SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE SOCIAL SERVICE RESEARCH CENTRE CONFERENCE 2024 “YOUTH MENTAL HEALTH LANDSCAPE: UPSTREAM PREVENTION AND DOWNSTREAM INTERVENTION”

Associate Professor Eddie Tong, Director of Social Service Research Centre,

Ladies and Gentlemen,

Good morning. Thank you for inviting me to join you at the Social Service Research Centre Conference today on youth mental health.

Background of the Youth Mental Health Scene

2.              I am very heartened to see the growing attention on the mental health of our young people in Singapore. It underscores the importance of prioritising their mental well-being but it also underlines the fact that we can do something about this. If you can help young people develop the life skills and resilience and get through the trials and tribulations of the first two or three decades of life, they will probably be okay. We cannot solve and prevent every problem, but teenagehood and young adulthood is a period of turbulence and change and having the right strategies for that difficult time is important, especially for those who are at risk of mental health and well-being issues.

3.              When we look at the research on the mental health of young people, including some here in Singapore, you can find numbers that are quite stark and concerning. In Associate Professor Eddie Tong’s speech, he cited the Ipsos World Mental Health Day 2023 Report which found that one in four young adults under the age of 35 reported having considered self-harm or suicide at least once. There was another recent nationwide study on adolescents’ mental health and resilience conducted by the National University of Singapore and the Ministry of Education which found that about 12% of Singaporean adolescents met the clinical criteria for a mental disorder.

4.              If you look closely at the data in the recent NUS-MOE study, you will see that over time, a significant number of adolescents who first demonstrated symptoms and concerns that could potentially meet the criteria for mental disorder - self resolved.

5.              If you look at various other studies, self-reported surveys, screening and triage, the numbers are very high. As those patients and clients are followed through, only a small proportion turn out to have a clinically diagnosed mental health condition. That delta is very important. We have to take seriously why there are these concerns at the point of presentation. Why is it that mental health symptoms and concerns about mental well-being self resolve. How can we help these clients, patients or individuals resolve these problems faster and better? How can we correctly identify the small number who turn out to have a clinical condition earlier and intervene faster? I explained this delta not to reduce the concern that we should have, but to encourage a deeper understanding of the issues, so that we can apply our strategies correctly.

6.              We can help people get through stressors, whether they are facing the normal stressors of life, or if they are having an abnormal reaction to the stressors of life. For cases where there is truly something wrong and where intervention by a multi-disciplinary team of professionals is needed, we must intervene earlier and identify those who have a clinical disorder. All of this does not remove the issue that mental health remains an increasing area of concern for our youth today. It is therefore important for us, as a society, to address these issues holistically.

Unique Mental Health Challenges Faced by Youths

7.              Youths face immense challenges in their developmental journey. As they navigate the transition from adolescence to adulthood, they have to grapple with many expectations and stressors tied to the pursuit of self-identity, as well as academic and personal goals. It takes time to establish who you are, that pursuit of self-identity. Amidst all these,  young people in the first three decades of life have to deal with the uncertainly and insecurity of the future such as their academic and professional goals or starting a family. But actually, that has been so for thousands of years and for many civilisations and societies around the world. Not all of which perhaps are dealing with mental health issues in the same way that we and many other developed societies are.

8.              My sense is that, there are two major factors in our society and in similar societies that are different and driving these concerns. These are issues to do with identity, survival, economic insecurity and potentially climate change. These large forces affect all of us around the world and many of these forces have been with us for some time. What is different now? I think there are two major issues. For one, I think our society is a little bit more, from an individual's perspective, fragmented. Our social networks are a little bit smaller even though we have much larger online connections. We have WhatsApp contact lists that run into the hundreds, if not thousands and we have Facebook friends that run into the tens of thousands. We need to have some physical connection which allows us to offload and share with others and have a shoulder to cry on. We have fewer people like that in our lives. We have to make an effort to find such connections – human, personal and real-world connections.

