Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016.

OBJECTIVE: This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore. DESIGN: This analysis utilised data from the Singapore Mental Health Study (SMHS 2016). SETTING: SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents. PARTICIPANTS: Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay. RESULTS: The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency. CONCLUSIONS: The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

The importance of air quality for underground spaces: An international survey of public attitudes.

Space is a resource that is constantly being depleted, especially in mega-cities. Underground workspaces (UGS) are increasingly being included in urban plans and have emerged as an essential component of vertical cities. While progress had been made on the engineering aspects associated with the development of high-quality UGS, public attitudes toward UGS as work environments (ie, the public's design concerns with UGS) are relatively unknown. Here, we present the first large-scale study examining preferences and attitudes toward UGS, surveying close to 2000 participants from four cities in three continents (Singapore, Shanghai, London, and Montreal). Contrary to previous beliefs, air quality (and not lack of windows) is the major concern of prospective occupants. Windows, temperature, and lighting emerged as additional important building performance aspects for UGS. Early adopters (ie, individuals more willing to accept UGS and thus more likely to be the first occupants) across all cities prioritized air quality. Present results suggest that (perceived) air quality is a key building performance aspect for UGS that needs to be communicated to prospective occupants as this will improve their attitudes and views toward UGS. This study highlights the importance of indoor air quality for the public.

Recognition of Depression and Help-Seeking Preference Among University Students in Singapore: An Evaluation of the Impact of Advancing Research to Eliminate Mental Illness Stigma an Education and Contact Intervention.

Background: The SMHS 2016 revealed that young adults in Singapore had the highest 12-month prevalence of mental disorders, with depression being the most prevalent condition. Additionally, the study found that those with higher education were less likely to seek treatment. The recognition of mental illness and knowledge of where to seek help has been found to influence one's ability to seek timely psychological help. This study thus aims to evaluate the effects of ARTEMIS, an education and contact intervention on university students' recognition of depression and help-seeking preference. Methods: A total of 390 university students were recruited over a period of 6-months (October 2018 to April 2019). Students had to attend a one-off intervention which comprised a lecture on depression and personal contact with a person with lived experience of mental illness. Recognition of depression and help-seeking preference were assessed using a vignette approach, at pre- and post-intervention as well as at 3-month follow-up. Results: The intervention was effective at improving student's recognition of depression and this effect was sustained at 3-months follow-up. The intervention was also effective in shifting student's help-seeking preference, although the effects were not sustained at 3-month follow-up. Having a close friend or family with mental illness was associated with better recognition, and being able to correctly recognize depression was linked to a preference to seek psychiatric over non-psychiatric help. Conclusion: This study elucidated the efficacy of a knowledge-contact-based intervention in improving university students' recognition of depression and help-seeking preference. However, while the benefits on recognition of depression is more enduring, it is more transient for help-seeking beliefs, and booster sessions may be needed to improve the long-term effectiveness of the intervention on help-seeking preference. Lastly, to investigate the generalizability of this study's findings, future studies could replicate the current one across other non-self-selected samples, such as by integrating the intervention as part of student's orientation.

Preliminary development of a bystander intervention scale for depression and the examination of socio-demographic correlates amongst Singapore university students.

BACKGROUND: Despite peer involvement having a positive impact on help-seeking behavior, there is a lack of a scale quantifying the possibility of an individual intervening upon noticing peers who show signs of depression. The aims of this study were to (1) develop a bystander intervention scale for depression that assesses the likelihood of university students intervening when a peer shows signs of depression based on the theory of bystander intervention, (2) identify the underlying factors contributing to the behavior, and (3) explore the socio-demographic correlates of the scale. METHODS: The proposed scale, the Bystander Intervention Scale for Depression (BISD), is a 17-item self-reported questionnaire that was developed based on existing bystander intervention theory and inputs from mental health experts. Data was collected as part of a larger study to evaluate the effectiveness of an anti-stigma intervention amongst university students from a local university. A total of 392 participants were recruited. Exploratory factor analyses were performed to identify the underlying factor structure. Multiple linear regressions were conducted to explore the socio-demographic correlates of the scale. RESULT: Four key factors were identified for the proposed scale: (1) Awareness of depression among peers; (2) Vigilance towards possible symptoms of depression; (3) Knowledge on how to intervene; (4) Acceptance of responsibility to intervene. Having experience in the mental health field was associated with all factors while having family members or friends with mental illness was associated with all factors except for knowledge on how to intervene. Students of older age were associated with higher vigilance towards possible symptoms of depression and knowledge on how to intervene. Those of non-Chinese ethnicity were associated with acceptance of responsibility to intervene. CONCLUSION: This study provides a preliminary tool to assess bystander intervention in depression amongst university students. This study identifies sub-groups of the student population that require more education to intervene with depressed peers and also informs the development of future strategies.

Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore.

BACKGROUND: After decades of anti-stigma initiatives, the Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) intervention study is one of the first in Singapore to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students. METHODS: 390 university students from a local university in Singapore were voluntarily recruited for the study. The ARTEMIS intervention comprises an educational and social contact component, as well as a question and answer (Q&A) session with experts in the area of mental health. The Community Attitudes towards Mental Illness (CAMI) scale was administered at baseline, post-intervention and at 3-months follow-up. A confirmatory factor analysis (CFA) was conducted. RESULTS: The CFA identified a 3-factor model for the CAMI with a decent fit (RMSEA = 0.06, CFI = 0.93, TLI = 0.93, SRMR = 0.06). Favourable shifts in attitudes across the factors were observed immediately after the intervention (p <  0.001). Gender (ß = - 1.19, 95% CI: - 2.10, - 0.27, p = 0.01) and nationality (ß = - 1.23, 95% CI: - 2.35, - 0.11, p = 0.03) were identified as significant correlates for the community mental health ideology (CMHI) factor. Linear effects indicated that having a close social contact with mental illness observed a smaller decrease in authoritarianism scores from pre- to post-intervention (ß = 0.85, 95% CI: 0.18, 1.53, p = 0.01); whereas quadratic effects found a greater decrease in scores from post-intervention to after 3-months for benevolence (ß = - 0.34, 95% CI: - 0.52, - 0.16, p <  0.001) and CMHI (ß = - 0.22, 95% CI: - 0.45, - 0.002, p = 0.048). CONCLUSION: The anti-stigma intervention shows promising short-term results across the CAMI dimensions even after adjusting for sociodemographic correlates. However, the intervention did not observe the sustained attitude shifts after 3-months. Recommendations for future anti-stigma interventions were also considered.

The association of mental disorders with perceived social support, and the role of marital status: results from a national cross-sectional survey.

BACKGROUND: This study investigated whether (i) mental disorders were associated with perceived social support and its subcomponents, (ii) current marital status was related to perceived social support, and (iii) 'Married' status influenced the relationship between mental state and perceived social support. METHODS: Data from a cross-sectional national survey comprising 6126 respondents were used. Lifetime diagnosis for five mental disorders was assessed with a structured questionnaire. Perceived social support was measured with the Multidimensional Scale of Perceived Social Support (MSPSS) that provides Global and subscale scores for Significant Other, Family and Friends. Multiple linear regression analyses were conducted to address the research questions with MSPSS score as the dependent variable. Structural equation modeling (SEM) was performed to test mediation by marital status. RESULTS: All mental disorders included in the study, except alcohol use disorder (AUD), were significantly and negatively associated with Global MSPSS scores. After controlling for sociodemographic factors and chronic physical illness, major depressive disorder (ß = - 0.299, 95% CI: -0.484 - -0.113, p = 002) and having any of the five mental disorders (ß = - 0.133, 95% CI: -0.254 - -0.012, p = 032) were negatively associated with support from Significant Other, while support from Family and Friends was lower among all disorders, except AUD. Being married was positively associated with perceived social support in people with and without mental disorders. Results of the SEM partially support mediation by mental state - perceived social support relationship by 'Married' status. CONCLUSION: Having mental disorders was associated with lower perceived social support. Being married has potential to influence this relationship.

The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students.

