預算辯論 · 2026-03-04 · 屆國會 15
2026衛生部供給委員會辯論：AI作為國家醫療使命
MOH供給委員會辯論中，議員Mariam Jaafar發表重要AI醫療政策演說。她質問部長一個更大的問題：如果醫療真的是國家AI使命，目標就不能只是漸進式採用，必須建設一個完整的系統——基礎設施、治理、人才、底層管道——讓AI安全、有效、大規模地改善每一位患者的治療效果。她指出新加坡需要培養同時精通臨床實踐和機器學習的"翻譯型"人才。一旦證明AI能在大規模上安全可靠地改善患者結果，新加坡將獲得全球競爭優勢。
關鍵要點
- • 醫療AI目標不能只是漸進式採用
- • 需要建設完整的AI醫療生態系統
- • 培養臨床+機器學習複合型人才
- • 大規模AI醫療效果證明將成為國家競爭優勢
Pritam Singh和Sylvia Lim參與辯論
醫療AI從漸進採用走向系統性轉型
參與人員 (7)
完整譯文（中文）
Hansard 原始記錄 · 2026-05-02
主席：衛生部（MOH）O項負責人。Mariam Jaafar女士。
下午6時59分
從護理融資到健康融資
Mariam Jaafar女士（實巴旺）：主席，我提議，“將預算中O項的總撥款減少100元。”
S+3M，即補貼醫療儲蓄（Medisave）、醫療保險（MediShield）和醫療基金（MediFund），是我國一項默默的成功。它保護了幾代新加坡人免受災難性賬單的影響，維護了系統的可持續性，植入了共同責任、個人擁有權和公平性。
但它是為過去的風險設計的。S+3M最初是為急性醫院事件設計的，比如手術、中風、突發住院。
如今，我們面臨的主要風險是慢性、漸進、社群基礎的疾病：糖尿病、痴呆、虛弱、心理健康狀況。它們不會讓家庭一夜破產，但會慢慢耗盡家庭資源。
痴呆日間護理每次約63元。即使有最新的補貼，中產家庭每年仍需支付超過12,000元，且不包括交通、居家護理、藥物和照顧者收入損失。在我於兀蘭的市民見面會中，我經常聽到兩個問題：一是“為什麼我不能用我的醫療儲蓄？那是我的錢”；二是“我已經用完了所有醫療儲蓄用於慢性護理”。
下午7時
L女士，一位退休人員，照顧患有早期痴呆的丈夫，同時管理自己的糖尿病。她告訴我，“我一生都在儲蓄，為什麼感覺我的錢仍不足以保持獨立？”或者24歲的K女士因其心理健康狀況未被正式認定為慢性病而自費治療。“我可能需要終身治療，這怎麼不是慢性病？”這些都是我們新加坡同胞的真實生活寫照。
漸進的限額調整和覆蓋範圍擴充套件有所幫助，但並未從根本上改變激勵機制。我們的系統仍然傳遞出一個訊號：當你已經非常病重時，我們才更關注你。這必須改變。我們的生活方式風險上升速度超過人口老齡化。更多久坐工作，更多螢幕時間，更豐富的飲食，慢性病更早出現。
新加坡正在投資於人口層面的預防——佔醫療預算的6%，計劃翻倍。健康新加坡（Healthier SG）全額補貼常規篩查和免疫計劃。公園、健身角、腳踏車道、活躍老齡中心和社群健康專案等活躍生活基礎設施鼓勵功能性健康。這些由中央資金支援。
但預防不僅僅是篩查。一些老年人需要物理治療以防止跌倒。一些需要居家康復以防止再入院。一些需要認知刺激以防止痴呆發作。一些成年人需要體重管理計劃以防止糖尿病惡化。一些青少年需要早期心理健康干預以防止惡化。這些是對獨立性的投資，而非可有可無的生活方式福利。S+3M必須進化，不僅僅是支付賬單，更要塑造行為，支援預防，維持獨立。
補貼。我提出三項上游轉變。
一、早期殘疾支援。許多計劃要求三項日常生活活動（ADLs）受限。引入“預虛弱”老年人的早期干預層級——資助物理治療、平衡訓練和力量鍛鍊。今天一個月的康復可以預防未來十年的護理院照護。
二、補貼診斷路徑。由健康新加坡全科醫生轉介時，首次專家諮詢和初步診斷掃描（CT或MRI），無論公私立，均應補貼。可治療的疾病不應因有人因費用猶豫而變成絕症。
三、對夾心家庭實行更公平的經濟狀況評估。兩個家庭可能人均收入相同，但支援年邁父母和幼兒的家庭負擔更重。調整多被扶養家庭的補貼等級。
補貼必須易用、透明，並設計成鼓勵早期預防行動。自動登記、共付額減少、整合醫療儲蓄獎勵和無縫數字理賠是推動行為的方式。
醫療儲蓄。即使有補貼，新加坡人長期仍面臨費用。醫療儲蓄必須進化。我建議醫療儲蓄靈活使用，年度提款限額與餘額掛鉤，設上限以維持可持續性。允許其資助慢性病管理、更廣泛的預防篩查、基於證據的醫生推薦功能健康或營養專案、輕微傷害或住院後的早期康復、痴呆或虛弱的早期干預、擴充套件心理健康支援。保留核心醫療儲蓄用於重大事件。未用的靈活餘額可結轉，獎勵負責任的早期行動。可根據慢性病管理和功能評估的改善發放獎勵。
補貼和醫療儲蓄靈活使用共同推動新加坡人早行動、遵守慢性護理並參與預防專案。新加坡人獲得更多靈活性，同時系統保持災難性保障。醫療保險生命計劃（MediShield Life）仍用於罕見高額住院，保持保費可負擔。若預防處方被證明節省成本，可探索保費抵扣。醫療基金仍是真正需要者的最後安全網。
S+3M實際上是我們跌倒時的安全網。但在老齡化社會，我們需要一個彈跳板，讓我們保持站立、強壯、獨立和健康。我們必須調整S+3M：不僅融資醫療，更融資健康本身，不是放棄原則，而是充分實現原則。
共同責任必須包括共同預防。個人擁有權必須賦能早期行動。公平必須承認累積負擔。這不是多花錢，而是更早花錢，從而後續花更少——無論是財務、社會還是情感上。
先生，這些改變不影響一件事。政府必須竭盡全力保持醫療可負擔，遏制醫療通脹。如果我們做對了，不僅治療疾病，還能維護獨立和尊嚴。不僅支付賬單，還能投資健康。
衛生部是否承諾研究並報告，最好在下一個預算前，如何重新校準S+3M以更好支援慢性和預防護理？
（程式文本）提案問題。（程式文本）
主席：Mariam Jaafar女士。
個人責任與集體責任
Mariam Jaafar女士：醫療保健常被視為個人責任。個人確實重要，但在新加坡，醫療風險是共享的。保費集中，補貼集中，照顧負擔共享。不存在純私人醫療費用。
當可預防疾病上升時，保費上漲，稅收上漲，家庭感受壓力，照顧者離開勞動力市場。然而，今天只有約六成符合條件的居民定期參與推薦的慢性病篩查，四成仍未受保護。
預防護理能救命並降低成本，但前提是人們參與。如果預防至關重要，就不應依賴誰記得點選連結。選擇加入需要時間、意識和信心——這些並非人人具備。預防必須是預設選項。我建議：轉為選擇退出篩查，主動、個性化健康輔導，輔以數字推動。
集體責任不是責備，而是設計。設計不只屬於衛生部。它關乎孩子們在學校吃什麼，熟食中心什麼負擔得起，工作場所如何安排時間和壓力，社群是否鼓勵或阻礙運動。健康選擇必須是簡單選擇。
如果我們從上游設計，就能節省下游成本。衛生部是否考慮將關鍵預防專案設為選擇退出，並說明如何跨政府部門合作，將預防預設嵌入日常生活？
改善北部健康
健康社群不是偶然形成，而是設計的。衛生部已啟動改善北部健康的計劃，我的選區兀蘭正在試點綜合預防健康模式。
北部條件優越。我們有多樣的老年人和家庭，涵蓋各種住房型別，強大的社群機構，以及加強慢性護理的機會。兩家醫院、數個綜合診所和活躍老齡中心近在咫尺，我們可測試如何將護理更貼近家園，完善綜合護理團隊模式。
試點基於四大支柱：一是強化轉診路徑和慢性病支援；二是將護理更貼近家園，確保順暢過渡；三是重新設計社群，使健康選擇更簡單；四是啟用社群成為健康倡導者。
我支援此舉，但不能停留在紙面政策，必須關乎真實人群，每天過更健康生活。因此，我有兩個問題和三項請求給部長。
問題：一，如何衡量成功？二，基層動員將有哪些資源？
請求：確保鎮級護理中心全面整合、人員配備穩定，居民可無延遲獲得服務；擴大社群護理和照顧者支援範圍，涵蓋更多病症和家庭；直接讓我的居民參與共設計干預措施，使方案反映真實需求，避免汙名化任何社群。
健康結果由系統塑造——交通、飲食、工作模式及社會經濟因素，而非道德缺陷。
想象一下。54歲的S女士每週三次在活躍老齡兀蘭健身房進行力量訓練，有志願者夥伴監督。她不想做飯時，坎邦阿德米拉熟食中心有豐富健康且負擔得起的清真食品。護理和支援更貼近家園，她的糖尿病得到控制，保持獨立。
如果我們能為健康重新設計一個鎮，我們就能重新設計一個國家。
醫療人工智慧
首先，我宣告本人為一家管理諮詢公司的董事總經理，該公司涉足人工智慧和醫療保健領域。
醫療人工智慧常以應用案例討論——早期疾病檢測、自動化文書、風險預測、個性化醫療。這些令人印象深刻。但今天，我想問部長一個更大的問題：我們的雄心是什麼？如果醫療是國家人工智慧使命，我們的目標不能是漸進式採用。我們必須構建一個系統——基礎設施、治理、人才、管道，使人工智慧能安全、有效、大規模地轉變護理，為新加坡每位患者帶來更好結果。
一旦證明人工智慧能安全可靠地大規模帶來真實患者利益，新加坡自然將從採用者轉為全球可信醫療人工智慧領導者。新加坡已奠定堅實基礎：HEALIX支援跨叢集分析；國家電子健康記錄（NEHR）匯聚患者記錄；健康資訊法案明確權利、責任和保障；早期人工智慧試點已減輕臨床工作負擔，改善患者結果。
但僅有基礎設施不足以使我們成為領導者。我們的資料仍然分散。互操作性支援護理交付，但創新和人工智慧開發（包括第三方）安全訪問仍有限。
要全球領先，三點關鍵。
一、更強的資料框架——國家資料架構、安全沙箱、合成數據集和聯邦學習，支援人工智慧創新同時保護患者隱私。
二、互作業系統，允許人工智慧模型跨機構學習，同時讓臨床醫生保持控制權。
三、治理規則：每個人工智慧建議必須可解釋、可審計、可問責。明確創新治理；自上而下或自下而上。
關於全球合作，我們立場明確：歡迎專業知識，但僅在保護資料、維護主權、建設本地能力和惠及患者的框架下。
法規也必須跟上。人工智慧發展迅速。我們需要國家驗證、認證和部署後監控——偏見、可解釋性和實際表現標準，讓患者和臨床醫生信任每個人工智慧決策。
最後，人才。醫療人工智慧是翻譯問題。我們需要既懂臨床現實又懂機器學習的專業人才。
先生，我們正走在用人工智慧提升效率的軌道上。但新加坡必須成為人工智慧解決方案安全構建、測試、認證和規模化的地方，患者結果在每一步都得到改善。醫療不應僅僅採用人工智慧，新加坡必須制定可信、安全、有效人工智慧的標準。
衛生部是否能概述一條明確路線圖和時間表，加強資料訪問框架、驗證標準和人才培養，使新加坡成為可信醫療人工智慧的領導者？
綜合保障計劃——額外提款限額
Pritam Singh先生（亞逸－宏茂橋）：2015年醫療儲蓄繳款上限為48,500元。如今，醫療儲蓄賬戶最高金額的基本醫療儲蓄額為79,000元，約十年間增加了3萬元。近70%的本地居民持有綜合保障計劃（IP），自醫療保險生命計劃推出以來，允許使用醫療儲蓄支付IP保費的最高額度（即年度提款限額）近十年未曾調整。
近年來，許多新加坡人持續抱怨自付費用，加之基本醫療儲蓄額逐年大幅上漲，公眾期望允許公積金成員使用更多醫療儲蓄支付IP保費的額外提款限額應予以修訂。多年後仍保持不變是不合理的。
衛生部是否計劃近期審查此事？如果不，原因何在？
醫療人力
《海峽時報》上月一篇評論文章標題簡潔表達了醫療系統的主要焦慮：“新加坡成為超級老齡社會：其醫療系統能否應對？”作者是一位公共衛生學者，觀察到許多新加坡人在訪問公立醫院和醫療機構時的常見情景——大量坐輪椅、明顯虛弱或行動困難的老年人。
