*Population in 2020，GNI and life expectancy are updated based on UN's 2019 data.

 *Medical information is based on WHO's report of 2017 Mental Health Atlas-country profile.

I.     Overview

　　The Republic of Singapore, also known as the Lion City, is commonly known as Star Country, or Singapore. It is a city-state island country, and located in Southeast Asia and at the southernmost tip of the Indochina Peninsula, guarding the southernmost exit of the Malacca Strait and separating from Indonesia by the Strait of Singapore in the south, and facing Malaysia by the Strait of Johor in the north. There are two bridges, namely, the Johor Causeway and the Second Link Expressway, in which connect between Singapore and Malaysia. In addition to its main island, Singapore’s territory also covers surrounding islands, including the largest outer island Tekong Island at northeast side. Since many years ago, the large-scale reclamation has increased the area of Singapore by 23%, which is equivalent to 130 square kilometers and adds the area up to a total of 728 square kilometers so far. Singapore used to be the most important strategic stronghold of the British Empire in Southeast Asia before World War II. Since the independence in 1965, it has quickly transformed the poverty into one of the four rich Asian tigers, relying on the operation of international trade and human resource and capital. At present, with its geographical advantages, it has become one of Asia's important financial, service and shipping centers.

　　Singapore has a population of 5.85 million, of which 74.3% are Chinese, 13.3% are Malays, 9.1% are Indians, and 3.3% are the other ethnic groups. The official languages are English, Chinese, Malay, and Tamil. Cultural and religious beliefs often affect their disease behavior and the way they seek medical treatment. It is common in the Chinese community to see the treatments from both traditional therapies and psychiatrists. In 2019, the WHO estimated that the average remaining life was 83.2 years, and the average fertility rate was 1.19 (2013). There is a trend of aging in the population, with the age over 65 accounting for approximately 12.4%. According to the classification of the World Bank, Singapore is a high-income country with a gross national income per capita of US$59,590 in 2019. The total medical expenditure in the 2015-2017 fiscal year made up a 2.1% proportion of the overall GDP, while the government's total expense on mental health as percent of total government medical expenditure is 3％..

　　The Ministry of Health (hereinafter called MoH) is the government responsible for managing the public health care system. It aims to ensure that all Singaporeans have access to high-quality and affordable basic medical services.

　　Singapore provides its citizens with universal health insurance. The basic concept is personal responsibility plus health care that everyone can afford. Singapore adopts the 3Ms health insurance system to comprehensively take care of different insured objects, and maintains national health through a three-layer protection system, so that Singaporeans will not be dragged down by huge medical expenses.

The 3Ms health insurance system includes:

(1). Medisave: It is a national medical savings plan that helps individuals save and deposit part of their income into their Medisave account to meet their future personal or family members' hospitalization, day surgery and certain outpatient expenses.

 (2). MediShield: Provides a medical insurance plan for Singapore citizens and permanent residents to help Medisave health savings account holders and their families pay for treatment costs for serious level of B2 and C or long-term illnesses, and assist people in filling up the insufficient Medisave balance .

 (3) Medifund: It is an endowment fund established by the government. As for a safety net, it is a direct medical subsidies and used to aid Singapore citizens who cannot afford the heavy burden from the reorganized hospitals.

II.      Mental health policy and system

　　The mental health (care and treatment) act replaced the previous mental illness and treatment act in 2010, and this act is necessary for admission, indwelling, care and treatment in the psychiatric institutions.

　　The promotion of a five-year national mental health blueprint was from 2007, in addition to introducing mental health policies and activities to people of different ages, it also allowed health service providers to furnish psychological health education, screening high-risk individuals and families, etc., with a total expense exceeding US$ 131 million. In 2012, it began to promote the care and support network system, and the main purpose of this community mental health project is to develop the services including the intermediate and long-term service institutions for the dementia and the required mental therapy.

　　The community mental health plan was implemented in 2012. In addition to expanding community mental health care programs and teams, it also shifted the care model from institutions to communities to improve the accessibility of services. The community psychiatric medical team includes psychiatrists, clinical psychologists, medical social workers, occupational therapists and nurses, and it also cooperates with social welfare groups to provide assistance for the at-risk young people who have been dropped out of the schools and families with poor functioning. Moreover, it provides services including early assessment and intervention for the primary and middle school students, and do the training for the teachers and school counselors, furnish home visit service for patients with mental illness living in the community to reduce the possibility to be hospitalized again and hospitalization time. Furthermore, there are also service hotlines and mobile teams for crisis handling when needed. For the elderly, it provides direct services and cooperates with long-term care service systems, such as day care center, community hospitals, nursing homes, home medical doctors, etc. to assist in the treatment of common mental diseases like dementia. Since 2014, this plan has focused on improving primary care as the entrance of mental health services including the integration of community resources, and increasing support for the aging people and their caregivers.

