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At her private clinic, psychologist Ooi Sze Jin caps her schedule at about four clients a day – not due to low demand, but because seeing more would compromise the quality of care.

Each of her sessions lasts about 60 minutes. But beyond that hour is another stretch of work: reviewing case notes, planning interventions and writing up documentation. 

"One client session can take closer to two hours of work in total," the founder of mental health social enterprise A Kind Place said.

Earlier in her career and at a previous workplace, Ms Ooi saw up to nine clients a day, a pace she described as exhausting. 

"If a therapist does that every single day, they will burn out. And they cannot be the best therapist because their minds are already clouded." 

Even though therapy fees can run into the hundreds of dollars per session, much of that does not translate into take-home pay. 

"It doesn't go all to us … we have to pay our staff, rent, marketing," she said, noting the overhead costs of running a practice. 

Across the system, the pressures look different but are just as challenging. 

Having worked in hospital, primary care, and community and prison settings, senior counsellor Roxanne Koh said that demand for mental health care services has risen sharply in recent years.

She is a senior counsellor at Filos Community Services, a community-based social service agency that provides subsidised mental health support outside the hospital system. She also runs her own private practice. 

In community care, clients often present with multiple, overlapping issues, from mental health conditions to caregiving stress, financial difficulties and social isolation. 

These require not just counselling, but coordination with families, social services and healthcare providers, Ms Koh said. 

"In hospital and community mental health settings where I have worked, counsellors rarely do just counselling."

Counsellors often provide accessible support for emotional and relational issues, while psychologists draw on their more specialised clinical training to assess, diagnose and manage more complex conditions. 

Ms Koh said that counsellors in these settings also take on case management, crisis response, outreach, and significant administrative work alongside direct clinical hours. 

She added that no single part of the work is overwhelming on its own, but the combined demands could leave little time for reflective practice, which she described as a structural matter rather than one specific to any single organisation.

Ms Koh and Ms Ooi's experiences reflect how structural issues, high overheads and a shortage of mental health professionals are among the constraints that Singapore must overcome as it ramps up mental health services to meet rising demand from a population increasingly mindful of its mental well-being. 

Across the board, clinicians and experts said that demand for mental health support has risen sharply in recent years, especially after COVID-19. 

This was driven by greater awareness and life stressors, with more people seeking help and presenting with increasingly complex needs.

The 2024 National Population Health Survey found that the prevalence of poor mental health was the highest among younger adults aged 18 to 29 years, at 25.5 per cent. 

However, one academic said that increasing the number of mental health professionals is not an overnight process, given the time required for training and honing their skills in practice. 

Professor Tan Bhing Leet, director of the health and social science cluster at the Singapore Institute of Technology, also said that expanding the mental health workforce is not simply about increasing numbers. 

It is ensuring that practitioners have the clinical experience and supervision needed to deliver effective, evidence-based care as well.

If workforce expansion prioritises numbers over supervision and competency, it could dilute the quality of the services rendered, she added.

An imbalance may also occur, where lower-income service users with chronic mental health conditions face longer waiting times, compared to self-paying service users who can afford services in the private sector.

The next phase of Singapore's mental health strategy will need to focus on strengthening training capacity, supervision pipelines and retention, to ensure the system can expand in a sustainable and coordinated way, she said.

Associate Professor Sharon Sung, from the health services research and population health programme at Duke-NUS Medical School, said that there have been some improvements to the cost of therapy, but the current model in Singapore serves some groups better than others. 

"Insurance coverage for mental health remains limited, and many policies still do not cover therapy costs. As a result, fees are largely paid out of pocket by patients." 

Furthermore, she said that providers of mental health services face high fixed costs and limited capacity, leaving little room to scale up or reduce their fees. 

WHY RAMPING UP THE TALENT POOL IS NOT SO EASY

Mental health conditions span a broad spectrum, so care needs to be delivered by a range of professionals, noted Prof Tan. But the workforce has not grown quickly enough to keep pace with demand.

In a 2023 parliamentary reply, the Ministry of Health (MOH) said the median waiting time for a new subsidised appointment was 42 days for psychologists and 45 days for psychiatrists.  

A ��ݮ��ý report in March also noted that Singapore is facing a shortage of psychologists amid rising demand. 

