How can we start destigmatising mental health conversations?

The World Health Organisation (WHO) has reported that one in seven or 14% of young people aged 10-19 years old experience some form of mental health condition, which goes largely untreated. Stress during adolescence can be exacerbated by exposure to adversity, peer pressure, exploration of identity, digital and social media influence, gender norms, and global events such as climate change, economic downturns and pandemics. Data from the second Singapore Mental Health Study in 2016, revealed youths, especially from ethnic minorities, households of low socioeconomic status and/or violent or abusive homes are at much higher risk of developing mental health issues.

According to Dr. Priyanka Rajendram, Assistant Director of Integrated Health Promotion, Ministry of Health (MOH) Office for Healthcare Transformation, many factors can affect the mental health of adolescents, and the more risk factors they are exposed to, the greater the potential impact on their mental health. 

Destigmatising conversations on mental health, and challenges to access and provision of interventions are among the many topics discussed at the recent Temasek Shophouse Conversations entitled “Youth Mental Health: Opportunities and Challenges in a Digital World.” Organised by Temasek Foundation in a bid to enhance resilience of future generations, the event was intended to encourage conversations on mental health among the youth and explore ways to improve support and access for communities at risk through innovative solutions. 

Before a consensus can be reached as to how resources can be conceived and channelled to support youth mental health, some misconceptions must be addressed. 

Fallacies of adolescent behaviour

Adolescents go through intense hormonal changes which directly influence brain development: for example, the production of testosterone increases 10 times in adolescent boys. Hormones impact the circadian clock in teenagers causing them to stay up late into the night and making it difficult for them to rise in the morning for school, among other things, according to Harvard Health.

All these changes are happening in a time of contradictions; adolescents are seeking a sense of identity and demonstrating a need for independence, while needing validation from their peers. While they feel emotions intensely, their rational-thinking capabilities are not yet fully developed, which makes them particularly sensitive to the judgement of people in their close circle of influence including parents, teachers, peers, and siblings.

It therefore seems instinctive to reason that adolescents are naturally moody and anti-social – mental health among the youth only appears to be declining because the issue is being talked about more often today than before. 

The truth is, and based on various studies, some of which were shared during the Temasek Shophouse Conversations, objective measures of anxiety, depression, self-harm, and suicide among youth have been increasing, especially over the past decade. The second Singapore Mental Health Study also revealed a significant association between younger age and mental disorders, with young adults aged 18–34 years having the highest lifetime prevalence as well as 12-month prevalence for any mental disorder.

In 2017, the Ministry of Health Singapore reported that mental illness was the largest contributor to years lost to disease among young people aged 10–34 years, and the second largest overall contributor across all age groups.

Studies have found that the incidence of mental disorders peak during the transition from childhood to young adulthood, or adolescence. Up to one in five people experience clinically relevant mental health problems before the age of 25, with 50% of them being symptomatic by the age of 14. So, it is no illusion; the problem does really exist. 

Another fallacy is that today’s mental health crisis amongst youth is principally caused by an overreaction to the COVID-19 pandemic. Again, this may not be entirely accurate. The rising challenges in youth mental health is likely not a new trend, but rather, one that has been accelerated by the pandemic. 

The spike in the number of mental health illnesses during the pandemic has in fact offered us some clues as to what is really driving this rise in mental health disorders among youth, especially mood and anxiety disorders, which may be fuelled especially by the over-reliance on social media and a lack of in-person socialisation. 

Social media partly to blame

Unlike previous generations, Generation Z (late 1990s to early 2010s) have been born into a digital world where social media is an inextricable part of daily life, so their sense of identity and purpose is often closely intertwined with what they consume online. Hence, we cannot have conversations surrounding adolescent and youth mental health without discussing digital technology and social media, and their impact on mental well-being.

The National Youth Council (NYC) poll released in the second half of 2021 showed that one in five Singaporean youths reported poor or very poor mental well-being during the pandemic. Having been cut off from avenues to socialise in person, many young people began turning to social media even more for information, connection, and validation. 

That same year, Samaritans of Singapore (SOS) reported that suicide rates among youths aged 10 to 29 years increased from 22.3% in 2020 to 29.6% in 2021, and deaths by suicide rose 23.3% for those aged 10 to 19 years. Factors such as forced social isolation, financial stress, and educational challenges brought on by the pandemic were listed among the key stressors.

