Regulating Mental Health Providers
Ms He Ting Ru (Sengkang): Madam, calls to regulate mental health providers are not new and I recently did so in early 2024. Such professionals include psychologists, therapists and counsellors, the roles and work of whom many lay people struggle to grasp. Concerns that the shortage of professionals will be exacerbated by introducing regulation have to be balanced against the real potential harm to already vulnerable clients seeking support from inadequately trained individuals purporting to provide therapy and the like. Just last week, worrying reports, emerged about unqualified individuals offering counselling services on platforms like Carousell.
Regulating this area also means that clients seeking help know that a professional has met a baseline level of training and understanding of the often-challenging ethical concerns that arise. It is also a first step for our existing financial health for healthcare financing to be used to expand access to such services. I, therefore, hope that the Ministry will develop a long-term plan to regulate the industry, taking into account the views of professional bodies while keeping an eye to make sure that barriers to entry are not overtly high.
A key part of this is to work with training providers and to increase the supply of qualified professionals to ensure that Singaporeans’ mental health needs are adequately and safely met.
Improving Mental Health Tracking and Outcomes
The National Mental Health Office has committed to tracking indicators measuring access to mental healthcare, such as medium treatment delay for common mental disorders. While access is important, the quality of mental healthcare services has to be ensured. A United Kingdom (UK) study of nearly 40,000 patients from 2010 to 2013 found that an above-average therapist can achieve a recovery rate of above 80% over 16 sessions, instead of close to 0% for a below-average therapist. The UK has also set a recovery rate target of 50% for all mental health services. Having real-time data about the efficacy of our mental health services allows both practitioners to recognise how they are performing and will inform the Government when developing a plan that includes standards on service quality.
I have two areas of clarification for the Minister. First, how will the National Mental Health Office track indicators relating to the quality of mental care, which should include recovery rates and deterioration rates? Will the office also set minimum standards of quality across the services outlined under the tiered care model? Second, can the data be readily made available in order for practitioners to use it to identify areas of strength, concern and ultimately, provide service quality.
Precision Medicine
Cutting-edge research and development (R&D) in the medical and health sciences appears to show great promise. Of these, developments in precision medicine has shown up the potential to, in the words of the Singapore National precision medicine strategy, benefit groups and individuals through early detection, refined diagnosis and tailored treatment.
We have had announcements, such as the introduction of the Helix platform, to consolidate healthcare data and the SG100K initiative launched to log the blueprint of 100,000 participants through time, specifically, with the aim of understanding interactions of the genome within the Asian context. These are welcome, but one area that warrants attention is how gender affects health and illness. This goes beyond our obstetrics and gynaecological conditions. I brought this up in this House previously, how researchers now know that the same condition can present differently in men and women.
As a Time magazine article notes, women are not just smaller men. And while progress has been made, there is still a long way to go. Apart from reacting differently to medication and vaccines, there remains significant gaps in areas, such as autoimmune disorders, which affect women more; and also mental health, where, for example, women are more likely to suffer from post-traumatic stress disorder, but most pre-clinical studies on treatment were done on men.
I would, thus, like to seek an update from the Minister about whether and how our efforts in personalised medicine will also cater to these gender gaps in medical research and treatment.
Additionally, for precision medicine to fulfil its promise, it must go beyond collecting and analysing data to deliver real, tangible benefits to patients, and possibly even be used as tools to tackle concerns about ageing demographics and increasing care costs. A data-driven approach is valuable, but it should serve as an enabler, not an end-point.
While we move towards turning research into more effective treatments with fewer side effects, such as precision gene therapies, these treatments remain expensive, raising concerns about inaccessibility, which would only accelerate as the field advances. Aside from increasing inclusivity in research, our health systems need to cater to the risks of inadvertently leading to greater disparities.
I would, thus, like to seek clarification from the Minister about the plans to ensure that advances in precision medicine translate into real benefits for those who need them most. Singapore has the potential to make great strides and lead in precision medicine. But leadership is measured not by infrastructure alone, but participating in global research, increasing our ability to develop and test new treatments and most importantly, ensuring that the accessibility of these advancements are available to all Singaporeans. We have to move beyond data collection to implementation, working to make the promise of precision medicine a reality for patients.
The Senior Minister of State for Health (Dr Janil Puthucheary): Ms He Ting Ru asked how we are harnessing the potential of precision medicine. MOH is taking steps to embrace precision medicine in a cautious manner as we identify appropriate precision medicine applications with clear evidence of public benefit for scaling up. One such application is genetic testing for familial hypercholesterolemia, which we will be rolling out nationally in mid-2025. We will also put in appropriate safeguards to mitigate risks, such as increased healthcare costs. To do so, we will only extend Government financing schemes, mainly subsidies, MediShield Life and MediSave, to precision medicine use cases that are assessed to be cost and clinically effective.
The Chairman: Ms He Ting Ru.
Ms He Ting Ru (Sengkang): Thank you, Sir. A clarification for the Senior Minister of State.
I think Senior Minister of State mentioned earlier that they are working towards registration for a subset of psychologists, if I understood him correctly. So, I just wanted to check with the Senior Minister of State whether there are plans, as I mentioned in my cut, to also include other mental health professionals, such as psychotherapists and counsellors, just because these are also professionals who work with vulnerable clients. I believe that, anecdotally, some practitioners have also shared with me their concerns that there are people out there holding themselves out to be therapists after doing some online courses or a weekend class in an area. I think this causes a little bit of concern because, after all, the clients who come to them for help are usually pretty vulnerable individuals.
And relatedly, I was also wondering what sort of public or consumer education is being undertaken so that members of the public who are seeking help can understand, for example, what is the difference between a psychotherapist, a counsellor, a psychologist, a psychiatrist. A lot of my residents who come to me, struggle to understand the difference and know where is the best place to seek help. And also, if they have some concerns about the person they are actually seeking services from, where do they go if they have got a complaint or they have got some concerns about some of the sessions that they are having with them.
Dr Janil Puthucheary: I thank Ms He for the questions. We are early in the process, so some of these details have not yet been established. But let me try to perhaps explain how we are thinking about this. We do indeed want to protect vulnerable individuals, and she has highlighted how someone who is seeking these sorts of services may well be in a position where they are vulnerable if not dealt with properly or dealt with by someone who is not entirely professional. So, that is the perspective we are coming from. How do we protect individuals seeking these services and at the same time raise the standards and quality of the profession?
The categories of psychologists and professionals that we are likely to then want to regulate and license in a particular way are those where their risk is likely to be higher to the clients and the patients that they are treating, that they are seeing. And this, by definition, means that they are involved in issues to do with diagnosis, pathology, interventions – this is the higher risk end of the profession.
Then, to her point where there are other professionals who are advertising or purporting to treat these types of problems with these types of interventions, we will have to look and see how we craft the licensing regime and the regulatory regime as to what tools we might then have to then go after such individuals.
It is early days, but we are thinking in terms of the risks associated as a result of the professional work that someone does – the diagnosis, the risks and interventions – as well as the vulnerability of the individual that we want to protect.
Indeed, public education will be important, and we will have to think through how we set out the naming, the nomenclature and the details, how a member of the public can choose who to go and get their therapy from and then make available public information.
The resources then for further information actually are already available. I mentioned quite a few of them in my speech. The websites, the chatlines,and then later on this year we will have the hotline. So, a member of the public who is concerned about the therapies that they are getting can access any one of these resources or contact MOH directly and we can also provide advice.
Ministry of Health
7 March 2025
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=budget-2621
Office of the Leader of the Opposition 