CC0005 LectureNotes WB Lec4 2023

23/05/2023
CC0005 Healthy Living and Wellbeing
Lecture 4
Building Mental Health

Awareness and Resources
Presented by Assoc Prof Andy Ho
© 2023 Nanyang Technological University, Singapore. All Rights Reserved.
Intended Learning Objectives

1. Describe the etiology and symptoms of
prevalent mental health issues among youths
2. Recognise the various available resources and

support systems for mental health issues
3. Practise empathic communication and basic

suicide gatekeeping skills
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01.
An Overview of Mental
Health and a Critical
Summary of Prevalent
Mental Illness Among
Young Adults
© 2021
2023 Nanyang Technological University, Singapore. All Rights Reserved.
“Mental health is defined as a state of well-being in which

every individual realises his or her own potential, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to her or his community.”
- World Health Organization -
“Mental health: strengthening our response” by World Health Organization is licensed under CC BY-NC-SA 3.0 IGO.
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Multifaceted Nature of Mental Health

A complete state of mental health consists of psychological,
social, and emotional well-being (Keyes & Lopez, 2002)
• Psychological well-being:
Competent, autonomous, self-acceptance, purpose in life
• Social well-being:
Prosocial attitude and behaviours, social acceptance,
contribution, coherence and integration
• Emotional well-being:
Happiness, life satisfaction
Keyes, C. L. M., & Lopez, S. J. (2002). Toward a science of mental health: Positive directions in diagnosis and interventions. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 45–59). Oxford University Press.
• While mental illness can affect individuals’ mental

well-being, its presence does not necessarily
How Mental Illness prevent people from flourishing in life.
Affects Mental Health • Similarly, the absence of mental illness does not
necessarily translate to complete well-being.
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HIGH MENTAL HEALTH
Only 17% of Americans

Struggling
experience flourishing
Flourishing & Flourishing

Mental Illness
About 26% of American

adults suffer from a Moderate Moderate
diagnosable mental Mental Health & Mental Health
illness in any given year Mental Illness

HIGH LOW
MENTAL MENTAL
ILLNESS ILLNESS
Languishing & Languishing
Mental Illness
Floundering 10% of Americans

experience languishing
(despair with negative
impact on mental health)
LOW MENTAL HEALTH
Keyes, C. L. M. (2007). Mental health as a complete state: How the salutogenic perspective completes the picture. In G. F. Bauer & O, Hämmig (Eds.), Bridging occupational, organizational and public health (pp. 179–192). Springer Science+Business Media Dordrech.
Mental illnesses are They are associated

health conditions that with distressed “Mental illness is common. It is nothing to be
involve changes in: functioning in: ashamed of. It is a medical problem, just like heart
Emotion Social activities disease or diabetes.”
Thinking Family life - American Psychiatric Association -
Behaviour Work
American Psychiatric Association. (2021). What is Mental Illness? https://www.psychiatry.org/patients-families/what-is-mental-illness
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Universal Challenges to Mental Health

1. Common Mental Illnesses Among Youths
Millions of individuals worldwide have mental illnesses; IMPORTANCE OF GETTING

affects individuals from every country SUPPORT
Lack of support
Most common among youths:
in the aftermath of stressful events
or for those with mental illnesses
1. Depression 2. Anxiety 3. Eating disorders
leads to:
• Poorer quality of life

• Shorter life expectancy
2. Acute Life Stressors • Suicide
Death-related grief and non-death
losses, especially during major
public health crises such as the
COVID-19 pandemic
Depression
• According to the Diagnostic and Statistical Manual
of Mental Disorders (DSM–5), depression or major
depressive disorder (MDD) is classified under the
umbrella of mood disorders.
• It is the “common cold of mental health problem” and
ranked by the WHO as the single largest contributor
to global disability.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). APA. https://doi.org/10.1176/appi.books.9780890425596
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Signs of Depression
Profound Negative Anhedonia Sleep Disturbances

Emotions - Loss of interest - Sleeping too much
- Sadness and pleasure in - Sleeping too little
- Worthlessness almost all
- Cannot fall asleep
activities
- Emptiness
Changes in Weight Functional Impairment Suicide Ideation

