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More people with bipolar disorder

  Friday, 18 l 03 l 2011  Source: The Straits Times   
By: Poon Chian Hui

Patients hail move to allow Medisave for outpatient treatment

bipolar disorderMORE people are being diagnosed with bipolar disorder, affirming the recent move by the Health Ministry (MOH) to free up Medisave funds to cover their outpatient treatment bills. The Institute of Mental Health (IMH), which handles the bulk of patients with this incurable mental illness, has 20 per cent more patients now than it did just three years ago. In raw numbers, this translates to 1,069 patients as of last year, up from 902 in 2008.

Over at the National University Hospital (NUH), the 200 people now being treated for the illness, marked by alternating mood swings of extreme elation and depression, represents a doubling of the 2006 figure.Associate Professor C. B. Khare, a senior consultant psychiatrist there, said the rise is likely due to better recognition of the disorder in recent years, he said.

Patients contacted said they welcomed being able to use their Medisave funds to pay for their treatment, which can be expensive. Some of them have to take more than one type of drug daily, with some of these costing as much as $5 a tablet. They also need to see their doctors a few times a year, or even monthly, and such consultations can each cost up to $30 for subsidized patients. Added to that is the cost of psychotherapy sessions, where they learn how to cope with stress and to recognise the onset of mood swings.

Under the Chronic Disease Management Programme, which will now include bipolar disorder, patients will be allowed to withdraw up to $300 per Medisave account yearly to cover consultation and medication fees. This leaves the patient out of pocket for only $30 of the bill, plus 15 per cent of the remaining amount each time.

Freelance administrator Nancie Koo, 45, who has struggled with the disorder for 18 years and sought help only in 2007, said the inclusion of the illness under the programme was “good news”, given that treatment for it is long term. It costs her $2,400 a year.

An MOH spokesman said bipolar disorder was put on the programme because the illness, which responds well to treatment, can make its sufferers suicidal, “hence the public health priority”. The MOH also turned to international guidelines in making the decision. Globally, 1 to 2 per cent of people are estimated to have the disorder.

Regular treatment is crucial in preventing relapses, which may land patients in hospital, adding thousands of dollars to their medical expenses. IMH psychiatrist Mok Yee Ming said when patients forget or are not diligent in taking their medication, they put themselves at risk of a relapse. Prof Khare said when this happens, the decisions they make, including important ones like marriage, may be affected. Dr Christopher Cheok, who heads the psychological medicine department at Khoo Teck Puat Hospital, said the mood swings may make it a challenge for them to hold down a regular job. But those who manage their condition well can live normal, productive lives, said Dr Mok.

Take Hafiz (not his real name), 32, a teacher and a father of two, whose condition is now under control. Diagnosed over 10 years ago, he used to hallucinate and, in his fits of violence, chased his parents out of the house and threatened to kill his wife. He continues to struggle with the stigma of being mentally ill. He said: “Until today, my mother doesn’t believe that I have bipolar disorder. She thinks I’m possessed by a spirit. She would tell me that I need to pray more.” He pays $1,500 a year for treatment - excluding the occasional hospital bill - and said that being able to use Medisave was of help, but more can be done to raise acceptance of the disorder.

Agreeing, Ms Koo said employers could be urged not to discriminate against mental patients. She suggested that employers be offered financial perks if they allow extended time off, or shorter and flexible working hours for employees with mental illnesses. Hafiz suggested that insurance companies include bipolar disorder on their schedules of illnesses that give payouts upon hospitalisation.

Another patient, who wanted to be known only as George, 40, called for the Medisave limit to be raised. The IT assistant spends up to $100 every two months for consultation and medication, and has a family, including two children, to support. But psychiatrist Tommy Tan, who has a practice at Novena Medical Centre, said $300 was a “sensible” amount, saying: “Allowing too much will drain the person’s Medisave account... “There’s a high chance of their encountering major diseases like cancer down the road, and surgery and chemotherapy will cost a lot more.” 


  • IMH has 20 per cent more patients now than it did three years ago: 1,069 patients as of last year, up from 902 in 2008
  • NUH has 200 people now being treated - a doubling of the 2006 figure
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