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Time for a mental health emergency hotline?

Jul 21, 2021 | 🚀 Fathership

Finding suitable treatment requires time and effort from an individual and it can be an overwhelming experience.

Anthea Ong, a former Nominated Member of Parliament who advocated for the prioritisation of mental health in the budget 2020 debate suggested that improving the quantity and quality of information about mental health resources may encourage a young person to take the first step to seek help.

She added that while the National Council of Social Service provides a list of available mental health resources online, there should be a “community navigator” that goes beyond “just information”.

“There's no guidance on where to go, the cost fees - at least list down some of the possible journeys or experiences and then map that.

“It’s not a site that helps you to navigate the services available,” she explained.

Lack of clear information an overwhelming experience for mental health sufferers

For those like Aisha*, who engages in self-harm 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 there 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.

“I do want to spend some time looking at the services ... but that’s just something I’m not ready for at this point of time - not when your mind is already in a mess.”

As much as there are many avenues of care out there, there may not be enough education on selecting an appropriate one, said Dr Tracie Lazaroo, a clinical psychologist from Inner Light Psychological Services and LP Clinic.

“Finding the appropriate mental health service can seem like an overwhelming experience.”

Psychiatrist or psychologist?

Kevin* for example, did not know the difference between a psychiatrist, a medical doctor who 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 about his problems, he unknowingly set an appointment with a psychiatrist at a private hospital 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 first few searches of Google,” he said.

“I was quite taken aback because it was more of a clinical setting (with the psychiatrist) and it was not very nice. I didn’t feel very comfortable.”

Mr Jackie Tay, the executive director of PSALT Care, a registered charity and mental health recovery centre, said 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 need the police, you call 999. But when you've got a mental health problem, who do you call?”

Mental health hotline exist but not obvious enough

Since September 2020, there is a National Care Hotline (1800-202-6868) operating from 8am to 12am daily. The hotline is manned by more than 300 psychologists, counsellors, social workers, psychiatrists and public officers.

According to MOH, there are consolidated sites that list mental health resources and “function as navigators”, such as the My Mental Health microsite that was launched this year by Temasek Foundation, in collaboration with the AIC.

“It is a resource hub that provides online mental health resources such as mental health-related articles, online forums and information on support groups to support one’s mental health during the COVID-19 period,” it added.

Another website with various resources on mental health was also launched to help users assess their wellbeing and match them with forms of assistance if needed.

The website, called mindline.sg, consolidates access to many resources and tools to help people "access and navigate care, with an emphasis on stress and coping”.

While there are an abundance of mental health resources, it may not necessarily be a good thing. Mental health sufferers might feel there is an information overload.

The issue isn't about the number of resources available but the ease of assessibility to such a resource.

Perhaps a simple 3-digit emergency hotline for mental health would provide much better outcome for those planning to seek help.

*Name has been changed to protect identity.

1 in 5 youths in Singapore has experienced a mental disorder in their lifetime

Jul 21, 2021 | 🚀 Fathership

One in seven people in Singapore have experienced a mental disorder such as bipolar disorder or alcohol abuse in their lifetime, more than three-quarters did not seek any professional help.

The top three mental disorders here were major depressive disorder, alcohol abuse and obsessive compulsive disorder. This is based on the finding of the second Singapore Mental Health Study by the Institute of Mental Health, which started in 2016 and involved interviews with 6,126 Singaporeans and permanent residents.

In the same study, youths between 18 to 34 years were presented as the most vulnerable group - one in five would have experienced a mental disorder in their lifetime.

The study was conducted on 6,126 participants, representing the population, between 2016 and 2018 in collaboration with the Ministry of Health (MOH) and Nanyang Technological University. It was funded by MOH and Temasek Foundation

One in 43 people has had a psychotic disorder in their lifetime

Psychotic disorders may involve one or more of the following:

  • Delusions, which are the fixed belief in something that is not true.
  • Hallucinations, which are sensations that are not real, such as seeing things that are not there.
  • Disorganised thoughts, making a person's speech difficult to follow with no logical connection.
  • Abnormal motor behaviour, which includes inappropriate or bizarre postures, or a complete lack of response to instructions.

