The topic of mental health, especially adolescent mental health, has been in the spotlight with the launch of the National Mental Health and Well-being Strategy in October 2023 and the rising occurrence of poor mental health in youths. According to the Singapore Youth Epidemiology and Resilience study by the Yeo Boon Khim Mind Science Centre, one in ten adolescents suffer from at least one current mental health disorder,1 while the prevalence of poor mental health was highest in younger adults.2 Youths face a multitude of stressors: uncertainty about the future and future adult responsibilities, finances, studies and worries about their family members' health.3
Why is this a pressing concern? Approximately 75% of mental disorders begin before the age of 25 years,4 highlighting a window of opportunity for early intervention, diagnosis and treatment.
Promoting mental health literacy
Having seen the impact of poor mental health in their peers, 104 youths from the Medicine Special Interest Group of the Gallus Society organised a webinar on mental health to promote mental health literacy among their peers, parents and teachers. 147 youths, parents and teachers attended the webinar, featuring keynote speakers Adj A/Prof Lee Cheng, Dr Kim Lian Rolles-Abraham and Dion Lo Zhen Yu. The webinar format, preferred by the audience members because of the sensitivity around the topic of mental health, allowed audience members to attend online from where they feel to be a safe space with the assurance of anonymity. It also enabled loving caregivers to participate within the constraints of their tight schedules.
The webinar covered three pertinent topics: stress management, common mental health disorders in youth and the psychology of eating disorders in youths. I summarise below the key insights from each of the esteemed speakers at this webinar.
Stress management (Adj A/Prof Lee Cheng)
- Internal sources of stress encompass thinking styles, social skills, personality and coping mechanisms.
- External stressors include pressures of studies, family problems, relationship difficulties, health issues, losses, bereavement, unemployment, financial troubles and work-related challenges.
- Stress manifests across five domains: physical, psychological, behaviours and actions, thought processes, and emotional.
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Chronic stress can lead to severe health consequences such as hypertension, coronary heart disease, migraines, tension headaches, ulcers, asthmatic conditions, chronic backaches, arthritis, allergies, skin conditions, low immunity, sexual dysfunctions and premature ageing.
Common mental health disorders in youth (Dion Lo Zhen Yu)
Psychology of eating disorders in youth (Dr Kim Lian Rolles-Abraham)
- Eating disorders serve various functions, including providing a sense of control and achievement, mood regulation, communication, increasing self-esteem and acting as a self-protective mechanism, particularly for individuals who have experienced physical or sexual abuse.
- Personality features associated with eating disorders include anxious temperament, rigidity, compulsiveness, determination, perfectionistic tendencies, disorganisation and impulsiveness/recklessness.
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The goals of psychotherapy are to stabilise medical and physiological conditions, develop insight into behaviours, cognitions and emotions, develop alternative coping strategies, and restore identity, self-acceptance and a healthy body image, while enhancing assertiveness.
The webinar was well received by the youths, who were eager to learn more about mental health symptoms and how they can support their peers.
Obstacles to access
Following the webinar, I spoke with some participants to find out more about the barriers they may have faced in accessing mental health. During these conversations, I gained insight into some issues pertaining to youth mental health.
Parents' role in recovery
The first is of the role of parents in recovery. Elanna* is a student in her first year of junior college, who loves badminton and movies. She found great comfort that parents were invited to the webinars because parents play an important role in helping or worsening the mental health of their children. Elanna shared, "I have a friend whose parents were arguing almost every day. They didn't understand mental health. They blamed it on her. Her parents wouldn't understand and couldn't help her." The role of parents in supporting their child's mental health should be highlighted during family conference discussions.
Confidentiality and trust
The second issue is of confidentiality. Elanna notes, "My friend sought help from the counsellor. She did not want the counsellor to share their discussions with her parents, but the counsellor told her parents anyway. She felt betrayed by the experience and refused to visit a counsellor again." This is a common occurrence among the youths I spoke with. The Singapore Medical Council's Ethical Code and Ethical Guideline 2016 stipulates that doctors must maintain the medical confidentiality of minors except when they deem that it is in their best interests for the minors' parents or legal guardians to be informed.5 Thus, doctors must navigate the fine balance between respecting the minor's confidentiality and safeguarding their well-being. The limits of confidentiality include when it is mandated by law; when it is necessary to protect patients or others from harm; when involvement of parents and legal guardians is beneficial to minors; or where such disclosure is in the minors' best interests.5
Consent
The third issue is that of consent. Under common law, the age of consent is 21 years old and above. Hence, parents have the legal right to give consent for their children.6 Presently, the Ministry of Health is reviewing the need for parental consent and its impact on access to mental health treatment for children and youths.
Final thoughts
To conclude, the focus on adolescent mental health is not only timely but imperative. Recent efforts to address youth mental health exemplify a proactive approach to promoting mental health literacy. However, several crucial issues remain unresolved. Doctors have a vital role to play in safeguarding their adolescent patients' best interests, while navigating complex ethical and legal considerations when providing mental health care to young patients. Addressing these issues requires collaboration between healthcare professionals and policymakers. I know that if we put our hands and minds together, we can build a nation with better mental health literacy and access.
*The interviewee is being identified by a pseudonym name to protect his/her privacy.