衛生部表示，醫療人力預計將從2024年的129,000人增長20%，至2030年約156,000人。評估認為，這一人數大致能滿足未來幾年的人口醫療需求。
人口快速老齡化與醫療服務需求增加的交匯，將使醫療人力的充足性成為焦點，任何短缺或感知短缺將最直接反映在服務質量、專科護理等待時間和看診等待時間等方面。
同時，鑑於預期患者負擔加重，醫療工作者——包括輔助醫療專業人員、護士和醫生——的福利令人擔憂。另一個問題是，預計每年有10萬名保單持有人將其保險覆蓋從私營轉向公立醫療部門，這可能嚴重加劇公立醫療系統壓力。部長曾表示這一數字預計將增加。
第一，當醫療系統達到156,000人上限時，突發容量範圍如何？是否包含額外醫生、護士和輔助醫療人員的緩衝？如果有，具體多少？如果沒有，是通過流程重組以少做多應對突發需求？若是後者，系統能維持最佳效能多久？
第二，衛生部是否計劃擴大公開報告的統計資料範圍，除現有的醫院急診、綜合診所和專科門診等待時間外？
我們應仔細追蹤系統應對人口結構變化帶來的重大需求的能力。值得記住，醫療是非常獨特的公共服務。總理將醫療確定為四大國家人工智慧使命之一。人工智慧確實能在生態系統層面注入新的生產力可能。
然而，對於需要醫療的普通新加坡人來說，醫療之所以是醫療，是因為那些在我們最脆弱時照顧我們的醫生、護士和輔助醫療人員。在這方面，人文關懷和個人聯絡永遠無法被人工智慧完全取代。
因此，如果未來醫療人力需要額外緩衝，我們應相應投入更多財政資源。
主席：Hamid Razak醫生，你可以一起發言。
遺傳性癌症的成本複雜性
Hamid Razak醫生（西海岸-裕廊西）：主席先生，對於一些新加坡人來說，醫療不僅僅是賬單，而是一生的風險。
今天，在本院，我想分享我遇到的一位年輕新加坡人的故事——關達琳。她二十出頭時被診斷出患有遺傳性乳腺癌。她的生活一夜之間發生了改變。她經歷了手術、手術併發症以及持續的化療。她接受了重建手術，但部分重建費用未被覆蓋，因為被認為是美容性質的。
對於一位年輕的癌症倖存者來說，重建並非美容手術。這關乎尊嚴，關乎心理康復。
如今社會上有許多像關達琳這樣的人。我所說的是那些具有遺傳性癌症風險的人。她的故事反映了更廣泛的差距。
如今的癌症護理不僅臨床複雜，而且在財務和心理層面也很複雜，尤其是遺傳性疾病。因此，政策問題是：我們如何支援那些今天可能尚未生病，但明顯處於高風險的人？為此，我想向部長提出三個廣泛的問題。
首先，我們如何將遺傳風險評估和基因諮詢整合進初級保健，並將其連線到“更健康的新加坡”計劃，使預防成為上游措施？
第二，衛生部是否會審查我們如何為醫學指示的預防性手術和重建手術提供資金支援，包括涉及當前健康器官的高風險情況，以確保支援一致且易於理解？例如，在關達琳的案例中，如果在一側乳房發現腫塊且確診為病變，她接受乳房切除術，那麼另一側目前健康但攜帶乳腺癌基因的乳房該如何處理？在照顧此類個體時，系統如何做到無縫銜接？
第三，我們如何加強年輕癌症患者的生存路徑，包括心理和社會支援，而不僅僅是醫療隨訪？
主席先生，考驗不僅是生存，更是倖存者如何重返生活。
精準醫學與功能健康
主席先生，如果遺傳性癌症說明了醫療護理的複雜性，那麼精準醫學則告訴我們如何智慧地應對這一挑戰。
我們已經看到方向。在國大醫健系統（NUHS），健康長壽中心正在構建強化健康壽命的專案，不僅治療疾病，還幫助新加坡人在衰老過程中保持身體強健、認知敏銳和代謝良好。
這很重要，因為公眾需求已經存在。人們在主流體系之外尋求檢測和最佳化。如果我們的公共路徑不能跟上可信證據的步伐，我們面臨兩大風險——護理碎片化且質量不均，導致不平等加劇，以及錯失新加坡作為可信賴區域中心負責任領導的機會。
雖然我們專注於照顧老年人和長者，這很重要，但隨著社會發展，關鍵問題是如何最佳化每位新加坡人，無論年齡大小，達到其年齡段的最高健康潛力？因此，主席先生，我想問部長三個問題。
第一，衛生部評估和採納精準醫學及長壽相關新興證據的路徑是什麼？如何確保安全和價值的明確保障？第二，“更健康的新加坡”計劃如何逐步增加功能健康指標，包括代謝、認知和虛弱指標，使預防個性化而非泛泛而談？第三，我們如何推動負責任的創新，確保基於證據、面向未來且值得信賴，使政策能隨著證據出現及時調整，而不是在證據成為主流後等待兩三年？
因為目標顯然不僅是延長壽命，而是延緩衰退、保持獨立和有尊嚴的老齡化。
癌症治療費用與保障
林瑞蓮女士（阿裕尼） ：主席先生，新加坡醫療費用通脹預計今年將達到近17%，遠高於低於2%的整體通脹率。
我認可並同意需要控制成本和管理保險保費。針對癌症，衛生部已採取重大舉措。例如，癌症藥物清單現有約394種藥物，符合MediShield Life和綜合計劃的補貼及理賠資格。
三個月前，衛生部宣佈住院保險關鍵政策變更。今年4月起，綜合計劃的新附加險將不再覆蓋衛生部設定的最低免賠額，且賬單5%的共付額上限由每年3,000元提高至6,000元。新附加險的保費預計比現有附加險低約30%。
部長在TikTok釋出了多段影片解釋變更。在其中一段影片中，他似乎暗示現有附加險的唯一用途是降低免賠額和共保額，公眾應考慮是否需要附加險。
然而，我瞭解到附加險可能對癌症患者尤為重要，原因有二。
首先，附加險幫助支付癌症藥物清單外的昂貴藥物，這對患者治療至關重要。其次，存在損失限額問題。沒有附加險，患者需支付住院賬單的10%，且無上限。
第二個更普遍的問題涉及預防性醫療干預，可能不被保險覆蓋。
一位年輕乳腺癌患者於1月28日在《海峽時報》論壇頁面講述了她的困境。她遵醫囑切除雙側乳房，儘管只有一側患癌。她的住院保險覆蓋了癌變乳房的手術，但對非癌變乳房的手術僅部分覆蓋。
去年4月，衛生部承認預防與診斷護理的界限日益模糊，尤其涉及遺傳性嚴重疾病如乳腺癌的情況。衛生部表示將於當年晚些時候釋出乳房相關手術理賠規則指導執業者。
請問該審查的現狀如何？
收入審查與孝道悖論
賴偉德先生（宏茂橋） ：主席先生，成年子女往往是年邁父母的預設照顧者。子女希望父母與他們同住是好事，父母健康活躍更佳。然而，一些新加坡人覺得為做正確的事而受到懲罰。這就是我所說的孝道照護悖論。
當子女將年邁父母接入家中，父母往往失去諸如社群健康援助計劃（CHAS）、銀髮援助或其他補貼等福利。父母被視為高收入家庭成員或居住在高年租值的房屋型別中。
主席先生，為支援照護並鼓勵孝道，我們需認識到照護責任的負擔可能相較於住房收入或型別更為重大。我並非建議放棄醫療和社會援助中的收入審查，但我們可以更明確地識別照護家庭。我有三點建議。
第一，考慮設立照護者住房豁免。年長者搬入成年子女家中照護時，應獨立評估，而非與整個家庭合併。第二，考慮設立過渡期。這是一個寬限期，使年長者的福利在照護安排變更時不會立即消失。第三，探索功能需求評估，根據實際需求而非僅看家庭收入或住房型別來評估社會援助。
主席先生，當成年子女將年邁父母接入家中照護時，我們應給予更多支援，而非更少。
醫療支出波動與MediSave限額
林志明副教授（盛港） ：我們中曾嚴重生病的人都深知醫療支出的波動性。即某一年可能無醫療支出，但另一年可能花費遠超預期。
即使是慢性病患者也常如此，因為新診斷或治療程式可能偶爾才需。健康經濟學的系統研究證實了支出峰值的現實。此外，臨終支出往往較高，也是波動性的另一表現。患者通常在生命最後幾年花費最多。
MediSave目前對多種護理設有年度提款限額。此政策初衷良好，避免患者耗盡MediSave資金，尤其考慮到大部分護理費用確實發生在生命末期。
但此政策與醫療支出的波動性不符，也忽視了保險（包括公共保險如MediShield Life）在此類情況下的作用，因為這些保險更可能支付重大疾病費用，否則患者將耗盡MediSave。
中央公積金的實際資料支援MediSave賬戶可能存在過剩儲蓄的觀點。2022年，陳詩龍部長在答覆國會質詢時報告，85歲及以上會員的MediSave賬戶餘額遠超退休賬戶，比例接近五倍。
有兩種方式可更好調整MediSave限額。
第一，允許未用額度最多結轉三年。這樣，發生超預期賬單者無需依賴自付資金，尤其退休者的自付常由工作年齡家庭成員支付以補充醫療費用。
第二，設立分級理賠限額，隨年齡增長逐步提高理賠額度。雖無法準確預測個體壽命，但可依據性別的總體死亡率統計調整限額。直覺上，晚年健康狀況惡化，應允許更多支出。
主席先生，這些簡單措施將更好地使MediSave使用與確保醫療需求時資金充足的良好初衷相匹配，無論需求是今天還是未來。
門診MediSave使用
嚴彥松先生（阿裕尼） ：主席先生，我再次呼籲衛生部將所有慢性病納入慢性病管理計劃覆蓋範圍，而非僅限23種批准病症。這樣任何需長期管理的病症都能通過CHAS獲得補貼，並可用MediSave支付。
晚上7點30分
即使是慢性病管理計劃內的病症，MediSave 500/700元提款限額也可能限制治療。我在2021年曾提出此問題，高階國務部長認為限額是防止過度消費的必要措施。但這如何適用於公立醫療機構？那裡的醫生受薪且遵循嚴格協議。真正風險不是過度消費，而是治療不足。患者在現金與治療間被迫選擇，有些可能為省錢而跳過用藥或預約。
今天的自我節制可能導致明天鉅額賬單和緊急住院。這對患者和醫療系統都是巨大負擔。衛生部是否評估過因MediSave提款限額嚴格導致的醫療不遵從的臨床成本？新加坡人希望自力更生，不必申請補貼或醫療援助。衛生部應允許60歲以上患者在公立醫療機構更靈活使用MediSave，尤其是那些MediSave餘額充足者。
心理健康資金與支援
鄭德源先生（先鋒） ：主席先生，我宣告本人為國大醫院集團心理健康委員會主席。我提出新加坡應將精神病院（IMH）定位為精神治療與護理的真正卓越中心，並向部長提出三問以達成此目標。
IMH是我們唯一專門的精神病醫院，擁有最資深的精神科醫生和專業團隊。但其資源被分散於各種病情嚴重程度。如果我們真心打造卓越中心，必須讓IMH專注於其最擅長的領域——領導研究、培訓下一代心理健康專業人員及管理最複雜病例。
第一個問題是人力資源。IMH是否比急症醫院擁有更充足資源處理複雜精神病患者？卓越中心不僅要治療，還應制定全系統及三大公立醫療集團的臨床標準。IMH的專業知識如何被三大集團利用，以提升所有急症醫院及社群的精神治療與護理，避免IMH因過多轉診而效率低下？
第二個問題是護理路徑。部長能否分享IMH及急症醫院出院精神病患者被多診所接納的比例？卓越中心無法正常運作，如果其床位被準備轉入下一級護理的患者佔用。是否有計劃擴充多診所精神病容量，使IMH能專注真正需要專科護理的患者？穩定患者常因社群設施不足而滯留IMH。
第三個問題是是否有計劃發展更多託管及下轉設施——如庇護所、支援性居住——以便IMH床位留給需要其全面臨床專長的患者？
心理健康
溫立生醫生（惹蘭勿剎） ：主席先生，心理健康是國家優先事項。近年來，我們在認識到心理健康是社會和經濟韌性的基礎方面取得顯著進展。年輕人、職場人士和長者的需求不斷增長。越來越多人主動尋求幫助，這是好跡象。
但壓力真實存在。心理健康問題每年給新加坡帶來約160億新元損失，主要因缺勤和帶病工作導致生產力下降。此數字提醒我們，心理健康不僅是醫療問題，還影響工人、家庭和國家韌性。
問題不在於心理健康是否重要，而在於我們的體系是否能持續滿足未來需求。
