When defining what “health” is, the World Health Organisation (WHO) embraces it as “physical, mental, and social well-being and not merely the absence of disease or infirmity”. According to the WHO, nearly half of the world’s population is affected by mental illness, which impacts their everyday lives. By 2029, mental illness is predicted to become the leading cause of diseases worldwide. One million people commit suicide every year, and 10 to 20 million attempt it.
Breaking the stigma of mental health
The importance of mental health was discussed during the TODAYOnline web series late last year (Dec 3, 2020): Breaking the stigma of mental health. The panellists included Mr Justin Ong, a journalist with TODAY, Mr Cho Ming Xiu, founder of Campus Peer Support for Youths, and Ms Khee Shi Hui, programme director of Common Ground. The consensus of the panellists was that the COVID-19 pandemic has definitely taken a toll on the mental health of many, bringing about more negative feelings such as stress, anxiety, frustration and hostility.
Nonetheless, they agreed COVID-19 has been a double-edged sword since it has also shone more light on the issue of mental health. However, when discussing how individuals could cope with the “new normal”, they mentioned bosses should be the ones taking the first step to set the culture and tone of the workplace. Otherwise, employees might not necessarily speak out even if measures were put in place. It was also suggested that employees can put their work away once they have clocked off, to focus on other enjoyable things.
The example of the Economic Development Board’s (EDB) managing director, Mr Chng Kai Fong, was brought up to show how a top-down approach would be beneficial when it comes to mental health. He shared that after being more accepting of such issues to his employees, they also reciprocated by opening up.
Singapore still has a long way to go
Nevertheless, Singapore still has much to learn and improve on as it came in 41 out of 50 cities on the list of work-life balance in Kisi’s study. The city-state is also the second most overworked amongst the others involved in the study. According to Kisi’s CEO Bernhard Mehl, as individuals, we need to find a balance between work and leisure. It is only then can we enjoy the safeguards and reforms the government and company implements without feeling stressed. The main aim of this study was to provide cities with a guideline to benchmark their ability to support the fulfilment of residents’ lives by improving the aspects of life which help to relieve work-related stress and intensity.
Despite the Singapore government encouraging companies to embrace a more flexible culture to help workers achieve work-life harmony, it is still largely dependent on the nature of the job, and the level of bureaucracy in the company. The ongoing COVID-19 pandemic has made this even more difficult for the healthcare frontliners. They have been working tirelessly round the clock, which could take a toll on their emotional and mental well-being. Apart from having a job that requires one to constantly be on call, many other circumstances could force an individual to forgo their mental well-being.
In their discussion on mental health, the panellists have overlooked those who may bear the burden of having more responsibilities like being the sole breadwinner. Some people have to care for their ageing parents or a family member who is physically or mentally disabled. There are also people living from paycheck to paycheck.
Mental health should be a necessity, but not everyone can afford it
We need to acknowledge that there are those who, due to the circumstances previously mentioned, cannot simply afford to “close their laptop at 9pm”, as suggested by Ms Khee. Sure they are able to do so, but it does not change the fact that they may have a deadline to follow or bills to be paid.
The panellists brought up several important points on tackling mental health, but there were also certain suggestions that could be perceived as naive and idealistic. While well-meaning, it only serves to paint a rosier picture of mental health awareness in Singapore. What they touched was simply the tip of the iceberg as mental health is a much more complex issue. Contrary to the ideal situations and solutions brought up, the Singapore culture is a different reality.
Could tackling mental health perhaps be a luxury not everyone can afford?
The Singapore work culture is described to be of a mix of Western and Eastern influences. While collectivism is key, the Singapore corporate structure, from local enterprises to home-grown international brands, ranks high on the power distance dimension and avoids high risks. These traits create an environment in which employees are not able to express their individuality and enforces the status quo. It would also inadvertently penalise non-conformity, such as leaving work on time or even taking leave. The pressure to conform to informal norms of their workplace would realistically result in high levels of stress and job dissatisfaction.
Mental health must be cultivated from young
The working culture is also reflected in the education system. Students experience the pressures of burning the midnight oil and forfeiting their weekends, just to attain a certain rank or grade. The competition between peers from a young age, through the Primary School Leaving Examinations (PSLE) and then the Ordinary and Normal Level examinations (O-Level and N-Level) have mentally scarred many youths in Singapore. According to a study by the Samaritans of Singapore (SOS), the number of suicides from 2018 to 2019 increased by 10 per cent. It also showed that there was a record-high number of suicides involving boys between the ages of 10 to 19. The release of the PSLE results has almost always come with news of innocent children who decide to take their own lives. The common reasons cited included parental or peer pressure to excel in the competitive environment.
While parents have expressed their anger about the impacts of the national exams on children, change to the education system has been very slow. However, recent changes to the N-Level and PSLE marking and eligibility criteria have shown there is still hope for those who “did not do well” in their first national exams.
Yet, the system still fails to address the stresses students are subjected to – from the endless supplementary lessons and homework to the back-to-back tuition classes parents sign their children up for so they can remain competitive.
However, the blame cannot fall solely onto the shoulders of Singapore’s education system. Though it has undergone several changes, the greatest responsibility lies with the parents. It may be natural for parents to want to push their children to achieve the best results. However, they must also recognise when this push starts to become unhealthy. Pressure makes diamonds, but it also bursts pipes. While a little pressure is needed to push ourselves to grow, too much of it can be unbearable.
As children grow up in this culture of competitiveness and pressure, the same mindset is likely to carry through to adulthood. The gruelling pace of life in Singapore has led many Singaporeans to be caught up in a rat race of an indefinite “survival of the fittest”. Only those who can overcome the strong pressures of school and work are able to succeed, leaving those who are “weaker” to break down from the pressure, resulting in them becoming the “losers” of society.
