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Mental health

15 months' jail for ex-teacher at top school who molested student who later committed suicide​

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Osmond Chia

May 24, 2022

SINGAPORE - A former teacher from one of Singapore's top schools who entered into a relationship with an underage student and molested her in 2011 was on Tuesday (May 24) sentenced to 15 months' jail.
The sentencing concludes the case that was brought to the police in 2018, after the victim broke her silence about the offence that occurred when she was 15 years old.
The court heard that she fell into depression following the offence and committed suicide in May last year, when she was 25 years old.
The offender, a Singaporean man, now 47, pleaded guilty in November 2020 to two charges of committing an indecent act on a young person under the Children and Young Persons Act. Two other charges under the same Act were considered during sentencing.
Details about the offender and the school cannot be disclosed owing to a gag order to protect the victim's identity.
District Judge Eddy Tham said on Tuesday: "This case shows the long term consequences of the offences led to a tragic loss of a precious life."
He added: "It illustrates that a sexual act on a young person can have a devastating effect... And shows why the law is there to protect a young person to prevent them from being exploited."


The former teacher was held in high regard, which worsened the degree of the breach of trust against the student, the judge added.
He had earlier called for a report to assess the man's suitability for a mandatory treatment order (MTO) to find out, among other things, whether the man's history of bipolar disorder contributed to his unlawful acts. Offenders given an MTO will undergo treatment for their mental conditions in lieu of jail time.
The MTO suitability report showed that the man's condition did not have a contributory link to his offences, said Deputy Public Prosecutor Ng Jean Ting in her submissions.

Investigations showed that he only made his advances on the victim when they were alone in a room at the school premises.
The DPP, who sought at least 12 months' jail for the accused, said: "This demonstrates that he was careful about and could control when he committed these indecent acts. He was clearly conscious that his actions were inappropriate."

In earlier proceedings, the court heard that the man joined the school in 2009 and got to know the victim when he taught her the following year. He was also the teacher in charge of a co-curricular activity where she was student leader.
They grew close and began a relationship in early 2011, during which the man made multiple advances and also molested her by surprise.
In August 2018, the victim told a female teacher at the school about her relationship with the man. Court documents did not disclose why she decided to break her silence then.
The teacher spoke to the vice-principal, who alerted the principal. The principal made a police report on Oct 2 that year.
In November 2020, the Ministry of Education told The Straits Times that the man was no longer an employee since 2018.
The man's jail term will begin on May 30.
 
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More young people seeking help at mental health wellness service Chat​

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IMH's Community Health Assessment Team received 2,172 referrals in 2021, more than double the 908 referrals it got in 2016. PHOTO ILLUSTRATION: SAMUEL ANG
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Linette Lai
Health Correspondent

JUN 5, 2022

SINGAPORE - More young people are seeking help through a free, confidential mental wellness service run by the Institute of Mental Health (IMH), which has seen referrals surge in the past five years.
Last year, the Community Health Assessment Team - better known as Chat - received 2,172 referrals, a majority of which were self-referrals.
This is more than double the 908 referrals it got in 2016. There were 51 referrals in 2009, when the programme was launched.
For many young people, Chat is where they receive a preliminary mental health check-up before being referred for further help if necessary. This can be done in person, over the phone or online.
While some are referred by their schools or through friends, the majority are people who approach Chat on their own.
Associate Professor Swapna Verma, who chairs IMH's medical board, attributes the programme's growth to a slight uptick in prevalence of mental health issues among the young, as well as improved awareness of the topic.
Chat also makes a conscious effort to make young people feel welcome and lower barriers to seeking help, she added.

For example, there is often a deep-seated stigma around mental health, Prof Swapna said. "They told me that coming to IMH was like having end-stage cancer. You only go when you're severely ill," she said.
Costs and confidentiality were two other concerns, as many young people did not want their parents to be involved, at least at the start.
Others believed it was normal to feel the way they did.

"In adolescence, your hormones are raging. You are going through so many transitional periods," Prof Swapna said. "So people feel it is OK to be 'emo', to have these ups and downs."
But at times, this emotional turbulence can also be a sign of an emerging mental illness, she added.
The Covid-19 pandemic shone a spotlight on mental health, especially among children and adolescents. Last month, a local study on the prevalence of mental health conditions among teens aged 11 to 18 found that one-third had experienced symptoms such as sadness, anxiety and loneliness.
MORE ON THIS TOPIC
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One of those who sought help from Chat last year was 26-year-old John, who declined to reveal his real name. He was struggling with suicidal thoughts and overwhelmed by the plethora of counselling options available online.
"It can be quite intimidating to randomly pick one and hope that it works," he said.
After contacting Chat, he was initially referred to a counsellor. He was later further referred to IMH because his counsellor felt that he needed formal psychiatric help.
Throughout the process, Chat staff contacted him on a regular basis to see how he was doing.
"It made me feel reassured that someone was still following up on my case, instead of being chucked around like a soccer ball," said John, who works in the logistics industry.
He is now in therapy, and is also taking medication to manage his mood.
Prof Swapna said Chat has started to train staff from social service agencies to carry out youth mental health assessments, given the growing need nationwide.
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Associate Professor Swapna Verma attributes the programme's growth to an uptick in prevalence of mental health issues. ST PHOTO: ALPHONSUS CHERN
In order to stay relevant to the young, it actively works to incorporate suggestions from young volunteers, she added.
These include 18-year-old Genevieve Lim, who volunteers as a programme ambassador and is working to shape Chat's upcoming podcast.
"I think Chat really does take into account everything we say, even if you just mention something small in a meeting," said the junior college year 2 student. "As an ambassador, it makes me feel that my perspective matters."
Added Prof Swapna: "You can't run a service for young people without getting the voices of the young."
 

Forum: Ensure quality care for people who seek help on mental health issues​



SEP 23, 2022

Mental health professionals have always encouraged individuals to seek help.
However, the rhetoric of "it is okay to seek help" or "it is important to seek help early" might not be enough.
The aim of messages like these is to try to reduce the stigma associated with seeking help. But I think there is also a need to assure people that there will be quality care when they do seek help.
There are many different professionals who provide mental health services. They include psychiatrists, counsellors, clinical psychologists and social workers.
But apart from psychiatrists, who are medical doctors, other mental health professionals are not licensed. This means professional bodies have limited legal powers to manage malpractice.
The Singapore Association of Social Workers has an accreditation process, and the Singapore Association for Counselling has a registration process, but more needs to be done to help the public understand the implications of such accreditation and registration.
The Ministry of Social and Family Development has developed a national work competency framework for social workers, and there are plans for a similar one for counsellors.

But while these competency frameworks create a useful pathway for career development, they do not cover standards or quality of care.
What should a person expect when he enters the room of a mental health professional? How would he know if the quality of care is not acceptable? To what extent are issues such as confidentiality, the qualifications of mental health professionals and whether the service is evidence-based discussed with the person seeking help?
There might be a need for the different associations representing different mental health professionals to come together to discuss how to enforce standards on quality of care.
The need for this is especially urgent now since mental well-being has become a major concern due to the Covid-19 pandemic, and small businesses offering mental health services are mushrooming.
If we want people to seek help, we need to go beyond trying to remove any stigma. We need to assure clients that they will be well taken care of when they do.

