Advancing Mental Health

2.20 pm

Dr Wan Rizal (Jalan Besar): Sir, I beg to move*, "That this House recognises the importance of mental health as a health, social and economic issue; affirms the importance of a robust national mental health ecosystem; and calls for a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being."

*The Motion also stood in the names of Mr Edward Chia Bing Hui, Ms Mariam Jaafar, Dr Tan Wu Meng and Mr Yip Hon Weng.

The Government Parliamentary Committee (GPC) for Health comprising People's Action Party (PAP) Members of Parliament (MPs) Mr Yip Hon Weng, Ms Mariam Jaafar, Dr Tan Wu Meng and Mr Edward Chia has brought forth a motion of profound significance, mental health, a matter that touches every individual in our society. In our journey towards a healthier, more resilient Singapore, we must recognise mental health not just as a component of our healthcare system but as a cornerstone of societal well-being and economic stability.

In my previous addresses, I have consistently emphasised a holistic approach to health, advocating for the interconnectedness of the various health dimensions, including physical, mental and social well-being.

As we navigate modern life's complexities, it becomes increasingly apparent that mental health is not a standalone issue. It is an integral part of our daily existence, influencing our capacities to learn, work, and forge meaningful relationships. It impacts our communities and workplaces, shaping the very heart of our nation’s productivity and social harmony. Mental health, once considered peripheral, has emerged as a significant contributor to the burden of disease, affecting all age groups and demographics. From our youths grappling with stress and anxiety to adults and the elderly facing conditions like depression and schizophrenia, these challenges are societal concerns requiring collective action.

The GPC's passion for promoting mental well-being stems from a deep conviction that every individual deserves the opportunity to live a fulfilling life, unencumbered by the shadows of mental health issues. In our numerous engagements with constituents, mental health professionals and advocates, educators and students, workers and retirees, young and old, the recurring theme is clear – mental health is everyone's business. But business as usual for mental health issues will not do.

The statistics are telling. With the escalation of mental health issues globally, Singapore is not immune. The 2022 National Population Health Survey revealed a concerning rise in mental health issues among Singaporeans. Notably, one in four young people face mental health challenges, as compared to one in five in 2020. This upward trend was also observed in the older age groups.

This House must recognise the multifaceted nature of mental health as a critical issue that transcends health, influencing our society and economy. Therefore, we need a robust mental health ecosystem that is proactive in promoting mental well-being, not just reactive in addressing illness.

The newly introduced National Mental Health and Well-being Strategy, and henceforth, I will refer to it as “the strategy”, launched by the Inter-agency Taskforce on Mental Health and Well-being in October 2023 is a commendable step forward. The Health GPC aims to refine this strategy constructively, aligning with global best practices while tailoring solutions to our unique societal context.

Mr Speaker, as we embark on this new chapter, we must acknowledge the foundations laid by our previous strategies – the National Mental Health Blueprint and the Community Mental Health Masterplan. The National Mental Health Blueprint, initiated over a decade ago, marked a significant step in our commitment to mental health, emphasising early intervention and community support. Following this, the Community Mental Health Masterplan further expanded our reach, bringing mental health services closer to the community and underscoring the importance of a more inclusive approach.

This brings us to the latest newly introduced strategy, which builds upon the successes and learnings of the past, further emphasising the whole-of-society participation while introducing comprehensive and innovative approaches to address current challenges such as digital well-being, workplace mental health and the mental health of our youths.

But how does this strategy compare with other countries? Countries like Australia, Canada and the UK have also developed comprehensive mental health strategies. Australia's strategy is a community-focused approach. Canada takes on an indigenous-centred approach and the UK adopts a tiered approach. Singapore combines these insights with specific strategies suited to its diverse population. Our strategy emphasises preventive care and integrates mental health services into the community.

Sir, at this juncture, I would like to highlight that the task force's commitment to mental health is evident in the strategy it has laid out. It is the product of the hard work of many agencies, mental health advocates and volunteer organisations. Their efforts deserve our recognition and support. Mr Speaker, understanding mental health as a multifaceted issue is pivotal. It is not just a medical concern, but it also significantly impacts our social fabric and economic stability.

According to the World Health Organization (WHO), depression and anxiety alone cost the global economy $1 trillion per year in lost productivity. In Singapore, a recent Duke-NUS Medical School study found that the economic cost of anxiety and depression is significant, amounting to $15.7 billion annually due to lost productivity and healthcare expenditure.

Mental health issues have a profound impact on our social ecosystem too. They influence the dynamics of interpersonal relationships and can be a source of considerable stress, leading to burnout and social isolation.

Sir, it is a ripple effect. When an individual struggles with mental health issues, those around them and their loved ones often bear a significant emotional and physical burden. For example, I recently shared with the media a phase when my wife went through post-natal depression. It was slightly prolonged, and it was not easy for me to see to my better half struggling; so too were the kids. It was difficult for me to see my kids having to put a strong front in front of their mother. I was often worried how it might affect them.

In workplaces, an employee's untreated depression can lead to decreased productivity and morale, impacting team dynamics and overall organisational health. Within our communities, the social isolation experienced by those with mental health issues can diminish the sense of belonging and support, which is a vital core for a cohesive society.

Sir, the economic and social impact of mental health issues underlines the necessity of a robust mental health ecosystem. A robust ecosystem is not just about treating mental illness. It is also about fostering overall mental well-being at every level of the society.

To achieve this, the Government outlined three strategic shifts in the strategy. First, a community-based strategy; second, empowering individuals with knowledge; and third, fostering inter-disciplinary collaboration.

Allow me to elaborate with an anecdote. Some time back, I encountered a youth struggling silently with anxiety. Sara, not her real name, is a bright student, but her performance started to decline. It began with coming late to class. Then, she missed classes, sometimes with medical leave, sometimes without. She struggled to submit her assignments and soon, isolated himself.

Recognising the signs, her peers and I reached out. And after many, many tries, she agreed to meet the school counsellor who, after a long period, eventually referred her to the Institute of Mental Health (IMH). This intervention marked a turning point for her, and she gradually learned to manage her anxiety.

Sara's struggle, her journey of silence, is difficult. But she received the support she needed and that underscores the importance of early intervention and comprehensive mental healthcare. Her experience not only highlights the challenges faced by individuals grappling with mental health issues but also illuminates the path through which they can find hope and healing.

As we pivot to examining the strategic shifts in mental health support, Sara's story serves as a poignant reminder of why these shifts are necessary.

The three strategic shifts, in tandem, will allow the strategy to not only catch individuals like Sara earlier in their journey but also ensure that every step towards recovery is supported by a cohesive network of care and understanding.

Mr Speaker, over the last three years, it has been my privilege to engage with a diverse group of mental health advocates, stakeholders and individuals from various walks of life, from podcasts to workshops and through campaigns like #452TooMany and #BetterTogether, as well as extensive community dialogues.

I am grateful for the invaluable insights gained, bringing forth a spectrum of concerns and suggestions.

Concerns raised ranged from the high costs and long waiting times for mental health services to challenges in insurance coverage for those with mental health conditions. The lack of mental health professionals was also highlighted. Workplace discrimination emerged as a poignant theme, with individuals expressing fears about being sidelined or overlooked for promotions due to their mental health conditions.

Within the education setting, through the Singapore Teachers' Union that I am a part of, there was also feedback for more para-educators and school counsellors to support the students and simultaneously lighten the load of teachers who may have find the administrative aspects of counselling quite a bit on their plate. I believe we can do more to support teachers in doing what they do best: caring for, planning and executing the best lessons for their students.

The issue of parental consent for minors seeking mental health services has emerged as a significant barrier too, especially when parents might not fully grasp the critical nature of mental health support or may be hesitant to seek help.

Our concerns related to the strategies is as follows – the role and functions of the Mental Health Office, with many debating which Ministry it should be positioned under. However, I do believe that the current set-up is appropriate, but we should empower them in two areas.

Firstly, on the four-tiered system where there is a need for more apparent referral paths and guidelines to ensure that those in the lower tiers are not overwhelmed and are adequately prepared for transitions. The Office can co-create a comprehensive scenario guide with stakeholders.

Secondly, conversations have led to questions about the oversight and accreditation of training within the different mental health tiers. Could the Office look into and ensure the quality of these programmes and certify the volunteers and professionals within?

Sir, I must admit that I have a very, very long list. However, I firmly believe that today's debate should not simply be about putting up a laundry list. It is about putting forth sensible suggestions to address concerns.

As I penned my suggestions, I ended up with an acronym, similar into my first Adjournment Motion in 2020. If you recall, it was called "LAST". And although I promised it would be the last, the acronym remains relevant in today's Motion, albeit with slight tweaks.

First, "L" for literacy. Mental health literacy is about recognising that it is okay to reach out. It is about seeing a friend's withdrawal not as coldness but as a cry for help and feeling confident to offer a hand. It is about parents understanding their child's silence is not just a phase.

I envision mental health literacy as a catalyst, a catalyst that unites us, fostering empathy and guiding us in how to be there for each other in times of need. To that end, mental health literacy must be viewed not only as knowledge about mental disorders and their risk factors but also as a construct that promotes positive mental well-being. Furthermore, mental health literacy cannot be limited to children, adolescents and young adults only. Our efforts must be made to extend literacy programmes to adults and the elderly too.

Sir, the strategy focusing on enhancing mental health literacy is commendable, particularly the development of a supportive "toolbox" to better support parents in helping to manage their children's mental health. But, like any other toolbox, it cannot be more than a mere collection of resources. It needs to be an integrated part of everyday life. It cannot also be just another "first aid box" – you bring it out in moments of crisis.

Thus, this toolbox should be complemented with workshops and interactive sessions, showing parents not only how to use these tools but also how to approach their children with empathy and support, ensuring that the toolbox becomes a bridge to stronger family connections. My suggestion is to work with existing networks like the Ministry of Education's (MOE) COMmunity and Parents in Support of Schools (COMPASS), which can amplify efforts, leveraging their engagement with the school-home-community triangle.

Beyond formal education settings, there is a need for varied and engaging programmes to complement mental health literacy efforts. In October last year, M³@Jalan Besar and the Health Promotion Board (HPB) conducted a Mental Wellness programme named "Cinta Minda", loosely translated as "loving your mind". Participants were engaged in an interactive theatre performance and critique a short film. What happened was a lively sparkling discussion on approaches to mental health challenges.

Sir, we need to continually find ways to disseminate educational content engagingly. Tailoring these educational efforts to suit diverse community needs and cultural contexts is key to complement mental health literacy efforts.

Next, "A" for accessibility. As we move towards a more community-based approach, we should explore expanding and nurturing t e number of access points, specifically, in shared safe spaces. These spaces foster connections through shared interests. It can be gardening, sports, or the arts, which can significantly affect our mental well-being.

Last year, I attended "Prompting Feelings," an innovative artificial intelligence (AI)-powered art exhibition, a collaboration between the Singapore Association for Mental Health (SAMH) and R/GA, a creative agency. It featured eight artists sharing their journeys with mental health disorders through AI-generated artworks, bending technology with human emotions to provoke conversations and understanding around mental health.

Most recently, I visited Thought Partner Studio, a vibrant example of how art can be a therapeutic medium, bringing people together in co-working spaces. Such initiatives highlight the importance of accessible, shared environments where communal activities based on shared interests can contribute positively to mental health. These are not just places. They are catalysts where connections deepen, understanding blossoms and support networks flourish, where everyone find sense of belonging.

Next, "S" for screening. I am grateful that the strategy emphasises screening, especially for expecting mothers. To that end, I reiterate the need to treat mental health screenings just as how we would treat physical health screenings. Similar to how physical screenings identify health issues and guide targeted interventions, mental health screenings can also offer insights into our mental well-being, paving the way for informed steps towards improvement.

I remember over a year ago, when my doctor advised me to lose some weight and get more active, I went all out to achieve the desired health targets. I came back to him 13 kilogrammes lighter and he was a bit too shocked. This can be similarly replicated for mental health. If I know that my happiness index is low – by the way, there is no such thing as a happiness index – I will try my best, so that by the next screening when I see my doctor, that number will improve.

Just like our physical health, we will make strides to ensure that our mental health is well looked after.

Enhancing our approach to mental health begins with early and accessible screenings, integrating them into the educational and workplace environments. In line with the Healthier SG initiative, which already promotes physical health screenings, I propose an innovative, buy-one-get-one-free concept; for every physical health screening, you get a free mental health check.

This dual approach not only emphasises the equal importance of mental health and physical health but also offers a practical win-win solution for early detection and intervention.

Next, "T" for time-outs. In my previous speeches, I emphasised the critical importance of mental health breaks, or "time-outs". These are essential in managing stress and preventing burnout.

And I mentioned burnout extensively in my maiden speech. Most recently, Liverpool Football Club manager, Jurgen Klopp, cited being burnt out and opted to take a break and everyone, opposition teams especially, embraced it. It shows that people know what burnout means. It is physical and psychological impact and the poignant fact is that no one is immune to it. Thus, allowing time-outs without stigma must be the way forward for us.

Creating a culture where it is acceptable to take a moment for mental well-being can make a significant difference in the schools and workplaces. It is about recognising and respecting our mental health needs as much as our physical health needs.

If I can use Sara’s example again as a context, she can take a mental health time-out anytime during the semester. We can even allow her to take it twice. However, if she takes it the third time, her case would automatically be flagged and a counsellor automatically must intervene.

It is a way to encourage students like Sara to acknowledge their struggles without fear of judgement, ensuring that they are not alone. This blend of empowerment and care creates an environment where students or workers feel seen and supported, fostering a culture of understanding and early intervention.

Mr Speaker, I want to introduce a new letter to the acronym – another "S", which now extends the acronym to "LASTS", and I hope our commitment to advancing mental health lasts forever.

The final "S" refers to spiritual health, another component of the seven health dimensions. Spiritual health transcends religious practices. It is about cultivating inner peace and a sense of purpose, values and connection, regardless of one's faith and belief system. In nurturing this dimension, we embrace practices that foster a sense of meaning and resilience, crucial aspects of self-coping mechanisms in our holistic approach to mental health.

Spiritual health is not to be conflated with religious faith, even if it could encompass it. Spiritual health emerged in many conversations with the community, especially the Indian and Malay/Muslim communities and engagement sessions with the young people too. Just two weeks ago, at a young PAP annual mental health dialogue, a young lady shared her five "F"s for good mental health.

What are the five "F"s? Family, Friends, Fitness, which is also health, Finances and Faith. I could not agree more.

Faith is a positive force for society. Faith has shown to be a strong societal pillar and we have seen this during the COVID-19 pandemic. Singaporeans drew strength from their diverse faiths and demonstrated remarkable unity and compassion, embodying the universal principle of neighbourly care found across religions.

Given the intertwined nature of community and religious life in Singapore, religious organisations have a unique opportunity to serve as platforms to advance our mental health efforts. By doing so, they can offer support, foster understanding and promote well-being within their communities, further illustrating faith's positive role in societal health and resilience.

Sir, I hope that this broader understanding of spiritual health will enrich our strategy, ensuring it caters to the diverse needs of our society more holistically as we move towards a community-centric, beyond the medical approach. Mr Speaker, in Malay, please.

(In Malay): [Please refer to Vernacular Speech.] Sir, in my interactions with community leaders, including religious teachers through PERGAS, they spoke about the erroneous views that still persist about mental health issues. The perception that spirituality is the only solution to mental health issues was often highlighted.

Most of the time, individuals who face mental health issues are accused of lacking in piety or not performing their prayers enough. Such views not only blame the ones who need help, but it also aggravates their mental health condition.

In addition, some people feel that individuals who suffer from mental health issues are actually being possessed by spirits and need religious intervention to get better. This can give rise to stigma and fear in the community, causing individuals who need professional help to instead face stress and isolation.

I recognise that in order to understand and treat mental health issues effectively, we do not need to separate spiritual issues from medical and professional therapy. While spirituality can form one aspect of support, it cannot be the only solution for complex mental health issues. To me, both are equally important and, in fact, both methods should be employed. Most importantly, treatment must be prompt.

We should also focus on raising awareness about mental health because it is our responsibility to eradicate any stigma associated with mental health issues and provide appropriate support for individuals who need help. It is my hope that we can build a more caring society that is prepared to help individuals who suffer from mental health issues without judging them.

(In English): Mr Speaker, in lieu of this being a Mental Health Motion, I took note of the time and made sure that I kept my speech short. I also want to give our many Members the chance to share their concerns from the community.

Before I conclude, I would like to take this opportunity to thank those who have engaged us and supported our efforts in mental health within the community. For me, it was Dr Jonathan Kuek and Total Wellness Initiative as well as Sabrina Ooi and Calm Collective, who form part of the Jalan Besar Mental Wellness Network. Likewise, organisations like Samaritans of Singapore (SOS), Singapore Association for Mental Health, Mental Act, Mental Health Film Festival, Club Heal, PERGAS and Silver Ribbon Singapore share the same passion and aspirations for advancing mental health in Singapore. There are many others and I apologise if I missed them out.

I want to emphasise our collective responsibility in advancing mental health in Singapore. This journey is not for the Government alone but for every segment of our society. Our schools and Institutes of Higher Learning are crucial in nurturing a supportive environment for our youth, integrating mental health literacy into their curriculum and providing adequate counselling resources.

Employers and workplaces must create cultures where mental health is prioritised and where employees feel safe to discuss their mental and well-being, and seek necessary support. Community organisations, including religious groups, have the unique capacity to offer support networks and foster a sense of belonging and purpose, which is crucial for our nation's mental resilience.

Finally, every individual. Every individual must be empowered and encouraged to take charge of their mental health, seek help when needed and support those around them. As we move forward with this strategy, remember, no strategy is perfect. What is important is that we remain committed to refining our approach, ensuring it remains relevant and practical.

In a recent dialogue session, I was asked about my aspirations for mental health in Singapore, and my answer is simple – it is about nurturing a resilient community that cares for one another, where anyone who needs help is able to get it without stigma and fear.

Together, let us build a nation where mental health is not just an aspiration, but a reality for all. I look forward to the speeches from the rest. [Applause.]

Mr Speaker: Thank you, Dr Wan Rizal, and also for your understanding. You kept well within the time limit that you were given. Coincidentally, last Sunday, I attended the 18th anniversary of Silver Ribbon, which was set up to combat the mental health stigma through better literacy.

Question proposed.

Mr Speaker: Ms He Ting Ru.

2.51 pm

Ms He Ting Ru (Sengkang): Mr Speaker, today, many would rightly acknowledge the work done in improving access to treatments and interventions for those suffering from poor mental health and the breaking down of stigma. I also note that many officeholders, including the Deputy Prime Minister, are slated to speak and this is attention long overdue.

However, today I wish to focus my speech to call for a more holistic and well-rounded approach to mental health, which looks beyond lifting people out of situations of poor mental health. I will speak on three broad areas: first, a call for a thriving and flourishing society to be built into policy formulation as an objective; second, for institutions and agencies to include and accurately promote good nutrition as part of our national mental health and well-being strategy; and third, for the promotion of structural barriers to mental health support and therapy.

When we look at the larger picture, mental health is a fundamental part of our overall health. Globally, WHO has indicated that depression is one of the leading causes of disability and noted that people with severe mental health conditions die as much as two decades early due to preventable physical conditions.

One hundred and ninety-four member states, including Singapore, have signed up to the WHO Comprehensive Mental Health Action Plan 2013-2030, which commits us to meet global targets for transforming mental health. The plan is wide-ranging and includes ensuring that member states strengthen information systems, evidence and research for mental health to better understand the needs of the local population, ensuring that data is disaggregated by sex and age, and reflects the diverse needs of sub-populations.

It calls for early intervention through evidence-based psychosocial and non-farmacological interventions based in the community, avoiding institutionalisation and medicalisation.

While many of these are points echoed in the national health and mental health and well-being strategy as well as in the Government's recently announced push for more community-located delivery of mental health services, I hope that we can also take inspiration from the ethos behind the WHO plan which, I think, is summarised best in the WHO's Constitution itself, and I quote, "Health, is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity."

Many of us know instinctively that this definition makes sense and should be what we aim towards as a society. Mental and social well-being does not mean just the absence or suppression of depression psychosis or any other mental health condition. What we need to consider, as part of today's debate on mental health, is to look beyond decreasing rates of mental ill-health and to discuss how to elevate well-being.

Having a thriving society has to stem from a study of how we can facilitate human flourishing. It is about, in the words of Liber Marskey, growing the seeds rather than removing the weeds.

I do not mean this replaces the importance and hard work undertaken by psychologists, psychiatrists, therapists and other workers and volunteers in the mental health sector who spent so much of their life working to tackle challenges brought about by mental illness and neurodiversity. It is, without doubt, that we are in a much better position today to understand, reliably diagnose and provide the necessary support, medication and treatment, for those suffering from various neuropsychiatric conditions.

Workers' Party MPs have, previously, called on the Government to ensure those in the mental health sector are supported in their work, for instance, by providing sufficient staffing and by facilitating financial support for those seeking the qualifications to become a counsellor.

That said, we should not rely solely on the disease model that has dominated psychology since the second world war. Instead of asking, solely, how can we make miserable people less miserable, I would like us to also ask, "What is right with you?"

Research in the last two decades has given us a better understanding of how we can measure and apply concepts of engagement, meaning and accomplishments in achieving well-being for individuals, organisations and societies, and that these areas are clear means by which we can improve well-being. In short, how can we go from ill-mental health to promote maximum flourishing?

This is not just about positive thinking or even toxic positivity but, instead, it is about figuring out how we can support our citizens in their journey to become the best versions of themselves. The research shows that understanding and ultimately playing to our strengths, has the added advantage of helping us face adversity in a way that does not breakdown our well-being. It is why we end up finding that people can still thrive in conditions of severe deprivation or conflict.

We need to entrench ideas of harnessing our strengths as individuals and as a society and use our own unique strengths as a solid foundation to build our future path forward. We can start this by helping our people understand what their own strengths are.

The strengths-based approach is already being undertaken in the social work sphere, and I believe that the experience the Ministry of Social and Family Development (MSF) has here could inform more opportunities for Government agencies and institutions to be able to apply this approach to other areas of policy.

As policymakers and political leaders, we should not look to the lowest common denominator and perpetuate an environment, which takes away the factors that people need to flourish. Aside from strengths, meaning, accomplishment and gratitude, another area which promotes well-being, is to identify an up-to-date common set of values as a nation which we embody.

To support this expanded approach to mental health, we should consider findings from existing longitudinal research on well-being. Assoc Prof Siok Kuan Tambyah and other researchers, repeated their Quality of Life survey in Singapore in 2022 and found significant decline in Singaporean's satisfaction of life between 2016 and 2022, and a drop in overall well-being between 2011 and 2022.

The authors also note that Singaporeans have, and I quote, "...become less happy, enjoyed life less and, have felt a decreased sense of achievement. They also felt that they did not have control over their lives and a sense of purpose."

An interesting observation from this research is also the positive correlation between Singaporeans' satisfaction, with five out of six recognised democratic rights, and their overall satisfaction with life. The findings further indicated a decline in satisfaction of democratic rights across the years in 2011, 2016 and 2022. The authors also note that more in-depth research is required to determine specific concerns and to implement initiatives to better engage the citizenry and, I believe, that this is worth looking further into.

Presently, there are also ongoing studies that dwell into the allocation of financial resources within Singaporean families toward the families' well-being. These findings will be instructive, particularly in an environment marked by stresses associated with resource scarcity, in the wake of cost-of-living and climate-related concerns. Such studies may also prove to be pivotal in shaping our national policies spanning, economic, housing, health and social domains, all of which are aimed at fostering a holistic advancement of overall well-being. We can leverage such findings to set the trajectory of our policies to better support Singaporean families.

The research initiatives I mentioned above also dovetail nicely with WHO recommendations to ensure that high-quality research and data are available to specific societies and populations, so that we better understand the driving factors that enable Singaporean families to flourish.

We also have to consider high-quality research in areas such as positive physical health. Studies in the US and Europe have found that patients with more optimism suffer from statistically significant lower rates of cardiovascular disease and decreased mortality rates. While the effects are comparatively smaller for other diseases such as infectious illness and cancer, they remain noteworthy.

At the moment, I am not aware of similar research being done in Singapore to explore the potential correlation between traits such as optimism and improved physical health. If the findings are replicated here, this would further reinforce the call to delve deeper into understanding how to enable our citizens to flourish beyond just being free from physical and mental health pathologies, but also to flourish in all aspects of their well-being.

Next, no discussion about enhancing and protecting mental health in a holistic manner can be done without mentioning our diet and lifestyle. The emerging field of research about the effect that our everyday diet has on our well-being and mood is one that has much to offer. For example, some studies have found that individuals on traditional Mediterranean and Japanese diets – which are high in vegetables, fruits, unprocessed grains, fermented foods, fish and seafood – experience a significant reduction in the risk of depression, ranging between 25% and 35%. Conversely, it has also been found that a diet that is high in refined sugars correlates to impaired brain function.

It would be a shame if we do not seriously consider the scientific evidence surrounding foods that support good mental health and implement policies that make it easier to ensure that our diets complement and support our brains. The field of nutritional psychiatry is an emerging one. Nevertheless, I hope that we can use our education and public health systems to include ways in which we can facilitate incorporating eating for a healthy brain into our everyday life. This means eating more varieties of vegetables, fruits and less processed foods, as well as ensuring that we have adequate intake of healthy fats and fibre, all of which also promote good physical health.

We can begin by intensifying efforts to amplify and update existing healthy eating initiatives. The existing Healthy Dining Programme should emphasise clearly that healthy eating goes far beyond just merely counting calories. Aside from eating to reduce chronic illnesses such as diabetes and cardiovascular diseases, it should also consider the importance of consuming a variety of food types to promote maximal healthy brain function. Steps to increase awareness of and to reduce our consumption of refined sugars – which are bad for both our physical and mental health in the long-run – through the introduction of the Nutri-Grade sugar level labelling laws are a good start. We should also explore the possibility of heeding WHO’s calls to implement an effective sugar tax that is equitable and does not punish those on lower incomes.

As the affordability of healthier food options remains a barrier to achieving healthy dietary practices, we must increase accessibility to healthier and more nutritious foods to as wide a segment of the population as possible. In a fast-paced society with escalating concerns about the ever-rising costs of living, the prospect of incorporating whole foods, often more expensive than readily available highly processed options, adds another layer of concern. With a global surge in food prices, it is the lower-income groups with the least resources that would face greater barriers to healthier food options.

The costs – both financial and also time costs – associated with eating healthily have to be mitigated further, to ensure that the ability to eat for a healthy brain is not one which is exclusive to those with greater economic means.

