Eradicating Mental Health Stigmatisation

ADJOURNMENT MOTION

The Leader of the House (Ms Indranee Rajah): Mr Speaker, Sir, I beg to move, "That Parliament do now adjourn."

Question proposed.

Eradicating Mental Health Stigmatisation

7.57 pm

Dr Wan Rizal (Jalan Besar): Mr Speaker, I would like to declare my interest as an educator and embark in research in health and wellness at Republic Polytechnic.

Mr Speaker, it seems like for this speech, I have my work cut short. Recently, many Members of this House had participated in the 25 push-ups a day challenge, raising awareness for mental health issues.

Some members of the public had asked what is the point of all these? Well, the point has come to this. When we come together to go beyond the label to lay the foundation to eradicate mental health stigmatisations.

I recall about 20 years ago, as a young Rota commander at a fire station attending to my first suicide incident. When I checked the call sheet, it was on the 13th floor, cliché.

As I went into the unit, I saw the subject standing close to the window and I was told that I had a few minutes before the rescue set-up would be complete. So, I engaged in small talk with the subject in the hope to distract him from our elaborate rescue set-up. Out of respect, I shall not share the outcome but I must say that the episode left a deep impression on me. It made me curious about mental resilience and the importance of a sound support systems that include family, friends and peers.

In my role as an educator, and as a community leader, one persistent issue that I have been confronted time and again is with regards to mental health.

Periodically, I receive news of suicide within the community and every single time, news of an individual taking his or her life hits me hard.

If we picture a pyramid structure of mental health issues, usually suicide is at the peak. What I want to bring forth today is not the peak, but the myriad of ways individuals in our community may be affected with mental health issues and how we may remove the stigmatisation.

So why does the stigmatisation exist?

According to the WHO, it is estimated that one-fifth of the world’s population suffer from mental health issues at some point of their lives. In Singapore, it is one in seven adults. The keyword is “adults”.

That means there is a high chance that someone you know, may know someone else who has suffered a mental health issue.

The fact that we do not know any, may suggest that: (a) we do not know, really; (b) we do not know; or worse; (c) we deny knowing people who know; because of the stigmatisation.

This is the inconvenient truth. It is common for us to label people with mental health issues as highly emotional, mentally weak, crazy, or even naturally violent, and we stay away from them.

Thus, it is clear that having awareness is important. Campaigns are good and platforms to share experience is great. These conversations must continue. However, I believe it is equally important that we go beyond awareness and I offer four strategies: literacy, accessibility, screening and time-outs.

I believe that it is important to make mental health literacy programmes mandatory in our schools and institutes of higher learning or IHLs. In that way, our students are not only able to identify such symptoms in themselves, or their friends, but they now can take an additional step to address such symptoms. These programmes may include self-care and of course, stress management.

Thus, rather than artificially creating a peer support programme in schools and IHLs led by student leaders, or handing the responsibility to teachers, lecturers or even the counsellors, we have an organic one where friends look out for one another because now they know they have the knowledge and they can help. Like how we offer first-aid classes for our students and there is a first-aid kit, we may now need to develop a mental health first-aid kit.

We can also replicate this at our workplaces. And I am sure the MOM got that covered in their upcoming advisory guide, and if not, I hope they will include it in the upcoming advisory.

Over the years, there have been discussions on the relationship between social media and mental health. So, I embarked in a systematic review of this relationship, and I was surprised to find that many studies actually shared that social media has a net neutral effect – that means the positives and the negatives cancel out each other. The reason for this is that it creates a platform for people to share and raise awareness.

In the hands of the knowledgeable and in the hands of the discerning, it is an important social tool.

However, one clear negative effect of social media is cyberbullying and the creation of fake realities. This effect is not only observed in children or youths, but also adults.

There is no quick fix about this. I suppose it would be far-fetched for me to suggest that we legislate against cyberbullying, or the creation of fake realities. However, I do think it is feasible for us to roll out a digital literacy programme for our children. Through this, I hope the future generations of social media users are discerning and are able to uphold an unwritten code of conduct.

