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More youths seeking help with mental health – but finding it isn’t always easy

SINGAPORE: After making it through secondary school without any close friends, introverted teenager Poh Zhi Nan vowed to “be a new person” at junior college.

He said ‘hi’ to everyone, went out with different people. But like any teen searching for identity, he wondered: “Who am I? Why am I trying so hard to be that outgoing person that I’m not?”

Before he could find a new rhythm, however, the COVID-19 pandemic hit in 2020, and schools switched to home-based learning. Without face-to-face interactions and support, Poh grew more anxious, ever so stressed, and began imagining worst-case scenarios.

He tried speaking to his parents about getting professional help – but they thought he was possessed. They put him through an exorcism ritual that left him traumatised.

“To their generation, there’s no such thing as mental health issues,” said Poh, now 19.

Things didn’t improve when in-person classes resumed. He got panic attacks, and was taken to hospital and diagnosed with post-traumatic stress disorder (PTSD).

That’s when he decided to prioritise his mental well-being – and made the “unglamorous” call to take a break from school.

He also knocked on several doors, approaching a few public hospitals and private healthcare providers, before he found a treatment setting and team he felt comfortable with.

Poh has not been alone in his struggle with mental health demons – or in his quest to get help and be better understood.

CNA Insider spoke in-depth to more than 15 youths about why and how they struggled, sometimes for years, with conditions such as depression, anxiety, self-harm and eating disorders. The upside: Most, if not all, had found a way out of their darkest days, and want their stories to serve as encouragement to others.

The worry? Many reported roadblocks on the way to finding help, be it at home, in school or from healthcare institutions.

Take Roy (not his real name), 22, who struggled to even find the motivation to seek help, didn’t have a close family and didn’t find his sessions with a community counsellor useful. It was when he landed at the Institute of Mental Health (IMH) in 2020 following a suicide attempt, that he decided he “could not let things get any worse”.

Other youths talked about the impact of parental expectations on their mental health – a recurring theme.

University student Zoe (not her real name), 21, remembers being caned by her mother when she missed a note during music practice when she was around four to six years old.

At first, they did not tell her mother, who was the stricter parent. Lee was referred to the Child Guidance Clinic at the IMH, where she was diagnosed with premenstrual dysphoric disorder, a severe form of premenstrual syndrome.

As part of treatment, the psychologist wanted Lee’s mother to attend a session. That’s when Mrs Lee, as she asked to be known, learnt of her daughter’s condition and got “really upset”, according to her daughter.

Mrs Lee’s reaction was to put her daughter’s feelings down to her perfectionist tendencies “as a Virgo” rather than clinical depression. “I just thought at the time, how could it be possible?” she recounted in Mandarin.

At university, Lee majored in psychology and gained a “deeper understanding” of how her family had affected her mental health. But this also gave rise to anger. She realised she needed to talk to her parents.

She first apologised to her mum. “It took us maybe 30 minutes to calm down and stop insulting each other and getting angry,” she said. The conversation turned out to be “monumental”.

What she learnt was that her mother had grown up with the tough expectations of being the eldest child herself. “That’s why I was also so strict with Karen,” said Mrs Lee.

“Suicidal thoughts were plaguing me,” said the 17-year-old junior college student who requested anonymity.

Germaine Goh, 18, remembers how she got on Instagram in Primary Four and kept tabs on who had the most followers and number of likes.

“There were people going around asking their friends to like their photos or to follow them so they’d seem more popular,” she said. “That was something I also resorted to.”

Back then, if a photo she posted did not garner more than 100 likes, she would delete it. “I tied my self-esteem to the amount of likes I was getting.”

For students with issues bigger than they can handle, schools have developed resources to help.

All schools have at least one or two full-time counsellors, while each polytechnic and Institute of Technical Education college has five to seven counsellors, the Ministry of Education (MOE) said in September last year. The autonomous universities are “similarly equipped”.

And what students share with school counsellors is confidential unless a student’s safety is at stake, according to the schools CNA Insider contacted.

But the experience of seeking help at school differs greatly, youths told CNA Insider. Some benefited from their school counsellors and teachers; others did not feel adequately listened to, and even felt betrayed.

Uma, for instance, felt that her school counsellor was becoming increasingly impatient towards the end of Secondary One. She claimed the counsellor also betrayed her confidence to her parents and teachers.

This magnified her stress as her parents “got very defensive and angry”, and teachers “no longer had a good impression” of her. She stopped seeing the counsellor in Secondary Two.

Related:

‘With school counsellors, it’s really hit-or-miss’: Behind the challenge of safeguarding student mental health

Goh, on the other hand, “really trusted” her junior college counsellor and teachers. They were the ones who urged her to tell her IMH doctors about having been sexually harassed so she could get help; it’s how she got diagnosed with PTSD.

Her teachers were also a pillar of support when she began hearing voices in 2020. She confided in them after the “voices” got so bad that she did not attend school for a week.

They referred her to the school counsellor, who she said made some calls to get her professional help. Owing to the waiting time involved, Goh opted to go to the emergency department of a hospital and was referred to the IMH.

While others have had similarly positive encounters, what can turn the experience of seeking help at school into a nightmare? Some pointed to educators and counsellors who belittled their woes.

Muhammad Syazwan Rahmat, 23, recalled how his discipline master and form teacher ascribed his problems in Secondary Three to laziness and truancy.

