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PERSPECTIVE: As Singaporeans become more aware of the very real tussle many of us have with mental health issues, the act of seeking out professional help has come to be more widely accepted in society.

Yet in this 2022 essay "Don't Make Mental Health A Specialists' Problem", the author shares his hope for our society to become one where everyone — from friends to employers — will play their part in creating a caring climate for those who may be struggling.

The essay was first published in The Birthday Book: (Re)Start. Mothership and The Birthday Collective are in collaboration to share a selection of essays from the 2022 edition of The Birthday Book.

The Birthday Book (which you can buy here) is a collection of essays about Singapore by 57 authors from various walks of life. These essays tell their stories of life in the city, as well as what it means to restart: at home, in their community, and for Singapore itself.

By Don Shiau

“How could you? We love you.”

This was the response when I told a family member in 2011 that I had become depressed and suicidal. When I later told my parents, my father damned his misfortune, and threatened to sell the new flat we had just moved into. My boss forfeited my remaining annual leave, as I’d already taken two weeks’ medical leave for my condition.

Dismal as it sounds, my experience was not unusual. It was what the conversation on mental health in Singapore looked like, then.

Thankfully, things are different in 2022.

Changing attitudes towards mental health

Several people I know have therapists. There are trained counsellors in all public schools in Singapore, taking appointments and walk-ins from students. The Health Promotion Board has launched MindSG, an online resource. Between October 2021 and March 2022, it ran a campaign called “It’s OKAY to Reach Out”. The government’s Interagency Taskforce on Mental Health and Well-being, set up to deal with Covid-19 pressures, may well become a permanent office.

We were probably already on our way, but Covid-19 did us a rare favour by removing any remaining stigma about mental health. Now, there is heightened public awareness about the unseen struggles many of us face, and political will for systemic change.

What could this change look like? Parliamentarians have had no shortage of ideas. Over the last two years, they have suggested allowing employees to take “mental health day” absences from work, enacting “right to disconnect” legislation to manage stress and burnout, ensuring that job interviews do not disadvantage candidates with mental health diagnoses, and increasing the provision of private insurance plans that cover mental health conditions.

Perhaps the most obvious suggestion is scaling up the number of mental health professionals and social workers in Singapore to meet the growing need for their services. On the face of it, there seems to be room for improvement. The World Health Organisation uses psychiatrists per 100,000 population as an indicator of the provision of mental health care in a country. By this metric, Norway leads the pack with 48 per 100,000. The United States hovers between 10 to 12, and Singapore trails with 4.4, but still ahead of China’s 2.2 – though there is no real consensus on what the target for any country should be.

Targets aside, it would not hurt to grow the number of professionals — not just psychiatrists, but also counsellors, social workers, psychologists, helpline operators, and more. We can then raise public awareness and let people know that more help is available. Problem solved? Not necessarily.

As interventions like counselling and therapy become more mainstream, mental health itself may become compartmentalised from other aspects of life, and be seen as the domain of specialists. Down the road, when those we care about turn to us for help, the first question we are likely to ask is: “do you have access to a professional?”.

Offloading emotional support

This deference to specialists is not wrong.

At best, it ensures that people get the kind of care they need. If we try to help, we may say or do things that hurt our friends further, even if we do not intend to.

At worst, it can become a crutch. People in troubled relationships may jump to the conclusion that referring the other to therapy is the answer, instead of taking ownership of conflicts, and working through differences together.

Either way, our social networks may end up offloading a lot of emotional support onto professional networks — possibly too much. I worry that we may end up making mental health a “specialist’s problem”.

This is concerning because the care system is getting overloaded: everyone wants therapy, but not everyone wants to be a therapist. A September 2021 article in The Straits Times observed that counsellors themselves were starting to face burnout, with case loads increasing around 20 per cent during the pandemic.

In addition, help is not cheap.

There are free counselling hotlines, but proper intervention is more involved, longer-term, and costly. This is easily justified – the work can be very emotionally and mentally demanding, but knowing this doesn’t make it any easier for those who can’t afford it. Former Nominated Member of Parliament Anthea Ong has estimated that each year, up to 130,000 Singaporeans could be avoiding treatment for their mental health because of prohibitive costs.

Formal care is not a quick-fix

The most important reason not to lean too heavily on formal care is that it is neither a quick-fix, nor a cure-all.

Mental health is, by its very nature, intensely personal. Its treatment therefore has to be carefully tailored to each individual. Yet, there are many competing approaches to therapy. To the uninitiated, they can sound mind-boggling: CBT, DBT, EDMR, psychodynamic, mindfulness and more. Then there are therapists themselves. Some people have to go through several before finding one they feel comfortable with, which itself can be a stressful and exhausting experience.

My first brush with a therapist in 2012 did not go so well. He crossed a line, was unprofessional, and I quit after four sessions. My next experience with a professional was in marriage counselling six years later, which was a much better fit. Now, in 2022, things are dark again. I’ve shared my troubles with a widening circle of friends. They’ve been helpful for the most part, but I keep hearing the refrain: are you getting professional help?

As of writing, I will be. But I also hope to spend more time with the most important people in my life. And I hope that we — both my circles and society at large — can all learn to be a little kinder, a little more patient, a little more present, a little more self-aware.

My earnest hope is for people who need help, to learn when and where to ask for help. For them to do it in a way that doesn’t impose on others, and respects their space and well-being.

For friends and caregivers to reach out more, and more often. To listen actively, but also know where to draw explicit boundaries when they’re not available. To suppress the instinct to offer solutions, and to avoid projecting their own experiences on those they are caring for.

And crucially, to recognise if and when they may be part of the problem. None of this requires a Master’s in Psychology — they are all things we can, and should learn. It is a kind of literacy as basic and essential as reading and counting.

There’s much we can do to make each other feel a little safer; to be kinder in a way that goes beyond platitudes or virtue signalling.

To be sure, nothing can replace professional expertise in listening, reframing, affirming, and healing. But the things that are driving us to therapy — the complexity of modern life, the isolation and indifference afforded by technology — are only going to increase.

The least we can do is spread the burden of care across a wider net.

Top image by Andrew Koay