9.              At the same time, we are faced with an order of magnitude increase in the amount of information about everybody else's socialisation. This includes the Instagram effect, where you look online and see the lives of everybody which may or may not be correctly represented. This balance of contracting physical and social circles and an increasing exposure to inordinate amounts of inappropriate information is perhaps one of those major driving factors. I think this is one of those things that we do need to pay attention to.

10.           The problem is that paying attention to these issues is not going to be about removing social media or removing access to technology, because the genie is out of that bottle and it is very much part of our lives. There are also a lot of good things that technology and social media can deliver for us. The question is how do we deal with these issues? How do we mitigate or push against the tide. Hence, the upstream and downstream interventions of your conference are very apt.

11.           Based on the National Youth Council’s survey in 2021, youths were concerned about online harms, unregulated use of technology and social media, which might have distorted their perception of reality, created unrealistic expectations and social comparisons, and strained their relationships with people. One of my takeaways is, young people get it. When we talk about these issues and what may be driving some of the pressures that they may have, they do not pretend that it is not so. They do get it and understand these concerns. This means that if we are able to come up with good strategies for mitigation and intervention, it would find fertile ground in the young people of today and it can make a real difference. We have a receptive audience who wants to do something for themselves and for their peers.

The National Mental Health and Well-being Strategy

12.           The complexities of youth mental health issues require a holistic and collective approach to address the underlying social and health-related factors. To better promote social-health integration for mental health, we set up the Interagency Taskforce on Mental Health and Well-being in July 2021 to oversee and coordinate national mental health efforts, focusing on cross-cutting issues that require interagency collaborations. The Taskforce launched the National Mental Health and Well-Being Strategy in October last year. We are setting out our approach on how we are going to deal with the problems that we have today and how we are going to organise ourselves going forward.

13.           Earlier last month, several Members of Parliament put forth a motion on advancing the mental health of the nation, and ultimately all of Parliament endorsed the whole-of-Singapore effort to implement the national strategy. The key issue we are struggling with is how are we actually going to get things done. These were the issues that were highlighted in the Parliamentary Debate including school-based and community-based efforts for supporting youth, youth-at-risk and the general population. There are continuing efforts and new initiatives being developed to address these issues.

Upstream Efforts to Develop Resilience from a Young Age

14.           One upstream effort to mitigate the risk of mental health issues among youths is to build resilience at a young age. Resilience is paramount in helping our youths navigate transitions and dealing with setbacks in life. We want them to be able to develop the capacity to bounce back from adversity and be able to effectively manage stress and the uncertainties that accompany many life transitions and milestones.  

15.           At the national level, upstream public education campaigns such as the Health Promotion Board’s (HPB) “It’s OKAY to Reach Out”, and the National Council of Social Service’s “Beyond the Label” campaigns help to normalise conversations around mental health and encourage early help-seeking.

16.           We also need to provide targeted support, especially to our youths in our schools. One of our upstream mental health initiatives is the promotion of Mental Health Education in the Character and Citizenship Education curriculum in schools, and mental resilience and well-being programmes in Institutes of Higher Learning (IHLs). We want students to take it a step further by having the knowledge and skills to deal with emotional regulation, differentiating normal stress from distress or mental illness, and playing a role for each other. It is not just about self-control and self-learning. But how can we help people around us by providing peer support and building the appropriate networks so that we generate a social resilience and not just a personal resilience.  

17.           There is also an ecosystem of support to identify early students with mental health challenges in schools and IHLs. Peer support structures have been established in schools and IHLs where students look out for one another and encourage a peer in distress to seek appropriate help from trusted adults, parents, educators or counsellors. All schools, polytechnics and the Institute of Technical Education (ITE) have dedicated time and space for educators to check-in and monitor students’ well-being to understand that these ideas of assessing the resilience of students and their abilities to cope with the stressors of life in the education system are built into the process. It was something that was done informally when I was educated, and a bit more understanding when I was an educator. Now it has come to the fore and it is very much part of the structured approach that educators have to put into practice by asking themselves if their students are coping well with what they are going through and providing support for their students.

