Commentary: Our approach to mental health needs to change. COVID-19 will force us to
The effects of COVID-19 on our collective mental health have yet to be studied systematically, but there are already repercussions felt worldwide, says Xiangyun Lim.
SINGAPORE: Suicide rates in Singapore were reported to be 8.36 deaths per 100,000 Singapore residents last year.
According to the Samaritans of Singapore (SOS), this is the leading cause of death for those aged between 10 to 29. This is a 10 per cent increase from 2017.
There is a high chance that the figures will continue to rise.
While the effects of COVID-19 on the collective mental health have yet to be studied systematically, psychosocial repercussions of the pandemic are already felt worldwide.
The US saw a 338 per cent increase in call volume to the Disaster Distress Helpline, a sub-network of America’s National Suicide Prevention Lifeline, in March compared to the previous month.
Researchers Lu Dong and Jennifer Bouey from the RAND Corporation found that China has reported “a heightened public mental health crisis” sparked by the outbreak despite emergency psychological crisis interventions proposed by the National Health Commission of China.
In Singapore, organisations such as SOS, the Singapore Association for Mental Health (SAMH) and Fei Yue Community Services have seen spikes in the number of people calling in the last month seeking assistance for distress.
The SOS reported that it received 3,826 calls in March, 23 per cent more than it received during the same month last year.
GAPS IN OUR MENTAL HEALTHCARE SYSTEM
And yet our response to mental health remains inadequate.
Gaps in our mental healthcare system were brought up even before COVID-19 led to the circuit breaker period. Accessibility, affordability and inclusiveness of professional services were particularly highlighted during the Parliamentary debate on the Ministry of Health’s budget in March.
We also face a lack of trained professionals. The national average of 4.4 psychiatrists and 8.3 psychologists for every 100,000 people in Singapore is lower than the 15 psychiatrists per 100,000 recorded by most OECD countries.
Mental health support offered at the national level did not seem to keep up in tandem with the increasing numbers of those seeking help.
Singapore’s total expenditure on mental health made up only 3 per cent of the Ministry of Health’s operating expenditure for 2017, according to latest data shared by the Health Minister in Parliament in 2019.
The insufficient level of resources ploughed into mental health in the past could come back to haunt us.
Neither the Resilience Budget nor the Solidarity Budget allocated any resources towards mental healthcare support or research.
It also took three full weeks after the circuit breaker first started to declare allied health services - including private counselling and social work - as essential services, thus allowing them to remain open.
Even if slightly late, this move shows that the Government recognises the impact this pandemic could have on mental health, as does its establishment of the National Care Hotline. More than 6,600 people have already called the hotline within two weeks of its launch on Apr 10.
According to media reports, there were also a few callers with suicidal tendencies, with police dispatched to tend to two cases.
But the same shortage of resources can be seen with how the 24-hour hotline is currently run, with about 500 volunteers from government agencies, registered mental health professionals, Social Service Agency-nominated psychologists, counsellors/social workers or personnel who are trained in psychological first aid.
From the 500, about 20 to 25 of them are rostered daily to provide emotional and psychological support to callers.
This small group of trained professionals daily may not be able to keep up with an increasing volume of people seeking mental health assistance.
NEED FOR A COLLECTIVE RESPONSE
Perhaps, rather than point out the shortcomings of our system, we need to develop an approach where all of us can play a part in protecting the mental health of our society.
As an editor of a book consolidating perspectives from across the ground - from academics, organisational leaders and practising professionals, to individuals with lived experiences and supporting figures - I have found strong commonality in the belief that addressing mental health should go beyond the confines of the social services and government.
We have to take steps to give mental health as much priority as physical health for ourselves and those around us.
This can help shift mental healthcare into a more preventive approach, thus alleviating some of the burden on the thin level of resources we can access.
Rethinking the role of mental health in our lives will enable us to work hand-in-hand with those on the policy front to forge ways to create and maintain mental health support - similar to a community-based care for medical treatment recommended by medical journal The Lancet, with “psychosocial treatments such as talking therapies being offered not just by medical professionals but also by community health workers, peers, teachers and the clergy”.
Everyone has a stake in the state of our collective mental health.
NORMALISING MENTAL HEALTH CONVERSATIONS
For this to happen, mental health issues have to first be more normalised. For starters, we need to openly talk about the challenges we may be currently facing.
It is a traumatic period with a protracted disruption to life for every individual. Social isolation offers no relief from uncertainty, fear and anxiety, and can in fact be a contributing factor. For some, it is a strain on family ties and relationships.
For those in abusive domestic conditions, it can be a matter of life and death. For those susceptible to mental health issues, COVID-19 can have serious effects on their health and recovery.
It is not the time to downplay feelings of fear and anxiety. It is the time to ensure you have a support system and find coping mechanisms. It is the time to reach out to others without shame when you find yourself unable to cope.
It is also not the time to call out on anyone who is experiencing mental distress or conditions in any form. Be careful about your language when speaking to others. It is easy to project personal distress upon others unconsciously, even if it is not your intention.
That is easier said than done. Despite national campaigns to create awareness, the stigma against mental health is still a large hindrance to tackling the issue.
Various studies conducted in Singapore capture a pervasive negative attitude towards mental health conditions.
One such survey by the National Council of Social Service (NCSS) in 2018 found that six in 10 people believe such conditions are caused by a lack of self-discipline and will-power, while up to 50 per cent of respondents would not give people with mental health conditions any responsibility.
There is also evidence of the impact stigma has on seeking treatment and recovery.
Statistics show a treatment gap of up to nine years for those experiencing mood disorders while 78.4 per cent choose not to even seek help for what they experience.
Reasons vary from the fear of being judged and being seen as weak, to losing autonomy and control over their lives.
Unlike physical ailments, mental health conditions are not visible. What is visible - the behavioural manifestations of disorders leaning towards severity - tend to break established social norms.
Those who do not know what is happening may then internalise the behaviour as threats.
Mental health conditions are complex, individualistic and heterogeneous in nature.
They also don’t have to be permanent.
There are actions we can take to support others. We can proactively question labels. We can have more discourse around mental health issues. We can learn to listen without putting forth our own judgements or offer solutions.
We can also remember that we are all susceptible to it, if we do not take steps towards mental resilience.
There is an urgency to start. We may not feel the strain on our already thinning mental health resources until it’s too late.
While the mental toll of COVID-19 has yet to be recorded or tracked, there is enough evidence of the profound and pervasive impact all around the world.
That includes us. If we do not step up now to take mental health seriously, we will be looking at another health crisis sooner than we expect.
Xiangyun Lim is the editor of White, a book that brings together perspectives from organisational leaders, academics, practising professionals and individuals for the first time in Singapore (available August 2020). She is the founder of Klin Studio, a publisher of mental health resources.
Editor’s note: Details about the volunteers rostered each day on the National Care Hotline have been corrected in this commentary. We apologise for the error.