In fact, he was feeling “empty” after being separated into a different class from his friends. His school subjects were also “getting tougher”, and he was grappling with confusion over his sexuality.

His parents were called to school over his poor attendance. The discipline master, he said, told him: “If you’ve really got issues, give me a doctor’s letter.” A session with the school counsellor “didn’t really help much” as his issues were still seen mainly as a truancy problem – he was given tips on staying motivated.

In recognition of how friends are often the first line of support, since last October, all schools and institutes of higher learning have had peer support structures in place, where participants look out for fellow students and encourage peers in distress to seek help from trusted adults.

The MOE also aims to deploy more than 1,000 teacher-counsellors in the next few years, up from the 700-plus in schools as at last year. These are teachers who have received additional training so they can help students who are dealing with more challenging social-emotional problems, like grief and loss.

Related:

MOE to strengthen support networks in schools; all teachers to get enhanced training on mental health literacy

For Goh, who was on medical leave from school for most of 2020, her teachers were and remain a fount of support.

When she returned, PTSD had affected her memory, and her teachers would sit down and help her understand various concepts taught in class. They were understanding when she needed to leave midway through a class to calm herself down. Her form teacher told her to take self-care days.

The school also gave her opportunities to shine and lead: She is the captain of her co-curricular activity as well as a school ambassador who helps to promote the institution during events such as open house.

“It makes me feel very good because they have that trust in me that I’m able to still uphold these responsibilities while I’m trying to fight my own battles,” she said.

When he eventually turned to his parents with his problem, his mother – after the initial shock of finding out – paid for a private psychologist, at S$300 to S$400 a session, for which Cheng was very grateful.

He was diagnosed with dysthymia, a form of depression also known as persistent depressive disorder, and attended monthly sessions for about half a year.

For 46-year-old Jasmine (not her real name), getting help for her 15-year-old daughter has wiped out the family’s savings.

Her daughter has major depression and has grappled with suicidal thoughts since Primary Five. A weeks-long stay in the IMH did not improve the situation, so Jasmine searched for alternatives and found a doctor at Mount Elizabeth Hospital.

A stay there of over three weeks cost about S$26,000 after Medisave withdrawals, said Jasmine. Plus there were monthly medication costs of about S$1,000 and subsequent inpatient stays.

She and her husband, who also have a younger daughter, remain stoic. But they have used up their savings, cashed out endowment plans and maxed out their Medisave withdrawals and insurance claims for general hospitalisation.

With a monthly household income of about S$5,000, they live from “pay cheque to pay cheque”.

On affordability, the Ministry of Health (MOH) is working with insurance companies and other stakeholders to “further optimise the coverage process”, Senior Minister of State (Health) Janil Puthucheary told Parliament last August.

The Covid-19 Mental Wellness Taskforce and an inter-agency task force on mental health are also looking at the infrastructure needed.

MOH said the IMH monitors appointment waiting times and has measures to optimise appointment slots. Non-urgent cases are referred to primary and community-based care providers, which include over 220 general practitioners and 14 polyclinics providing mental health and/or dementia services as of 2020.

But why are fees in the private sector so high? Chan said the fees help to cover the non-billable training hours put in by private practitioners.

“There’s a lot of learning, training… doctorate programmes, master’s programmes that we need before we become a psychologist,” she said. A lot of professional development costs also come out of their own pocket.

WATCH: Are Young People Getting The Help They Need? | Confronting Youth Mental Health Part 2/2 (31:15

Some providers have tried to lower the barriers to seeking help.

Last year, some members of the Singapore Psychological Society, where Chan is president, responded to the increased mental health needs brought on by the pandemic by offering reduced fees or pro bono services. This initiative will run until June.

Community service organisations that charge subsidised or affordable fees for seeing a counsellor or psychologist include Shan You Counselling Centre and Clarity Singapore, a Catholic mental health charity, Ong noted.

According to their websites, Shan You charges S$80 for an individual counselling session of 50 to 60 minutes, while at Clarity Singapore, it is S$40 per session.

Ong suggested people be allowed to use Medisave to seek help from such organisations.

HELP IN THE COMMUNITY

If she had a magic wand, Ong would also expand the IMH’s Community Health Assessment Team (Chat) to cater to more young people. This service in Orchard Road enables those aged 16 to 30 to seek a mental health check outside of a hospital or clinic.

For Goh, her posts about going to IMH marked a turnaround from those days when she refused to accept the diagnosis of her depression and anxiety and had an unhealthy relationship with social media.

“Growing up, I always had this (idea) that the IMH was very scary,” she said.

As for the link between heavy social media use and poor self-esteem, social media platforms have taken steps to mitigate harm.

Instagram’s owner, Meta, said last year it has a dedicated reporting option for eating disorder content. Among other measures, it has a feature called Restrict, which allows users to protect themselves from bullying.

For its part, TikTok has been driving mental health awareness in collaboration with local non-profit organisations and youths themselves, said Teresa Tan, its Southeast Asia head of public policy.

For example, the non-profits provided training in mental health knowledge that youths could translate into creative content. TikTok also launched the in-app Singapore Wellness Hub, which serves as a repository of resources.

FINDING HEALING

Several youths said their own struggles have spurred them on to help others.

Narish, for instance, he has dealt with the issues triggered by his childhood trauma. Today, he is a mental health advocate with Strengthening Youths in a Network of Care, the mental healthcare arm of the non-profit Impart. Narish also coaches youths in boxing and describes himself as “still healing”.

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