Sunday, March 4, 2012

What does it take to build an inclusive society? An open report to DPM Tharman, MOS Health-Dr Amy Khor

“Most of the important things in the world have been accomplished by people who kept on trying when there seemed to be no hope at all.”
- Dale Carnegie -

In Parliament on Wednesday 29th February 2012, Dr Amy Khor, Minister of State for Health mentioned that everyone has a role to play in building an inclusive society. She went on to add that while government policies can redistribute resources to help the vulnerable, an inclusive society is also about individual wanting to be helped and to help themselves.   

An inclusive society is one:
(a) In which all persons are to be valued for themselves, not merely for what they contribute;

 (b) That all persons are entitled to quality of life, and to opportunities for growth, not hampered by unjust social or economic conditions, or by inequalities caused by prejudice.

According to the United Nations:  “An inclusive society must be based on respect for all human rights and fundamental freedoms, cultural and religious diversity, social justice and the special needs of vulnerable and disadvantaged groups, democratic participation and the rule of law.”

Social inclusion involves ensuring that all groups and individuals have equal opportunities for development and growth.  One group that has great difficulty in securing equal treatment is the mentally ill and their caregivers.

Yet, besides newly elected PAP MP Tin Pei Ling who had the courage and conviction to speak out in Parliament on 29th February 2012   about the mentally ill being left out of in the Budget 2012, how many of our other Members of Parliament (MPs) – opposition MPs included, are willing to raise the plight of the mentally ill in Parliament? Aren’t MPs elected to serve the people of Singapore - ALL people?

Many people in society, even educated ones, are still indifferent to the mentally ill.  A large number of people choose to remain indifferent because of fear.  Their fear and lack of understanding of mental illness often leave the afflicted shunned and discriminated against.  This fear, when left unchecked, will continue to obstruct moves toward a more compassionate society, in which we care more humanely for the mentally ill within our community.  

Isolation; depression; shame; guilt; loneliness.  Mental illness can bring about these emotions. Stigmatisation can cause discrimination in the workplace, unnecessary violence and inappropriate hospitalisation.  Sufferers will lose self-esteem, self-worth and even hope altogether.  In extreme cases, the effects of social stigma can lead to suicide.

People suffer from stress for various reasons.  It could be that they are unable to cope with the burden of caring for a sick relative.  It could be because they are worried sick about their jobs, exam stress or facing financial calamity.  Or maybe, it's because of the traffic and overcrowding. 

Mental illness is creeping into our schools, our homes, in the heartlands, in the offices and even in places of worship, like churches.  Just like we cannot avoid the problem of suicides and failed marriages, we also cannot avoid raising the plight of the mentally ill and their caregivers.  Let’s work together as a government and as a community to help save and reclaims lives.

Provide better care for the mentally ill in public hospitals
In IMH, the C class wards house 30 or more patients in one ward. In the A class 6-8. How can anyone get any rest and peace of mind with 30 or more patients- many of them very disturbed in one crowded ward?  Aren’t people who are ill supposed to go to a hospital to rest?   Can’t it be down- sized to about 10-15 in the C class wards, allowing for not only better supervision of the patients and giving the patients a chance to have some peace of mind.  
The government actively promotes medical tourism and yet securing a bed in hospitals for our own citizens is such a mammoth task.

Funds to support the mentally ill
I’m glad that the Government has come up with various schemes to help ex-prisoners get a second chance in life.  It is encouraging that a great deal of effort has been put in place to secure jobs for ex-prisoners under the Yellow Ribbon Project.  Some churches even have a prison ministry that looks after the welfare of prisoners and their families.  Funds are also raised for them through the Yellow Ribbon Project. Because the Yellow Ribbon Project has strong political support, it is much easier to raise money for them. If ex-prisoners are able to get a second chance in life, why aren’t the mentally ill given even a 1st chance in life?  

In Singapore, funds are raised on a national level for all kinds of illness, which includes cancer, heart diseases and kidney diseases, but nobody has found it in their hearts to raise funds on a national level for people with mental illness. Why is this so, especially when many of them cannot find jobs because of discrimination?

Caregivers & patients who are coping well can go on national TV and move the audience with their true stories.

