Debated in Parliament on 6 Feb 2024.
Debate resumed.
Ms Nadia Samdin.
Mr Speaker, Sir, I rise in support of the Motion. A 2023 study conducted by Duke-NUS Medical School and IMH suggested that anxiety and depression could be costing Singapore nearly $16 billion a year as a result of absenteeism, reduced productivity and healthcare resources.
But beyond dollars and cents, mental health conditions are often deeply painful and cost individuals years of lost hope, fractured relationships with care partners and family who are unable to cope with the strain, ending of careers as their lives spiral into a form they do not recognise and feelings like stress and guilt as they struggle to cope on the surface. Sometimes, this lasts a lifetime and recovery is not linear.
In Cheng San-Seletar, student volunteers, corporate partners, grassroots leaders and agency representatives commemorate World Mental Health Day every October. We host a campaign incorporating self-care activities, nature and opportunities to form social networks among neighbours and friends. On the first day, we door knock more than 18,000 households to ask "How Are You?" checks on our residents and share access to mental health resources. The idea is to reach in and start a conversation on mental health in the community because mental health illnesses can be incredibly isolating and lonely, and it is not always easy to take the first step to seek help. Our message is that you are not alone and that we are here for you. Efforts continue for the rest of the year, working with community partners, including through our Calm Corners, which are rolled out at void decks in every zone.
However, the work to raise awareness and increase outreach is only a start. I am heartened by the launch of the National Mental Health and Well-Being Strategy by the Inter-agency Taskforce, and I am supportive of the four focus areas. I am also grateful for all healthcare workers and many different individuals whose work has brought us here.
The efforts in the strategy will take significant effort and resources, not just from Government but also from the different sectors, private sector as well as all of society in tackling stigma and creating a culture of care. It will also take time, and I note that the National Mental Health Office is likely to only be established by 2025.
But Sir, the issues are pressing here and now, and we must tackle them with haste. The prevalence of poor mental health rose from 13.4% in 2020 to 17% in 2022. And Singapore recorded more suicides across all age groups in 2022, with a significant increase amongst the elderly and youth populations.
Today, I will raise three key points on access and affordability to mental health treatment and support, caring for the mental health of our seniors and support for vulnerable groups.
Sir, we often tell those facing mental health challenges that they should reach out and seek help. While readiness to do so is, indeed, the first step, we must also consider the financial capacity of such individuals and the ease at which they can access mental health support.
Last year, MOH shared that the median waiting time for a new subsidised appointment was 45 days to see a psychiatrist and 42 days to see a psychologist. Past surveys have also cited high cost as a deterrent, resulting in a treatment gap which often leads to mental health conditions worsening over time. While there are helplines and some free counselling sessions available, long-term dedicated care and medication can cost patients hundreds or even over $1,000 per visit. Subsidies for Pioneer Generation, Merdeka Generation and CHAS card holders are up to $540 annually for the management of mental illnesses under the Chronic Disease Management Programme for only certain conditions.
This leads us to a crucial point – the Government's role in shaping the insurance market to promote affordable and accessible mental health coverage, as well as general health and hospitalisation coverage for everyday Singaporeans facing mental health challenges.
It is already tough enough for individuals facing mental challenges to get through their daily life, many of whom have to stop work and are faced with difficulties when asked to declare whether they have gone through or are currently facing mental health challenges, as they try to sign up for even simple hospitalisation insurance to try and avoid further financial stress.
Underwriting coverage for mental illnesses is complex given the diverse ways these disorders impact individuals. As several hon Members in this House, including just two before me, Miss Rachel Ong, have urged the Government to do more in this front, I will spare Members' well-being and not repeat the same points but I, too, reiterate this call to Government, as well as private insurers and would like to just ask if the Government has considered encouraging private insurers to launch innovative, affordable insurance products and if the Government has considered mental health parity laws to prohibit health plans from imposing barriers on access to mental health.
My second point. Sir, as a Member of Parliament looking after a ward with many elderly, I was disappointed that the strategy did not call out what we can better do for elderly mental health. Unlike youth mental well-being and health, there are few community organisations or ground-up groups which focus on supporting the mental health needs of seniors and, given our ageing population, I call on the Government to do more in this area.
Chronic health conditions, reduced mobility, retirement, empty nests and the passing of close friends – these are just some of the difficult moments that our seniors go through as time passes on. At the same time, digital transformation and a built environment, unlike the kampongs they grew up in, often feel alienating.
While efforts to destigmatise mental health conditions and encourage help-seeking behaviours are well-intentioned, some seniors expressed difficulty discussing mental health as it is considered taboo. This sentiment is also reflected in the National Population Health Survey 2022, as the proportion of residents least willing to seek help from healthcare professionals or their informal support networks are older adults aged 60 to 74. This trend is worrying especially as the percentage of seniors' death by suicide in 2020 reached a significant high in 29 years.
With a tiered care model, the provision of care is shared with community partners with trained personnel on the ground. However, staff are often stretched, managing many cases. We must encourage everyone to be eyes and ears, equip ourselves with knowledge and destigmatise early screening and help-seeking as the norm to provide timely interventions for our seniors.
In my constituency, community partners such as the mailmen and women from Sing Post monitor changes in mail collection patterns in blocks with a high number of elderly and participating hawkers are trained to recognise simple signs of depression and dementia before referring seniors to the nearest Active Ageing Centre (AAC) or our community clubs.
One of the biggest threats to our seniors' well-being is social isolation. In 2022, 78,600 households are seniors aged 65 years and above living alone. This is double the number 10 years ago and the number is forecasted to rise further. It is not only seniors who live alone who experience loneliness.
In a study on social disconnection and its impact on the health of older adults by the NUS, the findings found that most socially disconnected individuals are living with family members. In another research by the Centre for Ageing Research and Education, a significant percentage of older Singaporeans staying in multi-generational households indicated feeling lonely. These trends could stem from poor familial relationships or the lack of interaction between family members, as everyone is busy with their lives or on their digital devices.
On this note, how can adult children and grandchildren be better equipped with skills to talk about mental health with seniors? Beyond immediate family, how can wider community initiatives and befrienders reaching out to seniors to reassure them and encourage participation in community efforts?
On early screening and detection, I am heartened that the Healthier SG exercise will include mental health services by training GPs to manage mental health cases and work with communities and hospitals to meet the needs. I would like to ask on the progress of this uptake.
Likewise, I understand Age Well SG will scale up the quality and quantity of AACs to increase meaningful engagement with our seniors. The Silver Generation Office also does good work. They are reaching out to seniors at greater risk of isolation. This is likely to naturally engage the more active seniors. What are the efforts in place for seniors who are isolated or already experiencing mental health issues and how will efforts and resources, such as COMIT, be better resourced under the strategy?
Sir, our seniors have worked hard in the early years, and my wish is for seniors to age purposefully with good mental well-being. It deeply saddened our community when we lost some of our elderly residents to suicide, especially during COVID-19. I hope that the task force will consider developing a more targeted approach for seniors.
On my final point, I echo the points raised by hon Member Mr Ong Hua Han. Persons with disabilities are not only more likely to experience mental distress but also factors associated with a higher occurrence of mental health conditions, including financial stress. This intersectionality of disability, socioeconomic factors and healthcare access plays a pivotal role in shaping mental health outcomes within the Singaporean context.