我們啟動了國家心理健康與福祉戰略，擴充套件社群服務，加強初級保健。進入下一階段，部長能否更新進展？早期干預是否有可量化改善？等待時間是否穩定，尤其是中高風險病例？社群服務提供者是否得到充分支援以應對持續增長的需求？
每項戰略最終都會達到僅靠擴充套件不足以應對的階段，需要結構性強化。心理健康跨越醫療、教育、職場和社會部門。部長能否闡述心理健康辦公室的角色和職責？它如何跨機構協調、追蹤系統層面成果並確保問責？若真是全社會努力，治理必須明確且有意圖。
主席先生，服務最終依賴於人。臨床心理學家及其他高風險心理學專業需多年嚴格研究生培訓和監督實踐。標準必須保持高水平，患者安全依賴於此。
同時，需求增長。衛生部如何預測未來五至十年臨床心理學家及相關心理健康專業人員的人力需求？是否有計劃加強本地培訓和監督能力，建立強大本地核心，同時保持專業標準？衛生部是否考慮加強高風險心理實踐的專業監管，以保障患者並增強公眾信心？
心理健康護理必須作為一體化系統運作。心理學家、輔導員、社工、職業治療師和同伴支援專家各司其職，互為補充。人力規劃和培訓改革如何確保這些職業間更強整合，以及初級保健、醫院和社群服務提供者間更好協調？患者不應經歷碎片化，應體驗連續性。
展望未來，我們也應關注人工智慧在心理健康支援中的日益應用。AI工具或可用於自助心理教育和早期篩查，但應謹慎。如果技術開始替代專業護理，心理健康治療往往涉及複雜臨床判斷和危機應對能力。部長能否分享衛生部如何看待AI在心理健康中的角色，以及為確保技術輔助而非替代專業人員所需的保障措施？
主席先生，若心理健康是國家基礎設施，我們必須以堅實基礎、明確標準和長期可持續性來建設。我期待部長的回應。
主席 ：何亭如女士，請一併發表您的三段發言。
心理健康專業人員監管
何庭如女士（盛港選區）：主席先生，我宣告本人在福祉領域的從業者身份。鑑於心理健康危機沒有緩解跡象，衛生部是否能提供最新情況，並承諾設定明確的時間表來規範心理健康專業人員？
我想重申呼籲規範治療師和輔導員等專業人員，他們在支援心理健康狀況個體方面發揮關鍵作用。規範很重要，因為客戶可能不知道如果對專業標準或倫理有疑慮，應向何處尋求幫助。
同時，我們也必須確保專業人員的入門門檻不過高。大多數治療和輔導資格要求最低監督小時數和實習，費用高達每小時200新元以上，這對應屆畢業生和中途轉行者來說可能很困難。我希望我們能探索更多降低這些門檻的方法。除了補貼外，衛生部是否也考慮使用技能未來（SkillsFuture）學分？
心理健康與福祉戰略
設立國家心理健康辦公室（NMHO）是邁向心理健康與社會經濟決定因素連續體願景的第一步，心理健康不僅僅是疾病的缺失。
話雖如此，我們仍需努力實現一個明確的願景，以改善新加坡人的心理健康。例如，蘇格蘭2017年心理健康戰略側重於通過生命週期模型減少心理健康不平等及治療和獲取不平等；馬來西亞國家心理健康戰略計劃旨在將青少年抑鬱率從18%降至10%。這些戰略清晰地描繪了改善心理健康與福祉的成功願景，描述了心理健康人口的樣貌，幷包含了時間限定的目標和超越廣泛關注領域的成果。
這與世界衛生組織近期關於促進和保護政府部門心理健康與福祉的政策和戰略行動指導一致。該指導呼籲：一、積極與所有利益相關者接觸，確保有實際經歷者的有意義參與；二、定期報告和明確承諾；三、分配充分預算和專門資金支援政策指令和戰略行動，防止實施延誤。
我想提出四個澄清問題。第一，國家心理健康與福祉戰略的成功圖景是什麼？為協調跨政策領域和部門的努力，戰略應概述幾個關鍵成果並設定明確目標。
第二，NMHO計劃如何與各部委和機構合作，向新加坡人介紹當前舉措和未來計劃？納入有實際經歷者、社群和民間社會的持續反饋，將確保戰略保持相關性並紮根於真實需求。
第三，NMHO將如何通過定期更新協調報告、監測和評估？例如，蘇格蘭2026年1月的監測報告追蹤九個戰略成果的關鍵績效指標，以增強機構問責、響應性和效能。
第四，是否有專門資金支援心理健康與福祉舉措以支撐戰略？如果有，金額是多少？2020年至2022年，衛生部將約3%的醫療支出用於心理健康治療、推廣和預防。此金額是否增加，未來預計金額如何？
無煙一代
多年來，政府一直在研究可能推行無煙一代政策。今年早些時候，衛生國務部長在與我交流時表示，實施此類政策的效果並非簡單明瞭，且我們現有措施已使吸菸率降至8.4%的歷史最低水平。
主席先生，我同意實施無煙一代政策並非易事。黑市已使新加坡無法完全無毒品和無電子煙。同樣，儘管執法人員努力，禁菸場所也未能完全無煙。
然而，儘管紐西蘭部分基於政治理念廢除了相關法律，我們應繼續研究如何在有實際證據證明其有效性和可實施性的情況下推行無煙一代政策。馬爾地夫的政策已生效，英國法案也有望於2027年初實施。
像英國一樣，我們有條件推出類似政策，正因為我們的吸菸率已很低。最新研究，包括諾丁漢大學今年1月釋出的研究，表明世代禁菸將使吸菸率低於5%的水平提前數十年實現，這被定義為菸草的有效終結。
我強調終結目標，因為它設定了我希望我們儘快實現的目標。雖然與無煙一代政策相關，但我們應將終結目標作為總體政策目標。通過定期提高菸草稅等決策，我希望我們追求的是最大化罪惡稅的影響，而非考慮其財政收入影響。
同樣，我們應加大力度遏制公共場所吸菸的健康影響，例如解決邊走邊吸菸的問題。新加坡對毒品和電子煙採取零容忍態度，我們必須對菸草採取同樣態度。謝謝。
主席：蔡銀洲先生，您可以將兩段發言合併。
隱形醫療狀況
蔡銀洲先生（碧山-大巴窯選區）：謝謝主席。繼我在預算演講中提及隱形成本後，我想談談患有隱形疾病者的困境。
公共交通上的援助計劃雖已支援部分人士，但許多患有隱形醫療、自身免疫或慢性疾病的人在日常生活中仍面臨評判。衛生部是否考慮將這些舉措擴充套件至小販中心、圖書館等更多場所，營造一個以耐心而非懷疑為先的社會？
在新加坡，每五個兒童中就有一人，每十個成年人中就有一人忍受特應性溼疹的持續且令人難受的瘙癢。雖然可控，但持續治療的費用，包括溼敷和光療，是一筆重大經濟和情感負擔。衛生部是否考慮將特應性溼疹納入慢性病管理計劃，該計劃已涵蓋類似的銀屑病等疾病？
最後，一些青少年因擔心學校輔導員會自動且強制向家長報告自殺念頭，尤其當這些念頭源於家庭情況時，而不願分享。為鼓勵更多求助同時確保安全，衛生部是否會實施分級報告框架，允許根據風險程度更大程度保密？
主席，我們必須確保我們的護理基礎設施足夠強大，支援那些我們看不見的掙扎。我期待衛生部對更包容、更有同理心的醫療環境的願景。
老年人一站式服務
我的第二段發言回應一個古老問題：什麼是美好生活？我在碧山-大巴窯與許多長者交談，他們的答案不僅僅是更多的援助，而是尊嚴、選擇權和自主權，讓他們能按自己的意願度過晚年。
晚上7點45分
為此，我提出四項建議。
第一，將綜合社群護理提供者擴充套件為“長者禮賓服務”。翁部長曾談及單一協調點和85個子區域，這些將很快協調區域醫療系統、居家個人護理Plus、新加坡輔導中心、戒毒中心和積極老齡中心，形成“一環統籌……抱歉，是一份護理計劃統籌一切”。
我建議除了臨床成果外，進一步集中參與就業與就業能力學院的求職、人民協會的社群活動和社會服務辦公室的經濟援助申請的接觸點。一個聯絡人，一個協調員，全面照顧長者作為一個整體的人。
第二，衡量真正重要的指標。在我們10月會議中，衛生部關於追蹤社會孤立的回覆側重於出席率和外展人數。孤獨感更深，這些數字只是表面。我請求衛生部與教育機構合作，定期開展廣泛調查社會健康決定因素。我們需要本地化的“生活質量”指標，以瞭解我們的努力如何真正減少孤立。
第三，將專科醫療帶入社群。無法進食、聽力或行走直接關聯認知衰退和死亡率上升。然而，獲得專科幫助仍是障礙。我請求衛生部加強牙科、聽力學和足病學設施，特別是在長者集中居住的地區。我們必須在生活質量迅速下降前發現這些障礙。
第四，我請求衛生部考慮在高等院校開設聽力學和足病學的學位或文憑課程，以增加新加坡專業人才數量，從而更好地服務需要此類專科護理的長者。
通過簡化訪問、衡量重要指標、擴充套件專科護理和培養本地專業人才，我們確保長者不僅僅是“變老”，而是擁有自主權地生活。
提升長者護理與支援
葉漢榮先生（耀祖康選區）：主席先生，新加坡人享有較長壽命。但我們是在為生命增添年華，還是僅僅為年華增添生命？隨著醫療從醫院轉向家庭，真正的考驗不僅在於基礎設施，更在於我們培養的關係、組織的支援和維護的尊嚴。
首先，社會孤立。在我們密集的社群，許多長者孤獨生活，鄰里環繞，卻被沉默隔開。荷蘭和丹麥等國將社會處方納入初級護理，認識到處方可以是一個人、一個目標和歸屬感。
抑鬱、焦慮和悲傷的心理健康支援仍然資源不足。老年痛苦常常隱形，卻深刻感受。衛生部能否更新我們關於在健康新加坡計劃下正式推行初級護理社會處方及其成果？我們如何將常規心理健康篩查納入社群長者護理，以便早期發現痛苦？
在健康新加坡計劃下，積極老齡中心正在擴充套件，作為長者社群的錨點。衛生部能否分享是否觀察到社會孤立減少和福祉改善？
第二，痴呆症。家庭仍難以獲得痴呆症專門的日間護理和臨時照護服務。痴呆友好社群，即以同情而非汙名對待認知混亂的社群，仍不均衡。衛生部將如何加快痴呆日間護理和臨時照護能力建設？我們如何加強公眾教育，使汙名減少，包容增加？若要健康老齡，我們必須善待那些無法自我記憶的人。
第三，照顧者。儘管有補貼，許多照顧者仍面臨經濟壓力和倦怠。照顧不應意味著健康下降、儲蓄耗盡或孤立。衛生部是否會審視臨時照護，使其成為標準且易於申請的權益？隨著健康新加坡計劃推出綜合社群模式，如何衡量照顧者負擔和協調成果，確保家庭獲得緩解？
第四，姑息治療。善終也是生活的一部分。儘管許多人希望在家中離世，但因家庭缺乏支援，許多人仍在醫院去世。衛生部採取了哪些措施擴大居家姑息能力，並裝備全科醫生提供持續的醫療和心理社會支援？
最後，隨著擴充套件的EASE計劃允許私宅長者申請適老化補貼，這如何與健康新加坡計劃的居家養老策略相輔相成？如何追蹤使用率和影響？
主席先生，我們現在必須建立一個關懷社群，確保每位長者不僅活得更久，更活得有尊嚴。
支援與認可照顧者
法茲裡·法茲維先生（亞逸拉惹選區）：主席先生，新加坡正成為一個照顧者的國家。隨著社會老齡化，越來越多新加坡人將在生命中很大一部分時間照顧變得虛弱、殘疾或慢性病的配偶、兄弟姐妹、父母或祖父母。支援存在，但照顧者仍感到支離破碎。許多人在醫院和機構間反覆講述自己的故事，沒有統一的照顧者身份認證，也沒有貫穿各場景的簡單入口。
無償照顧不是小事。杜克-新加坡國立大學研究估算，75歲及以上需要人類協助的長者非正式照顧時間的貨幣價值約為每年12.8億新元。
由於聚焦75歲以上需要協助的長者，這可能低估了更廣泛的負擔。這就是為何早期識別重要。當地綜合護理研究發現，基線時感到壓力的照顧者有約四分之一的機率在12個月後仍感壓力，強調了早期評估和支援照顧者的重要性，包括出院規劃時。
2026年預算加強長期護理融資，包括向長期護理支援基金追加4億新元，用於CareShield Life增強的額外補貼。但僅靠融資無法解決認可和導航問題，因此我建議部長研究並試點英國部分地區使用的簡單工具——照顧者護照。一旦確認為照顧者，便獲得實體和數字憑證，實現跨接觸點的認可並觸發實際支援。
