IN FOCUS: The challenges young people face in seeking mental health help
SINGAPORE: Kevin* has known his heed "works differently" ever since he was in Secondary 3. Things like grocery shopping may be therapeutic for some, but it is an incredibly stressful task for him.
"It'southward e'er the difficulty of pick in making the simplest decisions, like what kind of pasta should I buy? I tin can take 15 minutes just standing at that place earlier deciding which to buy," he said.
Kevin did not know then that he had anxiety, which can interfere with decision-making. What he was familiar with, though, was the mutual refrain that he would hear from people around him urging him to cease worrying and thinking too much.
He went on with life struggling with not feeling "fully normal". It was another 13 years before he stepped into his first therapy session.
"Information technology took me quite a while to say that I wanted to seek help," said Kevin, who is now 29 years old.
"People always think that it's (mental illness) just a phase, until it becomes as well serious...I don't want to somewhen (commit suicide)."
Statistics from the Samaritans of Singapore (SOS) final week showed that the number of suicides in Singapore for those aged in their 20s remained the highest last yr compared to those in other age groups.
A full of 71 people aged between 20 and 29 killed themselves in 2019. Suicide continued to be the leading cause of death for those aged ten to 29 last year.
READ: Number of suicides among those in their 20s highest in Singapore
While Kevin took the starting time pace to seek help after a long struggle, non anybody does and so.
Co-ordinate to a Singapore Mental Health Study conducted in 2016, while one in seven in Singapore has experienced a mental disorder in their lifetime, more three-quarters did not seek whatever professional assist.
Respondents cited a "treatment gap" of 11 years as the median time between when they commencement experienced symptoms and when they sought aid for obsessive compulsive disorder.
It was 4 years for bipolar disorder and booze abuse, two years for generalised feet disorder and i year for major depressive disorder.
READ: 60,000 subsidised outpatients seek treatment for mental disorders each yr: Gan Kim Yong
In the same study, youths between eighteen to 34 years were presented equally the most vulnerable group - 1 in v would have experienced a mental disorder in their lifetime.
In Singapore, at that place is a comprehensive network of mental health services - from helplines and Voluntary Welfare Organisations (VWOs) offering youth-axial counselling services, to clinics at government hospitals and in private practice.
However, some immature people experience challenges in seeking professional help.
NAVIGATING MENTAL HEALTH SERVICES
Mental health awareness among young people appears to be growing.
According to the Ministry of Health (MOH), from 2022 to 2019, an average of 12,600 patients aged 15 to 34 years sought treatment for mental health conditions at public hospitals each year.
The Community Health Assessment Team (Chat) - a customs-based youth mental wellness outreach and assessment initiative - received around 1,800 referrals and conducted assessments for nigh 770 youths concluding yr.
That is 36 times more referrals and 15 times more assessments than 2009, when the initiative was beginning launched.
In March, so Senior Minister of State for Health Dr Lam Pin Min said during the Committee of Supply argue in Parliament that recent engagements with young people showed "mental well-being continues to be a meridian concern".
In response, a new initiative offering mental wellness back up and awareness to at-risk youths is expected to launch in the second half of 2020.
The Integrated Youth Service, jointly developed past the MOH, Institute of Mental Health, Agency for Integrated Care and Care Corner, was described in an MOH press release as a "one-stop service where at-risk youths tin can admission coordinated mental wellness and support services such as individualised basic emotional support, needs identification and befriending services".
Responding to queries from CNA, MOH said that the Integrated Youth Service began community outreach in the "Northern region in April 2020".
"In the midst of COVID-19, Care Corner'south mental health section, INSIGHT, has had to adapt its outreach to youths through alternative online platforms such equally Instagram, a Telegram bot and webinars," information technology added.
To date, these platforms take reached out to over 500 users.
READ: Mental wellness support service for at-hazard youths to be launched this twelvemonth: MOH
This resource may be a welcome addition to helping young people navigate their fashion through the range of options so they tin can find a solution that works.
