SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH & MINISTRY OF DIGITAL DEVELOPMENT AND INFORMATION, AT YOUNG SINGAPOREANS CONFERENCE 2024: MENTAL HEALTH, AT ORCHARD HOTEL, ON 16 SEP 2024

Ladies and Gentlemen,

Good afternoon. This theme of this conference on Mental Health is quite relevant. It is something that we have been occupied with for some time. When COVID-19 struck, we were quite worried about the extent to which this would affect our mental health, our mental resilience, and the extent to which isolation, Quarantine Orders, separation from our loved ones - what would the lasting impact and effects mean? 

2     The COVID-19 taskforce around mental health informed the work that we did around the Interagency Taskforce on Mental Health and Well-Being, which was discussed at some length by the panel. There were a lot of lessons learned in those few years. I think it's worth spending just a little time thinking about those lessons. 

3     For example, going into COVID-19, we assumed, that our seniors, the elderly, those who are socially isolated, would have great difficulty in coping with the Circuit Breaker and the increased isolation that was enforced. We assumed that young people - digital natives - people like yourselves, would do rather well when we shifted everything online. We also assumed that the pandemic and difficulties with the pandemic would leave a mental scar on us, socially as a nation. 

4     Actually, all three of those things proved to be not quite correct. The seniors, our data suggested, actually coped rather well, compared to the average population. They had a certain grit and resilience, perhaps because of their life experience that they had gone through. Young people were particularly badly affected and actually did not like doing everything online all the time. Coming out of the pandemic, they craved for a re-integration back into the real-world and looked for opportunities to reconnect. As a society, we bounced back rather better than we had anticipated back in 2020. People went back to socialising with each other in person, without masks, shaking hands, going to large events, crowding out stadiums and various other venues. 

5     Why did I spend time highlighting those three points? Because sometimes, our assumptions need to be challenged. Going into some of these difficult situations, it is worth having a little bit of humility to understand that we don't quite know which of our assumptions are going to be correct. 

6     The changes that we are seeing in mental health, may be a little bit like that. We ask questions about what's the right amount of social media exposure. Is it a boon or a bane? At what age should we start having these conversations? Can we overdo it? Are we under-exposing our children to mental health literacy? All of these are new spaces, and some of our assumptions about what is good or what will work, we need to be challenged. Time will tell. We have to go in with a sense of humility, the sense of collecting data and establishing robustly whether our assumptions are correct or incorrect. 

7     For example, the 2023 National Population Health Survey reported an improvement in the mental health of the general population between 2022 and 2023. I don't think you would have expected this. If I asked you in 2021, what would next year's National Population Health Survey say on mental health? I think an improvement would be the last thing that anybody could report. As I was chairing the Interagency Taskforce, that was not the sense we got, but that is what the data shows. However, younger adults aged 18 to 29 years old remained more affected than other age groups, with about 26% of them reporting poor mental health. We have an improvement. But as has been said before, and I quite agree, plenty more work to be done. There is a marked increase in the proportion of Singapore residents willing to seek help from healthcare professionals - 63% in 2023 compared to 57% in 2022. 

Mental Health across Stages of Youth 

8     Some of this is because the transition from childhood and adolescence to young adulthood is a time of change, an exciting time, and it's a time when we start new relationships, we start new goals. Our lives change quite considerably. What we know is that the period of transition and change now extends quite late into our 20s. The way in which our lives work is not quite the same. People have sometimes dismissed this as a protracted adolescence. But it is the way of the world and the reality is that even for 40 and 50 year olds, the pace of change is quite different. That transition from adolescence and young adulthood into a settled life as it were, having some sense of yourself now takes a bit longer. The period of time over which individuals face challenges as we navigate life's major milestones and take on new responsibilities has increased. Getting back to the data, perhaps that may explain why it's the 18 to 29 year olds who remain more affected around mental health challenges. 

9     The changes in life are over that time period can take a toll on mental wellbeing. But not every setback and stressor that we face, or life transition that we find difficulty in, results in a mental health condition; nor is it caused necessarily by a mental health condition. Not every case of poor mental health requires an intervention or a medical intervention. There are normal stressors of life, there are mental health symptoms that we experience on a day-to-day basis. Not all of them require intervention, and not all the interventions need to be medical. We need a broad set of strategies to ensure that the right care is delivered to individuals based on their needs. That’s why our National Mental Health and Well-Being Strategy focused on strengthening capabilities across our entire spectrum of care – schools, workplaces, the community, and in healthcare settings like polyclinics and among General Practitioners, so that more timely support can be rendered to those who need it the most in the right way.  