BACKGROUND: The reluctance of young adults to seek mental health treatment has been attributed to poor mental health literacy, stigma, preference for self-reliance and concerns about confidentiality. The purpose of this study was to examine the potential impact of an anti-stigma intervention that includes education about depression, information about help-seeking as well as contact with a person with lived experience, on help seeking attitudes. METHODS: A pre-post study design was employed. Changes in help-seeking attitudes were measured using the Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) immediately post-intervention and after 3 months. Sociodemographic data, information on past experiences in the mental health field and contact with people with mental illness were collated. Three hundred ninety university students enrolled in the study. Linear mixed models were used to examine the effects of the intervention. RESULTS: Scores on all subscales of the IASMHS, Psychological Openness (PO), Help-seeking Propensity (HP) and Indifference to Stigma improved significantly post-intervention and at 3-month follow-up compared to pre-intervention, with HP demonstrating the highest effect size. However, a significant decline was observed on all three scales at 3-month follow-up compared to post-intervention. Gender, having friends/family with mental illness, and previous experience in the mental health field moderated the intervention effects for the PO and HP subscales. CONCLUSION: The study showed that the brief anti-stigma intervention was associated with improvements in help-seeking attitudes among university students with differential effects among certain sub-groups. As the beneficial outcomes appeared to decrease over time, booster sessions or opportunities to participate in mental health-related activities post-intervention may be required to maintain the desired changes in help-seeking attitudes.

Causal beliefs of mental illness and its impact on help-seeking attitudes: a cross-sectional study among university students in Singapore.

OBJECTIVES: A considerable proportion of those who suffer from mental illnesses in Singapore do not seek any form of professional help. The reluctance to seek professional help could be due to misconceptions about the causes of mental illnesses. Research has shown that help-seeking attitudes can predict actual service use. As young adults are most at risk of developing mental illnesses, this study aims to elucidate the impact of causal beliefs about mental illness on help-seeking attitudes among university students in Singapore. DESIGN: Prior to attending an anti-stigma intervention, data on the Causal Beliefs about Mental Illness, Inventory of Attitudes towards Seeking Mental Health services and questions pertaining to sociodemographic background were collected from participants using a self-administered questionnaire. Multiple linear regressions were performed to examine the relationship between causal beliefs and help-seeking, as well as their sociodemographic correlates. SETTINGS: A university in Singapore. PARTICIPANTS: 390 students who were studying in a University in Singapore. RESULTS: Younger age was associated with higher scores on psychosocial attribution, while prior social contact with individuals with mental illness was significantly associated with lower scores on personality attribution. With regard to help-seeking attitudes; being a male and personality attribution were significantly associated with lower scores on 'Psychological Openness' and 'Indifference to Stigma', while psychosocial attribution was significantly associated with higher scores on 'Help-seeking Propensity'. Having prior social contact also predicted higher 'Psychological Openness', while being in Year 2 and 3 predicted lower scores on 'Indifference to Stigma'. CONCLUSION: Findings from this study suggest that help-seeking attitudes might be influenced by causal beliefs, with personality attribution being the most impairing. Hence, to reduce the wide treatment gap in Singapore, anti-stigma interventions targeting young people could focus on addressing beliefs that attribute mental illness to the personality of the individual.

Employee experiences in underground workplaces: a qualitative investigation.

Underground workplaces (UWS) are increasingly being recognised as a sustainable solution to concerns regarding lack of space facing megacities. UWS can multiply available space by reducing urban sprawl thereby improving quality of life in cities. However, developing workplaces that respond to the needs and preferences of occupants will be a crucial factor in determining the success of this concept. We examine the experiences of existing full-time employees of a large underground facility in North America and analyse how these are related to company policies and other organisational factors. From in-depth interviews of 73 participants, three predominant themes emerged from the analyses: environmental effects (e.g. lack of sunlight), design (e.g. the unique working environment), and organisational factors and social dynamics (e.g. policies regarding breaks). We discuss these themes in relation with interventions that may improve employee comfort and retention and suggest that many factors are within organisational control. Practitioner Summary: Underground workplaces are a sustainable solution to lack of urban space. However, developing effective workplaces is crucial to their success. We examine the experiences of existing employees of an underground facility in North America. We suggest that most negative attitudes towards underground spaces can be mitigated through simple organisational interventions. Abbreviations: UWS: underground workplaces; IRB: institutional review board.