Chua Wei Bin (Dr)
 

Forum: MOH ensures quality healthcare service for those seeking help for mental health​



SEP 30, 2022

We thank Dr Chua Wei Bin for his letter, "Ensure quality care for people who seek help on mental health issues" (Sept 23).
We share his view that quality healthcare services are essential in the recovery of persons with mental health conditions.
To better provide support and care for persons with mental health conditions, the Ministry of Health (MOH) launched the Community Mental Health Masterplan in 2012.
The focus is to provide for early identification and intervention for persons with mild symptoms or whose conditions have stabilised following management at the hospitals, to be cared for in the community.
Our primary care partners, including polyclinics and general practitioners, and community mental health service providers are trained by the public hospital teams to have the necessary knowledge and skills to manage individuals with mental health needs.
In addition, care processes, quality assurance frameworks and regular audits are in place to ensure standards and quality of mental health services provided by the different professionals, including clinical psychologists, counsellors, nurses and social workers.
To cater to the diversity of professionals providing mental health services across the continuum of care and arising from the recommendations of the Covid-19 Mental Wellness Taskforce, MOH, together with the Ministry of Social and Family Development, has set up a National Mental Health Competency Training Framework Workgroup.

The work group will align existing mental health training towards a common set of training standards and competencies expected of professionals and para-professionals who support persons with mental health conditions.
More details on the framework will be provided when ready.
MOH will continue to work with the various healthcare providers to ensure quality care is provided to persons with mental health conditions.

Jeannie Tey (Dr)
Director, Health Services Integration and Development
Ministry of Health
 

Charity aims to make mental healthcare more accessible to children, youth​

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The number of suicides among young people aged 10 to 29 in Singapore hit a record 112 in 2021. PHOTO: ST FILE
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Syarafana Shafeeq


OCT 2, 2022

SINGAPORE - With the number of suicide cases among youth in Singapore hitting a record high in 2021, a new charity seeks to make mental healthcare more accessible to them and provide crisis intervention in times of need.
Ms Nicole Pang, 25, was sparked into action when a social worker told her about his experience with children as young as 10 experiencing suicidal ideation, and youth having access to drugs or experiencing extreme social reclusion.
She and some friends piloted Project Cope and crisis response initiative Imna - short for "I'M Not Alone" - under charity Impart in 2020. Since its launch, more than 150 children and youth have been served across its mental health programmes.
Ms Pang, head of the mental healthcare arm at Impart, said there has been an increase in the number of cases over the years, and its waiting list has risen significantly over the last few months.
She added that the charity, which has more than 250 volunteers across all its operations, has seen more cases related to suicide, self-harm-related struggles and extreme social reclusion.
The number of suicides among young people aged 10 to 29 in Singapore hit a record 112 in 2021, up by 11 from the year before.
The Samaritans of Singapore told The Straits Times in July that its crisis hotline logged a 127 per cent spike in calls from those aged 10 to 19 from 2020 to 2021.


Under Imna, volunteers build relationships with the youth, and act as a first line of response when they feel troubled.
Ms Pang said the children or youth feel psychologically safer to reach out to volunteers directly for support once they have established a positive relationship.
If a person expresses an urge to self-harm, the team will find out key details to assess the situation - like location, intensity of emotions and whether he or she is alone.

A staff member, called a youth advocate, will try to intervene through calls or text messages but will send a member of the crisis team to the location to help the person if this is ineffective.
Once the latter is safe, caregivers, such as parents, are briefed on what to look out for and the team will check in with the person the next day.
But if safety cannot be attained or if the person is uncontactable during the initial intervention, the team will make the decision to break confidentiality and call an ambulance, or inform the police, for example.
Youth advocate Mohammed Narish Mohamed Noh, 22, was inspired to join the sector after getting tutoring help from the charity while completing his N levels as a private candidate.


"It was interesting to see how case workers engaged the beneficiaries - even the most difficult cases where they are unresponsive or run away, and how (the workers) managed to move them into a space where they are open to interventions and are motivated to do better for themselves," he said.
Not a stranger to his own mental health struggles in the past, Mr Narish feels strongly about supporting children in learning about emotional health.
The job is filled with ups and downs though. There is joy when a breakthrough is achieved, but devastation when there are relapses or if the beneficiary engages in unhelpful behaviour.
"At the end of the day, I have learnt that progress is not linear and that both ups and downs are part of the process," he said.
Ms Pang said while Singapore has become increasingly open in talking about mental health, translating insights and ideas into action will take time.
She added that while a lot of focus is placed on secondary or tertiary levels of mental healthcare, such as clinical psychologists or inpatient care, more needs to be done for primary mental healthcare, like peer supporters and community workers.
She said many of the struggles faced by youth in the community can be managed at the primary care level by groups like Impart, but they are often quickly referred to other care levels and encounter clinicians who are burnt-out due to the overload.
"As a result, clients experience long waiting times and are often even rejected by services because they do not meet certain thresholds.
"We can serve a wider range of the population if we are able to further tier mental healthcare, while still ensuring that there is some level of standardisation in our quality of care and delivery of interventions."
 

8 suicides by uniformed Home Team officers since 2018, rate in MHA half national average​

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The Ministry of Home Affairs conducts surveys and engagements to collect feedback on issues officers may face in the workplace. ST PHOTO: GAVIN FOO
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Jean Iau


OCT 4, 2022


SINGAPORE - There were eight suicides among uniformed Home Team officers between January 2018 and September 2022, while three other possible suicides are pending coroner's investigations.
The suicide rate among Ministry of Home Affairs (MHA) staff is about half that of the national average said Minister of State for Home Affairs Sun Xueling in Parliament on Tuesday in response to questions from Mr Zhulkarnain Abdul Rahim (Chua Chu Kang GRC) and Mr Melvin Yong (Radin Mas) as well as nominated MP Shahira Abdullah.
Ms Sun also reiterated the Home Team's measures to support its officers' mental well-being, which include in-house psychological services, external counselling services and peer support programmes, as well as resilience and stress management training for new officers.
The Singapore Police Force psychologists also try to demystify the myths and stigma of seeking help during regular mental health outreach to all police officers, said Ms Sun.
This comes after a police officer was reported to have fired two gunshots in the air using his service pistol before shooting himself at 1 Bayfront Avenue in September. He was later pronounced dead.
The police said that based on preliminary checks, the officer, 29, had not sought help from his unit, supervisors or counsellors.
Ms Sun said that between January 2018 and September 2022, 74 uniformed officers in the Home Team died while in service. While most of these deaths were due to illnesses or natural causes, eight were ruled as suicides and three possible suicides are pending coroner's investigations.

Referencing a Washington Post report published in 2021 that United States law enforcement officers were 54 per cent more likely to die by suicide than the average American, Mr Zhulkarnain stressed that Singapore would not want to face a similar situation.
Noting that the situation in Singapore is different, Ms Sun said: "Every suicide is one too many and I do not wish to trivialise the situation, but our statistics show that the suicide rate among MHA staff is about half that of the Singapore national average."
Mr Murali Pillai (Bukit Batok) asked if any study has been conducted to identify the psycho-social factors that contributed to the suicides among officers, such as exposure to traumatic incidents.
Ms Sun replied by reiterating that the MHA conducts surveys and engagements to collect feedback on issues officers may face in the workplace.
"This is continuous ongoing work, and we will need the help of family and friends because family and friends are often the most connected to these officers, and they would know if there are any life-changing events that would throw them off course and lead them to choose a very unfortunate way out," she added.
 