10     Listening to the earlier discussion, I am very excited to hear that the tiered-care model got so much attention, and people were paying attention to the details. I'm very heartened by the interest. It is an important piece of what we're doing. But the tiered care model is only a sub-section of our National Mental Health and Well-Being Strategy. It is an internal organising framework for how professional services, voluntary welfare organisations, educational institutions, professionals and volunteers can integrate and work together. It certainly should not be seen as a way in which we label patients, clients and families, nor diagnoses concerns or anxieties. And again, it's not a badge to be placed at the front of healthcare institutions or community institutions. It is an internal model of organising what we do. I'm glad there's so much attention, but I need to register the point that it's the 20% and not 80% of the population that needs the attention. There's a lot more to the strategy, and I would encourage that we think of it as a larger strategy, which will require quite a lot of coordination of many moving parts.

11     In order to coordinate our partnership efforts more effectively, we're setting up a new National Mental Health Office comprising officers from Ministry of Health, Ministry of Social and Family Development and the Ministry of Education. It will be fully established and will stand on its own in 2025 but the officers, personnel and the work are already in existence because we have the Interagency Taskforce on Mental Health and Well-Being. The officers and resources were pulled from the same ministries and in setting up this Office, we're looking, to institutionalise some of that, cross-disciplinary, inter-ministry, interagency cooperation and collaboration, as well as the networks that we have built, some of whom are represented in this room. 

Upstream Efforts to Mitigate Risk of Mental Health Issues 

12     Addressing mental health issues effectively requires both upstream and downstream interventions. We need to think about population measures to address people who are well, build up resilience, but we also need to recognise that you need crisis intervention and downstream interventions. An upstream effort to mitigate the risk of poor mental health among youth. One effort is to build resilience from a young age. This type of resilience is going to be important whether someone has a mental health challenge or not. The truth is, we can't tell ahead of time who will have mental health challenges and that sense of resilience then, is going to be very useful for us as a whole, as we deal with the stressors of life, or if we ourselves have mental health challenges. These are skills that we can teach young people to overcome adversity and develop their approach to manage the stressors of life and life’s concerns.  

13     Schools do this today. They have a deliberate approach among students to build up mental resilience through the Character and Citizenship Education curriculum. And our institutes of higher learning also have a curriculum, a deliberate approach to address these same needs. This learning is reinforced through experiences beyond the classroom, co-curricular activities, learning journeys, outdoor adventure learning camps. If we ask “Are our CCAs about mental health?” I would never have seen my CCAs as being about my mental health. It was about playing a game or doing sport or getting engaged with the community. But the way in which we make sure that children have access to CCAs, the way in which we make sure that there are non-academic activities available at every stage of education, and we integrate that into the life of an education institution. How that is done deliberately - that is part of thinking through the social resilience of that community within an education institution, and the mental resilience of the students that are there. I just want to draw attention that there many things out there which are structured in the education space with a view to building resilience and well-being in the broadest possible sense but are not explicitly labelled as part of mental health and wellbeing. It is how the educators and the people who run our education system think. 

14     Workplaces can also have a huge impact on our overall well-being, particularly for young people who have just entered the workforce. The transition from your education space, where in the schools and in the Institutes of Higher Learning, you might have peer support structures to help students look out for each other, foster a supportive environment. If you are someone who benefited from having this structure, it can be a jarring transition when moving into the workplace. It can be a transition that you may find very difficult to cope with. 

15     The stressors of your workplace can be significant, and studies have shown close associations between work stressors and mental health. We want to improve, and the government is committed to improving the mental well-being support systems and work-life harmony strategies for employees. As a Government, we want to increase employers’ adoption of mental well-being initiatives. We want to enhance support networks within the workspace. 

16     We recently expanded the Tripartite Advisory on Mental Health and Well-being, which provides practical guidance to employers on how to better support their employees’ mental well-being. We have developed a playbook on Workplace Mental Well-Being to guide employers to develop specific implementable strategies. We also started the Well-Being Champions Network which brings together a community of management-level staff and passionate individuals to exchange best practices in promoting workplace mental health. To support employees with mental health challenges, several companies already provide counselling services through Employee Assistance Programmes.  The Health Promotion Board (HPB) also offers trainings and workshops for employees to better cope at work and support their colleagues. In 2023, more than 55,000 working adults have benefitted from HPB’s mental wellness programmes. 

