History of clinical psychological services in Singapore

This article is about the history of clinical psychological services in Singapore. The Asian city state of Singapore is a multi-ethnic and multi-religious society of over 4 million people. Singapore is an island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the Singapore Strait to its south. Singapore is highly urbanised but almost half of the country is covered by greenery. This article outlines the roots, chronological contexts and growth of clinical psychology through the periods from the 1950s to the new millennium. This article shows that Western clinical psychology is applicable and useful in meeting the mental health needs of people of Asian cultural backgrounds.

== Beginning of psychological service in Woodbridge Hospital ==

Unlike many countries where the growth of psychology stemmed from academia, psychology in Singapore probably owes its genesis to the lunatic asylum. After the British had re-established colonial rule in Singapore at the close of World War II, the first known person to be appointed as a psychologist was V W Wilson, DSC, MA, Dip Ed. Dr J Browne was Medical Superintendent (1950–1958) and he introduced many changes and improvements to Woodbridge Hospital, including the need for a psychological service. Wilson, an Australian, was appointed to the colonial Medical Service on 11 September 1956 on contract from the United Kingdom to build up and incorporate a full psychological service within the mental health programme based at the Woodbridge Mental Hospital. The appointment of Wilson was in line with the policy of the time when key appointments were normally filled by British officers.

Just before Wilson's appointment, M K Wong, a graduate of Western Reserve University (USA), commenced limited psychological functions as a "pupil psychologist" for a short period before leaving for further clinical training at the Institute of Psychiatry, London.

Upon his engagement, Wilson established the basic framework for the development of a psychological service in four main areas:
 * 1) to provide psychological and clinical services in the medical, social welfare and educational fields;
 * 2) to plan a programme of basic psychological research into social and cultural influences;
 * 3) to organize formal courses in psychology for psychiatric nurses and other professional staff whose work brings them into contact with psychological problems; and
 * 4) to make available professional advice to Government bodies, for example, on selection and promotion methods.

From the outset, Wilson's framework for the establishment of a psychological service, although within the mental health programme, was quite far-reaching, covering medical, social welfare and educational fields as well as providing advisory services to government bodies. These became the platforms upon which psychological services were expanded and delivered to many government bodies and other organizations till the present time.

Psychological services in the 1960s
Wilson's contract expired in December 1959, so Wong who returned home at that time, took over Wilson's functions under the Malayanization process during which national workers replaced colonial expatriates at about the time when Singapore gained internal self-government. For about a decade, Wong (1959–1969) worked within the framework that Wilson had set by providing psychological services within Woodbridge Hospital as well as to the Department of Paediatrics in the Singapore General Hospital, School Health Services and various voluntary and welfare organizations such as the Singapore Association for Retarded Children, School for the Deaf, Singapore Association for the Blind, Singapore Children's Society. Wong also conducted lectures to nurses and other student groups.

In March 1968, F Y Long was employed as the second psychologist. Long, who completed his clinical psychology training at Sydney University, added impetus to what Wong had earlier embarked upon. Personality testing, including the use of projective techniques, became part and parcel of psychological assessment. Hitherto the psychologists conducted mainly IQ testing. Soon after, behaviour therapy was applied for the first time in Woodbridge Hospital on a case of stammering but psychologists were not accorded any therapeutic functions. In May, psychological assessment was extended to the selection of renal patients for haemodialysis at the Renal Unit in the Singapore General Hospital. In July 1968, Dr Ho Eng Siong (designated child psychiatrist) and Long commenced weekly child guidance clinic for cases from Gimson Boys' School and welfare homes. Following Wong's resignation in October 1969, Long continued to implement what his predecessors had established but focused more on clinical work at Woodbridge Hospital and services to SGH, TTSH and Prisons Department.

Clinical Psychology in the 1970s
During the early 1970s, with the Child Guidance Clinic in full-time operation, demands for psychological help were heavy. At the direction of the then Minister for Health, the late Mr Chua Sian Chin, a five-year projection for psychological services within the Ministry of Health was submitted in April 1970. Subsequently, several psychologists (David Oon, Lee Mee Mee, MC Foo and Lily Ng) were added to the staff at Woodbridge Hospital and Child Guidance Clinic.