Key measures should include ensuring that screening, care and support services are not only accessible but tailored to the unique needs of this population. There is a dearth in specialist healthcare for persons with disabilities, especially in our heartlands.
Beyond Government policies to promote inclusivity, efforts by employers and wider society aimed at enhancing educational and employment opportunities and fostering an open environment are essential towards reducing disparities and creating access. We should also start early. How is mental health included in health education lessons, for example, in our special needs schools? Sir, briefly in Malay, please.
(In Malay): [Please refer to Vernacular Speech.] A young man who was no longer cheerful and suddenly lost interest in his favourite sports; a woman who often cries after giving birth or perhaps an uncle who started to distance himself from others after losing his job. Mental health challenges affect all levels of society, both young and old. This issue is a pressing one. Thus, we should speak more about mental well-being in our normal conversations, especially when it concerns our senior citizens who may feel lonely.
Apart from being patient with them and praying for them, we should be tactful when giving advice and words of encouragement to those in need. We can also persuade and help them to seek advice from specialists, such as counselling and therapy, or to get enough medication. We should not feel embarrassed to seek support because such prompt assistance can help to save jobs, family or even the lives of loved ones.
Finally, let us focus on listening actively and caringly if anyone comes to us for a shoulder to cry on. Sometimes, they are not seeking our advice or expertise to solve their problems. They simply need a friend to pour their hearts out to.
(In English): Finally, Sir, alongside strategies to improve service coordination and care systems, we must consider local training and education pathways and spaces for professionals, such as clinical psychiatrists, to help the system cope with increased load, even as we move beyond tackling mental health crises to upstream intervention.
Further, as we encourage peer support, clarity on the qualifications and certifications necessary for practitioners or peer supporters at various tiers besides the expected relevant skills and knowledge will be helpful.
It is well and good to say that it is okay not to be okay. But think about perhaps the neighbour below who says they hear noises coming from your house and cannot control their emotions, lashing out at you in the corridor. Consider the hoarder, who perhaps arrived at this state because of the loss of loved ones years ago and has unprocessed trauma. Imagine a loved one, who was always a pillar of support for you, but now cannot get out of bed on the bad days. At the end of the day, it is true understanding, empathy and recognition that counts and can make a difference in someone's mental health journey.
The Government's commitment to mental well-being is instrumental in shaping a society where everyone, irrespective of background, can lead fulfilling lives, but this must be amplified by collaborative efforts with non-governmental organisations, philanthropy, the private sector, you and I. It will take all of society to destigmatise, talking about mental health and normalise health-seeking behaviour.
Some people dismissively say that those dealing with mental health conditions are weak but personally, oftentimes, they are the strongest people I know, for holding on despite the pain. Let us be mindful of the language and terms that we use and let us be kind to one another, especially when it is hard. To anyone facing a mental health condition and to their loved ones, we see you, we recognise you, you are worthy, and we are so glad that you are here. Sir, I support the Motion.
Assoc Prof Razwana Begum.
Mr Speaker, I stand in support of this Motion. By many indicators, the mental health status of an increasing number of Singaporeans is low and getting worse every year. Data from the 2022 National Population Health Survey shows that the percentage of Singaporeans with poor mental health has increased from just over 13% in 2020, to 17% in 2022. The situation is even worse for our young people. The same data shows that approximately 25% of those living with a mental illness are between 18 and 29 years of age. These figures tell us that approximately one in six Singaporeans is currently living with a mental illness of some sort and that one in four of those are young people.
Mr Speaker, commensurate with the increasingly poor mental health of many Singaporeans is an increase in the number of suicides. Data from the Samaritans of Singapore (SOS) shows that in 2022, there were 476 deaths by suicide, up from 452 in 2020 and 397 in 2018, an increase of 20% over four years. The same data shows that suicide is the leading cause of death for people between 10 and 29 years of age, accounting for almost one in every three deaths in this age group.
As a social worker and counsellor, I am distressed but not surprised by this data. Life is tough for many people, including many young people, and it is getting tougher. The impact of social media, climate change, global insecurity and uncertain employment, housing and relationship options present a bleak picture for many.
Suicide appears to be increasingly commonplace and this is deeply distressing. I have seen first-hand the impact that suicide can have on partners, friends, colleagues, even strangers, and I have recently witnessed the impact on my own children following the suicide of a long-term friend of theirs.
Mr Speaker, in response to such disturbing data, Singapore is taking the issue of mental health and suicide seriously, evident by this Motion and by comments made by my fellow Parliamentarians. I am also pleased to note that our Government is strengthening our existing mental health frameworks by developing the National Mental Health and Well-being Strategy, a strategy that I support.
Mr Speaker, I would now like to make some additional comments relevant to the Motion before us today. My comments fall into three areas targeted at accessible mental health services, suitability to practice and workplace mental health and well-being.
First, targeted and accessible mental health services. Mr Speaker, Singapore is progressively introducing a suite of mental health services across various touchpoints and various platforms so as to assist ensure that people can access assistance when and where they need it. Mr Speaker, while this expansion of services is positive, it is important that we consider the accessibility of these services to vulnerable populations in our society.
WHO defines vulnerable populations as, and I quote, "Those who, due to factors usually considered outside their control, do not have the same opportunities as other, more fortunate groups in society." There are many causes of vulnerability, including physical, social, cultural, economic and environmental factors, all of which can make it difficult for certain groups of people to access appropriate mental health services. For example, children, young people, the elderly, women, men, migrant workers, those under the care of others, people living with a disability, or living in poverty, or who are unemployed, or, somewhat ironically, people living with a mental illness. All of these people, in fact, all Singaporeans, can sometimes face barriers to not only recognising that they need assistance, but also seeking assistance and then accessing the appropriate care.
Mr Speaker, this Motion calls for a whole-of-Government approach to strengthening mental health and well-being. This is a positive approach. However, it is important that the Government also works closely with the private and community sectors and, importantly, with people of all ages, backgrounds and capabilities.
It is also important that we do not simply introduce more and more services but that we acknowledge and address existing and emerging factors that increase vulnerability and are an impediment to positive mental health and well-being. Mr Speaker, mental health is a vital component of overall well-being and is characterised by an individual's awareness of their abilities, capacity to manage life's stressors, productive work and contribution to their community.
In essence, mental health extends beyond the mere absence of mental disorders and is intrinsic to overall quality of life. Mr Speaker, with this definition in mind, I would now like to make some comments about quality of life, particularly for children.
Mr Speaker, it is frequently said that children in Singapore are blessed, and against many measures, this is true. Singapore is one of the safest countries in the world, has an exceptional education and health system and offers world-class sport and recreation opportunities.
However, as the National Population Health Survey and SOS data I referenced earlier indicates, this is clearly not enough. Something is missing and many of our children are struggling. It is, however, essential to remember that the difficulties that many of our children are experiencing, are not a reflection of their own character, resilience or strength but a reflection of the world in which they live.
Mr Speaker, significant attention is given in the literature to the concept of adverse childhood experiences (ACEs). ACEs are potentially traumatic events that occur in childhood and can include experiencing violence, abuse or neglect; growing up in a family with mental health or substance use problems; witnessing violence in the home; living in poverty or insecure housing; chronic unemployment; parental separation; or household members being in prison.