Mr Speaker, my next point is with regard to accessibility to help-seeking touchpoints.

In my conversation with mental health patients, many highlighted the need for greater accessibility, both in terms of quantity and in terms of the ease of getting support, especially for those at the early stage.

Imagine, you are feeling depressed, with a heavy head, heavy feet and walking into a psychiatric ward in a hospital and compare that with walking into a GP clinic.

Help-seeking touchpoints must be community based and non-labelling. This will not only encourage those who suspect they have mental health issues to come forward to seek help but it also lowers the stigmatisation. Inadvertently, this will create a new norm whereby it is okay to seek help if you feel unwell, or unmotivated, or are just feeling plain lousy.

Mental health issues are like other illnesses, if treated early, there is high chance of a speedy recovery. Thus, the Community Mental Health Programme by MOH must continue to expand. With 20 polyclinics and over 1,700 GP clinics in Singapore, but only 14 polyclinics and about 200 GPs in the programme right now, the touch-points currently may not be enough.

The third strategy is to provide regular screening just like how we do our physical health screening. Providing regular screening for all would encourage a new norm and a behavioural change that increases acceptance and the importance of mental health.

This involves having screening mechanisms in place in primary care settings like the GP clinics I mentioned earlier, or paediatric clinics, or gynaecological clinics, in schools and in IHLs, and also in the workplace. Anyone screened for being at risk or having symptoms of mental health issues, would be referred promptly to a clinic.

The objective is simple. The objective is to get people engaged early, before the illness has effects on the brain, disrupts their lives and risks them doing something that would harm themselves or others.

Mr Speaker, my final strategy is to introduce time-outs. Like in some sports where time-outs are allowed, it allows the team to re-strategise, to reorganise and recharge as they continue on with the game. Similarly, I hope such time-outs could be introduced in schools and workplaces.

I give you an example. A student or is having a really hard time in school. He or she feels overwhelmed, overworked and is falling behind, and they know, they know they need help. All he or she has to do now is to inform his or her parents, and the parents will call the school to ask for an excuse for the absence. So, it is not really a free pass for these students. Most importantly, the parents are now aware and the school has their absence recorded as a mental day so that they can keep track on how many the student has taken. If the student takes a second one, the student would be referred to the school counsellor for a quick chat.

This is important because we can catch students who are struggling before it is too late. Rather than waiting for the results to dip in mid semester, or worse, at the end of the semester, we can now intervene much earlier. At the same time, we are creating a culture that it is okay. It is okay if you need to take a break because mental health is just as important as physical health. I have had students who struggled midway, took a break, and came back stronger with much improved grades.

Another form of time-out that I strongly believe in but will not elaborate further is the Right to Disconnect legislature as raised by the hon Member, Mr Melvin Yong. He had discussed this at length yesterday and I am in support of this. Just like him, I await the good news from MOM.

Mr Speaker, recently, I met a few individuals who have further inspired me in preparing this speech. Mr Nicholas Patrick. He lived with depression for about 12 years. He even went through the Singapore Armed Forces’ Officer Cadet School with this depression. He experienced suicidal tendencies and thoughts in 2011 but before he could continue with his attempt, he had a simple text on the phone asking how he was doing in school. That led him to seek help and he overcame his depression in 2017. Nicholas has created the Ekho Academy, an online learning portal to provide support, share tips and stories of hope and recovery.

Mdm Sumaiyah Mohamed. She was diagnosed with schizophrenia and depression when she was 19 while in university. Her mother noticed that she was not feeling well, took her to a GP, and subsequently she received treatment at a hospital. She took some time-off, but when she came back, she managed to graduate with a second-class honours in Social Sciences. Sumaiyah is now married and a mother to a beautiful daughter.