18.           Turning now to the issue of technology and social media. One of the strategies that we talked about in the Taskforce and put out in our report is how to deal with this in a way that is appropriate. What we do not want to do is lay the blame on social media and technology and suggest that going screen-free is going to fix the issue. The reality is that technology can play a powerful, positive and useful role in our life and helps us to connect with people. I have aged parents. If it were not for social media and instant messaging, I would not be in such close touch with them and they would not have the ability to reach out to me in quite the same way.

19.           So there are positive uses. The Taskforce decided that we should focus on the positive uses of social media and messaging technology so we are developing a Positive Use Guide. We want to be able to establish what is a sense of good social behaviour and what are ways in which parents can role model good use of technology to their children so that they can grow up with these ideas from the best role models - their parents. The Positive Use Guide will guide the healthy and positive use of technology, and provide recommendations on how to mitigate its negative impact.

Downstream Efforts to Support Youths with Mental Health and Well-being Needs

20.           What about the downstream intervention? In schools, students, educators, counsellors, professionals have been trained to de-escalate strong emotions, facilitate classroom conversations on mental health and sensitivity, provide additional support by a referral to a trained counsellor or mental health professional.  So we have teams like the Response, Early intervention and Assessment in Community mental Health (REACH) teams that do this.

21.           In the community, social service agencies play an important role to support youths with mental health issues. Youth Community Outreach Teams (CREST-Youth) conduct mental health screening, provide basic counselling services and refer clients with greater needs to higher tier services such as Youth Integrated Teams (YITs) which provide more detailed mental health assessment and psychosocial interventions. These teams will be expanded incrementally by 2030, as announced during the recent mental health Parliamentary Debate.

22.           We will continue to improve and increase psychiatric services that are available at the National University Hospital, KK Women’s and Children’s Hospital, and the Institute of Mental Health, focusing specifically on the mental health of young people.

Social Service Research to Improve Youth Mental Well-Being

23.           We need upstream and downstream interventions. In the balance of my speech, I spent much more time talking about the upstream interventions and I think that is what we should be doing. How can we make sure that we prevent these issues if possible? But also give the greatest number of us the ability to deal with these issues, whether they are for ourselves or the people around them. If we can do that well, then the effectiveness of our downstream interventions will be improved, but also hopefully, we need less downstream interventions. But we should continue to make sure that we provide those interventions and make sure that they are increasingly available and increasing the capacity.

24.           Mental health is a multi-faceted issue influenced by a coMplex interplay of individual, biological and social factors. Your research is a vital part of how we are going to address these issues. The research helps us to deepen our knowledge and understanding of the issue, which then serves to inform appropriate policy decisions and strategies to tackle the issue. In our work at the Taskforce, a lot of our time was indeed spent trying to establish what were the research publications and research databases that were useful to our policy considerations, and, of course, coming to some conclusions about where we might need to do future research. 

25.           The Social Service Research Centre (SSR) spearheads much important research. For example, there is an ongoing study of digital peer support intervention training in local secondary schools, with an aim to enhance mental health support for our adolescents.

26.           Another research touches on in-work poverty and how employment conditions and experiences affect young workers’ mental health. Findings showed that lower-wage young workers were more likely to experience anxiety, while youths with adverse childhood experiences were more likely to show symptoms of depression. These are important pieces of work and I would encourage all of us to support the important work that you do at SSR. The SSR is continuing to explore ways to work with employers to bolster the mental well-being of employees.

Closing

27.           In keeping with the conference’s theme “Youth Mental Health Landscape: Upstream Prevention and Downstream Intervention”, both upstream prevention and downstream interventions are equally critical in cultivating mental wellness in our society. By actively engaging in upstream prevention, we can create a conducive environment that build youth mental resilience, promote their mental well-being and hopefully keep mental illnesses at bay. At the same time,we have to continue to make sure that our downstream interventions are accessible, good quality, effective and are applied to those who need the necessary support and care.

28.           This conference serves as a significant platform for the exchange of knowledge and ideas across the various roles we have in our mental health ecosystem for the many different types of professionals that bring to bear their multi-disciplinary skills. Together, we can better understand the issues and develop better solutions will make a significant impact on our youths.

29.           I wish all of you a fruitful conference and thank you for inviting me to join you here today.