ACEs are correlated with future chronic health problems, mental illness and substance use problems. ACEs can also negatively impact education, job opportunities, earning potential and future relationships.
In 2020, the Singapore Mental Health Study reported that the lifetime prevalence of ACEs in a sample of 6,000 adults living in Singapore, was 64% or, Mr Speaker, two in every three adults. For this group, we need to consider a holistic systemic approach. It is not just about providing mental health services. We need to consider what more can be done to alleviate ACEs. We cannot eliminate all factors, but we can do more to identify and mitigate these risk factors.
Mr Speaker, just because we offer mental health services, we cannot guarantee take-up of these services. We need to create an environment where individuals can access the services they need, when they need them, without any perceived or actual stigma, adverse consequences or reprisals.
In 2021, a national study by the National Council of Social Service (NCSS) on societal attitudes towards mental health, showed persistent stigma across Singaporean society. We need to address this stigma. We need to do more to make Singapore a community where children can safely say to their parents, their friends and their teachers that they are struggling; that they are not ok. This change will take time. However, with a coordinated and sustained effort by the Government, private and community sectors, we can get there.
Data from SOS indicates, that an increasing number of young people are calling their service seeking support, with a 127% increase in calls from young people between 10 and 19 years of age. While this is positive, in that it suggests that young people are becoming more willing to ask for help, it is still alarming that so many young people feel they need mental health support.
Mr Speaker, as we work towards implementing the national strategy, we also need to consider the provision of mental health services from the lens of a child. Everything and anything we do, from designing services, developing policies, undertaking community education campaigns, need to be informed by the views of children. We do things with children, not to or for children. We also need to consider cultural and religious preference or influences and, again, to do this effectively, we need to speak with the consumer.
Mr Speaker, we also need to ensure that all of services are trauma-informed. Trauma-informed practice is an approach that recognises that trauma is common, that people accessing services may be affected by trauma and, that trauma can have a significant impact on how a person sees and interacts with the world. Trauma-informed practice is an approach that is holistic, empowering, strengths-focused, collaborative and reflective.
Trauma-informed practice can be individual- or service-based and it can be whole-of-community. For example, research suggests that exposure to nature can reduce stress and increase overall well-being. Finland has actively embraced this idea and their integration of nature into urban spaces has been associated with positive mental health outcomes.
Mr Speaker, my second focus area relates to suitability to practice. It is essential that those delivering therapeutic services are suitably qualified and regulated. This was highlighted by my fellow Nominated Member of Parliament hon Dr Syed Harun. I am sharing my perspective as an educator.
While Singapore currently offers a world-class suite of post-secondary and tertiary courses in counselling and psychology, neither counselling nor psychology are currently a regulated profession and counsellors and psychologists do not need to be registered to offer services. This means that, in Singapore, anyone can call themselves a counsellor or a psychologist and charge for their services. This situation is inconsistent with other developed countries and, as part of the national strategy, I encourage the Government to consider introducing mandatory registration for anyone offering services under the banner of "counsellor" or "psychologist".
We do, however, need to recognise the invaluable assistance that suitably trained volunteers can offer to their friends, colleagues and the community. Peer-to-peer support networks, particularly among young people, are an essential component of a mental health service system and should be actively encouraged, maintained and valued.
At this point, I would like to share an example of a youth-led safety and well-being initiative, developed by Public Safety and Security students at the Singapore University of Social Sciences. Mr Speaker, before I do so, I should note that I am Head of the programme.
The initiative was called "ReKnew" and was established by a group of students to provide a safe space to discuss sexual abuse. The group adopted an approach based on the principles of restorative justice and they established learning circles to educate and empower students to discuss difficult topics in an open and safe environment.
Mr Speaker, this example highlights the need to de-medicalise and normalise conversations about mental health and the power of compassionate and skilled youth-led peer support. It also demonstrates that it is important that we do not over-pathologise mental health and that we do not assume that everyone who is having a bad day is having a mental health crisis. Sometimes, all that is needed is someone to ask, genuinely, "Hey, are you okay?" and to care about what the person says in return.
Mr Speaker, my final focus area relates to workplace mental health and well-being. In any discussion about mental health and well-being, it is essential to discuss the workplace, and this was also highlighted by hon Member Mr Melvin Yong.
Mr Speaker, not only do we need to work towards all workplaces being environments where employees can safely reach out to their colleagues and supervisors for support, we also need to step back and consider the negative impact many workplaces have on their employees' mental health and well-being.
Singapore has an international reputation as being a place where people work long hours. In a 2019 study of 40 cities conducted by American security solutions company, Kisi, Singapore ranked as the second-most overworked city. In another report by Mercer, titled the “Rise of the Relatable Organization” released in 2022, it indicated that 85% of employees said that they felt at risk of burnout; and almost 50% said that they intended to leave their job in the next 12 months.
The post-COVID-19 trend of working from home has not helped this situation. While flexible working arrangements have definite benefits and are preferred by many employees, working from home also comes at a cost. The 2022 Cigna 360 Global Well-Being Survey showed that those currently working in a hybrid model are most likely to feel stressed and to work outside normal hours at least once a week.
The "always-on" mentality has become the norm. Yet, it comes at a price. Not only do employees have less time to spend with their family and friends to enjoy recreational pursuits or have real holidays, the prevailing hustle culture has had a profoundly negative impact on our mental health. The culture of working long hours needs to change. It is a workplace hazard and needs to be treated as such by employers and employees.
Mr Speaker, achieving work-life balance is a shared responsibility between employers and employees. Employers have a duty of care, to provide a safe working environment for all employees, and reasonable working hours should be considered as one of those duties.
At the same time, employees need to take responsibility to prioritise their health and well-being and to stop treating working in the evening or on weekends as something to be proud of or something that they just have to do. A collaborative effort between employees and employers will ensure a healthier and more fulfilling professional and personal life for everyone involved.
Mr Speaker, many employers around the world have moved towards a four-day work week, with many of these employers reporting increased productivity, improved staff retention and improved staff well-being. Employee's performance should be outcome-based, and employers should model and reward reasonable hours.
To conclude, as we develop this national strategy, it is important to remember that mental illness is not a personal flaw or sign of weakness. It is a normal reaction to an abnormal or unpleasant situation. While we cannot live in a protective bubble and completely eradicate all stress and distress from our lives, we do have an obligation to reflect on our society and our culture and to consider how our expectations and the world we have created is making us ill.
The National Strategy is an opportunity for the Government to work hand-in-hand with the private and community sectors to make Singapore a place where we can all thrive and when we stumble, to be picked up and looked after with care and compassion.
Mr Xie Yao Quan.
Mr Speaker, Sir, I went through a rough patch recently. Looking back, I think it was early signs of burnout. Luckily, I was aware of what I was going through. I detected the signs, and I took steps to care for myself. And I am grateful that the self-care worked. I became better and I feel okay enough now to be able to make this speech in Parliament.
I decided that I would share in the speech, in Parliament, that I did not feel so okay, not too long ago.
I think this is what breaking stigma is all about and needs to be about. It is about normalising the struggles and challenges that so many of us have gone through or will go through at some point in time. It is about shining a light on these common experiences, deeply personal but actually common experiences, because they should not remain in the shadows of our minds and souls and we should chase these shadows away.