16 out of 1,000 primary school pupils required mental health support in 2021, number stable over five years​

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The number of primary school pupils that were referred to school counsellors for mental health-related issues was stable between 2017 and 2021. PHOTO: ST FILE
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Goh Yan Han
Political Correspondent


OCT 5, 2022


SINGAPORE - About 16 out of every 1,000 primary school pupils required mental health support in 2021.
The number of primary school pupils who were referred to school counsellors for mental health-related issues was stable between 2017 and 2021, said Minister of State for Education Gan Siow Huang in Parliament on Wednesday.
As some of these pupils may require counselling support even after they move on to secondary schools, counsellors engage parents to discuss how such help can be extended in their new schools, she added.
There were 232,650 primary school pupils in 2020, according to the latest 2021 edition of the Education Statistics Digest released by the Ministry of Education (MOE).
Ms Gan was responding to a question by Mr Darryl David (Ang Mo Kio GRC) on whether the number of primary school pupils requiring counselling for mental health issues had risen in the last five years, and how such pupils are managed as they transition into secondary schools and beyond.
With the parents' consent, information such as strategies to support the child and his or her challenges will be shared with the receiving school, she said.
Such information will be managed sensitively and will be shared only on a need-to-know basis, she added.

Mr Darryl asked how such information is shared beyond MOE with other government agencies, for example, whether the Ministry of Defence would have access to the information when a male student who needed mental health care during his time as a student enlisted for national service.
Ms Gan said the ministry is very concerned about the continuity of mental health care and support for young people, while balancing the need for medical confidentiality.
MOE is involved in the inter-agency task force for mental health and well-being on how best to do so, she added.
"We are discussing in great depth on how we can provide continuous care, as well as to do so in a manner that respects the need for medical confidentiality, and also to respect the wishes of individuals as well as their parents," she said.
In August, MOE said that about 70 out of every 1,000 students in schools and institutes of higher learning here received counselling support over the past two years for a wide range of issues such as relationship challenges and anxiety, with a smaller segment of these for mental health-related issues.
“With increasing awareness and availability of support and resources, more students have sought help for mental health in the last two years,” the ministry said.
 

Study finds that teens who attempt suicide face more stress, perceive parents as hostile​

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The study showed that family plays a very important role in the mental well-being of the youth. PHOTO: ST FILE
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Ang Qing

OCT 9, 2022

SINGAPORE - Apart from facing more stress, teenagers in Singapore who have attempted suicide are more likely than their peers to perceive their parents as aggressive, neglectful and cold, a recent study has found.
Their parents, however, were less likely than their children to think that they had been neglectful parents, according to the study, which compared the perceptions of 60 teenagers who have attempted suicide with those of their parents or main caregivers.
The gap in perception could come from parents being unaware of how their own behaviour is perceived by their child, the researchers said, but could also be for other reasons.
Parents may have modified their own practices following their child's suicide attempt, or a bias towards themselves could have resulted in inaccurate questionnaire responses.
Whatever the reasons, the study showed that family plays a very important role in the mental well-being of children, said National University Health System's (NUHS) Mind Science Centre's director John Wong, the study's first author. Parents, especially, can make a huge difference in how their children behave and respond to stresses, said Associate Professor Wong.
The study, which was published in the journal Frontiers In Psychiatry on Sept 29, found that teenagers who have tried to kill themselves face significantly more stress, especially from life at home, peer pressure and romantic relationships, than their peers.
Those who attempted suicide also tend to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleep cycle, among other factors that put them at risk.

Prof Wong said the study indicates what strategies could be taken for suicide prevention.
"We need to move beyond approaching mental illness by reacting to incidents and crisis like fighting fires. Instead we need to move towards building healthy resilience in youth," he told The Straits Times ahead of World Mental Health Day on Monday.
"From time to time, many of us will suffer setbacks and that's the whole idea of resilience, that we can learn from setbacks, which prepare us for overwhelming events in the future."
To help parents and the wider community better gauge the mental well-being and strength of young people in Singapore, NUHS Mind Science Centre and National University of Singapore department of psychological medicine developed the Singapore Youth Resilience Scale (SYRESS), said Prof Wong.
The assessment framework helps to identify areas of mental strength and areas where youth can improve their resilience.
Since the tool was rolled out internally in NUHS two years ago, it has helped create clearer assessments for the group's healthcare services including Reach West zone, a community-based mental healthcare service for students with emotional, social or behavioural issues.
"Knowing such information helps us in our treatment planning. This helps our parents and stakeholders understand the students' needs and how they can better support them," said Ms Stephanie Seow, NUHS team lead for Reach West zone, which oversees 83 schools in the area.
Currently, people can use the SYRESS assessment tool at this website and in hard-copy at the Teens & Kin exhibition in Alexandra Hospital, which ends in November.
Going forward, NUHS Mind Science Centre plans to introduce SYRESS to social service agencies as well, said Prof Wong.
 

Making mental health a priority for all​

Although inroads have been made in mental healthcare, it is the collective and moral responsibility of a caring society to do more for the mentally ill.​

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Chong Siow Ann
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In a civilised society, caring for those who are unable to do so is a collective and moral responsibility, says the writer. ST PHOTO ILLUSTRATION: LIM YAOHUI


OCT 10, 2022

There are almost 300 different types of mental illnesses, according to the American Psychiatric Association which lists all of them in its Diagnostic and Statistical Manual of Mental Disorders. For almost all, we do not know enough to either prevent or vanquish them.
These diverse disorders continue to afflict humankind and cause some of the most profound forms of human suffering, which has worsened in recent times with the worldwide mental and emotional fallout from the Covid-19 pandemic, deadly military conflicts, mass displacement of populations and the cycles of heart-wrenching humanitarian crises.
For these developments, the World Health Organisation (WHO) has chosen "Make mental health and well-being for all a global priority" as its theme for this year's World Mental Health Day on Oct 10.

Burden of disease​

Mental health matters globally in a number of ways. First, there is the burden of disease. At its simplest, it is the number of people suffering from mental illnesses. In the pre-pandemic 2019 world, one in every eight people had some form of mental illness; in absolute number, that would be about 980 million for that year. Following the onslaught of Covid-19, the number has grown, with an estimated 25 per cent rise in both anxiety and depressive disorders in just the first year of the pandemic.
Second, there is the calamitous impact of a mental illness on the individual and the family. Listen to anyone who has been affected by a serious mental disorder, either directly or as a caregiver, and you will hear of lives circumscribed by hidden suffering, shame, and discrimination and exclusion in schools, the workplace, marriage, celebrations, and many of those quotidian social activities. It is to consign that individual to exist as a non-person.
In places where there are no functioning mental health services, families would shoulder the responsibility of caregiving. Given that most mental illnesses run a chronic course, bereft of any external help the family would also run out of energy, patience, affection and money. At the end of their tether, hope would turn into desperation, forbearance into abhorrence, and protection into rejection.
Third, severe mental illnesses are a catalyst for mortality: life expectancy for people with these disorders is between 15 and 20 years shorter than the average. This is caused by a number of factors including unhealthy lifestyles, poorer physical health, and the lack or even denial of quality medical care.

Mental disorders also kill people in more direct ways. While there are many pathways to suicide, the presence of mental illness - as has been shown in a large body of studies - is a significant factor. More than 700,000 people die due to suicide every year, and it is the fourth leading cause of death among those aged between 15 and 19.
From a global perspective, the issue is not just the enormous burden and staggering numbers of people affected by mental disorders and the resultant disabilities and increased mortality. It is the fact that the vast majority of them do not receive the care we know can greatly improve and even save their lives - even among those living in the wealthiest countries.
In the United States, fewer than half of those with mental illnesses are receiving treatment; a significant proportion of people get poor or no treatment because of their lack of money, lack of connections, background or skin colour.

The jails and prisons have become the de-facto mental institutes, and teenage suicide is rising alarmingly, prompting the US surgeon general to warn of a "devastating" mental health crisis among adolescents.

