Singapore is a modern city state and the smallest nation (land area of 699 km2) in South East Asia. Its population of over 4 million is multiracial, with the Chinese (76.8%) constituting the majority of the population, followed by the Malays (13.9%) and the Indians (7.9%). The present health system is one that stresses individual responsibility, based on a system of compulsory medical saving accounts and on market mechanisms for the allocation of scarce healthcare resources. There are both public and private healthcare sectors. Since 1985, every public sector hospital has been ‘restructured’ – to grant some degree of autonomy in operational matters, with the intention of creating competition and financial discipline, although the government still retains 100% ownership of the hospitals.

Mental health services

Singapore has not engaged in a large move towards deinstitutionalisation, and community care for patients with a mental illness has not received high priority. The Institute of Mental Health (IMH) is the largest mental hospital, with a total bed capacity of 2200, and is the largest provider of mental healthcare. It provides a range of subspecialties, such as child and adolescent psychiatry, geriatric psychiatry, substance misuse, affective disorders, sleep disorders, early psychosis, psychiatric rehabilitation and forensic psychiatry. It provides a range of pharmacological and psychological treatments, as well as psychosocial rehabilitation.

More recently, however, there has been a resurgence in the recognition of the need for community psychiatry, with the establishment of a department of community psychiatry in 2001 within the IMH. The department provides an array of services, including community-based programmes such as the assertive community treatment (ACT) programme, the mobile crisis team (MCT) programme (a rapid-response team for crises in the home) and the community psychiatric nurse (CPN) service (Lim et al, 2005).

The IMH is the only statutory institution, in that patients can be admitted, detained and discharged in accordance with the Mental Disorders and Treatment Act 1985 and the Criminal Procedure Code 1985 of Singapore. The services include assessment of accused persons suspected to be of unsound mind and the psychiatric treatment of offenders who are mentally unwell. Powers to detain persons for treatment exist under the Mental Disorders and Treatment Act.