我設想的是新加坡版照顧者護照，允許在超市、藥房及其他照顧相關場所享受折扣。更重要的是，護照應允許照顧者參與出院和護理規劃，加快臨時照護和培訓的連結，促進結構化的工作場所靈活性對話，並通過社群夥伴支援日常生活參與。
我建議從兩個至三個區域試點，持續六至九個月，每個試點招募約100名照顧者，隨後評估採納率、導航成果及照顧者壓力變化。
我有三個問題請教部長。第一，衛生部是否會設立照顧者認可試點基金，支援這些試點及評估，以便推廣？
第二，衛生部是否支援試點期間採用低負擔驗證模式，如自我宣告並通過醫療或社會服務接觸點驗證？
第三，衛生部是否會資助最低運營部分：協調、簡單二維碼基礎設施、合作伙伴接入及適度啟用支援，以確保試點產生全國推廣的證據？
議長先生，認可照顧者是加強我們社會基礎設施的關鍵，以減輕照顧者負擔，使支援一致且易於獲取。
主席：資深議會秘書蔡恩澤先生，您可以將兩段發言合併。
釋放我們的銀髮紅利
蔡恩澤先生（女皇鎮選區）：先生，到2030年，每四個新加坡人中就有一人年滿65歲或以上。這既是挑戰，也是巨大機遇。我們常常關注長者的不足，是時候轉變觀念。長者不是負擔，許多人渴望且能夠為社會做出有意義的貢獻。我們必須超越赤字思維，擁抱他們的全部潛力。
我最近會見了林達·弗裡德教授，她是著名老年病學家、流行病學家，也是哥倫比亞大學梅爾曼公共衛生學院首位女性院長。她還是Experience Corps的開創者之一，這是一個跨代志願者專案，吸引五十多歲的長者作為公立小學兒童的導師和輔導員，同時促進志願者自身的健康與福祉。
該專案旨在實現“三重贏”：一，幫助兒童學業成功，特別是早期識字；二，提升老年人的身體、心理和社會福祉；三，通過連線不同代際，強化社群。
結果顯著。學生識字能力提升，參與度更高，行為問題減少。志願者抑鬱減少，認知功能增強，社交聯絡更緊密。學校報告學習環境豐富，社群聯絡加深。
看似簡單：積極參與的長者是健康的長者。然而，儘管我們理解社會健康決定因素的科學，啟用它卻是另一挑戰。衛生部的銀髮守護者計劃鼓勵長者在積極老齡中心做志願者。這是良好開端，但我們可以做得更多。賦權長者不僅豐富自身生活，還強化家庭、學校和社群，塑造一個每代人都能繁榮的新加坡。我建議長者貢獻的三種方式。
第一，促進社會流動性。長者可以幫助面臨經濟、社會和情感壓力的ComLink+家庭。許多家長因工作和照顧責任而壓力重重，孩子在識字和算術方面可能落後。受Experience Corps啟發，擁有教學或專業經驗的長者可以輔導孩子，提供知識、耐心和鼓勵。除了學業，長者還可以指導家長，分享觀點和人生智慧。這樣，他們不僅提供幫助，還帶來穩定和希望。
第二，心理健康。一項針對21至89歲成年人的新加坡同行評審研究發現，2020年疫情封鎖期間，老年人報告的抑鬱、焦慮和壓力水平顯著低於年輕成年人。相比之下，大約三分之一的青少年報告有內化症狀，如焦慮、孤獨或抑鬱。許多年輕人不願意讓父母或家人參與他們的掙扎。老年人憑藉其穩定、不帶評判的陪伴和生活經驗，能夠提供指導、安慰和希望；幫助年輕人減少孤立感，增強韌性。
最後，我們的遺產。歷史通過親身經歷講述時最具力量。像“紐約人類”這樣的專案之所以引起共鳴，是因為它們真實、未經濾鏡、充滿人性。我們的老年人往往掌握著社群中最有意義的故事。作為社群導覽員，他們成為通往那些可能永遠不會出現在教科書中但卻是我們共同記憶關鍵部分的活橋。通過他們的故事，我們不僅儲存事件，還儲存塑造我們遺產和集體人性的奮鬥、價值觀和默默的勝利。
先生，我們的老年人建設了我們今天所知的新加坡。他們的犧牲奠定了基礎，他們的韌性推動我們前進，他們的智慧繼續指引我們。讓我們不要從限制的角度看待老年人，而是從可能性的角度看待。作為導師、輔導員、照顧者和導覽員，他們可以塑造生命，強化社群。
讓我們建設一個不懼怕衰老而是慶祝衰老的新加坡；讓每位老年人都感到被重視、被賦權並且彼此相連。因為當我們提升老年人時，我們是在尊重過去，並確保未來不僅以成功定義，更以尊嚴、同情和共享的人性定義。
我們與多巴胺的危險調情
讓我這次發言不從統計資料或政策開始，而是從三個簡單的自我介紹開始。
“你好，我是Benny。我戒毒五年了。”我們大多數人會以欽佩回應。我們理解克服化學依賴所需的自律。
“你好，我是Benny。我戒酒五年了。”我們再次默默點頭。我們知道成癮對健康、家庭和生計的影響。
但如果我說：“你好，我是Benny。我戒除色情五年了。”我們內心會發生什麼？我們會不自在地移開視線嗎？抑制一絲嘲笑？還是質疑這是否算戒除？
晚上8點
這種反應告訴我們一個重要資訊。雖然我們準備公開討論物質成癮，但當成癮表現為行為、私密且性相關時，我們仍感不安。色情成癮常被視為放縱或數字時代成長的一部分。然而對某些人來說，消費變得強迫、痛苦且干擾日常生活。
今天，我不是來道德說教或譴責慾望的。我是來詢問我們是否足夠關注一種可能正在悄然出現的行為成癮，尤其是在年輕人中，並思考公共衛生能且應發揮什麼作用。
當然，多巴胺不是敵人。它是神經遞質，對大腦功能至關重要。它激勵我們，強化學習，並在努力和成就後帶來滿足感。但多巴胺也在成癮中扮演核心角色。
當某些物質或行為反覆觸發強烈的獎勵訊號時，大腦會適應。神經通路加強。隨著時間推移，大腦開始優先考慮與該獎勵相關的行為。起初是自願的，但對某些人來說，可能變得難以控制。藥物和酒精等成癮物質對此效應廣為人知。越來越多研究關注行為成癮，包括賭博障礙、遊戲障礙和強迫性性行為，這些都涉及類似的獎勵通路。
如今，色情內容即時、匿名、廉價，且通過智慧手機隨時可得。沒有物理障礙，幾乎沒有自然的停止點。對一部分人來說，反覆接觸和不斷升級的消費可能固化難以逆轉的模式。
一些國際研究表明，問題性色情使用可能影響低兩位數比例的人群，具體取決於定義。方法學不同，但新興文獻表明這不是孤立現象。
即使新加坡的患病率較低，受影響的絕對人數仍可能相當可觀。
我們還必須將此問題置於更廣泛的數字生態系統中。現代生活圍繞獎勵迴圈構建。社交媒體通知、網路遊戲成就、賭博勝利、自動播放流媒體。我們的注意力經濟被設計成讓我們持續參與。
色情存在於這一更大環境中。它是眾多數字刺激之一，爭奪我們的注意力。但它有一個重要不同點：它能塑造對親密、同意和關係的期望。當接觸開始得早，往往在情感成熟尚未形成時，所吸收的教訓可能不反映相互尊重或健康溝通。
在新加坡，關於性的話題往往謹慎。家庭可能難以開啟相關對話。學校對此話題持謹慎態度。公共話語仍然剋制。但沉默不等於保護。當缺乏指導時，年輕人可能轉向網際網路作為主要教育者，而我們都知道網際網路並非設計來傳授價值觀。
技術使誘惑工業化。曾經需要努力、耐心和真實人際互動的事物，現在瞬間呈現在設計來吸引注意力的螢幕上。如果我們的公共衛生響應僅聚焦於傷害後的治療，我們將永遠在應對損害，而非構建韌性。
先生，有人可能會問，為什麼這是一個醫療健康問題？
因為行為成癮重塑神經通路。它與焦慮和抑鬱共存。它推動諮詢、精神科護理和家庭治療的需求。如果我們忽視它，它不會消失。它會在我們的診所、心理健康醫院病房和社會服務機構中出現。
這是一個健康問題，因為它影響大腦功能、心理健康、關係穩定，並推動諮詢和精神科服務的需求。掙扎於強迫性色情使用的個體常報告在學校或工作中難以集中注意力，儘管嘗試停止但消費不斷升級，秘密行為和情感退縮，關係緊張，持續的羞恥感和低自我價值感。
這種行為可能起初是緩解壓力，但隨著時間推移會加劇痛苦。當關系惡化和情緒健康下降時，影響不侷限於私人領域。它影響家庭、工作場所和社群。
因此，作為關注心理健康的政策制定者，我們不能僅因討論不適而忽視新興的行為成癮。
在本地，社群組織如We Care社群服務觀察到尋求強迫性性行為幫助的個體數量增加，包括問題性色情使用。涉及性、色情和愛情成癮的報告案件近年來顯著上升。疫情後，尋求線上色情行為幫助的人數較疫情前翻倍以上。
大多數客戶年齡在20多歲。一些案例也出現在青少年中，甚至有些只有12歲；12歲，先生！這僅是那些主動求助的個體。更多人可能因汙名或不確定向誰或哪裡尋求幫助而保持沉默。
今天的青少年更早接觸到露骨內容，往往是無意中通過同伴分享或演算法推送。
2024年，超過460名19歲及以下青少年因性犯罪被逮捕。有關部門注意到，早期且反覆接觸色情材料可能是影響年輕人理解同意和健康關係的多個因素之一。
輔導員也指出，缺乏關於界限和尊重的有意義指導，年輕人可能誤解網路上看到的內容為正常和可接受的行為。
當然，我們必須避免簡單結論。家庭動態、同伴影響、創傷和更廣泛的文化因素都起作用。但我們不應忽視形成期反覆接觸的潛在影響。
這些不僅是道德問題。這是我們需要解決的公共衛生和社會穩定問題。
讓我花些時間分享一位新加坡人的故事。我們稱他為Dale。
一切開始得很無辜；同學間分享雜誌。然後是網際網路，然後是一張盜版DVD。Dale看到的畫面讓他不安，但他年輕的心靈發生了變化。好奇變成習慣，習慣變成強迫。表面上，Dale正常生活：學習、工作、服兵役。內心卻陷入迴圈。壓力、拒絕、慶祝都成為誘因。行為後是崩潰：羞恥、厭惡、承諾停止。
他描述自己過著雙重生活。週日去教堂，夜晚獨自面對成癮。罪惡感壓得他喘不過氣。曾有一刻他說：“我覺得我天生沒有愛的能力。”
色情將親密塑造成幻想和控制。
轉折點是Dale走進了匿名性癮者會議。普通男人——父親、專業人士——分享他們的故事。Dale意識到自己不是唯一掙扎的人。孤立開始破裂。
在We Care的支援下，Dale學會追蹤誘因，面對不適，命名情緒而非麻木。康復緩慢且不完美，但極具人性。
先生，當然，這不是道德失敗的故事。這是早期接觸、無聲條件反射、秘密、羞恥和勇氣的故事。在“成癮者”的標籤背後，是一個曾經好奇、被沉默困住、需要理解、社群和支援的人。
如果我們認真對待這個問題，必須從不適走向基於證據的策略。
目前，我們擁有的國家資料有限。我們的大部分理解來自國際研究和社群案例報告。我提出三步建議。
第一，委託一項嚴謹的跨學科國家研究，調查新加坡問題性色情使用。我們需要了解患病率、心理健康關聯、關係影響和風險因素。有了證據，我們可以合理且負責任地調整應對措施。
第二，審視我們的數字和性教育框架。年輕人需要情緒素養、數字韌性以及關於同意和健康親密的紮實理解。家長也可能需要支援，以應對快速變化的數字環境中的對話。如果接觸日益普遍，那麼為青少年及其家庭提供解讀所遇內容的工具就變得至關重要。
第三，擴大社群成癮服務的資金和能力。如果行為成癮相關諮詢需求上升，我們的支援體系必須跟上。尋求幫助的人應能獲得便捷及時的支援。
早期干預是人道的、預防性的且具成本效益。
先生，這不是關於數字內容的問題。這是關於心理健康。這是關於年輕人如何形成對關係的期望。這是關於伴侶如何隨著時間建立信任。如果我們想要強健的家庭和有韌性的青年，就不能將此問題視為禁忌。我們必須將其視為可解決的問題。
我們無法消除誘惑，但不應將傷害常態化。如果技術工業化了誘惑，那麼我們的回應必須工業化韌性：深思熟慮、適度且關懷。
讓我們不要因為話題不適而猶豫。讓我們選擇證據而非否認，勇氣而非迴避，支援而非汙名。因為擺在我們面前的問題不是這個問題是否存在，而是我們是否能共同正面應對。
英文原文
SPRS Hansard · Fetched: 2026-05-02
The Chairman : Head O, Ministry of Health (MOH). Ms Mariam Jaafar.
