Mental health is an important area of public health. As a nation, we aim to build a place where (i) primary care medical professionals are trained to recognise mental health issues, (ii) the afflicted can seek help without feeling judged and stigmatised, and (iii) the well-being of the mind is respected and valued.
Mental health lies across a continuum – with the "clinically diagnosed" at one end, the "at risk" with mild and moderate symptoms in the middle and the "well and coping" at the other end of the scale (see Figure 1). Depending on several factors like personal and work stress, lifestyle habits and ability to cope, each person's state of mind can change over time and at any time. In fact, we are all on various points of this mental health continuum at different points in our lives, and have the capacity to move along the scale, shuttling from adaptive coping, to mild and reversible distress and even to the severe end of the spectrum.
In Singapore, one in seven people has experienced a mental disorder in their lifetime.1 More than three-quarters of those with mental health issues do not seek any professional help. Of those who seek medical assistance, depending on their condition, they can sometimes delay seeking treatment up to 11 years. This is why the Health Promotion Board (HPB) sees that it is critical to help those who are well and coping to maintain a positive mental well-being, and for those who are at risk to seek timely help. To achieve our objectives, we adopt a two-pronged strategic approach – (i) build mental well-being among the well and coping population and (ii) facilitate help-seeking among the at-risk population. Our programmes focus on building mental well-being by equipping individuals with resilience and coping skills, as well as creating a supportive environment to encourage help-seeking. We adopt a life-cycle approach where we reach out to children and youth through schools, adults via workplaces and seniors through community platforms.
Starting the mental health journey from young
It is crucial to build mental resilience from a young age as it equips children with skills to manage transitions and face challenges in life. As children transit from kindergarten to primary school, and then to institutes of higher learning (IHLs), they have to manage changes in the school environment, including integrating with new classmates, as well as adapting to new teachers and various styles of education. This is why HPB has programmes at different education levels to help students cope throughout their school years.
In 2018, we piloted a Holistic Mental Health Package for preschools to help parents raise socially and emotionally healthy children. During the two-hour workshops, parents were taught the different aspects of a child's mental well-being and children learnt skills on how to identify and manage their emotions. The children were also given activity books on mental well-being. Parents were sent quarterly emails with tips and case studies on how to help preschoolers better manage their emotions. The pilot workshops were well received, with 86% of parent participants reporting an increase in their knowledge of mental wellness and 74% of them reporting their intention to apply what they had learnt during the workshop. A majority (91%) of parent participants also thought that the workshop was engaging for their children, and agreed that the activity was a good opportunity to practise the skills that they had just learnt. A total of ten two-hour workshops were conducted for about 350 parents and children in 2018.
We rolled out a sleep campaign for preschoolers from August to October 2018 to help parents inculcate good sleep habits in their children. As part of the campaign, Good Sleep Kits, comprising a resource guide with tips on how to prepare a child for bedtime and a suite of practical tools such as bedtime storybooks, were distributed to 20,000 preschoolers and their parents. The kit has since been enhanced to include other resources such as audiobooks and an audio sleepcast on relaxation exercises. A digital version of the kit is available to the public on goodsleep.sg.
At the primary school level, HPB provides interactive skits to equip students with skills on emotion and stress management. For Primary 6 students, we conduct transition workshops to help them better manage their transition to secondary schools.
Our Let's Face It programme adopts an interactive scenario-based drama approach to teach secondary school students how to manage their emotions using positive coping skills. The scenarios are based on common challenges, such as sibling comparison, bullying in schools and academic pressure. The programme benefitted over 30,000 students from 58 schools in 2018. We also conduct workshops for educators, as well as briefings and trainings for school counsellors so that they are equipped to support at-risk students who display signs and symptoms of mental health issues.
For the youths, our Peer Support Programme at the IHLs equips student volunteers with peer supporting skills that enable them to identify common mental health conditions and know when to reach out to their peers who might be in need of emotional support or, if need be, to refer them to school counsellors. In 2018, 1,500 students across 15 IHLs were trained as peer supporters. They shared that the programmes were useful in providing them with a better understanding of mental health and tips on helping their peers. They also found satisfaction in helping their friends and being part of a social support group that can make a difference in others' lives.
