Shining the Light on Mental Health

Keynote Speech, Singapore Academy of Law and Singapore Corpoate Counsel Association, 17 June 2020

Singapore Corporate Counsel Association

Thanks Jordan and Geeta. Hello, ladies and gentlemen — thank you for being here. Many of you have also sent in your questions prior to today’s session which demonstrates your level of interest, as well as the rising concerns of mental health in the legal community — that’s heartening to know. I hope this first 20mins of sharing will answer some of these questions, if not we can pick them up in the Q&A session after.

Instead of me talking into my rose pink Macbook seeing only Jordan and Geeta for the next hour, I would like us to have a conversation. So if you are game for it, can I ask you to go to www.menti.com, type in 414980. Let’s do a quick check in with ourselves: (SLIDE) How are you feeling right now? (use one word to describe if you can)

Thank you for that. This word cloud hopefully allows you to know you are not alone. Some of you asked in your advance questions on how to cope with stress and anxiety. I would like to offer my first tip of centering or grounding by inviting you to take a few mins of mental pause so we bring our racing thoughts to right here and now. Can I invite you to sit with your back straight, feet firmly on the ground and allow your shoulders to drop towards the floor away from your ears. Now if you are up for it gently close your eyes but if you are not, just lower and soften your gaze so that you take the pressure of your brain. Let the tension in your body slowly slide away. Now bring your attention to your breath. As you breathe, think quietly in your mind ‘breathing in, I know I’m breathing; breathing out, I know I’m breathing out’……… Did you know only humans can breathe by volition yet we don’t do enough of it? This is also one of the simplest yet most difficult life hacks — just intentionally breathing. Your stress hormone cortisol goes down immediately which allows you to recalibrate your emotions.

Let me please qualify that I’m no expert in mental health because I am trying my best to practise the zen philosophy that there exists few possibilities in an expert’s mind, but many in a beginner’s mind. However, I’m beyond vested in mental health. My relentless advocacy on this issue through the multiple hats I wear as a Nominated Member of Parliament, social entrepreneur as well as a leadership and life coach stems from my personal and professional experiences, including my own close shave with depression 14 years ago when my world collapsed in the most colossal manner when I was left with $16, a broken heart and a broken business. I won’t go into that here but I hope you are curious enough to go grab a copy of my book called 50 Shades of Love online which will help psychosocial support programmes for vulnerable children, including Rohingya refugees.

We are here to shine the light on mental health, so let’s start by getting a sense of the diversity and similarities in our little community here today. (SLIDE) What is the one word, that first thought, that comes to you when I say mental health?

GREAT! I was going to start this sharing with giving you some alarming statistics but let me scare you later instead because I would like us to start on a good note by having you commit to this first assertion that mental health is a critical part of total wellbeing. Good mental health is more than the absence of mental disorders, it’s an integral part of overall health. Because there is no health without mental health.

The second assertion is this: like physical health, we must see mental health as a continuum. We may think that mental health challenges only affect certain people, or some segments of our society. But if we just pause and have an honest conversation with ourselves, we will realise that we are ALL navigating along this continuum at different points in time through our life no matter who and where we are. Because who hasn’t suffered a loss? Who hasn’t had a major life transition? Who hasn’t felt overwhelmed with responsibility for another? Who hasn’t been marginalised in some way? Who hasn’t been made to feel like a failure?

So I want to start this conversation by inviting you to have empathy when you hear of someone struggling. And for those of you who are struggling, I want to assure you that you are not alone, and that it’s not a personal failing. Because wherever you are on this continuum is not solely a matter of personal agency but also largely determined by your social and workplace support structures, or lack of — which is what we are here to discuss.

This is rather simplistic but where do you think you are on this mental health continuum?

OK, now that I’ve assured you, let me scare you. Because some of you have asked what is the state and prevalence of mental health challenges in Singapore. One in seven persons in Singapore experience a mental health condition in their lifetime, and this is a conservative figure because this 2016 study by Institute of Mental Health only focused on certain conditions, and of course it was pre-COVID. The number is much higher with youths and elderly. Globally, this number is one in four persons. Will we head there? I personally think we are inching closer, in fact it sometimes feels like every other person I know is struggling with a mental health challenge which has been confirmed by a recent Profile Asia research that said nearly one in two Singaporeans reported that COVID-19 has adversely affected their mental health. This is not even thinking considering the higher risk groups such as low wage workers, single mothers, caregivers, persons with disabilities.

