobility
KidSTART provides upstream support to children age 0 to 6 years old from low-income families and deepen partnerships between the community and Government to give these children a good start in life.

Question 20

Rating scales for child abuse (2)

Answer 20

Screening tool for child abuse:

Sector-Specific Screening Guide (SSSG) And Child Abuse Reporting Guide (CARG)

Question 21

education to psychiatrist

Answer 21

IMH and Temasek Foundation launch Mental Health in Asia Programme to promote
exchange of best practices and insights on and build capabilities to better respond to mental
health issues in ASEAN

Question 22

Important studies in IMH

Answer 22

The Institute of Mental Health (IMH) is embarking on the second Well-Being of the Singapore Elderly (WiSE) study to track the changing trends in the prevalence of dementia and depression in Singapore. The first study conducted in 2013 found a prevalence of 10%
(1 in 10) for dementia and 3.7% (1 in 27) for depression among adults aged 60 and above.
=========================================

Novel Coronavirus, Population Well-being and Resilience: A Cross-Sectional Study
-to assess the well-being as well as psychological and behavioural responses of the general population in the respective cities during the outbreak of COVID-19

About 13% of the general population reported experiencing depression or anxiety symptoms. 8.7% has clinical depression, 9.4% has for clinical anxiety and 4.8% had comorbid anxiety and depression

9.3% met the criteria for mild to severe stress and 7.6% met the criteria for clinical insomnia

The top three sources of stress identified by participants were:
 risk of family members or friends getting infected by Covid-19
 financial loss, such as losing work opportunities or having to take unpaid leave
 unemployment

On willingness to seek help from a mental health hotline, 50.1% of respondents stated that they would not consider this. 32.8% were open to seeking help from a mental health hotline, but were unaware of one, while 14.8% would consider and were aware of mental health hotlines, but had not sought help. The remaining 1.8% of respondents had sought or were seeking help from a mental health hotline.

Based on published studies on global mental health, in particular depression, anxiety and stress, during the pandemic, Singapore fared better compared to the
United States and United Kingdom, as well as other Asian countries such as Japan and Hong Kong

Question 23

economic burden of mental health in singapore

Answer 23

These findings were derived from the second Singapore Mental Health Study (SMHS),
initiated in 2016, which examined the prevalence of common mental disorders here, their associated factors, treatment gap of the disorders, as well as the local adult population’s help-seeking behaviour.

Singapore has established the economic burden – or societal cost of six common mental disorders here, namely major depressive disorder, general
anxiety disorder, bipolar disorder, obsessive compulsive disorder, alcohol abuse and
alcohol dependence. A recent analysis of health services utilisation and cost of mental disorders estimates the average annual excess costs per person associated with any of these mental health conditions to be S$3938.90. That is, the health system or society would be expected to incur an adjusted S$3938.90 more in total costs per year for this
individual than someone without a mental disorder. Based on a 13.9% prevalence rate of common mental health conditions among adults aged 18 and above, this is likely to cost our society an estimated S$1.7 billion per year in terms of healthcare resource utilisation and productivity loss.

coast calculated:

• direct medical care
• intermediate and long term care services (respite, nursing home)
• indirect medical care cost: time spent by family and friends to travel to use the service
• productivity lost: absenteeism and presenteeism

The average annual excess costs incurred by a person with comorbid mental and chronic physical conditions were higher than the annual excess costs incurred by a person with mental disorders alone or a person with chronic physical conditions alone.

The main drivers of costs for individuals with mental disorders were direct medical care (54.8%) and loss of productivity (43.8%).

the total cost estimate of S$1.7 billion is likely to
be an underestimate of the true cost as the study did not include costs associated with caregiver burden, the use of justice system, peer support services, medications, supported (re)employment programmes, other social services, and loss of earnings
associated with unemployment. Also, our analysis in this study is limited to the six common disorders in Singapore and did not include other disorders such as
schizophrenia.

Question 24

Singapore Mental Health Study 2016

Answer 24

Singapore Mental Health Study (SMHS)

1 in 7 people in Singapore has experienced a mood, anxiety or alcohol use disorder in their lifetime.

MDD, alcohol abuse and OCD emerged as the top three mental disorders in Singapore. MDD was the most common with one in 16 people in Singapore having had the condition at some point in their lifetime.

There was an increase in lifetime prevalence of mental illness from 12% in 2010 to 13.9%
in 2016

The 2016 study found that the majority of people (i.e. more than three-quarters) with a
mental disorder in their lifetime did not seek any professional help

Among those who sought help, treatment delay (estimated in median values) was longest for
those with OCD at 11 years, followed by bipolar disorder and alcohol abuse at 4 years.

• Of the adult population in Singapore, 7.8% had thought about suicide, i.e. suicidal ideation, at some point in their lives. The lifetime prevalence of suicide planning was 1.6% (1 in 63), and that of attempts was 1.6% (1 in 63).
  1. 5 times more likley in females, 3.6 times more likley among young in 18-34 compared to 65+

higher in singles, divorced/separated, low education level, mental illness (strongest is bipolar)

the prevalence of schizophrenia and other psychotic disorders was 2.3% in Singapore’s population. The prevalence of schizophrenia was 0.86% while that of any other psychotic disorder was 1.44%.
-4.3 likley to be unemployed, lower income

Question 25

Definition of stigma

Answer 25

distinguishing mark establishing a demarcation between the stigmatized person and others, attributing negative characteristics to this person

Question 26

Support for prisoners/offenders

Answer 26

Prison-based:
Upon entry, inmates screened for mental health conditions, risk of reoffending and rehabilitative needs
Drug Rehabilitation Centre (DRC)
Prison psychiatrists; those with more complex disorders housed in Psychiatric Correction Unit (PCU) at Changi Prison Complex
Psychiatric rehabilitation – classes on social skills, occupational therapy, art therapy
Pastoral support, eg Prison Fellowship Singapore (also does Aftercare work)

Community-based/rehabilitation:
Youth: Guidance Programme, Enhanced STEP-UP, Youth Enhanced Supervision (YES), Triage — refer to child/adolescent services for details
Halfway Houses: New Charis, Pertapis etc
Community Action for the Rehabilitation of Ex-offenders (CARE) Network: alliance of SSAs and govt organisations dedicated to community engagement, coordination of aftercare efforts and enhancing service delivery for ex-offenders and their families.
Singapore After Care Association (SACA)
Yellow Ribbon: empowering ex-offenders rebuild their lives through skills training and long-term career development with an effective Aftercare support network
Precautionary measures: electronic tagging, parole officers, regular urine testing

Question 27

Support for healthcare professionals

Answer 27

anonymous feedback channels + surveys, peer support groups eg Peers around Landing Support (PALS) at KTPH, Staff Support Staff (3S) programme at TTSH, counselling services
Brahm centre: counselling, mindfulness, lectures