Speech by President Halimah Yacob at the 9th International Mental Health Conference Together Against Stigma

Professor Norman Sartorius, Co-chair of the World Psychiatric Association Section on Stigma and Mental Illness,

Professor Chua Hong Choon and Ms Tina Hung, Co-Chairs of the Advisory Committee, 9th International Conference – Together Against Stigma,

Distinguished Guests,

Ladies and Gentlemen,

Good morning. It gives me great pleasure to join you today at the Together Against Stigma International Conference. To all delegates who have travelled afar to join us, welcome to Singapore.

Mental health conditions are becoming more prevalent worldwide. According to a 2017 study by the National Institute of Mental Health, nearly one in five adults in the US lives with a mental illness. In England, a 2017 report by the National Association for Mental Health shared that one in six people reported experiencing a common mental health problem such as anxiety and depression in any given week. The Hong Kong Mental Morbidity Survey conducted between 2010 and 2013 showed one in seven, aged 16 – 75 years had a mood disorder.

We observe a similar trend in Singapore. According to the Singapore Mental Health Study conducted in 2016, one in seven Singapore residents above the age of 18 had experienced a mental disorder in their lifetime. This was an increase from one in eight persons from the previous study done in 2010. What is worrying is that in both studies, treatment delay for some conditions remains significant.  More than three-quarters of the people with mental health conditions did not seek professional help. For example, those with Obsessive Compulsive Disorder (OCD) waited on average 11 years before seeking help.

This is quite unfortunate, because all of us know that delay in seeking help for mental health conditions can affect the efficacy of the treatment.  So why is it that this is still happening?

One reason for low treatment uptake could be due to low levels of mental health literacy in the general community. Mental health literacy refers to knowledge and beliefs about mental health conditions, which aid their recognition, management or prevention. An increase in mental health literacy could lead to early and appropriate help seeking through the ability to recognise signs and symptoms of mental disorders in self or others. This early and appropriate help-seeking behaviour is associated with improved long-term outcomes for those with mental disorders.

Another reason could be due to stigmatisation. As found in the 2017 Attitude Study conducted by the National Council of Social Service (NCSS), more than one in two persons were not willing to live with, live nearby, or work with a person with mental health conditions. These attitudes, coupled with misconceptions, make persons with mental health conditions feel that they are not accepted and respected by the people around them.  This affects their willingness to make their difficulties known, and in turn their preparedness to seek help.

It is therefore important that we step up efforts to address the issue of mental health stigma. I am glad that we are hosting this international conference today, where we can exchange views on how we can do this as a global community.

Anti-stigma work is not new. More than two decades ago, Professor Norman Sartorius established the World Psychiatric Association’s ‘Open the Doors’ programme to fight discrimination associated with schizophrenia. It was the first major international collaborative programme against stigma, involving more than 20 countries.

In recent years, we have made more concerted and coordinated efforts to address mental health stigma at a national scale. The aim is to raise mental health literacy, empower individuals with mental health conditions, expand employment opportunities, and promote social inclusion.

Singapore launched its first nation-wide mental health anti-stigma campaign “Beyond the Label” in September last year, with a focus to raise awareness of the stigma towards persons with mental health. This year, we encourage the public to talk about mental health, and to support persons with mental health in their recovery journey. The campaign has been successful in raising public awareness, and increasing societal acceptance of people with mental health conditions. I am glad that persons in recovery are also supportive of these outreach efforts as their voices and views have been heard.

Going forward, we must adopt a multipronged approach to tackle mental health stigma effectively in Singapore. First, we must continue to raise awareness of mental health among the local community through public education. Second, we need to build competencies in our healthcare and social service providers, so that anyone who needs to receive care for their mental health conditions can do so easily, without fear or shame.

