United Nations Public Service Awards Case Studies

The Institute of Mental Health (IMH) and persons with mental illness both face a common dilemma – social stigma. And, social stigma remains a stumbling block in the recovery and re-integration of mental patients into the society.

As a result of social stigma and lack of awareness of mental illnesses, persons with mental illness do not seek early treatment for their condition. The problem is aggravated when patients do not have insight into their illness and fail to comply with treatment.

Moreover, recovered patients face difficulties in securing employment, thus remain economically inactive and are abandoned by loved ones as a result.

Hence, it is of paramount concern to IMH to change such mindset and improve the situation.

In order to debunk the stigma attached to mental illness, and introduce more patient-focused, cost effective and efficient mental health services, IMH embarked on a multi-pronged concept “TOPS”, viz Transformation & Destigmatisation, Outreach, Partnership and Service Improvement.

“TOPS” has proven to be a successful concept. IMH has since seen an increased number of patients who are willing to recommend IMH to their friends and relatives, more visitors from the community, schools and corporations, as well as more partners and volunteers taking an interest in the care of mental patients.

IMH is the first psychiatric hospital in Asia to have attained the Joint Commission International (JCI) accreditation. The subsequent sections will elaborate on how the “TOPS” concept has been applied to debunk the stigma and improve our service delivery for mental patients.

What is the initiative about? (the solution)
Our achievements can be summarised as follows: Transformation & De-stigmatisation IMH was awarded the inaugural Public Service Innovation Award 2006 (Merit) for its efforts in transforming the campus into a bustling medical park. IMH sits on a 25 Ha campus, which was renamed Buangkok Green Medical Park (BGMP) and subsequently launched in Apr 06. The rationale was to de-stigmatise and encourage more people to make use of its facilities. The re-naming of the campus took IMH a step closer to transforming it into a bustling medical park, offering a wide range of medical and wellness services, complemented by retail, F&B and recreational activities. Outreach EPIP won the WHO State Of Kuwait Health Promotion Award in 2006, the first to be given to a hospital in the region. IMH introduces the “Visit IMH” programme to encourage schools, institutions and corporations to visit the hospital as part of community involvement. The programme seeks to create awareness for mental healthcare and services. IMH also organizes public forums and workshops to educate the public and organisations. Partnership IMH won the “Community in Bloom” awards in 2005 and 2006 for its therapeutic gardens, which were collaborative efforts with Gap International, Le Jia Society, National Parks Board and National Library Board. IMH’s GP-Partners scheme has seen an increase of more than 20 partners since our launch in 2005, with more than 80 patients managed by these family physicians. IMH continues to partner and engage the community to take responsibility for the care of mental patients. Service Improvement IMH is the first psychiatric hospital in Asia to have attained the Joint Commission International (JCI) 2005 accreditation, with two exemplary citations, namely the seven clinical pathways which have been implemented for the treatment of psychiatric patients, and the competency assessment process for nursing staff. JCI provides the quality framework for benchmarking against international standards on clinical care and patient safety. In addition, IMH is a certified Singapore Quality Class (SQC) hospital since 2002 and was recently re-certified in 2006. IMH seeks continuous improvement on existing services and introduces new ones to better serve patients. IMH emerged top amongst all national specialist institutions in the Overall Satisfaction category of the Ministry of Health’s (MOH) Patient Satisfaction Survey from 2003 to 2005.

Who proposed the solution, who implemented it and who were the stakeholders?
Transformation & De-stigmatisation Apr 06 Official launch of Buangkok Green Medical Park (BGMP) Nov 06 Won the inaugural Public Service Innovation Award (Merit) for “Transforming IMH campus into a bustling medical park” Outreach Apr 04 New ‘Visit IMH’ Programme Feb 05 New Workplace Emotional Health Programme (WEHP) May 06 Won the inaugural WHO State Of Kuwait Health Promotion Award for Early Psychosis Intervention Programme (EPIP) Partnership Dec 04 Opening of ‘Pick N Choose’ Thrift Store Apr 05 New IMH-GP Partnership Scheme Sep 05 Developing new community theme gardens Dec 05 Opening of WE Centre for Addictions Recovery and Education (WE C.A.R.E.) Oct 06 Opening Of Barista Express Café Service Improvement Jul 04 Launch of Children’s One-Stop Psycho-Educational Services (COPES) Feb 05 Opening of Sayang Wellness Centre (SWC) Jul 05 Accreditation by Joint Commission International (JCI) Nov 06 Set up Crisis Intervention Unit (CIU) Jan 06 New Aged Psychiatry Community Assessment & Treatment Service (APCATS) Programme

