I have been a keen participant observer to changes in our mental healthscape over the past eight years - as an advocate, a youth mental health professional and from my own lived experiences. In this essay, I will share some of the narratives that I observed are underway, and my best hopes for us going forward.
Recovery: Embracing Possibilities and defining New Normals
Recovery is not the exception but the expectation. Traditionally, mental health professionals anchor themselves in what psychiatrist Robert D. Laing has called “the medical model”: often adopting expert positions, couched in deficits-driven questioning, and steeped in problem-focused approaches, as they seek to understand, diagnose and administer medicalized treatments. Increasingly, however, there’s an unmistakable shift towards embracing person-centered, strengths-based approaches to discovering the brilliance of our clients - seeing them as experts of their own lives, and capable of change. This shift could only have taken place with the emergence of more advocates sharing stories on the realities of recovery and achievement of meaningful lives after illness; and a growing openness towards disclosure, with a generation hopeful of achieving an accepting and inclusive Singapore. Having been a facilitator of a support group for persons with anxiety and/or mood disorders for five years, I had a ringside seat to see how each participant (re)defined their ‘new normal’, working at coping despite the stressors and still generously offering informal support to one another. Their resilience and ability to bounce back stronger inspires me.
In particular, I am encouraged by the wave of peer support specialists (PSS), persons with mental health issues (PMHI) employed to work in multidisciplinary teams as professionals in their own right to catalyse recovery among clients. Harnessing credibility earned from their own lived experiences recovering from mental illnesses, they provide a vivid reminder of the possibility of recovery. Furthermore, by using their gifts of adversity, they cheer peers on in their journey towards wellness. In 2017, more than 40 were trained and 16 were placed in various mental healthcare settings. A former PSS, Lee Ying Ying, even founded SOAR (School of Ability and Recovery) to serve as a recovery college to reduce stigma in the community through education, honest conversations and meaningful interactions.
The testimonies of these wounded healers provide hope and inspires mutual support in the healing journey. Sometimes, it takes one to know one. While the peer support movement is still in its infancy, such activism, involvement and participation of PMHI indicates its growing empowerment. Michel Foucault (author of the 1961 classic, History of Madness) would have been glad to see the recovery movement led by peers using their voices of experience, disrupting the ‘monologue by reason about madness,’ rupturing the previous silence of PMHI on mental health issues.
Advocacy: Energy from the Ground Up
Stigma is a well-known barrier towards help-seeking and recovery. While efforts at challenging stigma in the community have been mostly led by social service organisations, there are increasing ground-up efforts to raise awareness through greater mental health literacy, access to resources through empowerment, and peer support.
As the Founder of the National University of Singapore (NUS) Mental Health Wing, an advocacy group (2015 - 2017), I am constantly surprised to find many like-minded peers dedicated to raising awareness on the campus. So much so that my co-heads (Charmaine and QiuLuan) and I decided to focus our energies on connecting and raising the capacity of these peers instead. We encountered not one but four advocacy groups: one in each Residential College in University Town (CAPT Support, Love USP, Love Tembusu, RC4Wellness)! Our combined efforts and advocacy might have led to more administrative support through the creation of a Student Support Services (S3) office in NUS in 2018 to support students’ well-being. We are also inspired when meeting our counterparts in other universities - SMU Peer Helpers, NTU Peer Confidantes and Yale-NUS’ P.S. We Care who are already providing an emotional safety net for their peers, through a safe space for conversations with the supervisory support of counsellors. There is an unmistakable energy from the ground up!
Potential: A Stronger Community Approach
A commonly cited statistic in Singapore is that despite one in seven persons in Singapore experiencing a mental health concern at one point in their life, three in four do not seek help. However, in such a treatment gap lies unique opportunities to mobilise the community through task-shifting by participating in mutual helping, early detection and providing social support.
I was privileged to spend two weeks in 2015 shadowing KESWAMAS, a community mental health team in Yogyakarta, Indonesia. Freeing PMHI who are pasung (physically restrained) taught me that while one can be freed of the physical chains, the social chains remain. Hence it is important, to heal not just the individual but also their family (caregivers) and community. As such, on top of supporting the client and caregiver, KESWAMAS works with kader (community health volunteers, mostly housewives) to reach out to the community, educating and empowering them with relevant skills and knowledge to support PMHI, through the Desa Siaga Sehat Jiwa (Village Mental Health Readiness) programme. Truly, in recovery, it takes a village to heal PMHI. A community approach helps to dissolve invisible chains and strengthen bonds.
Applying this concept to Singapore, I have a dream that we can have a mental health first aider in every home. Dare we envision a time when all our youths are mental health literate? As psychological first aiders, they can erode generational stigma within the family, and help to build a more understanding and supportive Singapore. Consistent with the shift in emphasis from institutional to community care, we also need stronger mental healthcare support (and funding) at the primary level and the community to rally behind to support PMHI, for recovery-in-place to happen.
Hope: Working Together towards Mental Wellness for All
The past ten years have seen significant improvements to improve access to mental healthcare resources through many firsts: including the 2007 National Mental Health Blueprint, 2010 Singapore Mental Health Study and 2017 Community Mental Health Masterplan. Nonetheless, stigma persists as a barrier towards help-seeking and recovery. For one, the dilemma of disclosure (risking exclusions from employment opportunities and insurance) continues to plague many PMHI. We need not only to reduce social stigma and interactional discrimination through awareness-raising efforts, but also tackle structural stigma (discriminatory laws, institutional practices and social policies). These can help to alleviate self-stigma, improving recovery outcomes and help-seeking behaviours, reducing unnecessary suffering. In the sector, there is a common saying: ‘there is an i in illness and a we in wellness.’ By working together, we can achieve mental wellness for all in Singapore. Let us start by prioritising our mental health, taking better self-care, showing support to those around us and speaking out against stigma!
Yi Feng is an aspiring social service leader. Trained in social work and solution-focused practice, he is a Youth Support Worker at Community Health Assessment Team (CHAT), a national mental health assessment and outreach programme for young people aged 16 to 30. He has a dream, to achieve mental wellness for all (youths) in our Southeast Asia region. He is enthusiastic about martial arts (particularly Wing Chun) and takes superheroes seriously.