From The Straits Times    |
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Many local celebrities have, in recent years, opened up about their mental health struggles publicly. Among them are actresses Jeanette Aw and Michelle Chong, who have shared their experiences battling depression, as well as personalities like Munah Bagharib and Hanli Hoefer, who have discussed their anxiety-related struggles on social media. Even business leaders such Piyush Gupta, CEO of DBS Group, and Chng Kai Fong, former managing director of the Economic Development Board, have opened up about their mental issues.

But when we were compiling the Her World Health and Wellness Report 2022 – where we surveyed over 6,000 women in Singapore – 51 per cent of respondents said that they would rather solve their own problems before asking for help. And as highlighted by an October 2020 article by The Straits Times, a survey by communications consultancy Sandpiper Communications found that most young people are still uncomfortable discussing their mental health, despite increased stress from the Covid-19 pandemic.

If public figures among us have normalised talking about their mental health, why are most of us still uncomfortable discussing these issues?

Stigmas are still prevalent

As it turns out, while an increasing number of people are open to sharing their experiences, the stigmas attached to mental health conditions are still prevalent, and the public perception of mental health issues still has a long way to go.

“Although there is more awareness about these conditions, many people still do not possess a good understanding of them. For example, there is uncertainty on how depression or anxiety actually looks like, or the many forms they can take,” says Dr Annabelle Chow, a clinical psychologist at Annabelle Psychology. She adds that despite the distinct differences between various disorders, they are often categorised as a whole, and that those with mental health issues are commonly portrayed in the media as “dangerous or unhinged”. While both are considered as mood disorders, depression is typically associated with a persistent feeling of sadness, while anxiety is characterised by fear and worry.

“As such, people still fear the judgement of others, like being viewed as ‘less’. They might also feel that it is useless to talk about their issues as it does not make them go away.” Her sentiments are echoed by Pearlene Lim, a senior clinical psychologist at Promises Healthcare. “In my experience, stigmas are one of the biggest reasons why many people refrain from speaking openly about their mental health struggles. I personally see this more in adults than in young people, as adults typically have ‘more to lose’, like their relationships or careers,” she says.

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Jean* (not her real name), 32, is one such example. The marketing manager – who has been at her job for the past three years and on antidepressants for the past four years – shares that she has asked her supervisor for mental health days, but that “more often than not, they are not approved”. She lets on that she does not tell her colleagues about these requests as she does not want them to view her “in a
less favourable light”.

While not all workplaces are supportive of mental health issues, the good news is that a growing number of companies is starting to recognise the value of catering to the needs of their employees.

“One of my managers used to say, ‘People first, and profits will follow.’ Organisations that prioritise employee well-being, and have diversity, equity, and inclusion policies in place, are likely to find that these policies are lower-cost solutions that could have significant ROI in the long term,” says Eugenia Ng, director at recruitment firm Michael Page Singapore.

In fact, a recent US-based study by investment and insurance company The Hartford found that 71 per cent of employees claimed that deteriorating mental health had an adverse effect on the company’s financials.

Lack of awareness

If the desire to deal with one’s mental health privately does not stem from discomfort, then it might simply be that we are not aware that our mental health is on the decline.

“We generally don’t know what we don’t know, and if symptoms are mild and/or infrequently experienced, it may be easy to dismiss them as something else. Many mental health disorders often co-occur or have overlapping symptoms with other illnesses, whether physical or mental. This can make it hard to recognise that we are suffering from mental health issues,” says Pearlene.

She explains that in her experience, most people only realise that there is an issue to be addressed when they experience significant functional impairment, such as being unable to work or perform activities of daily living.

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“For example, in the case of dysthymia [a mild but long-term form of depression], patients may think that feeling ‘this way’ is normal as they are less functionally impaired compared to someone with major depressive disorder.”

She adds that they were usually raised in a home with a lot of family conflict, which makes them perceive their moods as normal.

“They typically can function well and, only when comparing situations when talking to friends, realise that their emotional responses to stressors are significantly worse. It is when they are encouraged to see professionals that they realise they have a mental health issue.”

Seek help if you need it

Family and friends are an invaluable source of support, but trained professionals can provide a different, non-biased perspective.