Finally, Mr Desmond Ng. He started experiencing hallucinations and feelings of paranoia when he was only 18 years old. But he was lucky because he was able to seek help and was diagnosed with schizophrenia and depression early. Desmond is currently in recovery and is using his personal experience to inspire other youths and those struggling with schizophrenia.

Collectively, they have proven to me the importance of intervention checkpoints and how they are able to move on with their lives and continue to achieve success. Mr Speaker, in Malay, please.

(In Malay): [Please refer to Vernacular Speech.] In my speech earlier, I highlighted the issue of mental health in our society.

In every life journey, each individual will certainly face challenges and obstacles and experience stress.

In every phase and area of life, be it in schools, workplaces or homes and in domestic affairs, all of us will face pressure from time to time.

Sadly, there are many within our community who belittle mental health issues.

It is easy for us to label someone with mental health issues as being too emotional, weak in their faith or that they are crazy and so on.

We must build an open-minded society and provide support to individuals facing mental challenges.

We should consider mental illness just like physical illness and provide the same professional treatment.

If one needs further help, I suggest that they seek professional mental treatment, such as therapy and so on.

Let us together become a society that is more caring and ready to help those who are facing mental health challenges.

(In English): Mr Speaker, we live in a highly dynamic world, a complex and interconnected world, a world where cuts and bruises may be inflicted covertly and hidden from our family and friends to see, a world where non linearity exists – small changes may lead to large implications and big changes may sometimes lead to small implications.

A clear example would be the COVID-19 situation. It has shown how interconnected we are and how dynamic the situation can change. And many, many of us are affected. I look forward to the New Joint Task Force and would like to put forth my name to be included in the task force in the future.

Mr Speaker, like every good teacher, I would like to end my speech by giving away an acronym – L.A.S.T.

L for Literacy – as we push forward for mental health and social media literacy in schools and workplaces.

A for Accessibility – as we increase the number of community touch-points and make it easier for them to come forward to seek help.

S for Screening – to provide regular mental health screening for all Singaporeans.

Finally, T for Time-outs – to allow individuals to recharge, reorganise, re-strategise and come back stronger, and it also becomes and acts as another screening mechanism.

There is a relevant quote summarising my speech today by Alexander Den Heijer who said, "When a flower does not bloom, you fix the environment in which it grows, not the flower". [Applause.]

Mr Speaker: We have about three minutes if anyone wants to chime in before the response. If not, Parliamentary Secretary, please.

8.14 pm

The Parliamentary Secretary to the Minister for Social and Family Development (Mr Eric Chua): Mr Speaker, I thank the Member for putting a spotlight on mental well-being and mental health. And I thank Members of the House for your patience for the next 10 minutes. Rest assured I have your mental well-being at heart.

Our work ahead of us can be categorised into two broad categories: first, fighting stigma; second, to lend better support for mental wellness in general and for individuals with mental health conditions.

Before we look ahead let us first take stock of what already has been done.

Since 2018, NCSS has passionately powered Beyond the Label movement, a campaign that aims at amplifying the anti-stigma message. NCSS has worked with partners to develop resources, organise outreach activities and the annual Beyond the Label Festival, which allows the general public to have a better understanding of the stigma faced by persons with mental health conditions.

Beyond broad-based campaigns, work has also been done in a more targeted fashion. For instance, MOE has incorporated the learning of socio-emotional skills and resilience building into school curriculum, CCAs and other programmes. We recognise the importance of equipping our children with the socio-emotional skills to handle challenges and better bounce back from difficult situations. This is all the more important in a world that is currently struggling with COVID-19 and its aftermath.

Next year, MOE will introduce the enhanced Character and Citizenship Education or CCE featuring mental health education. It will include topics such as "understanding common mental health issues and symptoms" and "developing empathy towards people struggling with mental health conditions".

On the other hand, HPB has also been conducting mental well-being roadshows and workshops at our workplaces. From next month, HPB will be rolling out the Peer Support @ Work series to help employees better understand how and what it means to be a peer supporter at work.