- Weight loss - Difficulty - Suicide attempts
- Weight gain concentrating - Actual suicide
- Loss of energy
- Listlessness
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Impact:
• Depression can take a terrible toll on individuals and
their families
• Depression often gets
worse without proper
treatment
• Depression can lead to
various emotional,
behavioural and health Onset:
problems that affect every
aspect of life • Often begins in adolescence,
20s or 30s, but it can happen
at any age
• Symptoms persist most of the
day, nearly every day, for at
least two weeks
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“That is the thing about depression: A human being can

survive almost anything, as long as she sees the end in
sight. But depression is so insidious, and it compounds
daily, that it’s impossible to ever see the end. The fog is
like a cage without a key.”
Elizabeth Wurtzel
America writer
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Depression Statistics
Singapore2 Youths in SG3

Globally1
In 2016, 6.3% of adult In 2016, an estimated 18% of
• Over 300 million people population had suffered Singapore’s youths suffer
suffer from depression from MDD in their from depression
• Equivalent to 4.4% of lifetime
the world’s population
1World Health Organization. (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression | 2Institute of Mental Health. (2021). Coping with depression. https://www.imh.com.sg/wellness/page.aspx?id=554 |
3Evlanova, A. (2019, April 16). What is the state of mental health in Singapore? ValueChampion Singapore. https://www.valuechampion.sg/what-state-mental-health-singapore
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Etiology of Depression
Genetic Biological Personal Environmental Social
Factors Factors Vulnerabilities Vulnerabilities Circumstance
Hereditary factors; Imbalance in Individual make-up, Acute stressful life Weak social network,
depression seems to neurotransmitter and cognitive, events, chronic stress, loneliness, isolation,
pass on from one hormones interpersonal, and and childhood and chronic physical
generation to the next personality factors exposure to adversity illnesses
1. Serotonin: Natural “feel good” chemical, regulates moods

2. Dopamine: “Feel good” chemical, reinforces behaviours
3. Norepinephrine: Sudden energy boost in stressful times
Depression usually results from a combination of these factors.
REGARDLESS OF CAUSE(S): HIGHLY TREATABLE
Institute of Mental Health. (2021). Coping with depression. https://www.imh.com.sg/wellness/page.aspx?id=554
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Anxiety Disorders
• According to the DSM–5, there are five types of
anxiety disorders including generalised anxiety
disorder, panic disorder, social anxiety disorder,
separation anxiety disorders, phobias, and
agoraphobia.
• Generalised anxiety disorder (GAD) is a general
feeling of excessive anxiety and worry that is
difficult to control. These feelings are not related to
any specific event or object.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). https://doi.org/10.1176/appi.books.9780890425596
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Possible Signs of Generalised Anxiety Disorder
Excessive and Feeling Agitated Frequent Feelings of

Disproportionate (Rapid Heartbeat, Restlessness
Worrying Dry Mouth)
Trouble Falling Asleep Easily Fatigued Difficulty Concentrating

or Staying Asleep
Avoiding Social
Irrational Fears Panic Attacks
Situations
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Impact:
• Generalised Anxiety Disorder can
impact family life and reduce social
adjustment and functioning
• It can also impair work
and job performance
• It can lead to a reliance
on alcohol and drugs to
manage anxiety
Onset:
• Develops gradually over time
• May not be noticeable until it
interferes with normal functioning
• Can be recurrent or chronic
Mayo Clinic. (2021). Anxiety Disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
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“Anxiety does not empty tomorrow of its sorrows,

but only empties today of its strength.”
Charles Spurgeon
English preacher
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Prevalence of General Anxiety Disorder
Globally1 Singapore2 Youths in SG3

In 2016, 1.6% of the Most common
3.8% of the world’s
Singapore population had psychological disorder
population suffers from amongst children and
generalised anxiety
an anxiety disorder disorder adolescents in SG
1 Ritchie, H. & Roser, M. (2018, January 20). Mental Health. Our World in Data. https://ourworldindata.org/mental-health | 2Institute of Mental Health. (2018, December). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime.
https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/ SMHS%202016_Media%20Release_FINAL_web%20upload.pdf | 3Singapore Association for Mental Health. (2020). Anxiety disorders. https://www.samhealth.org.sg/understanding-mental-health/what-is-mental-illness/anxiety-disorders
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Etiology of General Anxiety Disorder

Genetic Biological Personal Environmental Drug
Factors Factors Vulnerabilities Vulnerabilities Withdrawal
Hereditary factors; Faulty circuits in the Individual make-up, Acute stressful life Drugs may mask
anxiety disorders brain that control cognitive, events (e.g., anxiety; drug
may run in the fears and emotions interpersonal, and experiencing or withdrawal may
family personality factors witnessing trauma), heighten observable
chronic stress symptoms
Other Mental Health Disorders