It is about normalising the process – the journey of coping, of regaining health and well-being and of becoming better. It will take all of us, a whole-of-society effort. It cannot be the start of policy interventions or legislation. It takes the whole of society to talk more openly about our own mental health journeys.
Imagine a day, when parents tell their children, “Look, daddy and mummy have our struggles too, we may not fully understand yours, the struggles you are going through, but we know what it is like to be trying to cope on your own, so let’s help each other get through our challenges together.”
Imagine a day when bosses and supervisors in workplaces can tell their employees, “Look, we too have bad days, please tolerate and hold space for us, just as we must for all of you and let’s work together to protect and promote mental health on our jobs”.
I look forward to such a day. How do we get there? I have said this before during COS 2022, and I will say it again. Our words, our language and our actions, which shape our everyday discourse and interactions, really matter.
When we are careless with our words and actions, or worse, when we choose to deliberately exploit and weaponise mental health with our words and actions, these set all of us back. These tear people down, they build walls back up and they set the whole of society back in our journey to eliminate stigma.
I recently met Lisa Chan. This may be a familiar name to some of us. Lisa and her father have been coming out and sharing their story about Lisa’s struggles with depression and her journey in healing and recovery. Their story clearly resonates with others because Lisa has gathered quite a following on social media. And, by the way, this is alongside her full-time work because Lisa is also a thriving professional.
So, there are folks whom Lisa may be meeting for the first time but who already know of her and her story through social media. Lisa tells me some of these people, meeting her for the first time have gone, “Oh, so you are the girl with depression!”
To be clear, there is no ill intent behind these words. Indeed, these words may be borne of excitement, of resonance and of gratitude to Lisa for coming out and encouraging others with her story. And to Lisa’s credit, being the incredible person that she is, she totally took these words in her stride. But such words, while coming from a good place, can cut quite deeply.
And so, we need to be aware and we need to be conscious that our words and actions really matter and we need to learn the right language. On the other hand, when our words and actions are understanding, authentic and sensitive, it helps someone else to reach out to us. And it can also help us to reach someone who may need our help and care. So, let us build a kind, compassionate environment, a society free of stigma for mental health challenges, starting with our words and our actions.
Mr Speaker, the national strategy on mental health and well-being is an ambitious one, and rightly so.
The second point I like to make is to just remind all of us, as we forge ahead in this strategy – there is so much enthusiasm and support for the strategy in this House – let us remind ourselves that those who will operationalise this strategy and those who are providing care for the mental health and well-being of others, also need care themselves. And they may need care in different ways. They may have different care needs.
I wish to highlight two groups. First, the professionals in healthcare, social services, education, in the Home Team and even municipal services. As we try to strengthen all of these roles as touchpoints for mental health, let us remember that they are at the frontline, they are the ones dealing with difficult cases, sometimes very raw experiences. And they need care too.
I recently met a gentleman working on sexual trauma cases. His hobby is climbing. He was very active in school. So, I took the chance to ask if he still climbs regularly now that he is working. He said yes, in fact, he has to because it is his "me time" to get away from the cases that he is working with and, in his words, to “keep his sanity”. So, the professionals who give care need care too. There are more than 100,000 of these professionals that we are envisaging in the national strategy. They need care and we need to care for them.
The second group of persons who provide care are the laypersons in our community, family members who are caregivers to persons living with mental health conditions in the community. It is certainly ideal for persons with mental health conditions to remain plugged into the community while coping with their conditions, but we all know that some in the community are really not coping well. And in these situations, caregivers bear the brunt.
I have a resident, who is caregiver to not one but two family members dealing with mental health conditions. They were not coping well, they had disruptive behaviour but they were being kept in the community. One day, my resident lost his cool and got into a physical altercation with the family members. Police came, Police investigated, Prosecutors looked at it and, in the end, decided to proceed to charge my resident in Court. He spoke to my team, and we helped him defend himself against the charges. Thankfully, he got a compassionate sentence.
But the point is, caregivers can break, and caregivers need care too.
To summarise, as we aim to build what my hon colleague Dr Wan Rizal has described as "a next frontier in our national strategy for mental health and well-being", let us remember those professionals and caregivers standing at this new frontier and let us systematically take care of their mental health and well-being too. Let us make this a key workstream, a concerted vertical in our national strategy for mental health and well-being – caring for those who give care.
Mr Speaker, as I look at the national strategy before us, the final point I will make is this: how do we fund this entire plan, how do we fund this ambitious national strategy for mental health and well-being?
I will offer two thoughts. First, I think insurance must play a bigger role. This includes private insurance providers for sure. My hon colleague Dr Tan Wu Meng has spoken about this very eloquently. But it must surely be about our universal national healthcare insurance MediShield in the first instance. MediShield must do more because medications, counselling and therapy, they all cost money. And we know that the MediSave500/700 scheme alone is seldom sufficient. So, MediShield must do more.
But besides MediShield, I think philanthropy and charities must play a key role too. That is the second thought I will provide here. In the past, we have had philanthropy and charities anchoring intermediate and long-term care in our healthcare landscape. Think about community hospitals and nursing homes. And more currently, we have philanthropy looking deep into new frontiers in our healthcare landscape, like palliative care and special needs. I think we need mental health to become another new and next frontier for strategic philanthropic action, for breakthrough private-public-people partnerships.
I call on all stakeholders in the space to seriously think about funding and supporting mental health, and the national strategy for mental health and well-being in a big way, as a whole-of-society. With these, I support the Motion.
Mr Darryl David.
Mr Speaker, the subject of mental health has often been regarded as a stigmatised topic in Singapore. While the attitudes toward the mental health, especially among younger Singaporeans, are changing, it remains a topic that many people would rather not talk about. Much of this stigma could have arisen from two sources.
First, as a society, Singapore has traditionally placed a high value on success as represented by academic achievements and/or material acquisition. Often, the two are linked. With academic achievement, you should end up being able to acquire more materially. While these societal measures of success are slowing changing, there is still a sizeable proportion of the population that equates academic success at every level of education and having a well-paying job, a high-flying career and material acquisition as the pinnacle of accomplishments in life. Acknowledging that one is facing mental health struggles could thus be perceived as being incongruent with these societal ideals of success and be further misinterpreted as a form of weakness or failure.
Second, the general lack of understanding of what constitutes mental health could have led to a conflation between “mental health” and “mental disorders.” The distinction between the two, Sir, is important. A better understanding of the differences between them could possibly be a game-changer that might help to destigmatise the conversation around mental health.
Mental health refers to a state of psycho-emotional well-being where individuals can cope with normal daily stressors, being able to lead a fruitful, productive and fulfilling life. Mental disorder, on the other hand, refers to diagnosable mental condition that affects the way people think, behave, function and interact with others.
All of us probably have had mental health issues at one time or another, just like how we have all probably had issues with our physical health. Having a state of poor mental health does not necessarily mean that we have a psychiatric disorder, although persistently poor mental health over prolonged period could lead to mental disorders. It is therefore important that we identify symptoms of poor mental health early and provide targeted interventions before mental health challenges progress to mental disorders.
I would now like to talk about the cost of poor mental health. In the World Mental Health Day 2023 Report published by Ipsos, close to half of respondents in Singapore placed mental health as the biggest healthcare challenge faced by the country today, with cancer coming in second, and stress, which is highly correlated with mental health, in third place. Close to 50% of respondents reported being depressed to the point of feeling hopeless for weeks and roughly one-third of respondents had self-hurt and suicidal thoughts.