Broadly, there are two approaches for treating mental health weather condition: Medication and psychotherapy - both of which can exist used on its ain without another, with different effects on an private.
"Medication reacts differently for dissimilar individuals even if it's the same status - a certain medication may work perfectly well for one, simply for some other it tin can take more complicated side effects," said Mr Jackie Tay, the executive manager of PSALT Care, a registered clemency and mental health recovery heart.
On the other manus, psychotherapy and counseling involve the "human gene" or the social connection between the clinician and the patient.
"Information technology's the chemistry and connectedness - some patients would connect better with sure styles of therapists. You besides need to navigate around that," said Mr Tay.
As such, the continuum of care for mental health conditions can also be long, intensive and complicated. For example, one immature adult whom CNA spoke to likened the process of finding suitable treatment to finding a soulmate on matchmaking sites like Tinder. Kevin agreed.
Finding suitable handling requires time and try from an private. However, experts CNA spoke to suggested that improving the quantity and quality of data nearly mental wellness resources may encourage a young person to take the get-go step to seek help.
"This group of vulnerable people (with mental health problems) would already be cognitively overloaded," said Ms Anthea Ong, a quondam Nominated Fellow member of Parliament who advocated for the prioritisation of mental health in the budget 2022 debate.
She added that while the National Council of Social Service provides a list of bachelor mental health resources online, there should be a "community navigator" that goes beyond "just data".
"There'southward no guidance on where to go, the price fees - at to the lowest degree list downward some of the possible journeys or experiences and and then map that.
"It'south not a site that helps you to navigate the services bachelor," she explained.
For those like Aisha*, who engages in self-damage and suspects she has depression, the plethora of options that a Google search presents her has posed a hindrance.
"I remember Googling 'Singapore counselling session' and 'affordable counselling'... but at that place isn't a site that narrows down your options for you or tells you what kind of treatment is appropriate," the 23-year-old patient service associate at a local hospital said. She has yet to see a professional.
Equally much as there are many avenues of care out at that place, at that place may non exist enough pedagogy on selecting an appropriate one, said Dr Tracie Lazaroo, a clinical psychologist from Inner Light Psychological Services and LP Clinic.
"Finding the appropriate mental wellness service can seem like an overwhelming feel."
Kevin for case, did non know the divergence between a psychiatrist, a medical md who tin can diagnose mental disorders and prescribe medication, and a psychologist - someone who specialises in modes of therapy.
While he was hoping to speak to a therapist most his issues, he unknowingly set an appointment with a psychiatrist at a private infirmary instead, who prescribed him medication like Lexapro and Xanax.
"I didn't know where to start and where to search … (the private hospital) came out with the get-go few searches of Google," he said.
"I was quite taken ashamed because information technology was more of a clinical setting (with the psychiatrist) and it was not very nice. I didn't feel very comfortable."
Mr Tay added that the awareness of the availability of health and resources has not increased significantly over the last five years, neither has the "ease of search".
"For example, we know that when there's a fire, we call 995. When you lot demand the law, you call 999. Simply when you've got a mental wellness problem, who do y'all call?"
THE PRICE OF MENTAL HEALTH TREATMENT
Given the long-term nature of mental wellness handling and recovery, financial concerns can exist a factor in deciding whether to seek help, experts said. Nearly youths who spoke to CNA likewise said that the cost of treatment has been a concern.
Under the Chronic Disease Management Programme (CDMP), patients with schizophrenia, major depression, bipolar disorder and anxiety tin withdraw up to Southward$500 from MediSave per year to defray the price of outpatient treatments such as therapy and counselling treatment.
Each merits is subjected to a xv per cent co-payment in greenbacks.
To receive further subsidies at the Institute of Mental Health (IMH) - Singapore'due south only 3rd psychiatric care institution - 1 can go a referral from a doctor at the polyclinic. The first consultation costs Due south$forty and S$37 for the subsequent ones.
This is much cheaper compared to individual clinics that accuse anything between S$100 to S$250 for one session - depending on the preparation, specialisation and experience of the clinician.