Individuals with other mental health disorders, such as depression,
often also have an anxiety disorder.
General anxiety disorder results from a combination of these factors.
REGARDLESS OF CAUSE(S): HIGHLY TREATABLE

Mayo Clinic. (n.d.). Anxiety disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
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Eating Disorders
• The Diagnostic and Statistical Manual of
Mental Disorders (DSM–5), identifies 10 eating
disorders. The three most common are:
⁃ Anorexia nervosa
⁃ Bulimia nervosa
⁃ Binge-eating disorder
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
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Three Most Common Eating Disorders
Anorexia Nervosa Bulimia Nervosa Binge-eating Disorder

• Severely limits food • Cyclical • Periods of uncontrolled
intake • Oscillates between: continuous eating until
• Intense fear of weight uncomfortably full
Binge eating
gain • Uncontrolled • Often triggered by
• Perceives oneself to intake emotional events
be overweight despite Purging • Results in guilt
being severely • Self-induced - But no
underweight vomiting compensatory
• Preoccupation with • Laxative abuse behaviours
food and exercise • Extreme exercise
• Excessive fasting
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Possible Signs of Eating Disorders

Anorexia Nervosa Bulimia Nervosa Binge-eating Disorders
• Excessive focus on weight

• Excessive exercise
• Expressing guilt about eating (habits) • Repeatedly eating large
• Frequently checking mirror or scale amounts of sweets or high-fat
• Withdrawing from social activities due to food concerns foods
• Eating much more food than
what is commonly considered
• Highly restrictive diet “standard portions”
• May oscillate between highly
• Skipping meals/making • Expressing guilt or shame
restrictive diet and binge-
excuses not to eat about eating habits
eating unhealthy foods
• Making own meals rather
• Self-induced vomiting
than eating what the family
• Excessive use of laxatives
eats
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“You know you’ve got problems when your head is

hanging over the toilet, puking up your dinner, and
what you’re thinking of is your dad. And how he
thinks you’re not pretty.”
Teresa Lo
American author
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Prevalence of Eating Disorder
Globally1 Singapore2 Youths in SG3

At least 9% of population Estimated prevalence of 7.4% of females, aged
worldwide 6.2% of adults in 12-26, are at risk for
Singapore have an developing an eating
disorder
eating disorder
1World Health Organization. (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression | 2Institute of Mental Health. (2021). Coping with depression. https://www.imh.com.sg/wellness/page.aspx?id=554 |
3Evlanova, A. (2019, April 16). What is the state of mental health in Singapore? ValueChampion Singapore. https://www.valuechampion.sg/what-state-mental-health-singapore
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Etiology of Eating Disorder

Genetic Biological Psychological/ Other Mental Age
Factors Factors Emotional Factors Illnesses and Sex
Hereditary factors Brain chemicals, For example, low Including • Usually develops
including dopamine self-esteem, depression, anxiety, in teens/young
and serotonin perfectionism, and obsessive- adulthood
troubled compulsive disorder • More frequently
relationship. reported in
females
The (social) media puts a large amount of pressure on females to meet a
certain social and cultural standard of beauty, which can inevitably lead to poor body
image and eating disorders.
Eating disorders result from a combination of these factors.
Potentially PREVENTABLE at a young age
Institute of Mental Health. (2021). Coping with depression. https://www.imh.com.sg/wellness/page.aspx?id=554
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Grief, Loss and Mental Health

• Grief is a highly personal response to a life-changing
loss. It involves diverse emotional (i.e., affective),
psychological and physical reactions to death-related
and non-death related losses.
• While death-related grief is a natural reaction to the

loss of a loved one, individual responses vary.
Factors that shape responses include the context of
the death and the individual's relationship with the
deceased.
• 10–12% of bereaved individuals may experience

complicated grief when the death is complex and
traumatic. Complicated grief can cause marked
interference with all domains of functioning,
especially our mental health.
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Pandemic and Mental Health

