Advancing Mental Health

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.

Ms He Ting Ru.

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.

Dr Tan Wu Meng.

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.

Ms Hazel Poa.

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

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.

Dr Syed Harun.

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 Edward Chia.

Mr Mark Lee.

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.

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]

*Debate resumed. (proc text)]

Ms Mariam Jaafar.

Ms Mariam Jaafar, you have one-and-a-half minutes.

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.]

Ms Usha Chandradas.

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.

Ms Ng Ling Ling.

Mr Melvin Yong.

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.

Ms Jean See.

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.

Mr Keith Chua.

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.

Miss Rachel Ong.

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 Ong Hua Han.

Deputy Leader, Senior Minister of State Zaqy.