This, despite the evidence of the effectiveness of specific medications and psychotherapies, and where there is knowledge of what kinds of social support are most helpful for those experiencing mental health crises. But assembling and delivering them to those in need has been a problem everywhere.
In no country in the world is the proportion of expenditure of the health budget on mental health commensurate with the overall burden of mental disorders. The WHO Mental Health Atlas 2017, which asked for countries to estimate their government's total spending on mental health, found that among the 169 which responded, the average mental health expenditure accounted for less than 2 per cent of government budgets for health. The medical journal, The Lancet, in a report published the following year, stated caustically: "When it comes to mental health, all countries can be thought of as developing countries."
Against this global backdrop, where do we in Singapore stand?

Singapore's stance​

After 13 years as the director of the US National Institute of Mental Health, Dr Thomas Insel acknowledged that the solutions to mental health problems are "not medical", rather they are "social, environmental and political".
This is nothing new to mental health professionals who have known for the longest time that mental illnesses have a myriad of biological, social, economic and political determinants - all interacting in complex ways. Effective solutions lie not just in our hands but in many others as well.
If anything, and like anything that requires a profound societal shift in commitment, attitudes and resources, there must be strong and determined political will that either wells up from the ground or is driven top down.
In 2007, there came that pivotal national commitment: The Ministry of Health formulated the first National Mental Health Blueprint - the aims were ambitious and even lofty. It sought to build resilience to mental illness, work towards early detection of severe mental disorders, reduce stigma, engage the primary care doctors in the system of care, build up a network of support in the community, rectify the shortfall in mental health workers, ensure better access to services, and encourage research.

In the succeeding years, there have been further reiterations of this plan, including the building up of resources and support in the community and more lately, focusing on youth mental health.
I have been both a witness and participant of these changes, and I'm also old enough to remember what it was like for people with mental illness way before that. In the 1980s, when there was yet no Institute of Mental Health and when I started my training in psychiatry, we had far fewer medications and fewer therapies.
The care of those with severe mental illness was largely institutional and largely provided by the then Woodbridge Hospital - an antiquated sprawling complex with heavy iron gates that was built in British colonial times, and where patients would often stay for months and even years; community support was rudimentary, and there was hardly any research to inform our care.

People, place and purpose​

Now we have early detection services, a slew of programmes in the communities, more medications in our pharmacopoeia, a broad range of psychotherapies and other psychosocial interventions, an expanded mental health workforce including in key research areas, involvement of grassroots organisations, and a fledgling recovery movement of people with lived experiences.
We have laws to protect not just the rest of society from the potential dangers posed by people with serious untreated mental illness - a threat which while real is grossly exaggerated - but also laws that emphasise the protection of the rights and safety of mentally ill people.
We have also made some inroads in alleviating that terrible stigma of mental illness that can be so profound and pervasive - the mentally ill were unable to finish schooling, gain employment, marry, live independently, or have their care paid for by insurance companies - and which often pushes them to the margins of society.

The various research which we have done and the various initiatives to raise mental health literacy have brought about more open conversations in the community, appreciable reduction in the stigma, fear and isolation, particularly for depression and anxiety disorders, and this is no mean achievement.
My colleague, Associate Professor Mythily Subramaniam who heads research in the Institute of Mental Health, tells me she is often reminded of what a research participant had said during a focus group discussion: "While I would not downplay the impact of mental illness on the person, this is a good time to have a mental illness. Imagine having it a decade back versus today when one has access to many therapies and to people who are understanding and inclusive."
But there is always more that we need to do. We need more recovery and rehabilitative services, more housing options to support and shelter those who have nowhere to go; more access to psychological treatments; more support for caregivers; and funding for the right sort of research to address the real-world issues faced by the mentally ill, their families, and policymakers.
And we need to give our patients what Dr Insel called the 3 Ps: people, place and purpose. We need to have enough mental health professionals to provide that wide range of compassionate and effective care to patients (and render concrete support for caregivers to prevent burnouts); we need to have places and sanctuaries in hospitals and in the community where they can be safe and be healed; and we need to find ways and means for them to regain or discover some purpose in their life.
All this will be work in progress, of course, and will continue to be so. It does require an abiding iron political will and massive resources, but as a civilised society, caring for those who are unable to do so would be a collective and moral responsibility that we will gladly take on.
  • Professor Chong Siow Ann is a senior consultant psychiatrist at the Institute of Mental Health.
 

Forum: Help parents build mental well-being so they can better support their child​



OCT 15, 2022

I refer to the report, "Suicide bids by teens: Study highlights vital role of family in mental well-being" (Oct 10)
According to the report, while teenagers in Singapore who have attempted suicide were more likely than their peers to perceive their parents as neglectful, their parents were less likely than their children to think that they had been neglectful.
Researchers said that one reason for this gap could be that the parents were unaware of how their own behaviour was perceived by the child.
The definition of a good family differs between children and parents. In the course of my work as a therapist, I have seen parents who were helpless when it came to helping their children. They thought they had provided a good family for their children, but their children thought otherwise.
The parents of today's teenagers grew up at a time when mental health education was not common in Singapore. Most of us are likely to adopt our parenting styles from what we saw from our parents, who grew up in years when having the ability to place three meals on the table was more important. Concepts such as emotional well-being, emotional regulation and positive coping skills were unheard of.
We know that family plays a very important role in the mental well-being of children, but family members need to be equipped to play that role.
From my observation, what generally happens now is that children spend most of their time growing up away from their parents.

After the maternity leave period is over, the child is placed in infant care, then childcare, then student care, until he is eventually considered old enough to look after himself when he is in his teens.
Alternatively, the child is looked after by a helper or grandparents.
Many studies show that the first six to seven years of a child's life make up the most important phase for development and connection to the caregiver. If the child spends most of his time during this period away from the family, how then can the family build a connection with the child?
While I support the idea of building resilience among the youth, it is crucial to help them sustain the new pattern of coping during stressful situations.
It would be of little use if the child, with the newfound strength, goes back home to a troubled family.
Perhaps we should look first into helping parents to build their own mental well-being so that they can better support their child's mental well-being.

Shirley Woon
 

How to tell if I’m depressed or burnt out​

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Clinicians and researchers offer advice on how to tell the difference between depression and burnout, and what to do about both. PHOTO: NYTIMES


OCT 18, 2022

NEW YORK – You are tired all the time and feel unproductive at work. How do you know if you are depressed or burnt out?
The exhaustion, when it hits, is all-consuming. Your inbox chimes and you want to fling your phone across the room. You are sick of your flat, yet you cannot stand to leave it. You fumble for the right word: You tell friends you are tired, fried or just done.
How do you know if this wave of weariness signals a case of burnout or full-blown depression? Experts share ways to tell the difference between the two and how to alleviate the symptoms of both.
What is the difference between burnout and depression?
The concept of burnout comes from workplace psychology, said Dr Angela Neal-Barnett, a psychology professor at Kent State University and author of Soothe Your Nerves: The Black Woman’s Guide To Understanding And Overcoming Anxiety, Panic And Fear.
Therapists typically associate burnout with work, although researchers are also studying parental burnout, when caregivers feel chronically exhausted.
Burnout has become pervasive in the cultural lexicon, especially during the pandemic. The trend of “quiet quitting”, or doing the bare minimum at a job, has gone viral on TikTok, as people share stories about feeling burned out by long hours.

Workers can become burnt out when they feel like they do not have control over their day-to-day lives, getting bogged down in the minutiae of their tasks.
People who are burnt out may feel depleted and cynical about their jobs, and they can resent their assignments and colleagues. They might feel irritable and ineffective, like they cannot get anything done.
For people who interact with others in their jobs, such as healthcare workers or people in the retail and service industries, they might start to lose empathy, thinking of patients or customers as just another number or a task to complete.