To address this, MOH plans to expand the workforce, including increasing the number of public-sector psychiatrists by about 30 per cent to 260 and psychologists by about 40 per cent to 300 by 2030. 

To increase the pool of psychologists, new training pathways have also been introduced.

MOH worked with the Ministry of Education and the National University of Singapore (NUS) to recently launch an accelerated pathway that lets eligible undergraduate students in the university's Concurrent Degree Programme in Clinical Psychology complete their training in five years instead of the usual seven. 

The new structure follows a three-plus-two format, with three years of undergraduate study followed by a two-year master's programme.

The first intake will be in August this year.

Earlier this month, Nanyang Technological University and public healthcare group NHG Health introduced Singapore's first work-study clinical psychology pathway. 

The Applied Specialist Psychology Integrated Residency Education is a structured, stackable three-year programme that culminates in a master of psychology (clinical) degree, allowing trainees to earn the degree over three years while working.

Even with new training pathways, however, public-sector expansion is bottlenecked by limited clinical placements and supervision capacity.

Prof Tan said that a key component of training qualified professionals is clinical placements or internships, but there are constraints on the availability of clinical placements for students. 

Clinical supervision entails an experienced therapist regularly checking in with a junior therapist or trainee, discussing their cases, and guiding them to ensure patients are cared for safely and properly.

"Clinical supervision requires senior clinicians who are already stretched due to the increased demand for services," Prof Tan said 

This can create pressure on mental health service providers, as senior clinicians balance supervisory responsibilities alongside the delivery of care to a growing number of clients, she added. 

Assistant Professor Anne-Claire Stona, who leads the global mental health programme at the SingHealth Duke-NUS Global Health Institute, said that the bottleneck is not just a Singapore problem. 

"This is a global challenge – no country can train enough specialists to meet the rising demand."

As such, the “ideal future” for Singapore is not simply having more psychologists, but embracing a more diverse range of providers, she added.

They include frontline workers to deliver basic psychosocial support in everyday settings where people live, commute, work and interact, rather than relying on an exclusively medical model.

HOW TO BALANCE QUANTITY AND QUALITY 

As Singapore tries to expand access to therapy, supply is only half the equation. 

Experts and mental health professionals told ��ݮ��ý TODAY that quality can slip if growth outpaces training and supervision. 

Ms Liew Shi Min, director and clinical psychologist of Heartscape Psychology Clinic, said: "If we focus only on volume, we risk diluting the very thing that makes therapy effective: the quality of the therapeutic relationship and the depth of clinical thinking."

She added: "We ought to invest heavily in curating and developing clinicians and trainees, rather than scaling quickly," 

Regulation will have to be stepped up at the same time, experts said. 

Right now, counsellors and psychologists are not regulated by the authorities. Only psychiatrists, who are medically trained doctors, are regulated by the Singapore Medical Council.

This makes it hard for the public to verify the quality of care they are getting, especially when they are already distressed.

Prof Tan said that it can be hard for patients to tell whether a therapist is properly trained, because beyond Singapore university programmes, there are many private or overseas courses with titles that include terms such as "counselling" or "mental health". 

"For a layman, it is hard to discern if these courses consist of the necessary curricula and clinical training hours to produce competent mental health professionals."

Prof Tan added that in the absence of legal safeguards to protect clinician titles, anyone who sets up an independent mental health service can call themselves a "therapist", "counsellor", or "psychotherapist".  

Last year, an investigation by The Straits Times found several unqualified individuals, including someone describing themselves as an "ordinary teenager", offering counselling services on online marketplace Carousell.

Dr Priscilla Shin, founder and clinical supervisor at Range Counselling Services, said that as the sector expands, stronger regulation is important, so that clinical terms such as "attachment-informed" or "systemic" therapy are not just buzzwords, but refer to actual standards of care backed by supervised experience. 

She also said that clearer benchmarks for training and ethical practice would professionalise the field and reduce burnout, by ensuring that therapists are not pushed into complex cases without the right clinical infrastructure and support. 

Dr Ong Mian-Li, a clinical child and adolescent psychologist who runs Lightfull Psychology, his own practice focused on neurodiversity, described the need to expand the talent pool as a "catch-22".

"We need a lot more people trained, but it takes a lot of time to train people."