Advancing Research to Eliminate Mental Illness Stigma: The Design and Evaluation of a Single-Arm Intervention Among University Students in Singapore.

BACKGROUND: Anti-stigma interventions for school and college students have been studied in several countries, but to the best of our knowledge, this has not been addressed in Singapore. The current study was designed to address this lacuna and aimed to evaluate the effectiveness of an anti-stigma intervention focusing on depression among university students in Singapore. METHODS: A one-off intervention comprising education and personal contact with a person with lived experience of depression was carried out in nine consecutive sessions over 6 months (October 2018 to April 2019) among 390 university students. Knowledge of depression and extent of stigma toward mental illness were assessed pre- and post-intervention as well as at 3-month follow-up. RESULTS: The intervention was effective in improving depression knowledge (d = 1.09; p < 0.001), as well as reducing social distancing (d = 0.54; p < 0.001) and personal stigma (dangerous/undesirable: d = 0.60; p < 0.001 and weak not sick: d = 0.10; p < 0.033) pre- to post-intervention as well as pre- intervention to 3-month follow-up (p < 0.005). LIMITATIONS: While 3-month follow-up data indicates favorable medium-term impact on knowledge and stigma; the study lacks long-term follow-up to examine the impact of anti-stigma interventions across time. The data were collected through self-report measures; however, social desirability bias is possible despite the assurances of confidentiality. CONCLUSION: Given the impact of the intervention, there is a need to consider the feasibility, challenges, and enablers of implementation of such interventions into the curriculum of university students to ensure a broader and sustained outreach and stigma reduction.

Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support.

INTRODUCTION: Using data from Singapore Mental Health Study 2016 (SMHS 2016), we examined the prevalence of lifetime and 12-month obsessive-compulsive disorder (OCD), its sociodemographic correlates and association with comorbid psychiatric disorders and physical conditions, perceived social support and quality of life. MATERIALS AND METHODS: The World Mental Health Composite International Diagnostic Interview (version 3.0) was administered by trained interviewers to 6126 residents aged ≥18 years old to assess OCD prevalence and that of other select psychiatric disorders. Details on sociodemographics, perceived social support and health-related quality of life were obtained. RESULTS: Lifetime and 12-month prevalence of OCD was 3.6% and 2.9%, respectively. Adjusted regression analysis showed that those with OCD had significantly higher odds of major depressive disorder (odds ratio [OR], 5.4), bipolar disorder (OR, 8.9), generalised anxiety disorder (OR, 7.3) and alcohol abuse (OR, 2.7). OCD was significantly associated with suicidal ideation and suicidality (OR, 5.1). OCD subjects also had higher odds of chronic pain (OR, 2.4) and diabetes (OR, 3.1). Finally, OCD subjects had lower mean mental composite summary scores than controls (respondents without any of the psychiatric disorders and physical conditions included in SMHS 2016) and those with other lifetime psychiatric disorders and physical conditions. CONCLUSION: OCD prevalence in Singapore is high. Most people with OCD do not seek treatment despite experiencing significant comorbidity and loss of quality of life.

Beliefs About Help Seeking for Mental Disorders: Findings From a Mental Health Literacy Study in Singapore.

OBJECTIVE: This study investigated beliefs about help seeking, treatment options, and expected outcomes for alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD), and schizophrenia, by using a vignette-based approach. METHODS: The Mind Matters study was a comprehensive, population-based, cross-sectional survey conducted among Singapore residents (N=3,006) ages 18 to 65 to establish the level of mental health literacy. Questions were asked about whom the person in the vignette should seek help from, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. RESULTS: "Talk to family or friends" was the most common source of help recommended for alcohol abuse (30.1%), depression (54.2%), and schizophrenia (21.5%), and "see a doctor or general practitioner" was the most recommended for dementia (53.8%) and OCD (26.8%). Help-seeking preferences were significantly associated with age, gender, ethnicity, and income and with having a personal experience of or knowing someone with a mental disorder similar to that described in the vignette. Respondents rated seeing a psychiatrist as the most helpful intervention (88.4%) and dealing with the problem on his or her own as the most harmful (64.6%). Most respondents (79.3%) indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. CONCLUSIONS: Most respondents recommended seeking help for mental disorders from informal sources, such as family and friends. Targeted intervention strategies to improve mental health literacy related to help seeking, treatment beliefs, and effectiveness of evidence-based treatments are needed in Singapore.