Jobs for those coping with mental illness
Just go take a look at any Govt. job application form and you will find a clause there which requires the applicant to declare if he/she has a history of mental illness.   Why is this requirement still in place? In the U.S. to ask this question, is illegal.  This clause handed down since the colonial time is clearly outdated, and has to be removed if we want to give equal opportunity for all Singaporeans to secure jobs and to encourage treatment if a person is going through depression or other types of mental illness, because the illness is treatable.   Is this in any way giving the mentally ill a chance to help themselves, DPM  Tharman , Dr Amy Khor?
 If the Govt. takes the lead, the private sector will most likely follow suit.

Grants to support talented psychiatric patients& their family members
Grants and sponsorship can help people coping well with mental illness and their caregivers to work from home, earn some money, have a sense of worthiness and become self-reliant. If they can write, such grants will enable them to contribute to the literary culture here in Singapore. 

In a report published in The New Paper (TNP) on June 4th 2010 – “Work Support Programme – Govt study to track impact of scheme”, it mentioned that the Government (MCYS) is willing to provide better support for low-income families including those with mental health issues.  Encouraged, I responded to that report in a forum letter to TNP dated 14th June 2010 – “More social support needed for the mentally ill”, urging the Government to consider awarding grants or sponsorship to psychiatric patients and their caregivers to work from home with the skills that they posses or could acquire. To-date, no one from the Government has followed through on this.
Health insurance
Another burning issue that demonstrates how the mentally ill are deprived of proper care is; health care insurance.  For several years, I have tried to buy a health care insurance for my wife for her physical illnesses, but this was rejected time and again because no insurance company wants to provide coverage for anyone suffering from mental illness, even though I have clearly stated that the medical insurance is for her physical illnesses. 

This issue was raised during the previous top management of the Ministry of Health, but to-date, no one has followed through on this pressing issue, leaving those who suffer from mental illness to be deprived of proper medical insurance and to struggle with skyrocketing medical expenses.  If this is not discrimination, then what is it?

Public transport at IMH
To raise caregiving to a higher level, we need to build the infrastructure. As such, the public bus companies should ply the grounds of IMH and pick up/drop off passengers at IMH. The present feeder bus service provided by a private company only operates during office hours.  I had written to the present transport minister and the previous one to consider this, but both have chosen to ignore this much-needed service.  How can caregiving – which is now a very much talked about issue and which the government and church is paying more attention to, be taken to a higher level when conditions such as proving the infrastructure is sorely lacking? It is little wonder that many of the patients at IMH take a longer time to recover because of this lack of strong emotional support- a key component that is vital in the recovering of the afflicted.
As Singapore journeys towards becoming an inclusive society and caring nation, it must bear in mind that there will always be people who may need more help.  And undoubtedly, the mentally challenged, the lonely elderly and their families are some of those who need a great deal of help. The mentally challenged, Dr Amy Khor are more than willing to help themselves, but it is roadblocks, lack of support  and discrimination that hampers their growth and development.

I await your response, DPM Tharman, Dr Amy Khor.


Footnote: DPM Tharman's office has replied today,
Dear Mr Fernando,

Thank you for your feedback and suggestions on helping the mentally ill.

I’m pleased to share with you that Dr Amy Khor, the Minister of State for Health has just announced the Government’s plan to develop a wide range of community-based mental health programmes over the next few years. Our goal is to enable more patients with moderate to mild mental conditions to receive appropriate care in the local community. These programmes include setting-up multi-disciplinary teams in the community to provide quick and convenient access of mental healthcare to patients, providing more resources to support caregivers to care for mentally ill family members, and expanding the capacity of mental healthcare institutions, such as special outpatient memory clinics and psychiatric nursing homes.

The Ministry of Health will also conduct public consultation soon, to gather feedback on the proposal to extend MediShield coverage for inpatient psychiatric treatment.

We also agree with you that it is critical to improve public awareness and understanding about mental illness. The public needs to treat patients with mental illness with understanding and compassion. To this end, the Health Promotion Board (HPB) has worked with schools, workplaces and community organisations to reach out to some 170,000 people last year, and will continue with these efforts this year. At the workplace, HPB has put in place a mental health promotion grant to build resilience and wellbeing of employees and facilitate early detection and support. From April this year, the maximum quantum of the grant will be raised from $2,000 to $5,000 to sustain and augment companies’ mental health promotion programmes.

Thank you.

Leela Pokkan (Mdm)
for Quality Service Manager
Ministry of Finance

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