Pandemics aggravate the condition of those with pre-existing mental illness and cause distress to the caregivers of affected individuals. And can trigger new psychiatric symptoms even in the healthy, Some are even calling mental health the other Covid-19 crisis!

Many people — some I know and many I don’t — have reached out for help as their lives are turned upside down. An acquaintance almost killed himself a few weeks ago because he’s lost all his gigs as an event emcee. A single mother of a young boy, who lives with an elderly mother, has had her salary cut by 50%. A small business owner is in deep despair over having to retrench 80% of his staff, some of whom have been with him for over 20 years. Within a week from 2 to 8 June, 4 young people died by suicide — the youngest being 16 and the oldest 22. I could go on — with the deteriorating mental health of our migrant workers including the two suicides who were infected with COVID-19, our seniors who are struggling with loneliness and isolation especially in this Zoom-anic world. I’m also really troubled by the spike in domestic violence — in fact the other day there was one such case in my block. Her screams were just bone-chilling!

Covid-19 has illuminated the state of our mental health not as a new problem, but now a much bigger problem. How many of those with mental health conditions do you think seek help? Yes, this mental health crisis is exacerbated by this other alarming fact: Two thirds of those with mental health conditions in Singapore do not seek help because of stigma, discrimination and neglect. With stigma and discrimination comes shame and helplessness.

In the mental health sector, we often talk about 3 levels of stigma: social stigma, self stigma and structural stigma. Understanding these stigmas, and eradicating them, will help us understand how we can encourage and improve help-seeking behaviours.

According to a 2017 Public Attitudes survey by the National Council of Social Services, 4 in 10 had gross misconceptions and therefore prejudices about persons with mental health conditions. These were some of the misconceptions captured in that survey:

“Lack of discipline and willpower is one of the main causes of mental health issues.”

“Persons with mental health issues should not be given responsibility.”

“All I know (about persons with mental health issues) is what I have read online, watched movies and so I sort of know them.”

We know that this is not unique to Singapore. I remember feeling this punch in my gut when I saw this research in the UK of high school students on how they would describe someone who experiences mental health problems. There were 250 labels gathered from this study — this is just a sample. Which one have you used or thought of when you know of someone who has a mental health problem? Yes, we contribute to the stigma and discrimination.

At this juncture, I also wish to bring up this issue of “double-stigma” for certain groups. I wrote a commentary in Straits Times last year called Let’s Talk about ‘Men’ in Mental Health. In Singapore, men are 2½ times more likely to take their own lives than women. More alarming is the record 19 teenage boys who took their own lives last year, double that of the previous year and the highest since suicide numbers were recorded in 1991. According to SOS, there remains a perception among men that “help-seeking is associated with loss of status, damage of identity, dependence, incompetence and loss of control and autonomy”. In this case, the double stigma is both self stigma and social stigma. “Real men don’t cry” is not only an outdated narrative, but one that could kill more than a few good men, and teenage boys. (I wonder if this assessment by SOS resonates with you where the legal profession is concerned — does your profession encourage help-seeking?)

Another group is the LGBTQ+ community. WHO suggests that this community should be considered as a “vulnerable group”1 in mental healthcare, with the “double stigma” of homophobia and seeking help for mental health issues. For the LGBTQ+ community, specific issues include discrimination by mental healthcare professionals, as well as disclosing one’s sexual and gender identities to family without consent. It’s no surprise that the risk factor for mental illnesses is reported to be 20–30% higher for this group.

Let me now move to structural stigma. I’m sure we would all agree that the one place we need to change attitudes quickly which will have a significant impact on society is the workplace. Why? Because every employee is a member of our society. A study in Singapore some years back amongst psychologists and psychiatrists found that 90% of mental health conditions have their root cause in workplace stress. Not surprising given how much of our waking hours are spent at work, how the nature of work is changing so rapidly and more importantly, how much of a sense of self worth and dignity we derive from our work. Yet even as 72% of Singapore firms affected by workers’ mental stress, only 51% have emotional and psychosocial programmes in place. The same study by NCSS on public attitudes found that close to 1 in 2 Singaporeans were not willing to work with persons with mental health issues.

