Mental Health Must Be a Whole-of-Government Priority
Parliamentary Speech: Budget 2019 Debate
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Mr. Deputy Speaker, I would like to first thank the Finance Minister and his team for their hard work with Budget 2019, especially with the additional consideration of the bicentennial commemoration. Minister Heng had me at “Building a Strong, United Singapore” because it is a confident narrative that acknowledges our resources and strengths, alongside our challenges, as a nation. He also had me at quote “We are using our financial resources to help realise our strategies for a strong, united Singapore. But financial resources alone do not get us there.” unquote. And if I may state the obvious, neither should financial wellbeing alone be our aim.
Indeed, “Building a Strong, United Singapore” can only be possible with a people that is mentally resilient across all ages and segments of our society. Minister Heng mentioned ‘resilience’ and ‘confidence’ repeatedly throughout his Budget Statement. Resilience and confidence is a result of a mentally healthy society.
Therefore, mental wellbeing must be an ongoing national and whole-of-government priority with the recognition that our quality of life is defined not only by markers of economic growth and our material wellbeing but also our subjective well being. We must constantly question if our national policies and spending empower, beyond just enabling, our people to be ready for challenges ahead and confident of our future.
Given that, should mental health be one of the longer term domestic challenges alongside those highlighted in the Budget Speech, namely ageing, social mobility, inequality, economic transformation, and climate change? Mr Speaker, I would argue that it should — please allow me to share my personal experience and ground observations with the different communities I’m involved with to substantiate my claim.
Personal and Real, not just Statistics
My incredibly bright nephew was first diagnosed with anxiety disorder in 2017 at just 15, and later with depression last year. He is currently out of the school system at the promising age of 17.
The young man who works with me at A Good Space almost jumped off from the 15th floor of a HDB block a few years ago when he was just 19 even while he was on treatment for depression. There’s also the old uncle living in my block at Marine Crescent who was depressed from the death of his wife and started sleeping on the bench in the void deck at night.
Just the other day, a young taxi driver shared with me about his 87 year old grandfather jumping to his death by climbing up the flower pot racks along his HDB corridor after his breakfast, his whole family was still having their breakfast inside the flat when they heard the loud thud.
Then there’s my own close shave with depression over 12 years ago when my world collapsed at the height of professional and economic success.
Mr Deputy Speaker, in case members of this House think I’m the epicentre of mental health issues, let me absolve myself — not with any delight at all — by sharing some sobering numbers.
Mental Health: Across All Ages and Segments
My nephew is unfortunately not alone in his struggle. IMH recently reported that the number of young Singaporeans between the ages of 16 and 30 who sought help from its Community Health Assessment Team (CHAT) over 2015 to 2018 has jumped by an alarming 190%. A more troubling reality is that children aged five to nine calling the SOS hotline increased by more than 500% in less than 3 years. Suicide is the leading cause of death for those aged 10–29. As our young progress to adulthood, they continue to be most at risk of suffering from mental disorders, according to the latest Singapore Mental Health Study published in December 2018.
The mental well-being of working adults in Singapore is 13% lower than the general population. Further, 90% of psychological conditions with adults in Singapore have their root cause in workplace stress. Yet studies have shown that an overwhelming 86.5% of those employed do not seek help for their mental health difficulties.
My elderly neighbour and the taxi driver’s grandfather are also sadly not alone in their plight. One in five elderly persons in Singapore aged 75 and above show signs of depression. The number of elderly aged 60 and above who took their own lives peaked in 2017, the highest since suicide tracking started in 1991. An estimated one in 10 people aged 60 and above has dementia, whilst half of those aged 85 and older have it.
Mr. Deputy Speaker, let’s not forget the vulnerable and underserved communities in our midst who are exposed to a host of adverse conditions which determine health and mental health, including poverty and access to support infrastructure. 1 in 5 elderly caregivers in Singapore suffer from depression, 6 in 10 migrant workers with an injury or salary claim are likely to suffer from a serious mental illness, single-person-headed households struggle to seek state support, and it is generally accepted that individuals with physical and learning disabilities are at higher risk of suffering from mental health conditions although no study has been made.
