SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT CNA LEADERSHIP SUMMIT – MENTAL HEALTH @ WORK ON 10 OCTOBER 2022, 2PM

      Good afternoon everybody. Thank you for inviting me to speak to about Mental Health today at the CNA Leadership Summit.

2.            Mental health is a pressing topic. There was already a growing concern about its impact on our society and especially the young, before 2020. The COVID-19 pandemic cast a spotlight on the matter, and highlighted the importance of mental health, well-being and resilience in being able to cope with the crisis. The importance was understood at the personal, community and national level. The levels of depression and anxiety, the feeling of being isolated, the uncertainty about what was happening to us. Did our mental health get worse? Yes. Was it in itself a separate distinct crisis? Not quite. Although we were quite concerned at the time, the fortitude and resilience of our fellow Singaporeans, together with the success we had in limiting the deaths from the pandemic, eventually meant that we were able to cope, mentally, better than we had initially expected. However the experience of having to help the vulnerable, those with pre-existing mental health conditions, and those newly diagnosed, triggered or worsened by the pandemic taught us much. About what we got right, and about what we have to improve. There is no health without mental health. Today the COVID-19 restrictions have eased and social activities have resumed, however mental health remains a priority for the government, and we will not let up our efforts in promoting positive mental health and well-being.

3.            Mental health lies along a spectrum, from good mental health, the normal reactions to the stresses of everyday life, to a tendency for mental fragility associated with some risk factors, to diagnosed mental illness. The conversations about this should not conflate the various aspects of mental health, and should recognise the wide set of issues we need to deal with. Similarly, persons with mental health conditions are very varied, as individuals, and also over time. From being at-risk, to coping with difficult circumstances, to having mild illness, or subsequently deteriorating, or more hopefully, recovering, and integrating back into society with a hidden illness or risk. We must not consider these different archetypes and the challenges facing someone at different times of their life as being equivalent. We need the nuance and breadth of understanding in our conversations, interactions, policies and service delivery. A person’s mental health and well-being is influenced not just by biological factors, but also by social determinants, such as stressors or protective factors arising from interpersonal relationships, family dynamics, life transitions, in educational, employment, and social settings. To improve mental health and well-being of the population then is not a straightforward task that can be resolved by a single agency or entity, but requires the collective efforts of multiple parties working together towards a common goal and vision together.

4.            This is why the Interagency Taskforce on Mental Health and Well-being, which I Chair, was set up in July last year, to oversee and coordinate mental health efforts, focusing on cross-cutting issues that require interagency collaborations. The Taskforce brings together members from over 30 public, private and people sector agencies, and we have been working hard over the past year to review the landscape, study the gaps and challenges, develop preliminary recommendations to close these gaps, and seek feedback through public consultation.

5.            What does our Mental Health landscape look like today?

6.            We have been working with healthcare and social service providers, employers and grassroots organisations to raise awareness and normalise conversations on mental health. In parallel we have provided access to mental health support and services for individuals across schools, workplaces and the community.

a)  To support mental health promotion and destigmatisation efforts, we’ve had public education campaigns. Some examples include the “It’s OKAY to Reach Out” campaign by the Health Promotion Board, and the “Beyond The Label” campaign by the National Council of Social Service. These seek to raise mental health literacy, dispel stigma and improve attitudes and behaviours towards mental health issues. Content on mental health and well-being has also been incorporated into the Ministry of Education’s Character and Citizenship Education curriculum, and curated digital mental health resources are available through the MindSG website for the general public.

b)  To support early identification and access to services, one can call a hotline, such as the ones operated by the Institute of Mental Health, or the Samaritans of Singapore. These services can provide emotional support, or crisis intervention as needed. In the community we have mental health teams run by social service agencies to provide emotional support, assessment for early identification, and psycho-social therapeutic interventions. Polyclinics and General Practitioners provide clinical support and early help, in the community, for mental health conditions. For those with severe mental health needs requiring acute care, our tertiary hospitals such as IMH and other public hospitals have psychiatric inpatient and outpatient services.

7.            Notwithstanding these existing efforts, there remain gaps in our system today.

a)  First is the fragmentation and differentiation of the services provided. From my perspective it is clear what role each team, social service agency and clinical unit plays as part of the system. It may not be as clear from the perspective of a client or patient, and sometimes not so clear from the perspective of the professionals as well. Which client to refer to which team? Which centre, clinic or hotline to approach for which problem? The services are also not clearly differentiated for different levels of need. Which clients are the core strength of this team, and which do they need to seek help or a referral for? There are also challenges in coordination and care planning to deliver holistic care for individuals with mental health needs, especially among those whose mental health needs are managed by multiple service providers. The Taskforce has heard that there is a need to improve competencies and standards among frontline practitioners to better identify clients with mental health needs.

b)  The second group of issues is about the youth. We need to improve mental health support and services for young people and their parents as their primary caregivers. This concerns the accessibility as well as the content of resources. We need to enable parents to better look after their children’s social-emotional well-being.

c)   Third, stigma and negative attitudes toward mental health remain significant barriers. There are fears of being viewed negatively by family members, colleagues, and peers should one confess to be struggling with mental health issues.

d)  Lastly, there continue to be many challenges at the workplace for persons with mental health conditions, and employment support for mental well-being can be further enhanced. There are limited training opportunities for persons with mental health conditions to transit back to employment, which is an integral part of their journey to recovering and reintegration into the community. Implementing mental health and well-being support in the workplace is difficult due to time, resource and knowledge constraints. Dealing with these attitudes will require awareness and support for mental health among leaders, supervisors and staff.