III.   Human Resources

　　Statistics from the MoH of Singapore in 2014 showed that there were 2,386 professionals working in mental health institutions, among them 192 were psychiatrists, one third of which were in specialist hospitals, while the other two thirds were in psychiatric wards of general hospitals. The specialist hospital also has 130 non-psychiatric physicians, 978 nurses, 67.6 psychologists, 57.3 social workers, 51.7 functional therapists, and 909.4 other staff members. The number of indication has a decimal point because it is counted as a full-time employee basis. There is no other professional manpower information outside the specialist hospitals.

　　Duke-NUS Medical School (Duke-NUS) has a four-year Doctor of Medicine curriculum program (MD). The first year is the preparatory course; the second year is a clerk; the third year will be in the research and the fourth year stay for an advanced clinical rotation. Students who complete the course of study and meet the requirements will receive a joint medical doctorate from Duke University and the National University of Singapore (NUS). Each class accepts about 60 to 70 students, two thirds of the students are Singaporeans or permanent residents, while the others are from all over the world.

　　Singapore General Hospital (SGH) is the flagship hospital of SingHealth. It is also the main teaching hospital of Duke-National University of Singapore Medical School. Its campus includes four national specialist centers.

IV.    Mental health system and promotion

　　The medical care system in Singapore can be roughly divided into primary care, hospitals, intermediate and long term care (ILTC). The laws of the management for both private hospitals and medical clinics have been enacted to ensure the quality of service. According to the statistics of the MoH in 2015, there were 18 compound clinics and about 1,500 private clinics providing services in 2014. The compound clinic provides primary care, preventive health care and health education services. Cases requiring further treatment will be referred to the hospital, and it covers about 20% of the demand for primary medical services.

　　There have totally 8 public hospitals in Singapore, including 6 general hospitals, 1 women and children's hospital, and 1 psychiatric hospital. General hospitals provide multi-specialty emergency hospitalization, outpatient services, and 24-hour emergency services. Additionally, there are 8 national specialized centers that offer professional care for cancers, cardiology, ophthalmology, dermatology, neurology and dentistry. There are also 10 smaller private hospitals, 26 hospitals and specialist centers with a total of 11,230 beds. The range of services provided by these intermediate and long-term care centers (ILTC) is for the patients who are discharged from the general hospitals, and need further medical services including the elderly. The ILTC, which includes the rehabilitation places, half-way houses, psychiatric nursing homes and residential institutions, provides approximately 12,000 beds in Singapore.

　　Mental health services are mainly community-based, while inpatient and outpatient services are mainly provided by the Institute of Mental Health, a kind of specialist hospitals, with up to 2,010 beds. In addition, four general hospitals provide psychiatric services with a total of 78 beds. The number of institutions and beds for various types of mental health services are shown in Table 1.

Source: ASEAN Mental Health System report 2016, p137

　　The National Health Promotion Committee of Singapore is responsible for the promotion and disease prevention. Its purpose is to improve the understanding of the importance and empower individuals to have sufficient abilities and skills to enhance the mental health, promote awareness of the symptoms and problems, encourage early assistance, and reduce discrimination against people with mental illness. The National Mental Health Promotion designs the different intervention programs for different ethnic groups at the campuses, workplaces and general communities.

V.       Major issues, challenge, and opportunities

　　According to the statistics of the MoH, one-fifth of Singapore’s disease burden can be attributed to mental health problems, and depression is the most common mental illness in primary care, accounting for about 8% of the adult and 5% of the  elderly population. In 2010, there was a study on the prevalence of mental illness in adults, including major depression, bipolar disorder, obsessive-compulsive disorder, pans (pediatric acute-onset neuropsychiatric syndrome)-anxiety disorder, alcohol abuse, alcohol dependence, etc., and it is found that schizo-affective disorders, anxiety disorders and alcohol use problems have a lifetime prevalence of about 12%, and studies have also shown that most patients do not seek help.

　　In addition, the number of licensed psychiatrists is about 4.4 per 100,000 people, which is much lower than that of other developed countries, such as the UK’s 11 and Australia’s 14.

　　In the community's mental health service survey, even with the expansion of mental health services, it is found that there are still many mentally ill patients who do not seek medical assistance. Therefore, there are many related issues, such as stigma, medical awareness, identification of early symptoms, medical expenses, and literacy rates, which need to be concerned. A continuous survey, conducted in 15 countries in Asia from 2001 to 2016, improved the psychiatrist’s habit of prescribing schizophrenia. The Second Generation Anti-Psychotics (SGAs) have now replaced the traditional antipsychotics as the first choice for treatment, and benzodiazepines (BZD) and anti-Parkinson's medicines have gradually been reduced. At present, the treatment of single antipsychotic medications is common, and the average dose is relatively low. Besides, many patients with dementia only seek medical treatment when they have behavioral symptoms. The situation causes considerable stress on the family caregivers, who have also the symptoms about 56% with anxiety and depression.

VI.    Potential exchange issues

　　The main issues in Singapore include high youth suicide mortality, high prevalence of schizo-affective, anxiety disorders, dementia and alcohol use problems, and low service utilization. The density of psychiatric hospital beds and psychiatric medical manpower are lower than those of the developed countries. Therefore, suicide prevention, alcohol addiction and intervention for senile dementia, and mental medical manpower training are all the topics for subsequent exchanges.