Speech by Ms Carrie Tan, MP for Nee Soon GRC at the Budget Debate 2022 on “Better Mental Health for Singapore’s Carers”
Mr Speaker, I am thankful that Minister Lawrence Wong mentioned mental health in his Budget speech this year. COVID-19, has seen the mental health of care workers and caregivers, and I shall refer to them as ‘carers’. Their mental health have deteriorated significantly in the past two years, and many news articles have come out recently, documenting the stress that they come under due to the disruptions brought by Covid-19, whether they were social workers, teachers, healthcare workers, mental health workers or informal caregivers.
As my colleague, honorable member, Mr Louis Ng mentioned in his speech last evening, 56% of whom had mild to severe anxiety during the pandemic[1]. Such statistics point to an increased risk of burnout amidst a lengthy pandemic and the longer-term problem of an unattractive care sector. It is not surprising that 1500 medical workers resigned in the first half of 2021[2], when many of them worked too long hours with inadequate manpower and support.
Burnout occurs when people feel overburdened and depleted of emotional and physical energy. Some effects of burnout include loss of motivation, negativity, a sense of failure or self-doubt, and a cynical attitude towards others as well as a loss of empathy. Empathy is a bedrock of caring professions and it runs short when people are burnt out. What quality of care can we reasonably expect when those who toil in our care professions and social services are stretched too thin?
In charting a new way forward together, we need to protect the well-being of those who take on the work of caring for others. Because people can only provide quality care to others when they themselves are well, physically, mentally and emotionally.
Two things are vital to ensure quality care: adequate capacity and adequate recognition.
We need to provide sufficient resources and support to carers so that no one burns out. We also need adequate recognition through reasonable compensation and opportunities for advancement to boost morale and motivation and ensure that the caring industry remains sustainable in the long term. Most in care professions are motivated by a strong desire to care for others, and few are calculative about monetary compensation. However, we should still take good care of them and ensure that they have the means to sustain themselves.
My first recommendation is to enhance financial support for informal caregivers. I urge the government to increase the quantum of the Home Caregiving Grant for informal caregivers and implement Carefare.
Many caregivers shared with me in focus groups last year that they struggle to pay for outpatient expenses that are inadequately covered under Medisave. Such costs add to a family’s financial burden, especially for those who had little choice but to give up their jobs and income to care for ageing parents, special needs children, or mentally afflicted family members. The pandemic also made caregiving responsibilities and expenses heavier because care resources like daycare centres and domestic workers became short in supply, as shown in a survey done by the Singapore Alliance for Women in Ageing (SAWA) in 2020. Improving the Home Caregiving Grant will go a long way to lighten their load because finances are the biggest source of stress for informal caregivers. I suggest we tier the HCG according to the care recipient’s needs and associated expenses. Care recipients who require assistance with more activities of daily living (ADLs) can and should be supported with higher amounts of the HCG.
Carefare is what I propose before as a scheme similar to Workfare, but for lower-income individuals who provide full-time care to their loved ones, not by choice, but by circumstance. Many caregivers who had to quit their jobs suffer a loss of self-identity, decreased self-worth, and emotional stress. Often, the family members who are not personally involved in care work also fail to understand how demanding it is. Carefare is a way we can provide crucial financial relief and offer recognition for informal caregivers to their labour of caregiving.
首先，我建议政府提高给予非正式看护者的经济支持。我促请政府增加居家护理津贴的金额， 同时推行我之前曾提出的Carefare。
许多看护者与我分享他们面对的种种挑战，包括无法负担一些门诊费用。这些门诊费，不能使用保健储蓄支付，因此增加了这些家庭的经济负担。对于那些为了照顾年长父母、特需儿童或有精神疾病的家人而无奈放弃工作的看护者，更是雪上加霜。
新加坡妇女老龄化联盟在2020进行的一项调查显示，看护相关的资源，例如日间护理中心和帮佣因为疫情而出现短缺情况，更加重了看护者的压力和经济负担。经济问题往往是看护者最大的压力来源，而增加居家护理津贴，将大大减轻他们的负担。
我提出的Carefare，与现有的Workfare，就业入息补贴计划，异曲同工，但所帮助的是那些因为环境不允许，而必须全职看护身边人的低收入人士。许多必须放弃工作的看护者，也同时失去自己的身份认同，失去自信，也面对很多心理压力。即使是身边的家人，由于没有参与看护工作，往往不明白这其中的辛劳，辛苦和牺牲。Carefare能够提供重要的经济支持，同时认可看护者和他们的付出。
Second, we need to ensure adequate national resourcing for social work, social services, healthcare and mental health care to be adequately staffed and well-protected from work hazards. Beyond salaries, we can do more to enable their work and support them in their well-being.
