The Financial Burden of Long-Term Mental Health Care in Singapore
What is the cost of staying alive with a mind that demands your death? I ponder this question while talking to Lu*, a friend who lives with bipolar disorder and spends upwards of S$1,500 a month on psychiatric treatment. In today’s world, it’s increasingly common to see social media tributes and corporate campaigns encouraging people to #reachout and #gethelp. While raising awareness around mental illness is a step in the right direction, there is a lack of acknowledgment regarding what comes after seeking help.
The reality is that the challenges associated with mental illness do not stop after assistance is found. For many in Singapore, mental illness is a lifelong battle that can extend years beyond the point of #reachingout and #gettinghelp. Long-term psychiatric treatment often comes with a hefty price tag—especially for severe conditions like bipolar disorder and schizophrenia.
An Unavoidable Financial Burden
As the world recovers from the aftermath of COVID-19, inflation and rising living costs have led to increased financial challenges for many Singaporeans. For those struggling with mental health issues, seeking treatment—which frequently involves medication, therapy, and sometimes hospitalization—adds an additional financial strain.
Yohanna Abdullah, a 55-year-old Content Specialist at Club HEAL, was diagnosed with Bipolar I disorder in 1998. She continues to seek treatment for her condition. Bipolar I disorder is characterized by manic episodes lasting at least a week, making it challenging to maintain a full-time job, especially in demanding career paths.
“There would be one year where I’d be coping very well, and then suddenly there would be three years of constant hospitalizations,” she recalls. “The peak was in 2018 when I was hospitalized three times in six months.”
$90k Poorer
Yohanna’s frequent hospitalizations have come at a significant cost. Since 1998, she has experienced around 30 manic episodes, with each episode costing between S$1,500 and S$3,000 in hospitalization fees, medication, and sometimes Electroconvulsive Therapy (ECT). Over 24 years, this adds up to between S$45,000 and S$90,000 for her mental health treatment.
Despite some subsidies at public hospitals, long wait times often push those with severe illnesses to seek help from private clinics, driving up costs. Foreigners, including migrant workers and students, do not have access to subsidized care, further complicating the situation.
For Raelyn*, the costs of recovery following a suicide attempt at age 16 have been monumental, even with subsidies. Now 21, she spends S$2,180 monthly on therapy, medication, and psychiatrist visits, not including physical rehabilitation costs.
Costly and Lifelong
Both Yohanna and Raelyn deal with substantial treatment costs throughout their lives. After exhausting her MediSave funds, Yohanna relied on government financial assistance. Now working full-time, she worries about her medical bills, especially since one of her medications is a newer, unsubsidized drug.
Despite being a patient at a government hospital, she recalls a recent bill of S$280 for one consultation and medication. “Even though I’m a patient at a government hospital, my most recent bill was S$280 just for one consultation and medication,” she recounts.
Raelyn has similarly depleted her MediSave. “I’ve used up my personal MediSave, while my dad has used up his through paying my bills,” she says, now relying on her mother’s funds.
Beyond the Financial Toll
The mental and physical toll of living with a long-term mental health condition can be immense. Many patients grapple with medication that may not yield immediate results. Layla*, diagnosed with Bipolar II disorder at 13, has cycled through numerous medication combinations over the years, often leading to hospitalization.
While Layla has found some relief from a recent medication combination, her journey remains fraught with challenges, including debilitating side effects that hinder her daily functioning and led to dropping out of school.
Help is Available—With Caveats
Dr. Victor Kwok, a Senior Consultant at Private Space Medical Centre, notes that while many medications are subsidized in general hospitals, patients may still require newer, unsubsidized medications if older ones fail. Financial assistance is available through medical social workers, but ongoing outpatient treatments can be limited to a small annual cap.
Many chronic mental health patients like Raelyn struggle under the weight of substantial treatment costs, with MediSave only alleviating a fraction of their financial burden.
The Social Cost
The impact of mental illness extends beyond the individual. Daniel, who was diagnosed with schizophrenia at 18, relies on his family to cover his treatment costs. “Every time I relapse, it generates a lot of shame around the family,” he says, expressing concern over the stigma associated with his condition.
A Marker of Courage
Despite the high costs and ongoing challenges, many patients find purpose in advocacy and helping others. Yohanna now uses her experience to champion mental health awareness and has authored several books. “People in long-term mental health treatment are warriors because we are constantly putting out one fire after another just to start all over again,” she asserts.
For Layla, the hope for improvement continues, fueled by effective treatments. Daniel, on the other hand, finds meaning in volunteering and contributing to society. “I continue to live because of the faith and courage to live through the days and take each day as it comes,” he reflects.
The financial, physical, and social complexities of living with long-term mental health conditions reveal a harsh reality: the cost of staying alive extends far beyond the mere act of seeking treatment, encompassing a broader struggle against stigma, isolation, and a relentless battle for normalcy.
*Names have been changed to protect the identities of individuals. Bipolar I and II disorders have differing symptoms and severity, impacting individuals’ treatment journeys.