The same study also reported that about a quarter of respondents experienced debilitating mental health and stress-related issues that impeded their daily lives on several occasions in a year. Close to 40% of respondents took time off from work due to mental health and stress, with 15% having done so on multiple occasions.
These results correspond with a similar study published by Duke-NUS Medical School and IMH in June 2023. This study has been referenced already in the debate so far. It reported that up to 15% of the sample showed symptoms of poor mental health, and when extrapolated to the national level, poor mental health could cost Singapore $16 billion a year in terms of loss in productivity, absenteeism and medical care.
What is telling from these studies is not the number of people reporting poor mental health, but the low number of people who have proactively sought interventions for their mental health conditions. Only a quarter of those suffering from mental health conditions in the Duke-NUS Medical School and IMH study sought intervention from a mental health professional.
One of the reasons provided by the Ipsos study on why the treatment gap exists despite the general belief among Singaporeans that mental health is just as important as physical health, is because of the belief that the national healthcare system in Singapore does not reflect the same level of importance for mental health as it does with physical health. Perhaps, there is a kernel of truth in this belief.
According to a Parliamentary reply by MOH in 2021, there are 4.5 psychiatrists and 9.7 psychologists per 100,000 residents in Singapore. This is far lower than the ratio of 280 doctors to 100,000 residents in Singapore. In the same vein, there is only one mental hospital in Singapore, the IMH, that is serving a population of more than five million people.
There is also a perceived social stigma of seeking treatment at IMH since IMH sees both patients experiencing mental health and mental disorders, and people tend to associate individuals seeking treatments at IMH, regardless of their underlying conditions, as “crazy” even though they might not be suffering from mental disorders. The fact that IMH is colloquially referred to as “Siao Lang Keng” or the “mad house” in Hokkien is a reflection of this.
The general unwillingness to acknowledge that one is experiencing mental wellness challenges in fear of being labelled as a “failure” or being perceived as “weak”, the low ratio of mental health professionals to population and social stigma of seeking interventions at IMH for mental health issues will exert and is already exerting a toll on the community. We thus need to consider the social cost of not seeking treatment for mental health issues.
First, not seeking early and timely intervention due to stigma and the lack of accessibility to mental healthcare will erode the human capital potential of those experiencing mental wellness issues. Their overall well-being and functionality could be compromised, limiting their ability to realise their full potential as well as their ability to lead a fulfilling life in the long run.
Second, the caregivers of those experiencing mental health challenges are likely to be their immediate family members who might not be equipped with the right knowledge to provide care. We have heard many Members already speak about this. These family members are likely to experience the stress of caregiving due to the lack of caregiving knowledge and training, possibly experiencing mental health challenges themselves in the long run.
Sir, the social impact of not seeking intervention early is not insignificant. We need to pay more attention to how we can better support early intervention by making structural changes to our mental health ecosystem and the wider social attitudes towards help-seeking. I would like to offer some suggestions here.
First, to talk about how we can enhance the mental health ecosystem. One of the ways to encourage individuals to seek help early is to normalise help-seeking. I would like to suggest for an inter-Ministerial workgroup comprising MOH, MOE, MOM and the Ministry of Communications and Information (MCI) to look into how we can better promote mental health awareness in schools, workplaces and the general public.
I would like to ask MOE to consider blending mental wellness practices, such as mindfulness and grounding techniques, into the formal school curriculum or co-curriculum in primary, secondary and even post-secondary levels to promote the understanding and the importance of mental wellness at a young age, and to teach our young students in school how to deal with these mental challenges in what is, admittedly, a rather stressful time of their life, especially in primary school, such as the lead-up to the Primary School Leaving Examination (PSLE), for example.
In a similar vein, I hope that MOM will consider setting up a demand aggregation contract at a national level to strengthen the adoption of Employee Assistance Programmes (EAPs) which are confidential professional assistance programmes designed to help employees manage work and non-work stressors among companies in Singapore. To mitigate the cost and complexities of setting up EAPs by individual companies, I would like MOM to consider pre-selecting a panel of EAP providers for companies to send their employees to. This will bring affordable and professionally managed interventions into workplaces instead of having companies to design their own support schemes from scratch.
On the public front, a greater level of awareness must be created on what constitutes mental health and how having poor mental health or poor mental well-being is different from having a psychiatric disorder or psychiatric illness. I would like to suggest for MOM and MCI to run awareness campaigns about the differences between the two and to destigmatise help-seeking behaviour by educating the public that those who seek help for mental wellness issues are not "crazy" but are merely unwell, very much like how someone could have caught a flu or some illness during a particular influenza or season, where people tend to fall ill more regularly.
To further support the public education on the differences between mental health and mental disorder and to promote help-seeking, I would like to also suggest to MOH to consider splitting the functions of IMH into different institutions. Just as we have specialised medical centres like the National Skin Centre, National Heart Centre, National Cancer Centre and so on, can we not have a National Mental Wellness Centre that focuses on subsidised interventions for mental health, while IMH continues to provide medical interventions mainly for psychiatric disorders? So, delinking mental health interventions from psychiatric interventions provided by IMH will further help to "de-label" and destigmatise help-seeking.
The lynchpin in the national mental healthcare plan is the number of mental healthcare professionals and the availability of caregiver support programmes in Singapore. I would like to ask if MOH has specific plans to train more mental healthcare professionals in Singapore and to bring these numbers up, closer to the number of general healthcare professionals here? Once the numbers of mental healthcare professionals are brought up, would MOH consider setting up community-based mental wellness interventions and caregiver support programmes, perhaps, even in the polyclinics so that these resources are more widely accessible in the heartlands, leaving the proposed National Mental Wellness Centre to focus on more specialised and deeper interventions?
Mr Speaker, Sir, early identification and intervention on mental health conditions are essential to the success of the national plan to promote mental wellness. Since the COVID-19 pandemic, the issue of mental wellness has taken on greater importance and urgency. I am glad that we are paying more attention to the issue today, and I hope that the Government and, indeed, the whole of society, will adopt a more targeted approach to promote the topic and to make mental healthcare more accessible to those who need it. I end my speech in firm support of the Motion.
Ms Hany Soh.
Mr Speaker, I stand in support of the Motion in recognising, amongst other issues, the importance of mental health and calling for a whole-of-Singapore effort to enhance mental health and well-being. This is aligned with the Government's National Mental Health and Well-being Strategy introduced last year. My speech today will focus on the topic of mental wellness during and after pregnancy.
Studies have shown that about one in 10 women experience postnatal depression within the first three months of giving birth, with those who were depressed during pregnancy most likely to be depressed after delivery. I wish to share my personal experience of being in this category when I was expecting my eldest daughter.
My daughter was born five years ago, but even today, I can still remember vividly feeling delighted, yet fearful about being a first-time mom. The lack of sleep, coupled with the stress and anxiety of raising a newborn as a rookie mom caused me to be constantly exhausted, both mentally and physically. I was also unable to provide enough for my baby through breastfeeding alone, which intensified my feelings of guilt, sadness and frustration.