He noted that questions remain about what levels of qualification are enough and how, under a future registration framework, the public will be able to distinguish between different training routes and feel confident about the quality of care they pay for.

To further strengthen mental healthcare services and ensure patient safety, MOH is working towards registering psychologists in Singapore, focusing on those who provide direct care and are involved in higher-risk assessments and interventions. 

In response to queries from ��ݮ��ý TODAY, MOH said that it will register psychologists in five high-risk psychology sub-disciplines: clinical, clinical neuropsychology, counselling, educational, and forensic psychology. 

They will be registered under the Allied Health Professions Act 2011 to keep to high standards of practice and ethics. 

The registration schedule, requirements and roadmaps will be ready by early 2027.

There are no plans to register counsellors currently, MOH added. 

As of now, psychologists can join the Singapore Psychological Society, which has at least 870 members, but there is no official registry for the profession, just a voluntary one. 

Registering with the society's Singapore Register of Psychologists lets a psychologist use the title "Registered Psychologist (Singapore)" and it signals to employers and the public that they meet the society's required professional qualifications and code of ethics.

In response to queries from ��ݮ��ý TODAY, the Singapore Association for Counselling noted that without formal regulatory standards, it is incredibly difficult for members of the public to discern and select credible counsellors. 

Making such standards mandatory "ensures that practitioners have the necessary training and ability to provide ethical care", the association said. 

The regulations would also strengthen the profession by committing counsellors to "a continuous journey of professional improvement, clinical development and industry relevance" throughout their careers, it added.

Dr Karen Pooh, a clinical psychologist at her eponymous practice, agreed that, in addition to the lengthy training required to become a psychologist, the work is emotionally demanding. 

"Without sufficient systemic support, retention becomes a key challenge," she said. 

"There is rightly a strong emphasis on patient-centred care in the public sector.

"However, for the system to be sustainable, there also needs to be a greater focus on supporting clinicians."

Clinicians also stressed that quality control is not a one-off checkpoint at graduation. 

Psychologists require continuous clinical supervision, training and professional development to maintain safe and effective practice.

To remain on the Singapore Psychological Society's Register of Psychologists, practitioners must complete at least 60 hours of continuing professional development every two years.

Ms Liew of Heartscape Psychology said that ongoing professional development is not cheap.

At a minimum, psychologists pay for clinical supervision, training workshops and professional membership fees, which can total about S$800 to S$4,000 a year on average.

"Continuing education is very expensive here in Singapore," Ms Ooi said. She often compares rates for continuing education between Singapore and Malaysia.

"For us to upgrade ourselves, getting certified for one assessment here can cost close to S$3,000. In Malaysia, it might be a similar rate, but in ringgit, so it's about one-third of the price."

Ms Ooi explained that the high cost is probably because there are not enough qualified psychologists here to conduct certain training, so trainers have to fly in from other countries. 

She herself values continuing education and encourages her employees to take up courses overseas, which are often more affordable. This way, the high cost of training is not passed on to the client.

"If you want to stay up to date, to be the best psychologist you can be and keep up with the research, advances and new therapeutic techniques, you basically have to do continuing education every year," Ms Ooi added. 

MOH said that it has introduced the National Mental Health Competency Training Framework to standardise quality, training and competencies for mental health professionals such as counsellors and psychologists.

"This framework outlines the skills and knowledge required to address diverse mental health needs under the Tiered Care Model, enabling individuals and employers to identify training requirements," it added.

The Tiered Care Model categorises mental health services into four tiers depending on the severity of clients' mental health symptoms, or the needs and intensity of interventions required.

For those who rely on the public healthcare system, subsidies offer them some relief, but not enough. 

MOH said that at clinics under the Community Health Assist Scheme (CHAS), patients seeking mental healthcare receive subsidies of up to S$500 yearly for mental health conditions listed in the Chronic Disease Management Programme. 

This is capped at S$500 or S$700 a year, depending on the complexity of the patient's chronic condition. 

From January 2027, the withdrawal limits will be correspondingly raised to S$700 and S$1,000. 

Prof Tan said that schemes such as CHAS, MediSave and Healthier SG initiatives help to contain out-of-pocket spending, but many mental health services, especially therapy and rehabilitation, still require significant co-payment. 

Thus, families can face a significant financial burden when a condition affects a person's ability to work, she added.

