A Population Health Approach for Mental Health Care


A Population Health Approach for Mental Health Care Dr Chua Hong Choon CEO, Institute of Mental Health

About IMH

• Singapore’s only tertiary psychiatric institution • Looks after the most severe cases • Provides acute and long-term care • Conducts professional training and research 589 Daily Visits (Outpatient Clinics Only)

24* Daily Admissions * Excluding 23-hr observation ward

40,109 Outpatients (ES Included)

1,735 Average no. of inpatients per day

656 Acute

1,078 Long-stay 2015


HOSPITAL-BASED SERVICES • General Psychiatry • Geriatric Psychiatry • Child & Adolescent Psychiatry • Community Psychiatry • Forensic Psychiatry • Rehabilitation Psychiatry • Emergency Psychiatry • Early Psychosis Intervention








Job Club

• Addiction Medicine


• Psychotherapy


• Allied Health


National Mental Health Blueprint Programmes

Outpatient Specialist Clinics

[email protected] & HPB Clinic B

Community Wellness Clinic, Queenstown

NAMS Clinic

Community Wellness Clinic, Geylang

SWC Clinic

[email protected] and HPB

Specialised Units

Emergency Services

Dementia-Friendly Ward

High Dependency Psychiatric Care Unit

Addictions Ward

Mood Disorders Unit

EPIP Inpatient Service

Challenges in mental health care

Changing our paradigm

Changing our paradigm

The National Healthcare Group

Changing our paradigm



Adopting a Population Health Approach Child And Adolescent Psychiatry General Psychiatry

Living Well

Facilitate Effective Mental Health Promotion and Prevention


Community Psychiatry

Allied Health Forensic Psychiatry

Early Psychosis Intervention Programme

Crisis Care

Geriatric Psychiatry

National Addictions Management Service

Living with Illness

Deliver Effective Holistic Care and Optimise Patients’ Mental and Physical Well-Being

Living with Frailty

Dying Well

Facilitate the Development of Primary, Secondary and Long-term Mental Health Services for Singapore’s Population

All Patients – through Empanelment & Clinical Services Thrust Drivers Central Region – through Clinical Services Thrust & Depression Drivers IMH Medical Care Clinic Community Partners (Schools, workplaces, constituencies, community centres)

GP Partnerships Assessment and Shared Care Team

Mobile Crisis Team

GP Partnerships

Mental Health Helpline

Integrated Patient Assessment and Continuous Engagement program

Driver Diagram – Mental Illness Goal Statement

To Build A Mentally Healthy Population and Reduce The Burden of Mental Illnesses

Primary Drivers

Implement Evidencebased Activities

Secondary Drivers Anti-stigma campaigns targeting specific groups Increasing contact between public and PMIs Effective Mental Health Screening in the community (Identified NHG & IMH partners in primary & community care – Polyclinics & GPs) Organise events/campaigns aimed at increasing know-how, awareness of respective conditions & help-seeking behaviour (i.e., general public, caregivers) Partnerships with HPB to deliver programmes to nurture children, youths, parents on core attributes & life skills trainings Partnerships with HPB & Min. of Manpower to deliver stress mgt schemes to high stress workplaces Develop/implement/refine tx protocols for disease management & recovery Consults / Teleconsults through ASCATs (Identified NHG & IMH partners in primary & community care – Polyclinics & GPs) Effective Allied Health Services for both Outpts & Inpts

Physical Health Screening among IMH patients: 1) Screen outpatients for DHL. Patients prescribed with medication for at least one of the DHL conditions (New patients age 40 & above); 2) Screen inpatients (Long Stay patients) - DHL, DRP, DFS, Mammography, BMD IMH to work with nursing homes and step-down facilities to decant long stay patients

P3: Facilitate effective mental health promotion & prevention P4: Deliver effective holistic care & optimise patients’ mental & physical wellbeing P5: Facilitate the development of primary, secondary & long-term mental health services for S’pore’s population


Institute Engaging / Activating / Nudging for Health Clinical Govenance to work with Clinical Depts to consolidate tx protocols & ensure quality Corporate Comms to work with Clinical Depts to consolidate De-stigmatisation work

Create Mechanism to Enhance Adoption

Clinical Champions to work with Clinical Depts to consolidate early detection & prevention, & mental health promotion work Develop & implement frameworks for appropriate referrals &/or referrals between IMH & care providers Operations to develop/monitor LEAN processes to support above Activities Motivate staff to deliver evidence based activities through Performance Measures and meeting interests of key partners Education Office to consolidate/Improve/increase competency training sessions for secondary care providers Perform training needs analysis Build peer specialist programme to complement existing manpower

Build Supporting Structures

Adopt Technology (datamart) to monitor progress Adopt Social Media to support Activities Adopt Technology (EMR) to improve communication across institutions & departments Work with MOH to develop ILTC Ward Enhancements