Looking back, most of the stressors I faced then actually centred around social stigmas and expectations. My own troubles with breastmilk production stemmed from the normalised expectation that all mothers should be able to provide sustenance for their children exclusively by themselves. And like many working mothers, I also wrestled with my priorities of fulfilling my motherly duties while juggling my work obligations as a litigation lawyer, all of which contributed to much worry and stress that consequently sapped my energy.
Today, my daughter is an active, healthy and happy child. Even so, part of me still finds it difficult to forgive myself for not being able to provide her with the best in those early days, even though I know that I had done my best then.
Having gone through some difficult times during my first pregnancy, I can empathise with fellow moms who struggle with the stresses of raising their children. The experience, combined with the knowledge gained over the past few years through my interactions with fellow like-minded mommies, also helped me to prepare myself mentally for the arrival of my second bundle of joy last year, a baby boy.
During my confinement following the birth of my second child, I came across news articles about fellow mothers who had died by suicide with their infant children. The stories were tragic, but they also serve as reminders about the importance of recognising every mother's mental well-being during pregnancy and throughout the months after delivery.
Between April 2021 and March 2022, KK Women's and Children's Hospital (KKH) has seen a 47% increase in its patients who screened positive for postpartum depression, compared to the same period the previous year. This result does not come as a surprise to me. I am, therefore, heartened that one of the focus areas of our national mental health strategy pertains to strengthening mental health services for pregnant women. As we look into the well-being of mothers, I hope we may hopefully also be solving a pain point in our national birthrates.
Currently, various hospitals in Singapore, such as the National University Hospital (NUH) and KKH, have implemented their own respective measures to identify signs of postpartum depression. These are critical initiatives to enable early detection and ensure individualised care can be given at the earliest opportunity to prevent mummies' conditions from worsening.
But we will need to ensure that all hospitals in Singapore, public and private, that provide obstetrics and gynaecology services, are uniformly equipped with the relevant capabilities and resources to provide early detection and timely intervention to parents showing signs of requiring psychological support. Just as the monitoring of physical health is paramount for postpartum mums, so, too, should we devote resources to ensure their mental well-being after birth.
Under the new national strategy announced last year, I note that more hospitals, polyclinics and GPs will be providing mental health services. In this regard, I hope that MOH will ensure that these services will be provided to new parents facing issues in this area to encourage them to seek help through these various avenues.
Since 2019, specialists from KKH have begun to partner and train Punggol Polyclinic nurses, as part of the collaboration between SingHealth Polyclinics and Temasek Foundation to enhance their knowledge on postpartum depression in women. Can we expect to have more polyclinics provide mental health-related services during the regular routine check-ups for the babies? Apart from checking and ensuring that the various milestones of the newborn are met, I propose that these trained doctors and nurses also should take the opportunity to enquire about the parents' psychological states and advise them on the help and support available should they require it.
A study by the NUS Alice Lee Centre for Nursing Studies in 2021 revealed that support from peers can help to reduce the risk of mummies developing postpartum depression. As such, besides investing more resources in our healthcare system to improve coverage for mental wellness, I believe that we, as a community, should also band together to do our part towards increasing awareness of postpartum depression and provide a peer support network to ease the anxieties of mothers of newborn babies.
In 2021, I chanced upon an article on the Internet about Depressed Cake Shop Singapore and its founders, Debbra Lee and Tracy Heah, where they shared about their respective postpartum depression experience and how they eventually decided to set up a campaign to raise awareness in this aspect through baking or purchasing of grey cakes with a pop of colour, with grey symbolising depression and a spot of colour signifying hope.
I subsequently reached out to both of them to explore the possibility of working together to better support fellow mothers out there with their emotional well-being. The three of us hit it off right away from our first meeting and we began discussing ideas to collaborate with the objective of sharing practical tips to restore our mental health and accumulate our mental wealth to Woodgrove residents. In 2022, together with Depressed Cake Shop Singapore and with our community partner, the Singapore Association for Mental Health (SAMH), we organised and invited young parents with their children to attend a cookie decoration session at our Fuchun Communiity Club, in which SAMH shared several signs to identify if one is suffering from depression and the resources available in the community that can be used for support.
Last year, in collaboration with Mumpreneurs Go Places, the PAP Women's Wing Woodgrove branch continued to reach out to our community on mental wellness through a series of workshops, with one session focusing particularly on equipping participants with tips to practise self-care amidst busy schedules between work and family care commitments. In Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] From pregnancy to the birth of the baby, mothers often spend a lot of effort in caring for the newborn, neglecting that they themselves have also undergone many significant changes both physically and mentally. This often leads to postpartum depression. Research also shows that when mothers suffer from depression, out of every two husbands, one will also suffer from depression. Postpartum depression needs to receive attention and support from society, regardless of gender. If not treated promptly, it will not only have adverse effects on individual health, marriage, family life and career, but also affect the development of the baby.
(In English): I am thankful that throughout my two pregnancies, my husband was always by my side, providing both assistance and comfort, which he still does today. We both believe that parenthood is a partnership of equals. Our shared experience has taught me that fathers too deserve recognition and support, and increasingly so as they got more involved in parenting. Similarly, they also deserve the same level of emotional support as they are equally susceptible to the effects of stress and depression from parenting-related causes.
I am heartened to know that there are many who share the same opinion. During a focus group discussion organised by the PAP Women’s Wing last year, the feedback which we gathered from over 60 participants showed a consensus that, apart from having the need to do more to support mothers, more also needs to be done to support new fathers, as they too may be prone to suffering from depression in silence while trying to support their wives through this challenging period.
With that said, social stereotypes that push men towards the supposed ideal image of a strong, uncomplaining individual do exist, thus discouraging them from openly sharing emotions and getting support for depression. While that affects the mental well-being of men in general, it is more pronounced for fathers who would have to grapple with even more pressing worries and doubts. Therefore, one way to improve support for our fathers is to reduce the social stigma of men seeking emotional help, whether through friends and family, or via professional counselling services. By reassuring dads that seeking a listening ear is permitted and even encouraged, we can do much to improve their emotional and mental well-being.
Another way to reduce the stress of fathers is to work together with corporate entities to introduce new measures that allow them to play the role of caretaker while still maintaining a presence at work. Much has been said in recent years about the benefits of remote working in terms of achieving work-life balance, but it may be worth more of exploring an expanded version of remote working, especially for dads to cope with the arrival of their newborn and further ease the transition from paternity leave to resuming normal duties at work.
In recent years, the topic of mental health has increasingly become a serious issue both in Singapore and around the world. I applaud our Government for their foresight in focusing on this area, as lack of issues and action will lead to even more widespread problems in Singapore in the future, economically, socially and security-wise.
By tackling these issues head on, we will be able to ensure that Singaporeans will be further equipped to weather the storms as one united people. I support this Motion.
Mr Sharael Taha.
Mr Speaker, the Motion under discussion emphasises the critical importance of mental health across health, social and economic domains, advocating for a comprehensive national mental health ecosystem and a collective effort throughout Singapore to bolster mental health and well-being. This has been widely discussed by fellow Parliamentarians today, reflecting a societal shift towards greater openness and our concerted effort and action on this issue. The discussion continues as this will be a work-in-progress as we refine our approach and we come to a collective agreement on what we do about it.
Hence, I am glad in October 2023, MOH has taken the lead by launching the National Mental Health and Well-being Strategy focusing on four main areas: one, expanding mental health services; two, enhancing early identification and intervention by service providers; three, promoting mental health and well-being; and four, improving mental health in the workplace.