Describe how and when the initiative was implemented by answering these questions
a. What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
Background IMH has 78 years of legacy of care for the mentally-ill, with history dating back to 1928. Care provided then was mainly custodial and characterised by long hospitalisation. IMH is now a tertiary specialised psychiatric institution offering comprehensive inpatient and outpatient mental health services to both local and international patients. IMH has shifted from institution-based to community-based model of care with the objective of transforming and destigmatising mental illness and involving the community at large in providing mental healthcare services to the mentally-ill. In line with the development of community-based mental healthcare and patient-centred treatments, a range of community support services and greater liaison with primary care-givers are established by IMH. IMH has streamlined its services and programmes to cater to the differing needs of both our in- and outpatients. IMH has also accelerated its de-stigmatisation programmes and work with the community to re-integrate mental patients. 6b. Priorities and purposes IMH’s primary challenge is to debunk the stigma attached to mental illness and re-integrate patients into the community. IMH’s secondary challenge is to provide more patient-focused and cost effective and efficient mental health services. 6c. Strategies In order to address the challenges above, IMH embarked on a multi-pronged concept “TOPS”, viz, Transformation & Destigmatisation, Outreach, Partnership and Service Improvement. TRANSFORMATION & DE-STIGMATISATION The rationale is to de-stigmatise and encourage more people to make use of its facilities in the campus. We embarked on a 3-R approach, viz Re-name, Re-brand and Re-invigorate. Official Launch of BGMP IMH sits on a 25 Ha campus, which was renamed Buangkok Green Medical Park (BGMP) and subsequently launched in Apr 06. Over the next five years, IMH aims to bring in a variety of medical and wellness services complemented by retail, F&B and recreational facilities for the community and transform the campus into a bustling medical park. Bringing in & Involving the Community The tranquil surrounding of BGMP, with its lush greenery, is a haven for joggers and exercise buffs. Since the opening of an upgraded jogging track and fitness station, residents in the community have been having their morning and evening activities on the campus. OUTREACH This strategy seeks to create awareness about mental healthcare services among members of the public, care-givers which includes family members of mental patients and corporations. Visit IMH Programme IMH introduces the “Visit IMH” programme to encourage schools, institutions and corporations to visit the hospital and create awareness for mental healthcare and services. Public Education IMH also organizes public forums and workshops to educate the public through its Mind Your Mind (MYM) initiative in collaboration with the Health Promotion Board (HPB).

b. What were the key development and implementation steps and the chronology? No more than 500 words
WE C.A.R.E Drop-in Centre IMH’s Community Addiction Management Programme (CAMP) helps patients with addiction tendencies ranging from compulsive gambling to sex through the support of a multi-disciplinary team of doctors, nurses, psychologists and counsellors in the community owing to the stigma of institutional care. CAMP works with community partners to provide outpatient support through case management and referral services to relevant agencies and organisations. The WE C.A.R.E centre located at the Alexandra Day Centre, provides recovering addicts with a supportive environment, assistance and continuity of care to help them through the various stages of rehabilitation. The centre provides free information and referrals to encourage recovering patients to help themselves through self-help groups, learning and mentorship to re-integrate into the society. The FRESH (Families in Recovery through Education, Support and Hope) programme, which is also run by CAMP, assists family members of persons with addictions to develop self-care techniques and learn how to support their loved ones, without the need for institutionalised care. Early Psychosis Intervention Programme (EPIP) IMH’s EPIP is one of the successful community outreach programmes. It employs a combination of preventative interventions targeted at the general public, individuals with a higher than average risk of developing mental disorder and high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing a mental disorder. EPIP won the WHO State Of Kuwait Health Promotion Award in 2006, the first to be given to a hospital in the region. Workplace Emotional Health Programme (WEHP) IMH’s Corporate Consulting Services (CCS) offers organisations, services beyond routine mental treatment provided at IMH. These services range from mental health talks and seminars to customised programmes. Clients who sign up for WEHP not only receive personal one-to-one counseling under confidential cover, they can also call a dedicated hotline to speak to a trained counselor for help on acute emotional conflicts or distress. They can also seek specialist assessment with our psychiatrists at a designated employee guidance clinic session. Patient Education IMH’s medical social workers, nurses and psychiatrists run a fortnightly patient education session at one of its satellite clinic. The sessions cover topics on understanding mental illness, benefits of occupational therapy, rehabilitation, medicine compliance and aim to help care-givers and patients better manage their illness. PARTNERSHIP IMH continues to partner and engage the community to take responsibility for the care of mental patients. IMH-GP Partnership Scheme IMH collaborates with general practitioners (GPs) in the IMH-GP Partnership Programme to support its initiative to right-site care to the appropriate level. This helps provide affordable and convenient mental healthcare for stable patients with chronic mental illness. Moreover, GPs are more accessible in terms of their locations and clinic operating hours and social stigma is minimised. Since its inception, more than 20 GPs have been trained in the care and management of IMH patients within the community setting.