“Psychologists are trained to identify and change certain thought and behavioural patterns that contribute to a person’s distress. We also equip them with skills to not only cope with the challenges they might face, but also to grow and thrive, improving their overall quality of life,” says Dr Chow. One can also consider online therapy. Singapore-based telehealth companies that offer this service include Safe Space, Whitecoat and Lavica.

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“Online telehealth sessions are becoming commonplace and studies have shown that, in many circumstances, they can be an effective alternative to in-person therapy. That said, it is by no means a complete substitute for in-person therapy, so it is important to speak to your psychologist about what is best for you.”

The Government is also playing its part in raising support and awareness for mental health. In April 2022, the BetterTogether initiative was launched to champion mental health literacy, support and destigmatisation, which will entail “surveying perspectives and collecting feedback” and “[conducting] plenary sessions and dialogues on mental health and well-being”. The official statement goes on to add that the eventual goal is to “consolidate ground concerns and proposals for legislative and policy changes in this regard”.

This is on top of the “Beyond the Label” campaign that was launched by the National Council of Social Service in 2018 to address stigmas faced by persons with mental health conditions. One of its initiatives was the launch of the portal, a one-stop website with resources to help people cope with stress and improve their well-being.

As for how we as a society can encourage both ourselves and those around us to be comfortable talking
about our mental health issues, it can start with a few simple steps.

“Firstly, we can reframe how we view mental health and mental illness. While these terms are often interchangeably used, they are not the same thing. A person can experience poor mental health and not be diagnosed with a mental illness. Likewise, a person diagnosed with a mental illness can experience periods of physical, mental and social well-being,” says Voon Yen Sing, senior assistant director of Clinical Services at the Singapore Association for Mental Health.

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She adds that we can also cultivate an understanding that we all have to care for our mental health, just as we do our physical health, and be more aware of our approach towards mental health and mental illness.

“Choose to be informed about the facts – be open to attending awareness-raising events or check out credible sources to demystify commonly held stereotypes. And then, examine your own judgemental thinking or unconscious biases.

“Finally, choose your words carefully as they can affect the attitudes of others, and listen actively to people’s perspectives without giving them advice prematurely,” she advises.

Watch out for these common symptoms

There is no litmus test that can let someone know if they are struggling with their mental health or if it is the result of a physical illness. A medical practitioner will be best placed to make a diagnosis. We asked
Voon Yen Sing, senior assistant director of Clinical Services at the Singapore Association for Mental Health for some common symptoms that may be indicators.

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• Inability or reduction in ability to carry out daily activities or handle daily challenges and stress
• Changes in emotion, such as feeling excessively sad, anxious, guilty, angry or fearful
• Confused thinking or difficulties in concentrating
• Changes in social interaction, like avoiding friends and social activities, or exhibiting inappropriate behaviours like talking excessively
• Changes in sleeping habits or having low energy

How to help and lend support

Pearlene Lim, a senior clinical psychologist at Promises Healthcare, suggests some ways you can go about being a shoulder to lean on.

Recognise the signs: If there’s been a significant change in their behaviour and ability to function, talk to them to find out more and encourage them to seek professional help if needed.

Know the resources available: Take note of the various helplines they can reach out to and direct them to reputable online resources so they can find out more about their condition. However, it’s important that they do not self-diagnose.

Listen actively and accompany them to see a professional if necessary: Try to empathise – it can be scary for them to be vulnerable when talking about their struggles.

3 Tips for regulating your mood

1. Schedule worry time
It is natural to worry when you have a seemingly impossible workload, but by scheduling a specific time to worry and reflect on the tasks on hand, it allows you to create space to focus on those that are of immediate importance.

2. Practise STOP
Stop whatever you are doing, and take a short, mindfulness break: Focus on your breath, how the air feels on your nostrils and how your body moves as you breathe. Observe the sensations in your body, thoughts you are having and emotions you are feeling. Then, proceed with what needs to be done.

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3. Have self-compassion
When the voice of your inner critic becomes too loud, it can bring excessive negativity into your life. Acknowledge this voice, recognise what is relevant and what is not, and learn how to discern which feelings and thoughts will be beneficial in the long-run, and which ones to discard.

This is the final instalment of Her World’s What Women Want series.