How Big is the Mental Health Treatment Gap in Singapore?

What you need to know

• A large study in Singapore found that 78.6% of people with mental health conditions did not receive treatment in the past year.
• The treatment gap was highest for alcohol dependence (97%) and obsessive-compulsive disorder (84%).
• Common barriers to seeking help included concerns about cost, thinking the problem would get better on its own, and worries about what others would think.

The mental health treatment gap in Singapore

Mental health conditions like depression, anxiety disorders, and alcohol use disorders are common and can significantly impact people’s lives. However, many people who could benefit from treatment do not receive it. This difference between those who need mental health care and those who actually receive it is called the “treatment gap.”

Researchers in Singapore conducted a large study to measure the size of the mental health treatment gap and understand the reasons behind it. They surveyed over 6,000 adults to assess how many had mental health conditions and how many of those received treatment.

Key findings on treatment rates

The study found that overall, 78.6% of people who met criteria for a mental health condition in the past year did not receive any treatment. This means that fewer than 1 in 4 people with a diagnosable condition got professional help.

The treatment gap varied for different conditions:

• Alcohol dependence: 97% did not receive treatment
• Obsessive-compulsive disorder (OCD): 84% did not receive treatment
• Alcohol abuse: 80.6% did not receive treatment
• Bipolar disorder: 77.6% did not receive treatment
• Major depressive disorder: 73% did not receive treatment
• Generalized anxiety disorder: 62.1% did not receive treatment

These numbers show that even for more severe conditions like alcohol dependence and bipolar disorder, the vast majority of people are not connecting with mental health services.

Reasons for not seeking help

The researchers asked people who had not sought treatment, despite feeling they needed it, about their reasons for not getting help. The most common reasons given were:

1. Concerns about the cost of treatment (74.6%)
2. Thinking the problem would go away on its own (70.3%)
3. Wanting to handle the problem on their own (64.9%)
4. Not knowing where to go or who to see (64.5%)
5. Worrying what others might think if they found out about the treatment (43.1%)

Other reasons included thinking treatment wouldn’t work, concerns about time and inconvenience, and dissatisfaction with available services.

These responses highlight how both practical barriers (like cost and lack of information) and attitudinal factors (like self-reliance and stigma concerns) can prevent people from seeking professional help.

Factors associated with not getting treatment

Interestingly, the study found some unexpected patterns in who was less likely to get treatment:

• People with higher education levels were less likely to seek help compared to those with primary education or below.
• Employed individuals were less likely to get treatment compared to those who were unemployed.
• People who also had chronic physical health conditions were less likely to receive mental health treatment.

The researchers suggest a few potential explanations for these findings:

1. In Singapore’s achievement-oriented culture, highly educated and employed individuals may feel more pressure to appear high-functioning and resilient. They may avoid seeking help due to concerns about how it could affect their reputation or career prospects.

2. People juggling work responsibilities may find it harder to make time for mental health treatment.

3. When someone has both mental and physical health issues, doctors may focus more on treating the physical condition. Symptoms of mental health problems might be overlooked or attributed to the physical illness.

Comparing to previous years

This study was a follow-up to a similar survey conducted in 2010. Comparing the results, the researchers found that the overall treatment gap had decreased slightly from 82.1% to 78.6%. While this change was not statistically significant for most conditions, it does suggest a small trend in the right direction.

The most notable improvement was for alcohol abuse, where the treatment gap decreased significantly from 96.9% to 80.5%. This may reflect increased awareness and efforts to address alcohol-related issues in recent years.

Implications and recommendations

The high treatment gap found in this study is concerning, as it means many people are living with untreated mental health conditions that could be improved with proper care. Based on their findings, the researchers suggest several strategies to address this issue:

1. Increase mental health literacy: Many people didn’t seek help because they thought the problem would go away on its own or didn’t know where to get help. Public education campaigns could help people recognize mental health symptoms and understand treatment options.

2. Address cost concerns: Since cost was the top barrier, policymakers should consider ways to make mental health care more affordable and raise awareness about existing financial assistance programs.

3. Combat stigma: Concerns about others’ perceptions highlight the need for anti-stigma campaigns to normalize seeking mental health help.

4. Workplace initiatives: Given the lower treatment rates among employed individuals, workplace mental health programs and supportive policies could be beneficial.

5. Improve integration of mental and physical health care: Primary care doctors and specialists treating chronic conditions should be trained to recognize and address co-occurring mental health issues.

6. Youth-focused efforts: Most mental health conditions begin in adolescence or early adulthood. Schools and universities should prioritize mental health education and make it easier for students to access confidential support.

7. Culturally appropriate interventions: Programs and campaigns should be available in all local languages and incorporate culturally relevant concepts to reach Singapore’s diverse population.

8. Leverage technology: Given Singapore’s high digital connectivity, expanding access to evidence-based online mental health resources and teletherapy options could help overcome some barriers to traditional in-person care.

Conclusions

• The mental health treatment gap in Singapore remains large, with over three-quarters of those with diagnosable conditions not receiving professional help.
• Both practical barriers (like cost and lack of information) and attitudinal factors (like self-reliance and stigma) contribute to people not seeking treatment.
• Targeted interventions are needed to address unique cultural factors, like concerns about treatment affecting career prospects among highly educated individuals.
• While the treatment gap has decreased slightly since 2010, continued efforts are needed to improve access to mental health care and encourage help-seeking behavior.

This study provides valuable insights into the current state of mental health treatment in Singapore. By understanding the size of the treatment gap and the reasons behind it, policymakers, healthcare providers, and community organizations can work together to develop more effective strategies for connecting people with the mental health support they need.