6.59 pm
From Financing Care to Financing Health
Ms Mariam Jaafar (Sembawang) : Chairman, I move, "That the total sum allocated to Head O of the Estimates be reduced by $100."
S+3M, subsidies Medisave, MediShield and MediFund, is one of our nation's quiet triumphs. It has protected generations of Singaporeans from catastrophic bills. It has preserved system sustainability. It has embedded shared responsibility, personal ownership and equity.
But it was built for yesterday's risks. S+3M was designed for acute hospital episodes. A surgery, a stroke, a sudden hospitalisation.
Today, our dominant risks are chronic, progressive, community-based: diabetes, dementia, frailty, mental health conditions. They do not bankrupt a family overnight, but they exhaust a family slowly.
Dementia day care costs about $63 per session. Even with the latest subsidies, a middle-income family still pays over $12,000 per year, before transport, home care, medications, and lost caregiver income. At my Woodlands Meet-the-People Sessions, I often hear two concerns: one, "why can't I use my Medisave? It's my money"; and two, "I already used up all my MediSave for chronic care".
7.00 pm
Mrs L, a retiree, cares for her husband with early dementia, while managing her own diabetes. She told me, "I saved all my life. Why does it still feel like my money isn't enough to stay independent?" Or K, 24, pays out of pocket for mental health care because her condition is not officially chronic. "I'm probably going to need this for the rest of my life. How is that not chronic?" These are the lived realities faced by our fellow Singaporeans.
Incremental cap adjustments and coverage expansions help, but they do not fundamentally reshape incentives. Our system still signals we pay more attention when you are already very sick. That must change. Our lifestyle risks are rising faster than our population ages. More sedentary work. More screen time. Richer diets. Chronic conditions appearing earlier.
Singapore is investing in population-level prevention – 6 % of our healthcare Budget, with plans to double. Healthier SG fully subsidises routine screenings and immunisation programmes. Active-living infrastructure like parks, fitness corners, cycling paths, Active Ageing Centres and community health programmes encourage functional health. These are centrally funded.
But prevention is more than screening. Some seniors need physiotherapy to prevent a fall. Some need home rehabilitation to prevent a re-admission. Some need cognitive stimulation to prevent the onset of dementia. Some adults need weight management programme to prevent diabetes progression. Some youths need early mental health interventions to prevent a spiral. These are investments in independence, not discretionary lifestyle perks. S+3M must evolve, not just to pay bills, but to shape behaviour, support prevention and sustain independence.
Subsidies. I propose three upstream shifts.
One, early disability support. Many schemes require three Activities of Daily Living (ADLs). Introduce an early intervention tier for "pre-frail" seniors – funding physiotherapy, balance training, and strength exercises. One month of rehab today can prevent a decade of nursing home care tomorrow.
Two, subsidised diagnostic pathway. When referred by a Healthier SG general practitioner (GP), the first specialist consultation and primary diagnostic scan, CT or MRI, public or private, should be subsidised. A treatable condition should never become a terminal one because someone hesitated over the cost.
Three, fairer means testing for sandwiched families. Two households may have the same per capita household income (PCHI), but the one supporting elderly parents and young children carries a heavier burden. Adjust subsidy tiers for households with multiple dependents.
Subsidies must be easy to use, visible and structured to encourage early preventive action. Automatic enrolment, co-payment reductions, integrated Medisave bonuses and seamless digital claims are ways to nudge behaviour.
MediSave. Even with subsidies, Singaporeans face costs over the long term. MediSave must evolve. I propose MediSave flex where the annual withdrawal limit is linked to balances, with an upper cap to maintain sustainability. Let it fund chronic disease management, broader preventive screenings, evidence-based doctor-referred functional health or nutrition programmes, early rehabilitation after minor injuries or hospital stays, early interventions for dementia or frailty, expanded mental health support. Keep the remainder MediSave core for major episodes. Unused flex balances roll over, rewarding responsible early actions. Bonuses can be awarded, tied to improvements in chronic disease management and functional assessments.
Together subsidies and MediSave flex nudge Singaporeans to act early, adhere to chronic care, and engage in preventive programmes. Singaporeans get more flexibility while the systems preserve catastrophic coverage. MediShield Life remains for rare, high-cost hospitalisation, keeping premiums affordable. Explore premium credits for preventive prescriptions if they are shown to save costs. MediFund remains the final safety net for those genuinely in need.
S+3M actually has been a safety net catching us when we fall. But in an ageing society, we need a springboard that keeps us standing, strong, independent and healthy. We must adapt S+3M: financing not only healthcare, but health itself, not by abandoning the principles, but by fulfilling them fully.
Shared responsibility must include shared prevention. Personal ownership must empower early action. Equity must recognise cumulative burden. This is not about spending more. It is about spending earlier, so that we spend less later – financially, socially, emotionally.
And, Sir, none of these changes one thing. The Government must do everything in its power to keep healthcare affordable and rein in healthcare inflation. If we get this right, we will not only treat illness. We will preserve independence and dignity. We will not only pay bills. We will invest in health.
Will the Ministry commit to studying and reporting, ideally before the next Budget, how S+3M can be recalibrated to better support chronic and preventive care?
[(proc text) Question proposed. (proc text)]
The Chairman : Ms Mariam Jaafar.
Personal versus Collective Responsibility
Ms Mariam Jaafar : Healthcare is often framed as personal responsibility. Individuals matter, yes, but in Singapore, healthcare risk is shared. Premiums are pooled. Subsidies are pooled. Caregiving burdens are shared. There is no such thing as a purely private health cost.
When preventable illnesses rise, premiums rise, taxes rise. Families feel the strain. Caregivers leave the workforce. Yet today, only about six in 10 eligible residents participate regularly in recommended chronic disease screenings. Four in 10 remain unprotected.
Preventive care saves lives and reduces costs, but only if people participate. If prevention is essential, it should not depend on who remembers to click a link. Opt-in assumes time, awareness and confidence – luxuries not everyone has. Prevention must be the default. I propose: move to opt-out screenings, proactive, personalised health coaching supported by digital nudges.
Collective responsibility is not about blame. It is about design. And design does not sit with MOH alone. It is about what our children eat in school. What is affordable at the hawker centre? How workplaces structure time and stress? Whether our neighbourhoods invite movement or discourage it? The healthy choice must be the easy choice.
If we design upstream, we save downstream. Will the Ministry consider making key preventive programmes opt-out and outline how the Ministry will work across Government to embed preventive defaults in daily life?
Improving Health in the North
Healthier communities do not just happen by chance – they are designed. MOH has launched a programme to improve health in the North, and Woodlands, my Constituency, is piloting an integrated preventive health model.
The North is well placed for this. We have a diverse mix of seniors and families, the full range of housing types, strong community institutions, and opportunities to strengthen chronic care. With two hospitals, several polyclinics and Active Ageing Centres within easy reach, we can test how to bring care closer to home and refine integrated care team models.
The pilot rests on four pillars: first, stronger referral pathways and chronic disease support. Second, moving care closer to home, with smoother transitions; third, redesigning neighbourhoods so that the healthy choice is the easy choice; and fourth, activating communities as health advocates.
I support this initiative. But it cannot be policy on paper – it must be about real people, living healthier lives, every day. I therefore have two questions and three requests for the Minister.
The questions: one, how will success be measured? Two, what resources will be available for grassroots activation?
The requests: ensure town-level care hubs are fully integrated and consistently staffed so residents can access services without delay; expand the scope of community-based care and caregiver support, to cover more conditions and families; and involve my residents directly in co-designing interventions so solutions reflect their real needs and let us avoid stigmatising any community.
Health outcomes are shaped by the systems – transport, food, work patterns as well as socio-economic factors, not moral failings.
Imagine this. Mdm S, 54, does strength training three days a week at the Active Ageing Woodlands Gym under the watchful eyes of a volunteer buddy. When she does not feel like cooking, there are plentiful healthy and affordable Halal options at Kampung Admiralty Hawker Centre. With care and support closer to home, her diabetes is under control and she stays independent.
If we can redesign a town for health, we can redesign a nation.
AI in Healthcare
First, I declare my interest as managing director of a management consulting firm that works in AI and healthcare.
AI in healthcare is often discussed in terms of use cases – detecting disease earlier, automating paperwork, predicting risk, personalised medicine. These are impressive. But today, I want to ask the Minister a bigger question: what is our ambition? If healthcare is truly a national AI mission, our goal cannot be incremental adoption. We must build a system – the infrastructure, the governance, the talent, the plumbing that lets AI transform care safely, effectively and at scale, with better outcomes for every patient in Singapore.
Once we show that AI delivers real patient benefit safely and reliably at scale, Singapore will naturally move from adopter to a global leader in trusted healthcare AI. Singapore has laid strong foundations: HEALIX enables analytics across clusters; the National Electronic Health Record (NEHR) aggregates patient records; the Health Information Bill clarifies rights, responsibilities and safeguards; and early AI pilots are already easing clinician workload and improving patient outcomes.
But infrastructure alone does not make us a leader. Much of our data is still fragmented. Interoperability supports care delivery, but safe access for innovation and AI development, including with third parties, remains rather limited.
To lead globally, three things matter.
One, stronger data frameworks – national data architecture, secure sandboxes, synthetic datasets, and federated learning that enable AI innovation without compromising patient privacy.
Two, interoperable systems that allow AI models to learn across institutions while keeping clinicians in control.
Three, governance rules: every AI recommendation must be explainable, auditable, accountable. Clear innovation governance; top down or bottom up.
On global collaboration, our stance must be clear: we welcome expertise, but only under frameworks that protect our data, preserve sovereignty, build local capability and benefit patients.
Regulations must also keep pace. AI evolves quickly. We need national validation, certification and post-deployment monitoring – standards for bias, explainability and real-world performance, so patients and clinicians can trust every AI decision.
Finally, talent. AI in healthcare is a translation problem. We need professionals fluent in both clinical realities and machine learning.
Sir, we are on track to drive efficiency with AI. But Singapore must be a place where AI solutions are built, tested, certified and scaled safely, and where patient outcomes improve at every step. Healthcare should not merely adopt AI. Singapore must set the standards for trusted, safe and effective AI.
Will the Ministry outline a clear roadmap, with timelines, for strengthening data access frameworks, validation standards and talent development, so Singapore leads in trusted healthcare AI?
Integrated Shield Plans - Additional Withdrawal Limits
Mr Pritam Singh (Aljunied) : The MediSave contribution ceiling in 2015 was $48,500. Today, its equivalent – the Basic Healthcare Sum of the maximum amount in the MediSave account – is $79,000, an increase of about $30,000 in a period of about 10 years. With close to 70% of locals holding an Integrated Shield Plan (IP), there has been no increase for close to 10 years since the introduction of MediShield Life with respect to the maximum amount one could use from MediSave to service IP premiums, or what is referred to as annual withdrawal limits.
With out-of-pocket expenses a consistent bugbear for many Singaporeans over the last few years, and the basic healthcare sum rising exponentially year-on-year, there is an expectation that the additional withdrawal limits that allow Central Provident Fund (CPF) members to use more of their MediSave money to service their IP premiums, are in need of a revision. It cannot be reasonably expected that this number or the amount of money that can be used should remain the same after so many years.
Does the Ministry plan to review this in the immediate term? And if not, why not?
Healthcare Manpower
The headline of an opinion piece last month in The Straits Times expressed a major anxiety of the health system succinctly: "Singapore as a super-aged society: can its health system cope?" The author, an academic with a specialty in public health, observed what is commonplace for many Singaporeans when they visit our public hospitals and healthcare institutions – a large number of seniors in wheelchairs, visibly frail, or struggling with mobility.
The Ministry has shared that the healthcare workforce is projected to grow by 20% from 129,000 in 2024 to about 156,000 in 2030. The assessment is that this number would be broadly adequate for the population's healthcare demands for the years to come.
The intersection of a rapidly ageing population and higher demand for healthcare services will bring the adequacy of the healthcare workforce into distinct focus and any shortages or perceived shortages will be reflected most acutely in service quality, waiting times for specialist care and waiting times to see a healthcare professional, amongst others.
7.15 pm
In parallel, there are real concerns and worries about the welfare of our healthcare workers, from allied health professionals to nurses and doctors, in view of heavier patient loads that are anticipated. Separately, the projected increase in healthcare manpower begs the question of how much allowance or buffer is being factored into the healthcare system, including in the event of Disease X type scenarios – a key lesson learned from the COVID-19 experience.
