Expansion of NUP mental health services to meet rising needs1
Since July 2024, Health and Mind Clinics (HMC)2 providing community mental health care have been operational in all seven polyclinics under the National University Polyclinics (NUP). In 2022, it was announced by NUP that by 2024, three more NUP polyclinics would offer psychiatric services for mild-to-moderate forms of common mental health issues such as depression, anxiety and insomnia, to anchor such care in the community, and alleviate the high demand for mental health services faced by hospitals. This service has now scaled and expanded to all seven NUP polyclinics, namely Bukit Batok (2019), Bukit Panjang (2022), Jurong (2008), Pioneer (2018), Queenstown (2021), with Choa Chu Kang (2023) and Clementi (2024). Additionally, to further meet the increased mental health needs of the community, patients from the National University Health System (NUHS) with stable schizophrenia and stable obsessive compulsive disorder, on common oral medications are now being transitioned to continue their care at NUP polyclinics, where care teams will continue to provide for their mental and physical healthcare needs holistically.
Over the past two years, NUP Health and Mind Clinics have served 2,659 patients, of which approximately 68% had depression, 29% had anxiety, and 2% had insomnia, and an additional 91 doctors has been trained to manage these conditions. Although there has been an increase in the number of patients seen in HMC of 18% year on year between 2022 and 2023, many of these patients were successfully managed in the primary care setting towards recovery, and only 9.7% of the patients seen in HMC needed to be referred onward to psychiatry specialists.
Trained nurses to provide mental health assessment and care
To enhance its capabilities to provide more mental health services in the community, NUP psychologist has trained its nurses with a special interest in mental health on screening tools for assessing the severity of depression, anxiety, and insomnia, and in the following areas and competencies:
This training ensures that our nurses can effectively support patients with mental health needs and collaborate closely with family doctors and other health professionals, such as psychologists, to provide holistic and multidisciplinary mental health care. At least two nurses in each polyclinic have undergone such training and are now part of the care teams running the Health and Mind Clinics. These nurses perform initial mental health assessments, provide counselling and self-help strategies, and craft safety plans for patients with suicidal tendencies.
Caring for mothers’ postnatal mental health at NUP
Postnatal mental health problems (PMHPs) such as postnatal depression are common and can happen in the first year after mothers give birth. They can negatively affect child development or even lead to suicide and infanticide. In Singapore, over 35,000 mothers give birth annually with postnatal depression known to affect 1 in 14 mothers. Rising rates of maternal depression during the COVID-19 pandemic led to the release of Singapore’s first guidelines on perinatal mental health in February 2023. It recommended that primary care physicians such those in polyclinics and GP clinics screen and assess for PMHPs during well-child visits and manage affected mothers holistically through education, psychotherapy and medications where necessary.
To better understand the provision of postnatal mental health care by primary care doctors in Singapore, a team of researchers led by principal investigator, Dr Liow Yiyang, a family physician from Queenstown Polyclinic, performed in-depth interviews with 14 different primary care doctors working in polyclinics and GP clinics in the private sector. The study findings were presented in January 2024 in Family Practice, a medical journal published by Oxford University Press. The interviews found that primary care doctors saw themselves as the most likely healthcare provider mothers seek help from because of their greater accessibility, lesser stigma and strong doctor-patient relationships. Doctors used their clinical intuition and rapport with mothers, some of whom had been their patients for years, to detect subtle hints of psychological distress such as being more quiet than usual or presenting frequently with concerns about their child. They were confident in managing mothers with milder PMHPs but highlighted their need for greater access to psychological services, better coordination with specialists and raising public awareness that will encourage mothers to come forward to seek help.
Since the study, NUP has stepped up its efforts to provide more support for mothers with PMHPs. When mothers bring their infants and children to the clinic for childhood developmental visits, nurses proactively check their mental health and wellbeing with the assistance of standardised screening tools. Our nurses also address mothers’ other postnatal health needs including providing breastfeeding advice, performing cervical cancer screening and following up on gestational diabetes. Mothers who are found to have potentially serious problems such as PMHPs are then reviewed by family doctors in the polyclinic. Mothers found to be suffering severe PMHPs will be referred to our specialist partners at the NUH Women’s Emotional Health Service or KKH Women’s Mental Wellness Service, through established care pathways.
To download the PDF version of the media release, click here.