The most common psychotic disorder in Singapore was schizophrenia, with about one in 116 - or 26,800 people - having been diagnosed with it at some point in their lives.

Treatment gap of 11 years between first experience to seeking help

Respondents cited a “treatment gap” of 11 years as the median time between when they first experienced symptoms and when they sought help for obsessive compulsive disorder.

It was four years for bipolar disorder and alcohol abuse, two years for generalised anxiety disorder and one year for major depressive disorder.

According to the Ministry of Health (MOH), from 2017 to 2019, an average of 12,600 patients aged 15 to 34 years sought treatment for mental health conditions at public hospitals each year.

Current approaches to treating mental health conditions

Broadly, there are two approaches for treating mental health conditions: Medication and psychotherapy - both of which can be used on its own without another, with different effects on an individual.

“Medication reacts differently for different individuals even if it’s the same condition - a certain medication may work perfectly well for one, but for another it can have more complicated side effects,” said Mr Jackie Tay, the executive director of PSALT Care, a registered charity and mental health recovery centre.

On the other hand, psychotherapy and counseling involve the “human factor” or the social connection between the clinician and the patient.

“It’s the chemistry and connection - some patients would connect better with certain styles of therapists. You also need to navigate around that,” said Tay.

As such, the continuum of care for mental health conditions can also be long, intensive and complicated. For example, one young adult whom CNA spoke to likened the process of finding suitable treatment to finding a soulmate on matchmaking sites like Tinder. Kevin agreed.

“It's not like maths, where you have a correct answer. You have to slowly find what works for you,” he said.

More seeking help

Mr Asher Low, executive director of Limitless, a non-profit organisation that deals with youth mental health, said the organisation has seen over 250 new clients seeking help so far this year - 13 more than the number of new clients for the whole of last year.

"Quite a number of our existing clients deteriorated because they lost access to coping activities and social support, or were stuck at home in an unconducive environment, such as (one with) poor family relationships or abusive parents," he said.

But it is not just the young whose mental well-being has suffered due to the pandemic.

O'Joy, a voluntary welfare organisation looking after the mental health of seniors, saw a 26 per cent increase in the number of clients in August and last month compared with the same period last year.

O'Joy clinical director Teo Puay Leng said seniors who are still working may be anxious about losing their jobs and being unable to find another one in the current economic climate, while others are affected by their loved ones getting retrenched.

Those who are used to taking part in outdoor activities have also become anxious as they have had to stay home on their own, she said.

Meanwhile, Samaritans of Singapore - which focuses on suicide prevention - received 26,460 calls for help from January to August this year, up from 21,429 in the same period the year before.

Chief executive Gasper Tan said callers sought help for issues arising from the economic impact of Covid-19, stress from having to adapt to telecommuting and home-based learning, and social relationships affected by the virus situation.

Better mental help awareness

Ms Joy Hou, principal psychologist at EmpathyWorks Psychological Wellness, who saw an almost 20 per cent increase in clients, said that while the increase may be in part due to Covid-19 taking its toll, it could also point to greater awareness of mental health issues and reduced stigma in seeking professional help.

IMH senior consultant Jimmy Lee echoed the sentiment by saying that the increase in help-seeking behaviour during this period is "a good thing".

Dr Lee said that the crisis has resulted in various mental health organisations coming up with new initiatives such as virtual seminars, new helplines being set up, and people learning to identify and help those in distress.

"I think this is a good opportunity... People are concerned about the mental health needs of various aspects of the population," he said.

Mental Health Helplines

National Care Hotline: 1800-202-6868

Samaritans of Singapore: 1800-221-4444

Singapore Association for Mental Health: 1800-283-7019

Institute of Mental Health's Mobile Crisis Service: 6389-2222

Care Corner Counselling Centre (Mandarin): 1800-353-5800

Silver Ribbon: 6386-1928

Tinkle Friend: 1800-274-4788