We have also invited persons living with mental health conditions to serve as ambassadors in our anti-stigma movement. Since 2016, the Peer Support Specialist programme led by NCSS has been equipping persons with mental health conditions to leverage their lived experiences to inspire, empower and support others in their recovery journey.

Second, lending better support for mental well-being generally, as well as for persons with mental health conditions.

Within our communities, MOH and AIC has established community outreach and intervention teams, started mental health and dementia services in polyclinics, and trained GP partners to diagnose and support persons with mental health conditions. As of end 2019, AIC has set up 43 community outreach teams which reached out to more than 300,000 persons and assisted over 23,000 people at risk of developing mental health conditions or dementia.

To cushion the impact of COVID-19 on mental well-being in our communities, MSF – with MOH's support – set up the National CARE Hotline in April this year to provide emotional and psychological support to those in distress. Cases needing specialised support beyond what the helpline could offer are referred to service providers such as the IMH, the Samaritans of Singapore or SOS and other social service agencies. The hotline has since managed over 30,000 calls.

To help someone who needs to navigate through available resources on mental health, the MOH Office for Healthcare Transformation, MSF, NCSS and IMH launched mindline.sg in July this year. Mindline.sg is a portal offering resources on mental health, including a standardised tool for users to assess their own emotional well-being. Not forgetting Belle, the Beyond the Label chatbot that connects users to a comprehensive list of mental health services and resources based on keywords.

In essence, we have covered some ground in eradicating stigma, channelling resource to the mental wellness landscape and supporting individuals with mental health conditions. But, make no mistake: we remain a "work in progress" and our approach needs to evolve.

To that end, I am heartened to share that since February this year, the open call to recruit those keen to contribute to the Youth Mental Well-being Network saw over 1,000 youths, parents, care-givers, mental health practitioners and professionals pitching in. The Network takes a ground-up approach, with members surfacing ideas and identifying the areas they want to work on. It takes the view that Government does not have a monopoly of ideas, but we want to journey with the community in co-creating solutions in the spirit of SG Together.

Since work in the Network started, members have stepped forward to lead discussions, developed ideas and initiatives to strengthen support for our youth's mental well-being. Their diverse views and insights have enhanced our collective understanding and the Network has since identified 15 preliminary initiatives, within eight broad areas of interest, and these include enhancing mental health literacy, reducing stigma, and building emotional resilience.

Alongside the Network, the COVID-19 Mental Wellness Taskforce has been more recently convened to provide a coordinated national response to the mental health needs of Singaporeans arising from the pandemic. The Taskforce is co-led by MOH and the Institute of Mental Health, with members from MOM, MOE, MSF, MCCY, HPB, AIC, NCSS and PA. Why so many agencies, you might ask? Because we recognise that the issue of mental wellness and mental health has many facades.

Members of the multi-disciplinary Taskforce can leverage their colleagues' areas of expertise in staging a holistic response to address mental health issues arising from COVID-19 and beyond. In fact, the Taskforce will be better placed to identify issues such as those raised by the hon Member, Dr Wan Rizal, and conduct deep dives so that our people's collective mental health needs could be better addressed.

Mr Speaker, Senior Minister of State, Janil Puthucheary, Minister of State, Sun Xueling as well as myself have been recently appointed to support both the COVID-19 Mental Wellness Taskforce and the Youth Mental Well-being Network. We look forward to journeying with both the Taskforce and the Network to evolve the mental health and well-being landscape in Singapore.

Once again, I thank the hon Member for spotlighting mental wellness and mental health. It is an issue that we, as a society need to continually work on. I would like to conclude by assuring Members of this House that the Government is firmly committed to work with partners from the private and people sectors not only in eradicating stigma associated with mental health conditions, but in ensuring that mental health issues remain front and centre in our collective social consciousness.

Question put, and agreed to.

Resolved, "That Parliament do now adjourn."

Adjourned accordingly at 8.21 pm.