One way to achieve affordability and accessibility of healthier food choices is to ensure that our Government policies really lean into supporting the promotion of healthy diets. For example, in our drive to reach "30 by 30" for food sufficiency, we need to ensure that the bulk of the home-produced food would meet nutritional criteria. The WHO has indicated that countries can stimulate the supply of nutritious food by creating large-scale predictable demand and making production and procurement of such foods more economically viable, and I believe that changes to our policies can be made to accommodate these aims.

Other areas which are promising and should be given more attention include supporting research which is specific to our geography and population, especially as it appears that we do have unique biological responses to certain foods.

I spoke during last year’s Committee of Supply (COS) about the work being done by local enterprise, AMILI, to better understand the gut microbiome in local populations. Given the gut-brain axis links the emotional and cognitive centres of the brain with peripheral intestinal functions, we should continue to pursue research in this area to better understand our own population’s needs and which foods would best support mental health and well-being, and to harness newer technologies such as artificial intelligence to bring down the costs associated with tailoring healthy food choices to specific sub-groups in the population.

Employers, too, in their drive to support employee well-being, should consider ways in which to encourage healthy and mindful eating. Small initiatives such as offering fruit and nut instead of sugary snacks and biscuits in the office pantry, providing more accessible storage and food preparation areas, providing access to water in more places and having regular healthy eating weeks or events to help employees understand how to incorporate eating for a healthy mind and body into their daily lives can go a long way.

Lastly, to further enhance mental health support and break down the social stigma, we can do more to continue removing barriers to mental health support and therapy.

In respect of the upcoming guidelines for insurers to adopt fair and responsible practices towards persons with disabilities and those with mental health conditions, our regulators should ensure that guidelines prohibit insurers from declining applications on the basis of their disabilities or mental health conditions. Any differential treatment of persons with disabilities and mental health conditions should also be justified by accurate and relevant actuarial or statistical data, and there should be a mechanism by which insurers justify this. Insurers should also be required to make transparent their grounds for differential treatment or rejection of applications from persons with disabilities or mental health conditions. This will go a long way in ensuring that no one gets left behind.

The current lack of regulation of mental health workers is another area which warrants more attention. While it is undoubtedly the case that there are many dedicated and committed workers in the mental health space that are doing amazing work in raising the well-being of our society, we have to move beyond providing guidance on professional and ethical conduct for psychologists, counsellors and therapists. Setting up a regulating body with input from bodies, such as the Singapore Association for Counselling and Singapore Psychological Society, will ensure a universal standard of care and quality of care in the provision of such services to support mental health, and to ensure that there is at least a baseline level of training, expertise and ethical practice that underline the provision of such services. We should also look to establish safeguards, such as requiring those who work with children to be subject to mandatory background checks, for the protection of vulnerable minors.

Finally, I would like to reiterate a call made in my Cost of Living speech last November. I hope that the Government would consider allowing the use of MediSave to access mental health services in other practice settings aside from purely psychiatric settings, particularly in the private sector. It would not be a big step to use our 3Ms framework to better improve access to mental health treatments and interventions, as MediSave is already being approved for use for mental health services at places like IMH and polyclinics.

To close, although we have experienced headwinds in recent years and are rightly focusing on how to support increasing incidences of poor mental health, it would be remiss of us to not look more holistically at how to increase well-being. We have to build on research about how positive interventions at the personal, community and policy level can have a protective factor through challenging times, and also to look at how our nutrition can better support us in our quest for good mental health. All of us have a role to play in working to improve our own well-being, and given that happiness spreads more easily than depression, the hope is that increased well-being can continue to ripple and spread to the wider community, so as to increase flourishing for all. With that, I support the Motion.

Mr Speaker: Dr Tan Wu Meng.

3.09 pm

Dr Tan Wu Meng (Jurong): Mr Speaker, I declare that I am a medical doctor working at a public hospital and I have worked in the private sector before.

I stand in support of the Motion in the name of Dr Wan Rizal, my Parliamentary colleague. Today, I will speak on insurance and, in particular, I direct my questions to the Ministers-in-charge of the Monetary Authority of Singapore (MAS) as well as the Minister for Health.

May I start by drawing the Ministries' attention to the National Mental Health and Well-Being Strategy 2023? I read through it, 49 pages. In the entire report, the word "insurance" appears just once in a footnote on page 28. Yet, insurance today is an integral part of the healthcare landscape. It helps pool risk and safeguard Singaporeans from catastrophic bills arising from catastrophic unexpected illness. In the public healthcare system, we have MediShield Life under the Ministry of Health (MOH).

But in addition to MediShield Life, many Singaporeans purchase health insurance from the private sector too – Integrated Shield Plans, critical illness cover, life insurance and other forms of general insurance – hoping to attain peace of mind and support for their families should the unforeseen or unimaginable happen. So, it is a serious matter when a fellow Singaporean is worried about being denied insurance coverage or worried about being at the receiving end of an unreasonable or disproportionate decision by their insurer.

Last year, on 19 September 2023, I raised a Parliamentary Question to the Minister for Health on what happens when young Singaporeans encounter stigma from insurers or are declined insurance coverage because of a mental health condition.

This question arose partly from a The Straits Times Forum letter earlier that year – dated 18 July 2023 – where a worried parent, Tan Hui In, shared about how their teenage daughter was turned away by two large insurance companies because of a mental health diagnosis. She could not get coverage for hospitalisation or critical illness, not even for non-pre-existing conditions unrelated to mental health.

I have young Clementi residents who follow these issues and are concerned as well. Some are going through a tough time and want to seek help. But sometimes these young Clementi friends also asked themselves, "What if they are subsequently labelled with a mental health diagnosis and thereafter cannot get insurance from a commercial insurance company?"

Even if the actual number is not large, the effect, the sense of fear and anxiety about whether one might someday be denied insurance upon being labelled with the diagnoses, that fear extends beyond the number of persons who are actually affected and denied coverage.

And so, I put it to the Government and I put it to the Ministers, that all the efforts in the plan, all the efforts to increase subsidy for mental health care, in the mental health care ecosystem, all the efforts to improve access at multiple levels in the community and through various intermediaries, all the efforts to make workplaces more inclusive and more fair to persons with mental health conditions, I put it to the Government that we risk these policies and proposals not coming to their full potential or possibly even being undermined, as long as this issue of the private insurance market is not addressed.

I raised broader issues of insurance coverage 11 years ago, in 2013, in an op-ed piece in The Straits Times. And I would just like to revisit some of what I said. As I said 11 years ago, in a well-functioning market of insurance providers and potential clients, an efficient outcome would be for the applicant's additional risk to be appropriately priced in through a higher premium.

But what we see instead is, even if someone has that additional risk from the pre-existing condition, the insurance company, more often than not, according to my residents, regards them as someone they would not want to insure at all. In short, instead of a slope of additional premiums based on incremental risks, there is a cliff which people fall off when they are left out from the private insurance market.

Yes, indeed, there is MediShield Life in our public care system but, as the Minister for Health pointed out yesterday in response to my PQ on the private healthcare sector, the Minister for Health himself has acknowledged there is an important role for private healthcare ecosystems and that presumably includes the role of commercial insurance in the private sector in addition to the MediShield Life framework.

I also mentioned previously that with modern computational methods – 21st century mathematics, in short; it is not completely rocket science – it should not be too difficult for insurers to estimate and calculate the right price for the additional risk. But, again, we see perverse outcomes, and I think many Members in this House will have observed this with your own residents where that incremental increase in risk leads to a total denial of insurability from that insurance firm.

Sir, this is one area of market failure where regulators can step in. While insurance in general is a business, the commercial health insurance market can and should serve a public good.

As I said during the 2020 debate on the President's Address, when the invisible hand of the market becomes unbalanced, sometimes we need the visible hand of the regulator to attain the appropriate outcome for our people, in this case, to make sure that insurance companies make decisions which are reasonable and proportionate.

So, I call upon this Government to get MAS on board, look at improvements and reforms to the insurance sector, especially for young Singaporeans who may be facing mental health and mental wellness concerns and young Singaporeans who may then be labelled with a diagnosis, with their whole life ahead of them.

Because, Mr Speaker, as I have said before in this House, healthcare is about all our lives – your life and mine. The lives of our loved ones. The life of every Singaporean. And therefore, it is a serious matter when a young Singaporean runs the risk of not being able to get insurance coverage for life. And let us all remember, it could happen to anyone of us, or any one of our loved ones. I stand in support of the Motion.

Mr Speaker: Ms Hazel Poa.

3.16 pm

Ms Hazel Poa (Non-Constituency Member): Mr Speaker, Sir, mental health issues are not only a personal struggle, it is also a challenge to the whole society that demands our collective attention and concerted efforts. It is heartening that the Government has published a National Mental Health and Well-Being Strategy, outlining comprehensive moves to tackle this challenge from multiple angles.

I support the measures proposed in the paper and would like to make a few additional suggestions and seek some clarifications.

Mental health disorders have been rising over the years to become one of the most common illnesses. Has there been a study to examine what are the possible causes or the common risk factors? If causal effects cannot be determined, can we identify the risk factors that are common in many of the mental health cases? For example, do many of the patients come from dysfunctional families or perhaps parents with a history of mental health issues? Are the cases correlated to socioeconomic status or poor performance in work or school? Do patients have a supportive environment in terms of family members, friends, teachers, bosses or colleagues? If we are able to identify the highest risk factors, it can guide us on where we should focus our efforts.

If such a study has been done, can MOH share the results? If not, would MOH consider doing one?

Pre-COVID-19, post-natal depression affected one in 14 women, while pre-natal depression affected one in eight women. It is critical that we improve our capacity to care for, treat and support women going through pre- and post-natal depression and anxiety as we make efforts to increase our birth rate. Owing to concerns over the rise in the number of pregnant women or new mothers with depression, KK Women's and Children's Hospital (KKH) has introduced depression screening for all pregnant women since early last year. Can MOH update us on how effective this measure has been and whether there are plans to expand this to all hospitals and clinics including private ones?

In hospitals, patients' historical medical records are at the fingertips of the doctors in charge as these contain critical information for medical decisions. For patients with mental health disorders, are their mental health conditions and history also similarly available to the doctors? Often, doctors need to brief patients on the possible side effects of certain treatments or the risks of surgery or present difficult choices for the patient to make. Patients with mental health issues may not be able to handle such information or choices. If doctors have access to mental health information as well it can help them better know how to handle communication with the patients.

Mr Speaker, I would next like to turn our attention to the youths. Recently, the teenager who killed a River Valley High School student was sentenced to 16 years' imprisonment for his actions. We have learnt through the trial proceedings that his major depressive disorder was one of three major factors that contributed to the killing. This underscores the urgency of prioritising the mental well-being of our students.

During the Parliamentary Sitting on 27 July 2021, after this tragic incident, I urged the Minister for Education to consider implementing measures to monitor our students' mental well-being regularly and systematically, similar to the way we monitor their academic achievements and physical fitness every year.

Today, I would like to reiterate this call. This can be in the form of questionnaires that measure stress level, anxiety and depression. Similar tools have also been developed in MindSG and Mindline, which allow users to do self-assessments on their own stress levels and mental health risks. These tools, however, rely on the users themselves taking the initiative. The students who most need help may not take this initiative. Conducting a mental health assessment each year using developed tools will help us identify students who need help and proactively reach out to them so that we can prevent such a tragic incident from happening again.

In his Ministerial Statement, the Minister stated that the Ministry of Education (MOE) will strengthen the support network in our schools and ensure that all teachers will receive enhanced professional development on mental health literacy as a baseline. I would like to ask the Minister for an update on the progress and whether all teachers have received adequate training on mental health literacy?

The Minister also said that MOE aims to deploy more than 1,000 teacher-counsellors in the next few years. Could I ask how many teacher-counsellors are deployed in schools as of today and what is the counsellor-student ratio? What percentage of schools have two or more school counsellors? Do larger schools have enough counsellors to serve the entire school population? These are crucial metrics that define the effectiveness of mental health support in our educational institutions and should be tracked as part of our national mental health strategy.

Specifically for the students and teachers of River Valley High School who were involved in the tragic incident, I would like to ask the Minister what support had been provided to them over the past few years to monitor their mental well-being and assist them in getting over the incident? Are they still coping well within our education system or has anyone fallen out of the system? How many teacher-counsellors are deployed in River Valley High School today?

In my conversations with people with mental health conditions, one of the biggest concerns is jobs – finding a job and keeping it. Both job seekers and employees have reported an increase in discrimination due to mental health conditions. Would the Government consider some form of wage subsidy for employers who recruit staff with mental health conditions, similar to the way we used subsidies to encourage employers to employ older workers in the past? Hopefully, such a subsidy can compensate for the discrimination.

Another way is to encourage the option of four-day work week for employees with mental health conditions to reduce their stress levels and make working more manageable and sustainable. This can come with a pro-rated pay, just like other part-time employees.

Mr Speaker, in closing, I would like to speak about the importance of being kind. When we were going through very tough times together during the COVID-19 pandemic, we saw many acts of kindness towards one another in the community. People gave out free masks, opened their homes to Malaysian workers who were stranded in Singapore after the Movement Control Order shut down the Causeway and made special efforts to support food and beverage (F&B) businesses that were suffering.

A few weeks ago, my father had a stroke when he was out alone. He was unable to use his handphone to contact us. Fortunately, a student, who was nearby, came to his assistance. She contacted our family and shared her location with me. With that location, I was able to inform the Singapore Civil Defence Force (SCDF) and the ambulance reached the scene in 10 minutes! To the SCDF officers involved, I wish to thank you for being so excellent at your job. The student continued to stay with my father until the ambulance came, which is a great comfort to us when we could not be there. Her kindness is much appreciated by my family. I am grateful for all the people who shine like silver when the clouds are dark.

I hope that as memories of the pandemic recede, we will not forget to continue to be gracious, kind and empathetic to the people around us, especially those who may be facing difficulties in their lives. This will go a long way towards improving the collective mental health of our society. In Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] Recently, a teenager who killed a student from River Valley High School was sentenced to 16 years in prison. During the trial, we learnt that his major depressive disorder was one of the contributing factors of the murder. I once again urged the Minister of Education to regularly monitor the mental health of students, just as we monitor their academic performance and physical health every year. This will help us proactively reach out to students in need and prevent such tragedies from happening again.

In my conversations with individuals suffering from mental illness, I have found that employment is one of their biggest concerns. In recent years, there have been signs of increasing discrimination against individuals with mental health conditions. Could the Government consider providing wage subsidy to employers to encourage them to hire individuals with mental illness?

Mr Speaker, finally, I would like to talk about the importance of kindness. During the pandemic, we have seen many acts of kindness. People gave out masks for free, opened their homes to Malaysian workers stranded in Singapore and made special efforts to support the struggling F&B industry.

A few weeks ago, my father had a stroke while he was out alone. He was unable to use his phone to contact us. Fortunately, he received help from a nearby female student. She contacted our family and shared her location with me, allowing me to inform the SCDF. The ambulance arrived at the scene within 10 minutes! I want to express my gratitude to the SCDF for their excellent response. And the student continued to accompany my father until the ambulance arrived. I would like to thank her for her kindness.

I hope that even as the pandemic gradually becomes a thing of the past, we will continue to show kindness and compassion to those around us, especially those facing difficulties in life. This will help to improve the collective mental health of our society.

(In English): Mr Speaker, the Progress Singapore Party supports the Motion. Our collective commitment to the mental well-being of our citizens will define us as a compassionate and progressive society.

Mr Speaker: I am glad that your father is well now. Mr Yip Hon Weng.

3.29 pm

Mr Yip Hon Weng (Yio Chu Kang): Mr. Speaker, Sir, mental health is a globally complex issue. It often remains unseen and hidden beneath societal stigmas, especially in the context of Singapore and Asian cultures.

A specific challenge lies in individuals' struggles to seek help. While the report rightly identifies the need for more accessible services, I want to draw attention to a demographic needing specific focus – the mental well-being of our seniors. Why focus on our seniors?

Singapore is moving towards a super-aged society, with smaller family sizes becoming the norm. Our high-stress, high-cost living environment sets the stage for concerns like social isolation, loneliness and dementia among our seniors. A 2022 CNA commentary highlighted the rising number of senior suicides. There is a 60% increase amongst those aged 70 to 79 from 2021 to 2022.

This highlights the urgency of prioritising mental health support for seniors. Around 5.5% of elderly Singaporeans experience depression, as per the Well-being of the Singapore Elderly (WiSE) study. This seemingly small percentage translates to thousands of individuals silently battling mental health challenges.

The question is this: are we equipped, as a society, to handle these challenges? While MOH and the Agency for Integrated Care (AIC) have made strides, there are areas for enhancement.

First, Mr Speaker, Sir, we need a more targeted approach. The senior populace is diverse; individuals in their 60s differ significantly from those in their 70s and 80s. Our seniors are not of the same shade. Engaging seniors effectively requires recognising differences in education, independence, employment status and technological acumen.

I vividly remember challenges when I was leading the Silver Generation Office, particularly engaging Merdeka Generation seniors. Through perseverance, we succeeded in rallying these seniors, fostering a connection rooted in mutual understanding of shared trials and tribulations. Our outreach must reflect diverse profiles by tailoring interventions and support to each cohort's needs. A growing adversity is the lack of a comprehensive understanding of the evolving cohort of older adults.

Moving forward, we must categorise our seniors into segments for effective interventions, including the well and active, the potentially at-risk and inactive, those frail and inactive due to physical or having mental health issues, individuals living independently, digitally adept and with fewer familial support systems, seniors who are financially stable and seniors from the lower socioeconomic group.

Leveraging the strengths and ambitions of different cohorts is critical, especially among the professionals, managers, executives and technicians (PMETs). We must also shift the societal mental model from viewing elders as a burden to valuing their contributions and reframing their silver years as a different phase of life.

A promising avenue lies in senior employability. A re-evaluation of our workforce's HR systems is paramount. By allowing older individuals to choose to continue working, we not only address manpower shortages but also provide them with a profound sense of purpose and financial independence.

I commend the Ministry of Manpower's (MOM) consideration to legislate against workplace discrimination and address ageism. This is an important step towards extending retirement and re-employment ages. The synergy between keeping our seniors meaningfully engaged in the workforce and enhancing their mental well-being is undeniable. It is an endeavour that not only benefits that individual but also contributes significantly to the fabric of our society.

Second, Mr Speaker, Sir, we need a greater focus on building social networks for our seniors. Loneliness and the lack of social interaction are major risk factors for mental health issues in seniors. Beneath the surface of seemingly ordinary lives, unseen ebbs and tides of depression and anxiety can sometimes pull our seniors under. Studies consistently underscore the pivotal role that social connections play in fostering longevity and overall well-being. Encouraging informal networks to flourish can provide invaluable opportunities for socialisation among our seniors.

The Healthier SG initiative and the emphasis on social prescriptions align with promoting well-being. We should champion more grassroots initiatives and urge organisations, like the Housing and Development Board (HDB) and National Parks Board (NParks), to create more physical spaces conducive for these communities to congregate. Age-friendly environments with green spaces, accessible walkways and safe communal areas become vital. These initiatives encourage seniors to venture beyond their homes, fostering social awareness, exercise and a sense of safety and comfort.

Last month, Yio Chu Kang implemented several Dementia-Friendly Neighbourhood (DFN)-inclusive infrastructures based on a ground-up and community-based research study.

As part of a joint project by AIC, Singapore University of Technology and Design and the Centre for Liveable Cities, we conducted evidence-based research on the relationship between persons living with dementia, their caregivers and the built environment in Singapore's predominantly high-rise and high-density urban context. Adopting an ethnographic research-based approach, the study built on the first-hand feedback gathered from over 100 Yio Chu Kang residents, comprising of persons living with dementia, caregivers and residents, to enhance the neighbourhood to better meet their evolving needs. From the study, several DFN inclusive infrastructures were built and tested across Yio Chu Kang. This is to enable persons with early to moderate stages of dementia to live and age well in the neighbourhood.

We also launched two publications based on the findings. These will serve as future references for the building sector stakeholders like the Town Councils, urban planners, architects and designers to build more DFNs nationwide.

Third, Mr Speaker, Sir, we must continue empowering seniors through digital tools and technology. Limited access to mental health services, especially for those with mobility issues, can be a barrier. Expanding telehealth options and making services more readily available in eldercare facilities can bridge this gap. While the Government's efforts to assist seniors in embracing technology are commendable, harnessing technology to create interest groups and leverage existing digital social networks is imperative.

An exemplary initiative is the use of platforms like Vintage Radio, catering to individuals aged 60 and above. This platform serves as a conduit to disseminate information on critical health issues, such as sarcopenia. Moreover, it encourages the formation of local groups, fostering opportunities for gatherings centred around activities like tea sessions, exercise regimens or sessions discussing healthy lifestyle choices. Spurring initiatives like this through incentives or grants is essential.

Fourth, Mr Speaker, Sir, seniors with mental health concerns must have convenient and affordable access to quality mental health services. The silent struggles with mental health are particularly stark for our seniors. From the gnawing isolation that fuels depression to the constant worry that fuels anxiety, these invisible burdens weigh heavily on their hearts and minds. These conditions, often masquerading as loneliness or physical ailments, can impact their daily lives significantly, robbing them of any joy and fulfilment they deserve.

Misconceptions about mental health often prevent seniors from seeking help. Raising awareness and normalising conversations about mental well-being is imperative. Currently, the lack of options for assistance is pressing. We can gain insights form other developed countries with ageing populations by understanding the ratio of seniors to geriatric counsellors, caseloads and waiting times.

Another important aspect is the proactive implementation of preventive measures against mental health issues among seniors. Identifying effective therapies and interventions to prevent the onset of mental health conditions is paramount. We should assess the optimal age to begin initiatives aimed at supporting seniors' mental well-being.

In conclusion, Mr Speaker, Sir, mental health among seniors necessitates a multifaceted approach. Our strategy needs to evolve to meet the diverse needs of today's senior cohort, recognising differences between various age groups, particularly the baby boomer generation and the PMETs. Preparing them for life transitions involves leveraging their strengths and aspirations, fostering social activity through work or engagement in interest groups. Reviewing workforce HR systems to enable flexible roles for older individuals can address manpower concerns, instil financial independence and provide a sense of purpose.

Secondly, our perception of mental health must transcend the mere absence of illness. WHO defines mental health as a state of well-being encompassing psychological, emotional and social aspects. We must pivot our focus from solely discussing mental illness to adopting a holistic, person-centric approach, acknowledging the five key components: physical, emotional, intellectual, financial and social. By prioritising mental healthcare, we can bolster productivity, enhance self-image and fortify relationships.

Maintaining positive mental health and treating any poor mental health conditions are critical to stabilising constructive behaviours, emotions and thoughts. We must address isolation and loneliness through a holistic and person-centric approach. Technology serves as a force multiplier in enhancing mental healthcare. The use of telehealth to deliver services and support demonstrates promise. Initiatives that leverage technology not only streamline access but also create opportunities for innovation in mental healthcare delivery.

Lastly, it is pertinent to underscore the significance of accessible and affordable professional geriatric mental healthcare. This vital resource extends much-needed support to seniors grappling with various mental health challenges.

Mr Speaker, Sir, amid these challenges, let us never forget the inherent resilience of our seniors. Our Pioneer and Merdeka Generations have weathered storms and setbacks throughout their lives. They possess a wealth of experience, wisdom and strength that we should tap into. By fostering a supportive environment, acknowledging their struggles and celebrating their victories, we can empower them to thrive, even amidst their mental health challenges.

Therefore, I urge each of us, legislators, Government officials, healthcare professionals, family members and every resident, to play our part in creating a society that prioritises the mental well-being of our seniors.

Let us champion open conversations about mental health, break down the stigma and normalise seeking help. Support community initiatives, volunteer time, resources and expertise to build social connections and combat isolation. Advocate for accessible and affordable mental health services, ensure every senior has the resources they need to care for their mental well-being. Embrace and respect our seniors, recognise their contributions, value their wisdom and celebrate their resilience.

Mr Speaker, Sir, investing in the mental health of our seniors is not just a moral imperative. It is an investment in the future of our society. By working together, we can build a brighter tomorrow where every senior in Singapore can age with dignity, purpose and hope. Together, let us ensure that our Silver Generation shines not just because of their past contributions, but also because of the bright future we create for them today.

Mr Speaker: Dr Syed Harun.

3.42 pm

Dr Syed Harun Alhabsyi (Nominated Member): Mr Speaker, in the context of this Motion, I declare that I am a psychiatrist in private practice. I hold a Visiting Consultant Psychiatrist appointment in a restructured hospital and I am the Honorary Secretary of the Singapore Psychiatric Association.

Mr Speaker, as a mental health professional, seeing that this Motion is tabled today and responded to by at least 28 Members of the House, my heart is full and I say this on behalf of the very many colleagues who work with me in the mental health space. I am confident that the range and scope of what we will discuss today and put forth to the House will be wide ranging and impactful and it will inform the way we, as a country, see mental health and well-being. I am hopeful that this will lead to meaningful change in the way we view discourse over mental health and how it informs public policy from herein.

Mental health and well-being are not just an issue that resides in the realm and domain of healthcare and, for that, I am grateful to the five hon Members of the House who had put forth this Motion for us to debate and consider.

Importantly, that the debate is happening highlights two things. The first is that the issue of mental health and well-being permeates through and is relevant to all aspects of our individual lives whether it be in school, at work or at home. This is even before we venture into the realm of mental illness. Mental health and well-being features in how we socially interact with one another, impacts how we perform and fulfil our roles at work and has a very direct relationship to our physical health as well.

The second is that there is a now wider awareness, realisation and imperative at the national level in recognising the cost to our society if we do not act and leave things as they be. As mentioned by the hon Member of Parliament, Dr Wan Rizal, a recent study conducted by Duke-NUS Medical School and IMH estimated the total economic burden of lost productivity due to anxiety and depression in Singapore to be S$15.7 billion. This was based on survey data from 5,725 adults collected via an online panel between April and June in 2022, with the results made public in April 2023.

The Singapore Mental Health Study of 2016 also found that the average annual excess cost associated with mental disorders per person was estimated to be close to $4,000 and at a population level, the incremental costs of mental disorders in Singapore is about $1.7 billion per year. These costs tend to come from absenteeism, reduced productivity and direct medical care, including hospital visits and admissions. There is also increasing awareness of the longer-term costs relating to intermediate and long-term care services, as well as indirect medical costs on family members and caregivers.