Second, there are deep concerns that the addition of 100,000 policyholders converting their insurance coverage from the private to public healthcare sector each year may significantly strain the public healthcare system. This is a number which the Minister has said he expects to increase.
First, what is the scope of the surge capacity when our healthcare system reaches the upper end of 156,000 healthcare workers? Does the surge capacity account for an additional buffer of doctors, nurses and allied health workers? If so, how much? Or is the surge capacity a case of restructuring processes to do more with less in times of surge demands? If it is the latter, for how long can the healthcare system operate at an optimum level of performance?
Second, does the Ministry plan to increase the range of publicly reportable statistics from what is currently available to waiting times at hospital emergency departments, polyclinics and specialist outpatient clinics, amongst others?
We should carefully track the capacity of the system to cope with the significant demands our demographic shift imposes on it. It is useful to remember that healthcare is a very unique public service. The Prime Minister identified healthcare as one of four national AI Missions. AI indeed stands to inject new productivity possibilities into healthcare at the ecosystem level.
However, at the level of a Singaporean who needs healthcare, what makes healthcare, healthcare, are the people – the doctors, the nurses, the allied health workers – who look after us when we are at our lowest. In that context, the human touch and the personal connection will never be fully replaced by AI.
So, if it means that our healthcare manpower in the years to come would require additional buffers, we should devote more fiscal resources towards it accordingly.
The Chairman : Dr Hamid Razak, you can take your two cuts together.
Cost Complexity in Hereditary Cancers
Dr Hamid Razak (West Coast-Jurong West) : Mr Chairman, Sir, for some Singaporeans, healthcare is not just confined to a bill. It is a lifetime of risk.
Today, in this House, I want to share the story of a young Singaporean I met – Gwendalyn. In her early 20s, she was diagnosed with hereditary breast cancer. Overnight, her life changed. She faced surgery, complications of surgery and continued chemotherapy for her condition. She underwent reconstruction, but parts of her reconstruction were not covered because it was deemed to be cosmetic.
For a young cancer survivor, reconstruction is not cosmetic. It is about dignity. It is about mental healing.
There are many such Gwendalyns in our society today. People I speak about are those with hereditary risk of cancer. Her story points to a wider gap.
Cancer care today is not only clinically complex, it is also financially and psychologically complex, especially for hereditary disease. So, the policy question is this: how do we support people who may not be sick today, but are clearly at elevated risk? To that end, I would like to ask the Minister three broad questions.
First, how can we integrate hereditary risk assessment and genetic counselling into primary care and connect it to Healthier SG so that prevention becomes upstream?
Second, will the Ministry review how we finance medically indicated preventive procedures and the reconstruction, including high-risk situations involving a currently healthy organ, so that support is consistent and understandable? For example, in the case of Gwendalyn, if a mass was found on one breast and was found to be diseased, she undergoes mastectomy, what about the contralateral breast, which at current state is healthy but we know she carries the gene for breast cancer? How can the system be seamless when caring for such individuals?
Third, how do we strengthen survivorship pathways for young cancer patients, including psychological and social support, not just medical follow-up?
Mr Chairman, Sir, the test is not just about survival, but about how survivors can return to life.
Precision Medicine and Functional Health
Mr Chairman, Sir, if hereditary cancers speak about how complex medical care is, then precision medicine tells us how intelligently we can respond to the challenge.
We already see the direction. At National University Health System (NUHS), the Centre for Healthy Longevity is building programmes that strengthen healthspan, not just treat illness, helping Singaporeans stay physically strong, cognitively sharp and metabolically well as we age.
This matters because the public demand is already there. People are seeking tests and optimisation outside the mainstream system. If our public pathways do not keep pace with the credible evidence, we risk two things – fragmented care with uneven quality, with widening inequality and a missed opportunity for Singapore to lead responsibly as a trusted regional centre.
While we focus on taking care of our seniors and our elderly, which is important, the key question as we go about with our society is how do we optimise every Singaporean, regardless of age, to reach the highest potential health for their age? So, Mr Chairman, Sir, may I ask the Minister three questions.
First, what is the Ministry's pathway to evaluate and adopt emerging evidence in precision and longevity-related medicine with clear safeguards for safety and value? Second, how can Healthier SG progressively add functional health markers, including metabolic, cognitive and frailty indicators, so that prevention becomes personalised and not just generic? Third, how will we enable responsible innovation so that we remain evidence-based, future-ready and trusted, so that our policies can keep pace as the evidence emerge, and we do not wait for two to three years after the evidence has already become mainstream?
Because the goal obviously is not just longer life. The goal is delayed decline, preserved independence and dignified ageing.
Cancer Treatment Costs and Coverage
Ms Sylvia Lim (Aljunied) : Sir, Singapore's medical cost inflation is projected to reach nearly 17% this year, significantly higher than general inflation, which is under 2%.
I recognise and agree that there is a need for cost containment and management of insurance premiums. On cancer specifically, MOH has made significant moves. For instance, the Cancer Drug List now has about 394 drugs listed that are eligible for subsidies and claims under MediShield Life and integrated plans.
Three months ago, MOH announced a key policy change in hospitalisation insurance. With effect from April this year, new riders on integrated plans can no longer cover the minimum deductible set by MOH while the co-payment of bills at 5% of the total bill will be capped at $6,000 per year instead of $3,000. With these changes, the premiums for the new riders are expected to be about 30% lower than for the existing riders.
Sir, the Minister for Health has put up various videos on TikTok to explain the change. In one of them, he appeared to suggest that the only use of the existing rider was to reduce the deductible and co-insurance, and the public should consider whether they need a rider at all.
However, my understanding is that riders may be essential, especially to cancer patients for other reasons.
First, riders help to pay for costly cancer drugs that are not on the Cancer Drug List, which could be critical for the patient's treatment. Second, there is the issue of loss limits. Without a rider, the patient would need to pay 10% of a hospitalisation bill without any cap.
The second more general issue relates to preventive medical interventions which may not be covered by insurance.
A young breast cancer patient wrote about her plight to The Straits Times' forum page on 28 January. She followed the doctor's advice to remove both breasts even though only one was cancerous. Her hospitalisation insurance covered surgery for the cancerous breast, but only partially for the non-cancerous one.
In April last year, MOH recognised that the line between preventive and diagnostic care was increasingly nuanced, particularly in cases involving genetic predisposition to serious conditions, like breast cancer. MOH mentioned that it would issue claim rules to guide practitioners on breast-related surgical claims later that year.
What is the present status of this review?
Means Testing and Filial Paradox
Mr Victor Lye (Ang Mo Kio) : Mr Chairman, adult children are often the default caregivers for ageing parents. It is a good thing when adult children want their parents to stay with them, even better when the parents are active and in pink of health. Nonetheless, some Singaporeans feel penalised for doing the right thing. This is what I call the filial care paradox.
When children bring ageing parents into their homes, the parents often lose their benefits, such as the Community Health Assist Scheme (CHAS), Silver Support or other subsidies. The parents are now seen as part of a higher-income household or living in a housing type with a higher annual value.
Sir, to support caregiving and encourage filial piety, we need to recognise that the caregiving responsibilities can weigh more proportionately than housing income or housing type. I am not suggesting that we abandon means testing in our healthcare and social assistance architecture. But we can recognise caregiving households more explicitly. I have three suggestions.
First, consider a caregiver housing carve-out. Seniors moving into an adult child's home for caregiving should be assessed independently instead of being lumped into the entire household. Second, consider a transitional period. This is a grace period so that the seniors' benefits do not immediately disappear when caregiving arrangements change. Third, explore functional needs assessment, where we assess the social assistance based on actual needs rather than looking solely at household income or housing type.
Mr Chairman, when adult children bring their ageing parents into their home and care for them, we should give them more support, not less.
Lumpy Medical Spending and MediSave Limits
Assoc Prof Jamus Jerome Lim (Sengkang) : Those of us who have fallen seriously ill at one point or another will be keenly aware of how our healthcare expenditures are lumpy. That is, we may go one year without any medical expenses, but in another year, we may end up spending far more than we would have anticipated.
This is often the case even for chronic conditions since new diagnostic or treatment procedures may only be required on occasion. The reality of spending spikes is corroborated by more systematic research in health economics. Moreover, it is also well-known that end-of-life spending tends to be elevated. This is another manifestation of lumpiness. Patients tend to spend most in the final years of their life.
MediSave currently faces annual withdrawal limits of several types of care. The policy is well-meaning. One does not wish for patient to exhaust their MediSave funds, especially knowing that most of their care costs will indeed be incurred at the tail end.
But this is problematic because the policy is not aligned with the lumpy nature of medical expenses. It also glosses over the role that insurance, including public ones, such as MediShield Life, plays in such instances, since these are more likely to pay out for major illnesses that will otherwise exhaust their MediSave.
Actual data from the CPF supports this notion that there may be excess for saving in our MediSave accounts. In response to a Parliamentary Question posed in 2022, Minister Tan See Leng reported that MediSave account balances for members significantly exceed their Retirement Accounts, with the ratio for those aged 85 and above close to five times larger.
There are two ways to better calibrate MediSave limits.
First, we can permit carrying over of unspent limits for up to three years. This will allow those who incur larger than expected bills to not have to rely on out-of-pocket funds, which, especially for retirees, are frequently paid for by working-age family members so as to be able to top up their medical expenses.
Second, we can have a tiered system of claim limits, with the amounts allowed for claims gradually raised according to age. While nobody can accurately predict when an individual's demise might be, we can rely on aggregate statistics on mortality by gender to adjust claim limits accordingly. It is intuitive to allow more spending at later ages where individuals' health will have deteriorated more.
Sir, these simple steps will help better align the actual usage of MediSave, with the well-meaning constraints imposed to ensure sufficiency in time of medical need, whether they may be today or tomorrow.
Outpatient MediSave Use
Mr Gerald Giam Yean Song (Aljunied) : Sir, I repeat my call for MOH to extend coverage for all chronic diseases under the Chronic Disease Management Programme and not just the 23 approved conditions. This would ensure any condition requiring long-term management can be subsidised under CHAS and paid for via MediSave.
7.30 pm
Even for conditions on the Chronic Disease Management Programme list, the MediSave 500/700 withdrawal limits can be restrictive. I last raised this issue in 2021 and the Senior Minister of State argued that the risk of overconsumption necessitates these caps. However, how does this apply to public healthcare institutions, where salaried doctors follow strict protocols? The real risk is not overconsumption but undertreatment. When patients are forced to choose between their cash and their care, some may choose to skip medications or appointments to save money.
Self-rationing today can lead to a massive bill tomorrow and emergency hospitalisation. This is a tremendous cost to both the individual patients and the healthcare system. Has the Ministry assessed the clinical cost of medical non-compliance caused by rigid MediSave withdrawal limits? Singaporeans want to be self-reliant and not have to appeal for subsidies or medical assistance. The Ministry should allow for more flexible MediSave withdrawals at public healthcare institutions for patients over 60, especially for those with significant MediSave balances.
Funding and Supporting Mental Health
Mr Patrick Tay Teck Guan (Pioneer) : Chairman, I declare my interest as Chairman of the Mental Health Board at the NHG Health. I rise to make the case that Singapore should position the Institute of Mental Health (IMH) as the true Centre of Excellence in psychiatric treatment and care, and to ask the Minister three questions towards that goal.
IMH is our only dedicated psychiatric hospital, housing our most experienced psychiatrists and specialised teams. Yet it remains stretched across the full spectrum of acuity. If we are serious about building a Centre of Excellence, we must free IMH to focus on what it does best – leading research, training the next generation of mental health professionals and managing our most complex cases.
My first question concerns manpower. Is IMH better resourced than our acute hospitals to handle complex psychiatric patients? And a Centre of Excellence should not merely treat; it should set clinical standards across our entire healthcare system and across all three public healthcare clusters. How is IMH’s specialist expertise being leveraged across the three clusters to uplift psychiatric treatment and care in all our acute hospitals and in the community, so that IMH is not bogged down by excessive referrals beyond what they can handle effectively and efficiently.
My second question concerns care pathways. Will the Minister share data on polyclinic acceptance rates for patients discharged from IMH and acute hospitals with psychiatric diagnoses? A Centre of Excellence cannot function if its beds are occupied by patients ready for step-down care. Are there plans to expand polyclinic capacity for psychiatric cases, so that IMH can focus its resources on those who truly need specialist care? Stable psychiatric patients often remain at IMH simply because there are no community facilities to receive them.
My third question is whether there are plans to develop more custodial care and step-down facilities – sheltered homes, supported living – so that IMH’s beds are reserved for those who need its full clinical expertise?
Mental Health
Dr Wan Rizal (Jalan Besar) : Chairman, mental health is a national priority. Over the past few years, we have made significant progress in recognising that mental well-being is foundational to our social and economic resilience. We see growing demands across young people, working adults and seniors. More people are coming forward to seek help and that is a good sign.