Behaviour therapy became the psychologists' recognized role after 1971 when Professor S Rachman, a renowned pioneer in the field, convinced the psychiatrists at Woodrbdige Hospital of what the psychologists could contribute to the clinical management of psychiatric patients. A programme of token economy was successfully carried out in a chronic ward in 1973. The psychologists with the other members of the psychiatric team were involved in rehabilitation projects in Woodbridge Hospital. Psychology lectures for various groups of nurses at the School of Nursing in SGH, the WH School of Psychiatric Nursing as well as to students at the Department of Social Work & Social Administration, University of Singapore were in high demand.

Since the beginning of 1970, psychological services were extended to the Ministry of Social Affairs and the Prisons Department. John Elliott was appointed the first psychologist in the Ministry of Social Affairs (later known as the Ministry of Community Development). A few years later, Loh Yan Poh became the first psychologist serving full-time in the Prisons Department.

Moving into the 1980s
In the 1980s, in addition to the psychiatric services at Woodbridge Hospital, requests for psychological assistance and inputs from various Government agencies were relentless. The Ministry of Home Affairs commissioned psychological studies on secret society members and other youth groups. The Public Service Commission called on Woodbridge Hospital to provide psychological assessment on President's and Overseas Merit Scholarship candidates. The Singapore Police Force inducted two psychologists into their Hostage Negotiation teams as well as for other operational needs. The Prime Minister's Office also required psychological evaluation on political and other candidates earmarked for higher office. In view of these demands, a number of psychologists (KC Ong, KW Boey, Alice Yeoh, KW Ong, TG Oh, CL Lim, June Wong, Viven Chua and Chew Yang Hee) were appointed at varying periods. In 1984, the Department of Psychology was officially established as a centralised Psychological Service for the entire Civil Service (except for the Ministry of Education which had its own scheme of service for educational psychologists) with the Ministry of Health as the Central Appointing Authority. FY Long was appointed Head of Department and de facto Chief Psychologist. By the late 1980s a new lineup of psychologists (Lyn Chua, Elizabeth Pang, Lee Ming Shu, Teresa Foong, Vivienne Ng, Shirley Tan, Christopher Choo and Marina Yap) came into service and replaced those who had left. They were organized according to the Hospital's psychiatric units and clinics. With the rapid expansion of services, the Department of Psychology at Woodbridge Hospital in effect had spawned psychological service units at various government ministries and agencies; with psychology service units established at the Ministry of Community Development (now Ministry of Community Development Youths and Sports), Prisons Department, Singapore Police Force, Public Service Commission, School Health Services, Tan Tock Seng Hospital and Singapore General Hospital.

1990s: the golden years of psychological services
The 1990s could be said to be the golden decade for psychological service. In 1993 when Woodbridge Hospital moved its location to Buangkok Green as the Institute of Mental Health & Woodbridge Hospital, the first appointed CEO, Dr Luisa Lee, lent strong support to the Psychology Department in conducting mental health education, smoking cessation and stress management workshops for the community. Neuropsychological testing, cognitive behavioural therapy, individual and group psychotherapy were widely used. Requirements for psychology lectures, talks and courses continued unabated. Several new psychologists were recruited: Clare Yeo, Carolyn Kee, Yap Ang Keong, Janice Chua, Khoo Sue Ann, Matthew Woo, Joyce Leong, Lim Kok Kwang, Patricia Tan and Ong Li Min. The psychologists were deployed according to the revamped psychiatric departments, units, outpatient services, research and rehabilitation programmes.

In the aftermath of the Hotel New World disaster, the Ministry of Home Affairs enhanced the country's emergency planning to include the need for psychological support for victims of such incidents. In July 1994, in conjunction with the Ministry of Health and other Government agencies, Home Affairs set up the National Emergency Behaviour Management System with FY Long as the Chief EBO and TG Oh as Deputy to provide leadership in the development of the system. The NEBMS was activated during the 1996 North-South Highway accident, the 1997 SilkAir MI 185 and 2000 SQ 006 air disasters. Woodbridge Hospital played a key role in providing professional support in all three incidents as well as subsequent disasters like the Asian Tsunami.

2000s: epilogue & prologue
With the restructuring of the Ministry of Health and corporatisation of the health services and public hospitals, including Woodbridge Hospital, the Psychological Service as a Government centralised scheme of service was disbanded in 2000. It marks the close of an era of clinical psychological services in Singapore and opens a new chapter of opportunities and challenges for the next generation of psychologists in providing psychological help to those who need it. Several new officers: Andrea Lai, Lena Leong, Winifred, et al. joined the Department and together with their senior colleagues have received the torch to run the next lap in the history of psychological services at Woodridge Hospital.