A Pressing Challenge like Ageing, More than Diabetes?
Mr Deputy Speaker, the challenge of mental health is clearly wide ranging and reach across the lifespan of Singaporeans. The latest IMH study showed that one in seven persons in Singapore experience a mental health condition in their lifetime, an increase from one in eight just 8 years ago. Globally, this number is one in four persons. By way of comparison, USA is one in five whilst UK is one in four. Will we head there? Two thirds of those with mental health conditions in Singapore do not seek help because of stigma, discrimination and neglect.
At this juncture, I would like to remind the House that the prevalence of diabetes which we have waged a war against is one in nine people in 2017 versus one in seven for people with mental health conditions.
Ageing has been rightly prominent in our national policy-making narrative and was cited as the first longer-term domestic challenge in the Budget Statement because by 2030, one in four Singaporeans will be aged 65 and above. Yet, there is clear and present danger that the invisible yet mounting challenge of mental health could be headed that way with the escalating prevalence. We must therefore make mental health a deafening priority now rather than languishing it in the shadows because mental health affects the lives of Singaporeans across all ages and segments.
MOE informed me in my recent parliamentary question that they recorded 10 in 1000 students receiving counselling for stress and anxiety. Yet, the IMH study showed 1 in 7 adults experience mental health condition. While a direct causative link cannot be drawn so simplistically, the question nonetheless stands: How does 10 out of 1000 or 1 in 100 students receiving counselling become 1 in 7 adults experiencing a mental health condition in their lifetime? What have we missed in our policies? What more must we do?
Mental Health Requires a Whole of Government Approach
Mr. Deputy Speaker, there is no health without mental health. We must normalise mental health and bring it out to the open. The Government and community have to learn to value mental health as a basic need, and to then reduce stigma and improve help-seeking and recovery.
We have made much progress moving from a predominantly medical approach of the past on mental health to one that is aspiring to involve every member of society. The Community Health Action Masterplan was launched in 2017. Primary care providers like polyclinics and GPs are being trained to support mental health services in non-stigmatising environments. A national campaign “Beyond the Label” was launched in 2018 to break the stigma surrounding mental health by National Council of Social Service. This year, the President’s Challenge is focusing on mental health. I’m greatly inspired by these efforts.
Yet mental health is not and must not be the responsibility of Ministry of Health and social sector alone. All ministries should recognise their role in protecting Singapore’s mental health. The impact on the mental health of any group of stakeholders, whether it be citizen, service user, staff or other, should be considered consistently and robustly in all key government decisions. Cross-ministerial policy making will be required to address the burden of mental health in our society — from interventions in education, reforms in employment practices and community initiatives.
Despite the escalating prevalence amongst our children and youth, mental health education programmes such as the Holistic Health Framework by the Health Promotion Board, are still optional, placing the onus on schools to adopt and implement these programmes. Peer support programmes in schools and IHLs are also optional. Mandating mental health education in our schools and Institutes of Higher Learning is the surest signal to normalise mental health, together with providing support structures for parents and families to be equipped with emotional management skills, coping mechanisms, and problem solving skills to help our children and youth better navigate stress.
IMH studies have clearly demonstrated that mental disorders have significant consequences on the workforce in terms of lost work productivity in Singapore. 72% of employers in Singapore say that work has been affected by mental health issues, yet only half have psychosocial support programmes in place. We must update our employment policies to recognise and promote employee wellbeing by enacting clear and deliberate provisions that are upstream and preventive in nature. Our employment laws, including the Workplace Health & Safety Act, must also explicitly include and provide for psychosocial health and safety, beyond physical health & safety.