There are also a litany of physical symptoms that can come with the unending stress of burnout, such as insomnia, headaches, gastrointestinal issues.
The World Health Organisation includes burnout in the International Classification of Diseases – its diagnostic manual –characterising it as an “occupational phenomenon”, not a medical condition.
Depression, however, is a clinical diagnosis. People with depression often experience anhedonia, the inability to enjoy activities they once treasured. “You can be reading a book you used to love, and now you hate it,” said Dr Jessi Gold, a psychiatrist at Washington University in St Louis. “Or you love watching a movie, but now it doesn’t make you laugh any more.”
With burnout, you might not have energy for your hobbies; with depression, you might not find them fun or pleasant at all, said Associate Professor Jeanette M. Bennett, who studies the effects of stress on health at the University of North Carolina at Charlotte.
As with burnout, people with depression may sleep too much or too little, and may struggle to focus. People with depression may isolate themselves from others and may feel like it takes a lot of energy to shower or eat.

Depression can induce an overwhelming sense of sadness and hopelessness. In severe cases, people with depression may start having thoughts that they are worthless or that life is not worth living. These symptoms tend to last for at least two weeks, said Dr Gold and Prof Neal-Barnett.
A key differentiator is that burnout gets better when you step away from work, said Dr Rebecca Brendel, president of the American Psychiatric Association. When you take vacation time or a mental health day, you feel at least slightly recharged.
Depression does not go away if you change your circumstances. “There isn’t that bounce-back effect,” she said. “It takes more than that.”

What to do if you think you are burned out​

Taking a mental health day off work, if you are able to, can offer a reprieve from your symptoms.
If you feel constantly burnt out, you might want to consider a career change, which is easier said than done, said Dr Gold. “Being able to say, ‘This is a bad workplace, that’s it, I quit’, is a privilege beyond privilege,” she said. There are smaller ways to set boundaries, such as turning off notifications from your work e-mail at certain hours.
If there is one meeting you consistently dread, try to block off five or 10 minutes after it to do something that can help you relax, she said. “Being able to have some control is a preventer from burnout.”
You can also try to accentuate the elements of your job that you find meaningful. That may mean mentoring a more junior colleague, Dr Gold said, or offering to hand off responsibilities you enjoy less to a colleague in favour of helping him or her with a project you are more interested in.
According to Prof Bennett, exercise can help relieve work-related tension, as can carving out even a few minutes to decompress – without your phone.
“If you sit in front of a computer for your job, and then you’re on your phone while you’re commuting, and then you come home and watch Netflix – all of that is stimulation,” she said.
Your brain needs a break, so it can help buffer against stress. That means stepping away from screens, and giving yourself a few moments of quiet, sitting with your thoughts, without distractions.
If you are struggling to cope with burnout, consider speaking with a mental health professional.

What to do if you think you are depressed​

Reach out to a mental health provider, who can help develop a plan to treat and address your symptoms.
In the meantime, start small and simple. If you tell yourself you are going on a five-minute walk, you will probably end up walking for longer than that, said Dr Gold. “But it’s hard when you’re exhausted and sad to make yourself do anything.”
Getting out of the house will not alleviate all your symptoms, but any kind of movement can help you feel a bit better, she added. NYTIMES
 

Forum: Connecting with others is key in mental wellness​


OCT 12, 2022

I refer to the report, "Promoting mental wellness a 'kampung' effort in the community" (Oct 10).
Mental wellness is founded on relationships cultivated through connection and empathy.
Mr Benny Bong, a family and marital therapist, wrote in a Methodist Church publication in 2021 that what worsened mental health during the pandemic was the loss of social contact and connection, as face-to-face interaction with family and friends had to be cut back to protect ourselves and others.
He added that "as human beings, we are made for connection; that within us is a special need for relationships".
Being empathetic towards one who is facing mental turmoil is a process, not an emergency room procedure.
Often, the person needing help is not expecting immediate answers from the one offering help, but is seeking assurance that the other person understands and that he is not alone.
This requires rapport that comes from connection.

For example, a 69-year-old man, interviewed recently on TV as a case of an elderly person who tried to harm himself, had tried calling a counselling line but did not like the experience.
He was grateful to be visited in person by social workers from O'Joy Limited every other week, saying: "I can talk only to people I am familiar with."
I hope that community initiatives to bring about mental wellness will adopt a long-term view in sustaining the gradual and protracted process that mental healing requires.

Lai Yew Chan
 

Forum: No substitute for face-to-face contact in suicide prevention​



OCT 19, 2022


I am glad people can seek help faster by having easier access to emotional support, especially for those aged 10 to 29 in the suicidal high-risk group. These efforts include the Samaritans of Singapore’s Care Text messaging service through WhatsApp, 24-hour hotline and e-mail befriending service.
But as pointed out by Mr Lai Yew Chan (Connecting with others is key in mental wellness, Oct 12), there is often no substitute for face-to-face contact as counselling hotlines may not work for everyone.
While we try to get as many people to seek help as possible, it can be easy to forget that the quality of the first contact with a support service is more important than the number of accessible services. If there is no viable substitute for face-to-face emotional support, we may need support services (including volunteer numbers) to be expanded to cater to both virtual and face-to-face settings.
If initial virtual support translates into more individuals accessing different levels of support, organisations like the Samaritans of Singapore may be overwhelmed.
Besides looking into improving the training of its volunteers, SOS can perhaps consider implementing initiatives that reduce the risk of vicarious traumatisation of volunteers due to exposure to emotionally distressing information. This is especially important if a limited number of volunteers are forced to handle more distress cases during abnormal times such as the Covid-19 pandemic.
Researchers are now attempting to use artificial intelligence to study who is likely to attempt suicide and when (Using smartphones to try to predict suicide, Oct 11). This could be a valuable tool to assist volunteers and inexperienced clinicians in the preliminary assessment of persons in need.
However, we should resist the temptation to de-humanise every facet of emotional support simply because we can avoid discomfort and because it is convenient.

Instead, we should always bear in mind that it is having someone acknowledging our emotional pain and journeying with us which gives us the strength to overcome life’s adversities.

Victor Ho (Dr)
 

New guide for parents to help their kids manage mental health​

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Minister of State for Social and Family Development Sun Xueling with the co-chairs of MindForward Alliance. PHOTO: MINDFORWARD ALLIANCE SINGAPORE
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Shermaine Ang


NOV 2, 2022


SINGAPORE – Parents looking for tips on managing their children’s mental health can now turn to a guide on how to help their kids cope with stress, anxiety and social media addiction, among other issues.
MindForward Alliance, a global not-for-profit organisation that promotes mental health in the workplace, launched its Singapore chapter on Wednesday with a free guide for parents on caring for their children’s mental health.
The 44-page guide was put together by MindForward Alliance Singapore and one of its nine founding members, Asia Pacific Breweries Singapore, drawing on the knowledge of social service practitioners and mental health professionals. The other founding members include Goldman Sachs and HSBC Singapore.
The guide includes knowing what to look out for, when and how to get specialist help, among other practical advice.
It comes on the back of 2021 figures from the Samaritans of Singapore, which showed that the number of suicides among children and youth aged between 10 and 29 had hit a record high since the start of the millennium.
Minister of State for Social and Family Development Sun Xueling, who was guest of honour at Wednesday’s launch event, said the parents’ guide would help with workplace mental health as happy children mean happy parents and employees.
She added that leadership styles have changed due to flexible work arrangements during the pandemic, and leaders must learn to trust, inspire and care for employees.