For example, Raffles Medical Group states on its website that a session with a counsellor or psychiatrist will price at least S$160.50 and S$214 respectively.
While there are authorities subsidies available at public healthcare institutions, Dr Lazaroo said that some patients need prolonged care.
"These disorders require consistent long-term care on a weekly basis peculiarly within the first year of symptom onset, commonly spanning over the course of a few years," she added.
"Unfortunately, some of these patients may struggle maintaining employment while receiving therapy or psychiatric treatment, which will inevitably crusade them to have insufficient MediSave or MediShield Life funds."
The cost of weekly treatment volition besides "stack upward very quickly".
To farther encourage help-seeking behaviour, Ms Ong said that there is a demand to "do even more" to go on mental healthcare affordable in Singapore considering mental disease "does not necessarily have any obvious physical symptoms" and treatment volition non accept "simply one session".
She noted the difference in inpatient MediSave claims - while the daily limit is South$450 for concrete illnesses, it is S$150 for psychiatric treatment.
"The claims limit is already lower compared to physical health conditions and you might need to go for more treatment. It's a double whammy," Ms Ong added.
During the Ministry of Health's 2022 Budget debate in Parliament, so-Government minister of Land for Health Dr Amy Khor said that MOH reviews the corporeality of financial back up regularly to ensure that it is adequate.
Based on the latest data, fewer than three in 10 persons' subsidised bills exceed MediSave's daily withdrawal limit, she said.
Notwithstanding, financing for handling may be a claiming for those with conditions not covered by CDMP such as post-traumatic stress disorder and eating disorders, co-ordinate to the experts CNA spoke to.
In an email response to CNA's queries, MOH said that from Jan 2021, patients with "circuitous chronic conditions" will be eligible for a higher annual MediSave withdrawal limit of S$700.
"No one will exist denied appropriate healthcare because they cannot afford to pay. Those who cannot afford their treatment at the public healthcare institutions fifty-fifty after subsidies, MediShield Life and MediSave, can arroyo the medical social workers for MediFund and other financial assistance."
Fifty-fifty so, experts highlighted that handling at a private dispensary or voluntary welfare organisation (VWO) may be more than suitable for some simply that ways they would have no access to MediSave withdrawals.
"If you are seeing a psychologist every calendar week and you can't afford information technology because the fees are non claimable, you will have to stretch your therapy. Consequently, information technology takes that much longer to get well," said Mr Tay.
That is something that Ms Aleesha Khan can chronicle to. The 23-year-onetime was diagnosed with generalised anxiety disorder, depression and PTSD nine years ago and sought treatment at IMH'southward Kid Guidance Clinic for near v years.
Ms Khan went on to seek treatment for PTSD at a private dispensary, where she received Center Motion Desensitisation and Reprocessing (EMDR) - a four to six-week psychotherapy treatment that helps to alleviate distress associated with trauma.
As useful every bit that may be, she is paying nigh S$235 for every session.
"It'due south worth information technology considering it'south helping me, but it's so much money. Not everyone can afford that and there's no style to get subsidies considering they just don't encompass it," she added.
On top of that, she is also seeing a therapist to help with her anxiety and depression. To save money, she makes the "conscious choice" of going for one monthly session, if not it would "really be besides much".
"If I had a choice, I should actually be going to therapy more oftentimes...(but) I'g already spending S$235 a month, at least S$ii.8k a twelvemonth just on therapy," Ms Khan said.
"I'm heart-class but I know and so many people who demand information technology but they can't beget it."
SELF AND SOCIAL STIGMA However Exist
"Information technology's similar waves and waves of sadness...you feel like the world is non a identify for you." This is how beingness depressed feels like to Aisha, who said she maintains a "strong expect" daily even though she can break down several times in private.
"It'due south especially hard to be working in healthcare because you can't prove that to your colleagues or patients. But at the end of the day, when you go home and you are left alone to your thoughts - that's when it really kills me," the patient service associate said.
While Aisha has been considering seeking help e'er since she was in secondary school, the idea of receiving a diagnosis and "being sick" scares her.
