Mental Health Discrimination in Singapore: “When Ignorance Is Not Bliss”

(Disclaimer: We are by no means healthcare professionals or researchers, we are just a team working on bringing awareness to mental health discrimination. Do correct us if we have gotten anything wrong!)

The suicide rate in Singapore has gone up by 10% in 2019, with the most worrying age group being those between 10 to 29 years old. Despite more young people being willing to reach out for help, there is still a very prevalent social stigma when it comes to mental health. Due to societal stereotypes, mental health is seen as a weakness when it should start being seen as an illness. Let’s take a common flu as an example, when we get a stuffy nose or cough we find a way to fix those symptoms. So why do we not work on fixing our mental health in the same manner?(we’re talking 1 in 10 Singaporeans could potentially suffer from mental illness, almost the same probability as getting a common flu in Singapore)

Mental Health Demographics

Mental health has always been seen as a taboo topic in Singapore albeit a stronger awareness in the recent years. When one hears the word IMH (also known as Institute of Mental Health), the first thought that crosses their mind is “siao” (crazy in Chinese) or just a looney yelling at people or talking to themselves. Also, the thought of going for a counselling session is a terrifying thought to most people. Instead of viewing counselling and therapy sessions as a form of recovery, it is seen as a “problem with one’s self”.  Furthermore, in order to apply for jobs in the past, you had to declare your mental health conditions. Thankfully, the government stepped in to prevent mental health discrimination in the workforce, companies are now no longer allowed to ask about your mental health before a job offer is made. Thank you SG government! 

Mental Health Disorders Stats

But are all these laws and regulations enough?

As a conservative nation, many Singaporeans are apprehensive about seeing a mental health professional for fear of getting a diagnosis or being viewed as weird or crazy. And they are even more afraid to share about their mental health issues since it could possibly affect their livelihood and many other aspects of their lives. The lack of demand for these mental health services leads to a gap in reliable mental health research (how can you get reliable research without enough suitable participants?). However, research and data play a huge role in products and services offered by the economy since our economy runs on demand and supply. This lapse in research often makes it difficult for different industries to rationalise offering certain services or products for mental health. One example of this is the Insurance Industry. 

What is Insurance?

Although insurance offers financial coverage in different aspects of your life, they are ultimately a for-profit enterprise whose business model runs on underwriting and investments. Insurance companies globally offer insurance policies based on data and analysis. Intensive risk-based assessments are done by underwriters before an insurance company decides to create a new policy or review their terms and conditions. The money earned from policies sold are then used in large-scale investments for profits which will be returned to the company reserves. 

Insurance VS Mental Health

For the past two years, insurance and mental health have been at loggerheads with each other. Insurance simply does not understand mental health and does not have enough data from RELIABLE research to be able to cater to this customer base. From a legal point of view, to even fight against an insurance company in Singapore right now would be a losing battle as there would not be enough evidence to suggest that insurance companies are discriminatory towards mental health since insurance has always relied on data for their policies. Because mental health has become a huge”UNKNOWN” to insurance, regardless of the severity of your condition, all mental health issues are viewed as high risk. Furthermore, as far as the insurance industry in Singapore is concerned, there is no demand for such policies since there is only a small pool of individuals with mental health issues. Rarely do people request for such policies, and when they do, it is too late to buy these policies since they are already diagnosed or in the process of getting diagnosed.(This applies to getting policies for other illnesses, such as cancer, too!)

What can be done?

EDUCATE -> LEGISLATE -> REGULATE

The first step that can be done is to re-educate and keep reminding everyone that mental health is not a shameful problem that we should avoid (Here are some tips for talking about mental health issues). It is a problem but in order to fix a problem, acceptance and asking for help is key. Help should be easily accessible - all public hospitals and facilities should have a psychiatry/psychology department (if they do not already have one) and prices should be regulated to ensure that everyone is able to seek help without worrying about breaking the bank.

The government has to accept that mental health issues are still stigmatised, even between mental health patients. One potential step to take could also be to change the name of the Institute of Mental Health (IMH) to the National Mental Health Centre. This would tie them back to government-run healthcare institutions (e.g. National Skin Centre, National Cancer Centre, National Heart Centre) and make them sound less daunting (the word institute sounds like a prison in my opinion). IMH could be turned into a specialist centre, and psychiatrist/psychology departments could be expanded in general hospitals and clinics for milder cases. This would also improve accessibility of mental health services since they would be more spread out geographically. 

We can take some lessons from countries nearby such as Japan and Korea to deinstitutionalize and improve community mental health as a goal. This could include not allowing involuntary psychiatric admissions and ensuring that mental health facilities and services are geographically spread out evenly for equal access. 

If mental health is normalised and easily accessible, more individuals would step up to seek help for their mental state (mild or serious). This increase in number would help with quality research and data being released, which will result in an increase in demand for mental health related products and services. 



 

References
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Korean Mental Health Act 
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Picco, L., Lau, Y. W., Pang, S., Abdin, E., Vaingankar, J. A., Chong, S. A., & Subramaniam, M. (2017). Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: Findings from a cross-sectional survey in singapore. BMJ Open, 7(8), e018228. doi:10.1136/bmjopen-2017-018228
Subramaniam, M., Shahwan, S., Abdin, E., Goh, C., Ong, W., Tan, G., . . . Chong, S. (2020). Advancing research to eliminate mental illness stigma: The design and evaluation of a single-arm intervention among university students in singapore.Frontiers in Psychology, 11 doi:10.3389/fpsyg.2020.01151
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