More than meets the eye
The suggestions given by the panellist – talking to supervisors or colleagues, quitting a toxic job, and taking time off – to focus on one’s mental well-being were too idealistic to reflect the reality in Singapore.
In the fast-paced Singapore life, it is unrealistic to say “I need a break” if it means missing out on a promotion or losing favour with higher management. While the panellists seem to have found coping mechanisms to fit their working environments and careers, it is also important to realise their suggestions come from their own experiences and are shared in hopes that they would help others who are struggling.
Though Singapore might be slow to act when it comes to the subject of mental health, there are still helplines and initiatives for those who need it.
Slowly but surely
Singapore has been investing in building up mental health resources from the community level, to meet the needs of those who require the necessary services and interventions. Most recently, the Ministry of Health has set up the COVID-19 Mental Wellness Taskforce (CoMWT). This task force aims to analyse the mental health issues and causes prominent during the pandemic. They will also provide recommendations to enhance the national mental health strategy based on their research.
Another example is the community intervention team (COMIT) delegated across the country to satisfy the demand for mental health assistance island-wide. There is also the Employee Assistance Plan (EAP) to aid in any personal issues employees may have that could be affecting their performance at work. The programmes are free for employees by stand-alone EAP vendors or providers who are part of comprehensive health insurance plans. Additionally, the Flexible Work Arrangements guideline, by the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP), provides tips to guide employers in ensuring the well-being of employees while increasing their productivity.
However, those who need help must also take the initiative to reach out to someone. As much as a country can provide resources for its people, change cannot happen if no one is willing to talk about it. Even if the topic is commonly discussed, it might not necessarily mean society is completely open to those struggling with their mental health. Until the stigma on mental health is broken in Singapore, little progress will be made.
The seriousness of mental health was highlighted in July 2021, after a 16-year-old murdered a fellow 13-year-old student of River Valley High School. Preliminary investigations found that the accused is a former patient of the Institute of Mental Health after having attempted suicide in 2019. Though investigations are still ongoing at the time of writing, it has definitely shed light on just how important mental health is. The Ministry of Education has since teamed up with the Ministry of Social and Family Development and other organisations to address mental health, especially among students.
Lessons from other countries
Based on the 2021 World Happiness Report, Singapore has been ranked 31st out of 153 countries. The results are based on an average of three years of surveys between 2017 and 2019 and include factors such as gross domestic product, social support from friends and family, healthy life expectancy, freedom to make life choices, generosity of the general population, perceived corruption and recent emotions – both happy and sad. Singapore ranked 31st globally, and second among Asian countries; Taiwan clinched first. The top places were mostly held by Nordic countries such as Finland, Denmark, Iceland and Norway.
However, results from a study by the Human Resource Director in Oct 2019 showed 41 per cent of Singaporeans were not happy with their lives while one in two felt unfulfilled. In Jobstreet.com’s 2017 Job Happiness Index, 45 per cent of respondents were unhappy at work. While the two studies were not related, the similar results on unhappiness could imply that tackling unhappiness had little to no progress from 2017 to 2019.
Singapore may rank second among the Asian countries, but the happiness level in Singapore still decreased by 0.140 from 2008-2012 to 2017-2020. Hence, comparing Singapore to countries within the Asian continent is not representative of the improvement which needs to be made.
Nordic countries and Switzerland have been made good benchmarks for the ideal life we should work towards as a country. According to the 2021 World Happiness Report, several factors contributing to the high ranks include welfare generosity, a good government, income equality, social cohesion and trust, as well as the freedom to make life choices. Welfare benefits to bridge the rich-poor gap, and the high degree of freedom to express individuality makes it unsurprising that the people are able to say they are “happy”.
In Switzerland, while the prevalence of mental illnesses is comparable to that of other developed countries, they have managed to create a model for healthcare systems around the world. Their effort to control healthcare costs and make mental healthcare a part of essential and basic insurance coverage has made treating mental illnesses affordable. Switzerland’s broad insurance coverage and dense psychiatric facilities were applauded by the Organisation for Economic Cooperation and Development.
However, these countries have not always been as “happy” as they are now. For example, countries such as Finland had high suicide rates from the 1970s to the 80s. During that period, the high unemployment and low incomes drove many of the poor and low-educated to commit suicide. The long, dark and cold winters these countries experience can also impact happiness levels as compared to sunny, tropical countries.
This shows regardless of culture, geography, and wealth of a country, mental health issues are prevalent everywhere. However, steps can be taken to work towards curbing issues of mental health. The example of Nordic countries overcoming mental health issues shines a ray of hope that our little sunny island too can cope with these issues.
Changing Singapore’s status quo
The Singapore government is taking small steps to overcome wealth inequality to improve the mental well-being of the people. To better support these efforts, it is also important for the country to recreate the kampung spirit – a sense of community and solidarity, which has been lost through building our capitalist nation. It would initiate closer bonds between neighbours and give them opportunities to confide in each other about their stresses and difficulties.
The status quo needs to be broken and it can be broken. The community is slowly moving towards being more accepting and informed about mental health. As mental health becomes a more common topic among educators, employers and even policy-makers, perhaps a new status quo will slowly form. Whatever it is, mental health support should be made more accessible and affordable for all.
In the meantime, for those struggling with work, school, or any other sort of pressure, seeking help to find a coping mechanism is always beneficial. It could be talking to someone, exercising, being with friends and family, or even a relaxing quiet time at night before going to bed. It is crucial to research healthy routines or consult a professional when combating mental health.
If you find yourself or a friend/family needing help to cope with mental health, Samaritans of Singapore (SOS) operates a 24-hour hotline you can call at 1800 221 4444 or email email@example.com. You can also head to Youthopia SG for a collection of resources you can use to help yourself and others cope with mental health issues.