The power of 'we' in addressing wellness and mental health issues in Singapore

I have been a keen participant observer of changes in our mental healthscape over the past eight years — as an advocate and a youth mental health professional. Here, I will share some narratives that I observed are underway, and my hopes for these issues going forward. 

DEFINING NEW NORMALS IN RECOVERY

Recovery is not the exception but the expectation of all stakeholders, from patients to their families, doctors and the community at large.

Traditionally, mental health professionals anchor themselves in what psychiatrist Robert D. Laing has called “the medical model”: Adopting expert positions, focusing on the problem, questioning, seeking to understand, before diagnosing and administering medical treatments.

Increasingly, however, there’s an unmistakable shift towards embracing person-centred, strengths-based approaches to discovering the brilliance of patients, seeing them as experts of their own lives, capable of change.

This shift could only have taken place with the emergence of more advocates sharing stories on the realities of recovery and achievement of meaningful lives after illness. This is underpinned by a growing openness towards disclosure, with a generation hopeful of achieving an accepting and inclusive Singapore.

Having been a facilitator of a support group for persons with anxiety and/or mood disorders for five years, I had a ringside seat to see how each participant (re)defined his or her “new normal”, working at coping despite the stressors and still generously offering informal support to one another. Their resilience and ability to bounce back stronger inspire me.

In particular, I am encouraged by the wave of peer support specialists, persons with mental health issues (PMHI) employed to work in multidisciplinary teams as professionals in their own right to catalyse recovery among clients.

Harnessing credibility earned from their own lived experiences recovering from mental illnesses, they provide a vivid reminder of the possibility of recovery. Furthermore, by using their gifts of adversity, they cheer peers on in their journey towards wellness.

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In 2017, more than 40 were trained and 16 were placed in various mental healthcare settings. A former peer support specialist, Lee Ying Ying, even founded Soar (School of Ability and Recovery) to serve as a recovery college to reduce stigma in the community through education, honest conversations and meaningful interactions.

The testimonies of these wounded healers provide hope and inspire mutual support in the healing journey. Sometimes, it takes one to know one. While the peer support movement is still in its infancy, such activism, involvement and participation of PMHI indicates its growing empowerment.

ADVOCACY FROM THE GROUND UP 

Stigma is a well-known barrier towards help-seeking, recovery and inclusion. While efforts at challenging stigma in the community have been mostly led by social service organisations, there are increasing ground-up efforts to raise awareness. 

As the founder of the National University of Singapore (NUS) Mental Health Wing, an advocacy group, I was constantly surprised to find many like-minded peers dedicated to raising awareness on campus during the two years I was leading it.

So much so that my co-heads, Charmaine and QiuLuan, and I decided to focus our energies on connecting and raising the capacity of these peers instead. We encountered not one but four advocacy groups: One in each Residential College in University Town (CAPT Support, Love USP, Love Tembusu, RC4Wellness)!

Our combined efforts and advocacy encouraged more administrative support through the creation of a Student Support Services office in NUS in 2018 to support students’ well-being.

We are also inspired when meeting our counterparts in other universities, namely Singapore Management University Peer Helpers, Nanyang Technological University Peer Confidantes and Yale-NUS’ P.S. We Care. There is an unmistakable energy from the ground up.

FULFILLING POTENTIAL IN STRONGER COMMUNITY APPROACH

A commonly cited statistic in Singapore is that despite one in seven persons in Singapore experiencing a mental health concern at one point in their life, three in four do not seek help. However, in such a treatment gap lies unique opportunities to mobilise the community through task-shifting, to boost early detection and the provision of social support.

I was privileged to spend two weeks in 2015 shadowing Keswamas, a community mental health team in Yogyakarta, Indonesia. Freeing PMHI who are pasung (physically restrained) taught me that while one can be freed of the physical chains, the social chains remain.

Hence it is important to heal not just the individual but also their family (caregivers) and community.

As such, on top of supporting the client and caregiver, Keswasmas works with kader (community health volunteers, mostly housewives) to reach out to the community, educating and empowering them with relevant skills and knowledge to support PMHI. Truly, in recovery, it takes a village to heal PMHI.

A community approach helps to dissolve invisible chains and strengthen bonds.

Applying this concept to Singapore, I have a dream that we can have a mental health first aider in every home. Dare we envision a time when all our youths are mental health literate?

As psychological first aiders, they can erode generational stigma within the family, and help to build a more understanding and supportive Singapore.

Consistent with the shift in emphasis from institutional to community care, we also need stronger mental healthcare support (and funding) at the primary level and the community to rally behind to support PMHI, for recovery-in-place to happen.

WORKING TOGETHER 

The past 10 years have seen significant improvements to improve access to mental healthcare resources through many firsts including the 2007 National Mental Health Blueprint, the 2010 Singapore Mental Health Study and the 2017 Community Mental Health Masterplan.

Nonetheless, stigma persists as a barrier towards help-seeking and recovery. For one thing, the dilemma of disclosure (risking exclusions from employment opportunities and insurance) continues to plague many PMHI.

We need not only to reduce social stigma and interactional discrimination through awareness-raising efforts, but also tackle structural stigma (discriminatory laws, institutional practices and social policies).

These collective efforts can help to alleviate self-stigma, promote early help-seeking and reduce unnecessary suffering. In the sector, there is a common saying: “There is an i in illness and a we in wellness”.

By working together, we can achieve mental wellness for all in Singapore. Let us start by prioritising our mental health, taking better self-care, showing support to those around us and speaking out against stigma.

ABOUT THE AUTHOR:

Khoo Yi Feng is an aspiring social service leader and a Youth Support Worker at Community Health Assessment Team (Chat), a national mental health assessment and outreach programme for young people aged 16 to 30. This piece first appeared in The Birthday Book (2019), a collection of 54 essays on “narratives, undiscovered and underway” in Singapore. TODAY will be publishing other essays from the book.