• COVID-19 has disrupted our everyday lives. The
fear of infection and social distancing measures had
negative effects on our psychological, social, and
emotional wellbeing.
• With major disruptions in our learning environments

and social activities, along with uncertainties about
our career prospects, university students are
impacted greatly during the pandemic. This has
stunted young people’s development of self-identity,
self-esteem, and relational networks.
• However, COVID-19 also played an important role

in destigmatising mental illness because it made
clear just how inextricable mental health is from
physical health.
Ho, A.H.Y. (2020). COVID-19 and social distancing. Academia SG. https://www.academia.sg/academic-views/covid-19-and-social-distancing-impacts-on-youths-university-and-post-secondary-students/
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02.
Barriers and Help-Seeking
Behaviours for Mental
Health Issues and
Supporting Suicide
Prevention
© 2021
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“Too many people who struggle with mental health illnesses are still
suffering in silence rather than seeking help, and we need to see it
that men and women who would never hesitate to go see a doctor
if they had a broken arm or came down with the flu, that they have
that same attitude when it comes to their mental health.”
Barack Obama
44th president of the United States
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Treatment Delays
• Despite the high prevalence of mental illness around the
world and in Singapore, research has consistently
highlighted how delays in receiving proper diagnoses and
treatment are common.
• Research in 2016 found that 1 in 7 Singaporeans
experienced a mental disorder during their lifetime.
However, within this group, more than three quarters
(>75%) did not seek any professional help.
• Among those who sought help, there was generally a
delay in seeking treatment:
Mental Disorder Treatment Delays in Years

Major depressive disorder 1
Generalised anxiety disorder 2
Eating disorders Unknown
Institute of Mental Health. (2018, December 11). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime [Press release].
https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf
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Help-Seeking Behaviours College Counselling Services Used

Among College Students 1 During the Pandemic 2
% of full sample compared to select demographic groups
• Mental disorders often go untreated 80
among college and university students. 70
60
⁃ Only 24% of students with depression are
receiving treatment. 50
40
⁃ Less than 20% of students with anxiety
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disorder are receiving treatment.
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• College and university students with drug 10

and alcohol problems are significantly less 0
likely to receive treatment than their peers All students Students identifying
as nonbinary in
Private college
students
Students who had
accessed mental
who don’t attend college. gender health counselling
pre-college
No services used Tele-counselling
On-campus counseling Don't think college has provided
Source: Inside Higher Ed / College Pulse survey
1Hunt, J. & Eisenberg, D. (2009). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46, 3–10. https://doi.org/10.1016/j.jadohealth.2009.08.008 |
2Ezarik, M. (2021, April 14). Students struggling but not seeking campus mental health support. Inside Higher Ed. https://www.insidehighered.com/news/2021/04/14/students-struggling-not-seeking-campus-mental-health-support
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Perceived Barriers to Mental Health Support

Why are college students not seeking help?
• Public, perceived and self-stigmatising attitudes to mental
illness
• Confidentiality and trust
• Difficulty identifying the symptoms of mental illness
• Lack of accessibility
• Preference for self-reliance
• Concern about characteristics of provider
• Knowledge about mental health services
• Fear or stress about the act of help-seeking or source of
help itself
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10, Article 112, 1–9. https://doi.org/10.1186/1471-244X-10-113
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Consequences of Untreated Mental Illnesses

Persistence
of illness
Increasing
severity and
Suicide poorer
outcomes
Consequences of over time
Untreated
Untreated Mental Mental
Illness
Increased
contact with
Illnesses Premature
death
Could Lead
To
the criminal
justice
system
Lack of
attention of Personal
physical relationship
health difficulties
problems
Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, H. C., Tan, W. M., Tan, K. B., Verma, S. & Chong, S. A. (2019). Minding the treatment gap: Results of the Singapore mental health study. Social Psychiatry and Psychiatric Epidemiology, 55(11), 1415–1424. https://doi.org/10.1007/s00127-
019-01748-0
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Understanding Suicide
What is suicide?
• The act or an instance of taking one’s own life voluntarily
and intentionally, especially by a person of years of
discretion and of sound mind.
• It is a desperate attempt to escape intolerable suffering.

