Academic journal article East Asian Archives of Psychiatry

A 17-Month Review of the Care Model, Service Structure, and Design of THRIVE, a Community Mental Health Initiative in Northern Singapore

Academic journal article East Asian Archives of Psychiatry

A 17-Month Review of the Care Model, Service Structure, and Design of THRIVE, a Community Mental Health Initiative in Northern Singapore

Article excerpt

Introduction

The year 1928 marked the beginning of the mental health service in Singapore. (1) It began with a large asylum that provided mainly custodial care, and where the mentally ill were managed by a handful of expatriate medical pioneers and nurses. Drugs were limited and hospitalisation lasted for years. The scene has changed tremendously over the last 6 decades. Today the mental health service in Singapore is largely provided by the public sector with contributions from private and voluntary organisations. It provides a comprehensive and integrated programme comprising hospital-based and community-based treatment programmes with the objectives to promote good mental health for everyone and to provide the best possible treatment for those afflicted with mental illnesses of all types. The move to further enhance community-based interventions had its early beginnings with the conception of the Ministry of Health Community Mental Health Masterplan (20122017) that aimed to build novel services for the community. The Masterplan envisions the development of Assessment Shared Care Teams (ASCATs) and Community Intervention Teams (COMITs) to build the capacity and capability for psychiatric care to be delivered outside the hospital in the community.

The Concept of THRIVE (Total Health Rich In Vitality and Energy)

The Total Health Rich In Vitality and Energy (THRIVE) is 1 of the 2 pioneering ASCATs. At the onset, the THRIVEASCAT's strategic goals were to fulfil unmet needs and deliver novel services that leverage on technology. Rather than just increase the capacity of the existing services, the THRIVE-ASCAT focuses on building new capabilities and then increasing capacity. The goals of THRIVE-ASCAT are manifold. A key goal was to build a regional platform for the North of Singapore to network mental health services, community-based social services, government agencies and voluntary welfare organisation (VWO) as well as non-governmental organisations (NGO). A second goal was to build a tiered system to provide a spectrum of care catering to a wide variety of patients. Primary care starts from the general practitioner supported by COMITs and VWOs; secondary care is provided at Khoo Teck Puat Hospital (KTPH) and tertiary care at the Institute of Mental Health (IMH). Third, the internet is used to deliver self-directed psychological therapy to help-seeking and non--help-seeking individuals; educating the public and using traditional and social media to engage the public and change their perception of mental illness. Fourth, it is important to train professional colleagues, governmental and community agencies, and the public in mental health issues to reduce the stigma of mental illness.

Planning for a Programme

Planning for an ASCAT requires an understanding of the needs of the stakeholders balanced against evidence-based strategies. The key stakeholders identified include AIC (Agency for Integrated Care, under the Ministry of Health), VWOs, and NGO in the North of Singapore; and most importantly, the patients and their families. Hospital management and the general public are also key stakeholders.

A total of 200 members of the public were interviewed using standardised paper and internet surveys to understand their mental health help-seeking attitude. Open-ended questions were directed to elicit the main source of information utilised for issues related to mental health, and the characteristics of mental health services that are valued by an individual. The internet is the preferred information portal. The public values mental health services that are accessible and convenient to them, e.g. short waiting time for medical appointment, services that are close to place of work / home or available after standard working hours. In addition, the THRIVE spoke to various members of the NGO and VWO community to understand their needs. Some key issues were identified following interviews, surveys, and focus group discussion. …

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