DPM Lawrence Wong on the Motion on Advancing Mental Health (Feb 2024)

Mr Speaker, I rise in support of the Motion, and I thank Dr Wan Rizal, Mr Edward Chia, Ms Mariam Jaafar, Dr Tan Wu Meng, and Mr Yip Hon Weng for moving this Motion, as well as all members who have spoken passionately on this issue.

Mental health has grown in importance, both in Singapore and across the world. In the past, people dealt with mental health issues privately. It was always in the shadows, and not something that we talked about publicly. In recent times, attitudes have shifted, for the better – people are more informed about mental health, and more willing to talk about this openly.

COVID-19 also brought mental health issues to the forefront. Because across the world, people had to cut back social interactions, and isolate themselves from family and friends. And this took a toll on mental health. It happened in Singapore too. After the Circuit Breaker was introduced, we observed an increase in the utilization of mental health services, and more calls to IMH’s mental health helpline.

That’s why we set up the COVID-19 Mental Wellness Taskforce, which later became the Interagency Taskforce on Mental Health and Well-being, chaired by SMS Janil. The work of the Taskforce builds on previous national efforts to improve the quality and accessibility of mental health services in Singapore.

The Taskforce has published the National Mental Health and Well-being Strategy, which sets out concrete plans to plug existing gaps and to strengthen our mental health eco-system. We will now translate these plans into action. Our plans are not static. We will continue to evolve and update them, including taking on board the many useful suggestions from Members in this Debate. So let there be no doubt: the Government is making mental health and well-being a key priority in our national agenda.

Our Operating Context

To understand the approach in this new strategy, we must first appreciate the full range of mental health issues. On one end of the spectrum, are mental health issues that require medical treatment, like bipolar disorder and schizophrenia. These conditions can be debilitating – severely affecting a person’s ability to carry out important daily activities.

On the other end of the spectrum, are issues affecting mental well-being, like anxiety and stress. While these typically do not require medicalisation, it does not mean that we should take them lightly. If not addressed well, poor mental well-being can also affect our ability to lead our lives productively.

And because mental health issues lie on a spectrum, it means we need a broad suite of solutions. Not all mental health issues need to be treated in a specialist healthcare institution. It’s the same when we have a physical ailment. We don’t go to a specialist for treatment immediately when we experience some symptoms of ill-health. Instead, we first see our family doctor, and if it’s more serious, the matter gets referred to specialist care.

So, improving mental health is not just about hiring more psychiatrists or building more capacity at the IMH. We certainly will do that. But we also need to strengthen capabilities across our entire spectrum of care, including at our polyclinics and GPs, and across other settings like schools, workplaces, and the community, so that more timely support can be rendered to those in need.

Focus on Youths

In our strategy, we are redoubling our efforts to better understand the issues that young people face – something that many members spoke about. It has never been easy to be a teenager. Teenage angst has always been part of the growing up process – teenagers have to learn about themselves, take on new responsibilities and prepare for adulthood.

But something has changed around the world, since around the early 2010s, because the current generation of young people are expressing more concerns about their mental health than previous cohorts. Many countries have reported increases in suicidal ideation, as well as mental health conditions like anxiety, and depression amongst their youths. Last year, the US Surgeon-General called the increasing mental health needs of US youth as the “defining public health crisis of our time”. Even the Nordic countries, consistently rank high in global happiness and well-being surveys, they too are reporting rises in youth anxiety, depression and a variety of mental illnesses.

We see a similar trend in Singapore. It is not at the same high levels as some countries, where the mental health issues are conflated with other difficult issues like drug abuse, homelessness, and street violence. But it is nevertheless a worrying trend, and we are taking it seriously.

So we are linking up with researchers from around the world to try and understand the root causes behind this recent surge in youth mental health issues.

Some think that heavy social media usage is a major cause. Indeed, the constant pressure to present a positive image online, the fear of missing out, algorithms that flood news feeds with stories that are designed to spark outrage, and the issues of cyber-bullying – all these can take a toll on one’s mental health. Furthermore, the more time spent on the internet or social media means more sleep deprivation, less physical exercise, and less real life interactions – all of which are important for healthy brain development at a young age.

But other researchers think there is more to it, that it’s not just about more online safeguards, and that we also need to loosen up in the real world, and give our children more space for free play and autonomy. Because when children have less room to play and explore, or to interact and build social skills at an early age, they are also less likely to grow up with the sense of independence and confidence to take charge of their own lives.

The bottom line is that more work needs to be done to better understand what has changed globally in recent years. It’s an area that requires further research and study – to identify the key causal factors, and the interplay between these factors, so that we can design and put in place the appropriate interventions based on data and evidence to better help our young people.

Our Key Moves

These are some of the considerations behind our national strategies. Let me highlight several key moves that we will be making, with several targets we aim to achieve by 2030 or earlier:

We will increase capacity at the IMH and the redeveloped Alexandra Hospital for those that need specialist care. Capacity at long-term care facilities will also be increased to provide step-down care for those who need it.

We will increase the number of public sector psychiatrists and psychologists by about 30% and 40%, respectively.

We will introduce mental health services to all polyclinics, and 900 more GP clinics.

We will equip and train an additional 28,000 frontline personnel and volunteers, they serve at our various community and social service touchpoints, so they can identify people struggling with mental health and offer early assistance.