I will focus my speech on the call for whole-of-Singapore effort to implement this strategy of promoting the mental health and well-being of two particular groups of people – seniors staying alone and senior caregivers in our community, and on improving workplace mental health and well-being.
On promoting the mental health and well-being of seniors staying alone and senior caregivers in the community, we need to work on de-medicalising and normalising conversations surrounding mental health, increase mental health literacy and improve societal attitudes and reduce stigma towards individuals with mental health needs, as mentioned by many of fellow Parliamentarians today. Beyond policies and Ministry effort, we need the wider community to have the right knowledge and understanding about mental health conditions that will aid their recognition, management or prevention. This includes the ability to recognise symptoms of mental health conditions and to know where to seek help. Hence, it becomes increasingly important to strengthen the informal support networks in the community.
Let me share with you three cases of our residents in Pasir Ris East. Last Friday, I met Mdm Tan during our house visit. Mdm Tan is 70 years old and taking care of her bedridden mother with dementia. She shared with me how difficult it was to be caring for her own mother when she herself was getting older. But she said with a smile, "As hard as it is, it is my duty as she is my mother".
One of our other residents, Mdm Elena, is herself in her mid-60s. She has no siblings and is not married. She is taking care of her two elderly parents; her father in his 90s goes to the daily dementia care home and her mother, who is in her 80s, has dementia and stays at home. Another one of our residents, Mr Aziz, is a kidney dialysis patient in his 70s and taking care of his mother with dementia, who is in her 90s.
There are many individuals like Mdm Tan, Mdm Elena and Mr Aziz who are retirees but themselves caring for their parents. Caregivers can undergo an immense amount of stress, what more when the caregivers themselves are dealing with their own challenges. Beyond policies from MOH, how can the community come together to support individuals like this better?
In Pasir Ris, our community volunteers through our Pasir Ris East care store, visit the families every third Saturday of the month to catch up with them and check on how they are doing. For Mdm Elena, some of the grassroots leaders, such as Mr Charlie Cheong, offer to care for her parents while she gets a haircut, goes to the market or takes the day off from caregiving.
How can we continue to encourage more from the community to come forward and provide assistance to support the mental burden of such caregivers, especially in our fast-ageing society? To borrow the words of fellow MP Mariam Jaafar in her speech earlier, "We must care more for each other in our society."
Secondly, on improving workplace mental health and well-being, we know that good work is beneficial for our mental health. A healthy state of mental well-being can also contribute to improved productivity. According to data collected from MOM, one in three employees found it challenging to cope with work demands and pressures or felt exhausted physically or mentally from work.
Based on a survey conducted by MOM, there was an increase in the proportion of job seekers who faced discrimination due to mental health conditions, from 2.9% in 2021 to 5% in 2022, as well as an increase in the proportion of employees who felt that they were discriminated at work due to mental health conditions, from 3.2% in 2021 to 4.7% in 2022.
The National Mental Health and Well-being Strategy aims to address these issues by improving mental health literacy at work, reducing stigma, supporting the employment of individuals with mental health conditions, customising mental health support according to occupational needs and preventing discrimination through fair employment practices.
While companies can also put in policies to prevent workplace discrimination in their organisation and to prevent the discrimination for mental health and encourage mental well-being at the workplace, translating these strategies into practice poses significant challenges. For example, how do managers manage conversations and, in particular, performance appraisals, as it is the season now, for colleagues or subordinates with mental health conditions without making them feel discriminated, especially if their performance is affected by it when compared to other peers? How do we then balance and manage the expectation with the rest of the team too?
These issues cannot be legislated. But the devil is in the details when we try to translate the intent into practice.
If we want the approach towards mental health to change in the workplace, employers, employees and the people leaders must be equipped with the right skillset to drive that change.
Should that skillset be made available as a guideline for employees on the "do"s and the "don’t"s or should we impose it as a legal requirement by MOM? Or will it be something where we highly encourage employers to upskill their employees from a SkillsFuture perspective, as suggested by fellow Parliamentarian Mr Edward Chia?
Mr Speaker, Sir, as I have mentioned earlier, the discussion continues and is a work-in-progress. I am glad that our society continues to have this discussion as we refine our approach and come to a collective agreement on what we, as a whole-of-nation; Government, businesses, organisations, communities and individuals, can work together towards our inclusive society. I stand in support of the Motion.
Ms Carrie Tan.
Mr Speaker, my dear colleagues, I am well aware it has been a long day, and everyone is tired and even if your brains and minds are tired, I hope that you will be with me and open your hearts and your spirits to hear what I have to say.
I would first like to declare myself and my interest as a self-employed transformative and healing coach. There are three points I wish to highlight about mental health to contribute to our collective understanding of it so that we can properly contemplate what this means to our nation.
First of all, we all have mental health. It is not just mental illness, which is unfortunately what one in two Singaporeans consider it to be, according to a survey by MOH. By framing mental health as just a healthcare challenge, we risk adopting the traditional language of health, which pathologises and creates a chronic reliance on only formal healthcare institutions and medication. This relegates the ownership of recovery to the field of experts, such as psychologists and psychiatrists, which are in very short supply and also renders the individual dependent on the formal healthcare system’s capacity, which has its limitations. This is neither sustainable, nor true.
Mental health is something that every person can own, and be equipped to take care of for ourselves, until it deteriorates to a point where clinical assistance is necessary and that is where clear navigation and adequate resourcing of expert and clinical interventions are important. But I urge us to think and to go one step further, to also equip individuals. We can encourage a wide variety of activities that are personal-based to help Singaporeans access knowledge for maintaining their mental well-being.
There are activities such as yoga and meditation, as our colleague Mr Darryl David said, mindfulness practices, and different forms of traditional, art-based, music-based and somatic-based approaches to mental, emotional and spiritual wellness, which are all available currently, although relegated as "alternative wellness". It is time, I say, to mainstream these options because they are derived from the rich and deep history, wisdom and heritage of our Asian cultures. They cater to the varied cultural, faith and spiritual beliefs of Singaporeans and offer individuals more options towards holistic wellness that are accessible, and which resonate with each individual’s inclinations and preferences.
I support my colleagues, Mr Darryl David, Mr Xie Yao Quan and Assoc Prof Razwana Begum's, call for mindfulness for authentic listening and authentic care, which all fall under social emotional literacy and empathic care. And hence, I recommend extending SkillsFuture funding for such learning. This will accelerate and propagate emotional wellness skills more widely so that everyone can equip themselves to maintain good mental health as a lifelong endeavour. Mental health, just like physical health, is a journey that requires daily awareness and maintenance, starting with emotional literacy.
The Government can do its part to help make such knowledge and training more ubiquitous and accessible for the common man and woman on the street.
And here, I would like to share an example on what happens when I go to my training workshops. As a facilitator, I often ask the participants: "How are you feeling now?" And often, the replies I get are "Okay lor" or "Like that lor". It tells me that Singaporeans are sorely lacking in the emotional vocabulary to be able to identify and even acknowledge our own emotions.
One key point I would like to make, most importantly, is let us recognise the invisible forces that are undoing our mental health and mental health efforts. How is it that eight in 10 Singaporeans recognise mental health to be important and as important as physical health, yet less than half of us actively think about our mental well-being or how we are feeling on a day-to-day basis? What is the invisible force that is taking our attention away from something that all of us agree to be important, so important that we have a Motion in this Chamber today?