Addressing mental well-being in the workforce
Reinforcing the seriousness of workplace stress is the World Health Organization's recognition of burnout as an occupational phenomenon and a "syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed".
Mental well-being is important for a productive workforce and a healthy workplace, and creating a workplace that supports positive mental well-being takes concerted effort. Our Mental Health Workplace Programmes2 equip managers with skills and knowledge on how to support staff at work, and teach employees stress management skills, including self-care, so that they are empowered to cope with challenges.
We also hold experiential workshops where participants experience therapeutic activities such as ukulele playing and plastic shrink art crafting while learning effective stress management techniques. These workshops saw an increase in uptake of about 38% from 2017 to 2018. In addition, we also piloted a workplace wellness roadshow in 2018, where employees can assess their individual stress levels through a self-assessment test, learn about stress management tips and take part in experiential activities such as terrarium building. About 850 employees over ten locations attended the roving roadshow and 73% of the participants said they intend to try out the stress management tips they had learnt.
For mature workers with multiple shift patterns, such as taxi drivers, cleaners and security guards, we specifically customise our interventions in the form of individual or group health coaching, where they receive instruction on stress management skillsets like deep breathing and progressive muscle relaxation techniques, which they can incorporate anytime at work. We also educate them on sleep hygiene tips, especially if their shift work arrangement impacts their sleep routine.
To further encourage a supportive workplace environment for employees, HPB also conducts management training workshops to help managers and human resource (HR) personnel identify staff in need of assistance, and equip them with skills on how to approach and support these staff. Similarly, supplementary workshops are also available to further mental first aid skills, such as basic counselling and problem-solving tailored to make workplaces more conducive and supportive for staff with mental health issues or conditions. There has been a good demand for the workshops, which reached over 780 managers and HR personnel since it started. A postworkshop survey indicated that 64% of participants have applied the skills they learnt at their workplaces.
A holistic approach to health for Singapore's seniors
HPB regards mental health as a part of active ageing since different aspects of seniors' health conditions can influence their ability to continue leading a fulfilling life.3
In Singapore, about one in ten seniors aged 60 years and above have been diagnosed with dementia. With the prevalence of dementia expected to increase by 10% in the next 15 years,4 it is a priority to step up our efforts in dementia awareness. Locally, almost half (45.5%) of dementia cases are vascular dementia. This is why we need to focus on raising vascular dementia awareness and educating seniors and their caregivers on how to adopt healthier lifestyle habits so as to lower its risk.
Besides running awareness campaigns through marketing platforms, HPB also provides community programmes, such as "Balik Kampung" workshops, to educate seniors on the importance of good mental well-being through cognitive stimulation activities. These community programmes have been conducted at various locations such as community venues including senior activity centres and museums. In 2018, 50 workshops were conducted for 1,200 seniors who found the sessions educational and effective in imparting new skills.
Joining hands with all stakeholders to raise mental health awareness
To promote the importance of mental health, medical professionals and all segments of the community must have an understanding on how to safeguard mental wellness and be willing to do their part in helping Singaporeans stay mentally resilient.
HPB's role in this heterogeneous landscape is about raising awareness for self-care and imparting skills to manage stresses and challenges, while also identifying avenues for those in need to seek help.
Medical professionals are in the best position to engage with individuals and spot signs and symptoms of mental health issues early. They can act as a conduit to raise public health awareness on the importance of mental well-being and deepen individuals' understanding of mental health issues.
Events like the Together Against Stigma international conference3 and the annual Singapore Mental Health Conference serve as important platforms for mental health advocates to share their efforts in addressing mental health stigma and exchange ideas on how we can become better mental health advocates.
There is more to be done to bring mental well-being to the forefront of people's minds and reduce the stigma of mental health. Together, we must strive to achieve a reality where mental well-being is a top priority, by continuing efforts in research, developing best practices to manage conditions and removing barriers to access help.
Note
a. The upcoming 9th Together Against Stigma international conference will be held from 3 to 5 October 2019.