Similar patterns, Mr Speaker, and cost trends relating to mental health are evident not only in Singapore but the world over, and the costs of ignoring mental health and well-being are staggering. To that end, that the Government has promulgated the National Mental Health and Well-being Strategy paper published in October 2023 is much welcomed. I see this as a great start. It covers good breadth and, importantly, gives a frame and structure towards the national strategy in dealing with mental health and well-being.

I imagine many hon Members speaking today will approach the Motion with a wider population-level concern relating to the strategy paper. The scope of my contribution to this debate will consider the professional aspects of clinical delivery of mental health, particularly at tier 4 of the Tiered Care Model articulated in the said strategy paper.

Tier 4 services are of high intensity, delivered by psychiatrists, psychologists and other multidisciplinary mental healthcare professionals in hospital settings, both inpatient and outpatient, to support those with high mental health needs. These services comprise specialist-led psychiatric assessments, psychological and medical interventions, including acute and emergency services. As far as the National Mental Health and Well-being Strategy paper goes, tier 4 is the sharp tip of the strategy that deals with the most acute, challenging and complex of psychiatric cases.

Mr Speaker, what is palpable is that in tier 4, the forward developmental plans on healthcare manpower and competency are less articulated. I note that the strategy paper states that tier 4 services largely reside in hospitals which have their own competency development plans for clinical staff and would not be covered by the National Mental Health Competency Training Framework. However, it is important to ensure that tier 4 services keep up and remain in tandem with the larger national need and demand for mental health services.

I would like to surface four points for consideration at this tier of mental health services as we move to forward this Motion in advancing mental health for Singapore.

Firstly, Singapore needs more psychiatrists. I say this, conscious that I am one such psychiatrist, but it is not out of self-absorption of my specialty that I say this. I argue that the numbers speak for themselves when taken in relative comparison to the number of psychiatrists per population in other developed countries and the widening waiting times for psychiatric visits in Singapore over the years.

The number of psychiatrists in Singapore is estimated to be 4.4 out of 100,000 per population. This was the number given by the Ministry of Health (MOH) in response to a Parliamentary Question (PQ) by former Nominated Member of Parliament (NMP) Assoc Prof Walter Theseira in January 2020, four years ago. However, when compared to other developed countries, according to WHO data from dated numbers between 2015 and 2017, I could not find any data which was a bit more recent. Based on that data, Norway has 48 per 100,000, Switzerland has 43, New Zealand has 28, Australia has 13, Japan has 11 and the US has 10 per 100,000 population. This is in relative comparison to Singapore at 4.4.

The second point is also that the waiting time for patients over the years also indicates a widening of waiting times for psychiatric subsidised visits in our public hospitals. In response to a PQ by former NMP Ms Anthea Ong in January 2020, the median waiting time for new subsidised appointments to see a psychiatrist across public hospitals was 27 days in 2018. So, in 2018, it was 27 days. The answer to another PQ in 2021 to a question by Mr Leon Perera on waiting times was that the median waiting time for the IMH was 29 days in 2020. So, 27 days for all public hospitals in 2018 and 29 days for IMH in 2020.

Yet, more recently and more alarmingly, in July 2023, to a similar question by the hon Member Mr Yip Hon Weng, the median waiting time for new subsidised psychiatric appointments was 45 days. So, we see a leap of that from 27, 29 and then 45 days, as of the response last year. As I emphasised in my Adjournment Motion in October 2023, median times, while helpful for healthcare planning of resources, only reflect 50% of the patient experience, and there is another 50% of patients referred to a psychiatrist that is seen beyond 45 days.

Based on another Parliamentary reply in August 2023 to hon Member Ms He Ting Ru on 2022 figures, MOH also responded that 95% of subsidised patients were given an initial psychiatric appointment within three months. So, we have a data point for 95% within three months, which is about 90 days, as of 2022.

For sure, Mr Speaker, the numbers of psychiatrists are not everything in the delivery of mental healthcare. However, if we were to be serious about wanting to ensure that we are adequately resourced with expertise in our midst, surely, we need to look hard at these numbers and recognise how much better we can and should be in our delivery of mental healthcare services, especially at the specialist level of care where our patients are most vulnerable.

A good critical mass of experts in the field further helps us develop deeper expertise in sub-specialty areas, such as community psychiatry, child and adolescent psychiatry, psychogeriatrics, addictions, forensic psychiatry and psychiatric rehabilitation, and in key emerging treatment modalities, such as neurostimulation services for our patients. The same experts can also inform other aspects of community care and education in the other tiers of the National Mental Health and Well-being Strategy. Today, I posit that this is difficult and hardly possible because the same experts are stretched to meet the bursting demand for inpatient and outpatient care services.

My second point, Mr Speaker, is in relation to clinical services provided by clinical psychologists. As we finesse our mental health strategy towards improving care, the Government should consider the feasibility of a regulatory framework for clinical psychologists. This would be especially important for those working in tier 4 and in clinical settings in the community. Where clinical psychologists are concerned, there must be clarity over the prerequisite training and experience in clinical settings as they interface with patients regularly, patients who are vulnerable and are seeking care for their mental health needs. While psychologists' skillsets may be transferable to areas such as sports, education and organisations, the specific training for clinical psychologists needs to be further deliberated, structured and regulated in clinical settings, such as hospitals and outpatient clinics, and with the availability of adequate supervision.

Respectfully, there are many different branches of psychology, such sports psychology, education psychology and organisational psychology, but clinical psychology skillsets required in the delivery of mental healthcare and clinical services are, indeed, distinct and different.

To register my point, Mr Speaker, there are 641 psychologists registered under the directory of psychologists maintained by the Singapore Psychological Society (SPS). This list is by no means exhaustive and indicative of the total number of psychologists in Singapore, as not all psychologists maintain this association with SPS. However, when one filters the search to include only clinical psychologists, the number then whittles down to 292 clinical psychologists only.

It remains the case that MOH does have a regulatory framework for other allied health specialties, such as occupational therapists, physiotherapists and speech therapists, and we should allow for no less for clinical psychologists to give assurance to patients that the standards of care are high, commensurate with their needs and they can be assured of quality of care. From a healthcare manpower planning standpoint, accreditation and regulation would allow the Ministry sight of how many clinical psychologists the country and our public hospitals now have and need to ensure timely and accessible care as part of the wider National Mental Health and Well-being Strategy.

My third point relates to accessibility of tier 4 and its associated mental healthcare services and speaks to what I shared at the Adjournment Motion in October 2023. The Government can and should do more to ensure tier 4 services continue to be accessible to Singaporeans, even as it seeks to buttress the overarching national strategy over the initial three tiers of care.

I note the Government intends to increase psychiatric beds by 2030, but it is also important that for mental healthcare, the capacity for inpatient beds, rehabilitation programmes, psychiatric nursing homes and outpatient clinics keeps in tandem with the anticipation in demand in the coming years. In fact, hon Member Mr Yip Hon Wing's speech earlier spoke to the varied and increasing complex mental healthcare needs in Singapore's ageing society now and in the foreseeable future. It will continue to be a moving target, but we must plan forward as specialist resource and infrastructure take time, even years, to come to fruition.

I also urge the Government to consider subsidies of greater quantum and wider coverage for psychotropic medications as well as other treatment modalities, including evidence-based neuro-stimulation treatment, such as repetitive transcranial magnetic stimulation as well as electroconvulsive therapy. The better our subsidy and financial support coverage for treatment options at tier 4, the more focused treatment approaches can be and with good outcomes for our patients. In terms of insurance coverage for accessibility to mental healthcare services, as passionately expressed and outlined by hon Member and fellow medical professional Dr Tan Wu Meng, I urge the Government to maintain sight of this developing space to ensure adequate, fair and equitable insurance coverage for all.

In light of this, Mr Speaker, my fourth and final point would be to call for the Government to articulate, as part of its strategic impetus, measurable targets for all four articulated focus areas across the four tiers of its Tiered Care Model for the National Mental Health and Well-being Strategy.

For tier 4, at least one cluster of measurable targets I can offer to be met over the next five to seven years would be that the median and 95th percentile of waiting times for access to psychiatrists and psychologists must drop.

I believe that we should articulate a clear target on what is a reasonable waiting time for a patient referred from primary care services to specialist-type services and, in my humble view, I think the last patient referred to a psychiatric service, meaning the 100th percentile, should have access to a psychiatrist, at the very latest, within six weeks for a first visit. This is because under the National Mental Health and Well-being Strategy, this patient would have already exhausted all the initial three tiers of care and there is urgency in the need for specialist assistance by this point. It makes sense that this could be reduced if the expressed strategy were to achieve its full potential.

If the proximal three tiers are effective and adequately address mental health needs early, it would follow that at tier 4, there would be less referrals overall to our specialist services in hospitals and this, in turn, lends capacity to manage the care of higher intensity, specialist-led cases. Furthermore, if we set our mind to it and acknowledge that this is the outcome we wish to attain as part of our standard of care at tier 4 and that mental health and well-being are important as a priority for our nation, then we must galvanise the resources necessary to realise this vision.

Mr Speaker, I am in full support of the vision that the Government has in articulating the National Mental Health and Well-being Strategy. Beyond the health issue, there is great impetus in the social and economic domains to be realised for Singapore in the medium to longer term. Notwithstanding my comments, I am in support of this Motion.

Mr Speaker: Mr Edward Chia.

3.58 pm

Mr Edward Chia Bing Hui (Holland-Bukit Timah): Mr Speaker Sir, I am pleased to speak today as a co-proposer of the Motion and in support of hon Member Dr Wan Rizal. I will focus my speech on the case for better support for mental wellness at the workplace. My speech will build upon parts of my Adjournment Motion on Strengthening Mental Wellness at the Workplace which I delivered last January in this House.

Most adult Singaporeans spend most of their time at the workplace. Hence, suffice to say that better support at the workplace will make a significant difference to the overall wellness of our society and create positive ripple effects for other segments in our community. For example, greater mental health literacy acquired at the workplace can equip parents to support their children back home and empower neighbours to support one another in the community.

In the realm of productivity measurements, the Asia-Pacific Workplace Mental Health Study by Intellect, a Singapore-based mental health tech company, reveals profound insights. It demonstrates how absenteeism and productivity improved significantly – by 4.83% and 6.89% respectively – within just six weeks of active engagements with their services, such as self-help in-app content, personalised coaching and counselling from mental health professionals.

According to the Mental Health Toolkit for Employers, published by the National Council of Social Service (NCSS), every $1 invested in workplace adjustments generates average returns of $5.60, reduces average annual medical expenses by 13.3% and increases the average yearly income per person by 6.5%. Improved levels of employee morale and productivity observed in mental health-friendly companies also reduce retraining and hiring costs, which average $3,650 per employee in Singapore.

Such findings are consistent with realities on the ground. For example, in the 2023 Health and Well-being Survey by the National University of Singapore’s (NUS) Office for Health and Well-being revealed that workplace mental health interventions can help to activate the building blocks for human flourishing. These building blocks were measured as positive emotion, engagement, relationships, meaning and accomplishments and health, PERMA + H, a model developed by Dr Seligman at the University of Pennsylvania. The survey revealed that employees from departments who promote mental health are 2.53 times more likely to have a high PERMA score, compared to those who are not.

Another notable example is Singtel's iCare programme, encompassing mental, physical and financial well-being, which resulted in enhanced job satisfaction, stress management and emotional resilience among employees. iCare garnered strong support within months of its launch and 82% of employees felt strongly supported by the organisation and their managers in their overall well-being. This demonstrates that investing in mental wellness directly benefits a firm's bottom line, aligning with strategic economic goals and sustainable business growth.

Mr Speaker, Sir, I wish to be clear that investing in mental health resources at the workplace is not merely to improve the firm’s bottom line. It is to help every Singaporean thrive in the workplace and not just survive. It is about helping every Singaporean to maximise their potential and derive purpose and meaning in their endeavours.

MOH’s Health and Well-being Strategy for 2023 acknowledges the increasing prevalence of mental health disorders and emphasises preventive care. It proposes a tiered care model that focuses on supporting employers, customising care, reducing stigma, improving employment opportunities for individuals with mental health conditions, promoting re-integration and preventing discrimination.

I support these measures proposed to improve workplace mental health and well-being. I echo the call for more support to be rendered to employers. This is a collective responsibility – while employers set the tone, every member of the organisation must contribute to systemic improvements in workplace mental health. I have five suggestions to enhance the support to employers further.

One, harmonising existing measurement tools. As it is often said: "You can’t improve what you don’t measure." Enhancing the effectiveness of existing measurement tools is crucial in improving mental wellness at the workplace.

Currently, tools like iWorkHealth and Human Capital Diagnostic Tool (HCDT) operate in silos, focusing on specific aspects of workplace well-being without interconnection. iWorkHealth is an online, self-administered psychosocial health assessment tool for companies and employees to identify common workplace stressors, while HCDT evaluates the broader organisational health and human capital aspects. This approach limits the understanding of how individual and organisational factors interplay in workplace mental health.

To better support mental health at work, we should blend tools like iWorkHealth and HCDT. iWorkHealth looks closely at each person's mental health while HCDT checks the overall health of a company. By combining them, we can obtain a fuller picture – understanding both what each employee is going through and how the workplace might be affecting them. This way, companies can create better plans to help everyone, considering both individual needs and the work environment. In addition, we need to promote greater awareness and adoption of these measurement tools among employers. Hence, I would like to ask the Government if there are any specific plans in the pipeline to promote greater adoption.

Two, scaling up Well-being Champions Networks to share best practices. The recent launch of the online portal Kaleidoscope, as part of the newly minted Well-being Champions Network, is one such example of how various tools and resources can be consolidated into a single platform to promote more effective access to workplace mental health resources. Using Kaleidoscope, members of the network can access physical and online networking events, workshops and training, an online forum to discuss issues with fellow members and expert personnel, tailored virtual consultations with professional consultants and a directory of curated articles, case studies and best practices.

I would like to ask what is the current membership criteria for admission into the network. And what are the plans to increase the membership numbers? I would also like to clarify if the services offered through the network are accorded free of charge to members or what are the benefits for members beyond networking.

For reference, Hong Kong has established a Mental Health Workplace Charter under its Occupational Safety and Health Council Ordinance, which is a statutory board. The 1,200 and more signatories of the Charter are entitled to free access, sponsored by the Charter, to one in-house mental wellness workshop, one advisory session with professional consultants and mental health first aid courses.

Three, organisational wellness framework. I wish to emphasise the dynamic nature of well-being, which varies along a spectrum, with individuals experiencing fluctuations over time. Recognising this, the WellNUS Mental Health Framework plays a pivotal role in mapping out the various stages of an individual’s well-being journey, providing a systematic approach to identify necessary initiatives and key stakeholders for support.

A framework serves as a blueprint for employers, especially our SMEs in supporting their employees across different stages – from maintaining well-being, through periods requiring intervention and support, to recovery and the critical transition back to work. Crucially, this framework facilitates the smooth reintegration of employees into the workforce. It ensures that as they return, they do so to an environment that actively supports and nurtures their recovery.

Wider adoption of this framework can significantly enhance the support provided to employers and employees across various sectors, leading to a more inclusive and supportive workplace. This is not merely a matter of policy but ensuring effective translation on the ground.

Establishing an organisational framework is a good first step but we must recognise that organisations engaging in different activities will have different work settings and stressors. Hence, it is necessary to contextualise the framework based on industry and workplace nuances.

However, contextualisation and customisation often limit the scalability of a framework. So, the next logical step is to contextualise the framework for organisations in similar trade and workplaces. This is an opportunity for the Government to partner with trade associations and chambers (TACs) to contextualise and scale up organisation mental health frameworks.

So, I call on the Government to partner up with our TACs to implement industry-based mental health frameworks and offer funding through productivity solutions grants schemes. This will better support TACs in customising the organisation framework for their members and adopting mental health tech solutions.

Four, scaling up of HR professionals and Chief Human Resource Officer (CHRO)-as-a-service. In my Adjournment Motion speech last January in this House, I highlighted the potential of broadening the roles of Human Resource (HR) managers, or other relevant managers, to encompass workplace mental well-being. We need to empower HR managers to oversee well-being policies, programmes and strategies within organisations, a move that balances efficacy with financial prudence.

The Institute of Human Resource Professionals (IHRP) has been instrumental in this area. A significant initial step would be the integration of mental wellness competencies into the existing frameworks for HR professionals. So, I propose that MOM works closely with IHRP to refresh its Body of Competencies to include these vital mental wellness aspects. In addition, I hope that MOM can consider initiating collaborations between NUS and IHRP to infuse the organisation's mental health framework into existing HR frameworks.

We must also recognise the constraints faced by SMEs, which often operate with leaner teams and limited resources. To further support employers who do not have the available resources to expand HR capacities, I propose that MOM deliver services through a CHRO-as-a-service programme. A similar model exists with the Chief Technology Officer (CTO)-as-a-Service programme by the Infocomm Media Development Authority (IMDA) that enables SMEs to engage digital consultants. Through a relevant organisation such as IHRP, MOM can consider offering CHRO-as-a-service and adopting the workflow as a possible tool to guide companies in improving mental wellness policies at the workplace.

Beyond HR professionals, we need every employee to play an active role in strengthening mental wellness at the workplace. I wish to reiterate my previous call to SkillsFuture, urging the introduction of new Continuing Education and Training (CET) courses, specifically in the realms of peer support and managerial support training.

As we move forward, I propose that SkillsFuture Singapore (SSG) updates its core critical skills courses. This update will enable employers to access a growing pool of individuals trained in implementing mental wellness policies and initiatives, a critical step in fostering a supportive work environment.

A key skill set that we should aim to cultivate across all levels of our workforce is psychological first aid. WHO defines psychological first aid as a method to support people in crisis, focusing on meeting basic needs, showing care and concern, and respecting their culture, dignity, and capabilities. The primary objective of psychological first aid training is to empower every employee with the knowledge and skills necessary to assist colleagues in distress until they receive professional help or the crisis is resolved. This approach is akin to traditional physical first aid but focuses on mental health crises.

Regarding the critical core skills training under SkillsFuture, there are already mentions of relational skills, soft skills, developing people and self-management but a notable lack of "psychological first aid". A search for "psychological/mental health first aid courses" returns less than 10 partially funded results. Hence, there is a need to include psychological first aid training as a distinct and essential critical core skill, widen the pool of providers and funding for such courses and offer a clearer tiered outline for such training in the curriculum. By making psychological first aid training a more prominent and integral part of our skills development framework, we ensure that our workforce is not only professionally competent but also mentally resilient and supportive, creating a healthier, more compassionate workplace for all Singaporeans.

And five, recognising employers who implement mental wellness policies. A critical aspect of promoting mental wellness at the workplace is recognising and incentivising employers who take proactive steps. The annual National Workplace Safety and Health CARE, or Culture of Acceptance, Respect and Empathy, Award is a commendable initiative, spotlighting organisations that exemplify outstanding mental well-being practices. These organisations are celebrated as model employers, setting a benchmark for others.

In our quest to create a more robust recognition system, partnerships are key. The National Volunteer and Philanthropy Centre's (NVPC) Company of Good framework, which now includes mental wellness policies in its evaluation criteria, presents an excellent partnership opportunity. By aligning the Company of Good recognition scheme with the MOM and Workplace Safety and Health (WSH) Council’s efforts, we can create a unified platform. This consolidation not only streamlines the recognition process but also makes it easier for job seekers and consumers to identify exemplary employers. Moreover, a unified approach can potentially draw more attention and resources, and reduce duplications and wastages, thus elevating the profile and impact of these awards.

Mr Speaker, Sir, I believe these five recommendations will empower employers to strengthen mental wellness in the workplace. One, implement a comprehensive tool for employers to measure workplace mental wellness considering individuals and organisational factors. Two, scale up best practices sharing opportunities for employers. Three, offer a customised organisational mental health framework supported by the Productivity Solutions Grant for implementation of policies, training, and programmes. Four, provide HR professionals, CHRO-as-a-service, and individual workers with mental health literacy to effectively implement frameworks and policies. And five, consolidate recognitions, such as WSH Care awards and NVPC Company of Good, to facilitate the identification of exemplary employers, promoting a positive cycle of prioritising workplace mental wellness.

Mr Speaker, Sir, in my maiden speech in Parliament, I shared that our enterprises and entrepreneurs have not only economic value but deep social value. Our enterprises are agents of social change. Strengthening mental wellness at the workplace is a social mission worth advancing. Let us partner with our enterprises to make mental wellness a cornerstone of our national economic and social strategy. That way, every Singaporean can maximise their potential and derive purpose and meaning in their endeavours.

Mr Speaker: Mr Mark Lee.

4.16 pm

Mr Mark Lee (Nominated Member): Mr Speaker, Sir, in March 2021, our company experienced a profound loss with the passing of a cherished colleague, Mdm X.

She had been a part of our team since 2008 and was known for her quiet dedication and tireless work ethic. Often staying late into the night, Mdm X was battling a private challenge unknown to us, a struggle with hoarding. A tragic fire at her home, fuelled by the very items that once brought her comfort, ultimately led to her untimely death. She was just 48 years of age. This event deeply affected both myself and our entire company, highlighting a stark reality. Despite our close-knit interactions over 13 years, we were unaware of the mental health struggles Mdm X faced.

In response to this tragedy, we took proactive steps to strengthen our community within the company. We restructured our teams into smaller cell-groups of 20, aiming to enhance camaraderie. With the support from the company, these groups engage in informal outings and fitness activities, encouraging open dialogue and support, not just in physical health but in all aspects of life. They share photographs and positive affirmations, building a network of assistance and encouragement and creating a safe space for members to seek help and peer support.

This incident underscores the critical role businesses play in promoting mental health and well-being as part of a national effort. The recent publication of a National Mental Health and Well-being Strategy is a significant step forward. This strategy highlights the iWorkHealth online tool, developed by MOM and its partners. This tool is invaluable and I wished our company would have had this tool earlier.

My first recommendation is for the Government to look into ways to engage and incentivise more companies to use the tool and support the implementation of suggested interventions to address specific workplace stressors identified in the report. I also hope the Government will continuously engage with businesses for feedback after the roll-out to continue improving on this tool.

Not all organisations are the same. Similarly, not all HR professionals have the necessary skillsets and experience to handle workplace mental health issues. My second recommendation is for the Government to continue supporting companies to train HR professionals and senior managers, working closely with organisations like Singapore Human Resources Institute (SHRI) and IHRP, to build up these capabilities within the HR community. This will make the appointment of mental well-being champions more effective.

Mr Speaker, in my 18 September maiden speech, I called on the Government to create a detailed framework for acknowledging companies that back important national initiatives. These include enhancing Government-Paid Paternity Leave (GPPL) and Government-Paid Maternity Leave (GPML), embracing the tripartite standard, obtaining Progressive Wage Mark accreditation, and now, supporting a forward-thinking workplace culture that emphasises the mental well-being of employees. Implementing such a framework would significantly speed up our nation's efforts to forge a workforce that is both more inclusive and equitable.

My third recommendation therefore continues to emphasise the importance of recognising companies that support these national-level initiatives and highlighting those that excel in these areas. We should consider integrating this recognition framework with tangible economic incentives, such as prioritisation in Government procurement processes, already associated with Progressive Wage Mark accreditation and possibly, temporary enhancements to foreign workforce access. Such measures would serve as a strong motivation for businesses to align with these national objectives.

Another focus area covered in the paper is the customisation of mental health support for specific occupational needs. Working with MHA and Ministry of Defence to strengthen mental health support for Police officers and National Servicemen is a good start. But there is scope to expand this approach to other occupational groups, such as frontline services sectors that are susceptible to specific mental health stressors.

As suggested by my hon colleague, Mr Edward Chia, my fourth recommendation is for the Government to support sectoral agencies and trade associations and chambers to work together to develop a holistic mental health support system for their sector. I have spoken quite a bit on mental health and well-being, and this is an opportune moment to emphasise that workplace well-being is a multifaceted concept that cuts across physical health, emotional wellness, social connectivity, financial security and professional growth and fulfilment.

At the foundation of holistic well-being is physical health. As a fundamental baseline, companies must provide a stable environment for employees to work safely and without risks to health. But the responsibility of a company goes beyond that. It is therefore essential to encourage workplaces to promote physical activity, offer healthier meal options and facilitate regular health screening. Emotional well-being, influenced by the workplace atmosphere, plays a pivotal role here.

Business leaders should take the lead in championing a respectful, collaborative and cohesive workplace setting where disputes can be resolved amicably, and a culture of inclusion and communication is celebrated. Companies must be intentional about defining and implementing work-life harmony strategies that balance operational and commercial demands alongside employees' need to recharge, spend time with loved ones and pursue personal passions.

Finally, an employee's financial security and professional growth significantly impacts their overall well-being. Companies should provide employees with structured opportunities for continuous learning, skills development and career advancement. Adjacent to this is the principle of workplace fairness, which companies must uphold so that all employees, both locals and foreigners, have a fair and merit-centred basis to chart out their career paths.

In conclusion, in our rightful pursuit to address mental health, we must tread carefully. We cannot let our focus on mental well-being erode the very resilience that has been the cornerstone of our success. We do not wish in the long-term, in the name of mental health support, see our competitive edge dulled, our youth's ambition softened by an over-promise of comfort and an under-preparation for challenge.

Our approach must be different. It must blend empathy with endurance. We must build support systems that acknowledge mental health, not as a sign of weakness, but as an aspect of our humanity. But equally, we must guard against a culture where resilience is mistaken for indifference, where perseverance is confused with silent struggling.

This balanced approach aims to foster an environment where empathy and endurance coexist, ensuring mental well-being is recognised and supported without diminishing the value of resilience.

On a lighter note, to everyone celebrating Chinese Lunar New Year and facing a mental health issue from relatives, remember, a healthy dose of bak kwa and pineapple tarts will help. Mr Speaker, Sir, I support the Motion.

Mr Speaker: Order. I propose to take a healthy break now. I suspend the Sitting and I will take the Chair at 4.45 pm.

Sitting accordingly suspended

at 4.25 pm until 4.45 pm.

Sitting resumed at 4.45 pm.

[Deputy Speaker (Ms Jessica Tan Soon Neo) in the Chair]

Advancing Mental Health

Debate resumed.

Mdm Deputy Speaker: Ms Mariam Jaafar.

4.45 pm

Ms Mariam Jaafar (Sembawang): Mdm Deputy Speaker, I am grateful for the opportunity to co-sponsor this Motion. Mental health must be a key priority for this House and this Government. My speech today will focus on an area I am passionate about: the mental health and well-being of our children and youth. My speech takes into account the plans announced in the National Mental Health and Well-being Strategy and considers how we can do even more for our children and youth.

