Support In The Community
The Agency for Integrated Care (AIC), together with the Ministry of Health (MOH), developed the Community Mental Health Masterplan in 2012 which enables persons with mental health and dementia to seek early treatment nearer to their homes and ensure that they are well supported in the community. The Masterplan focuses on access to care and promote early identification of mental health conditions, integrating health and social care for those with such conditions, and building a dementia care network.
To do this, AIC works to build an integrated community mental health network across various care settings and sectors to support persons with mental health issues and their caregivers, so that they can age well in the community. Our partners in this network include General Practitioners (GPs), Polyclinics, as well as Social Service Agencies (SSAs) and community partners who run the community outreach teams, community intervention teams, specialist-led teams and other care and support services.
Read more about the programmes below.
Programme Details
The community outreach team, also known as the Community Resource, Engagement & Support Team (CREST), focuses on raising public awareness of mental health conditions and dementia, promote early recognition of at-risk individuals and providing emotional support to individuals and their caregivers. This team works with other community partners on facilitating preventive activities to reduce the risk of mental health issues and conducts meaningful activities to support the clients’ well-being and stimulate their cognitive functions. It is also the community node to link individuals to relevant health and social care services when necessary.
The caregiver community outreach team, also known as the Community Resource, Engagement & Support Team (CREST) – caregivers, focuses on caregivers who have or are at risk of developing depression, anxiety and burn-out due to their caregiving role. The team increases public awareness of caregiving concerns and promote identification of caregiver needs. The team also supports caregivers in self-care through health and wellness activities, stress management and future planning. Caregivers are linked up with support groups and counselling services where needed.
The youth community outreach team, also known as the Community Resource, Engagement & Support Team (CREST) – youth, increases awareness of mental health and promotes early identification by organising outreach events for the youth population, as well as those in their circles of support. The team involves parents and peers in the recovery journeys through youth-for-youth initiatives. The team is also the community node linking youths and their families to appropriate health and social support networks.
The community intervention team (COMIT) provides assessment, counselling, therapy, case management and psychoeducation support for clients with mental health issues and dementia, including their caregivers. With the assessment, the team develops individualised care plans for clients or link up the clients with other more suitable services. Caregivers will be provided with the appropriate assessment and intervention such as psychoeducation, training, support and support group. COMIT works closely with the community outreach teams, partner General Practitioners, Polyclinics and other community partners to provide holistic care to clients.
The youth integrated team increases awareness of mental wellness through targeted outreach to youth at risk of mental health issues. It provides assessment, therapeutic intervention and case management while engaging youth for ongoing monitoring and support. The team facilitates the formation of supportive relationship with family and peers, and works actively with other youth agencies, schools and community partners to provide holistic case management for the youths and their families.
The Aftercare programme provides transitional care support for clients who have complex needs and frequent relapse episodes. After discharge from the hospital, coordinated case management is provided to optimise functioning of the clients, sustain their psychological well-being and re-integrate them back into the community.
The Assessment & Shared Care Team (ASCAT) comprises of a multi-disciplinary team to provide assessment, treatment, and holistic care for clients with moderate to severe mental health conditions. In addition to supporting clients and caregivers, the team also builds capability of community mental health providers through training and clinical leadership.
Clients with mild to moderate mental health and chronic health conditions can seek holistic treatment at a nearby General Practitioner (GP) clinic, Polyclinics or Family Medicine Clinics (FMCs). The programme enables individuals to seek consultation, diagnosis and treatment close to home in a less stigmatising environment.
The Post-Diagnostic Support Programme for persons newly-diagnosed with dementia and their caregivers (PDS-Dementia) provides timely support for persons living with dementia and their caregivers upon diagnosis over six months. The programme provides education on the condition, coordinates community resources and facilitates early planning and management of the condition. The programme also includes a caregiver support network where caregivers can engage and interact with each other through their shared experiences, co-develop solutions to challenges and lean on each other for social and emotional support.
The Night Respite programme provides respite for caregivers caring for persons living with dementia with sundowning behaviour such as restlessness, agitation, disorientation, visual and auditory hallucination. Through the programme, persons living with dementia are engaged meaningfully at night which allows caregivers to have a good rest. The programme, which is part of the Caregiver Support Action Plan, also provides education and support to caregivers.
Resources for Partners
Based on feedback to AIC, most caregivers do not know where to search nor have time to read through the many resources. As such, AIC has put together a top 5 curated list of resources for caregivers which you can share with them. While the top 5 curated resources provide quick help, we do recognise that partners may need support in sieving out the relevant resources for the caregivers. Complementing the top 5 resources, a consolidated listing of resources has also been pulled together to address the varied needs of the caregivers.
Top 5 Mental Health Resources
Top 5 Dementia Resources
More Resources
If you would like to find out more on the respective resources, find out more below:
- Resources and Respite for Caregivers
- General caregiving resources
- Dementia resources: Dementia Hub and AIC resources
- Mental health resources
For service information, linkage, and resources on caregiving or mental health email us at enquiries@aic.sg.
