The Big Read: Enough is enough. Just what does it take to break mental health stigma at the workplace?
Tackling the stigma surrounding mental illness and encouraging employees to speak up about their problems may be the biggest workplace challenge, based on interviews with workers, employers, human resource experts, general practitioners and psychologists.
SINGAPORE: For more than two years since she started working at a bank, Mavis (not her real name) has been keeping a secret from her bosses: She suffers from depression and anxiety.
While her company has hired counsellors, Mavis has never used their services, and seeks external counselling instead.
She has kept her mental health condition under wraps due to the “toxic” work culture, said the 25-year-old associate, and she fears that her chances of a promotion will be stymied if her condition is out in the open.
“Some have told me that (the company counsellors) will report back to the bank, though my boss said that this doesn’t happen - but you never know,” she said.
"In my industry, you are expected to work very hard and expected to have endurance … Those who can work a lot and handle a lot are seen as better."
A former trainee at a law firm, who wanted to be known only as Chloe, had a similar experience.
The 26-year-old, who began working at the firm early last year, developed anxiety attacks throughout her six-month traineeship. Things worsened to the point where she broke down during several lunch breaks, after feeling like she was manipulating her clients by withholding information.
“I felt like I had to lie to my client ... and I was under so much anxiety. During lunch, I would go down to cry, because I felt like I just couldn’t cope.”
Like Mavis, Chloe did not tell her bosses about her deteriorating mental health, but put on a poker face when she returned to the office after each breakdown.
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“I have friends in the legal practice, and the advice given to me was that I could not speak to anybody about (my emotional issues). The concern was really stigma, so I had to go for private counselling,” said Chloe, who is no longer with the firm but is furthering her studies.
This is what some employees here have to face. But what about the employers? What do they have to say?
Those interviewed stressed that they are open to listening to their staff about whatever problems they may have, including mental health issues. However, they admit that a line has to be drawn, especially when it comes to business-critical roles.
If the employees continue to fall short of expectations or are unable to work for long periods of time due to their mental health conditions, the employers said they may have no choice but to refer the workers to other roles within the company or fire them.
Still, having to support staff who have reached their breaking point may not be the biggest challenge when it comes to mental health issues at the workplace in Singapore.
It is actually tackling the stigma surrounding mental illness and encouraging employees to speak up about their problems, based on interviews with workers, employers, human resource (HR) experts, general practitioners (GPs) and psychologists.
While calls to improve mental health awareness in the workplace are not new, the issue has taken on an added urgency this year with COVID-19 creating new stresses and pressures for everyone.
And with more people forced to work from home as the pandemic rages on, the boundaries between work and rest have been blurred, taking a further toll on the mental health of many employees.
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But even before the coronavirus struck, the mental health situation here has been a growing concern: The Singapore Mental Health Study conducted between 2016 and 2018 found that one in seven people experienced a mental disorder in their lifetime, compared with one in eight people in 2010’s Mental Health Study.
Just earlier this week, TODAY reported that the Ministry of Manpower (MOM) is investigating allegations made against a firm here where a former employee has committed suicide allegedly due to harsh working conditions.
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Against this backdrop, a tripartite advisory on mental well-being at workplaces was issued last week by the MOM, Singapore National Employers Federation and National Trades Union Congress.
In introducing the advisory, Manpower Minister Josephine Teo said “protecting workers’ mental health has become even more important” during the pandemic.
Among its guidelines are:
- To appoint mental wellness advocates to raise employees’ awareness of mental well-being and mental health conditions through talks and workshops.
- To provide access to counselling services such as through Employee Assistance Programmes.
- To review HR policies to ensure hiring practices, workplace practices and performance management systems are non-discriminatory and merit-based in nature.
- To form informal support networks such as peer support programmes, parenting support groups, or a mentor/buddy system.
While these guidelines are a step in the right direction, more can be done in ensuring that these initiatives are not treated as a paper exercise, and that cultural changes are enacted at the workplace, HR experts and mental wellness advocates said.
Ms Anthea Ong, founder of the WorkWell Leaders Workgroup, a community of leaders from various companies and national agencies which champion workplace mental well-being, said that the guidelines are “solid building blocks” but it will be up to the bosses to take the lead in eradicating stigma at the workplace.