Asst Prof Stona said that cost remains a key barrier to access, and argued that a crucial next step is to expand insurance coverage and reform reimbursement models beyond medication alone, to include psychotherapy and other evidence-based interventions as well.

HOW MUCH SHOULD THERAPISTS BE PAID?

At the same time, some experts said that there may be reason to look at having stronger "retention levers" in the mental health sector workforce, including easing the financial pressures these professionals face. 

Mr Gerald Boh, the clinical director at counselling and psychotherapy provider MindsHeart, noted that early-career clinicians may have lower income while bearing "high training and supervision costs", which can undermine long-term retention.

Professionals in the public sector are typically paid a monthly salary. 

As of April this year, the Ministry of Social and Family Development and the National Council of Social Service updated the FY2026 Skills and Salary Guidelines for the Social Service Sector, which provide benchmarks for job roles in the sector.

For associate counsellors and counsellors, the recommended monthly pay ranges from S$3,970 as a starting pay to S$5,590 as a reference point.

For psychologists, the monthly pay starts at S$4,620 with S$5,790 as a reference. 

As for private practitioners, the S$200 they typically charge for an hourly session suggests that these professionals are well-paid. 

However, as mental health professionals in private practice told ��ݮ��ý TODAY, the fees represent a balancing act. They have to ensure client affordability while covering the real costs of delivering care and sustaining a practice. 

Assoc Prof Sung of Duke-NUS Medical School said the session fee is not the therapist's salary; what clients pay reflects many hours of unseen work outside of the therapy hour. 

Furthermore, after accounting for overheads such as supervision, professional development, insurance and administrative costs, "actual earnings are often much lower than people would assume", Assoc Prof Sung said. 

"Running a therapy clinic is nuanced," Ms Liew of Heartscape Psychology said. "To provide high-standard, thoughtful, ethical and seamless care is costly." 

She added that therapy is not a high-volume model, and the profit margins are often more modest than people think. 

Agreeing, Ms Koh said: "Private fees aren't just a number; they reflect a real cost structure, and often, practitioners may not be earning as much as the headline rate suggests." 

Dr Nisha Rani is clinical director at the Centre for Psychotherapy (C4P), a Singapore-based social enterprise established in 2003, which provides evidence-based psychotherapeutic services. 

It reinvests its resources to support subsidised care alongside specialised programmes with government and community partners.similarly said that the "visible hour" does not reflect the full scope of practice. 

The principal psychotherapist said: "With every client, it's about one hour of solid thinking and understanding. The brain is in use totally for that one hour." 

Dr Nisha said her staff members try not to go beyond three clients a day each, because of the cognitive load and the need to reset emotionally between sessions.

These economics explain why pro-bono and sliding-scale care are hard to scale. 

Dr Nisha and her colleagues sometimes take a "very low pay cheque" so that they can see more clients on a pro-bono basis, and that fees from those who can pay help to fund the care for those who cannot.

Even then, she stressed that capacity is finite, because quality relies on manageable caseloads and sustained supervision.

On the point of affordability, it is not a simple public-versus-private divide; there is a broad spread even within the private market.

Ms Antoinette Patterson, co-founder and chief executive officer of mental health platform Safe Space, said that many people assume therapy is unaffordable because they see only the top end of private fees. Safe Space offers a range. 

The digital platform helps users find and book counsellors, psychotherapists and psychologists, with sessions offered online and in person across different price tiers.

Pricing starts as low as S$30 and goes up to more than S$280 a session.  

Lower-priced sessions may come from trainee counsellors, retirees or practitioners who offer therapy as a second career or a form of giving back to society, Ms Patterson said.

But even tiered pricing does not solve affordability for everyone. "Unfortunately, for a lot of the clients, they can't afford it, no matter what price point that it comes at," she added.

For example, for clients who have been laid off work, getting food on the table becomes the priority, and pursuing such therapy is a luxury.

The platform has been exploring how government grants might help offset costs for such clients. 

Ms Koh said: "Over time, I've come to see that counselling, however well-delivered, is not enough on its own."

For these services to be effective, they need to be supported by strong referral pathways, accessible services and a well-coordinated ecosystem, she added.

"That is also why I continue to be committed to community mental health – because it allows us to work not just with individuals, but with the broader systems that shape their well-being."