c. What were the main obstacles encountered? How were they overcome? No more than 500 words
Therapy Gardens Community volunteers adopt and work side-by-side with IMH patients to tend to herbs, spices and fruits in our gardens. Some of these gardens are supported in part by the National Library Board and National Parks Board. ‘Pick N Choose’ Thrift Store The Thrift Store is a patient rehabilitation collaboration project between IMH and The Salvation Army. Manned by patients, the store provides employment and training opportunities for them in retail-related skills, such as customer relations, packaging and cashiering. Barista Express Café This first social enterprise is the collaboration of business community, volunteers and IMH to help re-integrate mental patients into the community. Funded by the Ministry Of Community Development, Youth and Sports (MCYS), the café employs mental patients and exposeS them to the challenges of a competitive work environment. It operates outside of IMH, in the Central Business District (CBD) and this helps create awareness of better acceptance of mental patients within the community. SERVICE IMPROVEMENT IMH seeks continuous improvement on services, with the objective of providing more patient-focused, accessible, cost effective and efficient mental health services. Sayang Wellness Centre (SWC) SWC was setup as a private mental healthcare facility targeted at patients who prefer exacting and quality care under better ambience. Inpatient Rehab Programme Rehab operates within a therapeutic milieu that simulates a patient’s home and social environment. Patients are rehabilitated through life skills training, social skills learning, behaviour modification, didactic individual and group sessions and supportive therapy approaches. Patients are also educated on available community resources and social support linkages to facilitate effective post-discharge follow-up and community integration. Telemedicine Consultation Tele-Medicine consultation with the National Skin Centre (NSC) was introduced for IMH’s geriatric patients with dermatological problems in an effort to allow patients to be treated in familiar surroundings of the ward. Patients no longer need to travel out for treatment, thus alleviating the need for additional manpower, anxiety on the patients and maximizing time for the dermatologist. Children’s One-Stop Psychoeducation Service (COPES) IMH’s Child Guidance Clinic (CGC) launched its COPES service with the aim of providing a one-stop multi-disciplinary assessment and intervention service for children who require learning, social, emotional or behavioural support. With COPES, children with multiple learning disabilities no longer need to visit different agencies to get the help they need. Aged Psychiatry Community Assessment and Treatment Service (APCATS) This programme aims to reach out to homebound elderly with mental health problems so that the problem can be arrested and treated at their homes, thus minimizing unnecessary inpatient treatments in a psychiatric hospital. APCATS provides assessment and treatment through a multi-disciplinary team comprising medical officer, psychiatric nurse, clinical psychologist, medical social worker and occupational therapist under the supervision of a geriatric psychiatrist. Mobile Crisis Team (MCT) IMH runs a Crisis Hotline and Mobile Crisis Team that aim to help patients or caregivers who need assistance when patient suffer a relapse. If the situation warrants, nurses from MCT will be deployed to attend to the patient in crisis.

d. What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Assertive Community Treatment (ACT) The Assertive Community Treatment (ACT) service was started to provide intensive rehabilitative programme to help chronic psychiatric patients to settle well within the community. Crisis Intervention Unit (CIU) IMH has set up a Crisis Intervention Unit (CIU) to help patients who are emotionally or mentally stressed. The unit provides a calming environment for patients and intensive counseling can be rendered to these patients so that they can return to their normal life in the community instead of being admitted to the hospital. Tele-psychiatry IMH kicked off eOne (electronic Orders and Notes Entry) to set in motion a series of projects with perspective partners aim at creating paperless innovation for enhanced mental health services for patients and staff. 6d. Changes resulting from the achievement(s) “TOPS” has proven to be a useful concept in steering IMH onto introducing more patient-focused, accessible, cost effective and efficient mental health services. The major changes resulting from these achievements are as follows: The Patient Satisfaction Survey (PSS) conducted by the Ministry Of Health in 2005 indicated that three quarters of the patients and relatives were willing to recommend the hospital to their friends and relatives. The public is now more receptive towards IMH and mental illness. The “Visit IMH” programme welcomed more than 4000 visitors to BGMP, including schools, institutions and corporations. In addition, IMH’s public forums and workshops registered attendances of close to 5000 in 2005. Since the renaming of IMH campus, the number of tenants has increased. We have attracted several new tenants who will provide a range of medical and wellness services. Active discussions are also ongoing with several prospective partners, including retail and F & B operators. More volunteers are coming forward to contribute and participate in social activities organised for patients, such as outings, gardening, excursions and parties. Currently, IMH has more than 30 groups of active volunteers (groups and individuals) who regularly engage our patients in various activities. Note: Due to technical constraint, we have divided the whole section of "Narrative" into 4 sections instead of the 4 headings. We will follow up with an email of full documentation to Mr Kauzya.

