In July this year, a 16-year-old student at River Valley High School was charged with the murder of a fellow 13-year-old schoolmate on campus. The mental health of adolescents here quickly became a focus of public interest.
But look a little deeper and you'll see that it has been a matter of growing concern in recent times: According to Samaritans of Singapore, suicide was the leading cause of death for those aged 10 to 29 in 2019, the highest number in that year compared to those in other age groups.
When considering those statistics and the recent shocking incident, the condition of adolescents is of particular concern. What can we as a society do to make things better?
READ MORE: River Valley High School tragedy: Student seen holding axe, asking others to call police
The root cause
While there are many factors that contribute to the mental health of a young person, experts generally agree that those with traumatic childhood experiences are more prone to developing mental health issues.
"These events include physical, emotional and sexual abuse, neglect, parental divorce, the death or abandonment of a parent, or bullying in school or at home.
They send damaging messages to a young person's fragile sense of self, and make them vulnerable to feeling like they are helpless, hopeless, useless or insignificant," says Dr Mark Toh, a clinical psychologist at Promises Healthcare who has extensive experience in working with children and adolescents.
His sentiment is echoed by Lee Yi Ping, principal case manager and programme lead at Community Health Assessment Team (Chat), a national outreach programme under the Institute of Mental Health that supports young people with mental health issues.
"When these negative emotions become persistent, they can affect a young person's ability to function in their daily life," she says.
As it stands, emotional neglect is common in Singapore. The Singapore Mental Health Study released last year found that 46.5 per cent of adult Singaporeans reported emotional neglect as the most frequent adverse experience in their childhood.
Plus, adolescence is typically a tumultuous time in a person's life. "This period between childhood and adulthood is often filled with anxiety. There is self-doubt, confusion and the pressure to conform, on top of feeling like they have no control over the stressors they face," adds Dr Toh.
Here's the thing: The youth of today not only face different challenges from those of 10 to 20 years ago, but also bigger ones.
"Given the significant improvement in population mobility and communications, youths now face greater competition in education and at work. And with the advancement in technology, many jobs are at risk of being displaced, so there's more pressure on them to excel," says Yi Ping.
The prevalence of social media also has a huge part to play in the way people feel about themselves.
Much as the various platforms make it easy for them to gain acceptance, make connections and earn recognition, they also facilitate the opposite effects.
"The use of social media is often a solitary affair, and a young person may become distressed if they feel disappointed or rejected by the responses received. This distress can be exacerbated by cyberbullying, particularly when the cyberbullies hide under the cloak of anonymity. All these intense emotions can make them develop depression or anxiety."
And then there's the modern condition that is gaming addiction. According to Dr Toh, those addicted to gaming are twice as likely to be depressed than those who do not game.
In addition, the damage of excessive gaming among children can lead to shortened attention span, difficulty concentrating, struggles with delayed gratification and weaker memory.
The fallout from the Covid-19 outbreak has also been detrimental to this age group.
"Children may be particularly vulnerable to the effects of the pandemic and circuit breaker because of their limited understanding of the events. Their coping strategies are often limited, so they may not be adept at communicating their fears or emotions to adults," he says.
"The closure of schools, separation from friends, lockdown at home, disruption to their regular routine, and media coverage of the event as a 'crisis' could also have added to their stress."
Remove the stigma
Most of the time, adolescents suffer in silence, and there are a couple of reasons why they choose to do so. The pervasive stigma surrounding mental health issues is one.
"Young people have a desire to achieve independence, so they may prefer to be self-reliant when it comes to managing mental health challenges."
Coupled with the fear of being judged for experiencing mental health-related difficulties, and they may shy away from seeking help," explains Yi Ping. She adds that cost is also an inhibiting factor.
That's not to say that help isn't easily available: The number of mental health support services for young people has surged over the last decade, and there are now plenty of subsidised, if not free, offerings.
For example, a subsidised first-time session with a consultant at IMH for a child or adolescent costs $46, with subsequent subsidised sessions costing $43.
Also, under the Chronic Disease Management Programme (CDMP), patients with schizophrenia, major depression, bipolar disorder and anxiety can withdraw up to $500 from Medisave per year to defray the cost of outpatient treatments. Each claim is subjected to a 15 per cent co-payment in cash.