8.            We have considered these gaps and challenges very seriously, and developed some preliminary recommendations:

9.            To improve accessibility, coordination and quality of mental health services, we have recommended implementing a care model with a tiered system of services to cater to individuals of varying levels of mental health needs; this will identify and endorse service providers to look after different groups of clients and patients with different needs. It will also help us to develop a common language for service provision, referrals and care coordination. The standardisation of processes and systems to improve care coordination will be important and well served by this tiered care model. To help with the public facing issues of access to help, we recommend designating selected first-stop touchpoints for mental health support. We will also leverage the structure of the care model to develop resources to improve the mental health competencies and knowledge of frontline workers.

10.       To strengthen services and support for youth mental well-being, our preliminary recommendations include using the tiered care model to enhance the range of quality mental health services for young persons; developing resources for parents about youth mental health and cyber wellness; and promoting the positive and healthy use of technology and social media.

11.       For the workplace the recommendations include standardising assessment and referral frameworks for employment support agencies to provide customised support services for individuals with mental health needs; improving access to training opportunities for persons with mental health conditions; increasing the number and variety of job opportunities available for persons with mental health conditions; and equipping employers with knowledge on creating inclusive workplaces and how to support persons with mental health conditions. My colleague MOS Gan Siow Huang and the other panellists will be covering these issues in the subsequent panel discussions.

12.       Our final set of recommendations for improving mental health literacy and awareness has already been put into practice, through the launch of the SG Mental Well-being Network. The Network serves as the partnership arm of the Taskforce, and brings together partners in the mental health and well-being space to collaborate on initiatives. The Network’s focus areas align with and contribute to the strategies, and its first focus is on strengthening community and peer support, raising awareness through engagement initiatives with the aim of encouraging help-seeking, tackling stigma and raising mental health literacy.

13.       The Network has started a series of Well-being Circles in towns across Singapore. These provide a safe space for citizens to support one another, and to be equipped with skills to look after themselves as well as others’ mental well-being needs.

14.       Having developed these preliminary recommendations, we went on to a public consultation process. We are still reviewing and analysing the feedback we have gathered and will adjust our recommendations to consider what we have heard, before releasing the National Mental Health and Well-being Strategy. In the meantime, let me to share a few early insights from this process of public consultation.

15.       There was significant positive support. Most people thought most of the recommendations were appropriate and useful. The feedback was that these were timely and implementable. There were some caveats, and suggestions that we are looking at closely and considering how to respond to in the strategy.

16.       Some of the sentiments suggested that having a uniform and thorough system for mental health would not necessarily be universally well received. There was a sense that having diverse service providers in various settings, engaging in different models of care would ensure that the breadth of conditions and clients would be well catered for. This sentiment also extended to the idea that for the sake of privacy and confidence in seeking help, some would prefer to seek help away from their school, workplace, or local community. Maybe for some people the difficulty of access to a service is a reassurance of privacy and confidence of mental health services.

17.       Stigma, the attitudes of members of the public and the anxieties about discussing mental health continue to be significant concerns. This tells us we need to do more. We know that attitudes and behaviours take time to shift, and such changes do not happen overnight. We will need to continue conversations on mental well-being and encouraging ground-up activities promoting well-being in the communities. There was a sense that just being aware on having more information on mental health condition does not in and all itself reduce the stigma and the attitudes. The shift in attitudes will not happen simply because we provide information and instruct that it is the right way to behave. For a real change in mindset there will need to be increasing ownership and engagement of this by the community, which is what the Well-Being Circles hopes to achieve.

18.       Finally for workplace support for persons with mental health conditions, there was a sentiment to shift away from a mental model of a one-size-fits all approach, to one that actively supports customised vocational training and in-employment support tailored for each individual. It would also be important to facilitate the translation of knowledge into supportive behaviours for leaders, supervisors, and co-workers.

19.       Today’s Leadership Summit focuses on the workplace. This is a crucial aspect of our lives, where we spend many hours a day and several decades of our lives. It is where we find an avenue to participate meaningfully in society, develop ourselves personally and professionally, support ourselves and our families with dignity, and forge positive bonds and relationships with colleagues and partners. It may also be a place of significant stress for persons with or recovering from mental health conditions. They need support. Designing workplace structures that are inclusive for individuals with mental health needs, to having supportive employers and caring colleagues. Getting better at this and getting it right will need the active participation of Unions, companies, employers, and individual employees.

20.       What will success look like with all these efforts? What do we hope to see as the picture of mental health in Singapore in the future? I hope for a cohesive system of diverse mental health providers from the community to the tertiary hospitals, coordinating care using a common language, a common frame of reference and tiered model of care delivery. I hope for mental health services to be delivered in a wider variety of settings, especially in the community, and that Singaporeans have confidence in the quality of care provided. I recognise that the stigma of mental illness will still be with us for a long time, but I hope that we understand that changing this mindset will be our collective responsibility as a people, and not something we ask someone else to do on our behalf. I hope that our workplaces are seen as part of the solution to helping persons with mental illness reintegrate into the community, a place for them to find purpose and dignity and to help with their journey of recovery. Finally, I hope that when we face the next national crisis, which causes us great stress, anxiety, and fear, we all have the confidence in each other that we will come through it, steadfast and resilient, our mental well-being understandably challenged, but ultimately strong and resilient.

21.       I hope you have a productive summit and enjoy the discussions.

Thank you very much.