17     Another area which the panel touched on earlier is social media. There is a growing concern over the widespread use of social media especially among young people. We are developing a Positive Use Guide. Our approach is to think that there are some aspects of this technology and social media which are beneficial. How do we explain which are the beneficial aspects? How do we provide that kind of guidance? And so a Positive Use Guide is being developed to provide recommendations on how to mitigate the negative impact of technology and social media use, and ensure that young people can navigate the digital space safely.

Downstream Efforts to Support Youths – First-Stop Touch Points

18     Making it easier for youth to access mental health services will facilitate early detection and intervention. Today, there are over 200 mental health touchpoints in a variety of forms, including hotlines, text or email platforms, digital resources, and in-person services. it can be quite overwhelming for someone who needs to navigate these touchpoints.  

19     We are working to simplify this - by designating first-stop touchpoints that will direct individuals to the most appropriate services based on their needs. Our first-stop touchpoints will include (a) One, a number to call or text, (b) two, a digital platform with online resources and (c) three, a physical location where you can go to seek help. So we need to do all three in parallel, because no one of these services will address everybody's needs. Some people want to call, or text and some want to go online to search for their own resources, and some will want to turn up at a physical location to talk to someone. 

20     We will set up a new National Mental Health Helpline and Textline service. This will be operational by mid-2025. This service offers psychological first aid for individuals facing general mental distress. Through phone or text, trained counsellors provide support, will address common mental health concerns and offer a listening ear, along with brief counselling for those dealing with challenging situations or displaying mild symptoms of mental health conditions. Anyone requiring more extensive or long-term mental health support will be triaged and referred to relevant mental health services. It is not just where do I get help - you will have that first level of support and first-day counselling to provide you with some advice, and then a connection downstream to a more substantive treatment should you need it. Not everybody will. For those that do, there will be further treatment available, or further assistance rendered. This approach facilitates early intervention which would help to reduce the treatment gap and prevent over-medicalisation or unnecessary escalation of care. We want to balance the ease of access to get people into contact with a professional swiftly and in an easy way, but to do so in a way that does not automatically mean a medical escalation, especially if social intervention or community intervention would be more appropriate. The helpline will be a four-digit number so that people can remember it easily. We are also working with relevant agencies to streamline existing hotlines that offer similar services. In addition, as we observe that some individuals may prefer seeking help via text message. This service will also include a textline hosted on Mindline.sg, which we hope will encourage more people to reach out for support in a way that feels comfortable to them. 

21     We will also be streamlining our digital resources. The public can access digital platforms such as Mindline or MindSG. These provide curated content by mental health experts as well as self-assessment tools for users. 

22     For those who prefer personal interaction, we will build up and promote in-person first-stop touchpoints through our Community Outreach Teams (also known as CREST) and CHAT (Centre of Excellence for Youth Mental Health). Specifically, the Youth Community Outreach Teams (also known as CREST-Youth) conduct outreach to raise awareness of mental health issues and identify youths who need support early. Over the next few years, we will continue to expand these teams across the island. Young people may also approach CHAT, a national youth mental health outreach and assessment service to receive mental health checks, intervention and outreach services.

Destigmatising Mental Health Conditions 

23     As a Government, we are fully committed to doing more to improve the mental health and well-being of Singaporeans. The launch of our Strategy was not the closing of the process. It was the launch of the next phase of operations, services, programmes, and integration across a number of agencies, ministries and services. It was a way to frame our approach going forward. But for all these plans to work, we need to do more as a society to improve mental health literacy, normalise conversations around mental health, and destigmatise mental health conditions. I am encouraged by the impactful ground-up initiatives by our stakeholders, which have been instrumental in breaking down barriers to mental health support. These include the Beyond the Label movement by the National Council of Social Service, It’s OKAY to Reach Out campaign by HPB, and online resources such as MindSG and mindline.sg. 

Closing

24     Thank you very much for inviting me here today to have the opportunity to share some of the things that I'm passionate about and I've been working on together with many colleagues and friends for a couple of years, and I think it continues to be an important issue for us to tackle and build a more resilient and supportive community. I look forward to your questions and our conversation later. Thank you.