Then there are concerns about confidentiality. "They're left to wonder, 'Who is the therapist or counsellor going to tell?'
This is exacerbated by the fact that many sources of help require parental consent for youths under 18, which becomes even more of an issue when their mental distress is also caused by their parents," says Asher Low, the founder of Limitless, a non-profit organisation that supports youths with mental health issues.
In an ideal world, every young person grows up in a loving home where they receive guidance and have their needs met. But since that isn't always the case in the real world, we as a society should try to lend a helping hand where possible.
Not sure where to start? You can do your part to destigmatise mental health issues. Asher suggests talking about them the way you would about a common cold or flu, on top of practising empathy.
"This takes away its power to isolate someone struggling with it. More open discussions about mental health demonstrate that it's okay to not be okay," he says.
Yi Ping also suggests keeping a lookout for young people who may be going through tough situations, such as significant loss in the form of a break-up or death of someone close, an illness that can trigger a change in mood, or a personal crisis that impacts their self-esteem like doing badly in a major exam.
"Accompanying them to attend the first or second session with a professional can go a long way in making them feel assured about seeking help, so they stay in the help-seeking process," she says.
"With timely and appropriate medical and/or psychosocial interventions by formal sources of support, coupled with informal sources of support like family and friends, our youth stand a better chance of recovery and the capability to pursue their ambitions in life."
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Why are more youths in SG struggling with mental health issues?
Chong Ming Xiu, 34, founder of Campus PSY (Peer support for youths)
"People struggling with mental health tell us they're not sure what help is out there — apart from hospitals or the Institute of Mental Health.
Actually, there are many NGOs and clinics you can access confidentially. For example, the Samaritans of Singapore helpline is free and open 24/7.
Campus PSY also works with six local agencies that focus on community-based mental health services for children and youth: Acceset, Boys' Town, Caregivers Alliance Limited, Limitless Singapore, Singapore Association for Mental Health, and Singapore Children's Society. You can find more resources on our Tiktok and Facebook page."
Anya Low, 25, design management student
"I think it can be helpful to follow mental health pages on social media. I prefer to follow organisations as I find them more trustworthy. I like the Instagram account @letsbreaktheshame — it's run by 20 people in their teens, 20s and 30s. They post something about mental health every day."
Elly Yeoh, (@elly. minty), 28, founder of mental health service Shin.tsugi
"I'm part of Tiktok's Youth For Good mental health programme. I create educational content about Mental Wellness in creative formats such as singing, journalling and calligraphy.
For example, www.shintsugi.com offers personalised mental wellness workshops. We tap on the therapeutic effects of self-expression, art and fandoms, to help people discover their own best-fit approach to mental wellness.
If you can't get together in person, I find that it helps to catch up with friends on social platforms, and share an article or meme to inspire them or make their day. I also recommend using apps like Teleparty to watch Netflix together with friends, or host a game night together online."
Marlene Low, 21, art student
"It's tempting to text… but if you can meet face to face, it gives you a different perception. During home-based learning, we did video presentations. We could record ourselves and edit out the mistakes. It was like making a Youtube video. When it was time to present, you just sent the link and everyone watched it."
"Then we had to do a presentation in real life. I saw all the people present in front of me, and I got extremely nervous… but I did the presentation anyway."
"Afterwards, I felt proud that I had handled my nerves. These social experiences help you grow. To learn and grow, you have to experiment, sometimes even show your mistakes."
Teresa Tan, head of Public Policy, Singapore and Southeast Asia, Tiktok
"Tiktok's Youth For Good initiative aims to inspire a ground- up movement to normalise conversations around mental health, and create a strong peer support ecosystem.
We hope our wellness educators can encourage people to reach out and seek help from the local non-profit organisations available.
As an example, one of our non-profit partners @limitless received strong traction for its first-ever Tiktok video — close to a hundred people reached out to it for help.
Youth For Good is a collaboration with the Ministry of Culture, Community and Youth (MCCY), Ministry of Education (MOE) and National Youth Council (NYC)."
This article was first published in Her World Online.