Exclusive: Inside Singapore’s mental health hospital

By Charlene Chin

Exclusive interview with Dr Daniel Fung, Chairman of the Medical Board at Singapore’s Institute of Mental Health.

A broken nose can be spotted and fixed, but mental health issues can often go unseen or untreated. Even when they are, there often isn’t a simple medicine that treats the wound.

So how can hospitals integrate care and support throughout a patient’s life, ensuring that they lead content lives and recover?

GovInsider caught up with Dr Daniel Fung, Chairman of the Medical Board for the Institute of Mental Health (IMH) to find out how his agency redesigned its approach to make treatment more holistic.

Patient at the centre

First, IMH used design-thinking to re-engineer their hospital so that it catered more to its patients. When they built the dementia-friendly ward, staff retrained themselves to understand how patients felt because they can sometimes be “very aggressive”. Some stayed overnight in the wards to empathise with how it felt like to be admitted in-care.

This enabled them to build a soothing environment that encourages recovery. Previous efforts would “focus on creating a safe environment that patients will be able to get their treatment and not harm themselves; we created a very sterile environment”, he says.

IMH has also created full-time roles - called Peer Support Specialists - for people who have recovered to share their testimony to patients and workers. Medical staff, as a result, understand better what patients are going through.

The initiative started this year, and “in five years, we hope to train and hire about 40 peer support specialists to support patient care in various clinical services”, he says. At present, IMH has employed three of them, in the departments of community psychiatry and early psychosis.

Out with the old

More broadly, Fung is revamping the treatment model. Currently, “we are focused on hospital care”, which implies that “people are significantly ill and they require to be hospitalised or seen by a specialist”, he says. This isn’t ideal, and he wants to minimise patients being admitted to hospitals through early intervention.

IMH intends to do this by providing care throughout the whole patient journey. In the past, “we focused a lot on the medical treatment”, but “now, we’re looking at the whole picture”, he explains, as a healthy lifestyle extends beyond a person’s symptoms.

To do that, the hospital made two moves. First, it removed internal silos. Different doctors were assigned to a patient’s inpatient and outpatient visits, Dr Fung says, and “sometimes, that hand-over is lost.” His team assigned clinicians into single teams that are responsible for a patient’s care, starting last year. “That will create a higher level of accountability and responsibility in the teams and the patients.”

Second, they are working through outside providers to give support in the community. Some of these include voluntary welfare organisations; community and social service agencies; housing authorities and job placement firms. For patients with chronic mental illnesses, they may need help in attaining education, jobs, and even housing support in cases where they aren’t able to return home yet, Dr Fung explains.

Case managers - commonly nurses or psychologists - will be the “single point of contact” for patient care. They will need to understand the patient’s condition and guide them on doctor visits, rehabilitation sessions, even job searches. For patients who can’t function normally, case managers will need to work with families and try to keep the ill “meaningfully occupied so that there is meaning and worth to life”, he says.

There is a more important concept behind this, he says: “You want to look well beyond the ill population”. With a tight-knit community, people with early symptoms of illnesses can be spotted, preventing a further downward spiral.

Dr Fung will be assigning staff to monitor specific geographic areas, working with local GPs. This is cohesive, and “truly integrated”, as people suffering from chronic mental illness could very well suffer from other medical complications, he explains. “If we work collaboratively, we are more able to provide a holistic care”.

Are there enough doctors around?

The traditional view of healthcare - where citizens visit doctors when they fall ill - uses a doctor-patient ratio to gauge whether there is a manpower crunch. This does not apply to preventive healthcare, Dr Fung says. “We know it’s impossible for us to reach the kind of ratio that developed countries have” because the nation is small. Instead, it has to be nimble.

One way to address that is through skill transfers, where healthcare roles can overlap. A primary care physician can perform basic psychiatric analysis on patients with mild to moderate illness. “Let’s be realistic; how many psychiatrists do you need? How many nurses can you get? How many psychologists will you be able to train and manage?”, Dr Fung asks. Doctors need to take on more roles across specialities.

The hospital is trying to change the concept of mental health care, right across the broader medical industry. This is a national effort, he says, and Dr Fung sees IMH as just a cog in the machinery. He puts it aptly: if Singapore is described as a body, then “we could be an arm, or a leg”.