Recognition of mental disorders among a multiracial population in Southeast Asia.

BACKGROUND: Mental health literacy is an important mediating factor in help-seeking behavior. An important component of this literacy is the proper recognition of mental disorders. The aim of this population-based study in Singapore was to determine the proportion of adults in the resident population who were able to recognize vignettes pertaining to alcohol abuse, dementia, depression, obsessive compulsive disorder (OCD) and schizophrenia correctly. The sociodemographic characteristics that were associated with the ability to correctly recognize these disorders were also examined. METHODS: This was a nationwide cross-sectional study that involved establishing mental health literacy using a vignette approach. Respondents were recruited using a disproportionate stratified sampling design by age and ethnic groups. Face-to face-interviews were conducted with respondents aged 18 to 65 years belonging to Chinese, Malay, Indian and Other ethnic groups. RESULTS: A total of 3,006 respondents completed the survey (response rate of 71%). The most well recognized conditions were dementia (66.3%), alcohol abuse (57.1%) and depression (55.2%). The least recognized were OCD (28.7%) and schizophrenia (11.5%). Younger age and higher educational levels were found to be significant factors associated with the better recognition of specific disorders. CONCLUSION: The relatively high rate of recognition of dementia was likely to be due to the emphasis on public education programmes on dementia which is viewed as an emerging challenge due to Singapore's rapidly ageing population. The role of education and the portrayal of depression and alcohol related problems in the local mass media are possible influences in their better recognition as compared to OCD and schizophrenia. Sociodemographic characteristics influencing mental health literacy need to be considered in planning intervention strategies that target mental health literacy.

Where do people with mental disorders in Singapore go to for help?

INTRODUCTION: This study aims to examine the pattern of services utilisation and the factors associated with help-seeking behaviour among those with mental disorders in the multi-ethnic Asian population of Singapore. MATERIALS AND METHODS: A household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders and the services sought was the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). The 'services' component of the instrument contains questions, which examine service utilisation for mental health problems. RESULTS: A total number of 6616 completed respondents constituted a representative sample of the adult resident population in Singapore. Only 31.7% of those with mental disorders had sought help: 15.7% from mental health providers, 8.4% from general practitioners, and 7.6% from religious/ spiritual advisors or other healers. Among respondents with severe disability across any disorder assessed in our survey, 50.1% had sought help from some service in the past 12 months. Individuals with moderate or mild levels had lower rates of consultation, i.e. 35.4% and 30.6% respectively. The rate of using the Internet as a source of help was low in this population. CONCLUSION: There is a need to engage and work collaboratively with healthcare providers (including religious and spiritual healers) in the community to detect, assess and treat those with mental illness. More general practitioners need to be involved, and the role of the Internet also requires further consideration as a source for help.

A population-based survey of mental disorders in Singapore.

INTRODUCTION: Mental illnesses are not only a growing public health concern but also a major social and economic issue affecting individuals and families throughout the world. The prevalence of mental disorders, the extent of disability caused by these disorders, and services utilisation of these patients has been well studied in developed countries. The aim of this study was to establish the prevalence of select mental disorders and their associated sociodemographic correlates in the adult Singapore resident population. MATERIALS AND METHODS: This was a cross-sectional, populationbased, epidemiological study of adult Singapore residents aged 18 years and above. The subjects were randomly selected using a disproportionate stratified sampling method. The diagnoses of selected mental disorders including major depressive disorder (MDD), dysthymia, bipolar (bipolar I & II) disorders, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), alcohol abuse and alcohol dependence were established using the Composite International Diagnostic Interview, which is a fully structured diagnostic instrument that assesses lifetime and 12-month prevalence of mental disorders. RESULTS: Among the 6616 respondents (response rate of 75.9%), 12.0% had at least one lifetime affective, anxiety, or alcohol use disorders. The lifetime prevalence of MDD was 5.8% and that of bipolar disorder was 1.2%. The combined lifetime prevalence of the 2 anxiety disorders, GAD and OCD was 3.6%, with the latter being more common than GAD (0.9% and 3.0% respectively). The lifetime prevalence of alcohol abuse and dependence were found to be 3.1% and 0.5% respectively. Age, gender, ethnicity, marital status and chronic physical illnesses were all significant correlates of mental disorders. CONCLUSION: The identified associated factors would help guide resource allocation, policy formulation and programme development in Singapore.