In the healthcare sector, on top of burnout, cases of nurses being physically or verbally abused, and even sexually harassed by patients are increasing. More preventative steps need to be taken to ensure that healthcare workers remain safe and supported at work. I encourage MOH to look into proactive policies in hospitals and other healthcare settings to protect our healthcare workers from abuse. We could also consider amending our laws to toughen punishments for those who abuse healthcare workers, to send a very clear signal that such behaviour will not be tolerated.
Beyond just salaries, we need to ensure safety, support and adequate staffing, to retain and develop individuals in the care sector for as long as possible to adequately meet the needs of our ageing population
Similarly, we need to protect our teachers from burnout. The role and workload of teachers have expanded drastically over the years. Yet, teachers face more challenges as well as increased expectations on them with home-based learning and the rising concern over youth mental health. In October last year, there was a letter from Mr Ng Wei Yang to ST and his plea went, “My wife’s a teacher. Can I have her back with the family please?”
I have spoken about this before in Parliament, and I caution again about putting dual responsibility on teachers to double up as counsellors. Although teacher-counsellors will have a reduced teaching load, I am concerned about whether they will have sufficient bandwidth and emotional capacity to do both effectively while maintaining their own mental health. Some teachers shared with me that providing students with some form of counselling to students is already part of their role, and they do it quite organically. However, my concern about formalizing this role could create even more expectations by parents and the public towards teachers. The mental health of our teachers is next on the line if we continue to load them with too many expectations. I hope the Ministry of Education will augment the efforts in this area with effective stakeholder communication towards parents.
On top of that, other than being trained in youth psychology, the Ministry could also consider adding on training in family therapy for school counsellors. School counsellors need to be well-versed in everyday struggles faced by youths, including those they encounter within their families. Other skills such as mediation could be helpful to foster and bridge relationships between students and their parents, especially during the difficult adolescent years.
Within the wider community, I urge MOE and MSF to jointly resource and enable the training of mental health responders and volunteers from the grassroots to be empathic listeners. Our PA grassroots network has been a formidable and dependable way to outreach to residents in times of need. From mask distribution to mobilization for vaccination, and in pre COVID time, organising activities to bring people together. We can tap on this network further, provide targeted training to suitable members and build their capabilities in 1 to 1 care support to residents. Social Service Agencies can partner with PA to train and and equip volunteers as befrienders in the community for anyone who needs a non-judgemental listening ear and guidance on further resources for help. Someone facing mental health struggles may not need to see a counsellor if they feel listened to early on in their difficulties. Those who require more attention and expertise can be given advice by the befrienders on where to get more support. This pool of volunteers serves to help distribute and mitigate the care load from the limited number of existing professional counsellors until we can train more to handle the needs in the system.
I am piloting this in Nee Soon South with the support of Yishun Health and Health Promotion Board this year, and I look forward to share our learnings to help build this community care network model in Singapore.
Lastly, we need to enable Social Service Agencies (SSA) to improve their capacity-building capabilities. Increasing funding from private, corporate and philanthropic donors can help reduce SSA’s reliance on government funding and the government’s administrative workload. I am heartened by the Budget announcements that the Government will provide $100 million top up to continue the dollar-to-dollar matching for donations to charities until end 2024. We should use such support to encourage private philanthropists and corporate donors to finance capacity-building in Singapore’s social service agencies, for roles and headcounts such as volunteer management, marketing and communications, and fundraising. Getting multiple sectors to sponsor and support diverse and value-adding job roles to careers in SSAs will make the sector more attractive and vibrant for Singaporeans, This helps to increase the nonprofit sector’s capacity and brings three wins. One, it reduces the stress that SSAs often experience due to public funding limitations and large reporting and bureaucratic requirements. Two, it allows for more experimental approaches to support vulnerable communities, and three, it frees up government monies to be directed to the professional training of additional social workers and healthcare workers.
The Charities Capability Fund by MSF Community Capability Trust are steps in the right direction and I am glad for the $26 million top-up to this effort. I look forward to the implementation details and hope that it will be a simple process for SSAs in its execution.
A mentally healthy nation is a strong nation. The Mental Health of those who take on the brunt of care work in our country is an immediate priority. We need to help redistribute their care load. In this year ahead, I urge more attention and resourcing to look after the mental health of our carers.
人民心理健全的国家，才能是个强大的国家。如果我们能更好地照顾我们的看护者，他们也能更好地照顾其他人。
I look forward to coordinated plans by MOH, MOE, and MSF to enhance their support and care of our care workers. If we take better care of our carers, they can care better for many more.
Notwithstanding the above, I fully support the budget.
Thank you.
[1] https://onlinelibrary.wiley.com/doi/full/10.1111/aswp.12237
[2] https://www.businesstimes.com.sg/government-economy/some-1500-medical-workers-quit-in-h1-2021-amid-severe-strain-on-healthcare-system
Watch the speech here.