"Information technology's like, 'I'grand working in the medical line and I'm like that?' I think that will exist the perception of people ... so I just suck information technology upward," she said.
The perpetuation of stigma can come from various sources, such equally the public, family or even within oneself. Immature people are also more than decumbent to its furnishings as they are in a "developmental phase" where they are trying to "grade their identity".
"They might be self-conscious and are typically more concerned near how others may come across and perceive them, peculiarly then past like-minded peers," SOS added.
"To avert beingness judged or associated with the perceived negative stereotypes, youths may choose to hide their struggles in gild to avert beingness seen as 'weak' ...fifty-fifty if they harbour thoughts of suicide."
"There's probably a very big mindset departure," said Ms Charlotte Chen, a therapist from Counselling & Intendance Centre.
"I noticed that (youths) seem to exist more open to sharing with their peers than adults, peculiarly their parents. They have the impression that their parents won't believe that mental disease is real."
Most youths that CNA spoke to have not told their families near seeking treatment or their struggle with mental health.
*Kiara, a 27-year-old early intervention teacher said it took her a few years before she went to a professional for her low and borderline personality disorder equally she came from a "very religious, conservative family".
"Anytime they see me feeling sad, or aroused, their start advice to me is to seek God. They mean well but these words are not really effective… (they don't empathise that) it'southward the brain chemicals in your brain that's going off," she said.
"And then I but kept telling myself, it's okay I can handle this. What's the point of seeking help when I'm gonna end up dead anyway?"
Similarly, 27-yr-former Yi Wei* said that it is "very disheartening" whenever she brings up the topic of mental health with her parents.
"They don't understand what it is … they just see it as something difficult that you have to overcome like everything else in life."
The business relationship executive added that while "working very hard" is one of her outlets for coping with depression, doing well in school or at work has not helped in disarming her parents that mental health treatment is necessary.
"That translated to my parents thinking, 'She'due south doing very well in school, so it's not as bad as what she makes it out to be? How tin can it be so hard when yous are actually excelling?'"
"Living with that sort of mentality within your family unit is difficult. That's why information technology took me so long to get diagnosed and seek help," she added.
Not only is "destigmatising" mental illness important, there is also a demand to undo the "narrative" that it only happens to sure individuals, said Ms Anthea Ong.
"Kids might think, 'My parents send me to a good school, I'yard from a well-to-do family and all that - how can I have this issue? I have everything I want.' That's when they outset to beat themselves up, thinking they are self-indulgent."
She added: "But that is not true ... at that place are so many ways to be challenged mentally in the society that we're living in."
THE ONES WHO Make full THE GAP
While affordability and dubiousness about who to plough to are central barriers for some young people who demand mental health treatment, at that place are charities and VWOs aiming to address some of those concerns.
Shan Y'all Counselling Centre, for case, charges S$80 for every hour of counselling and offers a 50 per cent subsidy for students.
"In some instances, some of the young people may still not be able to afford (it), and then we volition offering further subsidy," said its director Dr Kum Yew Siew.
Dr Kum added that seeking assist at VWOs or private clinics does non require a referral different in public hospitals where a psychiatrist volition accept to make a diagnosis before someone tin can be directed to a psychologist.
"Not only is there a delay but also on a psychological level, having to go through multiple professionals and having to decide whether you even want to become through multiple people before you tin can talk to someone tin pose every bit a barrier."
"In my opinion, you practise non need a diagnosis to provide help and intervention," he said.
Ms Chen from Counselling & Care Centre added: "When youths come to a counselling centre, we are not trained to diagnose a mental health status and so we work with wherever they are, whatever struggles they're dealing with and we support them from there through talk therapy."
"Given that we are a VWO, I imagine they feel a petty bit safer in terms of their records being kept confidential. That sense of safe and anonymity is really of import (to youths)," said Ms Chen.
"Sometimes in seeking employment they might ask if y'all have any psychiatry issues. If they have received an official diagnosis (at the infirmary), I imagine they would face a dilemma of whether they should or should not disclose."