Blinded by feelings of self-loathing, hopelessness, and
isolation, a suicidal person can’t see any way of finding
relief except through death.
• Despite their desire to end their perceived suffering and

pain, most suicidal people are deeply conflicted about
ending their own lives. They wish there was an alternative
to suicide, but they just can’t see another option.
Smith, M. Robinson, L. & Segal, R. (2020). Suicide prevention. HelpGuide.org. https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm
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Suicide in Singapore
• A total of 452 people died by suicide in Singapore in 2020.
⁃ Five times more than deaths caused by transport accidents
⁃ Leading cause of death for those aged 10-29
⁃ Males account for more than 70% of all suicides in 2020
⁃ For every suicide, at least six suicide survivors are left behind
• Suicide among youths aged 10–29 increased by 7% from

2019.
⁃ Accounting for 1/3 of all deaths in this age group
⁃ Highest among all age groups
• Highest recorded suicide deaths (154) for elderly aged 60

and above, a 26% increase from 2019.
Samaritans of Singapore. (n.d.). Learn about suicide – quick facts. https://www.sos.org.sg/facts-and-figures | Samaritans of Singapore. (2021, July). Singapore reported 452 suicide deaths in 2020, number of elderly suicide deaths highest
recorded since 1991 [Press release]. https://www.sos.org.sg/pressroom/singapore-reported-452-suicide-deaths-in-2020-number-of-elderly-suicide-deaths-highest-recorded-since-1991
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Warning Signs of Suicide

Talk:
⁃ “My family will be better off without me” (communicates a sense of worthlessness or the belief that no one cares) #HOWRU
⁃ “My life is meaningless anyway” (communicates negative things about the self more broadly)
⁃ “If you don’t love me, I’ll kill myself” (communicates the threat to harm or kill oneself)
Mood:
⁃ Emotional outbursts (anger, sadness, recklessness)
⁃ Loss of interest
⁃ Humiliation or anxiety
Actions:
⁃ Giving away treasured possessions and saying goodbye
⁃ Researching suicide methods
⁃ Writing suicide notes (including emails, diaries, blogs)
Samaritans of Singapore. (n.d.). Learn about suicide – quick facts. https://www.sos.org.sg/facts-and-figures. Rethink Mental Illness (n.d.). Suicidal thoughts – How to support someone. https://www.rethink.org/advice-and-information/carers-hub/suicidal-thoughts-how-to-support-someone/
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Myths and Facts of Suicide

Myths Facts
Someone who isn’t depressed can still be at risk of suicide and not everyone
Suicide is caused by depression.
suffering from depression dies by suicide.
Only those acting moody and sad are suicidal. Suicide does not have a ‘look’, it can happen to anyone.
There were 452 suicide deaths in 2020, and it is the leading cause of death for
Suicide is a rare occurrence and is not a concern in Singapore.
those aged 10–29.
While it may seem sudden, the process of suicide involves ideation, gestures,
Suicide happens on impulse alone.
plans, and attempts.
Suicidal people want to die. They want to live, but living has become too painful.
There are no warning signs to suicide. Those contemplating suicide would often communicate their intentions.
Asking someone about suicide encourages them to become suicidal.

Talking about suicide encourages communication, which is the first step to
helping them to see other possibilities of life.
Suicide only affects those from lower social economic backgrounds. Suicide cuts across all social economic statuses.
Quek, E. (2018, May). 10 myths and facts about suicide. Samaritans of Singapore. https://www.sos.org.sg/blog/10-myths-and-facts-about-suicide
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03.
Supporting Self and Others
Facing Mental Health Issues
and Suicide Ideation
© 2021
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“It’s not about getting the feeling out of

the mind, or hiding it, but about
experiencing it with acceptance.”
Carl Rogers
American psychologist
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Self-Awareness:
The Key to Taking Care of Your Mental Health and Well-Being
How do you practise and enhance self-awareness?

• Mindfulness
• Meditation
What is self-awareness? The key to taking care of your
• Journaling mental health and well-being
• Self-awareness involves
• Speaking with people you trust
stepping back and • Self-awareness takes courage.
observing your thoughts and • Trying new things
feelings as they unfold. • Creating art • You may not always like what you
realise about yourself—that’s
• Self-awareness aids us to Questions you can ask yourself:
alright.
make desired changes. 1. What am I feeling in my body right now?
Being aware of our inner 2. What thoughts are running through my mind? • Grow in self-care and self-
state is the first step to compassion.
3. What am I saying to myself?
growth. You can’t change
things about yourself that 4. What emotions are around? • Contradictions within yourself are
you don’t know about. 5. What am I wanting to do or what am I doing as a normal and human.
consequence of how I think and feel?
Baulch, J. (n.d.). Self-awareness: The key to taking care of your mental health and wellbeing. Inner Melbourne Clinical Psychology. https://www.innermelbpsychology.com.au/self-awareness-mental-health/
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NTU Resources for Mental Health Support