De-stigmatisation towards PMI Early detection & prevention Mental health promotion Adherence to best standards of care (through KPIs) for tx Aggressively increase partnerships with Primary care & or Secondary Care Standardised Systems (Work Instructions) for internal & external stakeholders Incentivise internal and external stakeholders Leverage on enablers (Manpower)

Leverage on enablers (Technology) Leverage on enablers (Infrastructures)

Empanelment: One-Patient-One-Clinician Team • Re-organise acute patient care to provide better continuity post discharge • Consider one-patient-one-clinician team concept

Empanelment: Re-organising Manpower & Resources


Snr Medical Doctor Panel of Team Doctors



Allied Health Team Community Partners


Provide integrated services across the care spectrum, from prevention, early detection, treatment to long term care in collaboration with community partners, based on patients’ and caregivers’ needs

Empanelment: Achievements 1) Single Point of Contact determined for each patient 2) Panel Teams Established 3) Risk and Needs Analysis Zone Overall







Feb-16 82 392



181 423











235 394

4) Reducing Frequent Admitters Total Empanelment Admitters (unique headcount) 800 700 600 500













Total Empanelment Admitters (unique headcount)


Harnessing the power of teams • The power of cohesive teams to create the multiplier effect

Harnessing the power of teams • Multi-disciplinary, inter-disciplinary, trans-disciplinary care… getting more done • Working at the top of your license

Our patients’ physical health • How about our patients’ physical health? • Are we winning the battle but losing the war? People with schizophrenia - average health profile that is 10 to 15 years older than their counterparts in the general population and have a higher mortality rate especially from cardiovascular diseases Greater risk of premature death, dying as much as 25 years younger than the general population (1)

Higher than expected prevalent rates of co-morbid general medical conditions, particularly metabolic and cardiovascular disease

Understanding People with Mental Illness (PMI)

Contributing factors to overall excess mortality is cardiovascular disease (2) - high rates of cigarette smoking, obesity, diabetes, hypertension and triglyceridemia.

A recent meta-analysis of quality of medical care for people with comorbid mental illness reported that the majority of studies demonstrate significant inequalities in receipt or uptake of medical care for people with SMI (4)

Current Medical Care Services - Overview Specialist Outpatient & Satellite Clinics

DHL screening for : a.Patients prescribed with medication for at least one of the DHL conditions b.New patients age 40 & above c.Smoking Cessation Prog.

Dental services for long stay patients

Inpatient (Long Stay)

Allied Health Services

Program for inpatient with risk of Dysphagia

Speech and Language Therapy Service

Podiatry Services for inpatients

Physiotherapy + Occupational Therapy Services

Screening for : a.DHL b.DRP, DFS c.Mammography d.BMD • Osteoporosis Detection and Treatment Prog •Tele-Dermatology


Engaging the Community

Multi-pronged Approach 1. Understand needs of community 2. Build capability through mental health training 3. Direct liaison with GRLs

Community Engagement List of Partners

43 FSCs 52 SACs 7 TCs 7 VWOs

Oct 2015

16 Constituencies 8 CREST agencies 5 Cluster support 1 Hospital 3 Others

Total: 141

MHH has trained almost 700 pax from FSCs, SACs, TCs and VWOs, as well as 330 grassroots and community partners via the constituency engagement

Listening to patients… I mean really listen! • Not ‘what’s the matter with you’, but ‘what really matters to you’ • “Nothing about me, without me”

Enhancing Communication

ANDS Passport (for patients with intellectual disability)

My Wellness Passport (for patients with general psychiatric conditions)

Use of “passports” to enhance communication among patient, care providers and coordinators

• 30 patients updated the patient/caregiver section, & included information such as “their daily BP reading” & “how am I feeling today” • 20 patients updated the healthcare service providers section on their health progress • 22 utilized both patient/caregiver & healthcare service providers sections

Giving Persons with Mental Illness A Voice: “Voices of Experience” Programme

Patients and caregivers as: Advocates who are willing to speak positively about their recovery

Patient commissioned to illustrate a series of display posters on what mattered most to her about IMH

Consultants who give input to new and existing services, programmes

Peer Specialists who help others along the journey of recovery

Patients were involved in the planning and design phase of the new mood disorders and psychosis wards

Giving Persons with Mental Illness A Voice: “Voices of Experience” Programme Speaking opportunities at public forums & conferences Singapore Mental Health Conference 2013

Psychosis Symposium 2013

What the future has in store…


A Population Health Approach for Mental Health Care

A Population Health Approach for Mental Health Care Dr Chua Hong Choon CEO, Institute of Mental Health About IMH • Singapore’s only tertiary psychi...

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