Is the initiative sustainable and transferable?
IMH will continue to review its achievements through re-accreditation, continuous benchmarking and development. IMH benchmarked itself and took a leaf from successful organisations in both public and private sectors in the process of developing the “TOPS” concept. The concept is thus applicable to the public service and private organisations, especially those that seek to remark themselves and embark on transformation journey. This could be achieved through: a) Transformation & De-stigmatisation – rebrand and reinvigorate to encourage buy-ins and attract new customers b) Outreach – provide continuous public education and create awareness for public policies c) Partners - partner and engage customers in designing service delivery processes d) Service Improvement – continuous review of existing services and introduce new ones for improved delivery and customer satisfaction.

What are the impact of your initiative and the lessons learned?
Social stigma remains one of the difficulties faced by IMH in its drive to push for community-based care and get the community committed to providing or assisting with step-down care for the mentally-ill, including job placements and employment. IMH’s destigmatisation and transformation initiative helps to dispel the myths of mental illness and encourage those suspected of suffering from various forms of mental illness into IMH early for treatment. Patients diagnosed early can receive prompt treatment as well as counseled, together with their family members on preventive measures to be taken. Early treatment invariably reduces the need for institutionalised care and patients can be re-integrated into the society faster, with the help of loved ones and community assistance when they seek employment. As the national centre providing psychiatric care, IMH is mindful of meeting the staffing needs of the nation. The challenge to attract and retain professional healthcare workers to ensure continuity of care for the mentally ill remains very much a shared national concern. In this respect, IMH works closely with Ministry Of Health, Nanyang Polytechnic (NYP) and National University Of Singapore (NUS) to beef up its training initiatives. Training opportunities have been expanded at all levels. Undergraduate courses in mental health nursing are now offered locally, enabling more to be trained at a lower cost. Overseas attachment stints for healthcare professionals to reputable psychiatric facilities to upgrade and keep themselves abreast of the current and future developments in psychiatric care. IMH’s commitment to research and clinical teaching activities helps to generate awareness and interest in the work that we are doing. IMH hopes to attract like-minded people to make IMH their choice institution for psychiatric care as well as career. Looking back, while IMH had made strides with TOPS, it was a step that was long deemed overdue. The results and changes thus far have been encouraging. The challenges in manpower staffing, rising operating costs and funding However, to remain competitive and viable, IMH will continue to benchmark itself against the best by : a. Not maintaining “status quo” - refuse to adopt a defeatist attitude b. Thinking “out of the box” - there must be a way out of this mess c. Learning and benchmarking against best practices - no loss in being humble and learn from others d. Recognising potentials and opportunities - look again, is there something we’ve missed ? e. Refusing to accept that stigma is not “death” but a challenge to change mindset - change our perception and we’ll begin to change others’ f. Leveraging on information technology - personalise care delivery for patients from their homes IMH believes that it can play a part in helping to achieve the vision of making ‘Singapore Medicine’ a global brand.


Institution Name:		Institute of Mental Health
Institution Type:		Public Organization
Contact Person:		Lim Soh Har
Title:		Deputy Director, Quality Management
Telephone/ Fax:		+65 63892158
Institution's / Project's Website:
E-mail:		soh_har_lim@imh.com.sg
Address:		10 Buangkok View, Buangkok Green Medical Park
Postal Code:		539747
City:
State/Province:
Country:		Singapore

The Problem

Solution and Key Benefits

Actors and Stakeholders

(a) Strategies

(b) Implementation

(c) Overcoming Obstacles

(d) Use of Resources

Sustainability and Transferability

Lessons Learned

Contact Information