However, VWOs that CNA spoke to reflected challenges in sustaining affordable services. Ms Chen said that while there was a pro-bono scheme in the past, the centre has not been able to go on that service due to the lack of funding.
"That is a real claiming and struggle. I practice have one or ii clients who can't quite proceed counseling considering of the fees," she added.
The difficulty of fundraising can also be tied to the stigma of mental affliction, said Mr Tay from Psalt Care, and this prevents patients from sharing their stories and experiences with the public.
"Most of us in the clemency sector ... try to exercise our best with the limited resources. Nosotros would certainly promise we tin can accept more and then that we can do more."
According to MOH'due south latest data, NCSS provided Due south$eight.vii 1000000 and S$5.7 million in funding to Social Service Agencies (SSAs) for mental wellness back up services and counselling programmes, respectively, in 2018.
While there are counsellors in school and upstream efforts from the Ministry of Education - such every bit plans to requite more focus to mental wellness in the Character and Citizenship Education (CCE) curriculum - Ms Ong suggested that more funding needs to get to "community back up" and VWOs.
READ: Schools to offer mental health lessons from 2021; more trips to Asian countries
"It is important to allow young people know that at that place is trusted, third-party support available out of campus that is affordable. We know the ratio of counsellors in school to the number of students," she added, noting that waitlists be for university counselling services as well.
"Community mental health agencies tin can as well exist a great resource to young people."
NEED TO "SOLVE STRUCTURAL ISSUES"
As awareness of mental health issues amidst young people has grown, fifty-fifty more than efforts are being put into providing help and support. This includes the 24-hr National Care Hotline launched in April this year, which is manned by more than 300 psychologists, counsellors, social workers, psychiatrists and public officers.
Co-ordinate to MOH, at that place are consolidated sites that listing mental health resources and "function equally navigators", such as the My Mental Wellness microsite that was launched this year by Temasek Foundation, in collaboration with the AIC.
"It is a resources hub that provides online mental health resource such as mental health-related articles, online forums and information on back up groups to support one's mental health during the COVID-xix flow," it added.
Another website with various resource on mental wellness was too launched to help users assess their wellbeing and match them with forms of assist if needed.
READ: COVID-xix: One-stop mental health platform launched to match users with resources and helplines
The website, called mindline.sg, consolidates admission to many resources and tools to help people "access and navigate care, with an emphasis on stress and coping".
While there has been a "groundswell" of customs efforts in recent years - such every bit the Beyond the Label campaign past NCSS to accost mental wellness stigma – Ms Ong said that the prevalence of mental health concerns among youths is indicative of the work that still needs to exist done.
"That already empirically tells you that as much as nosotros rally on the ground, we are not solving the structural issues of our mental healthcare such as affordability, accessibility and quality."
READ: AIA launches start insurance policy in Singapore that covers mental illnesses
In the meantime, young people like Ms Khan are playing their role. The psychological science student shares her personal experience in help-seeking and resources on her Instagram page, including a compilation of affordable mental healthcare in Singapore.
"Back then, there weren't a lot of resources ... a lot of support and answers I needed were not available to me. So my objective (at present) is to provide information that I needed as a teenager who was in distress," she said.
Ms Khan added that she receives many letters from youths who follow her page - some of them needing a listening ear, others looking for data on where to seek help.
"Some go overwhelmed looking at hospital websites...I have my own listing that is categorised - if someone comes to me, I go far a point to refer them to the appropriate data," she added.
"What I really try to exercise is to make sure that they are equally informed as they tin exist and so that they can advocate for themselves."
*Name has been changed to protect identity
Where to get aid: Samaritans of Singapore operates a 24-60 minutes hotline at 1800 221 4444, or you tin can email pat [at] sos.org.sg . If someone you know is at immediate risk, call 24-60 minutes emergency medical services.
Source: https://cnalifestyle.channelnewsasia.com/singapore/focus-challenges-young-people-face-seeking-mental-health-help-278706
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