Provide a support ecosystem for students through:
• Counselling service
University Wellbeing Office • Proactive and preventive programming
• Critical care and first responder support
• Governance and partnerships
6790 4462 (Office Hours)

6904 7041 (After office hours; Psychological emergency)
Email Address: UWC-students@ntu.edu.sg
University Counselling Centre For Counselling Service, make an appointment and head down to:
#02-01 University Health Service
36 Nanyang Avenue
Singapore 639801
Line 1: 9295 1900

Line 2: 8223 0560
NTU Psychological Crisis Hotline (24/7) Line 3: 9753 6360
Email Address: UWO-incidentsupport@ntu.edu.sg
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Community Support Services

Counselling and Care Centre (CCC) 6536 6366
Silver Ribbon (Singapore) 6386 1928
6389 2222 (Mental Health Helpline; 24-hr hotline）

Institute of Mental Health 6389 2200 (For making appointments only)
Mount Elizabeth-Charter’s Helpline 1800 738 9595 (24-hr hotline)
CARE Singapore 6583 3481
Samaritans of Singapore (SOS) 1800 221 4444 (24-hr hotline)
Singapore Association for Mental Health 1800 283 7019
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Virtual Support Services

Free counselling chat room run by youth service website for
Singaporean youths and young adults
eC2.sg by Fei Yue Community Services Operating hours: Monday to Friday; 10am to 12pm, 2pm to 5pm (excluding
public holidays)
http://www.ec2.sg/
Free video call counselling for those struggling with

mental health woes.
Silver Ribbon (Singapore)
https://www.silverribbonsingapore.com/ccs.html
Free and confidential mental health checks for Singaporean

youths between 16 and 30 years old
Community Health Assessment Team
(CHAT) Operating hours: Tuesday to Friday; 1pm to 8pm (excluding public holidays)
https://www.chat.mentalhealth.sg/get-help/make-chat-referral/
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Subsidies for Mental Healthcare in Singapore

• Outpatient treatments (MediSave):
⁃ The Chronic Disease Management Programme (CDMP) allows patients suffering from a variety of mental
illness disorder to withdraw up to S$500 from MediSave per year to subsidise therapy and counselling
treatments.
MENTAL HEALTH ISSUES IN SINGAPORE
Resources available to help reduce financial costs
• Further subsidies at the Institute of
Mental Health (IMH): Grants and
MediSave Withdrawal limit of $150/day
Inpatient
Subsidies
MediShield Life $100/day, up to 35 days/year
⁃ Get a referral from a doctor at the
polyclinic. The first consultation costs AIA Beyond critical care
S$40 and S$37 for the subsequent Insurance
Integrated
Covers inpatient psychiatric treatment
ones. Shield Plans
Affordable Therapy sessions by different agencies
Other
treatment Free helplines based on individual needs
• Community Health Assist Scheme Alternatives options Counselling sessions (online/offine)
(CHAS) Subsidised ~$380.70 per month
Cost of
Treatment
Unsubsidised ~$990 per month
For anyone who needs help in their journey towards recovery…
Adapted from Yeo, R. (2021, January 20). Mental health issues: Subsidies available and how to navigate through the financial costs. Seedly. https://blog.seedly.sg/mental-health-costs-subsidies-singapore
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What to Expect When Seeking Help with a Mental

Health Professional?
Before Your Visit: During Your Visit:
• If you are feeling anxious, consider taking time to sit in silent • You can expect the mental health professional to ask you a few questions that would allow
contemplation and write down the thoughts and information them to get to know you, evaluate and understand your mental condition.
you intend to share. Having an actual list will help ground
• Be honest with your care provider, as the help you will receive would depend on the
you and remind you of your intention to get help
truthfulness of your responses. Being upfront and honest can help determine what is
• You can consider bringing along someone you trust, who happening and put together a plan of care specifically tailored to your needs.
knows you well and has your best interests in mind. They
• As the session ends, your mental health professional would likely have developed a
can serve as a calming presence to soothe your fears.
treatment plan with you or provide you with a referral for psychotherapy or counselling. If you
are seeing a psychiatrist, he or she may prescribe you medication with a confident diagnosis.
After the Session:

• Remind yourself that mental health professionals have your best interests in mind. They are committed to formulating a treatment plan
for you that is in line with your values and your goals. You are on your way to getting better.
• Evaluate for yourself if the synergy between you and the mental health professional is optimal for you. It is very much your choice to stay
on or find a more suitable mental health professional.
Promises Healthcare. (2021, March 11). What to expect during your visit to a psychiatrist? https://www.promises.com.sg/what-to-expect-during-your-visit-to-a-psychiatrist/
47
Suicide Gatekeeping Tips

TIP 1: Speak Up if You Are Worried TIP 2: Respond Quickly in a Crisis TIP 3: Offer Help and Support
You can’t make someone suicidal by showing you When your friends tell you that they are thinking about The best way to support is to offer an empathetic
care. death or suicide, it is important to evaluate the listening ear. Let your loved one know that they’re not
immediate danger the person is in. alone and that you care. Don’t take responsibility for
Ways to start a conversation: healing your loved one. You can offer support, but you
• I’ve been feeling concerned about you lately. Ask these questions: can’t make a suicidal person get better. They have to
• Recently, I’ve noticed some differences in you and Plan: Do you have a suicide plan? make a personal commitment to recovery.
wondered how you are doing. Means: Do you have the means to carry out your
plan? Sustainable help for a suicidal person:
Questions you can ask: Time set: Do you know when you would do it? 1. Get professional help.
• When did you start feeling like this? Intention: Do you intend to take your own life?
• Have you thought about getting help? 2. Follow-up on treatment.
Level of Suicide Risk
3. Be proactive.
What you can say that helps: Low Some suicidal thoughts. No suicide plan.
• You are not alone in this. I am here for you. They said they won’t attempt suicide. 4. Encourage positive lifestyle changes.
• When you want to give up, tell yourself you will Moderate Suicidal thoughts. Vague plan that isn’t very 5. Make a safety plan.
hold off for just one more day, hour, minute— lethal. Says that they won’t attempt suicide.
whatever you can manage. 6. Remove potential means of suicide.
High Suicidal thoughts. Specific plan that is highly
lethal. Says they won’t attempt suicide. 7. Continue your support over the long haul.
Severe* Suicidal thoughts. Specific plan that is highly
lethal. Person says they will attempt suicide. It takes a lot of courage to help someone who is
suicidal. As you’re helping a suicidal person, don’t
forget to take care of yourself.
*If severe, call the 999 or Samaritans of Singapore at 1800-
221-4444. Do not leave a suicidal person alone.
Smith, M., Robinson, L. & Segal, R. (2020). Suicide prevention. HelpGuide.org. https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm
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When Talking to a Suicidal Person

DOS DON’TS
Be Yourself Argue With the Individual
• Let the person know you care, and he/she is not alone. • Avoid saying things like “You have so much to live for”, “Your
• Finding the right words is not nearly as important as showing suicide will hurt your family”, or “Just snap out of it”.
your concern.
Listen Act Shocked
• Let the person vent and unload his/her feelings. • Lecture on the value of life.
• No matter how negative the conversation seems, the fact that • Argue that suicide is wrong.
it is taking place is a positive sign.
Be Sympathetic and Non-judgmental Promise Confidentiality or be Sworn to Secrecy
• The person is doing the right thing by talking about his/her • A life is at stake, and you may need to speak to a mental
feelings, no matter how difficult it is to hear. health professional in order to keep the person safe.
Offer Hope Offer Ways to Fix your Loved One’s Problems
• Reassure them that help is available. • Give advice.
• Let the person know his/her life is important to you. • Make the person feel like he/she has to justify their feelings.
• It is not about how bad the problem is, but how badly it’s
hurting.
Take Them Seriously Blame Yourself
• Ask if the person is having thoughts of suicide. You’re allowing • You can’t “fix” someone else’s depression, you are doing the
him/her to share his/her pain with you, and not putting ideas in best that you can. Another person’s happiness is not your
his/her head. responsibility.
Smith, M., Robinson, L. & Segal, R. (2020). Suicide prevention. HelpGuide.org. https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm
49
Empathic Listening
• Empathy is the ability to project oneself into the Empathic Listening
personality of another person to better •Builds trust and
A Skilled Listener
understand that person’s emotions or feelings. respect
1. Takes information from
others while remaining •Enables the sharing
• Through empathic listening, the listener is non-judgmental and party to release their
informing the speaker, “I understand your empathic. emotions
problem and how you feel about it without 2. Acknowledges the •Reduces tensions
judgement.” speaker in a way that
invites communication •Encourages the
• In difficult situations, sometimes the best and to continue. surfacing of information
most respectful response is silence with 3. Provides a limited but •Creates a safe
presence. encouraging response, environment that is
carrying the speaker’s conducive to
• We “bear witness” to the pain of another and by idea one step forward.
collaborative problem
doing so, we value the speaker’s experience and solving
validate what is most important.
Salem, R. (2003). "Empathic Listening." Beyond Intractability. Eds. Guy Burgess and Heidi Burgess. CO: Conflict Research Consortium, University of Colorado.
50
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23/05/2023
Guidelines for Empathic Listening

