Source: Straitstimes online
http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_337806.html
Feb 13, 2009
MEDISAVE USE FOR MENTALLY ILL
By Judith Tan
PSYCHIATRISTS and lobbyists have welcomed the decision to relax restrictions on Medisave use, as it will allow up to 20,000 people currently suffering from schizophrenia and clinical depression to dip into their compulsory medical savings to pay for treatment.They make up the bulk of the 30,000 mentally ill patients living in the community and treated as outpatients by the Institute of Mental Health (IMH).
Most of them are on lifelong medication that can cost between $290 a year for subsidised patients and up to $1,000 a month for specialised treatment.
On Monday, Health Minister Khaw Boon Wan addressed questions from Members of Parliament, asking for the chronic disease management programme (CDMP) to be extended to cover mental ailments.
‘Just like the other chronically ill, the mentally ill patients need continuous and often long-term outpatient treatment, where cumulative costs are high,’ said Mr Khaw.
The CDMP allows patients with chronic illnesses to withdraw up to $300 a year from each Medisave account to use towards their clinic bills.
This withdrawal limit with deductibles and co-payment will also apply for treatment of schizophrenia and depression.
CDMP was first introduced for diabetes and later expanded to include hypertension, lipid disorders and stroke, and most recently asthma and chronic obstructive pulmonary disease.
A spokesman for the Ministry of Health (MOH) said that discussions are under way with general practitioners and psychiatrists on how best to implement the new initiative, which will be ready before October.
In the last three years, new schizophrenia cases formed between 2 per cent and 4 per cent of all new outpatient cases seen, and newly diagnosed depression cases formed between 8 per cent and 10 per cent.
Ms Porsche Poh, executive director for Silver Ribbon Singapore, an organisation that promotes a positive attitude towards mental health among the community, said: ‘This will also encourage patients to start seeking help or continue their treatment as many delay or stop treatment due to financial difficulties.’
Many people believe that all who have mental illnesses are dangerous and should be locked away. Doctors say this stigma still clings tenaciously to patients, preventing them from studying, working and socialising in the community.
A 31-year-old schizophrenia patient, who did not want to be named for fear of losing her job, described her bills from four years ago as ‘dead high’ when she did not have stable employment and was earning just $800 a month.
She used to spend about $200 on consultations with a psychiatrist and medication that lasted her for six months.
‘It is going to be helpful for people who have a low income. For those who earn less than $1,500, this Medisave scheme will help them a lot,’ said the woman, who now works in the engineering industry and makes $2,000 a month.
But Dr Adrian Wang, a consultant psychiatrist in a private practice, said the challenge is ‘knowing where to draw the line’.
‘We don’t want everybody to say ‘Hey, I’m depressed’. A set of guidelines is needed to ascertain what is appropriate and what is necessary,’ he said.
Mr Khaw’s earlier reason for not adding mental illness to the list of chronic diseases covered by CDMP was a lack of consensus among psychiatrists on the proper treatment.
Private consultant psychiatrist Calvin Fones said there is a lack of objective measures at the moment, ’such as tracking the progress of psychiatric patients during treatment’.
Speaking to The Straits Times, Dr Brian Yeo, another consultant psychiatrist in private practice, said: ‘I can see their concerns. But in general, I don’t think the system will be open to abuse. These are diagnoses that carry a strong stigma.’
Dr Fones felt that the extension of Medisave ‘de-stigmatises and helps people put mental illness in the same category as other chronic diseases’.
‘Like those with hypertension and diabetes, these are people who need long-term treatment to get them well and, perhaps more importantly, to keep them well,’ he said.
When the MOH announced in March 2006 that the list of chronic diseases for which Medisave could be used to pay for outpatient treatment – in a departure from the policy that had so far reserved the savings mainly for in-patient treatment – mental illness was left out.
Dr Wang said only about half the people with schizophrenia and on lifelong medication ‘would be able to return to some form of normal daily function, but not enough to return to a proper job’.
One such patient is Madam Doris Lau Siew Lang, 56, who has been treated for schizophrenia since she was 17.
Her husband, Mr Raymond Anthony Fernando, 59, said she still suffers a relapse every five years, ‘triggered by things such as a loud noise, even while she is on medication’.
‘When I’m no longer around, I don’t know what she is going to do. She can’t even go downstairs to withdraw money. And when she gets a relapse, she doesn’t know what she is doing,’ he said.
Dr Chua Hong Choon, the vice-chairman of the IMH Medical Board, said that while scientific research suggests that individuals with three or more recurrent episodes of depression should receive lifelong treatment to reduce the risk of relapse, two-thirds to three-quarters of all schizophrenic patients will require treatment for life.
juditht@sph.com.sg
Additional reporting by Yeo Sam Jo and Jalelah Abu Baker