Our attitude towards stress at work illustrates this. In 2020, our Parliamentary colleague, Mr Melvin Yong, God bless his heart, proposed a "Right to Disconnect" law mandating downtime from work for better mental health. What is illuminating is that despite acknowledging its intentions, there were many concerns over its feasibility. For example, would bosses and other colleagues see a desire for greater work-life balance as a sign of lower motivation compared to their peers competing for the same limited opportunities? What happened to the age-old wisdom, in Chinese, “休息是为了走更长远的路”, meaning "Rest is to help us travel even further"? How have we, as a society, come to equate rest with lower motivation? What has caused this collective judgement that demonises the act of rest and restoration?
In a recent commentary on CNA by NUS lecturer Jonathan Sim, he talks about youth "hustle culture" and warns of the perils of a lack of the ability to introspect. He observed that, for many university students, introspection is sidelined as a, I quote, "stagnant inactivity" because pausing to do it "does not seem to contribute directly to any measurable progress". He notes, and I quote, "the inability to sit alone with their thoughts and the tendency to bury themselves in work or digital distractions, creating a superficial busyness that masks an inability to process deeper emotions".
This does not just afflict youths, but many successful adults as well, including many of us in the Chamber. In my role as a healing coach, I have come across many accomplished professionals and leaders who baulk at the idea of slowing down. Are we somehow living within a bubble where a constant need to be achieving something has made slowing down something that terrifies people? Does rest ironically create more stress? The term "stress-laxing" is found in UrbanDictionary.com, feeling stressed because you are relaxing and not working, the cause of your stress in the first place!
What kind of ludicrous phenomenon is this! We must ask ourselves.
We have to recognise what is creating this "pressure cooker" bubble we are all living in. The very narrative of our nation's survival and success thus far has been fuelled by the notion of scarcity which then fuels an endless culture of competition and a sense of inadequacy.
This is, unintentionally, of course, encapsulated by our classic National Day song "Stand Up for Singapore." If you recall the lyrics, we are first called to stand up for Singapore to do the "best you can", only to be called a few lines later to also "be prepared to give a little more." I love this song. I love to sing it with pride and increasingly, I recognise, some irony. Are we perhaps the only country in the world where our best is still not enough?
To be clear, I am not calling for slackness because reaching our fullest potential does require hard work. I am also not a proponent of the "lie flat" movement either. In fact, I am trying to solve or prevent it.
Learning from hypercompetitive Asian societies, like South Korea and China where the 躺平, or "lie flat" movement has begun as a silent rebellion by youths against a system in which many feel hopeless about ever catching up with, we must be mindful of the long-term costs of a "pressure cooker" society.
We can see this already happening when new technology emerges, such as AI, what a helpful tool, to help us be more productive. But instead of working less, we end up cramping more expectations into our workplans to achieve even more. What is stopping us from reaping the benefits and advantages of technology to avail ourselves the precious time to rest, to nurture relationships and to enjoy our families?
Last year, Duke-NUS Medical School reported just depression and anxiety alone could conservatively cost Singapore $16 billion annually. An economically prosperous yet chronically unhealthy Singapore would be a hollow success.
In an individual, chronic stress and tension entrenches the flight or fight response as a default reaction. In an ecosystem, chronic stress entrenches similar responses, such as demanding, defending, deflecting or sometimes, a collective numbing, which manifests as a lack of ownership.
This may hurt to hear but our Civil Service is one of the most afflicted. I do not blame our civil servants because they take the brunt of overwhelming workloads that inadvertently cause mental and emotional burnout. We surely must agree that a burnt-out and emotionally "checked out" people is not what will create progress. The inability to slow down is a serious symptom that we are disregulated as an ecosystem and society. We must take daring steps to foster a collective restoration of our societal nervous system.
We need new norms. The "Right to Disconnect" has to be seen as a necessity, not as a problematic "nice-to-have". Do we have the gumption to allow a collective slowing down, to cater time and space for our collective mental and emotional restoration? It may sound illogical or even terrifying to some, to cater for a period of slowing down, especially when imagined in economic terms. But I challenge the notion that growth and productivity is only possible with relentless hard work, especially in this technologically abundant era. Growth is possible with more collaboration in place of competition. Collaboration is more possible when we are well-regulated in our bodies and minds to allow for better listening and more empathy that then fosters more trust.
This needs to be a whole-of-Government effort and I recommend the current Inter-agency Taskforce to become a permanent National Well-being Office, not under MOH but directly under the Prime Minister’s Office. This office should consist of well-being champions from each Ministry and Statutory Board, and include a consultative committee of representatives from the private and people sectors. Their role can be as resource persons, sounding boards as well as act as inter-Ministry bridgers to ensure the well-being lens is present in policy discussions and formulation across Ministries. To this end, a National Well-being Index adapted from existing Quality of Life surveys will be helpful to keep this Office's duties on track and accountable for outcomes.
This will actualise what Singaporeans have already expressed in many Forward SG conversations, that desire for a different vision for Singapore, in the paths available, the aspirations and the definitions of success. Singaporeans want to thrive, without being in a constant rat race. How might we enable a deeper sense of fulfilment than the never-ending chasing of KPIs, material or financial success?
The 2022 Quality of Life survey results show that those who took a more balanced approach to life, valuing traditionalism, sustainability and family relationships over material success were more satisfied than those who valued materialism over these intangible things. It tells us that the answer lies in the intangibles, the quality of our relationships with ourselves, with the people around us, as well as with our planet earth. This aspect of life requires a slowing down introspection in order to be nurtured.
If slowing down feels foreign, selfish or even un-Singaporean, we can seek inspiration from our National Pledge. In outlining Singapore's national objectives, it lists "happiness" ahead of "prosperity" and "progress". And here, "happiness" can be taken to mean and referred to the overall sense of security and satisfaction that our people feel as Singaporeans, not just happiness as a fleeting emotion. Such sense of security and satisfaction is critical to mental well-being.
To improve on this sense of security, let us have the courage to take a pause and the gumption to try a different narrative than scarcity. Let us focus on our abundance and on an attitude of gratitude to foster the collective sense of security. What do we wish to see in our children's and youths' faces? Certainly not stress, not anxiety or the blank disconnected faces like what we are seeing increasingly today, afflicted and glazed over by digital addictions, anti-depressants or sleeping aids that they use to cope with the disconnection within them untended to and unheld by our collective lack of mindful presence and the constant doubting of what is enough.
I wish to see children and youths who are healthy, strong in their minds and bodies, with curiosity and connection alive in their eyes. I wish to see a workforce that is free from the burden of relentless and unnecessary busyness, rejuvenated and revitalised to have a high sense of ownership in every interaction, because people, who are well-rested, will have sufficient mental and emotional bandwidth to do so.
I hope by the end of 2024, all of us, including us in this Chambers, would have taken enough pauses to introspect and to reconnect within ourselves and to acquire the language for emotional awareness, to be a more emotionally regulated, emotionally secure and mentally well society.
Ms Carrie Tan, you would be happy to note that in my former corporate role, I introduced at my workplace, some four to five years ago, that we do not have any meetings on Friday afternoons. Dr Wan Rizal.
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