We often talk about the potential of youth; about how they are our hopes and dreams, and how they will shape the future. We tell them that the world is full of rainbows to follow and opportunities to seize. But youth can also be a difficult time, with many transitions.

Childhood is a time when we form the basis for our relationships and friendships, which greatly influence our future physical and mental health throughout our lives. Then you start school and, all too quickly, academic pressures build up, pressure to meet the expectations of teachers and principals, parents and, more often than not, our own.

Adolescence and young adulthood are thought to be particularly tumultuous times in neuro-psychological and physical development, when mental disorders typically emerge. The second Singapore Mental Health Study, conducted in 2016, revealed a significant association between younger age and mental disorders. In particular, young adults aged 18 to 34 had the highest lifetime prevalence for any mental disorder. In 2017, it was reported that mental illness was the largest contributor to years lost to disease among young people aged 10 to 34 in Singapore.

Fast forward a few years, the statistics tell us the problem has not only persisted, it is getting worse. The Samaritans of Singapore (SOS) reported that suicide among youths aged 10 to 29 has gone up, from 94 in 2018 to 125 in 2002; more than 500 young lives lost in the past five years. In a 2023 NUS study, one in three youths reported internalised mental health symptoms, such as depression, anxiety and loneliness, while one in six experienced externalised symptoms like hyperactivity, rule breaking and aggression, while 12% met full diagnostic criteria for having at least one mental health disorder.

This all puts pressure on the system. The volume of calls and texts for help to social services agencies and suicide hotlines has increased significantly year on year, and residents have told me that it can be very difficult to get through the hotline.

Similarly, as has been mentioned, it takes months to get an appointment at IMH and other hospitals or polyclinics.

Not only are we seeing rising numbers, we are also seeing more severe and complex mental health needs amongst our children and young people, including among those with learning disorders and autism. We can identify determinants of health and their impact on mental health and well-being, which include social, economic, cultural, relational and physical environments, such as housing and diet. Some children and youths are still feeling the effects of isolation and uncertainties due to the pandemic. Some parents are dealing with their own mental health and well-being issues. They are stressed, worried about their jobs, families, money problems, the rising costs of living, nevermind recognising their children’s needs and helping them to develop resilience. To help these children, we need to also help their parents.

Mdm Deputy Speaker, it is abundantly clear that a shift is needed in how we approach mental health. To relieve the pressure that is building up and increasing the risk of a mental health tsunami where the system simply cannot cope any longer, we need to focus on prevention and on population health.

If this sounds familiar, it is because we have come to this conclusion before when we launched Healthier SG. And this brings me to a core tenet – if the disease burden of mental health is up there with more commonly understood diseases, mental health and how we deal with it must be on par with physical health. The principles of Healthier SG must equally apply and, indeed, mental health must be integrated in the Healthier SG framework. There is no Healthier SG without a mentally Healthier SG.

I welcome the shift envisioned in the National Strategy, moving from a focus on treatment and institutionalisation, to focus equally on prevention and early identification and intervention in the community, on building an effective mental health ecosystem. I welcome the plans to do more upstream, addressing societal driving forces, raising awareness and building mental resilience and coping abilities in our people.

Specifically for youths, I would like the focus areas and interventions identified, including a post-discharge intermediate facility for youths at risk of suicide, scaling up mental health literacy efforts for children and youths starting from preschools, improving the support to parents and promoting safe use of the online space and digital mental health platforms.

Mdm Deputy Speaker, I would like to share the mental health stories of three young Singaporeans, to bring to life the challenges they go through as well as to highlight the opportunities to make a difference.

The first, A, is a young Woodlands resident. She was in Primary 1 when the pandemic struck. She developed a phobia of falling sick and dying. She started to refuse to go to school or would cry in school until the teachers called her parents to pick her up. She developed chest and stomach pains that resulted in frequent trips to the doctors and the Accident and Emergency department. But each time, the finding would be, "Everything is normal. We do not know what is wrong." This went on for more than a year until her mother asked for a referral to a psychologist. Finally, she was diagnosed with anxiety.

She was then referred to her school counsellor. While the school had failed to identify the early signs, once diagnosed, they gave A very good support. She had an anxiety toolkit of coping mechanisms. Whenever she felt a panic attack attacking, she could leave class immediately and run to the counsellor’s office. The counsellor would often sit with her at recess and talk to her. She would not be scolded for being late for school. Her teacher sent her daily personal notes of encouragement. Today, A is more resilient. She has joined a co-curricular activity (CCA) after school and has a close group of friends. Her parents credit the school’s accommodative and flexible approach as being key to helping her get better.

In contrast, the subject of my second story, B, did not get the same support from her school. Now, in her earlier 20s, B had always been anxious about her academic performance, even though she did well. But the transition from her all-girls secondary school to a top junior college (JC) was a difficult one. She was harassed by a group of boys. They made comments about her, her looks and her body on social media. The harassment spilled over into the physical world. She developed severe anxiety and it affected her grades, which made her anxious. She did not want to go to school. She saw the school counsellor but did not find the sessions particularly helpful or empathetic. "They were not really focused on me", she said. "Like they would give me study tips when what I needed was someone to help me with my emotions." She developed self-harming behaviours, in part, influenced by her peers, and then made her first suicide attempt. She was then referred to a psychiatrist and a psychologist at a restructured hospital, whom she still sees today.

She eventually dropped out of JC to go to polytechnic. The people were nicer, the teachers kinder and more patient, but she still struggled. Then she went to university in Australia, where she experienced a very different culture, one where people were much more open about their mental health. The university had tailored Disability Support Plans for students with physical or mental issues. She estimated 30% of students were on some sort of support plan. Her support plan, after consultations with a psychiatrist and general practitioner (GP), included exemptions from public speaking and presentations, and extra time for exams and locations in a different room.

This open culture extends to the workplace. She had a part-time job. Her colleagues and supervisors were open, understanding and supportive of one another’s mental health needs. After another episode which forced her to leave her job for three months, she was surprised to be warmly welcomed back to work. "It was like they were really happy to see me back", she said.

In the community there were regular large-scale mental health carnivals to raise awareness and help people learn coping skills. There would be specific organisations presenting to different audiences, for example, people from the military or parents who had lost a child to suicide. Often, the speakers would have mental health conditions themselves or be caregivers. The specificity helped to make people feel that there were people who really understood what they were going through.

Now, back in Singapore and looking for a job, B feels a lot of uncertainty about her future. But her self-awareness and understanding of her condition helps. Her mother told me it had been a struggle to learn how to support her daughter and she is still learning.

Finally, I share the story of C, as recounted to me by his mother, my Woodlands resident. He was a playful child who liked to play pranks on people. But at the tender age of 14, he was diagnosed with bipolar disorder after his first suicide attempt. He struggled, despite seeking treatment at the Child Guidance Clinic, despite the strong support of his mother, who was both his caregiver and the sole breadwinner for the family as C’s father also had bipolar disorder. He refused to see a school counsellor or psychologist after the first session. His condition deteriorated further when he entered National Service (NS) and turned 18, when he was transitioned from the Child Guidance Clinic to IMH. He hated going to IMH. He did not feel like he belonged with "all those crazy people" he would see in the waiting room. He attempted suicide again and was discharged from NS.

He started working but found it difficult to hold down jobs. Of course, he never declared his condition. When he became unstable due to anxiety, employers considered him a risk and terminated his employment. He had no one to turn to at work who understood.

Despite all these struggles, C got married and he and his wife bought a Build-To-Order (BTO) flat and had a baby. His wife was aware of his condition and supported him, making sure he took his medication, and his mother supported them financially. But his mother-in-law started belittling him, calling him a "useless idiot" and accusing him of faking illness so he did not have to work, even after his mother went to see her to try and make her understand. They accorded him little dignity and respect and even kept his baby from him.

The stresses of his life, in trying to keep his job, trying to get his colleagues, bosses and in-laws to understand his bipolar disorder and the weight gain due to the medications led him to eventually succumb to taking methamphetamine to cope with his anxiety. He wanted to stop but, when he sought help, the IMH hotline told him to get help from the National Addictions Management Service (NAMS) for addiction, but NAMS told him they could not help him on his addiction because of his bipolar condition.

In mid-2023, C told his mother he had been terminated from his job as a temporary staff after two months because he could not meet his key performance indicators (KPIs). Not long after, he took methamphetamine again, this time, a huge dose. His wife then filed for divorce and moved her parents into their home. His sister told his mother that his wife should just divorce him because of his bipolar condition, just like his mother had eventually divorced her own bipolar husband. His mother took him back to her house and took him to NAMS. He was sent to hospital to detox. After his discharge, he went back to NAMS and was told he was fine, to go home and just come back for counselling in 10 days.

Back at home, he did seem better. He asked for his favourite food and started eating again, he talked about plans for the future. But two days after coming back, in the evening, he went out for a walk. He did not allow his mother to accompany him, insisting he was fine. But a couple of hours later, his mother received his suicide note over WhatsApp. It said he could not bear the cravings any longer and he did not want to be a burden to his family any longer. C ended his life by hanging himself in the stairwell of the multistorey car park that evening. It was his own brother who found him after a frantic search.

When I heard C’s story, I wept for C and for his mother who had lost her first-born son. She has a second son who suffers from depression, a bright boy in primary school whose life trajectory changed when he went to an elite boys' secondary school and found himself unable to keep up. She has a mother who has dementia. She worked multiple jobs to support all of them. But at no time during all the doctor and hospital visits for C, his brother or their father, her ex-husband, did anyone ask her how she, the caregiver, was coping.

These stories can be hard to listen to. But they are real, and they point to the scale and complexity of the challenge, and this is why Dr Wan Rizal, Dr Tan Wu Meng, Mr Yip Hon Weng, Mr Edward Chia and I have filed this Motion and why so many Members are rising to speak.

The National Strategy on Mental Health and Well-being is a very important step. I believe we can do even more, particularly in the difficult area of driving societal change.

No amount of Government interventions with new structures, new care models, new resources and new legislations will work if we do not, as a society, transform. If we do not, as a society, become more aware of what people around us are going through and make it safe for people to be more open about the mental health challenges that they or their loved ones face; if we do not accept that not everyone is able to deal with it no matter how much they try; if we do not become more understanding and compassionate; and if we do not stand together to act to improve the mental health and well-being of every Singaporean.

How can we further strengthen key care settings: (a) families; (b) schools, including universities; (c) community; (d) primary care, (e) acute care; and (f) online space? I would like to touch on the first four today.

Firstly, families. The National Strategy recognises the need to better equip parents to support their children’s mental health and well-being. It highlights strong relationships with their children as a foundation for strengthening children’s mental and emotional resilience, as well as parenting in a digital age. I cannot agree more.

I would like to see us invest more in building these early relationships, beyond the parents' toolbox. We need a range of avenues in the community, virtually and physically, for parents to be supported on the ups and downs of family life in order to address the desire for privacy and the need be able to reach out widely and at scale to foster a more open culture. We need to take a population health approach that addresses health inequalities and social determinants of health on the mental health of youths and ensures that the strategy is inclusive. Support for parents' mental health must also be prioritised, especially more vulnerable parents. We need more family therapies. Social services agencies play a critical role.

All this will take time. In parallel, the issue of consent is one that will need to be addressed so children can get help even if their parents are not in the right state to support them, and I look forward to details on how the Government will address this.

Secondly, schools. It is timely that the Government is committed to promote mental health literacy, starting now at the preschool level. We can do more to make our schools more accommodating to students' mental health needs, including at critical transition points. The idea of support plans and accommodations based on their specific needs experienced by B in Australia and A in Singapore come to mind. There should be greater consistency in how schools acknowledge and address these challenges. This cannot be subject to the personal ambitions or dispositions of the school leaders. We must drive common understanding and best practice sharing among principals, teachers and parents.

Mdm Deputy Speaker, the academic stresses faced by our students is a topic that comes up regularly in this House.

While MOE is constantly refining the education system, we know, in our society, it will be difficult to escape a certain level of academic pressure. But that makes it all the more important that we be very intentional in building a reservoir of positive experiences in school that students can dig into when the going gets tough.

In surveys, students say that they are most comfortable talking to their friends with their anxieties and problems, ahead of parents, teachers or school counsellors. So, let us not underestimate the power of school activities that help students form friendships and be quick to dismiss them, or of making an extra effort to support the kids who sit by themselves or who have learning disabilities.

Thirdly, the community. There are several community agencies, civil organisations and frontline staff involved in the mental health ecosystem. We know that the community is the best site for care for many. But we also know that the quality varies. Even experienced doctors, teachers and social workers can miss the signs, as was in A.

How can we ensure that the quality of care in the community will meet the requirements? How will we ramp up capacity fast enough? Beyond standard processes, training and tools, how do we structure measures and incentives to drive the outcomes we want, which ultimately must be better care for our people? Community partners I talk to also cite better collaboration with the public health system as a key enabler of better outcomes.

Finally, primary care. The Government plans to increase the capacity and capability of mental health services in polyclinics and GPs. This is much needed. Wide awareness of the availability of mental health services in polyclinics can help to destigmatise mental health, especially given the stigma around IMH.

I urge the Minister to consider making mental health services available in all polyclinics and not just all new polyclinics. GPs will also play an important role. But we must also recognise that the support today is very patchy. Anecdotally, although we have a few PCN-MH in Woodlands, only one has made any referrals to our appointed CREST partner. It is not clear whether this is down to the patients or the GPs.

In the context of youths, we should assess whether youths prefer a different setting from the GP setting, such as specialist youth drop-in centres. I would like to ask the Minister how MOH understands the pattern of needs among youths in the primary care setting.

I would also value the Minister's vision for mental health support from GPs under Healthier SG, including whether GPs will perform regular mental health screening and serve as the primary gateway or gatekeeper for referrals.

Mdm Deputy Speaker: Ms Mariam Jaafar, you have one-and-a-half minutes.

Ms Mariam Jaafar: Across all these settings, we require a robust workforce plan to recruit, train and retain a workforce with experience and competencies in working with young people. I would like to say a few words in Malay.

(In Malay): [Please refer to Vernacular Speech.] I have just shared a true story about C, who struggled with bipolar disorder. C was Malay. When he lost his job, his mother-in-law belittled him and peppered him with insults like “useless idiot”.

Unfortunately, such a response is not uncommon in our community. Many older people do not have a good understanding of mental health issues. We should recognise that they are key to increasing mental health awareness. We should not downplay the amount of effort that is desperately needed.

Nonetheless, our community possesses certain traits that are helpful. We have many social workers within our community. We also have many Malay/Muslims who are frontline workers such as Police officers, SCDF officers, teachers and nurses; all of whom would certainly have a good understanding of mental health.

If they are able to raise awareness of mental issues in their own families, we will be able to raise this awareness with more people. Our community will certainly be more supportive and more understanding towards this issue. In other words, we can make changes from deep within our own community.

(In English): Mdm Deputy Speaker, I am not a betting person, but I would bet that every single one of us in this Chamber has had a personal brush with mental health, whether in our families, our friends or ourselves. I have and perhaps that is why this is personal.

As leaders, we can help to create a new openness about mental health by being open ourselves about our own personal experiences. Let us work together to create a society that is kinder and more understanding, especially for our children and youths. Let us work together to create a society where our children and youth know that whether it is coping with the normal stresses of life or battling more debilitating mental health conditions, they are not alone. [Applause.]

Mdm Deputy Speaker: Ms Usha Chandradas.

5.07 pm

Ms Usha Chandradas (Nominated Member): Mdm Deputy Speaker, I rise in support of this Motion and would like to bring to the attention of the Government two issues that relate to the arts community.

First, I would like to speak about the importance of art-related therapies in alleviating mental health conditions; and second, I will address the mental health concerns faced by arts and cultural workers themselves. The hon Member, Dr Wan Rizal, in moving this Motion, briefly mentioned the role of art in wellness initiatives and I will be expanding on this idea as well.

To provide some background, the term "arts therapies" is generally understood to refer to the four separate professions of music therapy, drama therapy, art therapy and dance movement therapy. Each of these arts therapies requires specialist training in their own art form and in the application of these art forms in a clinical therapeutic setting.

For ease of reference, when using the term "arts therapies" in my speech, I will be referring to the wider understanding of the term and when I refer to "art therapy" in the singular, it will be to describe the particular form of psychotherapy that helps people to effect change and growth through the use of art media and creative outlets, in a supported and safe environment. LASALLE College of the Arts, which is now part of the University of the Arts Singapore, has offered a Master's level degree in Art Therapy since 2006. It will also be launching a Master's programme in Music Therapy come August 2024.

According to a 2022 op-ed written for Today Online by Mr Ronald Lay and Mr Lay is the programme leader of the Master's of Arts in our Therapy programme at LASALLE, 198 qualified art therapists have graduated from his programme. From a training perspective, this amounts to over 177,000 hours of documented clinical art therapy services provided across Singapore by postgraduate trainees.

Art has an important part to play in both preventative and curative healthcare. There is a whole sliding scale of uses of art for therapeutic purposes. On one end of the spectrum, you have arts as they are practised by the individual. So, quite simply put, if you or I engage in the act of, say, painting, this act of painting allows us to immerse ourselves in an activity which is meditative and contemplative. It might allow us to momentarily lose focus on our troubles and this is an example of what is sometimes referred to as the "therapeutic value of art".

I am glad that the Government presently supports many art and cultural wellness initiatives through the good work of the National Arts Council (NAC) and the National Heritage Board (NHB), as well as their partners in the private sector.

On the other end of the spectrum, we have the notion of "art psychotherapy", and this is where a third-party professionally trained practitioner engages in a form of psychotherapy that utilises art media and creative outlets as its primary mode of expression and communication. Art and music therapy, for example, allow participants to express themselves, when words are not enough to express their thoughts and emotions. It is especially useful in cases where such participants are non-verbal or pre-verbal, and where modalities like cognitive behavioural therapy cannot work. Both curative and preventative healthcare are needed as part of a holistic approach to public health. This is something that the National Mental Health and Well-being Strategy 2023 advocates for with its tiered approach.

Having said that, the Strategy does not expressly mention anything about the role that the arts can play. This is in contrast to the policy positions that have been taken overseas. In Greece, a Memorandum of Cooperation for Cultural Prescription has been signed between the Ministry of Culture and Sports and the Ministry of Health. This sets out specific cross-governmental programmes of work to train artists, cultural workers and healthcare workers concurrently on the design, implementation and development of cultural prescription programmes. It also raises awareness of such schemes with the public. In Wales, Memorandums of Understanding have been signed between the Welsh National Health Service (NHS) Confederation and the Arts Council of Wales. These set out efforts to work together for the advancement of arts, health and well-being.

In September last year, I asked the Minister of Health the extent to which art therapy is included as part of HPB's initiative towards helping communities to achieve better mental health. He replied that HPB does incorporate art-related activities, for example, mindful colouring, in their mental well-being workshops and acknowledged that "the appropriate inclusion of art, music, exercise and social interactions into our daily routine will be good for all of us." However, he also stated that evidence on the effectiveness of art therapy was said to be "still evolving."

The Minister is not wrong in his focus on an evidence-based approach and, indeed, one common misconception about the field of art therapy is that its statistics and data are not as detailed or rigorous as the clinical data typically relied upon in the medical profession.

On this point, I would like to emphasise that a good deal of research is being done and has been done in the field. In 2019, the WHO Evidence Network released a landmark scoping review of over 3,000 research studies that explore the effect of the arts on health and well-being. The studies looked at participation in performing arts, visual arts, literature and engagement with culture and heritage. Overall, the review concluded that the arts could have key roles to play in the prevention of ill health, the promotion of good health and the management and treatment of a range of different conditions.

There are many examples of studies that have been conducted in the field. But for today’s purposes, I would like to highlight a 2017 UK report by the All-Party Parliamentary Group on Arts, Health and Well-being.

This report was issued in the UK and it spotlighted a scheme called the Artlift Arts on Prescription Scheme. This was administered in Gloucestershire County in the UK. Here, health professionals referred patients with diverse mental and physical conditions to an eight-week arts programme. A University of Gloucestershire evaluation, using the Warwick Edinburgh Mental Well-Being Scale, showed significant improvements in the well-being and moods of patients. With larger sample sizes being observed in 2014 and 2017, the findings remained consistent.

Statistical analysis revealed a remarkable 37% drop in GP consultation rates and a 27% decrease in hospital admissions. By considering the reduced costs to the NHS in relation to the cost of the Artlift interventions, it was determined that there was a real saving of £216 per patient. This underscores the compelling impact of art-based interventions on mental health outcomes.

The points I would like to communicate here are simply this.

First, there are quantifiable health and cost benefits in the utilisation of art as a form of wellness and in personal artistic experiences, as well as in the field of art psychotherapy. We see this locally, from the experience of other countries and also from the research of the WHO. These benefits support the case for a formal acknowledgement by the Government, of the arts as an important device in our arsenal of tools to promote better mental well-being. The arts and arts therapies have a key role to play in every tier of Singapore's National Mental Health and Well-being Strategy.

Next, having identified the importance of the arts and art therapies, resources should be put in place to ensure that more relevant data is obtained, and that the practitioners of the arts therapies and arts wellness initiatives, are themselves well-supported.

We have all the basic building blocks for this in Singapore and more. We have masters-level educational programmes in art and music therapy. We have a brand-new University of the Arts with excellent research capabilities and we have professional associations such as the Art Therapists’ Association Singapore (ATAS). We also have an Association of Music Therapy Singapore. We already have entities like the Assisi Hospice, Singapore Cancer Society and various hospitals, amongst others, that not only work with our art schools but have also put in place dedicated art therapy and arts wellness programmes. These are in place for their staff, patients and beneficiaries.

Our national mental wellness strategies should explicitly include these arts therapies and arts-related wellness initiatives. I urge the Government to commit resources towards supporting our arts community in this direction.

There are a few ways in which the support can be rendered.

First, as I have said, we can dedicate more funding towards the research of arts therapies and arts wellness initiatives. In this way, we will be able to mine more data on their efficacy. While it is possible to rely on foreign research findings, cultural specificity in data is also important. The kinds of therapies and methods that might work in a Singapore context might not be applicable elsewhere and vice versa. Private charities like the Red Pencil are already doing significant work in gathering data on the effects of art therapy, and their activities and those of other like them should be supported by the Government.

Next, I would also like to urge the Government to consider engaging with the arts therapies communities to assist them, if required, in implementing some kind of formal accreditation and regulation system. The Art Therapists’ Association Singapore is one example of a non-partisan not-for-profit professional body which is run and regulated by its members. It was established in 2008 to represent the emerging profession of art therapy in Singapore, and it seeks to advance its' members growth and development.

In 2021, when asked in a PQ filed by the hon Member Mr Muhamad Faisal Abdul Manap on whether there are plans to recognise art therapists as allied health professionals, the Minister for Health replied that there was no need to legally regulate the practice of art therapy. The view taken was that art therapy by its nature does not pose significant risk of harm to patients.

With respect, I beg to differ with the position that has been articulated by the Minister. As explained to me by various members of the art therapist community, there is a clear difference between a situation where an individual engages in art-making or creative activities on their own for their personal enjoyment and therapeutic benefit, and a situation where a third-party practitioner uses art therapy techniques as interventions for diagnosed physical and mental health conditions. As the Minister has himself observed in his reply to my PQ filed last year, these kinds of interventions should be guided by professional recommendations. Regardless of this, in Singapore, anyone can hold themselves out as being an art therapist.

Because of the lack of local regulation and accreditation, it is not necessary for people to be trained in any particular way. I have been told anecdotally by art therapy practitioners that there can be unethical or uninformed use of art therapy by untrained persons, who may design programmes and art-based interventions intended for vulnerable populations. These include people who have diagnosed with mental health conditions or who have special needs. When this happens, harm can be inflicted and there is no recourse for such populations. In the UK, by contrast, arts therapists are included as allied health professionals and accordingly, they are subject to a level of regulation and accountability. Here we see that regulation protects vulnerable populations, enhances confidence in the field and stimulates growth in the profession.

That being said, I also recognise that regulation in the field of arts therapies is not a straightforward exercise. Practitioners themselves are divided on the issue, and there is some acceptance of the idea that certain art-based interventions and modalities can be delivered well by experienced practitioners who do not have a formal post-graduate education. However, what all practitioners I have spoken to agree that the idea is that harm can be caused, and especially amongst vulnerable patients. Minimally, frameworks should be put in place to stop this from happening. Whether they have to do with formal frameworks of better consumer education, there are certainly steps that can be taken to protect vulnerable populations.

In his 2022 op-ed for Today Online, Mr Ronald Lay rightly points out that art therapy as a discipline is relatively new in Southeast Asia and that postgraduate art therapy training at LASALLE is the only one of its kind in Singapore and in Southeast Asia. With growing interest in the field, there is an opportunity here to create new and better jobs for our creatively inclined communities. To this end, further professional development and support for the field of art therapies, and arts-related wellness, is something that I urge the Government to consider seriously.

Next, Mdm Deputy Speaker, I would like to address the mental health issues faced by the arts community itself. Now, this is a community that is composed of a great number of self-employed people. As much as we wish to consider a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being, we should not forget the specificities related to individual groups within the wider community.

In a similar vein, the National Mental Health and Well-being Strategy correctly identifies that an individual's mental health is not just affected by his or her own psychological well-being but is shaped by larger driving forces in society. This includes a combination of biological, social and environmental factors.

In a recent research report from Queen's University Belfast, which involved a survey of nearly 600 creatives across a range of artforms, it was found that the likelihood of mental health problems in the arts sector was three times that of the general population. The most common diagnosed disorders were anxiety at 36% of the group and depression at 32%. This was linked with job precarity in the industry and included factors like erratic and short-term employment, low pay, work-over and under-load, and time away from loved ones. These are problems that affect our arts and cultural workers in Singapore too.

The National Arts Council's Arts Resource Hub has done good work in supporting the arts community. One of its recent projects involved hosting a gathering led by CITRUS Practices. This is a group that does important work in providing free resources for the care, support and wellness of arts workers. Initiatives like this should be encouraged and supported further, ideally with funding from the Government where this is required.

While our National Mental Health and Well-being Strategy identifies the issues faced by workers in a traditional employment situation, there is scant detail on the problems faced by the self-employed. As we know, at least one-third of the arts and cultural workforce operates on a self-employed basis. This is something that I had spoken about previously as well.

While we seek to improve mental health and well-being for employees in a workplace environment, we should also remember to protect and respect the mental health of third-party service providers. These are service providers who may work with us on a self-employed basis or on a freelance basis. Workers such as these may not have access to things that the rest of us take for granted, like paid medical or childcare leave. It is not right, for example, for organisations to prioritise the mental well-being of their permanent staff internally while pushing third-party service providers or freelancers to work to the point of burnout.