Social media has been likened to alcohol in that it is mildly addictive, and for some young people, can lead to dependency and mood disorders. This is corroborated by an Instagram internal report, where one-third of girls who were polled said that scrolling through Instagram made them sad, but they just could not help logging in. 

Accommodative Parenting

Another aspect we should look at is “accommodative parenting.” What this means is, for example, if a child does not like dogs, the parents then avoid visiting places with dogs so the child does not have to interact with dogs. However, by removing the presence of dogs from the child’s life, the parents are taking away a huge part of what is essential to becoming well-balanced adults, which is learning how to deal with, manage and release negative emotions, and navigating through uncomfortable situations. If children are not equipped with these tools and skills when young, they are more likely to struggle with mental health later in life.

Barriers to reaching out for help

Despite increasing conversations surrounding mental health and mental illness, particularly during the pandemic, the stigma surrounding mental illness is very deep-rooted, and acts as a barrier for youths in seeking help for their mental illnesses, particularly in Asia. 

There are three main types of stigmas when it comes to mental illness, as stated by the American Psychiatric Association. They are self-stigma, which is the negative attitude and internalised shame people with mental illness have about their own condition; public stigma, which is largely based on societal norms, beliefs and mindsets, such as the notion of “loss of face,” a strong feature of Asian cultures; and systemic or institutionalised stigma, such as the lack of access to professional help, which acts as an additional barrier for marginalised or at-risk youth. 

A 2017 study on mental health stigma among Singapore’s youth revealed approximately 44.5% of respondents associated mental illness with negative and derogatory terms, while a further 46.2% of them said they would feel “very embarrassed” if they were diagnosed with a mental illness.

In this regard, parents and elder members of the family play a significant role in terms of how they respond to, or frame mental health and mental illness. The embarrassment, shame, and prejudice associated with mental illness by adult members of the family or close social circles, can prevent youths who are suffering from mental illness from reaching out for help.

Unfortunately, there is no quick fix to this issue; it is something we know exists and have been working on for a while, and it will probably take time for stigma to be considerably weakened such that more youth and parents of youth will have fewer apprehensions about reaching out for support. 

A silver lining of the pandemic, if there is one, is that it has accelerated the process of normalising mental health issues and increasing conversations around this topic. Right now, each conversation, each initiative in support of youth mental health is a step in the right direction.

Normalising mental illness

The good news is that for most adolescents and youth, mental health distress is episodic and not permanent. With the right person-centric support, most youth can successfully navigate the challenges that come from experiencing a mental health disorder, using both preventive and strength-based approaches. 

In a preventive approach, the aim is to reduce the incidence, prevalence, and severity of targeted mental health conditions; while a strength-based approach focuses on enhancing the strengths, capacity, and resources of individuals and communities to enable them to increase control over their mental health and its determinants.

A support system addressing the various concerns of the patient according to the degree of severity of the issues and their impact on everyday life is necessary, so we can deliver more personalised mental health support and intervention to every child and youth.

It is important to provide a range of treatment approaches or interventions to address the spectrum of mental health illnesses, including peer support and counselling at the schools, community, tertiary institutions and workplaces with young, entry level employees and beyond.

Because mental health distress during adolescence is largely impermanent, in most cases medical intervention is not required. Youths with anxiety and mood disorders tend to benefit tremendously from peer support as the first layer of intervention, and are more likely to seek out support from someone in their immediate circle than a healthcare professional.

Instead of focusing on destigmatising mental health, which implies an act of undoing something that already exists, which is always more difficult, let us shift our focus to normalising conversations surrounding mental health and wellbeing, which implies an act of creation that is more positive and hopeful. Concerted effort in this direction by all the stakeholders towards a culture of open conversation around mental wellbeing and acceptance of mental health conditions can go a long way. Starting from the immediate family, community, schools, and workplaces, we can influence knowledge, attitudes and practices that aim to shift cultural and social norms surrounding mental health and wellbeing. 

However, let’s first open ourselves up to accept that this journey will be an uncomfortable one, and we have to persevere, for there can be no growth without discomfort. Only then can we work towards building a more resilient society for the future, together. 

Tags: mental health, World Health Organisation

Category: Features, Top Story