COMMENT: Mental health must be a national priority in Singapore
By Anthea Ong
Mental health must be an ongoing national and whole-of-government priority with the recognition that quality of life in Singapore is defined not only by markers of economic growth and material achievements but also subjective wellbeing.
My incredibly bright nephew is currently out of the school system at the promising age of 17 because of depression. For years, a cousin of mine has been on treatment for major depression and mild bipolar, which has affected his employment situation. There’s also the old uncle living in my block at Marine Crescent who was depressed from the death of his wife and started sleeping on the bench in the void deck at night.
Just the other day, a young taxi driver shared with me about his 87-year-old grandfather jumping to his death – his whole family was having their breakfast inside their flat when they heard a thud. Then there’s my own close shave with depression over 12 years ago.
Finance Minister Heng Swee Keat spoke about “Building a Strong, United Singapore” in his Budget 2019 speech – this goal can only be possible in a nation of people who are mentally resilient.
Pressing challenge across age groups
Poor mental health affects across age groups and segments in Singapore.
The number of children aged five to nine calling the Samaritans Of Singapore has increased by more than five-fold in less than three years.
My nephew is unfortunately not alone in his struggle among his peers. The number of young Singaporeans between the ages of 16 and 30 who had sought help from the Institute of Mental Health’s (IMH) Community Health Assessment Team from 2015 to 2018 has almost tripled.
My cousin’s mental health state isn’t a rare statistic. Around 90 per cent of adults grappling with mental health issues have cited workplace stress as a primary cause. Yet an overwhelming 86.5 per cent of those employed did not seek help for mental health difficulties, according to a 2012 study by the IMH on mental disorders and work disability in Singapore.
It is incumbent upon employers to do more for the mental health of their workers. My cousin is now with Hush TeaBar, a social enterprise which employs and empowers deaf persons and persons in recovery from mental health conditions.
My elderly neighbour and the taxi driver’s grandfather were also sadly not alone in their plight. One in five elderly persons in Singapore aged 75 and above has shown signs of depression. The number of elderly aged 60 and above who took their own lives was 129 in 2017, the highest since the Samaritans of Singapore started tracking suicide cases in 1991.
Valuing mental health in the community
The latest IMH study showed that one in seven persons in Singapore would experience a mental health condition in their lifetime, an increase from one in eight just 8 years ago. In comparison, one in nine people suffered from diabetes in Singapore in 2017 yet there has been far more attention given to this issue.
We must normalise mental health and bring it out in the open. The government and the community have to learn to value strong mental health as a basic need, and reduce stigma and improve help-seeking and recovery.
We have made much progress by moving away from a predominantly medical approach of the past – the five-year Community Health Action Masterplan launched in 2017 is a step in the right direction. Primary care providers like polyclinics and general practitioners are being trained to support mental health services. A national campaign “Beyond the Label” was launched in 2018 to break the stigma surrounding mental health issues by the National Council of Social Service. This year President’s Challenge has a focus on mental health.
Yet mental health must not be the responsibility of the Ministry of Health and the social sector alone. All ministries should recognise their role in enhancing mental health in Singapore. Ministries should work in tandem in framing policies to address the burden of mental health in our society in areas such as intervention in education, reforms in employment practices, and community initiatives.
Need to expand mental health education
Despite the escalating challenges of mental health among our children and youth, programmes such as the Holistic Health Framework by the Health Promotion Board are still optional in schools. Peer support programmes in schools and institutes of higher learning (IHLs) are also optional.
Mandating mental health education in schools and IHLs is the strongest signal that the authorities can send to normalise the topic of mental health. There should also be support structures for parents and families to equip them with emotional management and problem-solving skills to help children and youth cope better with stress.
We should aim for the seamless integration of mental health education into the health education curriculum to give students a more holistic understanding of health and wellness. Peer support programmes should be introduced in all schools and IHLs to create a school culture of mental wellness. Students could be trained to be mental health first aiders.
Revamp employment practices
Mental disorders have significant consequences on the workforce in terms of lost work productivity in Singapore. Among employers in Singapore, 72 per cent of them say that work has been affected by mental health issues, yet only half of them have psychosocial support programmes in place.
Singapore’s employment laws, including the Workplace Health & Safety Act, must be amended to also provide for psychosocial health and safety. In Australia, individuals who suffer from psychological injuries or mental disorders arising from stress in the workplace can seek compensation.
Discriminatory employment practices need to be abolished to create a more inclusive workforce. Many employers, including the public service, still require declarations by candidates in the recruitment process on their history of illnesses, including mental health conditions. Existing employment schemes like the Special Employment Credit and the Open Door Programme which incentivise employers to hire, train and integrate people with disabilities should be expanded to include persons in recovery from mental health conditions.
Nationwide campaign required
Our social policies must place mental health as a priority for the underserved and vulnerable communities alongside measures to care for their basic needs.
The Quality of Life Standards by NCSS is a great start but more should be done in designing solutions to tackle mental health issues.
The community must come in too. I applaud the many efforts by voluntary welfare organisations, informal groups, and social enterprises to provide mental health and support services. A group of top business leaders and I came together to form the WorkWell Leaders Workgroup last year as a national ground-up effort to discuss inclusive practices for workplace wellbeing. The first-ever mental health insurance product was launched early this year by a commercial insurer, which augurs well for destigmatisation efforts and provides much-needed support for those with mental health conditions.
Mental health disorders are on the rise in every country in the world and could cost the global economy up to US$16 trillion between 2010 and 2030, according to the Lancet Commission Report in 2018. “No other health condition in humankind has been neglected as much as mental health has.” said the report. To date, there has not been a similar report on the impact of mental health disorders on the economy, productivity, social cohesion, infrastructure and medical services available in Singapore.
The way we look at mental health reminds me of climate change. It’s invisible, and so it is pushed to the back of our minds. Yet like climate change, it’s our future that we are jeopardising most if we continue with a transactional approach in addressing the challenge.
We should establish a national coordinating body involving various ministries for the purpose of working with stakeholders to increase awareness and understanding of mental health issues.
It can be done and it must be done because mental health is crucial to the core of a strong and united Singapore.
Anthea Ong is a Nominated Member of Parliament, a social entrepreneur and founder of Hush TeaBar and A Good Space, and author of 50 Shades of Love.
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