In order for our National Mental Health and Well-being Strategy to be effective, we must not forget the self-employed and we should ensure that positive mental wellness initiatives extend to everyone.

Mdm Deputy Speaker: Ms Ng Ling Ling.

5.22 pm

Ms Ng Ling Ling (Ang Mo Kio): Mdm Deputy Speaker, I rise in support of the Motion raised. Madam, MOH launched the National Mental Health and Well-Being Strategy in October 2023, which signals the Government's recognition that mental health is a significant issue that ought to be tackled coherently and comprehensively at the national level. Several Members of this House have mentioned the concerning data from the National Population Health Survey 2022 which shows that the prevalence of poor mental health has increased significantly between 2020 and 2022 from 13.4% to 17%. This is almost one in five Singaporeans prone to mental health suffering. What is of greater concern is the higher proportion of poor mental health among our younger adults aged 18 to 29 at 25.3%, or one in four young adults.

I believe that the National Mental Health and Well-Being Strategy and today's Motion are important steps towards creating a mental health inclusive society in which every individual with a mental health challenge can feel safe to be accepted, supported and most importantly, to recover.

I would like to focus my speech on three aspects: one, caregiver support for those looking after individuals afflicted by mental illnesses; two, the accessibility and affordability of mental health treatment in primary and community settings; and three, work accommodation for individuals with mental health conditions.

Firstly, we need to continue strengthening caregivers' support for those who are caring for loved ones afflicted by mental illnesses, especially at the onset of the conditions and when the conditions are recurring and chronic. In 2020, a survey by the Singapore Management University (SMU) showed that three in four caregivers are tired and exhausted from caring for persons with mental health issues and nine out of 10 of them require the hiring and specialised training of a domestic helper. These caregivers can be parents, spouses or even children, depending on which stage of life that the mental health conditions afflict an individual.

Undoubtedly, caregivers of persons with mental health conditions can be bewildered and confused on what is the best course of support, especially at the onset of the mental illness in their loved ones. Even for those who achieve remission, a relapse can also be very hard for their caregivers to accept and to provide support. We can imagine the emotional anxiety and physical exhaustion that they may experience resulting from having to monitor the mental conditions and physical symptoms of their loved ones and looking out for their needs.

By prioritising the needs of their loved ones over themselves, many caregivers can themselves fall into depression as they have to struggle with also complex emotions of anger, disappointment, exhaustion and guilt.

Although there are resources available for caregivers in general, such as training programmes, support groups and counselling services, as mental illnesses can be more complex and can occur at different life stages, I would like to suggest for more tailored care and support for caregivers for persons with mental illnesses. Social service agencies such as Caregivers Alliance Limited have been making remarkable contributions to these fronts, but more resources may be needed to scale caregivers' support programmes as we see the prevalence rates for mental health conditions increase. I feel that more can be done for this group of vulnerable caregivers, especially those dealing with chronic and recurring care recipients.

I would thus like to propose for the Government to enable more research and to develop strategies to address the unique needs of caregivers dealing with loved ones afflicted with recurring or chronic mental illnesses. For example, will the National Mental Health Competency Training Framework guide mental health practitioners in acquiring the knowledge, skills and competencies required? Can these be also extended and contextualised to family caregivers to strengthen the collaborative relationship between practitioners and caregivers of persons with mental illness?

Second, one of the major focuses of the National Mental Health and Well-Being Strategy is the expansion and improvement in access to mental health services in the primary and community settings. I support the shift of mental health treatment in the community closer to home to increase care access. As stated in the strategy report, 17 out of the 24 polyclinics today already provide mental health services. By 2030, this will be extended to more polyclinics, including new ones. This is certainly a step in the right direction.

However, in Singapore, a substantial portion of primary care family doctors are operating out of private GP clinics. Although it is encouraging to see that since 2012, more than 400 GPs have been trained under the Mental Health General Practitioner Partnership Programme (MHGPP), this is still less than a quarter of about 1,700 GP clinics in Singapore. Several of my Jalan Kayu residents shared with me that GP clinics are often more convenient and perceived as less stigmatising for them to approach for mental health challenges concerns, as compared to the mental health section of polyclinics or even psychiatric wards of public hospitals. However, the ease and costs of receiving both medication and counselling intervention in the primary and community settings still have their gaps as they may be delivered by different professionals from different organisations at different locations.

Let me illustrate this with an example. For an individual with early onset of mental challenge symptoms like prolonged insomnia and low moods and clinically diagnosed for depression and/or anxiety, he or she may benefit from the counselling therapy as the first line of treatment and some medication from a GP. However, he or she is unlikely to receive both care at the same GP clinic at the same time, especially for the counselling therapy component.

If they need a certain type of prescription medication not carried by the GP, this will also pose some difficulties in their access to the needed care. Counselling therapy sessions in the private setting also usually cost more than in polyclinics or public hospitals. Usually, individuals facing mental health challenges are already scared, overwhelmed and in distress when diagnosed. Such fee gradients and wait-time between medication and counselling at their GP private clinics in the neighbourhood versus public polyclinics and hospitals' psychiatric wards may increase patients' psychological burdens and disrupt treatment follow-up.

While I appreciate schemes to make mental health treatment at GP clinics to be more affordable and accessible, such as the CHAS subsidies at CHAS GP clinics under the Chronic Disease Management Programme and MediSave support, I believe that more can be done to enable individuals, who require both medication and counselling therapy in the primary and community setting to get more seamless help. I hope that the Government can elaborate on more plans and protocols to manage the cost and facilitate the referral and provision of both medication and counselling therapy in the primary and community care settings.

For example, instead of having the patients navigate a myriad of different professionals for medication and counselling support in different places, would MOH consider adopting approaches, such as Collaborative Care Model in the US, by resourcing private GPs within the MHGPP, to organise their GP-led team to include behavioural therapists and counselling therapists and, focus on providing evidence-based and goal-oriented mental health care for intervention, preferably at designated time or at the convenience of a GP clinic.

Lastly, I wish to address the need for employers and co-workers to understand accommodation needed by individuals with mental health conditions. We know that while work is essential for economic and social reasons, it can be challenging for those affected by mental illness to sustain employment. Studies in Europe have shown that, although most persons with severe mental illness are willing to seek competitive employment, they are nevertheless substantially excluded from the workforce. To better support persons with mental health conditions, workplace intervention and accommodation is necessary to help those who desire employment, which will allow them to achieve financial independence and security, contributing to their sense of belonging to a community and boosting their self-confidence and positive identity.

I am heartened to know that one of the Government's key focuses in the National Mental Health and Well-Being Strategy, is on improving workplace mental health and well-being. This includes enhancing mental well-being in the workplace, tackling workplace discrimination and strengthening employment support for individuals with mental health conditions. I am also encouraged by the moves of various companies in the private sector that has introduced flexible work arrangements and welfare policies to support the mental well-being of employees with differing needs.

I believe that helping persons with mental illness seek or stay in employment, is an important part of mental health intervention to be incorporated in their care and treatment plan. Nevertheless, stigma and discrimination inevitably continue to exist within some workplaces. I would like to ask, whether the Government will systematically roll out initiatives to better educate employers and train co-workers to better understand and facilitate work accommodations for colleagues with mental health conditions?

For example, many people are not aware that common mental health conditions, such as depression and anxiety, have almost 50% chance of a first relapse and a higher chance of further episodes of relapses thereafter. It should not be a surprise that such common mental health conditions are included in the Chronic Disease Management Programme in Singapore. Because, they are, unfortunately, often chronic in nature.

I have heard of stories of inclusive work teams who, out of good intentions, had thought that helping a colleague with mental health condition to discontinue medication is a sign towards recovery, just to be shocked to see their colleague suffer a relapse after a high workload period. To enable more inclusive workplaces, appropriate education for employers and co-workers is, thus, crucial.

Hence, I would like to propose for the Government to leverage on the tripartite relationship between employers, the Government and the union to work with the mental health professionals to promulgate more accurate understanding of mental health conditions and some form of Individual Placement and Support (IPS) plans for appropriate accommodation for persons with mental health conditions to integrate and sustain employment for as long as possible?

In conclusion, Mdm Deputy Speaker, let me quote from the Constitution of the WHO, which states, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Mental health is more than merely an absence of mental disorders or disabilities. Rather, it is a state of well-being in which an individual can realise his or her abilities and potential to work productively and make contributions to the society.

Today's Motion and the National Mental Health and Well-Being Strategy are a commitment to the holistic well-being of every Singaporean. It is a pledge to foster a society where mental health is no longer seen as a stigma, but as part of a nation's collective responsibility. As our nation starts incorporating mental health as a key pillar of our healthcare policy, I believe that as a united people, we can work together to build a more resilient, compassionate and mentally healthy Singapore. Notwithstanding my considerations raised, I support the Motion.

Mdm Deputy Speaker: Mr Melvin Yong.

5.36 pm

Mr Melvin Yong Yik Chye (Radin Mas): Thank you, Mdm Deputy Speaker. I stand in support of the Motion. It is no secret that Singapore and Singaporeans are stressed.

According to the 2023 Cigna Healthcare Vitality Study, Singaporeans are more stressed than the global average. The study also reported that, 16% of Singaporean respondents felt unable to manage their stress loads.

Another study from the National Youth Council (NYC) and the Institute of Policy Studies (IPS) Social Lab, found our young people and young workers experiencing high levels of burnout and that their mental well-being had still not fully recovered from the impact of the COVID-19 pandemic.

Union leaders, too, have told me that their fellow colleagues, across all workforce segments – rank and file, PMEs and freelancers – are highly stressed at the workplace. The main reason cited was how it is almost impossible to disconnect from work when we live in a hyper-connected and global world.

We must, therefore, do more to prevent, identify and treat mental health-related issues at the workplace. Let me start by commending the Government's launch of the National Mental Health and Well-being Strategy in October 2023. The strategy aims to create an effective mental health ecosystem, comprising accessible and good quality clinical care, with a supportive community and society. Instead of an over-emphasis on mental disorders, the Government has recognised that the state of mental well-being is intertwined with a supportive community.

I fully agree with this. And I argue that our workplaces, where most of us spend most of our waking hours, must form a key part of societal support. We need strong upstream measures to address workplace mental health stresses.

Madam, I have spoken on numerous occasions, both in and out of this House, about the need for workers to have a right to disconnect, one that is contextualised to the realities of our global workforce and one that will help ensure employees have protected time to rest and to recharge.

Since I first mooted the idea of the right to disconnect in this House in 2020, several countries have moved ahead with their own versions of the right to disconnect. In 2023, Luxembourg amended its labour code to require that a right of disconnection, outside working hours, must be implemented at the company or sector level. Belgium passed a law in February 2022 that allowed civil servants to disconnect after hours without a fear of reprisals. Closer to home, the Philippines is debating a Bill that seeks to give workers the right to disconnect after work hours.

Locally, union leaders have told me that there are exemplary practices at the company level that provide workers with the ability to switch off after work. I am glad that senior public sector leaders in MOM and MOH, just to name a couple of examples, have made it a point to tell staff that they do not need to feel obligated to respond to emails or work messages sent after work hours, unless it is expressly marked as urgent. We should make this workplace culture the norm rather than the exception.

In November 2020, we published the Tripartite Advisory on Mental Well-being at Workplaces that set out practical guidance on measures that employers can adopt to support their employees' mental well-being. The Advisory also called on employers to recognise the need for staff to have adequate rest outside work hours, in recognition that the work-from-home arrangement had blurred the lines between work and personal life.

In March 2021, MOM launched a new assessment tool, called iWorkHealth, to help companies identify common workplace stresses among employees. The tripartite partners further refresh the Tripartite Advisory on Mental Well-being at Workplaces in 2023 to include the setting up of a peer-support system to help employers create a supportive environment for employees in need and to de-stigmatise mental health issues at work.

These examples show that the close working relationship between the Labour Movement, the Government and the employers have resulted in successful and tangible measures that have helped to advance mental health outcomes at the workplaces.

But let us work and agree on a set of Tripartite Guidelines that establish principles on, what a right to disconnect could mean for different sectors and for different job roles. After a few years, we could then review how effective the guidelines are and to consider further action, including legislation, if necessary at the point of time.

Mdm Deputy Speaker, in some ways, Parliament, too, recognises the right to disconnect. Standing Order 2 expressly states that, Parliamentary proceedings shall be interrupted at 7.00 pm, unless the Leader of the House moves a business Motion to extend the day's Sitting beyond that moment of interruption. After all, Members should be accorded ample time to rest and to recharge and to prepare for the next day's Sitting. On this, I am sure that all Members would not disagree with me.

Individuals, too, can play our part. We only have 24 hours in a day. Lack of adequate downtime can lead to job burnout, decreased job satisfaction and reduced productivity. It is, therefore, crucial for individuals to re-evaluate our approach to work and life. By prioritising, focusing and scheduling downtime, we can reduce stress, enhance our creativity, improve our productivity and, more importantly, lead a healthier and more balanced life.

In addition to disconnecting after work, we need to have trained personnel at the workplace that can identify and do basic triage of early mental health symptoms. Deploying such trained mental health ambassadors at the workplace can help employers maintain a well-adjusted and mentally healthy workforce, thereby ensuring high levels of productivity.

Union leaders can play this important role of mental health ambassadors. Today, NTUC has trained over 1,700 union leaders in workplace safety and health. And the Labour Movement stands ready to partner with our tripartite partners in training and deploying mental health ambassadors at all workplaces.

To help our youths and young adults deal with stress, Young NTUC and the NTUC LearningHub have jointly developed a course to provide peer-to-peer mental well-being support and psychological first-aid skills to distressed colleagues and peers. This course is WSQ-certified and supported by the WSH Council and, I encourage all youths to sign up for this course to become a peer supporter.

Madam, lay-offs also contribute a significant level of stress at the workplace. Statistics by MOM show that the number of retrenchments in Singapore more than doubled in 2023. It is now commonplace to read about company retrenchments, due to restructuring and cutbacks. Recent examples include Alphabet, Amazon and Lazada, which show that even the workers in growth sectors, such as technology and e-commerce, are not spared.

Retrenched workers are more than a statistic. They are men and women who must deal with a sudden loss of income and a disrupted career. Some may feel a deep embarrassment about being retrenched, even if the layoffs were unrelated to their own work performance. Layoffs also affect the "surviving" employees within the company. Those who are retained often take on an immense amount of additional workload and they constantly wonder if they will be the next to get laid off.

I, therefore, hope that companies can recognise that retrenchments should be done as a last resort. So, what can employers do to limit the psychological impact of a retrenchment exercise?

First, communication should come from the top, with the leadership team owning the message. But it also needs to be a two-way process, allowing all employees to have their questions answered.

Second, every impacted group needs support that is tailored to their needs. Providing more generous compensation packages for retrenched workers can help to alleviate immediate financial concerns. Employers can work with NTUC on job placements and training for new job roles.

Third, employers need to think carefully about job redesign and workload distribution for the remaining roles of those who are left behind in the company.

Retrenchments are never pleasant, but there are ways for employers to undertake the process with compassion and to treat all employees – whether they are staying or leaving – with utmost dignity. Companies which retrench irresponsibly should not be let off the hook for the stress and mental trauma that they cause.

Mdm Deputy Speaker, workers today are subjected to high levels of workplace stress, be it through a retrenchment exercise, a relentless workload or the inability to disconnect after work. I hope that there can be greater support to help with the treatment of workplace mental health challenges. This can be achieved through a widespread adoption of Employee Assistance Programme (EAP) providers.

EAPs are professionally conducted programmes that are designed to engage employees to deal with their personal and relational difficulties that may impede their work performance. I, therefore, welcome the Government’s current efforts to subsidise the fees of some of these services. However, more can be done to improve the affordability of mental healthcare.

We should also grow the industry and increase capacity to reduce waiting times. Assurance must also be given to employees that their confidentiality is protected and it would not affect their personnel records with the company. I urge more companies to adopt EAP services and to engage credible EAP service providers. The Labour Movement has and will continue to help drive the adoption of EAP services at workplaces to safeguard workers’ mental health.

Mdm Deputy Speaker, the challenges arising from workplace stress have been on the rise even before the COVID-19 pandemic exacerbated the issue. It was recently reported that the findings from the 2022 Quality of Life Survey found that Singaporeans have become less happy over the past decade, despite real incomes rising over this period. Even high net worth individuals in Singapore are found to be concerned with their work-life balance, according to a recent study reported in The Business Times.

Mental health issues at the workplace affect everyone, regardless of socioeconomic status and designation. We need to tip the balance and advance mental health outcomes at the workplace. We must prevent workplace burnout by doing more for workers to have the right to disconnect. We should train and deploy workplace mental wellness ambassadors to help identify early mental health challenges and, where necessary, we certainly need a proliferation of EAP providers to treat and to address mental health challenges. Madam, I support the Motion.

Mdm Deputy Speaker: Ms Jean See.

5.49 pm

Ms See Jinli Jean (Nominated Member): Thank you, Mdm Deputy Speaker. I appreciate Dr Wan Rizal and fellow Parliamentarians' initiative of putting forth this Motion.

A 2022 survey on the well-being of small business owners by global small business platform, Xero, revealed a startling paradox. Compared with peers in Australia and the UK, Singapore’s small business owners ranked highest in levels of work-related stress. Other data points that made me sit up: 39% were taskmasters who found it hard to take a break from work, while 41% expressed a low sense of fulfilment from work.

Driven by a constant sense of responsibility and duty to their business, it is inevitable that many small business owners work intensive hours in intense focus. The pool includes freelancers and self-employed persons, a less visible group of our Singapore workforce, whom my fellow NMP Ms Usha Chandradas also spoke about. For brevity, I will refer to them as freelancers.

Spurred on by pandemic fears and financial losses and challenged by the increasingly uncertain business outlook, freelancers as diverse as photographers, sports coaches and private hire vehicle drivers have been working relentlessly to rebuild their confidence, business and savings. Many are now feeling overworked and burnt out.

In my capacity as a labour representative, I would like to give voice to the concerns of three groups of freelancers who are hard-hit by internal and external stressors. They are the platform workers, working caregivers and mature-age small business owners. I would also suggest three approaches that could contribute to improving their mental health and well-being.

First, platform workers. A 2022 IPS study of private hire drivers and food delivery riders found that 84% worry about not having enough retirement savings, while 88% worry about not being able to cope financially if an accident or serious illness befalls them or a family member. Unsurprisingly, 94% reported facing moderate to high financial stress. What is more worrying is that while nearly two-thirds surveyed professed resilience to the uncertainties of platform work, this is not reflected in their state of health. A significant 44% of private hire vehicle drivers reported that since they started driving, their health has been on the decline.

Because of global challenges and inflation, platform workers expect operating costs to continue to rise. However, many worry that their incomes are not keeping pace. This is because job allocation and trip fares are at the mercy of the black box algorithm of platform operators. Uncertainty can be unsettling.

The upcoming changes in legislation are intended to better protect platform workers. Nonetheless, it is only if the changes are reinforced by shared responsibility of the tripartite of Government, platform worker associations and platform operators can these changes translate to positive outcomes of sustainable livelihood and improved well-being of platform workers. To platform workers, sustainable livelihood means knowing that for the same amount of work done, they will receive consistent, transparent and fair compensation, and not inconsistent and fluctuating amounts, whilst improved well-being means giving platform workers the assurance that platform operators’ pursuit of profit and returns to shareholders are not at the expense of platform workers’ health and safety. In this regard, I echo the platform workers’ hope for a brighter tomorrow as we await the new legislation to come onstream this year.

Second, freelancers who are working caregivers. The same IPS study revealed that 46% of the platform drivers and riders surveyed were unable to find other work due to personal reasons, such as caregiving responsibilities. For instance, a condition such as dementia impacts more than those living with the condition. Dementia affects about one in 10 in Singapore aged 60 and above. This number is set to rise as Singapore ages.

The CEO of Dementia Singapore, Jason Foo, shared in a 2022 The Straits Times article: "For every person with dementia, one or two family caregivers have to change their entire lifestyle, or give up work, to care for the person with dementia".

I know of individuals who switched to freelancing because of caregiving responsibilities. I know, too, of freelancers who dialled back on work because of caregiving duties. Unplanned circumstances can be stress-inducing.

This suggests a need for an inclusive, enlightened and supportive ecosystem for freelancers with caregiving responsibilities. Freelancers who are caregivers should be uplifted and supported with the same degree of accommodation and care as what we seek for employees with caregiving responsibilities.

In respect of the freelancer ecosystem, I would like to ask that service buyers and platform operators give leeway in service delivery or incentive framework if the freelancer or platform worker must respond urgently to caregiving emergencies. Similarly, care facilities, such as hospitals and homes, could extend consideration to freelancers who are juggling caregiving and income-earning responsibilities. Some freelancers shared their frustrating experiences when liaising with different agencies and facilities that, in turn, have different levels of empathy and responsiveness to these freelancers in need.

Allow me to relate the experience of Ms T, a private hire car driver and sole breadwinner. Ms T found herself stranded after a second fall at home worsened her aged mother's injury. Ms T sought help from the social worker when she found it challenging trying to juggle the logistics and finances of caring for her mother at home while trying to make ends meet driving. Ms T was told by the social worker that Ms T’s mother did not qualify for subsidised nursing home care. When Ms T tried to find out the reason for rejection, she was ignored. Ms T was left feeling stranded, stressed, tired and helpless.

Freelancers, such as Ms T, feel they are held hostage to unproductive and frustrating processes. They find themselves unable to assert their need for empathy and expedience and thus, suffer in silence. Freelancers with caregiving responsibilities would benefit from an integrated approach to supporting care recipients and their caregivers. This entails a whole-of-nation commitment to build an inclusive, enlightened and supportive ecosystem.

Last, mature freelancers. The Xero study of small business owners found that Singapore’s small business owners under age 30 had higher overall well-being levels than those over 50. This could be a consequence of rapid digitalisation.

The acceleration of digitalisation during the pandemic compelled businesses to adapt to new consumer demands. NTUC’s National Instructors and Coaches Association (NICA) represents freelancers who are instructors teaching sports, arts, exercise or enrichment. During the pandemic, NICA was quick to roll out digital literacy and skills training to equip coaches and instructors to conduct virtual classes. Despite support from NICA, many mature NICA members struggled with the transition. Unprecedented disruption can be worrying.

This suggests a need for the Government to partner bodies, such as NICA, to provide targeted and sustained funding support for mature freelancers to procure and upskill in digital technologies and harness these technologies for productivity and business development. Many from this group are financially stretched to part with funds upfront for updated software and technology. Mature freelancers who are trying hard to cope with the pace of change while overcoming the digital divide by upskilling would certainly appreciate targeted and sustained funding support from the Government.

I would like to conclude on a positive note. Circling back to the same Xero survey, Singapore’s small business owners ranked second in terms of overall well-being and life satisfaction. Therefore, despite the challenges, freelancers are generally optimistic about the future.

I had earlier shared the stresses of three groups of freelancers, in particular, platform workers, working caregivers and mature small business owners. I had also suggested three approaches to uplift their mental health and well-being. Allow me to recap how, as a whole-of-nation, we could provide the solidarity and support to improve freelancers’ mental health and well-being.

First, stakeholders could commit to a shared responsibility towards freelancers’ well-being. Second, a national level commitment to build an inclusive, enlightened and supportive ecosystem to support freelancers with caregiving responsibilities. Third, the Government could collaborate with freelancer-centred associations to provide mature freelancers with targeted and sustained funding support for upskilling and to procure new software and digital technologies. This empowers mature freelancers with the confidence and ability to strive for sustainable business and longevity of livelihood.

These three approaches can be the game-changers for platform workers, freelancers with caregiving needs and mature freelancers in Singapore. They give freelancers and self-employed persons the confidence to pursue professional progress and personal happiness as viable intertwined priorities and could be practical next steps in the articulation of this Motion. Mdm Deputy Speaker, I support the Motion.

Mdm Deputy Speaker: Mr Keith Chua.

5.59 pm

Mr Keith Chua (Nominated Member): Mdm Deputy Speaker, I stand in full support of the Motion for a whole-of-Singapore effort to forge a national strategy to address mental health and well-being.

May I, first, declare my interests serving on the Boards of Social Service Agencies providing various levels of support for persons in rehabilitation and recovery from mental health conditions. I am also a member of WG3 that contributed toward the National Mental Health and Well-Being Strategy.

Mental health issues affect a wide percentage of our population in varying degrees of severity. The onset can take us totally by surprise or can be the result of life's challenges. It can be triggered at home, in school and at work by an emotional experience or a bereavement. Support for mental health issues require a combination of access to primary healthcare, social support, family support and caregiving. There may also need to be financial support both for meeting the cost of services and where there is a loss of income.

I have been a volunteer in mental health services for about 30 years, and over this period, our mental health services have seen several areas of increasing support with the introduction of more services and also more treatment options.

[Mr Speaker in the Chair]

We have seen the move toward recovery in the community. We are gradually addressing the issues of stigma that have long prevented persons with mental health conditions from seeking help. We are seeing more individuals re-integrated back to employment and educational institutions. In the more recent years, we can state with increased confidence to persons with mental health conditions that recovery is possible.

While we have progressed, we need to keep improving across all areas of mental health and well-being. The National Mental Health and Well-being Strategy launched in October 2023 will bring further enhancements to building up effective mental health services across four areas of focus and calls for a whole-of-society approach. I would like to add some observations and suggestions in the areas of early intervention, suicide risk and early prevention, support in recovery and removing stigma and normalising mental health.

Identifying mental health issues early remains a key area to try to reduce the eventual severity by accessing professional support and where necessary treatment, including counselling and medication. IMH has excellent services in early detection and intervention. Unfortunately, the continuing existence of stigma associated with mental health issues continues to hold back individuals from seeking proper care and help early.

I am encouraged by the response to a question I raised in November that MOE will be ready to step up counselling support in our schools and Institutes of Higher Learning (IHLs) if and when necessary. One of the areas we need to resolve is where parents withhold consent for their children's treatment. We should address this as a matter of priority.

In the workplace, we also see improving understanding of mental health and wellness. We need to continue to bring on board the CEOs, senior executives and HR professionals to better understand mental health issues in the workplace. Recent studies have shown the economic cost of mental health issues and more companies, whether SMEs or larger companies, need to proactively embrace conducive working environments. Many of my colleagues have mentioned this already.

Our seniors also are vulnerable to loneliness and isolation and, as a community, we need to ensure that as we move toward an ageing society, we have in place the necessary support systems to address mental health issues, including cognitive functions.