“If the leaders do not catch on and only leave it to the HR department to go and fulfil the requirements on the advisory, then I don’t think we have actually made a dent,” she said.
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“Until it is actually embraced, acknowledged and acted upon by the leaders ... only then do we start seeing these programmes, policies and practices making an impact on the ground,” said Ms Ong, a former Nominated Member of Parliament.
CHALLENGES FACED BY EMPLOYERS
While larger firms may have more resources to implement the tripartite advisory guidelines, this is not always the case for small and medium enterprises (SMEs), many of which are feeling the crunch from the current economic slowdown.
Mr Adam Esoof Piperdy, chief executive officer and founder of events company Unearthed Productions, said that SMEs like his are in a “very precarious position” during the pandemic and it may not be practical for them to tick every box in the advisory.
“Such measures would (require) quite a high investment. I think what we would rather do is to have more informal practices of checking in with each other,” he added.
Even for larger firms with comprehensive mental health initiatives, the issue of employees not speaking up about their conditions remains a problem - one that has been exacerbated by remote working.
Ms Anuradha Purbey, people director at insurer Aviva Europe and Asia, said that a consequence of remote working is that managers are not able to meet their employees on a frequent basis.
“Hence, it becomes harder to ‘visibly’ identify any mental health and other challenges that employees are facing,” she said.
“So, we have to rely, primarily, on the online catch-ups and frequent surveys.”
And like what Mavis and Chloe faced, Ms Anuradha acknowledged that the stigma surrounding mental illness is what prevents many firms from detecting mental health issues in the first place, since employees are reluctant to reach out for help.
“While mental health awareness has been gaining traction in Singapore, for many it is still considered taboo to acknowledge their struggles,” she said.
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“At Aviva, we want to make talking about mental health as normal as talking about physical health and continue to do what we can do to remove this stigma."
While there are firms which are willing to cut some slack for employees with mental health issues, they also said that there is a limit to how much employers can do.
Mr Piperdy, for example, said that he will try his best to get any colleagues struggling with mental health to seek professional help or give them days off if they are unable to cope. However, since the event industry is a client-facing role, he cannot continually make concessions at the risk of letting his clients down.
“At the end of the day, the job scope doesn’t change … if they’re not able to manage the workload that comes in, which is something we actively do, then I think we will help this person to transition to another job, maybe we will look for opportunities for this person.
"We have successfully redesignated some of them, to find suitable jobs in more fixed, permanent (roles) such as working in a venue instead of working for an events company,” Mr Piperdy added.
“But we are actively trying to avoid that by having early intervention, coaching and mentorships.”
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TAKING THE FIRST STEP: BOSSES SAYING ‘IT’S OK TO NOT BE OK’
In recent years, some companies in Singapore have come up with a slew of measures to promote mental wellness at the workplace, many of which are in line with the tripartite advisory’s guidelines.
For instance, national media network Mediacorp introduced earlier this month an emotional and mental well-being support initiative that consists of emotional and mental wellness training and a one-on-one confidential counselling service, among other things.
Mediacorp Chief Human Resources Officer Yvonne Ee said: “As part of our corporate wellness initiative, we continue to support our people with resources they need to adapt positively and perform well, during these unprecedented times.”
She added: “Through (the initiative), we look to create an environment where staff can build strong mental and emotional resilience, and feel secure as they continue to contribute to the organisation.”
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Biopharmaceutical firm AstraZeneca Singapore said that among its mental wellness initiatives is an internal online platform for employees to discuss mental health issues and queries within chat groups. It also has in place the employee assistance programmes which provide confidential counselling.
President of AstraZeneca Singapore Vinod Narayanan said: “While we continue to build our open and inclusive culture at the workplace, we also recognise the impact COVID-19 has on mental well-being of our employees and will continue to build that space where it is safe for employees to speak openly about mental health issues.”
In response to queries, business consultancy PwC Singapore said it provides several avenues to support mental health including an employee assistance programme, workshops, support groups and online resources to drive awareness of the subject.
Online marketplace Carousell said it has a dedicated wellness programme where employees “come together as a team to focus on our well-being”, at least once a month. It is also looking into establishing an employee assistance programme to offer support to employees struggling with personal and work-related problems.