But the pressures are real. Mental health conditions cost Singapore around $16 billion annually, largely from lost productivity due to absenteeism and presenteeism. That figure reminds us that mental health is not just a healthcare issue. It affects our workers, families and national resilience.
So, the question is not whether mental health matters. The question is whether our system is built to sustain the demand ahead.
We launched the National Mental Health and Well-being Strategy. We expanded community services and strengthened primary care. As we move into the next phase, could the Minister update us on its progress? Are we seeing measurable improvements in early intervention? Are the wait times stabilising, particularly for moderate and higher-risk cases? Are community providers adequately supported as the demand continually grows?
Every strategy eventually reaches a point where expansion alone is not enough. It requires structural strengthening. Mental health also cuts across healthcare, education, workplaces and the social sector. Could the Minister elaborate on the role and mandate of the Mental Health Office? How does it coordinate across agencies, track system-level outcomes and ensure accountability? If this is truly a whole-of-society effort, then governance must be deliberate and clear.
Sir, access ultimately depends on people. Clinical psychologists and other higher-risk psychology disciplines undergo years of rigorous postgraduate training and supervised practice. Standards must remain high. Patient safety depends on it.
At the same time, demand is growing. How is MOH projecting manpower needs for clinical psychologists and allied mental health professionals over the next five to 10 years? Are there plans to strengthen the local training pipeline and supervision capacity to build a strong local core while maintaining professional standards? And does the Ministry see scope to strengthen professional regulation at higher-risk psychological practice to safeguard patients and reinforce public confidence?
Sir, mental health care must operate as one integrated system. Psychologists, counsellors, social workers, occupational therapists and peer support specialists each play important and complementary roles. How will workforce planning and training reforms ensure stronger integration across these professions and better coordination between primary care, hospitals and community providers? Patients should not experience fragmentation. They should experience continuity.
Sir, as we look ahead, we should also be mindful of the growing use of AI in mental health support. AI tools may be useful for self-help psychoeducational early screening, but we should be cautious. If such technologies begin to substitute professional care, mental health treatment often involves complex clinical judgement and ability to respond appropriately in crisis situations. Could the Minister share how MOH is thinking about the role of AI in mental healthcare and what safeguards may be needed to ensure that technology compliments, rather than replaces, trained professionals?
Sir, if mental health is a national infrastructure, then we must build it with strong foundations, clear standards and long-term sustainability. I look forward to the Minister’s response.
The Chairman : Ms He Ting Ru. Please take your three cuts together.
Mental Health Professionals Regulation
Ms He Ting Ru (Sengkang) : Mr Chairman, I declare my interest as a practitioner in the well-being space. With the mental health crisis showing no signs of abating, would the Ministry provide an update along with a firm commitment to fixed timelines to regulate mental health professionals?
I would like to repeat my call to regulate professionals, such as therapists and counsellors, who play key roles in supporting individuals with mental health conditions. Regulation is important as clients may not know where to go for help if they have concerns about professional standards or ethics.
At the same time, we must also ensure entry barriers are not prohibitive for professionals. Most therapy and counselling qualifications require minimum supervision hours and practicums costing upwards of $200 an hour, which can be difficult for fresh graduates and mid-career entrants. I hope we can explore more ways to reduce such barriers. Beyond subsidies, could the Ministry also consider the use of SkillsFuture credits?
Mental Health and Well-being Strategy
The set-up of the National Mental Health Office (NMHO) is a first step to a vision where mental health sits on a continuum with socio-economic determinants and is not merely the absence of illness.
That said, we still have to work towards a clear vision to improve Singaporeans' mental health. For example, Scotland's Mental Health Strategy 2017 focuses on reducing inequalities for mental health and treatment and access using a life stage model and Malaysia's National Strategic Plan for Mental Health aim to reduce adolescent depression rates from 18% to 10%. These strategies clearly outline a vision of success for improving mental health and well-being, describing what a mentally healthy population looks like. They also include time-bound targets and outcomes beyond broad focus areas.
This aligns with recent World Health Organization guidance on policy and strategic actions to promote and protect mental health and well-being across Government sectors. The guidance calls for: one, active engagement with all stakeholders and ensure meaningful participation of those with lived experiences; two, regular reporting and clear commitments; three, allocating fully costed and dedicated funding to support policy directives and strategic actions to prevent implementation delays.
I would like to seek four clarifications. First, what is the picture of success of the National Mental Health and Well-being strategy? To coordinate efforts across policy areas and sectors, the strategy should outline a few key outcomes and have clear targets.
Second, how does the NMHO plan to work with Ministries and agencies to engage Singaporeans on current initiatives and future plans? Incorporating ongoing feedback from those with lived experience, communities and civil society will ensure the strategy remains relevant and grounded in real needs.
Third, how will the NMHO coordinate reporting, monitoring and evaluation through regular updates? For instance, Scotland's January 2026 monitoring report track key performance indicators across nine strategic outcomes to enhance agency accountability, responsiveness and effectiveness.
Fourth, is there dedicated funding for mental health and well-being initiatives to support the strategy? If so, what is it? Between 2020 and 2022, MOH dedicated around 3% of its healthcare expenditure towards mental health treatment, promotion and prevention. Has this amount increased, and what are the projected amounts going forward?
Smoke-free Generation
For years now, the Government has been studying the possible roll-out of a tobacco-free generation policy. Earlier this year, the Minister of State for Health said in an exchange with me that the effectiveness of implementing such a policy is not straightforward and that we are already at an all-time low smoking rate of 8.4% with the existing suite of measures.
Mr Chairman, I agree that implementation of a tobacco-free generation policy is not straightforward. Black markets already stop Singapore from being completely drug-free and vape-free. Similarly, places where smoking is banned are not completely smoke-free despite the efforts of our enforcement officers.
Nevertheless, while New Zealand repeals its laws partly on grounds of political ideology, we should continue to study how to roll out a tobacco-free generation policy once there is real-world evidence on its efficacy and implementability. Maldives' policy has already come into effect, while the United Kingdom (UK) Bill is on track to becoming law, is set to be implemented at the start of 2027.
Like the UK, we are well-placed to introduce a similar policy precisely because our smoking rate is already low. The latest studies, including a Nottingham University study published in January, suggest that a cohort ban will bring forward by decades a smoking prevalence of under 5%, which is defined as an effective endgame for tobacco.
I highlight the end-game because it sets out a target I hope we can work as fast as possible to achieve. Although associated with the smoke-free generation policy, we should state the endgame as an overarching policy objective. With decisions like periodic increases to tobacco duties, I hope we are seeking to maximise the sin tax impact instead of considering its revenue impact.
Similarly, we should be doing more to curb the health impacts of public smoking, for instance, by tackling smoking while walking. Singapore takes a zero-tolerance approach to drugs and vaping. We must do the same with tobacco. Thank you.
The Chairman : Mr Cai Yinzhou, you may take your two cuts together.
Invisible Medical Conditions
Mr Cai Yinzhou (Bishan-Toa Payoh) : Thank you, Chairman. Following the invisible costs highlighted in my Budget speech, I want to address the struggles of those with invisible conditions.
With the helping hands scheme supporting those on public transport, many with hidden medical, autoimmune or chronic diseases still face judgment in daily life. Will the Ministry consider expanding these initiatives outside of public transport to more settings like hawker centres and libraries to fostering a society that leads with patience rather than suspicion?
In Singapore, one in five children and one in 10 adults endure the constant, debilitating itch of this atopic eczema. While manageable, the cost of continuous treatment, including wet wraps and phototherapy, is a significant financial and emotional burden. Will the Ministry consider adding atopic eczema to the Chronic Disease Management Programme, which already covers similar conditions like psoriasis?
Lastly, some youths are deterred from sharing suicidal thoughts with school counselors because they fear an automatic, mandatory reporting to their parents, especially when those thoughts might stem from family circumstances. To encourage greater help-seeking while ensuring safety, will the Ministry implement a tiered reporting framework that allows for greater confidentiality in a risk-proportionate manner?
Chairman, we must ensure our infrastructure of care is robust enough to support the struggles we cannot see. I look forward to the Ministry’s vision for a more inclusive and empathetic healthcare landscape.
One Touchpoint for Seniors
My second cut addresses the age-old question: what is a life well lived? For many seniors I have spoke with in Bishan-Toa Payoh, the answer is not just more handouts, but dignity, choice and the agency to live their golden years on their own terms.
7.45 pm
To this end, I have four proposals.
First, expanding the Integrated Community Care Providers into a "Senior Concierge". Minister Ong has spoken about a single coordination point for care and 85 sub-regions, which will soon provide coordination across Regional Health System, Home Personal Care Plus, Singapore Counselling Centre, Drug Rehabilitation Centre and Active Ageing Centres with One Ring to Rule… excuse me, One Care Plan to coordinate them all.
I propose beyond clinical outcomes, to further centralise touchpoints for participating in Employment and Employability Institute for job search, People's Association for community events and Social Service Offices for financial aid applications. One contact, one coordinator, for the whole senior as a person and being.
Second, to measure what truly matters. In our October Sitting, the Ministry's reply on tracking social isolation focused on attendance and outreach numbers. Loneliness cuts deeper and these numbers only scratch the surface. I ask the Ministry to partner with our educational institutes to conduct regular, widespread surveys on the social determinants of health. We need a localised version of "Quality of Life" indicators to understand how our efforts are truly reducing isolation.
Third, bringing specialist healthcare to the heartlands. Not being able to eat, hear or walk, is directly linked to cognitive decline and increased mortality. Yet, access to specialised help remains a hurdle. I ask the Ministry to ramp up dental, audiology and podiatry facilities, specifically to estates with high concentrations of seniors. We must catch these impairments before the rapid decline in quality of life.
Fourth, I ask the Ministry to consider introducing degree or diploma courses for audiology and podiatry in tertiary institutions, to increase the number of Singaporeans specialising in these areas and in turn, be better able to serve our seniors who require such specialised care.
By streamlining access, measuring what matters, expanding specialist care and building local expertise, we ensure our seniors are not just "ageing", but are living with agency.
Enhancing Elderly Care and Support
Mr Yip Hon Weng (Yio Chu Kang) : Mr Chairman, Singaporeans enjoy a long-life expectancy. But are we adding life to years or merely years to life? As healthcare shifts from hospital to home, the real test lies not only in infrastructure, but in the relationships we nurture, the support we organise and the dignity we uphold.
First, social isolation. In our dense estates, many seniors live in loneliness, surrounded by neighbours, yet separated by silence. Countries, like the Netherlands and Denmark, embed social prescribing into primary care, recognising that a prescription can be a person, a purpose and a place to belong.
Mental health support for depression, anxiety and grief remains under-resourced. Suffering in old age is often invisible, yet deeply felt. Can MOH update us on formalising social prescribing in primary care and outcomes under Healthier SG? How are we integrating routine mental health screening into community eldercare, so distress is detected early?
Under Age Well SG, Active Ageing Centres are expanding to anchor seniors in their communities. Can the Ministry share whether reductions in social isolation and improvements in well-being are being observed?
Second, dementia. Families still struggle to access dementia-specific day care and respite services. Dementia-friendly communities, where confusion is met with compassion rather than stigma, remains uneven. How will MOH accelerate dementia day care and respite capacity? How are we strengthening public education, so stigma recedes and inclusion grows? If we are to age well, we must care well for those who can no longer remember for themselves.
Third, caregivers. Many caregivers face financial strain and burnout despite subsidies. Caregiving should not mean declining health, depleted savings or isolation. Will MOH review respite care so it becomes a standard, easily claimable entitlement? As Age Well SG rolls out integrated community models, how will caregiver burden and coordination outcomes be measured to ensure families experience relief?
Fourth, palliative care. Living well includes dying well. Though many prefer to pass on at home, many still die in hospitals because families lack support. What steps are being taken to expand home-based palliative capacity and equip GPs to provide sustained medical and psychosocial support?
Finally, with the expanded EASE scheme allowing seniors in private homes to tap subsidies for age-friendly fittings, how does this complement Age Well SG's ageing-in-place strategy, and how uptake and impact be tracked?
Mr Chairman, we must now build a community of care that ensures every senior lives not only longer, but with dignity at the end.
Supporting and Recognising Caregivers
Mr Fadli Fawzi (Aljunied) : Mr Chairman, Singapore is becoming a nation of caregivers. Our ageing society means more Singaporeans will spend a significant part of our lives caring for a spouse, sibling, parent or grandparent who becomes frail, disabled or chronically ill. Support exists, but caregivers still experience it as fragmented. Many repeat their story across hospitals and agencies, with no common way to be recognised as a caregiver and no simple front door that follows them across settings.
Unpaid caregiving is not a small matter. A Duke-National University of Singapore study estimated the monetary value of informal caregiving time for seniors, aged 75 and above, who require human assistance, at about $1.28 billion a year.