Suicide continues to be an area of concern with the vulnerable groups being teenagers and young adults and the seniors. Our community can play a role in identifying individuals with suicidal ideation and guide them in seeking support and professional help where appropriate. It was noted in response to a PQ that a number of individuals who completed suicide did not have any record of seeking help. We need to find avenues to address this particular area.

As mentioned in the October report under Competency 6, efforts must be taken to identify those at risk of suicide and intervene effectively. As we build up our care and support systems, we must do all we can to prevent the next suicide.

Support in recovery is a key part in helping everyone with mental health issues. Recovery is an individual journey, and everyone will recover at a different pace. This means that our support systems need to be able to accommodate each individual. Some may recover at a faster pace, others may take longer.

In providing professional support, we may need to review the often-used quantitative approach. Rather, a more qualitative approach would ensure appropriate levels of care and support tailored to each individual. I do hope the tiered approach will help us move in this direction. The KPIs, for example, set for service providers who are supported by public funding, should also be reviewed to enable adequate care and support in programmes, such as our Community Intervention Teams (COMITs). Every person with a mental health condition has their individual journey of recovery.

About 20 years ago, one of the organisations I volunteered with piloted a clubhouse model for recovery. The clubhouse model can be either residential or daycare. The model engages members in recovery in a whole variety of activities and at a level and pace that the individual member can manage. These would range from the simpler to the more advanced roles. Members can be engaged with cleaning, administration, preparing meals, planning and running activities, pursuing hobbies, arts and crafts, finding jobs and providing support to those who have jobs.

One area that we found limited our model was the absence of an allowance, such as a disability allowance provided for in some other countries. And these are for those members who were not yet ready to return to work and earn some income. In Hong Kong, for example, there is access to disability allowance and the clubhouse model works quite well there for persons who find this suitable recovery track. In studying their model, it was found that the availability of a disability allowance did not necessarily become a disincentive for members to eventually return to work when they were ready.

I have long advocated for the consideration of some form of financial support for those persons in our community in recovery. As mental illness is not classified as a disability in Singapore, there is no specific access to financial support during the period where a person is unable to return to work. In some cases, this can be years, especially for the more severe cases.

While there is the provision of ComCare Short-to-Medium-Term Assistance (SMTA) for persons with lower income and unable to work for extended periods, can we review the provision of a disability allowance scheme where individuals who have financial difficulties during the treatment and recovery can receive adequate support until they are ready to return to earning income?

In Asia, places like South Korea, Japan and Hong Kong provide various levels of disability allowances which include mental illness. Similar support is available in Australia, England and the US. The availability of some form of disability allowance extends the rehabilitation options and programmes for persons in recovery. I understand that IMH is reviewing the implementation of the clubhouse concept for helping persons in recovery, having recently sent teams to study this, operating both in Hong Kong and in China.

I would like to acknowledge the many employers who, over the years, have stepped forward to provide employment opportunities for persons in recovery. You have made invaluable contributions to helping so many reintegrate and recover. We need more employers to step forward and provide opportunities for persons in recovery to find suitable jobs.

In helping persons in recovery to return to the workplace, there are employee assistance programmes that support both the individuals and the employers. There is a cost attached to providing these employment opportunities. In order to support more companies to step forward and here, I am thinking of particularly the SMEs which may provide, in many cases, a more suitable and conducive environment for re-employment, I would suggest that we consider schemes where employers can be provided with credits for employing persons in recovery. This could be by expanding the Enabling Employment Credit scheme in place for persons with disabilities to include persons with mental health conditions as more flexible arrangements are often required.

Social enterprises have also been established to provide employment opportunities for persons in recovery. The common challenge for social enterprises has been financial sustainability. Notwithstanding this fundamental challenge, a few have found ways to stay financially sustainable and continue to offer hope to many persons in recovery. I would like to thank you for your continued commitment and perseverance.

Our society has to keep working toward normalising mental health and wellness. The stigma associated with mental health issues remain but perhaps, we are seeing this gradually becoming less of a hindrance for people seeking proper help and towards accepting persons in recovery in our community.

Recovering in the community is still the better approach for persons with mental health issues. Better understanding of mental health issues will reduce stigma. Stories of recovery will provide better understanding. As we build mutual respect as a nation, we will encourage acceptance of those in our midst who are differently abled and more vulnerable.

Mr Speaker, Sir, we must continue to do all we can to help those in our community seek early help for mental health issues. We must continue efforts to find ways to intervene effectively to help those at risk of suicide. We must provide the necessary support structures for persons to recover at their own pace and do so with dignity. We need to continue to reduce and eventually remove stigma associated with mental illness.

Mr Speaker: Miss Rachel Ong.

6.12 pm

Miss Rachel Ong (West Coast): Mr Speaker, my speech will focus on encouraging help-seeking behaviours in our youths and working adults.

A 2022 study by Duke-NUS Medical School revealed that only half of those with anxiety and depressive mental disorders in Singapore were formally diagnosed. A lesser 31% sought mental healthcare and still lesser consulted a mental health provider. This is a treatment gap, or gap between those who need treatment and those who actually get treated, of almost 70%. We must reduce barriers and increase entry points to help-seeking.

First, encouraging help-seeking in youths. For the fourth consecutive year, suicide has been the leading cause of death among our 10- to 29-year-olds, and 30% of youths who committed suicide in 2022 were 10- to 17-year-olds. This makes supporting help-seeking for our under-18s critical.

May I propose five interventions for our youths?

First, age requiring parental consent. I am encouraged that the Government is presently reviewing the age of consent for youths to access counselling or therapy. Common law states 21 as the age of consent, while some local mental health providers generally require parental consent to serve those under 18. But requiring parental consent, whether at age 18 or 21, discourages help-seeking in many youths. Some do not want their parents to know at the onset, especially if parents are unsupportive. Some fear disappointing their parents or believe it would further burden their already burdened parents. There are also instances where parents have declined medication for their child simply because of stigma.

If our young people are deemed responsible enough to drive as well as bear arms in NS at the age of 18, they should not be held back from accessing mental health services and taking ownership of their mental well-being. I urge the lowering of age of consent for mental health services to 18 years old, including interventions requiring medication.

Youths aged 14 to 16 report more serious symptoms than those other youths with depression and anxiety. Mental health support must be readily accessible for our youths from 14 to 18 years old. For this group, may I ask the Government to consider tiered guidelines for the types of mental health services that would or would not require parental consent?

For example, access to mental health screening, assessment or basic counselling could be tier 1 services not requiring parental consent. This supports the good work many youth counselling agencies are already doing. Tier 2 services requiring parental consent could include interventions requiring medication, hospital admissions or surgical procedures. Where parents are deemed absent or unwilling to make decisions beneficial for the child, MSF could be invited to step in on behalf of the child or the Gillick Competency Test can be applied by a certified clinician.

At the same time, it is vital we protect our 14- to below 18-year-olds from errant mental health practitioners. This leads to my next point: proper licensing of mental health practitioners serving youths.

As we upgrade the capabilities of our mental health service providers, we need to ensure proper certification and licensing of professional mental health service providers, particularly those who list themselves as psychologists, counsellors and therapists. This is crucial for those who treat youths below 18. Presently, the only mental health practitioners that are properly regulated are psychiatrists, who fall under the purview of the Singapore Medical Council.

Anyone can refer to themselves as a therapist or counsellor. To ensure the safety of our youths, mental health services they have access to should be regulated and licensed. There must be strong disciplinary consequences to violations of professional conduct and ethics. This will perhaps ease the concerns of our parents and also promote safe help-seeking behaviours in our youths.

Third, leveraging social media. In our work at Trybe, a youth non-governmental organisation (NGO), we observe an increasing trend in youths educating themselves on mental wellness via social media resources. Some sources have been particularly helpful, supporting our youths in their mental wellness journey, but some have provided inaccurate or incomplete information.

We have youths telling our counsellors, "I know you are using CBT on me, and I know the next question you're about to ask", or "I want another therapy approach". This view of believing that they know what CBT, short for Cognitive Behavioural Therapy, or any one approach, is all about is an inaccurate view of therapy as a whole.

Different therapy approaches are not a menu meant to fit personal preferences alone. Good therapists draw on various techniques and tools to meet the client's needs at different points of the therapy. Such information on social media can create mistaken notions of what therapy is, when actually, if approached consistently, would bring out the best results for the client.

Social media has become and will continue to be a regular source of information and news for our youths. We should continue to leverage social media to support youths in their mental wellness journey as there remains many positive influences. But to reduce misinformation, the Government could explore co-curating a list of social media accounts on mental wellness together with our youths, validating accounts recommended by our youths themselves.

Fourth, intervention programmes for transition years. I was heartened to hear that HPB conducts Mental Wellness Skills Equipping Programmes addressing life transition years from preschool to Primary 1 as well as Primary 6 to Secondary 1. I would also like to propose that the Government look into the transition years of Secondary 2 to Secondary 3. Youths and counsellor friends shared observations that there seems to be a marked increase in mental health issues and stressors for youths entering Secondary 3, or the 15-year-olds, especially among the females.

The pressure at this transitional stage stems from various reasons: the increased pressure and workload due to the approaching "O" levels, the adjustments to new classmates from streaming, and greater awareness of one's sexuality, relationship and identity issues. Others active in their CCAs are given increased leadership responsibilities when the Secondary 4 students step down from their positions, all these while navigating in these formative years. A more in-depth survey could be done to gain further insights on this unique transitional age for our Singapore students.

As we develop resources for school intervention programmes, might we consider a more collaborative approach with our youths?

In the UK, in preparation for Children's Mental Health Week, the team gathers feedback from primary and secondary students on what and how they would like to learn about mental health in school. Downloadable resources are then developed for students from four-year-olds to 18-year-olds, to facilitate conversations during mental health week in families and in schools. Two interesting findings from the feedback were received: first, getting students to lead lessons on mental health; and second, for school assemblies on the topic to be short and engaging. The resources are used in over 500 schools across the UK and downloaded over 200,000 times in 2022 alone. Who knows what we may uncover as we work together with our youths for their mental health.

Fifth, incorporate mental health check-ups in schools. HPB's Youth Preventive Health and Dental Services conducts annual health screening for our students in primary and secondary schools. Meanwhile, the Youth Integrated Team (YIT) also conducts mental health screening for youths at risk of mental illnesses. Considering these two available platforms, may I propose for basic mental health assessments to be incorporated as part of the annual health screening? This supports early intervention and normalises mental health discussions at school-going age for our students and parents.

On interventions to encourage help-seeking in adults.

First, insurance. The issue of lack of insurance coverage for people with mental illness has been raised by several Members last year, specifically, the challenge in obtaining insurance for physical health conditions outside of the mental illness individuals have or used to have. This gap impedes help-seeking behaviours in adults who may not afford treatment without the support of insurance. A psychiatrist friend related how patients have requested to be officially discharged or not to be treated at all, just so they can purchase physical health insurance. In one case, a patient's financial consultant shared with him that buying accident and health insurance would be impossible if he remained on medication.

Senior Parliamentary Secretary Rahayu Mahzam had responded in Parliament that those wishing to top up subsidised services and MediShield Life may do so via private insurers. These insurers are expected not to indiscriminately reject an application based solely on declared information, including mental health conditions. However, such incidents happen in far greater frequency than reported.

In a published interview from 2020, Ms Linda Lui reported that after fully recovering from a field accident as an army cadet, she experienced post-traumatic stress disorder (PTSD). This happened a year after she returned to civilian life. And as she sought therapy in a Government institute, her doctors advised her not to disclose her PTSD diagnosis because it would complicate things and affect the insurance coverage she had bought prior to the diagnosis. She states, "I chose to remain silent about my mental health in order to protect my physical health". The fear expressed by her and her doctors are not unfounded.

In another published interview, Ms Vas shared how countless insurance companies denied her applications to be insured against critical illness and hospitalisation on account of her bipolar disorder diagnosis. This is even after her doctor certified her physically healthy and compliant to her medications. In her interview, Ms Vas also revealed the multiple appeal letters made to various insurance companies, including an appeal by her MP. They were all submitted to no avail.

These appeals only add mental load to their already mentally burdened state. Given ongoing examples of rejection, coupled by warnings from doctors and insurance brokers not to declare their illnesses, one's options are to conceal, skip treatment or go without insurance.

There are private insurers that do insure those with mental illnesses. However, their premiums are often unaffordable for the masses. In Ms Vas' case, she finally found an insurer, at a premium of $8,000. Individuals recovering or have recovered from mental illness should not be penalised for boldly seeking help for their mental health. Yet, the discrimination against people recovering or have recovered from mental illness when obtaining insurance for physical health conditions can be daunting.

May I propose for the Inter-Agency Taskforce on Mental Health and Well-being to take on this complex but necessary task to clarify with insurance companies when exclusions are discriminatory against people with mental illnesses and to also outline the recourse available for individuals facing the discrimination?

Second, support workplace leave policies. Mental health clinics often operate during work hours and weekend slots get filled very quickly. This means when an individual needs to seek mental health support on a weekday, they would need to take leave from work. Under current MOM guidelines, paid outpatient sick leave requires employees to be certified unfit for work by a medical professional registered under the Medical or Dental Registration Act. Since only psychiatrists are licensed under the Medical Registration Act, those seeing psychologists, counsellors and mental health therapists will not qualify for paid medical leave. Individuals then hesitate to seek treatment due to their limited annual leave and the risk of it being known that they are seeing a mental health professional.

Some companies have implemented a 14-day well-being leave in place of the traditional medical leave. It allows staff to take leave for physical or mental illness for when their dependants require care or to take time-off for their own personal well-being, all without the need for medical certification. This benefits parents, caregivers and individuals across a broad spectrum. For individuals seeking mental health support, this also provides a level of privacy. I submit for consideration modifying the traditional medical leave system to recognise a broader range of interventions for mental health. This will meet the evolving needs of Singapore.

Third, mental health check-ups in national health screening. As with the youths, mental health check-ups could be incorporated as part of the national health screening programme for adults or as part of workplace health screening. Such a check-up incorporated into our National Healthcare Plan will communicate the importance of mental wellness, encourage conversations and advocate for early help-seeking.

Mr Speaker, renowned neuro-psychiatrist and expert on resilience, Dr Boris Cyrulnik states, "No child is doomed by their past. But if we abandon injured people, there will be no resilience". By reducing institutional barriers and increasing entry points to help-seeking, we will show up meaningfully for the individuals in need, raising the resilience of our people and society. With that, Mr Speaker, I support the Motion.

Mr Speaker: Mr Ong Hua Han.

6.28 pm

Mr Ong Hua Han (Nominated Member): Sir, the Motion tabled today is timely, given we have just launched our National Mental Health and Well-Being Strategy last October. A topic of national significance requires a collective effort to achieve our shared objective. This is not just a medical issue, but a national and social one. I support this Motion.

According to a study conducted by the Instant Group in 2022, employees in Singapore are the most overworked in the Asia Pacific, clocking an average of 45 hours per week. Even for us "kiasu" Singaporeans, this is probably not the statistic we are most proud of. In my line of work, a fast-paced demanding working life is also my personal experience. For many adult Singaporeans, a majority of their waking hours is spent working. With digitalisation, now augmented by artificial intelligence, more will be demanded of workers than ever before. Yesterday's work-life balance has become today's work-life integration.

It is crucial then that the mental well-being of Singaporeans has to be looked after at the workplace. I am glad that our national strategy, under focus area 4, recognises this clearly.

In the employment landscape, over 70% of Singapore's workforce is employed by small and medium enterprises (SMEs). Unlike larger corporations, SMEs generally do not include mental health coverage in their medical benefits. With tighter budgets and limited human resources, SMEs are more cautious in structuring their employee mental health benefits, preferring to start with basic inclusions, like having a 24/7 counselling hotline.

In contrast, multinational corporations (MNCs) have more at their disposal. Employee Assistance Programmes (EAPs), third-party vendor-led sessions and mental health toolkits are not uncommon finds at leading MNCs. While there has been a sharp increase in companies including mental health coverage from 2020 to 2023, MNCs are mostly behind driving this.

Regardless, the need for mental health support in SMEs is pressing, and 75% of SME employees believe that mental wellness is a key factor for their overall well-being.

To encourage such companies to implement well-being programmes and mental health coverage, the cost of adoption must be reduced. Digital tools are now able to provide objective data on the mental health landscape of an organisation using employee self-assessments. The Tripartite Advisory on Mental Health and Well-being at Workplaces recommends organisations to use iWorkHealth, a digital self-administered tool, to understand the general state of employee well-being. A few hon Members who spoke before me have also mentioned this useful tool. Other national level digital tools such as MindSG, Mindline and Let’s Talk, are also highlighted in the Mental Health Strategy Report.

While these tools are a step in the right direction, there is a need to find more innovative ways to encourage SMEs to leverage technologies or platforms that help them better understand and support employee well-being in a cost-effective way.

Well-meaning SMEs looking to advance their mental health support often find themselves constrained by a lack of expertise. Under the Total WSH Programme by the WSH Council, companies will be paired with Total WSH Service Providers who will work with them to assess health, mental well-being and safety risks in the workplace before introducing specific interventions.

A programme like this has the potential to amplify the mental health resources available to SMEs, in a consistent and scalable manner. At this point, I have three questions. Could the Government share an update on whether this programme has been successful, and what more can be done to encourage SMEs to participate? What were some of the learnings, workplace adjustments or best practices that companies can easily adopt? Would it be feasible for MOM and WSH Council to expand grant coverage to include consultancy costs, so that SMEs can better deliver the "how to" in addition to the "what to" on the mental health matters?

The utilisation rate of Employee Assistance Programmes (EAPs) in the private sector is notoriously poor. On average, they range between 1% and 3%. It would be insightful to understand how the Public Service Division’s EAPs compare. Low utilisation rate in the private sector can be attributed to a lack of trust towards companies, stigma around calling a counsellor and unconvincing communication regarding the benefits of EAPs.

The Tripartite Advisory on Well-Being at Workplaces recommends that companies assure employees that conversations with EAP providers will be kept confidential. This is absolutely critical to ensure that EAPs are used at all. Addressing mental health concerns within the workplace requires confidentiality, support, and the eradication of stigma. This is especially important for those grappling with chronic mental health conditions.

A 2021 study showed that only six in 10 respondents were willing to work with someone with mental health conditions. This shows that stigma is still at large. The long-term hidden nature of chronic mental health conditions requires ongoing support and more understanding. For someone with these conditions, to disclose or not to disclose is a real dilemma. Given this, the upcoming Workplace Fairness Legislation, which recognises mental health as a "protected characteristic", is highly relevant. For employees and employers alike to navigate this new landscape confidently, clarity is essential.

Can the Government clarify how this legislation will protect employees who choose to disclose their mental health conditions or even invisible disabilities? How will it guarantee that such disclosures result in genuine support and prevent any form of further stigma or discrimination? Such clarifications will go a long way to enable those who need help, to seek the right support.

Improper handling of mental health disclosures creates an environment where employees may hesitate to seek help due to fears of repercussions or discrimination. Someone once shared with me a real conversation they had at an SME. When they sought support for mental health concerns, the response from their manager was dismissive: "Don't tell me. I don't want to know. If you want help, tell HR and have it on your record."

When an employee discloses their mental health condition to their supervisor, there is also an implicit expectation of confidentiality, if not support. When this information is further freely shared with senior management or other employees without consent or regard, trust is eroded, giving rise to the impression that open disclosure can be punished. Such fears or lack of trust cannot be allowed to fester, for it is trust and psychological safety that make up the foundation of a truly inclusive and supportive workplace.

In the public sector, the Government has a significant opportunity to play a leading role in promoting the normalisation of working with individuals facing mental health conditions. Could the Government shed light on the support measures and initiatives in place for public service officers' mental health and share data on the percentage of officers who accessed mental health support for each of the years between 2020 and 2023? This will help us gain valuable insights into the effectiveness of current support measures, helping us understand what has worked and what has not.

Government initiatives such as the well-being champions network tap on managers to identify signs of burnout and stress among employees. Some companies have also trained mental health first aiders to create a peer support network. This is important. I have personally heard stories where workplace peers were able to spot an employee showing signs of distress, signs even their family missed.

While trained managers and peers play a key role in workplace well-being, it is essential to acknowledge that they do not replace expert help. When addressing workplace mental health, we must not forget that they shoulder an emotional burden in the service of others, on top of their regular workload. We must not neglect their well-being too.

Moving on from the workplace, I would also like to touch on the more vulnerable groups in our society before I close. In the US, a study by the Centers for Disease Control and Prevention, found that adults with disabilities report experiencing more mental distress than those without disabilities. It was estimated that in 2018, 32.9% of adults with disabilities experienced frequent mental distress, defined as 14 or more reported mentally unhealthy days in the past 30 days. This is a significant proportion.

When addressing disability, we cannot focus on just the medical dimension alone. We must not neglect the mental health risk that comes with feelings of limitation, lack of agency or loneliness. For instance, it is common for mental health conditions like depression to accompany those who acquire disability in adulthood, as they navigate profound adjustments to a new reality.

Living with chronic or severe illnesses is emotionally challenging. A study conducted in the UK shows patients with a chronic physical condition were less likely to have sought treatment for mental health. The demands of managing the chronic physical condition may lead to the failure to spot mental health symptoms, both by doctor and patient, during clinic visits. Developing personalised mental health plans that address the emotional aftermath of illness is essential for a patient’s long-term well-being.

In the Singaporean context, while we make mental health a national agenda, it may make sense for the national strategy to also include a dedicated approach to identify and look after the mental health of our more vulnerable residents. It would be helpful to know if the Government will consider this when implementing our mental health strategy.

Addressing this is relevant to all Singaporeans. The unpredictability of life means we cannot discount the possibility that any one of us could acquire disability or significant health challenges in future, especially as we age.

Mr Speaker, navigating the complexities of mental health issues is no small effort. In our national approach, we must strive for authentic solutions and stay well clear of well-being washing. When we do this well, I am positive that every Singaporean will benefit.

Mr Speaker: Deputy Leader, Senior Minister of State Zaqy.

Debate resumed.

Mr Speaker: Ms Nadia Samdin.

6.40 pm

Ms Nadia Ahmad Samdin (Ang Mo Kio): Mr Speaker, Sir, I rise in support of the Motion. A 2023 study conducted by Duke-NUS Medical School and IMH suggested that anxiety and depression could be costing Singapore nearly $16 billion a year as a result of absenteeism, reduced productivity and healthcare resources.

But beyond dollars and cents, mental health conditions are often deeply painful and cost individuals years of lost hope, fractured relationships with care partners and family who are unable to cope with the strain, ending of careers as their lives spiral into a form they do not recognise and feelings like stress and guilt as they struggle to cope on the surface. Sometimes, this lasts a lifetime and recovery is not linear.

In Cheng San-Seletar, student volunteers, corporate partners, grassroots leaders and agency representatives commemorate World Mental Health Day every October. We host a campaign incorporating self-care activities, nature and opportunities to form social networks among neighbours and friends. On the first day, we door knock more than 18,000 households to ask "How Are You?" checks on our residents and share access to mental health resources. The idea is to reach in and start a conversation on mental health in the community because mental health illnesses can be incredibly isolating and lonely, and it is not always easy to take the first step to seek help. Our message is that you are not alone and that we are here for you. Efforts continue for the rest of the year, working with community partners, including through our Calm Corners, which are rolled out at void decks in every zone.

However, the work to raise awareness and increase outreach is only a start. I am heartened by the launch of the National Mental Health and Well-Being Strategy by the Inter-agency Taskforce, and I am supportive of the four focus areas. I am also grateful for all healthcare workers and many different individuals whose work has brought us here.

The efforts in the strategy will take significant effort and resources, not just from Government but also from the different sectors, private sector as well as all of society in tackling stigma and creating a culture of care. It will also take time, and I note that the National Mental Health Office is likely to only be established by 2025.

But Sir, the issues are pressing here and now, and we must tackle them with haste. The prevalence of poor mental health rose from 13.4% in 2020 to 17% in 2022. And Singapore recorded more suicides across all age groups in 2022, with a significant increase amongst the elderly and youth populations.

Today, I will raise three key points on access and affordability to mental health treatment and support, caring for the mental health of our seniors and support for vulnerable groups.

Sir, we often tell those facing mental health challenges that they should reach out and seek help. While readiness to do so is, indeed, the first step, we must also consider the financial capacity of such individuals and the ease at which they can access mental health support.

Last year, MOH shared that the median waiting time for a new subsidised appointment was 45 days to see a psychiatrist and 42 days to see a psychologist. Past surveys have also cited high cost as a deterrent, resulting in a treatment gap which often leads to mental health conditions worsening over time. While there are helplines and some free counselling sessions available, long-term dedicated care and medication can cost patients hundreds or even over $1,000 per visit. Subsidies for Pioneer Generation, Merdeka Generation and CHAS card holders are up to $540 annually for the management of mental illnesses under the Chronic Disease Management Programme for only certain conditions.

This leads us to a crucial point – the Government's role in shaping the insurance market to promote affordable and accessible mental health coverage, as well as general health and hospitalisation coverage for everyday Singaporeans facing mental health challenges.

It is already tough enough for individuals facing mental challenges to get through their daily life, many of whom have to stop work and are faced with difficulties when asked to declare whether they have gone through or are currently facing mental health challenges, as they try to sign up for even simple hospitalisation insurance to try and avoid further financial stress.

Underwriting coverage for mental illnesses is complex given the diverse ways these disorders impact individuals. As several hon Members in this House, including just two before me, Miss Rachel Ong, have urged the Government to do more in this front, I will spare Members' well-being and not repeat the same points but I, too, reiterate this call to Government, as well as private insurers and would like to just ask if the Government has considered encouraging private insurers to launch innovative, affordable insurance products and if the Government has considered mental health parity laws to prohibit health plans from imposing barriers on access to mental health.

My second point. Sir, as a Member of Parliament looking after a ward with many elderly, I was disappointed that the strategy did not call out what we can better do for elderly mental health. Unlike youth mental well-being and health, there are few community organisations or ground-up groups which focus on supporting the mental health needs of seniors and, given our ageing population, I call on the Government to do more in this area.

Chronic health conditions, reduced mobility, retirement, empty nests and the passing of close friends – these are just some of the difficult moments that our seniors go through as time passes on. At the same time, digital transformation and a built environment, unlike the kampongs they grew up in, often feel alienating.