We will also redouble our existing efforts:

MOE is on track to achieving its target of deploying more than 1000 teacher-counsellors across our schools. This is on top of the basic counselling skills that all teachers will be trained in; as well as the 1 to 2 counsellors that every school will have to support students with more challenging social and emotional needs.

We will provide parents with resources to support their children’s mental health and well-being needs.

We will establish more peer support networks in the community, including in schools, Institutes of Higher Learning, workplaces, and amongst our national servicemen. These networks will have trained peer leaders who can spread the message on the importance of mental health, and provide a first line of response for their friends or colleagues who need help.

My colleagues, SPS Rahayu and Eric Chua, MOS Gan and SMS Janil will elaborate later on some of these areas. These are significant moves. They will require more coordinated efforts, more training, more people and ultimately more government spending. But we will set aside the resources to advance this important agenda.

Through these moves, we aim to reduce waiting times, and make mental health services more accessible, and closer to where individuals are, be it at home, schools or workplaces. We will ensure that mental health services are affordable, and we will do so through our national healthcare financing framework of Government subsidies and the 3Ms, which will cover all cost-effective mental health treatments. Importantly, no one in Singapore will be denied access to appropriate care because of inability to pay.

Several members also spoke about private insurance coverage outside of healthcare, including in areas like life insurance. Life insurers in Singapore have in fact offered coverage to persons with mental health conditions. But the underwriting of such persons can be a complex matter, as our own data is limited, and insurers here typically reference the underwriting guidelines of global life reinsurers. We will study and review how this coverage can be improved, and ensure that financial institutions deal fairly with all their customers, including those with mental health conditions.

Importantly, we will have a bigger focus on preventive care, so that everyone can take proactive steps and take charge of their own mental health. We will start young in schools. We want our children to develop good cyber habits, so they learn to use the internet and social media safely and responsibly. Our approach is not to remove all stress, that is not going to help our children. Instead, we want our children learn to deal with stress at age-appropriate levels. We want them to develop self-belief and resilience, and grow up with the confidence to tackle challenges, stressors and demands that they will surely encounter later in life.

We will continue to integrate mental well-being into our Healthier SG and other preventive health programmes. We sometimes think of body and mind as separate entities, but they are closely linked, each affecting the other greatly. Staying active, exercising regularly, connecting with friends in person, not online, learning new skills, contributing to a larger purpose – these all sound like commonsensical advice but they are not so easy to do. And they are foundational habits that will enable all of us to improve our overall wellbeing.

Changing Attitudes and Mindsets

The Government is fully committed to doing more to improve mental health and well-being. But for all these plans to work, we also need to change our attitudes and mindsets.

We need to do more to destigmatise mental health conditions, so that people do not hesitate to seek help. Stigma reduces a complex and difficult problem into unhelpful labels or stereotypes. It opens people struggling with mental health to discrimination, such as in the job market. It may cause them to be socially ostracised. It makes them feel ashamed, isolated, and stops them from seeking treatment. As I mentioned just now, we do see attitudes shifting. But the stigma remains, and we can do much more to build a society where we help one another cope with life’s stressors, and are considerate of others’ feelings, and carve out safe spaces for them.

We also need to change our mindsets about what we consider success in life. It’s good to have a culture in Singapore that values hard work and excellence, and encourages everyone to aspire and strive to be better. But we should not be unwittingly drawn into a rat race of hyper-competition and endless comparisons with one another, just to get ahead of others, and end up worse off as a society.

In fact, this was one of the key points from our Forward SG engagements. The vast majority of Singaporeans wish to see a more inclusive Singapore Dream – one where we are not pressured to conform to narrow definitions of success; where we embrace excellence and talents across many different areas, and find meaning and purpose in what we do. The government is making policy moves in this direction – by reviewing our education system, narrowing wage gaps, and strengthening safety nets, so that everyone can be better assured of their basic needs at every life stage, and can have the space to venture forth, and be the best version of ourselves. But we cannot make this happen through policy alone. Our attitudes, our mindsets must also change and align with our shared aspirations for a refreshed Singapore Dream.

Working Together

Indeed to achieve all of these goals, we must work together. There are many ground-up initiatives and community and social services organisations already working in different ways to meet the mental health and well-being needs of Singaporeans. I know from personal experience, having served as Patron to the Samaritans of Singapore for more than 10 years. I’ve interacted with many of the volunteers there, and seen firsthand their commitment and dedication to save lives.

We value the collaborations and partnerships with all of you. Through the SG Mental Well-being Network, we have been linking up with many groups and volunteers, to address the diverse needs of our people, be it befriending lonely seniors, or providing a safe space for youths to talk about their mental health struggles. The setting up of the National Mental Health Office will enable us to coordinate these partnership efforts more effectively, and to better synergise and maximise our efforts on the ground.

I call on all Singaporeans, who are passionate about this issue of mental health and well-being, to join us in this national movement. We have lots to do, and a full agenda ahead of us. The government has set out clear plans and deliverables. But the issues are complex and we do not have all the answers. We want everyone on board, so that we learn together, and continue to fine-tune our strategies based on your feedback and ideas, and our shared experiences and insights.

Together, let us build a Singapore where everyone matters, where everyone has a place and where everyone belongs. Together, hand-in-hand, let us improve the mental health and well-being of all Singaporeans.

Mr Speaker, I support the motion. Thank you.

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