Schools play a vital role in helping to promote mental well-being in young people. The Ministry of Education and Health Promotion Board (HPB) train students at mainstream schools and Institutes of Higher Learning with peer supporting skills, so that they can identify common mental health conditions and reach out to peers who need the support. To date, 1,500 students have been trained as peer supporters under this programme. I hope that MOE can expand this programme so that every school in Singapore will have peer support for students with mental health conditions.

Social Service Agencies (SSAs) in Singapore have also stepped up to educate our young through various ground-up initiatives. One of these initiatives is the interactive school-based mental health education programme, called “Do You M.I.N.D.”, introduced by TOUCH Community Services in 2017. This year, they have enhanced the programme by introducing virtual reality elements to better engage our youths.

Mental health issues can have significant impact on the workforce, as it reduces work productivity in the organisations. Therefore, we must continue to build supportive work environments, where employees are encouraged to look after their mental health, and are not afraid to seek treatment if they are unwell. In this regard, I would like to commend MINDSET for championing the mental health cause in the workplace. Through its activities, MINDSET has engaged more than 4,000 persons-in-recovery and their caregivers. To date, some 350 individuals have received job training and 170 have gained employment opportunities through the MINDSET Learning Hub that was set up in 2016. I hope that more employers will adopt inclusive hiring practices and leverage technology to enable more persons with mental health conditions to participate in the workforce.

I am pleased to note that as part of Singapore’s ten-year national Workplace Safety and Health (WSH) 2028 Strategies, the Ministry of Manpower (MOM)’s WSH Institute has worked with various stakeholders to jointly develop an online self-administered psychosocial health assessment tool – iWorkHealth 1.0. It is a free tool for organisations and their participating employees to identify workplace stressors so that the appropriate interventions can be implemented to foster mental well-being and resilience. MOM can work with the unions to encourage their members to use this tool.

Promoting good mental health is for all ages.  Let me now turn to the elderly population. The Well-being of the Singapore Elderly (WiSE) study conducted by the Institute of Mental Health (IMH) in 2013 found that one in 10 people aged 60 and above has dementia. With our ageing population, the number of people with dementia is expected to increase. To this end, the Agency for Integrated Care (AIC) has developed a “Dementia Friends” app to provide easy access to information and resources on dementia and caregiving. Through this platform, it helps educate the local community about dementia, so that they can provide better support to this group of elderly.

Above all, we must ensure that our healthcare and social service providers are trained and ready to provide the necessary support to persons with mental health. Over the years, AIC and IMH have trained over 14,000 frontline officers and community partners to support individuals with mental health issues. Today, we have over 190-trained general practitioners and 12 polyclinics that provide mental health and dementia services. All these initiatives have increased touchpoints for persons with mental health to seek support. With increased accessibility, I hope they will see mental health services as commonplace, and will be more willing to seek help early.

Peer support is also crucial in the empowerment of persons with mental health. When peers are empowered, they are capable of making significant contributions. In Singapore, we have a Peer Support Specialist programme that trains individuals with mental health conditions to use their lived experience to support others in their recovery journeys. To date, some 80 Peer Support Specialists have joined this programme to contribute in various healthcare and social service settings.

Let me take this opportunity to share with you a real life story of Dr Sarah Gordon, who is sitting with us in the audience. Dr Gordon has lived with mental distress since she was 17. Despite this, she is a leading academic in the area of anti-stigma work in New Zealand, and has been involved in the “Like Minds, Like Mine” programme since it started 23 years ago. The programme is developed and delivered by experts with lived experience. For more than 20 years, Dr Gordon has been using her experience to advocate for better mental health services, and improved societal perceptions of persons with mental health.

I am certain that we have a lot to learn from the other countries, especially those with more established national campaigns, like Beyond Blue (in Australia), Opening Minds (in Canada), Time to Change (in UK), and many others.

In closing, I would like to say that we are all not alone on this journey. Let us all stand together and unite against mental health stigma. Together, we can empower those living with mental health conditions to achieve their fullest potential, and use their lived experience to help others in their recovery journey.

I wish everyone a fruitful conference. Thank you.