While companies ramping up their mental wellness initiatives is a positive sign, HR experts said that this has to be coupled with bosses who lead by example in creating a more open company culture.
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Earlier this week, Bloomberg reported that Economic Development Board managing director Chng Kai Fong had opened up about his mental health struggle during the pandemic at a technology conference on Nov 22.
Mr Chng - who was formerly the principal private secretary to Prime Minister Lee Hsien Loong - said that family matters that occurred in April had affected his emotional and mental state, leading to feelings of “heat and anger” and depressive bouts.
According to Bloomberg, Mr Chng said he wanted to openly share his experience with others who might be facing mounting pressure to lead during times of fear and uncertainty.
“We can do a lot more as leaders to acknowledge that (it’s OK not to be OK) and to share a little bit more about ourselves,” Mr Chng said. “And that builds trust.”
Otis Asia Pacific president Stephane de Montlivault, who is a member of the WorkWell Leaders Workgroup, said that being more open about his struggles with mental health meant that employees of the elevator company were more willing to share their problems as well.
“I shared my personal situation as I happened to also have a number of difficulties (amid COVID-19). I lost a colleague and very close friend who died in a car accident … and shortly after that my father-in-law had a heart attack and was in the ICU,” he isaid. “I was facing a lot of stress, and had sleeping issues, anxieties."
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When he shared these issues at a forum with his employees, many of them started opening up, and subsequently many were willing to go to their bosses directly with their problems, he said.
“(We) made it very open and clear that it is not only okay, but normal and encouraged to talk about our difficulties and to work on them as a team,” said Mr de Montlivault.
“This actually caused us to take some actions in some cases when we found that people had difficulties when we were constrained by not being able to come to the office.”
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Agreeing, Ms Ong said that bosses who are willing to reveal their vulnerable side send a clear signal to employees that having mental health issues does not mean that they will not be able to succeed at work.
“That’s a very big part of stigma in the workplace, (which) stems a lot from concerns with career progression and advancement,” she said. “When leaders are the ones sharing, then it says that it does not affect your promotion options, your career progress, and your potential.”
Veteran HR practitioner Carmen Wee said that the employer-employee relationship should be one that is centred on the well-being of the employee. “If employees are fearful in asking for help, there’s something wrong with the culture or leadership approach,” she said.
“If you work in a company where the company respects you, wants to look after their well-being, which employee will not flourish and perform?
”There would not be such a fear if employees “feel supported and don’t feel like their psychological safety is threatened”, she added.
Ms Wee noted that for cases where an employee’s mental health condition becomes too severe to continue working at a company, firing the employee should be a last resort.
Other alternatives such as no-pay leave, counselling and job coaching should first be considered.
“If at the end of the day, the person still can’t cope and the job is still contributing to the stress, there needs to be a heart-to-heart talk, and if everything cannot be worked out, they might have to part ways,” she said.
Even when making such a decision, the company must also be sensitive given the pandemic situation, where it may be difficult to find employment. Employers can introduce the affected workers to new jobs that may be more suitable, or link them up with job courses.
“Each person’s circumstance is different, so the company needs to examine and come up with an individualised plan,” Ms Wee said.
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PHYSICAL AND MENTAL HEALTH SHOULD BE SEEN ON PAR
Although awareness of mental health here has grown, there remains a common misconception that physical health takes precedence over it, when both in fact should be viewed on par, said psychologists and GPs whom TODAY spoke to.
Dr Geraldine Tan, director and principal psychologist of The Therapy Room, said that whether it is a physical or mental illness, patients can be “struck down” by it for a prolonged period.
“When they have their diagnosis of anxiety and depression, they cannot go into the office, and someone else has to take over, so it is as bad as having surgery, or breaking your leg,” she said.
Agreeing, GPs said that they would give medical certificates (MCs) regardless of whether it is a physical or mental ailment.
Dr Sunil Kumar Joseph, a GP who runs Tayka Medical Family Clinic in Jurong, reiterated: “Mental illness is treated the same as physical illness from a medical point of view, so there is no issue.”
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
According to the American Psychological Association (APA), physical and mental health are interconnected and cannot be viewed in isolation.
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“Stress can take a toll on our physical health, while physical challenges can also bring new stress into our lives,” the APA said on its website.