Ms Laure de Panafieu, co-chair of MindForward Alliance Singapore and partner at multinational law firm Linklaters, said: “What I realised with one foot in Europe and one foot in Asia, is that in Asia, the stigma around mental health is deeper, both at home and at work.
“So it’s even more important that we equip leaders so that they are prepared and ready to share and just be vulnerable and brave so that they create safe spaces for others.”
Mr Kenneth Choo, co-chair of MindForward Alliance Singapore and managing director of Heineken Asia Pacific, said managers can start the ball rolling by showing vulnerability – for instance, about feeling nervous about a presentation – and encourage employees to also speak up about their fears about being judged or making mistakes.

“Employees need to feel that it’s okay to share their fears, that they’re not alone in feeling that way. Once you start to talk about the fear, it actually goes away and that will provide psychological safety in the workplace.”
He said the corporates that are members of the MindForward Alliance can take the lead in promoting workplace mental health, benchmarking areas of mental health management and awareness, and developing best practices or validating their strengths.
The guide for parents includes schemes these companies have to support parents, such as hybrid work arrangements, meetings capped at 15 people, and having no meetings during lunchtime.
Clinical psychologist Carol Balhetchet said working parents have been overwhelmed during the pandemic, and find it harder to maintain a work-life separation as they work from home.
They should make it a point to spend structured time with their kids regularly – be it talking or enjoying a film together – as the children need their attention to ensure good mental health and development, she said.

Companies could allow parents to go home an hour early once a month to spend time with their kids, she suggested.
Administrator executive Joline Chue, 53, has a son and daughter, aged 19 and 23, who are stressed from deadlines and exams in the final year of polytechnic and the penultimate year of university.
She makes sure to check in on them, ensure they get enough rest and have time to unwind with music and sports, as well as to be with family and friends.
She said the guide will help her and other parents to understand the mental health issues her children are facing, so she can better help them.
The guide can be found at https://mindforwardalliance.org.sg/parents-guide-to-mental-health-in-children-and-adolescents/
 

Singaporeans stressed at work: Spotlight on mental health issues at the workplace​

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Mr Daniel Paul Anugraham experienced a low level of job engagement, low job satisfaction and poor overall quality of life last year. ST PHOTO: SYAMIL SAPARI
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Amrita Kaur


NOV 15, 2022

SINGAPORE – In June 2021, Mr Daniel Paul Anugraham started having more frequent anxiety attacks. The 24-year-old, who had been a fitness trainer at a gym since December 2020, would have prolonged moments of heightened fear, dread and uncertainty.
Sometimes, the feelings lasted for a few hours, and other times, they stretched from the time he woke up till he went to sleep at night.
One day, he reached “a breaking point” when he found himself retreating to the storeroom of the gym, shaking from an anxiety attack and on the verge of tears. This forced him to call a psychologist from his mobile phone, seeking help for the first time.
“My psychologist gradually talked me out of that dark and noisy place in my head, and guided me into explaining what I was going through,” says Mr Anugraham.
Since then, he has been seeing a psychologist once or twice a month.
Mr Anugraham had been feeling burnt out. He was juggling work in the day and studying for a degree in the evening. He also wanted to earn more money and took on more clients for personal training.
“I continued putting on my best front for everyone, and stayed silent about my struggles. I didn’t want to show weakness,” he says.

He was losing the motivation to go to work and often felt mentally exhausted before noon. His energy levels during his workouts dipped with each passing week.
“I lost my appetite and could not sleep well most nights despite being exhausted. I started despising the very job that had empowered me,” he adds.
He experienced a low level of job engagement, low job satisfaction and poor overall quality of life last year. The management at the gym lowered his workload when he shared with them that he was feeling burnt out. He left the gym in October and now works as a remote strength and performance coach.


A study released in September that surveyed 3,000 employees in Singapore, Indonesia and the Philippines has identified the workforce here as having the poorest mental health.
Conducted by South-east Asian consumer research company Milieu Insight in collaboration with Intellect, a Singapore-based mental health app, the survey carried out in July found that only 57 per cent of Singaporeans rated their mental health to be “good”, “very good” or “excellent”, compared with 68 per cent in Indonesia and 78 per cent in the Philippines.
The survey showed that employees here report the lowest levels of engagement and job satisfaction, with only 42 per cent of Singaporean employees reporting high engagement at work compared with 52 per cent of Indonesian employees and 56 per cent of Filipino employees.
According to the survey, employees here were mainly motivated by a sense of accomplishment, to improve the chance of being promoted and by the fear of not being able to do better than their peers.
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Daniel Paul Anugraham said exercising is one way in which he relaxes. PHOTO: JUAN CHAN
Psychologists tell The Straits Times that they have seen an increase in patients with burnout and fatigue at work.
Dr Annabelle Chow, principal clinical psychologist at Annabelle Psychology, says there has been an increase of about 60 per cent in the number of such patients from August 2021 to this year.
The spike, she says, could be due to the blurred work-life boundaries brought on by the Covid-19 pandemic and the poor economic outlook, which might cause a dip in workers’ motivation levels. A lack of mental health support at the workplace could have also contributed to the increase in patients.
Work-related stressors, she adds, include long or longer working hours, exhaustion, changing workloads or job scopes and heavier-than-usual workloads as well as a lack of support with tasks.
“The common complaints or woes of patients include poor work-life balance, high or changing work demands and the pressure to perform at work,” she notes.
Dr Felicia Neo, director and clinical psychologist at Neo Cooper Psychology Clinic, has seen a 20 per cent increase in patients experiencing burnout since January.
Burnout, she explains, is brought on by prolonged or repeated emotional and physical stress, which can be caused by a combination of stress from work and one’s personal life.
“A lack of support from management in achieving work goals, feeling that the company does not value the employee and an unhealthy work environment are common factors that lead to (employees) feeling defeated and emotionally exhausted,” adds Dr Neo.

In addition, employees may compare themselves with others, harbour a fear of judgment, scrutiny and failure and feel shame, or try to live up to societal expectations, she says.
Employees may often feel the need to hustle for promotions, increments and bonuses, which is compounded by the fear of missing out, says Dr Neo.
Some workers are worried that they may be found lacking compared with their peers. “This leads to the pressure of doing more, or the need to do everything at work, from upskilling to attending workshops and learning new languages,” says Dr Neo.
Mr Benjamin Low, clinical psychologist and corporate wellness consultant at Psych Connect, says younger professionals, or those who are about to start their first job, often come in with anxiety over adjusting to their new role. “This can range from uncertainty over what ‘success’ at this stage of life is meant to look like, impostor syndrome or social anxiety.”
Those in the later stages of their career struggle with more strategic issues.
“These include learning how to manage people and relationships rather than technical tasks, dealing with missed or thwarted career goals, or finding that they have lost the motivation for work even if they are doing well,” he says.
Mr Anugraham says it took him a while to work things out with his psychologist, “but I can sum it up as unrelenting standards for myself, a fear of failure and insufficient self-control”.
He now views therapy as maintenance for his mental health, “similar to how you would brush your teeth as part of your daily maintenance routine”.
He journals and goes on long walks to relax and has also turned to his girlfriend and family for a listening ear.
He adds: “I was able to share my fears, insecurities and my lowest moments with them. Talking about it always made it easier to regain clarity and take back control over my situation, no matter how out of control the circumstances seemed.”

