Wellbeing: A Psychiatrists View 25 Sep 2015 Disclosures Financial - PowerPoint PPT Presentation

Preschool Emotional and Social Wellbeing: A Psychiatrist’s View 25 Sep 2015

Disclosures • Financial – Receives no honorarium and sponsorship from commercial and pharmaceutical companies in the last 3 year • Nonfinancial – President, Singapore Association for Mental Health; Board member PLMGS; Receives no compensation as member of boards Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

What I will Cover SINGAPORE WELLBEING AND ILLNESS 3 I S ROLE OF PRESCHOOLS Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Singapore Public Healthcare System Primary Private Public Care GPs (80%) Polyclinics (20%) Secondary/ Private Public (80%) Tertiary (20%) Care Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Global Rankings of Health 3rd 6th 1st 2003 2014 Political and Economic Risk Consultancy 4th 2009 Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Singapore: Then and Now 2005 2010 2015 Land area 716.1 km 2 • Land area 710.3 km2 • • Land area 692.7 km 2 • Pop: 4.99 million • Pop: 5.40 million • Pop: 4,45 million – Below 15: 18.4% – Below 15: 16% – 15 to 64: 72.9% – 15 to 64: 73.5% • 20.8% under age 14 – Above 65: 8.7% – Above 65: 10.5% • Ethnicity • Ethnicity • Ethnicity • Chinese (76.2%), Malays (13.8%), – Chinese (74.7%), Malays (13.6%), – Chinese (74.2%), Malays (13.3%), Indians (8.3%), Others (1.7%) Indian (8.9%), Others (2.8%) Indian (9.1%), Others (3.3%) • Infant Mortality 3.6 deaths per • Infant Mortality 2.2 per 1000 live • Infant Mortality 2 per 1000 live 1000 live births births births • Life expectancy at birth 79.9 yrs • Life expectancy 83.7 yrs • Life expectancy at birth 82.5 yrs • Literacy Rate 98% • Literacy Rate 100% • Literacy Rate 100% • Health expenditure 1% GDP • Health expenditure 1.1% GDP • Health expenditure 1.9% GDP Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Expenditure on Health So what’s the Problem? Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

What’s Wrong with Medicine Today? Good at Illness Care Costly, Resource intensive We see patients not people/populations We see them late We cannot sustain Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Challenges for Singapore 3319 adolescents interviewed in a 2145 families interviewed in a school based study in 2014 school based study in 2004 • Emotional & Behavioural Problems 12.5% • Internalising Problems 12.2% • Externalising Problems 4.9% Woo et al 2007 Singapore Med J 4.9% of 745,502 (population below 15) 36,530 potential patients 12% of 990,230 (population 15-24) 118,828 potential patients Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Challenges for Singapore Singapore undertook a massive training and recruitment exercise to increase psychiatric manpower We now have >15 public sector child psychiatrists but… We will never have enough 20 residents psychiatrists! annually Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Opportunity: Preschool Landscape in Singapore Number of children in preschools in Singapore in 2013 68,002 Total enrolment in 86,124 Kindergartens Total enrolment in Child Care Centres Source: Singapore Social Statistics in Brief 2014, MSF Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

WELLBEING AND ILLNESS Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

In search of Happiness umbrella term to include: positive, desirable subjective experiences that include affective and cognitive experiences. Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Child Mental Wellbeing in Singapore Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Wellbeing of preschoolers Good Wellbeing “Health is a state of complete Orthogonal: physical, mental and social well- Statistically being and not merely the absence Independent Flourishing of disease or infirmity” Flourishing Preamble to the Constitution of the World Thriving Thriving Health Organization 1948 with illness No illness Healthy, Mental No Mental Illness Illness Languishing Languishing No/Little With Illness illness Wellbeing “…continuous process of growing and Poor thriving in an individual” Wellbeing Ryffe 2001 Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Wellbeing of preschoolers Good Mental Health Strong support from family, friends and Good mental health, no community, a mental illness child copes well with a mental illness. Healthy, Mental No Mental Illness Illness They may be not be in school, living in poor housing, with little Child may have severe family or social support. stresses on their mental health but do not have The greatest needs for a mental illness. both mental health services and community support. Poor Mental Health Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Wellbeing of preschoolers Good Mental Health Reclaim Promote Healthy, Mental No Mental Illness Illness Treat Prevent Poor Mental Health Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Strategies in Preschoolers Skills/ Competence Health Promotion Promote Education Life Crisis Management Social Support Prevent Illness Systems Specific Protection Prevention Psychologically Healthy Environment Reduce Maladaptive Outcomes Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Illness: Life Course Effects Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Example: SES and the Brain  SES disadvantages reduces brain volume, function, and cortical thickness, especially in the left hemisphere.  Areas: Prefrontal cortex (E.g. OFC and the pACC) and the amygdala-hippocampus formation.  Childhood adversity: Volume changes in subcortical structures (Include ventral striatum & hippocampus), and in prefrontal regions (E.g. ACC and the OFC)  Prenatal smoke exposure: Decreased prefrontal volume and activity (Including ACC and IFG), and ventral striatum activity but with no effect on limbic areas. Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Mental Health of Preschoolers 301 children aged between 1.5 - 5 years from  Up to 30% of pre-schoolers have behavioural or emotion regulation difficulties PAP kindergartens  Expulsion rate in preschool is 3 times more than 50 in primary school 40 30 20 Males Females 10 0 Total Problems Internalizing Externalizing  10.3% of children reported Emotionally Reactive problems  19.3% of children reported Anxious/Depressed problems  19.6% of children reported Somatic Complaints  18.9% of children reported Rescorla et al 2011 Withdrawn/Depressed problems Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup Loving Hearts, Beautiful Minds

Mental Health of Preschoolers Lian et al 2012 Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Mental Health in Preschoolers Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

The 3 Is INTEGRATION, IMPROVEMENT & INNOVATION Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Models of Care Education Healthcare Medical Consult Intensive Intensive Individual Individual Intervention Intervention Wellbeing Illness Small Group Instruction Universal Education Universal Healthcare Early Interventions Improve Quality Effective, Accessible, Timely, Affordable, Safe Social Emotional Learning RTI RTI Response to Interventions Response to Illness Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

New Model of Care for Youths Treatment Individual Treatment (Usually in Clinics) Group Interventions Diagnosis: Labelling No labelling Basic Assessment at school entry Etiology or earlier? Current Model Desired Model Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Hospital Centric Model Treatment (Usually in Clinics) Medical Services Schools, IHLs Social Services Etiology Family Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup

Response Early intervention & Assessment in Community mental Health 10% 1. Professional Educational Helpline 70% Psychologists Counsellors 2. Training and GPs Capability Building Social workers Medical Services Schools, IHLs Social Services 20% 3. Establishing Community Networks Family Loving Hearts, Beautiful Minds A member of the N ational H ealthcare G roup