As it focuses on 75-year-old-plus seniors needing assistance, it likely understates the wider burden. This is why early identification matters. Local integrated care research found that distressed caregivers at baseline had about a one in four chance of remaining distressed 12 months later, and highlighted the importance of assessing and supporting caregivers early, including during hospital discharge planning.
Budget 2026 strengthens long-term care financing, including a $400 million top-up to the Long-term Care Support Fund to fund additional subsidies from CareShield Life enhancements. But financing alone will not solve the recognition and navigation problem, so I asked the Minister to study and pilot a simple tool used in parts of the United Kingdom (UK) – a carer passport. Once a person is verified as a caregiver, they receive a physical and digital credential that enables recognition across touch points and triggers practical support.
What I have in mind is a Singapore-adapted caregiver passport that would allow some discounts at supermarkets, pharmacies and other caregiving-related outlets. More importantly, the caregiver passport should also allow caregivers to be involved in discharge and care planning, speed up linkage to respite and training, enable structured workplace flexibility conversations and support daily life participation through community partners.
I propose starting with two to three precinct pilots, for six to nine months, enrolling about 100 caregivers per pilot, followed by an evaluation to measure take up, navigation outcomes and changes to caregiver strain.
I have three questions for the Minister. First, will MOH seed a caregiver recognition pilot fund to support these pilots, including evaluation, so we can scale up works?
Second, will MOH support a low burden verification model during pilots, such as self-declaration with validation through healthcare or social service touchpoints?
Third, will MOH fund the minimum operating pieces: coordination, simple QR infrastructure, partner onboarding and modest activation support, so that pilots produce evidence for national adoption?
Mr Speaker, recognising caregivers is about strengthening our social infrastructure, so that we can relieve the burden on our caregivers and make support consistent and easy to access for all.
The Chairman : Senior Parliamentary Secretary Eric Chua, you may take your two cuts together.
Unlocking Our Silver Dividend
Mr Eric Chua (Queenstown) : Sir, by 2030, one in four Singaporeans will be 65 or older. This presents both a challenge as well as a tremendous opportunity. Too often, we focus on what seniors lack. It is time to shift that view. Seniors are not liabilities: many are eager and able to contribute meaningfully to society. We must move beyond a deficit mindset and embrace their full potential.
I recently met Prof Linda Fried, distinguished geriatrician, epidemiologist and the first female Dean at Columbia University's Mailman School of Public Health. She is also a trailblazer for co-designing Experience Corps, an inter-generational volunteer programme that engages seniors in their fifties as tutors and mentors for children in public elementary schools, while promoting the health and well-being of the volunteers themselves.
The programme aims for "triple wins": first, to help children succeed academically, especially in early literacy; two, boost the physical, mental and social well-being of older adults; and three, strengthen communities by connecting generations.
The results are striking. Students show improved literacy, better engagement and fewer behavioural issues. Volunteers experience reduced depression, enhanced cognitive function and stronger social connections. Schools report enriched learning environments and deeper community ties.
It seems simple: an engaged senior is a healthy senior. Yet, while we understand the science of social determinants of health, activating it is quite another challenge. MOH's Silver Guardian programme encourages seniors to volunteer at Active Ageing Centres. It is a great start, but we can do more. Empowered seniors do not just enrich their own lives; they strengthen families, schools and communities, shaping a Singapore where every generation thrives. I suggest three ways seniors can contribute.
First, on social mobility. Seniors can help ComLink+ families facing financial, social and emotional strain. Many parents are stretched by work and caregiving, while children may lag behind in literacy and numeracy. Inspired by the Experience Corps, seniors with teaching or professional experience can tutor children, offer knowledge, patience and encouragement. Beyond academics, seniors can also mentor parents, share perspective and life wisdom. In so doing, they provide not just help, but lend stability and hope.
Second, mental health. A peer-reviewed Singapore study of adults aged 21 to 89 found that seniors reported significantly lower levels of depression, anxiety and stress than younger adults during the 2020 pandemic lockdown. By contrast, about one in three youths reports internalising symptoms, such as anxiety, loneliness or depression. Many young people hesitate to involve parents or families in their struggles. Seniors, with their steady, non-judgemental presence and life experience, can offer guidance, comfort and hope; helping young people feel less isolated and more resilient.
Lastly, our heritage. History is most powerful when told through lived experiences. Projects, like Humans of New York, resonate because they are real, unfiltered, human. Our seniors often hold the most meaningful stories of our communities. As community docents, they become living bridges to moments that may never appear in textbooks, but remain a crucial part of our shared memory. Through their stories, we preserve not just events, but the struggles, values and quiet triumphs that shape our heritage and collective humanity.
Sir, our seniors built the Singapore we know today. Their sacrifices laid our foundations, their resilience carried us forward and their wisdom continues to guide us. Let us see seniors not through the lens of limitation, but of possibility. As mentors, tutors, caregivers and docents, they can shape lives and strengthen communities.
Let us build a Singapore where ageing is not feared but celebrated; where every senior feels valued, empowered and connected. For when we uplift our seniors, we honour our past and secure a future defined not only by success, but by dignity, compassion and shared humanity.
Our Dangerous Dalliance with Dopamine
Let me begin this speech not with statistics or policy, but with three simple introductions.
"Hi, I'm Benny. I'm sober and I have stayed away from drugs for the past five years." Most of us would respond with admiration. We understand the discipline required to overcome chemical dependency.
"Hi, I'm Benny. I'm sober and I have stayed away from alcohol for the past five years." Again, we nod silently. We know the toll addiction can take on health, on families, on livelihoods.
But what if I said: "Hi, I'm Benny. I'm sober and I have stayed away from pornography for the past five years." What happens inside us? Do we shift uncomfortably? Suppress a smirk? Or question whether that even counts as sobriety?
8.00 pm
This reaction tells us something important. While we are prepared to discuss substance addictions openly, we remain uneasy when the addiction is behavioural, private and sexual in nature. Pornography addiction is often dismissed as indulgence or simply part of growing up in a digital age. Yet for some individuals, consumption becomes compulsive, distressing and disruptive to daily life.
Today, I rise not to moralise or to condemn desire. I rise to ask whether we are paying sufficient attention to a behavioural addiction that may be quietly emerging, particularly amongst our young people, and to consider what role public health can and should play.
To be sure, dopamine is not the enemy. It is a neurotransmitter essential to how our brains function. It motivates us, reinforces learning and gives us satisfaction after effort and achievement. But dopamine also plays a central role in addiction.
When certain substances or behaviours repeatedly trigger intense reward signals, the brain adapts. Neural pathways strengthen. Over time, the brain begins to prioritise the behaviour associated with that reward. What begins as voluntary can, for some, become difficult to control. Addictive substances, such as drugs and alcohol, are well recognised for this effect. Increasingly, research has examined behavioural addictions, including gambling disorder, gaming disorder and compulsive sexual behaviours, which engage similar reward pathways.
Pornography today is instant, anonymous, inexpensive and available through smartphones at any hour. There are no physical barriers and few natural stopping points. For a subset of individuals, repeated exposure and escalating consumption can entrench patterns that are hard to reverse.
Some international studies suggest that problematic pornography use may affect figures in the low double digits, depending on definitions used. Methodologies differ, but the emerging literature suggests this is not an isolated phenomenon.
Even if prevalence in Singapore is lower, the absolute number affected could still be significant.
We must also situate this issue within the broader digital ecosystem. Modern life is structured around reward cycles. Social media notifications, online gaming achievements, gambling wins, auto-play streaming. Our attention economy is engineered to keep us engaged.
Pornography exists within this larger environment. It is one of many digital stimuli competing for our attention. But it differs in one important aspect: it can shape expectations about intimacy, about consent and about relationships. When exposure begins early, often before emotional maturity has developed, the lessons absorbed may not reflect mutual respect or healthy communication.
In Singapore, conversations about sexuality are often cautious. Families may find them difficult to initiate. Schools approach the topic carefully. Public discourse remains restrained. But silence does not mean protection. When guidance is absent, young people may turn to the Internet as their primary educator, and we all know that the Internet is not designed to teach values.
Technology has industrialised temptation. What once required effort, patience and real human interaction now arrives instantly on screens engineered to capture attention. If our public health response focuses only on treatment after harm, we will always be reacting to damage, rather than building resilience.
Sir, some may ask, why is this a healthcare issue?
Because behavioural addiction reshapes neural pathways. It co-occurs with anxiety and depression. It drives demand for counselling, psychiatric care and family therapy. If we ignore it, it does not disappear. It presents later in our clinics, our IMH wards and our social service agencies.
This is a health issue because it affects brain function, mental health, relational stability and drives demand for counselling and psychiatric services. Individuals struggling with compulsive pornography use often report difficulty concentrating at school or work, escalating consumption despite attempts to stop, secrecy and emotional withdrawal, strained relationships, persistent shame and low self-worth.
This behaviour may begin as stress relief, but over time it can worsen distress. When relationships deteriorate and emotional health declines, the impact is not confined to the private sphere. It affects families, workplaces and communities.
So, as policy-makers concerned with mental health, we cannot ignore emerging behavioural addictions simply because they are uncomfortable to discuss.
Locally, community organisations, such as We Care Community Services, have observed an increase in the number of individuals seeking help for compulsive sexual behaviours, including problematic pornography use. Reporting cases relating to sex, porn and love addiction have risen significantly in recent years. Post-pandemic, those seeking help for online pornography behaviours more than doubled compared with pre-COVID levels.
Most clients are in their 20s. Some cases have also appeared among teenagers, with some of them as young as 12; 12, Sir! These are only the individuals who have come forward. Many more may remain silent due to stigma or uncertainty about who or where to seek help.
Youths today are exposed to explicit content at younger ages, often unintentionally through peer sharing or algorithmic feeds.
In 2024, more than 460 youths aged 19 and below were arrested for sexual crimes. Authorities have noted that early and repeated exposure to sexually explicit materials can be one of several contributing influences shaping young people's understanding of consent and healthy relationships.
Counsellors have also pointed out that without meaningful guidance on boundaries and respect, young people may misinterpret what they see online as normal and acceptable behaviour.
To be sure, we must avoid simplistic conclusions. Family dynamics, peer influence, trauma and broader cultural factors all play roles. But we should not dismiss the potential impact of repeated exposure during formative years.
These are not purely moral questions. These are public health and social stability questions we need to address.
Let me take some time to share one Singaporean's story. Let us call him Dale.
It all began innocently; magazines shared among schoolmates. Then came the Internet, and then a pirated DVD. The images Dale saw disturbed him, yet something in his young mind shifted. Curiosity became habit. Habit became compulsion. Outwardly, Dale functioned: studied, worked, served National Service. Inwardly, he was trapped in a cycle. Stress, rejection, celebration all became triggers. After acting out came the crash: shame, disgust, promises to stop.
He described living a double life. Church on Sundays, alone with his addiction at night. And guilt was crushing. At one point he said, "I think I am born without the capacity to love."
Pornography had shaped intimacy into fantasy and control.
The turning point came when Dale walked into a Sexaholics Anonymous meeting. Ordinary men – fathers, professionals – shared their stories. Dale then realised he was not the only one struggling. Isolation began to break.
With support from We Care, Dale learned to trace his triggers, sit with discomfort and name his emotions instead of numbing them. Recovery was slow and imperfect but deeply human.
Sir, to be sure, this is not a story of moral failure. It is a story of early exposure, silent conditioning, secrecy, shame and courage. Behind the label of "addict" is a human being, once a curious boy, trapped in silence, who needed understanding, community and support.
If we are serious about addressing this issue, we must move from discomfort to evidence-based strategy.
Today, we operate with limited national data. Much of our understanding is extrapolated from international research and community case reports. I propose three steps.
First, commission a rigorous, interdisciplinary national study on problematic pornography use in Singapore. We need to understand prevalence, mental health associations, relational impacts and risk factors. With evidence, we can calibrate responses proportionately and responsibly.
Second, review our digital and sexuality education frameworks. Young people need emotional literacy, digital resilience and grounded understanding of consent and healthy intimacy. Parents too may need support navigating conversations in a rapidly evolving digital landscape. If exposure is increasingly common, then equipping youths and their families with tools to interpret what they encounter responsibly becomes essential.
Third, expanding funding and capacity for community addiction services. If demand for counselling related to behavioural addictions is rising, our support ecosystem must keep pace. Those who seek help should encounter accessible and timely support.
Early intervention is humane, preventive and cost-effective.
Sir, this is not about digital content. It is about mental health. It is about how young people form expectations about relationships. It is about how couples build trust over time. If we want strong families and resilient youths, then we cannot treat this problem as unspeakable. We must treat it as solvable.
We cannot eliminate temptation, but we should not normalise harm. If technology has industrialised temptation, then our response must be to industrialise resilience: thoughtfully, proportionately, with care.
Let us not hesitate simply because the subject is uncomfortable. Let us choose evidence over denial, courage over avoidance and support over stigma. Because the question before us is not whether this issue exists, but whether we can address it together head on.