Companies taking action​

Companies in Singapore are adopting initiatives to ensure that their staff’s mental health is being looked after.
UOB, for instance, has implemented a permanent two-day a week remote working arrangement to encourage a sustainable balance between work and personal life.
Mr Dean Tong, head of UOB group human resources, says: “This is on top of other benefits targeted at balance, such as Flexi-2 which gives all staff an additional two hours off during the work day every month to attend to personal matters, and a choice of staggered start-work times.”
In June 2021, the bank also launched weekly Mental Wellness Days. “On such days, which typically fall on Fridays, employees can participate in webinars, workshops (such as one on making a scented stick diffuser in November) and activities specially curated to address salient concerns and improve their mental well-being,” says Mr Tong.
And since 2021, food delivery platform foodpanda has been providing its employees mental health support via an app called Intellect.
Mr Ingo Laubender, vice-president of people and corporate technology at the delivery platform, says users can book one-on-one online consultations with licensed counsellors and behavioural coaches, and also engage in self-care programmes.
An employee resource group called “zen pandas” also facilitates open discussions about mental well-being at the firm.
“Employees can apply to be certified care providers, so they are equipped to support their co-workers better. Normalising mental health support has encouraged employees to come forward and help one another,” says Mr Laubender.
 

Forum: Wide spectrum of mental health issues that can affect society​


NOV 22, 2022

When we think about mental health issues, we often think of depression, anxiety disorder, obsessive-compulsive disorder or schizophrenia.
There may, however, be a wide spectrum of mental health issues within these diagnoses. For instance, bipolar disorders may show up as extreme depression initially, but when treated for depression, people may swing to mania (accompanied by hyperactivity and mood swings).
Paranoia (which comes with complaints of various people trying to hurt patients or steal from them) may manifest itself in patients with dementia.
In my medical practice, I have seen such patients being agitated and upset to the point of being violent against their loved ones, even though they were previously described as being gentle and considerate. One patient even made numerous police reports against family members and domestic helpers. Such behaviour causes much distress for caregivers, who in turn may come down with insomnia, depression and anxiety.
Patients with dementia may also lose their inhibitions. Some were reported to have stripped off their clothes and behaved in a bizarre manner in public. They should not be labelled as public nuisances as the behaviour is linked to dementia.
Alzheimer’s disease is not the only form of dementia. Dementia may develop from vascular diseases – minor repeated strokes in the brain can cause loss of memory and generalised weakness, and the strokes may affect certain parts of the brain and result in behavioural disorder.
Minor strokes affecting the visual cortex may cause patients to see funny and scary images which cause them to be very alarmed, with loved ones also finding this abnormal and worrying.

There needs to be an awareness that vascular diseases may come with repeated minor strokes, and that vascular problems are associated with old age, high cholesterol, hypertension, obesity and metabolic disorders like diabetes.
These may not affect only aged patients; young patients can also have dementia, strokes and heart attacks, causing morbidity and mortality, so we must take steps in preventive medicine as well as educate patients (including the younger ones) to be proactive in taking care of their health.
Medical problems like dementia, strokes and metabolic illnesses would mean a greater need for caregivers, presenting another complicated problem for society. Also, patients who turn violent and uncooperative may not be manageable at home. There would therefore be a greater need for institutions with trained staff to take care of patients without them causing much damage to themselves and their families.
Recognising the wide spectrum of mental health issues and their accompanying problems affecting families and society may help us plan and be proactive in managing our own health.

Quek Koh Choon (Dr)
 

New youth counselling service gets over 170 calls in first week of operations​

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Helpline volunteers in helpline booths (background) tending to calls to Youthline. ST PHOTO: ONG WEE JIN
Sarah Koh

JAN 1, 2023

SINGAPORE – After leaving his engineer job of more than 30 years, Mr Lawrence Leong wanted to do something meaningful with his free time, and decided to take up courses to become a freelance counsellor.
“One of the main inspirations is my wife, who was a nurse. She is very giving and shows concern for not only her patients, but also family, friends and even strangers,” said the 75-year-old, who described himself as conservative and quiet.
Mr Leong is one of 307 volunteers helping out at youth counselling service Youthline, a non-profit organisation that was established by a team of professionals from different backgrounds, including Catholic priest Father Simon Pereira.
Launched in November 2022, the organisation aims to create a safe and non-judgmental space for all young people regardless of race and religion, providing a helpline service and free counselling support for those aged 18 to 35.
Said Mr Marc Khoo, chairman of Youthline: “The needs of the young are very unique. They are in a phase of life where they go through many transition phases, and they are constantly inundated with information on social media.
“If you look at the statistics, mental health issues are a major challenge for them.”
Youthline volunteers whom The Straits Times spoke to said some of the most common problems are loneliness, family issues and studies.

According to statistics in 2022 from the suicide prevention non-profit organisation Samaritans of Singapore, the number of suicides among young people aged 10 to 29 hit a record 112 in 2021, since its earliest recorded data in 2000. Its crisis hotline logged a 127 per cent increase in calls from those aged 10 to 19 from 2020 to 2021.
Youthline’s helpline service, which runs from 9am till midnight daily, received more than 170 calls within its first week of operation. The number doubled the following week.
To meet a projected increase in service demand, Mr Khoo said the organisation plans to raise $5 million by the second half of 2023, which will go towards funding a bigger office in a convenient and central location, and recruiting more permanent staff to help with operations.


The organisation is currently located at social service hub Agape Village in Toa Payoh, and is mostly run by volunteers.
End-to-end therapy platform Talk Your Heart Out (TYHO) has also seen a steady rise in the number of new clients every month, said co-founder Chirag Agarwal.
“We believe one of the reasons for this is people along the entire spectrum of mental health are starting to see the benefit of seeking professional help,” he added.
“They understand that you don’t need to wait till you are in crisis to benefit from therapy.”
During the pandemic, he said, many clients struggled with social isolation and loneliness due to movement and crowd restrictions, while others were stressed by factors such as greater difficulty in finding employment or the threat of retrenchment.
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Youthline’s chairman Marc Khoo and executive director Sandra Loo. ST PHOTO: ONG WEE JIN
“As we emerge from the pandemic, what we have observed is that people are also seeking therapy for self-improvement and growth,” added Mr Agarwal.
“For example, they want to improve their communication skills in a relationship, become more confident at work, or achieve lasting habit change.”
The chief well-being officer of Singapore Counselling Centre, Mr John Shepherd Lim, said the centre drew a higher number of clients during the pandemic, and the trend has been maintained since.
He added that the greater emphasis placed on mental health during the pandemic through initiatives such as the National Care Hotline (NCH) and expanded engagement by social service agencies, youth groups and organisations helped to shift attitudes towards therapy, with individuals becoming more open to attending counselling sessions.
NCH’s operations ceased on Saturday owing to a decrease in calls received. It was launched in April 2020 amid the circuit breaker to provide assistance to those experiencing emotional distress related to the pandemic.

Freelance creative Daniel Teo, 37, decided to seek out therapy with TYHO during the circuit breaker in 2020, as he was feeling overwhelmed by the pandemic, but was initially hesitant due to a bad experience in his youth with a therapist who lacked empathy.
His fears were allayed when he was connected to his current therapist, whom he has engaged with for two years.
Mr Teo said: “Therapy has equipped me with self-understanding, as well as self-support and de-escalation strategies. And of course, if I can’t manage alone, I can always count on my therapist to have my back.”
He added that he believes therapy should be thought of in the same light as a routine health check-up or dental appointment.
“I know now that it isn’t a magic bullet. You’re not going to be ‘cured’, which in itself is an unhelpful and unhealthy way to approach mental health,” said Mr Teo.
“Instead, therapy is about understanding and unlearning one’s bad habits, and learning how to manage the ups and downs of life in healthier ways.”
Members of the public who wish to donate to Youthline can do so via its website.
 