The Singapore Mental Health Study: an overview of the methodology.

The Singapore Mental Health Study (SMHS) is a population-based, cross-sectional, epidemiological study on the Singapore multi-ethnic adult population. This article provides an overview of the research design and methods used which took into consideration the unique characteristics of the country and its multi-ethnic population. A face-to-face household survey of Singapore residents aged 18 years and above was undertaken from 2009 to 2010. The nationally representative probability sample was derived using a disproportionate stratified sampling method. In order to increase precision for subgroup estimations the design was stratified with over-sampling of Malays, Indians and those aged 65 years and above. Respondents were assessed using the English, Chinese (computerized) and Malay (paper and pencil based) version of the Composite International Diagnostic Interview (CIDI) 3.0 to establish lifetime and 12-month prevalence of mental disorders, the current use of mental health services (both Western and traditional services), the treatment gaps and loss of role functioning.

From well-being to positive mental health: conceptualization and qualitative development of an instrument in Singapore.

PURPOSE: There is no global definition of well-being. Cultural differences in the perception of well-being and the social and behavioral contexts further limit its measurement. Existing instruments are developed in Western societies that differ in their conceptualization of well-being from Asian populations. Moreover, very few instruments address the multidimensional construct of well-being. METHODS: Literature was reviewed to develop a priori conceptual framework of mental health and well-being. Concepts were identified based on specific criteria to guide the qualitative investigations. Finally, focus group discussions were conducted among adults belonging to the three major ethnicities in Singapore to identify salient domains of mental health and well-being. RESULTS: Mental well-being is a multidimensional construct constituting of positive affect, satisfaction, and psychological functioning. While well-being explains the functional and psychological components, positive mental health is a combination of these and the skills required to achieve them. Although there is an overlap between the concepts identified from the literature and those identified in Singapore, certain differences existed, particularly with the relevance attributed to family interactions and religiosity or spirituality. Similar findings were observed across the three ethnic groups. CONCLUSION: Domains identified can be used to develop a culturally relevant instrument in Singapore.

Providing integrated mental health services in the Singapore primary care setting--the general practitioner psychiatric programme experience.

INTRODUCTION: The aim of our programme was to right site a selected group of patients to the care of the primary sector for follow-up management. Mental disorders are recognised as a major public health problem worldwide which places an enormous burden on health services. Patients on treatment in the hospitals are largely managed by specialists either in the restructured hospitals or in private practice with minimal involvement of general practitioners (GPs). Yet, there are many patients with chronic mental illnesses who are stable, require maintenance medications and are best managed in the community. STRATEGIES: GPs were given appropriate training and support to help them manage patients with mental illnesses in their clinics. The training involved in-depth, comprehensive training on mental illness, providing the GPs with the skills necessary to manage the stable patients within the community. It also facilitated Early Detection Intervention by enhancing the GPs capabilities to detect and manage the mentally ill. Patients screened by psychiatrists who fulfill the referral criteria agreed upon by both the specialist team and the GP partners were referred to the GPs with initial support from case managers when required. The benefits to patients include: increased convenience, savings in terms of transport costs and travel time, the flexibility of being seen during after office hours, less stigma and the option of managing their other medical conditions, if any, by the same doctor. RESULTS: To date, a total of 200 patients have been successfully referred to the 30 GPs in the programme. This represents an average savings of more than 1000 consultation visits to the hospital per year. CONCLUSION: The programme allows for the right siting of care for patients and allows the hospital to channel precious resources to more appropriate uses.