A Short Introduction to a Vast Topic

By Shiksha Guru and Sunny Singh

Mental health is a phenomenon that is formally defined as a person’s condition with regard to their psychological and emotional well-being. The concept has only recently started to come to light after centuries of being neglected, and now that we have started to give it more attention after realizing its importance, a lot of opinions have started to evolve around it. There are two main branches of opinions – those who believe mental health should be given as much importance as physical health and those who think mental health is a hoax. This difference is views may arise from several reasons, including lack of knowledge or understanding of the subject.  

What people say Mental Health is VS What it really is

This brings us to issue - the way mental health is seen by most people now is far from what it actually is. Ordinarily, when asked about what people think depression is, the answer would be “someone really sad? Someone who is a little more introverted than usual? Someone who may not be doing very well in life?” - a misconception like this leads to sensitive words, such as depression or anxiety, to be thrown about very loosely, which in turn degrades the value of the term - which may not seem very serious but it is. The word that is used as a legitimate psychological diagnosis being used irresponsibly would be equivalent to saying “I have a brain tumour” when having a light headache. 

Coming back to the subject, actually having depression is much more different from simply feeling it; the symptoms and effects of depression are way more complex, a myriad of psychological, physical, and social symptoms. Including lack of motivation, irritability to suicidal thoughts, lack of energy, unexplainable body aches to changes in appetite, and withdrawal symptoms [1]. It has nothing to do with feeling sad, contrary to popular beliefs. Moreover, the way people “feel” when they really have depression varies from person to person. Most studies suggest that the most common “feelings” are that of helplessness, anxiety, or guilt. But these are just some of the effects, and an example of how mental illness affects different people differently. 

Anxiety, on the other hand, is another mental illness that is thrown about unjustly. It’s not about simply feeling nervous or scared; It’s a whirlpool of mental breakdowns, a constant voice of doubt haunting you, a recurring ringing in your ears, amongst other things. Hence, the misapplication of this word would be nullifying the seriousness of a mental condition. 

ASD, i.e. Autism Spectrum Disorders are a range of developmental disorders characterized by difficulties in communication and socialization. It’s a shame to see that a medical condition whose physical conditions are more prevalent than conditions like depressive disorders are still treated as “limerick material”. It’s become a common joke to point at someone doing the most mundane things in a weird way, and say, “Dude, that’s so autistic”. The term is thrown about in the most insensitive manner, which is equivalent to mocking someone actually diagnosed with ASD. Autistic people are simply those whose brains function in a slightly different manner from ours [i.e. the very ‘wiring’ of their brain is different], because of which they get very nervous in social situations, don’t know how to respond or interact with people - this doesn’t give us the right to use their condition as a form of humour, this isn’t the 17th century. [2][3]

These were just a few examples of mental disorders and illnesses that some use as jokes and the problem stretches so much beyond this: all the way over to self-diagnosis, stereotypes and making these illnesses a trend or using them to get clout - but these would be discussed in fine detail later in the blog.

Context-Setting

Through the coming posts, we hope to investigate this social aspect of mental health and understand its roots, liabilities (or benefits), among other things. In this first post, let’s set the context in which this project has been started – why Mental Health, specifically? And why advocacy? This is specific to Singapore, but we will bring in the global context wherever relevant as mental health is universal.

Firstly, to provide a balance argument, let us see what Singapore has done in favour of this cause:

1. The National Council of Social Service (a national coordinating body for member Social Service Agencies (SSAS) in Singapore) recognizes people with mental disabilities and mental health issues as a vulnerable group within Singapore society that require aid via social services. [4]

(i)Many-Helping Hands Approach – this approach was adopted to empower the community to solve these issues, putting the government in a supporting role. As the people volunteering to help these vulnerable groups are (1) doing it out of passion (2) typically experienced with the community, it allows for the best utilization of resource, as they know what niche / specific problems to focus on when providing for their services

2. Every strategy has its flaws too, e.g. Overlapping of services and competitiveness to receive funding. All of which are being slowly thought through and overcome through different methods, so it is an evolving process that priorities helping those who are vulnerable. [5]

3. Numerous Volunteer Organizations – a comprehensive resource page list is here, where there are organizations that specialize within the mental health community to provide maximum support for them.

(i)The problem is not the lack of institutional recognition of the problem – the social service sector appears to be responsive towards this issue.