Ambitious parents are instrumental in childhood’s modern malaise​

Parental anxiety is contagious but we constantly push for our children’s successes and intervene in their failures​

Camilla Cavendish
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Few are immune to wondering whether we are failing our children by not being pushy enough, says the author. PHOTO ILLUSTRATION: PEXELS

JAN 2, 2023

The run-up to Christmas was also the season for piano exams. I was waiting with my youngest in some soulless hall, when a boy of about eight arrived with his father and two teachers, all of them whispering last-minute instructions at him. The organiser had to prevent the father accompanying his son into the exam room: Children must perform on their own, he explained. This seemed to be a new idea.
When my own child trooped off to his fate at the keyboard, I asked the father which grade his son was taking. “Grade 1”, he replied: beginner level. Whoa, I thought, this was a truly vertiginous level of helicopter parenting.
But from Twinkle Twinkle Little Star, perhaps, he envisaged a career at Goldman Sachs would follow for his son.
Raising three children in central London, I’ve seen my fair share of over-parenting: Dads screaming abuse on touchlines and mums doing their kids’ homework. But this latest example upset me.
Music is one of the greatest gifts you can give a child. For me, playing the piano has been a life-long form of therapy. But a music teacher tells me he sees many wealthy families push their kids as hard as possible to play instruments until they are about 14, at which point they abruptly switch focus to GCSEs. The ones with talent are devastated – the others have already been put off music for life.
Modern children can seem instrumental to the ambitions of their parents. I now realise how lucky we Generation Xers were, to have parents who considered achievements to be ours, not theirs. Mine never took credit for my successes; nor did they bail me out of failures. They worried about me, of course – but took care not to transmit those worries to me.
Perhaps, this is what has changed. The flip side of ambition, after all, is often fear. Our children face a deluge of depressing information: about climate change, automation, war and poverty. They, and we, are constantly being told that the stakes are high. That if they don’t land the right internship, they’ll never get on the housing ladder.

Some parents – like the pregnant mother I met touring a posh Notting Hill nursery – conclude they must start the race even before birth.
This is not irrational. In Love, Money And Parenting, economists Matthias Doepke and Fabrizio Zilibotti find that raising kids has become more intense in countries with greater inequality. They contrast the United States and Britain with Scandinavia, arguing that rising financial returns from a university degree have made Americans and Brits try much harder than in the 1970s to get their offspring into top institutions. At the extreme, of course, this has led to some families in the US cheating their way into top colleges.
Yet in the sensational coverage of the alleged college fixer William “Rick” Singer, it was rarely asked what message bribery sent to the teenagers who supposedly benefited.


Few are immune to wondering whether we are failing our children by not being pushy enough. I have endless school gate discussions about this – often with fellow working mothers who worry that stay-at-home friends may be right to focus relentlessly on their child’s career, rather than their own.
Part of this guilt is feeling that we modern parents are everywhere and nowhere. We ask our kids if they’ve done their homework, but too often we are stuck on our phones at that vital moment when they might have wanted to tell us something.
We blame social media for its myriad failings, but we are addicted too. The scene around our Christmas table was predictable, with shouts of “put your phone away”. But it was the teenagers doing the shouting – at the parental scrolling.

I have spent years worrying about the possible effects of screens on my children. A new study from the University of Michigan finds that pre-school kids don’t learn to regulate their emotions properly if they are regularly handed a smartphone or iPad to distract them. While it may deflect an immediate tantrum, the researchers say, the intervention makes toddlers far more likely to have emotional meltdowns.
Reading this, I suddenly wondered if the same might apply to us grown-ups too. The days between Christmas and New Year ought to be a blissful time to switch off. The younger generation seems better at this than me. Our eldest son has asked our youngest to lock his phone away, so that he can relax without interruption. In contrast, I, the self-professed Grinch of Tech, am sending online New Year greetings to make up for Christmas cards I didn’t get round to posting; replying embarrassingly rapidly to WhatsApp messages, and checking the news, unable to tear myself away from the full horror of the world.
The pandemic accelerated trends of depression and anxiety in young people – lockdowns represented a bigger proportion of their lives. In Britain, growing numbers of university students have called the mental health service Nightline. A recent National Health Service survey says 75 per cent of girls aged 17 to 19 now have a “possible eating problem”.
This makes it even more imperative that we parents try to curb our own behaviour: A welter of studies show that parental anxiety is contagious. But many parents have not fully recovered from pandemic burnout. Those with school-age children reported higher levels of mental distress during the pandemic than other groups. Some described a crippling apathy and fatigue from the relentless effort to balance everything.
So my New Year’s resolution? Worry less. Oh, and let’s preserve music for what it is: A way to spread joy in the world, a way to shield ourselves from anxiety, not to build the CV. FINANCIAL TIMES
 

Forum: Ethical and professional standards lacking in mental health sector​

Jan 12, 2023

Chief Justice Sundaresh Menon recently said that there has been a rise in breaches of ethics and professional standards by lawyers, and called for those in the profession to remain anchored to the values of honesty, integrity and service (Rise in breaches of ethics, professional standards by lawyers: Chief Justice, Jan 9).
It is a relief to know that these professionals, who are integral to ensuring that justice is upheld, are required to meet such high standards.
As someone who works in the mental health sector, I envy those in the legal profession, because many people operating in the mental health space are not required to meet similarly stringent regulatory and ethical standards. There are few legislative mechanisms that protect consumers and ensure accountability when they encounter unethical practices, unless the practices violate the law.
What I find worrying is that with the greater attention being paid to mental health issues these days, coupled with a lack of regulatory frameworks, the potential for bad actors to exploit the most vulnerable is very real.
Only doctors, nurses, and allied health professionals who come under the Allied Health Professions Council need to be registered. This means that a significant proportion of the mental health sector operates within self-regulatory frameworks. People who work so intimately with the human condition should be held to a higher standard of practice.
Ethics and professional standards are essential to all professions, and appropriate licensing and regulatory bodies need to be in place. More can be done within the mental health sector to achieve this.

Jonathan Kuek Han Loong
 

Forum: Look out for emotional abuse of youth athletes​

Jan 12, 2023

There has been much discussion about the mental health of youth as well as national athletes. I wish to highlight another group which also requires attention – youth athletes, in particular students under the Direct School Admission (DSA) scheme.
Emotional abuse can be subtle and hidden in accepted coaching practices. Emotional abuse by coaches can include belittling, name-calling, scapegoating, rejecting, isolating, intimidating, guilt-tripping and biased treatment. Coaching that uses such methods can contribute to psychological distress and cause an emotional breakdown in athletes.
Parents and administrators need to recognise and prevent behaviour that can lead to such emotional abuse. However, emotionally abusive coaching can sometimes be difficult for parents of athletes to recognise.
Additionally, the youth may not even know that they are being subjected to emotional abuse. They and their parents may also choose to suffer in silence, since it is difficult to establish a case, and they are worried about the potential consequences.
For athletes under DSA, where a student must commit to his chosen school for the duration of the programme, this could further aggravate their sense of helplessness under such a negative environment.
While the Ministry of Education (MOE) has taken a more holistic approach to school competition, the same cannot be said for external vendors like coaches. Coaching contracts are awarded on an annual basis, and an overzealous coach may seek to show quick results to maximise his chances of contract renewal.
The authorities have ramped up support for the mental well-being of our national athletes to prepare them to excel in a high-performance setting. Initiatives include raising awareness on mental health, supporting athletes with sports psychologists, and working closely with coaches. These initiatives could be selectively replicated in schools.

The pressure school athletes face can be similarly daunting. Athletes, teachers and school coaches should receive education on the importance of mental health and identifying emotional abuse. These could come in the form of talks and promotional videos.
For monitoring and early detection of abuse, I suggest that all DSA students be given a chance to provide feedback on their training and experiences annually. These records should be kept confidential and in a centralised system maintained by MOE. Individual schools would be able to access their own records, and investigate and intervene when appropriate.
The feedback process should be simple and easily accessible, so that young athletes would feel comfortable enough to report any mental stress without fear.

Goh Wee Ming
 
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