MPs stress need for better insurance coverage for mental health conditions, regulation of professionals

SINGAPORE: A man who had been diagnosed with bipolar disorder struggled with holding down jobs due to his condition. He was also belittled by his mother-in-law.

To cope with the stresses in his life, he turned to drugs but eventually sought help from the National Addictions Management Service for a growing addiction.

Back home, his family thought he seemed better – until he was found dead by suicide one evening. 

This was shared in parliament by Ms Mariam Jaafar (PAP-Sembawang), who teared up as she recounted the story told to her by the man's mother, her Woodlands resident. 

"These stories can be hard to listen to, but they are real and they point to the scale and complexity of the challenge” of tackling mental health issues, she said.

Over six hours on Tuesday (Feb 6), the House heard similarly impassioned speeches from MPs on a motion filed by the Government Parliamentary Committee (GPC) for Health: “That this House recognises the importance of mental health as a health, social and economic issue; affirms the importance of a robust national mental health ecosystem; and calls for a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being.”

The motion comes on the back of the national mental health and well-being strategy launched in October last year, which aims to address mental well-being through health, social and education settings. 

A total of 15 MPs, seven Nominated MPs and a Non-Constituency MP spoke on various aspects of mental health, including the need for better insurance coverage for mental health conditions. 

STRONGER REGULATION OF MENTAL HEALTH PROFESSIONALS

One common concern MPs raised was the need for better regulation and accreditation of mental health professionals.

Dr Wan Rizal (PAP-Jalan Besar) - kicking off the debate as a member of the GPC for Health who had filed the motion along with four others - said his conversations with diverse groups over the last three years led to “questions about the oversight and accreditation of training with the different mental health tiers”.

The tiered care model aims to provide more tailored support depending on one’s needs. 

At its lowest tier, the four-tier model will cover community-led mental health promotion, self-help and peer support, while its highest tier encompasses the most intensive level of care in hospitals and specialist clinics.

“Could the (future Mental Health Office) look into and ensure the quality of these programmes and certify the volunteers and professionals within?” asked Dr Wan Rizal.

Ms He Ting Ru (WP-Sengkang) similarly said that the “current lack of regulation” warrants more attention, even though she acknowledged the dedicated and committed mental health professionals.

She proposed setting up a regulating body with input from bodies such as the Singapore Association for Counselling and the Singapore Psychological Society, to “ensure a universal standard of care and quality of care in the provision of such services to support mental health”. 

Such a body will also ensure that there is “at least a baseline level of training, expertise and ethical practice” in the provision of such services. 

Ms He also suggested establishing safeguards for the protection of “vulnerable minors”, such as mandatory background checks for those who work with children.

BETTER MENTAL INSURANCE COVERAGE 

MPs also highlighted the need for better insurance coverage for mental health conditions.

Dr Tan Wu Meng (PAP-Jurong) pointed out “the sense of fear and anxiety” of being denied insurance upon getting diagnosed with a mental health condition.

All efforts to improve mental health are at risk of “not coming to their full potential” or “being undermined”, he stressed, “so long as this issue of the private insurance market is not addressed”. 

Dr Tan, one of the five MPs who had filed the motion, called upon the government to get the Monetary Authority of Singapore to look at improvements and reforms to the insurance sector. 

This is “especially for young Singaporeans who may be facing mental health and mental wellness concerns, young Singaporeans who may then be labelled with a diagnosis with their whole life ahead of them”. 

In her speech, Ms He also said that in light of upcoming guidelines for insurers to adopt “fair and responsible” practices towards people with disabilities and those with mental health conditions, regulators should ensure that guidelines prohibit insurers from declining applications on the basis of a person’s disabilities or mental health conditions.

“Any differential treatment of persons with disabilities and mental health conditions should also be justified by accurate and relevant actuarial or statistical data, and there should be a mechanism by which insurers justify this,” she added. 

“Insurers should also be required to make transparent their grounds for differential treatment or rejection of applications from persons with disabilities or mental health conditions.”

Ms He reiterated her hope that the government would consider allowing MediSave to be used to access mental health services beyond “purely psychiatric settings” – particularly in the private sector.

“It would not be a big step to use our 3Ms framework to better improve access to mental health treatments and interventions, as MediSave is already being approved for use for mental health services at places like IMH (Institute of Mental Health) and polyclinics,” she said, referring to MediSave, MediShield and MediFund.

Echoing that insurance “must play a bigger role”, Mr Xie Yao Quan (PAP-Jurong) added that MediShield “must surely” be the first avenue Singaporeans can turn to. 

TREATING MENTAL HEALTH SCREENING AS PRIMARY CARE  

To further reflect the importance of mental health, MPs stressed the need to treat mental health and physical health screenings with equal importance. 

Dr Wan Rizal suggested that similar to how physical health screenings identify health issues and guide targeted interventions, mental health screenings can also offer insight into the individual’s mental well-being, “paving the way for informed steps towards improvement”. 

He added that this approach begins with “early and accessible” screenings for mental health, such as via schools and the workplace. He also proposed a “Buy One Get One Free concept”, where every physical health screening would come with a free mental health checkup. 

Ms Mariam called for an increase in the availability of mental health services in all polyclinics – “not just all new polyclinics”. 

She noted that while general practitioners (GPs) will play an important role, current support is “very patchy”. Pointing to the different settings in which youths may prefer seeking help, she asked how the Health Ministry understands the “patterns of needs among youths in the primary care setting”. 

She also sought clarity on the vision for mental health support from GPs under the HealthierSG initiative, including whether GPs would perform regular mental health screening and serve as the “primary gateway or gatekeeper for referrals”.

Ultimately, normalising mental health conversations is key to overcoming stigma, various MPs noted. 

In a bid to do so, Mr Xie began his speech by admitting that he had been through “a rough patch” recently, and had recognised it as “early signs of burnout”. He said he decided to share his experiences in parliament as he believed open sharing of one’s struggles was what “breaking stigma” was about. 

“No amount of government interventions and new structures, new care models, new resources, new legislations will work if we don’t as a society transform,” added Ms Mariam, among those who filed the motion.

“If we don’t as a society become more aware of what people around us are going through and make it safe for people to be more open about the mental health challenges that they or their loved ones face. If we don’t accept that not everyone is able to deal with it, no matter how much they try. If we don’t become more understanding and compassionate. If we don’t stand together and act to improve the mental health and well-being of every Singaporean.”

The debate will continue on Wednesday.