The first phase of most movements is to get official recognition and be considered as a “legitimate problem”. This is complete to a considerable degree within Singapore. However, while we have the tools for recovery, in the form of multiple NGOs and other Community Services to help those recovering from mental illnesses to find jobs, suicide hotlines, and other support systems, there still seems to be a problem:

Essentially, what we see here is stigma among the general population towards the issue. Even anecdotally, many can attest that within their own social circles, their peers have ostracized them for having a mental illness or have trivialized it. We have the tools ready but if society rejects these people then the system cannot function in itself. Hence, we are of need of a second phase to ensure the community is well-versed in knowing how to use these tools.

These behaviours and perceptions proliferate and exist because of two things: (1) the lack of education that bars them from learning about the real facts and hence opening their minds (2) the stigma present that feeds into their present world view. But how does this stigma present itself when it comes to mental health? Typically, it comes in the forms of stereotypes, misconceptions, or hyper-focus on only specific symptoms that may not even reflect the entire illness. This has already dealt with in the earlier section.

This stigma, among other problems, is highly problematic, for numerous reasons:

1. 1900 Young people, from the age of 5 to 19, called the SOS (Samaritans of Singapore) hotline back in 2016. [7]

2. It prevents those with mental health issues from integrating themselves back into the community (such social isolation could even hamper their recovery). [8]

3. Creates reluctancy for individuals to seek help in the first place. [9]

It is also worth noting that there have been institutional efforts in ‘phase two’ [as referred to before]. The “Beyond the Label” campaign was created as an initiative to primarily end the stigma around mental health by targeting the misconceptions about people who are mentally ill. You can learn more about it here. While it is a wonderful campaign, and a signal of hope that change is coming, it isn’t an end-all solution: we need the promotion and support for mental health awareness to come from the community itself, so we connect the issue more personally with our own lives. Such change is needed to be perpetuated by people and not a government/institution to highlight the social and human aspect of it.

That is what our job is here for: we want to normalize the discussion of mental health in a healthy manner in order to reduce the stigma around youth. There have been misconceptions and other discriminatory views that have been passed down that are, based on research, simply not true, at least to the extent they are made out to be. We want to bring facts, analysis, and of course our own opinions and advice to break the stigma.

We have identified three main groups of behaviour that we believe are stymieing efforts for the integration of those with mental health issues into the community. People can display behaviours from more than one group, this grouping is really just to increase the efficiency of targeting these behaviours:

Intention may or may not play a role in the contribution to stigma, because it is about how the other receives it. Joking with friends is also a private matter, that brings further questions about the extent people should police their vocabulary, if at all, given the context that we live in. Another issue is when behaviours to publicly comment on other people, who may not know the nature of your intent. This culture can be widely seen, especially on social media (which arguably in itself exacerbates the severity of the Mental Health crisis). These are all complex issues and will be addressed properly in coming posts.

How about Globally?

The WHO has made a mental health action plan, hence there is a form of guidance and a framework to develop policies regarding the Mental Health worldwide. However, laws and policies surrounding Mental Health have not been drawn up worldwide. 28% of Member States do not have a stand-alone policy or plan for mental health. But it is a minority number, isn’t it? What about the majority? Among the 72%, there are other structural problems – availability of data, resource allocation to ensure proper care, etc. Essentially, there is still a considerable amount of work that needs to be done before Phase 1 can be deemed complete globally. [10][11]

Even in countries where there have been successful reforms to promote mental-being (e.g. in Germany, Argentina, and Norway), there have been other problems. To name a few:

1. Using the “medical model” over the “social model”, leading to a lack of initiative to integrate those with mental health issues/disabilities into the community. [12]

2. Abuses that occur within institutions for patients with mental health issues. Human right violations occur even in the countries that have appeared to have made the most progress, so there is a need for continual focus to resolve the underlying issues. [13]

Socially, there are still persisting social misconceptions and ‘myths’ that arise – namely who can be affected by mental health issues, misunderstandings of statistics, etc, to name a few. Such myths need to be addressed and be corrected, as many before us have done, and the facts must be propagated to ensure that they become common knowledge. [14]

Of course, there may or may not be larger issues at hand, and we do not mean to trivialize these larger issues at all. We simply want to give voice to this particular issue, so that in times of reforms, mental health policies would not be completely forgotten. We also want to acknowledge that there has been a plethora of others before us who have done commendable work in picking up this topic. We want to contribute our own two cents, research, and reach more people so that through our collective efforts worldwide, we can spread awareness about the importance of mental well-being and mental health issues / disorders.

