Wednesday, 3 May 2017

Mental health cases treated at polyclinics

They make mental health or dementia care accessible and reduce the stigma for those afraid to go to IMH
By Joyce Teo, The Straits Times, 2 May 2017

Housewife Ng Guat Hua, 64, who suffers from anxiety, had previously sought help at a hospital whenever she had an anxiety attack.

But now, she goes to a polyclinic near her home for help.

Meanwhile, Mr Steven Tan (not his real name), 63, seeks treatment for depression at Queenstown Polyclinic.

Though the service at the polyclinic is run by the Institute of Mental Health (IMH), he said it felt more reassuring to go to a neighbourhood clinic rather than a hospital.

In recent years, it has become easier for people with mental conditions, whatever their age, to seek help at a polyclinic nearby.

By 2021, one in two polyclinics will have mental health or dementia clinics or both, the Ministry of Health (MOH) announced in March. This is part of its plan to strengthen community mental health care over the next five years.

This expansion will make mental health and dementia care more accessible, said a joint statement from MOH and the Agency for Integrated Care.

Polyclinics offer subsidised primary care. There are two healthcare groups - National Healthcare Group and SingHealth - which run polyclinics.

Currently, seven out of the 18 polyclinics in Singapore offer mental health services. The first such clinic opened at Geylang Polyclinic in 2003, followed by Queenstown Polyclinic in 2008.

More mental health clinics, as well as five clinics offering dementia care services, have opened at various polyclinics since 2012.

The latest polyclinic to do so is in Jurong, which started its Health & Mind Service last year.

It is clear that there is demand for such services at polyclinics.

For instance, the two mental health clinics in Outram and Tampines saw more than 3,000 cases from July 2013 to the end of last year.

The mental health services at polyclinics treat common problems such as depression, insomnia or anxiety disorders. An MOH spokesman said: "These patients typically have co-morbid chronic physical conditions, which make them vulnerable to developing mental health issues."

They are referred from the general pool of polyclinics for further assessment and care, he said.


But the better accessibility to care is not just a matter of distance.

Dr Wei Ker-Chiah, chief of IMH's department of community psychiatry, said: "There is also less stigma attached to seeing a doctor at a polyclinic. Patients benefit from the management of co-morbidities of medical conditions, such as diabetes and high blood pressure."

Most of the polyclinics' mental health services operate once or twice a week and do not see walk-in clients. Patients must be referred.

Only IMH's satellite clinics, which operate five days a week, accept patients who are not referred. But they have to make an appointment.

Each of the clinics is managed by a multi-disciplinary team, comprising family physicians, nurses, medical social workers and psychologists, said the MOH spokesman.

At some polyclinics, doctors are guided by hospital specialists. At SingHealth polyclinics, for example, doctors work with psychiatrists from Singapore General Hospital or Changi General Hospital. These patients have mild to moderate conditions.

Those with severe depression, anxiety disorders or insomnia will still have to be seen at IMH or the psychiatric departments of restructured hospitals, said the SingHealth spokesman.

The IMH satellite clinics have a multi-disciplinary group of IMH specialists, including occupational therapists and community psychiatric nurses.

The more common mental health conditions seen there are schizo- phrenia, depression and anxiety disorders, said Dr Wei.

"Treatment includes the use of medication and psychological therapies, which are tailored to the patient's needs," he added.

Charges at the polyclinic mental health clinics are similar to consultation fees at polyclinics. For example, a consultation with a family physician may cost around $24 to $30.

The increased provision of community mental wellness care is beginning to bear fruit.

Dr Winnie Soon, a family physician and consultant at Ang Mo Kio Polyclinic, said the early detection and management of mental health issues have helped to reduce the stigma associated with the illness. It has also encouraged people to seek help for their condition.

Dr Wei said: "By focusing on prevention and creating more awareness of mental health issues and avenues of help, we can address the needs of patients earlier. We can also detect and manage problems before they become more severe."

Mental health clinics

ANG MO KIO POLYCLINICHealth & Mind Service (No walk-ins, referrals only)

JURONG POLYCLINICHealth & Mind Service (No walk-ins, referrals only)

WOODLANDS POLYCLINICHealth & Mind Service (No walk-ins, referrals only)

OUTRAM POLYCLINICHealth Wellness Clinic (No walk-ins, referrals only)

TAMPINES POLYCLINICHealth Wellness Clinic (No walk- ins, referrals only)

GEYLANG POLYCLINICCommunity Wellness Clinic (By appointment only, call 6389-2200)

QUEENSTOWN POLYCLINICCommunity Wellness Clinic (By appointment only, call 6389-2200)

IMH scary? Visit a community wellness clinic instead
By Joyce Teo, The Straits Times, 2 May 2017

Mr Steven Tan (not his real name) took on a new job a year ago, after leaving the company where he had worked for more than two decades.

It was a similar operational role but he had to deal with a new environment, culture and colleagues.

"I had a phobia communicating in Mandarin. I was putting a lot of pressure on myself," said Mr Tan. "I gradually developed depression, but I didn't realise it at that time."

The 63-year-old's work anxieties affected his sleep and appetite. He also suffered from constipation.

He said: "I'd wake up every hour or two at night. I couldn't think straight and everything seemed to go wrong. I was like a zombie."

Three months ago, he went to see a doctor, who diagnosed him with depression. Mr Tan said: "I thought it was just insomnia, due to my age. I didn't believe him."

The doctor advised him to talk to a psychiatrist.

Mr Tan went to Bukit Merah Polyclinic and the doctor there referred him to the community wellness clinic at Queenstown Polyclinic.

At first, the doctor had suggested the Institute of Mental Health (IMH), but Mr Tan refused to go there.

"IMH is an alarming name," he said, referring to its reputation as a place for people with all sorts of mental illnesses. "I told them my case was not that serious."

At the community wellness clinic, Mr Tan was treated by a psychiatrist who was "caring and frank with what she thought about my condition".

He learnt from her that he was feeling the way he did because he was depressed.

He said: "The medicine she gave was spot on and worked on the first night. I had a good sleep for seven to eight hours."

Mr Tan will soon be attending a follow-up session at the same community wellness clinic. He said he was grateful that care was easily available at a polyclinic.

"It takes a lot of courage to go and see a psychiatrist," he added.

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