While efforts to destigmatise mental health conditions and encourage help-seeking behaviours are well-intentioned, some seniors expressed difficulty discussing mental health as it is considered taboo. This sentiment is also reflected in the National Population Health Survey 2022, as the proportion of residents least willing to seek help from healthcare professionals or their informal support networks are older adults aged 60 to 74. This trend is worrying especially as the percentage of seniors' death by suicide in 2020 reached a significant high in 29 years.

With a tiered care model, the provision of care is shared with community partners with trained personnel on the ground. However, staff are often stretched, managing many cases. We must encourage everyone to be eyes and ears, equip ourselves with knowledge and destigmatise early screening and help-seeking as the norm to provide timely interventions for our seniors.

In my constituency, community partners such as the mailmen and women from Sing Post monitor changes in mail collection patterns in blocks with a high number of elderly and participating hawkers are trained to recognise simple signs of depression and dementia before referring seniors to the nearest Active Ageing Centre (AAC) or our community clubs.

One of the biggest threats to our seniors' well-being is social isolation. In 2022, 78,600 households are seniors aged 65 years and above living alone. This is double the number 10 years ago and the number is forecasted to rise further. It is not only seniors who live alone who experience loneliness.

In a study on social disconnection and its impact on the health of older adults by the NUS, the findings found that most socially disconnected individuals are living with family members. In another research by the Centre for Ageing Research and Education, a significant percentage of older Singaporeans staying in multi-generational households indicated feeling lonely. These trends could stem from poor familial relationships or the lack of interaction between family members, as everyone is busy with their lives or on their digital devices.

On this note, how can adult children and grandchildren be better equipped with skills to talk about mental health with seniors? Beyond immediate family, how can wider community initiatives and befrienders reaching out to seniors to reassure them and encourage participation in community efforts?

On early screening and detection, I am heartened that the Healthier SG exercise will include mental health services by training GPs to manage mental health cases and work with communities and hospitals to meet the needs. I would like to ask on the progress of this uptake.

Likewise, I understand Age Well SG will scale up the quality and quantity of AACs to increase meaningful engagement with our seniors. The Silver Generation Office also does good work. They are reaching out to seniors at greater risk of isolation. This is likely to naturally engage the more active seniors. What are the efforts in place for seniors who are isolated or already experiencing mental health issues and how will efforts and resources, such as COMIT, be better resourced under the strategy?

Sir, our seniors have worked hard in the early years, and my wish is for seniors to age purposefully with good mental well-being. It deeply saddened our community when we lost some of our elderly residents to suicide, especially during COVID-19. I hope that the task force will consider developing a more targeted approach for seniors.

On my final point, I echo the points raised by hon Member Mr Ong Hua Han. Persons with disabilities are not only more likely to experience mental distress but also factors associated with a higher occurrence of mental health conditions, including financial stress. This intersectionality of disability, socioeconomic factors and healthcare access plays a pivotal role in shaping mental health outcomes within the Singaporean context.

Key measures should include ensuring that screening, care and support services are not only accessible but tailored to the unique needs of this population. There is a dearth in specialist healthcare for persons with disabilities, especially in our heartlands.

Beyond Government policies to promote inclusivity, efforts by employers and wider society aimed at enhancing educational and employment opportunities and fostering an open environment are essential towards reducing disparities and creating access. We should also start early. How is mental health included in health education lessons, for example, in our special needs schools? Sir, briefly in Malay, please.

(In Malay): [Please refer to Vernacular Speech.] A young man who was no longer cheerful and suddenly lost interest in his favourite sports; a woman who often cries after giving birth or perhaps an uncle who started to distance himself from others after losing his job. Mental health challenges affect all levels of society, both young and old. This issue is a pressing one. Thus, we should speak more about mental well-being in our normal conversations, especially when it concerns our senior citizens who may feel lonely.

Apart from being patient with them and praying for them, we should be tactful when giving advice and words of encouragement to those in need. We can also persuade and help them to seek advice from specialists, such as counselling and therapy, or to get enough medication. We should not feel embarrassed to seek support because such prompt assistance can help to save jobs, family or even the lives of loved ones.

Finally, let us focus on listening actively and caringly if anyone comes to us for a shoulder to cry on. Sometimes, they are not seeking our advice or expertise to solve their problems. They simply need a friend to pour their hearts out to.

(In English): Finally, Sir, alongside strategies to improve service coordination and care systems, we must consider local training and education pathways and spaces for professionals, such as clinical psychiatrists, to help the system cope with increased load, even as we move beyond tackling mental health crises to upstream intervention.

Further, as we encourage peer support, clarity on the qualifications and certifications necessary for practitioners or peer supporters at various tiers besides the expected relevant skills and knowledge will be helpful.

It is well and good to say that it is okay not to be okay. But think about perhaps the neighbour below who says they hear noises coming from your house and cannot control their emotions, lashing out at you in the corridor. Consider the hoarder, who perhaps arrived at this state because of the loss of loved ones years ago and has unprocessed trauma. Imagine a loved one, who was always a pillar of support for you, but now cannot get out of bed on the bad days. At the end of the day, it is true understanding, empathy and recognition that counts and can make a difference in someone's mental health journey.

The Government's commitment to mental well-being is instrumental in shaping a society where everyone, irrespective of background, can lead fulfilling lives, but this must be amplified by collaborative efforts with non-governmental organisations, philanthropy, the private sector, you and I. It will take all of society to destigmatise, talking about mental health and normalise health-seeking behaviour.

Some people dismissively say that those dealing with mental health conditions are weak but personally, oftentimes, they are the strongest people I know, for holding on despite the pain. Let us be mindful of the language and terms that we use and let us be kind to one another, especially when it is hard. To anyone facing a mental health condition and to their loved ones, we see you, we recognise you, you are worthy, and we are so glad that you are here. Sir, I support the Motion.

Mr Speaker: Assoc Prof Razwana Begum.

6.55 pm

Assoc Prof Razwana Begum Abdul Rahim (Nominated Member): Mr Speaker, I stand in support of this Motion. By many indicators, the mental health status of an increasing number of Singaporeans is low and getting worse every year. Data from the 2022 National Population Health Survey shows that the percentage of Singaporeans with poor mental health has increased from just over 13% in 2020, to 17% in 2022. The situation is even worse for our young people. The same data shows that approximately 25% of those living with a mental illness are between 18 and 29 years of age. These figures tell us that approximately one in six Singaporeans is currently living with a mental illness of some sort and that one in four of those are young people.

Mr Speaker, commensurate with the increasingly poor mental health of many Singaporeans is an increase in the number of suicides. Data from the Samaritans of Singapore (SOS) shows that in 2022, there were 476 deaths by suicide, up from 452 in 2020 and 397 in 2018, an increase of 20% over four years. The same data shows that suicide is the leading cause of death for people between 10 and 29 years of age, accounting for almost one in every three deaths in this age group.

As a social worker and counsellor, I am distressed but not surprised by this data. Life is tough for many people, including many young people, and it is getting tougher. The impact of social media, climate change, global insecurity and uncertain employment, housing and relationship options present a bleak picture for many.

Suicide appears to be increasingly commonplace and this is deeply distressing. I have seen first-hand the impact that suicide can have on partners, friends, colleagues, even strangers, and I have recently witnessed the impact on my own children following the suicide of a long-term friend of theirs.

Mr Speaker, in response to such disturbing data, Singapore is taking the issue of mental health and suicide seriously, evident by this Motion and by comments made by my fellow Parliamentarians. I am also pleased to note that our Government is strengthening our existing mental health frameworks by developing the National Mental Health and Well-being Strategy, a strategy that I support.

Mr Speaker, I would now like to make some additional comments relevant to the Motion before us today. My comments fall into three areas targeted at accessible mental health services, suitability to practice and workplace mental health and well-being.

First, targeted and accessible mental health services. Mr Speaker, Singapore is progressively introducing a suite of mental health services across various touchpoints and various platforms so as to assist ensure that people can access assistance when and where they need it. Mr Speaker, while this expansion of services is positive, it is important that we consider the accessibility of these services to vulnerable populations in our society.

WHO defines vulnerable populations as, and I quote, "Those who, due to factors usually considered outside their control, do not have the same opportunities as other, more fortunate groups in society." There are many causes of vulnerability, including physical, social, cultural, economic and environmental factors, all of which can make it difficult for certain groups of people to access appropriate mental health services. For example, children, young people, the elderly, women, men, migrant workers, those under the care of others, people living with a disability, or living in poverty, or who are unemployed, or, somewhat ironically, people living with a mental illness. All of these people, in fact, all Singaporeans, can sometimes face barriers to not only recognising that they need assistance, but also seeking assistance and then accessing the appropriate care.

Mr Speaker, this Motion calls for a whole-of-Government approach to strengthening mental health and well-being. This is a positive approach. However, it is important that the Government also works closely with the private and community sectors and, importantly, with people of all ages, backgrounds and capabilities.

It is also important that we do not simply introduce more and more services but that we acknowledge and address existing and emerging factors that increase vulnerability and are an impediment to positive mental health and well-being. Mr Speaker, mental health is a vital component of overall well-being and is characterised by an individual's awareness of their abilities, capacity to manage life's stressors, productive work and contribution to their community.

In essence, mental health extends beyond the mere absence of mental disorders and is intrinsic to overall quality of life. Mr Speaker, with this definition in mind, I would now like to make some comments about quality of life, particularly for children.

Mr Speaker, it is frequently said that children in Singapore are blessed, and against many measures, this is true. Singapore is one of the safest countries in the world, has an exceptional education and health system and offers world-class sport and recreation opportunities.

However, as the National Population Health Survey and SOS data I referenced earlier indicates, this is clearly not enough. Something is missing and many of our children are struggling. It is, however, essential to remember that the difficulties that many of our children are experiencing, are not a reflection of their own character, resilience or strength but a reflection of the world in which they live.

Mr Speaker, significant attention is given in the literature to the concept of adverse childhood experiences (ACEs). ACEs are potentially traumatic events that occur in childhood and can include experiencing violence, abuse or neglect; growing up in a family with mental health or substance use problems; witnessing violence in the home; living in poverty or insecure housing; chronic unemployment; parental separation; or household members being in prison.

ACEs are correlated with future chronic health problems, mental illness and substance use problems. ACEs can also negatively impact education, job opportunities, earning potential and future relationships.

In 2020, the Singapore Mental Health Study reported that the lifetime prevalence of ACEs in a sample of 6,000 adults living in Singapore, was 64% or, Mr Speaker, two in every three adults. For this group, we need to consider a holistic systemic approach. It is not just about providing mental health services. We need to consider what more can be done to alleviate ACEs. We cannot eliminate all factors, but we can do more to identify and mitigate these risk factors.

Mr Speaker, just because we offer mental health services, we cannot guarantee take-up of these services. We need to create an environment where individuals can access the services they need, when they need them, without any perceived or actual stigma, adverse consequences or reprisals.

In 2021, a national study by the National Council of Social Service (NCSS) on societal attitudes towards mental health, showed persistent stigma across Singaporean society. We need to address this stigma. We need to do more to make Singapore a community where children can safely say to their parents, their friends and their teachers that they are struggling; that they are not ok. This change will take time. However, with a coordinated and sustained effort by the Government, private and community sectors, we can get there.

Data from SOS indicates, that an increasing number of young people are calling their service seeking support, with a 127% increase in calls from young people between 10 and 19 years of age. While this is positive, in that it suggests that young people are becoming more willing to ask for help, it is still alarming that so many young people feel they need mental health support.

Mr Speaker, as we work towards implementing the national strategy, we also need to consider the provision of mental health services from the lens of a child. Everything and anything we do, from designing services, developing policies, undertaking community education campaigns, need to be informed by the views of children. We do things with children, not to or for children. We also need to consider cultural and religious preference or influences and, again, to do this effectively, we need to speak with the consumer.

Mr Speaker, we also need to ensure that all of services are trauma-informed. Trauma-informed practice is an approach that recognises that trauma is common, that people accessing services may be affected by trauma and, that trauma can have a significant impact on how a person sees and interacts with the world. Trauma-informed practice is an approach that is holistic, empowering, strengths-focused, collaborative and reflective.

Trauma-informed practice can be individual- or service-based and it can be whole-of-community. For example, research suggests that exposure to nature can reduce stress and increase overall well-being. Finland has actively embraced this idea and their integration of nature into urban spaces has been associated with positive mental health outcomes.

Mr Speaker, my second focus area relates to suitability to practice. It is essential that those delivering therapeutic services are suitably qualified and regulated. This was highlighted by my fellow Nominated Member of Parliament hon Dr Syed Harun. I am sharing my perspective as an educator.

While Singapore currently offers a world-class suite of post-secondary and tertiary courses in counselling and psychology, neither counselling nor psychology are currently a regulated profession and counsellors and psychologists do not need to be registered to offer services. This means that, in Singapore, anyone can call themselves a counsellor or a psychologist and charge for their services. This situation is inconsistent with other developed countries and, as part of the national strategy, I encourage the Government to consider introducing mandatory registration for anyone offering services under the banner of "counsellor" or "psychologist".

We do, however, need to recognise the invaluable assistance that suitably trained volunteers can offer to their friends, colleagues and the community. Peer-to-peer support networks, particularly among young people, are an essential component of a mental health service system and should be actively encouraged, maintained and valued.

At this point, I would like to share an example of a youth-led safety and well-being initiative, developed by Public Safety and Security students at the Singapore University of Social Sciences. Mr Speaker, before I do so, I should note that I am Head of the programme.

The initiative was called "ReKnew" and was established by a group of students to provide a safe space to discuss sexual abuse. The group adopted an approach based on the principles of restorative justice and they established learning circles to educate and empower students to discuss difficult topics in an open and safe environment.

Mr Speaker, this example highlights the need to de-medicalise and normalise conversations about mental health and the power of compassionate and skilled youth-led peer support. It also demonstrates that it is important that we do not over-pathologise mental health and that we do not assume that everyone who is having a bad day is having a mental health crisis. Sometimes, all that is needed is someone to ask, genuinely, "Hey, are you okay?" and to care about what the person says in return.

Mr Speaker, my final focus area relates to workplace mental health and well-being. In any discussion about mental health and well-being, it is essential to discuss the workplace, and this was also highlighted by hon Member Mr Melvin Yong.

Mr Speaker, not only do we need to work towards all workplaces being environments where employees can safely reach out to their colleagues and supervisors for support, we also need to step back and consider the negative impact many workplaces have on their employees' mental health and well-being.

Singapore has an international reputation as being a place where people work long hours. In a 2019 study of 40 cities conducted by American security solutions company, Kisi, Singapore ranked as the second-most overworked city. In another report by Mercer, titled the “Rise of the Relatable Organization” released in 2022, it indicated that 85% of employees said that they felt at risk of burnout; and almost 50% said that they intended to leave their job in the next 12 months.

The post-COVID-19 trend of working from home has not helped this situation. While flexible working arrangements have definite benefits and are preferred by many employees, working from home also comes at a cost. The 2022 Cigna 360 Global Well-Being Survey showed that those currently working in a hybrid model are most likely to feel stressed and to work outside normal hours at least once a week.

The "always-on" mentality has become the norm. Yet, it comes at a price. Not only do employees have less time to spend with their family and friends to enjoy recreational pursuits or have real holidays, the prevailing hustle culture has had a profoundly negative impact on our mental health. The culture of working long hours needs to change. It is a workplace hazard and needs to be treated as such by employers and employees.

Mr Speaker, achieving work-life balance is a shared responsibility between employers and employees. Employers have a duty of care, to provide a safe working environment for all employees, and reasonable working hours should be considered as one of those duties.

At the same time, employees need to take responsibility to prioritise their health and well-being and to stop treating working in the evening or on weekends as something to be proud of or something that they just have to do. A collaborative effort between employees and employers will ensure a healthier and more fulfilling professional and personal life for everyone involved.

Mr Speaker, many employers around the world have moved towards a four-day work week, with many of these employers reporting increased productivity, improved staff retention and improved staff well-being. Employee's performance should be outcome-based, and employers should model and reward reasonable hours.

To conclude, as we develop this national strategy, it is important to remember that mental illness is not a personal flaw or sign of weakness. It is a normal reaction to an abnormal or unpleasant situation. While we cannot live in a protective bubble and completely eradicate all stress and distress from our lives, we do have an obligation to reflect on our society and our culture and to consider how our expectations and the world we have created is making us ill.

The National Strategy is an opportunity for the Government to work hand-in-hand with the private and community sectors to make Singapore a place where we can all thrive and when we stumble, to be picked up and looked after with care and compassion.

Mr Speaker: Mr Xie Yao Quan.

7.12 pm

Mr Xie Yao Quan (Jurong): Mr Speaker, Sir, I went through a rough patch recently. Looking back, I think it was early signs of burnout. Luckily, I was aware of what I was going through. I detected the signs, and I took steps to care for myself. And I am grateful that the self-care worked. I became better and I feel okay enough now to be able to make this speech in Parliament.

I decided that I would share in the speech, in Parliament, that I did not feel so okay, not too long ago.

I think this is what breaking stigma is all about and needs to be about. It is about normalising the struggles and challenges that so many of us have gone through or will go through at some point in time. It is about shining a light on these common experiences, deeply personal but actually common experiences, because they should not remain in the shadows of our minds and souls and we should chase these shadows away.

It is about normalising the process – the journey of coping, of regaining health and well-being and of becoming better. It will take all of us, a whole-of-society effort. It cannot be the start of policy interventions or legislation. It takes the whole of society to talk more openly about our own mental health journeys.

Imagine a day, when parents tell their children, “Look, daddy and mummy have our struggles too, we may not fully understand yours, the struggles you are going through, but we know what it is like to be trying to cope on your own, so let’s help each other get through our challenges together.”

Imagine a day when bosses and supervisors in workplaces can tell their employees, “Look, we too have bad days, please tolerate and hold space for us, just as we must for all of you and let’s work together to protect and promote mental health on our jobs”.

I look forward to such a day. How do we get there? I have said this before during COS 2022, and I will say it again. Our words, our language and our actions, which shape our everyday discourse and interactions, really matter.

When we are careless with our words and actions, or worse, when we choose to deliberately exploit and weaponise mental health with our words and actions, these set all of us back. These tear people down, they build walls back up and they set the whole of society back in our journey to eliminate stigma.

I recently met Lisa Chan. This may be a familiar name to some of us. Lisa and her father have been coming out and sharing their story about Lisa’s struggles with depression and her journey in healing and recovery. Their story clearly resonates with others because Lisa has gathered quite a following on social media. And, by the way, this is alongside her full-time work because Lisa is also a thriving professional.

So, there are folks whom Lisa may be meeting for the first time but who already know of her and her story through social media. Lisa tells me some of these people, meeting her for the first time have gone, “Oh, so you are the girl with depression!”

To be clear, there is no ill intent behind these words. Indeed, these words may be borne of excitement, of resonance and of gratitude to Lisa for coming out and encouraging others with her story. And to Lisa’s credit, being the incredible person that she is, she totally took these words in her stride. But such words, while coming from a good place, can cut quite deeply.

And so, we need to be aware and we need to be conscious that our words and actions really matter and we need to learn the right language. On the other hand, when our words and actions are understanding, authentic and sensitive, it helps someone else to reach out to us. And it can also help us to reach someone who may need our help and care. So, let us build a kind, compassionate environment, a society free of stigma for mental health challenges, starting with our words and our actions.

Mr Speaker, the national strategy on mental health and well-being is an ambitious one, and rightly so.

The second point I like to make is to just remind all of us, as we forge ahead in this strategy – there is so much enthusiasm and support for the strategy in this House – let us remind ourselves that those who will operationalise this strategy and those who are providing care for the mental health and well-being of others, also need care themselves. And they may need care in different ways. They may have different care needs.

I wish to highlight two groups. First, the professionals in healthcare, social services, education, in the Home Team and even municipal services. As we try to strengthen all of these roles as touchpoints for mental health, let us remember that they are at the frontline, they are the ones dealing with difficult cases, sometimes very raw experiences. And they need care too.

I recently met a gentleman working on sexual trauma cases. His hobby is climbing. He was very active in school. So, I took the chance to ask if he still climbs regularly now that he is working. He said yes, in fact, he has to because it is his "me time" to get away from the cases that he is working with and, in his words, to “keep his sanity”. So, the professionals who give care need care too. There are more than 100,000 of these professionals that we are envisaging in the national strategy. They need care and we need to care for them.

The second group of persons who provide care are the laypersons in our community, family members who are caregivers to persons living with mental health conditions in the community. It is certainly ideal for persons with mental health conditions to remain plugged into the community while coping with their conditions, but we all know that some in the community are really not coping well. And in these situations, caregivers bear the brunt.

I have a resident, who is caregiver to not one but two family members dealing with mental health conditions. They were not coping well, they had disruptive behaviour but they were being kept in the community. One day, my resident lost his cool and got into a physical altercation with the family members. Police came, Police investigated, Prosecutors looked at it and, in the end, decided to proceed to charge my resident in Court. He spoke to my team, and we helped him defend himself against the charges. Thankfully, he got a compassionate sentence.

But the point is, caregivers can break, and caregivers need care too.

To summarise, as we aim to build what my hon colleague Dr Wan Rizal has described as "a next frontier in our national strategy for mental health and well-being", let us remember those professionals and caregivers standing at this new frontier and let us systematically take care of their mental health and well-being too. Let us make this a key workstream, a concerted vertical in our national strategy for mental health and well-being – caring for those who give care.

Mr Speaker, as I look at the national strategy before us, the final point I will make is this: how do we fund this entire plan, how do we fund this ambitious national strategy for mental health and well-being?

I will offer two thoughts. First, I think insurance must play a bigger role. This includes private insurance providers for sure. My hon colleague Dr Tan Wu Meng has spoken about this very eloquently. But it must surely be about our universal national healthcare insurance MediShield in the first instance. MediShield must do more because medications, counselling and therapy, they all cost money. And we know that the MediSave500/700 scheme alone is seldom sufficient. So, MediShield must do more.

But besides MediShield, I think philanthropy and charities must play a key role too. That is the second thought I will provide here. In the past, we have had philanthropy and charities anchoring intermediate and long-term care in our healthcare landscape. Think about community hospitals and nursing homes. And more currently, we have philanthropy looking deep into new frontiers in our healthcare landscape, like palliative care and special needs. I think we need mental health to become another new and next frontier for strategic philanthropic action, for breakthrough private-public-people partnerships.

I call on all stakeholders in the space to seriously think about funding and supporting mental health, and the national strategy for mental health and well-being in a big way, as a whole-of-society. With these, I support the Motion.

Mr Speaker: Mr Darryl David.

7.24 pm

Mr Darryl David (Ang Mo Kio): Mr Speaker, the subject of mental health has often been regarded as a stigmatised topic in Singapore. While the attitudes toward the mental health, especially among younger Singaporeans, are changing, it remains a topic that many people would rather not talk about. Much of this stigma could have arisen from two sources.

First, as a society, Singapore has traditionally placed a high value on success as represented by academic achievements and/or material acquisition. Often, the two are linked. With academic achievement, you should end up being able to acquire more materially. While these societal measures of success are slowing changing, there is still a sizeable proportion of the population that equates academic success at every level of education and having a well-paying job, a high-flying career and material acquisition as the pinnacle of accomplishments in life. Acknowledging that one is facing mental health struggles could thus be perceived as being incongruent with these societal ideals of success and be further misinterpreted as a form of weakness or failure.

Second, the general lack of understanding of what constitutes mental health could have led to a conflation between “mental health” and “mental disorders.” The distinction between the two, Sir, is important. A better understanding of the differences between them could possibly be a game-changer that might help to destigmatise the conversation around mental health.

Mental health refers to a state of psycho-emotional well-being where individuals can cope with normal daily stressors, being able to lead a fruitful, productive and fulfilling life. Mental disorder, on the other hand, refers to diagnosable mental condition that affects the way people think, behave, function and interact with others.

All of us probably have had mental health issues at one time or another, just like how we have all probably had issues with our physical health. Having a state of poor mental health does not necessarily mean that we have a psychiatric disorder, although persistently poor mental health over prolonged period could lead to mental disorders. It is therefore important that we identify symptoms of poor mental health early and provide targeted interventions before mental health challenges progress to mental disorders.

I would now like to talk about the cost of poor mental health. In the World Mental Health Day 2023 Report published by Ipsos, close to half of respondents in Singapore placed mental health as the biggest healthcare challenge faced by the country today, with cancer coming in second, and stress, which is highly correlated with mental health, in third place. Close to 50% of respondents reported being depressed to the point of feeling hopeless for weeks and roughly one-third of respondents had self-hurt and suicidal thoughts.

The same study also reported that about a quarter of respondents experienced debilitating mental health and stress-related issues that impeded their daily lives on several occasions in a year. Close to 40% of respondents took time off from work due to mental health and stress, with 15% having done so on multiple occasions.

These results correspond with a similar study published by Duke-NUS Medical School and IMH in June 2023. This study has been referenced already in the debate so far. It reported that up to 15% of the sample showed symptoms of poor mental health, and when extrapolated to the national level, poor mental health could cost Singapore $16 billion a year in terms of loss in productivity, absenteeism and medical care.

What is telling from these studies is not the number of people reporting poor mental health, but the low number of people who have proactively sought interventions for their mental health conditions. Only a quarter of those suffering from mental health conditions in the Duke-NUS Medical School and IMH study sought intervention from a mental health professional.

One of the reasons provided by the Ipsos study on why the treatment gap exists despite the general belief among Singaporeans that mental health is just as important as physical health, is because of the belief that the national healthcare system in Singapore does not reflect the same level of importance for mental health as it does with physical health. Perhaps, there is a kernel of truth in this belief.

According to a Parliamentary reply by MOH in 2021, there are 4.5 psychiatrists and 9.7 psychologists per 100,000 residents in Singapore. This is far lower than the ratio of 280 doctors to 100,000 residents in Singapore. In the same vein, there is only one mental hospital in Singapore, the IMH, that is serving a population of more than five million people.

There is also a perceived social stigma of seeking treatment at IMH since IMH sees both patients experiencing mental health and mental disorders, and people tend to associate individuals seeking treatments at IMH, regardless of their underlying conditions, as “crazy” even though they might not be suffering from mental disorders. The fact that IMH is colloquially referred to as “Siao Lang Keng” or the “mad house” in Hokkien is a reflection of this.

The general unwillingness to acknowledge that one is experiencing mental wellness challenges in fear of being labelled as a “failure” or being perceived as “weak”, the low ratio of mental health professionals to population and social stigma of seeking interventions at IMH for mental health issues will exert and is already exerting a toll on the community. We thus need to consider the social cost of not seeking treatment for mental health issues.

