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The Financial Burden of Mental Illnesses: Depression, OCD, Schizophrenia, Alcoholism and Dementia

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Joanne Poh

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Try telling your boss you need to take a mental health day off work and see where that gets you in Singapore.

Clearly, there is still much room for improvement before attitudes towards mental illness in Singapore leave the stone age.

According to a 2015 World Health Organisation survey, Singapore had the highest rate of depression in Asia. That means that if you, a close friend or family member are dealing with a mental illness, you are far from alone.

The statistics are depressing. It doesn’t help that Singaporeans have considerable stigma towards people suffering from mental illnesses and the financial burden of mental illnesses is heavy.

What is the true cost of managing a mental condition?

 

Top 5 common mental illnesses and treatment costs involved

There are many forms of mental illnesses, including anxiety disorders, panic disorders and schizophrenia. Here are the top five mental illnesses in Singapore, treatment and costs involved.

1. Major Depressive Disorder

Everyone feels a bit blue now and then, but Major Depressive Disorder is a lot more serious. If you persistently feel sad and uninterested in the things that used to make you happy for a prolonged period of at least two weeks or have had suicidal thoughts, you might be suffering from Major Depressive Disorder. The good news is that depression can be treated, and many people do get better.

2. OCD or Obsessive Compulsive Disorder

While people tend to associate OCD with an obsession with order or cleanliness, the disorder can also manifest itself in other ways. Any impulses, images or ideas that recur persistently and result in compulsive behaviour of any sort might be a sign of OCD. Symptoms might include compulsive counting, hoarding or having certain recurrent thoughts.

OCD specialists will usually prescribe a combination of antidepressants and behavioural psychotherapy. However the patient may have to try different medication before the find the effective one.

3. Schizophrenia

Schizophrenia is a serious illness that can manifest in many ways, with patients often experiencing hallucinations or suffering from delusions. For instance, they might believe that they are being watched, persecuted or made victim of a conspiracy. It is a result of fragmented mental processes, and sufferers may struggle to carry out daily tasks at work or school.

Antipsychotic medication is usually prescribed to help normalise biochemical imbalances in the brain.

4. Dementia

Dementia is a state of intellectual decline that hits primarily elderly people. Alzheimer’s Disease is probably the most well-known form of dementia, and can make the sufferer forgetful, disoriented and eventually unable to recognise people or manage their daily lives.

Most forms of dementia cannot be cured, but there are medications that can help to improve symptoms. Doctors may also prescribe occupational therapy to make the living environment safer for patients with dementia. If the sufferer is older, you may also need to hire a caregiver or consider a nursing home facility if there is no one at home all the time.

As the illness affects the elderly mainly, sufferers can seek treatment at IMH psychogeriatric clinics and Community Wellness Clinics at Geylang Polyclinic and Queenstown Polyclinic. There are also dementia-friendly wards at IMH that deals with severe behavioural and psychological symptoms of psychiatric patients 65 years and above.

5. Alcohol abuse or alcoholism

Many of us have been known to knock back a pint or ten after a stressful day, but alcohol abuse or addiction is an illness that goes beyond binge drinking or even being dependent on alcohol. Alcohol abuse is a lot more damaging and involves compulsive drinking despite recurrent problems that have resulted from the use of alcohol. Attempts to quit are often met with withdrawal symptoms. Sufferers tend to be reclusive and are unable to carry out normal daily duties.

In Singapore, there are some organisations dealing with addictions such as National Addictions Management Service (NAMS) and specialist outpatient clinic The Cabin.

 

Financial cost of mental illness

If you suspect that you or a close friend or family member has a mental illness, making sure the sufferer gets a proper diagnosis and treatment is key. Here are some example of costs you can expect.

Diagnosis for a mental health condition

The main public channel is the Institute of Mental Health (IMH), which charges $38 for a first consultation if you are a subsidised patient, and $35 for subsequent consultations. Note that you must first get a referral from a doctor at a polyclinic to become a subsidised patient at IMH, which costs an additional $10.70, otherwise you will have to pay the non-subsidised price.

For non-subsidised patients, you pay $92 to $140 for a first consultation, depending on the seniority of your consultant, and $62 to $92 for subsequent consultations.

An appointment with a private psychiatrist usually costs $100 or more per session.

Counselling

If appropriate, you might be prescribed a series of counselling sessions with a psychologist or psychotherapist. At public healthcare providers, this usually costs about $40 to $60 per session, but be prepared for longer waits and bigger gaps in between sessions.

Private therapists usually charge anywhere from $140 to more than $200 for a session spanning 50 minutes.

Medication

Depending on your symptoms, medication may or may not be required. In the case of a long-term condition like schizophrenia, medication may be required for years if not life.

According to this article from 2016, a patient suffering from depression could pay up to $90 for three weeks worth of medication. This cost really depends, as you will need to try out different medication in order to find the right remedy.

Hospitalisation

In serious cases, the patient might have to be warded, whether at IMH, a hospital or, in addiction cases, some sort of wellness or rehab centre. IMH wards cost $32 to $61 per day, in addition to a $15 to $31 daily treatment fee.

For private psychiatric wards, you can expect similar costs to private hospital charges, or even more in specialist facilities.

Illustration of the cost of a month’s stay in IMH

If you are staying in a ward in IMH, the costs really add up. You may be spending $960 plus $450 daily treatment fee a month, which totals to $1,410 a month. Mental illnesses require long-term treatment so you may be staying for several months. You can claim the costs by using Medisave though (see last section).

After being hospitalised, you may need outpatient treatment as well, which costs at least $226 per month based on subsidised rates (see calculation below).

Illustration of costs for an outpatient mental illness patient

Unless your condition is severe and necessitates hospitalisation, most mental illness patients receive outpatient treatment only. If a patient is suffering from depression, goes to the clinic twice a month and receives counselling one a month, his expenses may look like this:

Type of cost Cost per month
Medication $90
Consultation $35 x 2
Counselling (subsidised) $60
Grand total $226

 

Does insurance cover the cost of mental illnesses?

Let’s talk about Medisave first. Yes, you can use Medisave, but only up to certain limits. In general, you need to be warded in order to use Medisave.

You get to use up to $150 per day when warded for daily psychiatric episodes, including a maximum of $50 for doctor’s daily attendance fees. You can only spend a maximum of $5,000 a year on psychiatric hospital charges. Do note these limits are very low, so avoid staying at private hospitals unless you are sure you can afford it.

If you have schizophrenia, major depression, bipolar disorder, dementia, anxiety or Parkinson’s disease, you can also use up to $500 a year for outpatient treatment under the Chronic Disease Management Programme. Do note that if you are suffering from other conditions on the list of CDMP conditions, psychiatric or not, the money you spend on them will also count towards that $500.

What about private insurance? Well, in general, insurers in Singapore tend to offer significantly lower protection against treatment for mental illnesses than physical. You should also check whether pre- or post-hospitalisation charges and emergency ward charges are excluded.

Finally, do note that most private insurers exclude situations where suicide or self-harm is involved.

 

Support groups and hotlines for mental illnesses

While anyone suffering from mental illness should, to the best of their ability, get professional help, these support groups and hotlines can offer additional support:

Do you have any questions about seeking help for mental illness in Singapore? Leave them in the comments.

 

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Joanne Poh

In my previous life, I was a property lawyer who spent most of my time struggling to get out of bed or stuck in peak hour traffic. These days, as a freelance commercial writer, I work in bed, on the beach, in parks and at cafes, all while being really frugal. I like helping other people save money so they can stop living lives they don't like.