Academic journal article Hong Kong Journal of Psychiatry

Community Psychogeriatric Services in Singapore-The Missing Piece in the Jigsaw Puzzle

Academic journal article Hong Kong Journal of Psychiatry

Community Psychogeriatric Services in Singapore-The Missing Piece in the Jigsaw Puzzle

Article excerpt

Abstract

With the rapid ageing of the population in Singapore, there is an urgent need for the establishment of comprehensive, accessible, and affordable psychogeriatric services. As well as being at greater risk for physical illnesses, elderly people are also likely to develop mental disorders. Elderly people with mental disorders face greater obstacles in accessing mental health services. Although psychogeriatric services have been in place since 1993, the lack of community-based mental health services remains a major gap for those who cannot access the current inpatient and outpatient services. A well-tested model of community-based old age psychiatric services in clinical case management with a multidisciplinary approach is discussed.

Key words: Community mental health services, Health service accessibility, Psychogeriatrics

Introduction

In Singapore, there is growing concern about the rapid increase in the elderly population. In 1980, only 5% of the population was aged 65 years and older, but by 2030, this figure will increase to 19%. The proportion of the 'old-old' (age, 75 years and older) will increase from 27% of the elderly population in 1980 to 36% in 2030. In absolute numbers, the elderly population will increase 7-fold from 111,900 in 1980 to 798,700 in 2030, while the increase of the 'old-old' population will be even more alarming, with a 9-fold increase from 30,700 in 1980 to 290,000 in 2030. In a community study of mental disorders in the elderly population in Singapore, the prevalence of psychiatric disorders was 10.0% (dementia, 2.3%; depression, 5.7%; neurosis, 1.5%; and paranoid disorder 0.5%). (1) With the rapidly ageing population, the projected number of people with dementia is expected to more than triple from 7000 in the year 2000 to 24,000 in the year 2030. (2)

As well as being at greater risk for physical illnesses, the elderly are also likely to develop mental disorders. Approximately 60% of the mental problems experienced by older adults are due to functional psychiatric disorders, and the remaining 40% are due to organic mental disorders such as dementia. (3) This distinction is important for understanding the patterns of community and home care for older adults compared with younger adults. In addition, with an increased life span, many patients with major psychiatric disorders are growing older, thus adding to the overall burden of mental disorders in the elderly population.

Models of Mental Health Services for Elderly People with Mental Disorders

An international survey showed that many countries remain unprepared to meet the challenge of an ageing population. (4) Mental health professionals and policymakers in many developed countries have long believed that an ideal mix of community services would provide effective treatment for the majority of mentally ill people and reduce the need for less desirable and more expensive inpatient care, especially long-term institutional placement. (5) One of the 10 overall recommendations in the World Health Report 2001 on mental health is to provide care in the community, as community-based services can lead to early intervention and reduce stigmatisation. (6) Large custodial mental hospitals should be replaced with community care facilities, and supported by general hospital psychiatric services.

Community mental health teams for older people are listed as an integral component of the services in the technical consensus statement Organization of Care in Psychiatry of the Elderly by the World Health Organization and World Psychiatric Association. (7) Draper argued that the best way to provide effective treatment for functional disorders, reduce behavioural disabilities among people with dementia, and relieve stress on carers was through adequately resourced, comprehensive psychogeriatric services that include an integral range of hospital- and community-based staff and resources. …

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