First, not seeking early and timely intervention due to stigma and the lack of accessibility to mental healthcare will erode the human capital potential of those experiencing mental wellness issues. Their overall well-being and functionality could be compromised, limiting their ability to realise their full potential as well as their ability to lead a fulfilling life in the long run.

Second, the caregivers of those experiencing mental health challenges are likely to be their immediate family members who might not be equipped with the right knowledge to provide care. We have heard many Members already speak about this. These family members are likely to experience the stress of caregiving due to the lack of caregiving knowledge and training, possibly experiencing mental health challenges themselves in the long run.

Sir, the social impact of not seeking intervention early is not insignificant. We need to pay more attention to how we can better support early intervention by making structural changes to our mental health ecosystem and the wider social attitudes towards help-seeking. I would like to offer some suggestions here.

First, to talk about how we can enhance the mental health ecosystem. One of the ways to encourage individuals to seek help early is to normalise help-seeking. I would like to suggest for an inter-Ministerial workgroup comprising MOH, MOE, MOM and the Ministry of Communications and Information (MCI) to look into how we can better promote mental health awareness in schools, workplaces and the general public.

I would like to ask MOE to consider blending mental wellness practices, such as mindfulness and grounding techniques, into the formal school curriculum or co-curriculum in primary, secondary and even post-secondary levels to promote the understanding and the importance of mental wellness at a young age, and to teach our young students in school how to deal with these mental challenges in what is, admittedly, a rather stressful time of their life, especially in primary school, such as the lead-up to the Primary School Leaving Examination (PSLE), for example.

In a similar vein, I hope that MOM will consider setting up a demand aggregation contract at a national level to strengthen the adoption of Employee Assistance Programmes (EAPs) which are confidential professional assistance programmes designed to help employees manage work and non-work stressors among companies in Singapore. To mitigate the cost and complexities of setting up EAPs by individual companies, I would like MOM to consider pre-selecting a panel of EAP providers for companies to send their employees to. This will bring affordable and professionally managed interventions into workplaces instead of having companies to design their own support schemes from scratch.

On the public front, a greater level of awareness must be created on what constitutes mental health and how having poor mental health or poor mental well-being is different from having a psychiatric disorder or psychiatric illness. I would like to suggest for MOM and MCI to run awareness campaigns about the differences between the two and to destigmatise help-seeking behaviour by educating the public that those who seek help for mental wellness issues are not "crazy" but are merely unwell, very much like how someone could have caught a flu or some illness during a particular influenza or season, where people tend to fall ill more regularly.

To further support the public education on the differences between mental health and mental disorder and to promote help-seeking, I would like to also suggest to MOH to consider splitting the functions of IMH into different institutions. Just as we have specialised medical centres like the National Skin Centre, National Heart Centre, National Cancer Centre and so on, can we not have a National Mental Wellness Centre that focuses on subsidised interventions for mental health, while IMH continues to provide medical interventions mainly for psychiatric disorders? So, delinking mental health interventions from psychiatric interventions provided by IMH will further help to "de-label" and destigmatise help-seeking.

The lynchpin in the national mental healthcare plan is the number of mental healthcare professionals and the availability of caregiver support programmes in Singapore. I would like to ask if MOH has specific plans to train more mental healthcare professionals in Singapore and to bring these numbers up, closer to the number of general healthcare professionals here? Once the numbers of mental healthcare professionals are brought up, would MOH consider setting up community-based mental wellness interventions and caregiver support programmes, perhaps, even in the polyclinics so that these resources are more widely accessible in the heartlands, leaving the proposed National Mental Wellness Centre to focus on more specialised and deeper interventions?

Mr Speaker, Sir, early identification and intervention on mental health conditions are essential to the success of the national plan to promote mental wellness. Since the COVID-19 pandemic, the issue of mental wellness has taken on greater importance and urgency. I am glad that we are paying more attention to the issue today, and I hope that the Government and, indeed, the whole of society, will adopt a more targeted approach to promote the topic and to make mental healthcare more accessible to those who need it. I end my speech in firm support of the Motion.

Mr Speaker: Ms Hany Soh.

7.36 pm

Ms Hany Soh (Marsiling-Yew Tee): Mr Speaker, I stand in support of the Motion in recognising, amongst other issues, the importance of mental health and calling for a whole-of-Singapore effort to enhance mental health and well-being. This is aligned with the Government's National Mental Health and Well-being Strategy introduced last year. My speech today will focus on the topic of mental wellness during and after pregnancy.

Studies have shown that about one in 10 women experience postnatal depression within the first three months of giving birth, with those who were depressed during pregnancy most likely to be depressed after delivery. I wish to share my personal experience of being in this category when I was expecting my eldest daughter.

My daughter was born five years ago, but even today, I can still remember vividly feeling delighted, yet fearful about being a first-time mom. The lack of sleep, coupled with the stress and anxiety of raising a newborn as a rookie mom caused me to be constantly exhausted, both mentally and physically. I was also unable to provide enough for my baby through breastfeeding alone, which intensified my feelings of guilt, sadness and frustration.

Looking back, most of the stressors I faced then actually centred around social stigmas and expectations. My own troubles with breastmilk production stemmed from the normalised expectation that all mothers should be able to provide sustenance for their children exclusively by themselves. And like many working mothers, I also wrestled with my priorities of fulfilling my motherly duties while juggling my work obligations as a litigation lawyer, all of which contributed to much worry and stress that consequently sapped my energy.

Today, my daughter is an active, healthy and happy child. Even so, part of me still finds it difficult to forgive myself for not being able to provide her with the best in those early days, even though I know that I had done my best then.

Having gone through some difficult times during my first pregnancy, I can empathise with fellow moms who struggle with the stresses of raising their children. The experience, combined with the knowledge gained over the past few years through my interactions with fellow like-minded mommies, also helped me to prepare myself mentally for the arrival of my second bundle of joy last year, a baby boy.

During my confinement following the birth of my second child, I came across news articles about fellow mothers who had died by suicide with their infant children. The stories were tragic, but they also serve as reminders about the importance of recognising every mother's mental well-being during pregnancy and throughout the months after delivery.

Between April 2021 and March 2022, KK Women's and Children's Hospital (KKH) has seen a 47% increase in its patients who screened positive for postpartum depression, compared to the same period the previous year. This result does not come as a surprise to me. I am, therefore, heartened that one of the focus areas of our national mental health strategy pertains to strengthening mental health services for pregnant women. As we look into the well-being of mothers, I hope we may hopefully also be solving a pain point in our national birthrates.

Currently, various hospitals in Singapore, such as the National University Hospital (NUH) and KKH, have implemented their own respective measures to identify signs of postpartum depression. These are critical initiatives to enable early detection and ensure individualised care can be given at the earliest opportunity to prevent mummies' conditions from worsening.

But we will need to ensure that all hospitals in Singapore, public and private, that provide obstetrics and gynaecology services, are uniformly equipped with the relevant capabilities and resources to provide early detection and timely intervention to parents showing signs of requiring psychological support. Just as the monitoring of physical health is paramount for postpartum mums, so, too, should we devote resources to ensure their mental well-being after birth.

Under the new national strategy announced last year, I note that more hospitals, polyclinics and GPs will be providing mental health services. In this regard, I hope that MOH will ensure that these services will be provided to new parents facing issues in this area to encourage them to seek help through these various avenues.

Since 2019, specialists from KKH have begun to partner and train Punggol Polyclinic nurses, as part of the collaboration between SingHealth Polyclinics and Temasek Foundation to enhance their knowledge on postpartum depression in women. Can we expect to have more polyclinics provide mental health-related services during the regular routine check-ups for the babies? Apart from checking and ensuring that the various milestones of the newborn are met, I propose that these trained doctors and nurses also should take the opportunity to enquire about the parents' psychological states and advise them on the help and support available should they require it.

A study by the NUS Alice Lee Centre for Nursing Studies in 2021 revealed that support from peers can help to reduce the risk of mummies developing postpartum depression. As such, besides investing more resources in our healthcare system to improve coverage for mental wellness, I believe that we, as a community, should also band together to do our part towards increasing awareness of postpartum depression and provide a peer support network to ease the anxieties of mothers of newborn babies.

In 2021, I chanced upon an article on the Internet about Depressed Cake Shop Singapore and its founders, Debbra Lee and Tracy Heah, where they shared about their respective postpartum depression experience and how they eventually decided to set up a campaign to raise awareness in this aspect through baking or purchasing of grey cakes with a pop of colour, with grey symbolising depression and a spot of colour signifying hope.

I subsequently reached out to both of them to explore the possibility of working together to better support fellow mothers out there with their emotional well-being. The three of us hit it off right away from our first meeting and we began discussing ideas to collaborate with the objective of sharing practical tips to restore our mental health and accumulate our mental wealth to Woodgrove residents. In 2022, together with Depressed Cake Shop Singapore and with our community partner, the Singapore Association for Mental Health (SAMH), we organised and invited young parents with their children to attend a cookie decoration session at our Fuchun Communiity Club, in which SAMH shared several signs to identify if one is suffering from depression and the resources available in the community that can be used for support.

Last year, in collaboration with Mumpreneurs Go Places, the PAP Women's Wing Woodgrove branch continued to reach out to our community on mental wellness through a series of workshops, with one session focusing particularly on equipping participants with tips to practise self-care amidst busy schedules between work and family care commitments. In Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] From pregnancy to the birth of the baby, mothers often spend a lot of effort in caring for the newborn, neglecting that they themselves have also undergone many significant changes both physically and mentally. This often leads to postpartum depression. Research also shows that when mothers suffer from depression, out of every two husbands, one will also suffer from depression. Postpartum depression needs to receive attention and support from society, regardless of gender. If not treated promptly, it will not only have adverse effects on individual health, marriage, family life and career, but also affect the development of the baby.

(In English): I am thankful that throughout my two pregnancies, my husband was always by my side, providing both assistance and comfort, which he still does today. We both believe that parenthood is a partnership of equals. Our shared experience has taught me that fathers too deserve recognition and support, and increasingly so as they got more involved in parenting. Similarly, they also deserve the same level of emotional support as they are equally susceptible to the effects of stress and depression from parenting-related causes.

I am heartened to know that there are many who share the same opinion. During a focus group discussion organised by the PAP Women’s Wing last year, the feedback which we gathered from over 60 participants showed a consensus that, apart from having the need to do more to support mothers, more also needs to be done to support new fathers, as they too may be prone to suffering from depression in silence while trying to support their wives through this challenging period.

With that said, social stereotypes that push men towards the supposed ideal image of a strong, uncomplaining individual do exist, thus discouraging them from openly sharing emotions and getting support for depression. While that affects the mental well-being of men in general, it is more pronounced for fathers who would have to grapple with even more pressing worries and doubts. Therefore, one way to improve support for our fathers is to reduce the social stigma of men seeking emotional help, whether through friends and family, or via professional counselling services. By reassuring dads that seeking a listening ear is permitted and even encouraged, we can do much to improve their emotional and mental well-being.

Another way to reduce the stress of fathers is to work together with corporate entities to introduce new measures that allow them to play the role of caretaker while still maintaining a presence at work. Much has been said in recent years about the benefits of remote working in terms of achieving work-life balance, but it may be worth more of exploring an expanded version of remote working, especially for dads to cope with the arrival of their newborn and further ease the transition from paternity leave to resuming normal duties at work.

In recent years, the topic of mental health has increasingly become a serious issue both in Singapore and around the world. I applaud our Government for their foresight in focusing on this area, as lack of issues and action will lead to even more widespread problems in Singapore in the future, economically, socially and security-wise.

By tackling these issues head on, we will be able to ensure that Singaporeans will be further equipped to weather the storms as one united people. I support this Motion.

Mr Speaker: Mr Sharael Taha.

7.49 pm

Mr Sharael Taha (Pasir Ris-Punggol): Mr Speaker, the Motion under discussion emphasises the critical importance of mental health across health, social and economic domains, advocating for a comprehensive national mental health ecosystem and a collective effort throughout Singapore to bolster mental health and well-being. This has been widely discussed by fellow Parliamentarians today, reflecting a societal shift towards greater openness and our concerted effort and action on this issue. The discussion continues as this will be a work-in-progress as we refine our approach and we come to a collective agreement on what we do about it.

Hence, I am glad in October 2023, MOH has taken the lead by launching the National Mental Health and Well-being Strategy focusing on four main areas: one, expanding mental health services; two, enhancing early identification and intervention by service providers; three, promoting mental health and well-being; and four, improving mental health in the workplace.

I will focus my speech on the call for whole-of-Singapore effort to implement this strategy of promoting the mental health and well-being of two particular groups of people – seniors staying alone and senior caregivers in our community, and on improving workplace mental health and well-being.

On promoting the mental health and well-being of seniors staying alone and senior caregivers in the community, we need to work on de-medicalising and normalising conversations surrounding mental health, increase mental health literacy and improve societal attitudes and reduce stigma towards individuals with mental health needs, as mentioned by many of fellow Parliamentarians today. Beyond policies and Ministry effort, we need the wider community to have the right knowledge and understanding about mental health conditions that will aid their recognition, management or prevention. This includes the ability to recognise symptoms of mental health conditions and to know where to seek help. Hence, it becomes increasingly important to strengthen the informal support networks in the community.

Let me share with you three cases of our residents in Pasir Ris East. Last Friday, I met Mdm Tan during our house visit. Mdm Tan is 70 years old and taking care of her bedridden mother with dementia. She shared with me how difficult it was to be caring for her own mother when she herself was getting older. But she said with a smile, "As hard as it is, it is my duty as she is my mother".

One of our other residents, Mdm Elena, is herself in her mid-60s. She has no siblings and is not married. She is taking care of her two elderly parents; her father in his 90s goes to the daily dementia care home and her mother, who is in her 80s, has dementia and stays at home. Another one of our residents, Mr Aziz, is a kidney dialysis patient in his 70s and taking care of his mother with dementia, who is in her 90s.

There are many individuals like Mdm Tan, Mdm Elena and Mr Aziz who are retirees but themselves caring for their parents. Caregivers can undergo an immense amount of stress, what more when the caregivers themselves are dealing with their own challenges. Beyond policies from MOH, how can the community come together to support individuals like this better?

In Pasir Ris, our community volunteers through our Pasir Ris East care store, visit the families every third Saturday of the month to catch up with them and check on how they are doing. For Mdm Elena, some of the grassroots leaders, such as Mr Charlie Cheong, offer to care for her parents while she gets a haircut, goes to the market or takes the day off from caregiving.

How can we continue to encourage more from the community to come forward and provide assistance to support the mental burden of such caregivers, especially in our fast-ageing society? To borrow the words of fellow MP Mariam Jaafar in her speech earlier, "We must care more for each other in our society."

Secondly, on improving workplace mental health and well-being, we know that good work is beneficial for our mental health. A healthy state of mental well-being can also contribute to improved productivity. According to data collected from MOM, one in three employees found it challenging to cope with work demands and pressures or felt exhausted physically or mentally from work.

Based on a survey conducted by MOM, there was an increase in the proportion of job seekers who faced discrimination due to mental health conditions, from 2.9% in 2021 to 5% in 2022, as well as an increase in the proportion of employees who felt that they were discriminated at work due to mental health conditions, from 3.2% in 2021 to 4.7% in 2022.

The National Mental Health and Well-being Strategy aims to address these issues by improving mental health literacy at work, reducing stigma, supporting the employment of individuals with mental health conditions, customising mental health support according to occupational needs and preventing discrimination through fair employment practices.

While companies can also put in policies to prevent workplace discrimination in their organisation and to prevent the discrimination for mental health and encourage mental well-being at the workplace, translating these strategies into practice poses significant challenges. For example, how do managers manage conversations and, in particular, performance appraisals, as it is the season now, for colleagues or subordinates with mental health conditions without making them feel discriminated, especially if their performance is affected by it when compared to other peers? How do we then balance and manage the expectation with the rest of the team too?

These issues cannot be legislated. But the devil is in the details when we try to translate the intent into practice.

If we want the approach towards mental health to change in the workplace, employers, employees and the people leaders must be equipped with the right skillset to drive that change.

Should that skillset be made available as a guideline for employees on the "do"s and the "don’t"s or should we impose it as a legal requirement by MOM? Or will it be something where we highly encourage employers to upskill their employees from a SkillsFuture perspective, as suggested by fellow Parliamentarian Mr Edward Chia?

Mr Speaker, Sir, as I have mentioned earlier, the discussion continues and is a work-in-progress. I am glad that our society continues to have this discussion as we refine our approach and come to a collective agreement on what we, as a whole-of-nation; Government, businesses, organisations, communities and individuals, can work together towards our inclusive society. I stand in support of the Motion.

Mr Speaker: Ms Carrie Tan.

7.57 pm

Ms Carrie Tan (Nee Soon): Mr Speaker, my dear colleagues, I am well aware it has been a long day, and everyone is tired and even if your brains and minds are tired, I hope that you will be with me and open your hearts and your spirits to hear what I have to say.

I would first like to declare myself and my interest as a self-employed transformative and healing coach. There are three points I wish to highlight about mental health to contribute to our collective understanding of it so that we can properly contemplate what this means to our nation.

First of all, we all have mental health. It is not just mental illness, which is unfortunately what one in two Singaporeans consider it to be, according to a survey by MOH. By framing mental health as just a healthcare challenge, we risk adopting the traditional language of health, which pathologises and creates a chronic reliance on only formal healthcare institutions and medication. This relegates the ownership of recovery to the field of experts, such as psychologists and psychiatrists, which are in very short supply and also renders the individual dependent on the formal healthcare system’s capacity, which has its limitations. This is neither sustainable, nor true.

Mental health is something that every person can own, and be equipped to take care of for ourselves, until it deteriorates to a point where clinical assistance is necessary and that is where clear navigation and adequate resourcing of expert and clinical interventions are important. But I urge us to think and to go one step further, to also equip individuals. We can encourage a wide variety of activities that are personal-based to help Singaporeans access knowledge for maintaining their mental well-being.

There are activities such as yoga and meditation, as our colleague Mr Darryl David said, mindfulness practices, and different forms of traditional, art-based, music-based and somatic-based approaches to mental, emotional and spiritual wellness, which are all available currently, although relegated as "alternative wellness". It is time, I say, to mainstream these options because they are derived from the rich and deep history, wisdom and heritage of our Asian cultures. They cater to the varied cultural, faith and spiritual beliefs of Singaporeans and offer individuals more options towards holistic wellness that are accessible, and which resonate with each individual’s inclinations and preferences.

I support my colleagues, Mr Darryl David, Mr Xie Yao Quan and Assoc Prof Razwana Begum's, call for mindfulness for authentic listening and authentic care, which all fall under social emotional literacy and empathic care. And hence, I recommend extending SkillsFuture funding for such learning. This will accelerate and propagate emotional wellness skills more widely so that everyone can equip themselves to maintain good mental health as a lifelong endeavour. Mental health, just like physical health, is a journey that requires daily awareness and maintenance, starting with emotional literacy.

The Government can do its part to help make such knowledge and training more ubiquitous and accessible for the common man and woman on the street.

And here, I would like to share an example on what happens when I go to my training workshops. As a facilitator, I often ask the participants: "How are you feeling now?" And often, the replies I get are "Okay lor" or "Like that lor". It tells me that Singaporeans are sorely lacking in the emotional vocabulary to be able to identify and even acknowledge our own emotions.

One key point I would like to make, most importantly, is let us recognise the invisible forces that are undoing our mental health and mental health efforts. How is it that eight in 10 Singaporeans recognise mental health to be important and as important as physical health, yet less than half of us actively think about our mental well-being or how we are feeling on a day-to-day basis? What is the invisible force that is taking our attention away from something that all of us agree to be important, so important that we have a Motion in this Chamber today?

Our attitude towards stress at work illustrates this. In 2020, our Parliamentary colleague, Mr Melvin Yong, God bless his heart, proposed a "Right to Disconnect" law mandating downtime from work for better mental health. What is illuminating is that despite acknowledging its intentions, there were many concerns over its feasibility. For example, would bosses and other colleagues see a desire for greater work-life balance as a sign of lower motivation compared to their peers competing for the same limited opportunities? What happened to the age-old wisdom, in Chinese, “休息是为了走更长远的路”, meaning "Rest is to help us travel even further"? How have we, as a society, come to equate rest with lower motivation? What has caused this collective judgement that demonises the act of rest and restoration?

In a recent commentary on CNA by NUS lecturer Jonathan Sim, he talks about youth "hustle culture" and warns of the perils of a lack of the ability to introspect. He observed that, for many university students, introspection is sidelined as a, I quote, "stagnant inactivity" because pausing to do it "does not seem to contribute directly to any measurable progress". He notes, and I quote, "the inability to sit alone with their thoughts and the tendency to bury themselves in work or digital distractions, creating a superficial busyness that masks an inability to process deeper emotions".

This does not just afflict youths, but many successful adults as well, including many of us in the Chamber. In my role as a healing coach, I have come across many accomplished professionals and leaders who baulk at the idea of slowing down. Are we somehow living within a bubble where a constant need to be achieving something has made slowing down something that terrifies people? Does rest ironically create more stress? The term "stress-laxing" is found in UrbanDictionary.com, feeling stressed because you are relaxing and not working, the cause of your stress in the first place!

What kind of ludicrous phenomenon is this! We must ask ourselves.

We have to recognise what is creating this "pressure cooker" bubble we are all living in. The very narrative of our nation's survival and success thus far has been fuelled by the notion of scarcity which then fuels an endless culture of competition and a sense of inadequacy.

This is, unintentionally, of course, encapsulated by our classic National Day song "Stand Up for Singapore." If you recall the lyrics, we are first called to stand up for Singapore to do the "best you can", only to be called a few lines later to also "be prepared to give a little more." I love this song. I love to sing it with pride and increasingly, I recognise, some irony. Are we perhaps the only country in the world where our best is still not enough?

To be clear, I am not calling for slackness because reaching our fullest potential does require hard work. I am also not a proponent of the "lie flat" movement either. In fact, I am trying to solve or prevent it.

Learning from hypercompetitive Asian societies, like South Korea and China where the 躺平, or "lie flat" movement has begun as a silent rebellion by youths against a system in which many feel hopeless about ever catching up with, we must be mindful of the long-term costs of a "pressure cooker" society.

We can see this already happening when new technology emerges, such as AI, what a helpful tool, to help us be more productive. But instead of working less, we end up cramping more expectations into our workplans to achieve even more. What is stopping us from reaping the benefits and advantages of technology to avail ourselves the precious time to rest, to nurture relationships and to enjoy our families?

Last year, Duke-NUS Medical School reported just depression and anxiety alone could conservatively cost Singapore $16 billion annually. An economically prosperous yet chronically unhealthy Singapore would be a hollow success.

In an individual, chronic stress and tension entrenches the flight or fight response as a default reaction. In an ecosystem, chronic stress entrenches similar responses, such as demanding, defending, deflecting or sometimes, a collective numbing, which manifests as a lack of ownership.

This may hurt to hear but our Civil Service is one of the most afflicted. I do not blame our civil servants because they take the brunt of overwhelming workloads that inadvertently cause mental and emotional burnout. We surely must agree that a burnt-out and emotionally "checked out" people is not what will create progress. The inability to slow down is a serious symptom that we are disregulated as an ecosystem and society. We must take daring steps to foster a collective restoration of our societal nervous system.

We need new norms. The "Right to Disconnect" has to be seen as a necessity, not as a problematic "nice-to-have". Do we have the gumption to allow a collective slowing down, to cater time and space for our collective mental and emotional restoration? It may sound illogical or even terrifying to some, to cater for a period of slowing down, especially when imagined in economic terms. But I challenge the notion that growth and productivity is only possible with relentless hard work, especially in this technologically abundant era. Growth is possible with more collaboration in place of competition. Collaboration is more possible when we are well-regulated in our bodies and minds to allow for better listening and more empathy that then fosters more trust.

This needs to be a whole-of-Government effort and I recommend the current Inter-agency Taskforce to become a permanent National Well-being Office, not under MOH but directly under the Prime Minister’s Office. This office should consist of well-being champions from each Ministry and Statutory Board, and include a consultative committee of representatives from the private and people sectors. Their role can be as resource persons, sounding boards as well as act as inter-Ministry bridgers to ensure the well-being lens is present in policy discussions and formulation across Ministries. To this end, a National Well-being Index adapted from existing Quality of Life surveys will be helpful to keep this Office's duties on track and accountable for outcomes.

This will actualise what Singaporeans have already expressed in many Forward SG conversations, that desire for a different vision for Singapore, in the paths available, the aspirations and the definitions of success. Singaporeans want to thrive, without being in a constant rat race. How might we enable a deeper sense of fulfilment than the never-ending chasing of KPIs, material or financial success?

The 2022 Quality of Life survey results show that those who took a more balanced approach to life, valuing traditionalism, sustainability and family relationships over material success were more satisfied than those who valued materialism over these intangible things. It tells us that the answer lies in the intangibles, the quality of our relationships with ourselves, with the people around us, as well as with our planet earth. This aspect of life requires a slowing down introspection in order to be nurtured.

If slowing down feels foreign, selfish or even un-Singaporean, we can seek inspiration from our National Pledge. In outlining Singapore's national objectives, it lists "happiness" ahead of "prosperity" and "progress". And here, "happiness" can be taken to mean and referred to the overall sense of security and satisfaction that our people feel as Singaporeans, not just happiness as a fleeting emotion. Such sense of security and satisfaction is critical to mental well-being.

To improve on this sense of security, let us have the courage to take a pause and the gumption to try a different narrative than scarcity. Let us focus on our abundance and on an attitude of gratitude to foster the collective sense of security. What do we wish to see in our children's and youths' faces? Certainly not stress, not anxiety or the blank disconnected faces like what we are seeing increasingly today, afflicted and glazed over by digital addictions, anti-depressants or sleeping aids that they use to cope with the disconnection within them untended to and unheld by our collective lack of mindful presence and the constant doubting of what is enough.

I wish to see children and youths who are healthy, strong in their minds and bodies, with curiosity and connection alive in their eyes. I wish to see a workforce that is free from the burden of relentless and unnecessary busyness, rejuvenated and revitalised to have a high sense of ownership in every interaction, because people, who are well-rested, will have sufficient mental and emotional bandwidth to do so.

I hope by the end of 2024, all of us, including us in this Chambers, would have taken enough pauses to introspect and to reconnect within ourselves and to acquire the language for emotional awareness, to be a more emotionally regulated, emotionally secure and mentally well society.

8.13 pm

Mr Speaker: Ms Carrie Tan, you would be happy to note that in my former corporate role, I introduced at my workplace, some four to five years ago, that we do not have any meetings on Friday afternoons. Dr Wan Rizal.