Regardless of the literature, Dr Sunil said the main obstacle is the stigma that prevents patients from visiting him in the first place. And one policy that propagates the stigma is company-paid insurance, he noted.
“Indirectly, (the company) is able to access all your medical history because you signed a waiver to your rights of confidentiality,” he said. “So very few people who are using corporate insurance are willing to disclose mental health conditions, so that’s one stumbling block.”
He added that a lot of insurers do not pay for mental health treatment.
One guideline in the tripartite advisory says that companies with flexible employee benefits, such as medical benefits, should consider extending the scope of coverage to include mental well-being programmes, mental health consultations and treatments.
Companies such as Aviva Singapore, consultancy firm PwC Singapore and investment holding company Jardine Cycle & Carriage have health coverage plans that include mental health treatment.
Otis’ Mr de Montlivault said that as per the guidelines, his firm will be looking to include mental health as part of its health coverage as well. In the meantime, Otis employees can tap internal company self-funded insurance which has been expanded to include coverage for psychological support services.
If employees are hesitant to get MCs for their mental ailments, some companies have a policy where a limited number of sick days can be taken without having to produce an MC.Some employers also provide medical leave based on trust, rather than having to always provide MCs.
Mr Jeffery Tan, chief executive officer of charity organisation Jardines Mindset Singapore and group general counsel of Jardine Cycle & Carriage, said that if employees report that they have mental health issues without an MC, it will come down to “managerial discretion and empowerment by the supervisors”.
“Even for physical ailments, we don’t always need to be able to produce an MC before we can go off; we can see someone is struggling with an ailment, they can take an afternoon off,” said Mr Tan, who is also part of the WorkWell Leaders Workgroup.
“This is coupled with an element of trust in a safe environment, as opposed to starting off by saying ‘if I have this, are people going to game the system and be less than truthful?’,” he added. “I think those are all the wrong dynamics.”
Agreeing, Ms Audrey Ng, global head of HR for mining firm Anglo-American Marketing, said that trust is “central to the relationship with our teams”.
“We know that the overwhelming majority of them are highly dedicated and committed to achieving great results for the entire organisation, so if we see that someone needs a break, we try to ensure that he or she feels empowered to take some time off with line manager approval,” said Ms Ng.
Still, some employees said taking medical leave as and when they need to is not feasible, as they are on project-based jobs.
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A junior art director at an advertising firm, who wanted to be known only as Isabel, said that the number of projects she had to do during the circuit breaker period increased by about 40 per cent as more clients were looking to advertise online.
The longer working hours and higher workload resulted in the 24-year-old feeling stressed and anxious to the point where she would vomit regularly and lose her memory while at work.
She could not take a break as she had to meet the clients’ deadlines, and no one could take over her projects as they would not be familiar with the clients’ requests.
“In advertising, the mindset is always clients first, and that’s very detrimental on the employees,” she said.
WHAT EMPLOYEES CAN DO THEMSELVES
Dr Douglas Kong, a mental health expert and performance coach, said that those who are stressed at work may not be able to identify the signs until it is too late.
“Those who are under stress, or have some issues in their life that they aren’t handling well … they can’t see it, and they do their best to cope and handle it,” he said.
He has seen several cases of employees who would not admit to their stress and anxiety, only for their mental health conditions to worsen and affect their productivity.
“So people think that mental illness is terrible, that you must not have it … But the point is that if you can deal with it earlier... it can allow the person to overcome it and get on with their lives and work,” said Dr Kong.
Mr Adrian Choo, founder of career strategy consulting firm Career Agility International, said that employees must know “when to back off” when caught in a stressful situation.
“Employees themselves need to know when they are being stretched and are hitting the limit… (They) need to ask themselves what is more important, your health or your career?” he said. “Because if you are burnt out, you are of no use to your company anyway.”
For Mavis, the bank employee who is hiding her mental health condition from her bosses, only a significant cultural shift in her company will prompt her to open up about her struggles to her superiors.
“If I see a culture where you’re talking openly about mental health, and it’s very clear that if I say something about it, not just my bosses but my colleagues will not think differently of me,” she said. “(Instead) it will be something that can actually help me, with people being more caring and it is not something that will be looked down on.
”She added: “But right now, it is a far cry from that.”
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