1. Be attentive. Be interested. Be alert and not distracted. 7. Indicate you are listening by:
Create a positive atmosphere through non-verbal behaviour.
 Providing brief, non-committal acknowledging responses,
2. Be a sounding board. Allow the speaker to bounce ideas and e.g., "Uh-huh“, "I see"
feelings off you while assuming a non-judgmental, non-critical
manner.
 Giving non-verbal acknowledgements, e.g., head nodding,
facial expressions matching the speaker, open and relaxed
body expression, eye contact.
3. Don't ask a lot of questions. They can give the impression you
are "grilling" the speaker.  Invitations to say more, e.g., "Tell me about it." and "I'd like
to hear about that."
4. Act like a mirror. Reflect back and paraphrase what you think
the speaker is saying and feeling. 8. Follow good listening "ground rules":
5. Don't discount the speaker's feelings by using standard × Don't interrupt.

phrases like "It's not that bad." or "You'll feel better tomorrow."
× Don't change the subject.
6. Don't let the speaker "hook" you. This can happen if you get × Don't rehearse in your own head.
angry or upset. Do not allow yourself to get involved in an
argument, or pass judgement on the other person. × Don't interrogate.
× Don't teach or give advice.
 Do reflect to the speaker what you understand and how you
think the speaker feels.
Salem, R. (2003). "Empathic Listening." Beyond Intractability. Eds. Guy Burgess and Heidi Burgess. CO: Conflict Research Consortium, University of Colorado.
51
“Let your story go. Allow yourself to be

present with who you are right now.”
Lalah Delia
Spiritual writer
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23/05/2023
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27

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23/05/2023

CC0005 Healthy Living and Wellbeing

Building Mental Health

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Intended Learning Objectives

2. Recognise the various available resources and

3. Practise empathic communication and basic

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

“Mental health is defined as a state of well-being in which

- World Health Organization -

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Multifaceted Nature of Mental Health

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

• While mental illness can affect individuals’ mental

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

HIGH MENTAL HEALTH

Only 17% of Americans

Flourishing & Flourishing

About 26% of American

illness in any given year Mental Illness

Floundering 10% of Americans

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Mental illnesses are They are associated

American Psychiatric Association. (2021). What is Mental Illness? https://www.psychiatry.org/patients-families/what-is-mental-illness

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Universal Challenges to Mental Health

Millions of individuals worldwide have mental illnesses; IMPORTANCE OF GETTING

• Poorer quality of life

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Profound Negative Anhedonia Sleep Disturbances

Changes in Weight Functional Impairment Suicide Ideation

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

“That is the thing about depression: A human being can

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Singapore2 Youths in SG3

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

1. Serotonin: Natural “feel good” chemical, regulates moods

Depression usually results from a combination of these factors.

REGARDLESS OF CAUSE(S): HIGHLY TREATABLE

Institute of Mental Health. (2021). Coping with depression. https://www.imh.com.sg/wellness/page.aspx?id=554

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Possible Signs of Generalised Anxiety Disorder

Excessive and Feeling Agitated Frequent Feelings of

Trouble Falling Asleep Easily Fatigued Difficulty Concentrating

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Mayo Clinic. (2021). Anxiety Disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

“Anxiety does not empty tomorrow of its sorrows,

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Prevalence of General Anxiety Disorder

Globally1 Singapore2 Youths in SG3

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Etiology of General Anxiety Disorder

Other Mental Health Disorders

General anxiety disorder results from a combination of these factors.

REGARDLESS OF CAUSE(S): HIGHLY TREATABLE

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

© 2023 Nanyang Technological University, Singapore. All Rights Reserved.

Three Most Common Eating Disorders