Our social policies must place mental health as a priority for the underserved and vulnerable communities alongside basic needs. The Quality of Life Standards by NCSS is a great start yet we can and must do more in partnering these communities to design solutions that take into account their mental wellbeing and dignity, beyond merely fixing problems or providing services for them.
The community must come in too. There are many ground efforts in mental health and support services including VWOs, informal groups and social enterprises. A group of 25 C-suite leaders and I came together to form the WorkWell Leaders Workgroup last year as a national ground-up effort to share, discuss and co-create inclusive practices for workplace wellbeing. The first ever mental health insurance product was also launched early this year by one commercial insurer which augurs well for the surging de-stigmatisation efforts and providing much needed support for those with mental health conditions.
Mr. Deputy Speaker, mental health disorders are on the rise in every country in the world and could cost the global economy up to US$16 trillion between 2010 and 2030, according to the Lancet Commission Report in 2018. How much Singapore shares in this we are not sure because no study has been done by the Government to-date. We could, however, surmise with the wide ranging impact mental health disorders have on innovation, productivity, economy and social cohesion as well as rising medical services and infrastructure needs, it might not be too far from the $2.5billion that we expect diabetes to cost Singapore by 2050.
“No other health condition in humankind has been neglected as much as mental health has.” said the same Lancet Report. The way we look at mental health reminds me of climate change, Mr. Speaker. It’s invisible, and so it gets parked mindlessly and incorrectly in the ‘important but not urgent’ quadrant of our awareness. Yet like climate change, it’s our future — our young ones — that we are jeopardising most if we continue with a transactional approach in addressing the challenge.
The clarion call made by Budget 2019 to build a Strong, United Singapore is, as I read it, bringing our attention back to our biggest asset — our people. Because ‘strong’ and ‘united’ are finite in concept if we merely rely on our financial resources, economic growth and pre-existing institutions. Poor mental health will cost Singapore our future if our children cannot reach their full potential, especially when their lives end prematurely. The impact of poor mental health on our productivity and innovation is indisputable. Our social cohesion cannot be taken for granted — resilient communities follow from resilient citizens.
The Government must ensure its policies are underpinned by a drive to help our people thrive mentally and confidently as empowered citizens. I strongly doubt one-off and indiscriminate bonus payouts yield this outcome. Neither do they engender a caring and inclusive societal attitude. Could we have instead put the whole of society rhetoric for increased citizen well-being into action by establishing a national coordinating body for this purpose to work with all stakeholders (government, employers, communities, schools etc) including mental health literacy training to every citizen? This can also be the inter-ministerial agency to integrate citizen subjective wellbeing in policy making. Its mandate of improving and sustaining our quality of life is as important as the other agencies’ on improving our quality of living.
Mr Deputy Speaker, I urge the Government to enshrine mental health as a longer-term challenge in Budget 2019 which Minister Heng has presented as a strategic plan, and to allocate the necessary resources to address this challenge. It’s time for the Government to recognise, acknowledge and understand the complexity of mental health and to create opportunities and solutions to improve the lives of our people, especially our children and youth. It’s time to redefine our values as a nation as cherish every individual’s subjective well-being, dreams and aspirations beyond just their material and economic achievements. It can be done, it must be done because mental health is what makes us human. And this sure is what a Strong, United Singapore must, first and foremost, always be.
Mr. Deputy Speaker, notwithstanding my request and clarifications, I support the Budget.
Anthea Ong is a Nominated Member of Parliament. (A Nominated Member of Parliament (NMP) is a Member of the Parliament of Singapore who is appointed by the President. They are not affiliated to any political party and do not represent any constituency. There are currently nine NMPs in Parliament.)
The multi-sector perspective that comes from her ground immersion of 12 years in different capacities helps her translate single-sector issues and ideas across boundaries without alienating any particular community/group. As an entrepreneur and with many years in business leadership, it is innate in her to discuss social issues with the intent of finding solutions, or at least of exploring possibilities.
She champions mental health, diversity and inclusion, environment — and volunteerism in Parliament.