Over 630 GPs in Singapore now part of scheme that empowers them to treat mental health

Previously, said Dr Jonathan Yeo from Family Medicine Clinic Chinatown, most GPs and family physicians would have assessed a patient’s condition before prescribing the appropriate medication, and referred the patient to a psychiatrist only if his condition was complex or if he was at risk of self-harm.

The introduction of the new protocols has empowered primary care providers with a road map for holistic care.

Besides educating their patients on general lifestyle measures and prescribing medication if required, these doctors can now refer their patients for supportive counselling, psychoeducation and psychotherapy by allied health professionals, said Dr Yeo.

Community mental health teams here are fully funded by the Government, and there is no out-of-pocket cost to patients. 

These allied health professionals can co-manage the patient together with the doctor by assessing if what is required is social intervention to address underlying difficulties, psychotherapy to treat dysfunctional ways of thinking and behaviour patterns, or counselling to cope with life changes, for instance, he added.

If not for the new care protocols, one of Dr Yeo’s recent patients, who had been struggling with depressive symptoms for some time, would have been assessed to have mild depression, based on the patient’s score on the Patient Health Questionnaire-9. This screening tool entails patients answering how often they have experienced nine core symptoms of depression over the past two weeks.

However, Dr Yeo said, the care protocols led to a revised diagnosis of moderately severe major depressive disorder.

In addition, the use of the Columbia-Suicide Severity Rating Scale as part of the protocol helped him to determine that the patient’s risk of suicide was low.

“The patient chose to continue being followed up by me, and as I also have postgraduate training in mental health… I was comfortable to continue delivering care to this patient despite the moderate severity of the condition,” he said.

For family medicine specialist Kenneth Tan from Kenneth Tan Medical Clinic, having a guide helps him discuss with patients their options, as many do research their condition and treatment options before seeing a doctor.

“With the new protocols, I’m able to provide them with some psychological advice, connect them to mental health services in the community, or consider a referral to my paired COMIT team, Allkin Singapore,” Dr Tan said.

“The COMIT team keeps me updated on whether the referral is successful, and I am able to follow up with the patient and see if the psychosocial interventions are helping or if we need to consider starting medications.

“Many patients actually improve on their symptom assessment scores through this approach.”

Dr Tan said his patients are often surprised to learn that he is able to create a mental health plan for them that could involve school or corporate counsellors, private mental health services, free COMIT services, or a referral to a tertiary hospital.

CHAS subsidies and MediSave can be tapped by Pioneer Generation, Merdeka Generation and CHAS card holders seeking care at MHGPP GP clinics, for mental health conditions under the Chronic Disease Management Programme.

The public can find community mental health and dementia services near them with this mental health finder.

If the clinic is part of Healthier SG, these card holders can also get enhanced subsidies for selected chronic medications.

MOH said it is currently reviewing the need to develop care protocols for other mental health conditions moving forward.