The goal is to remove the stigma, understand that mental illnesses are just as normal as physical illnesses, and ensure that the community is willing to work with those with mental health issues to create a more inclusive society. There’s a science behind mental health issues and mental health in general – it isn’t just what you feel. We look forward to engaging with our audience in the comment section and creating awareness about this topic.

Take care!

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Citations:

[1] (National Health Service, 2019)

[2] (National Health Service, 2019)

[3] (Institution of Mental Health, n.d.)

[4] (National Council of Social Service, n.d.)

[5] (Sim, Ghoh, Loh, & Chiu, 2015)

[6] (Ng, 2018)

[7] (Mohandas, 2017)

[8] (Evlanova, 2019)

[9] (Evlanova, 2019).

[10] (World Health Organization, 2018)

[11] (World Health Organization, 2018)

[12]  (Puras & Gooding, 2019)

[13] (Rodriguez-Cayro, 2017)

[14] (MentalHealth.gov, 2017)

Bibliography:

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• Evlanova, A. (2019, April 15). What is the State of Mental Health in Singapore? Retrieved from ValueChampion: https://www.valuechampion.sg/what-state-mental-health-singapore

• Guest Blogger of Mental Health Foundation. (2016, May 9). Social media and young people's mental health. Retrieved from https://www.mentalhealth.org.uk/blog/social-media-and-young-peoples-mental-health

• Hazzard, D. (2017, August 19). MENTAL ILLNESS IN DEVELOPING COUNTRIES. Retrieved from The Borgen Project: https://borgenproject.org/mental-illness-in-developing-countries/

• Institution of Mental Health. (n.d.). Autism Spectrum Disorders. Retrieved from IMH: https://www.imh.com.sg/clinical/page.aspx?id=250

• Lai, L. (2015, October 6). IMH study reveals stigma surrounding mental illness. Retrieved from The Straits Times: https://www.straitstimes.com/singapore/health/imh-study-reveals-stigma-surrounding-mental-illness

• MentalHealth.gov. (2017, August 29). Mental Health Myths and Facts. Retrieved from MentalHealth.gov: Let's talk about it.: https://www.mentalhealth.gov/basics/mental-health-myths-facts

• Mohandas, V. (2017, September 25). More kids in Singapore seeking help for mental health issues. Retrieved from Channel News Asia: https://www.channelnewsasia.com/news/singapore/more-kids-in-singapore-seeking-help-for-mental-health-issues-9241214/

• National Council of Social Service. (n.d.). Persons With Mental Health Conditions. Retrieved from NCSS National Council of Social Service: https://www.ncss.gov.sg/GatewayPages/Social-Services/Persons-with-Mental-Health-Conditions

• National Health Service. (2019, December 10). Clinical Depression: Symptoms. Retrieved from NHS: https://www.nhs.uk/conditions/clinical-depression/symptoms/

• National Health Service. (2019, April 18). What is autism? Retrieved from NHS: https://www.nhs.uk/conditions/autism/what-is-autism/

• Ng, K. (2018, March 11). ‘Crazy, weird, scary’: Survey unveils negative labels youths associate with mental illness. Retrieved from TODAYOnline: https://www.todayonline.com/singapore/crazy-weird-scary-survey-unveils-negative-labels-youths-associate-mental-illness

• Pang S, L. J. (2017). Stigma among Singaporean youth: a cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population. BMJ Open. doi:10.1136/bmjopen-2017-016432

• Puras, D., & Gooding, P. (2019). Mental health and human rights in the 21st century. World Pyschiatry. doi:10.1002/wps.20599

• Rodriguez-Cayro, K. (2017, October 12). What Does Mental Health Care Look Like Abroad? This Is How 9 Countries Treat Mental Illness. Retrieved from Bustle: https://www.bustle.com/p/what-does-mental-health-care-look-like-abroad-this-is-how-9-countries-treat-mental-illness-2885010

• Sim, I., Ghoh, C., Loh, A., & Chiu, M. (2015). THE SOCIAL SERVICE SECTOR IN SINGAPORE: An Exploratory Study on the Financial Characteristics of Institutions of a Public Character (IPCs) in the Social Service Sector. NUS Faculty of Arts & Social Sciences, , Department of Social Work. Singapore: Centre for Social Development (Asia). Retrieved from https://www.fas.nus.edu.sg/swk/doc/CSDA%20An%20Exploratory%20Study%20on%20the%20Financial%20Characteristics%20of%20IPCs%20in%20the%20Social%20Service%20Sector.pdf

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