Remember I shared that only ⅔ of those with mental health challenges seek help? Well, this number goes up to 85% amongst those employed! I was pretty disturbed by these numbers to be honest. In May 2018, 25 C-suite leaders and I came together in Singapore to form the WorkWell Leaders Workgroup, a groundup leaders’ initiative to champion workplace mental wellness as a leadership priority. We meet quarterly to share, discuss and co-create inclusive practices such as peer support and allyship programmes, mental health first aid training, EAPs etc with each other as well as to collectively influence systemic challenges such as mental health insurance, mental health leave, parity in medical claims. We also recently put together a Workplace Wellness E-guide as a public service that is free to use where we share our experiences through an I.N.C.L.U.S.I.O.N Framework. You may go to our website at www.workwellleaders.org to download — I will send the link in the chat room. Please share this with your colleagues and associates.

For those of you leaders and managers out there, this is another assertion for today: in a Covid-19 world, mental health is workforce health. This is a grand opportunity for you to ask yourselves — how can you respond as leaders? What actions can your company and your managers take to improve wellbeing and mitigate some of the negative effects of COVID-19 outbreak on employers — not just as band aids but as structural and cultural shifts to your organisational psychology and DNA?

In the interest of time, I won’t go into the details of workplace adjustments for mental wellbeing. There were questions on workplace adjustments for those who return to work after recovery. NCSS did a survey and has shown that for every $1 invested in workplace adjustments in this regard, the employer gets $5.65 in returns from increased productivity, reduced sick days and medical claims. NCSS also created a Mental Health Toolkit for Employers in consultation with members of the WorkWell Leaders Workgroup. Do go to their website to download.

I would like to highlight the critical importance of modelling how we break the silence on mental health in the workplace as leaders. A senior partner in Accenture who leads a US$1bil business shared in a town hall his own experience with generalised anxiety disorder. Hsieh Fu Hua, a well known business luminary not only shared his own experience with his mental health challenge but also his experience as a caregiver to his daughter who lived with depression. I think coming forward and sharing your own experiences really speaks of a different level of leadership. Because you help open up the space of trust for your team members to know that if they have mental health difficulties, it doesn’t mean that they are less. Someone once said that we are at our most powerful the moment we no longer need to be powerful.

I will not go into the other aspect of structural stigma which is perpetuated and affected by our mental healthcare policy narratives or maybe more accurately, priorities specifically in terms of affordability, accessibility and quality. I’ve spoken much on this and they are all public information — and I post all my speeches and the responses from the Government on my Medium account. Happy to answer specific questions on our mental healthcare system later if you wish. I also would like to take this opportunity to invite you to address structural issues that you face as a sector, as a profession. Without this, the change you want to see as lawyers and as a profession will be incomplete.

Ok, now that I have scared you enough with the what, I’ll like to conclude with some of the hows. How do we identify mental health issues? How and where can we seek help?

It is too easy to go about our busy lives and not notice symptoms of physical or mental illness. Our body has built-in warning systems which alert us to the signs that we need to pay attention to. What are the common warning signs? There are many lists out there but I thought these 5 are what I can most relate to, based on what I experienced personally and how I’ve been supporting my coaching clients and others: Long-lasting sadness or irritability; Extremely high and low moods; Excessive fear, worry, or anxiety, Social withdrawal; and Dramatic changes in eating or sleeping habits. Having said that, the symptoms of mental illnesses are not crystal clear, unlike those of the flu. They occur as a cluster of symptoms and have subtleties that only a trained mental health expert can identify and diagnose so always seek help if you are not sure, whether for yourself or for your loved ones.

That night some 14 years ago now, when I was lying down on the floor with only $16 in my bank account, I was so awashed with shame and despair that for a fleeting moment, I even contemplated the distance between the big windows of my 18th floor apartment and the ground below. At 39 years old, I was CEO no more, a wife no more, a full wallet no more. A broken tape recorder was playing in my head, recounting what I had lost.

And yet, 4 long hours after lying there on the floor, something strange happened. Maybe because I had lain so scarily still, the silence of my body finally overcame the chattering mind. This is why taking these quiet mental pauses like we did at the start of this conversation is so important. Unless we stop the chatter in our minds, we are instinctively led to focus on what we lack, what we have lost — instead of focusing on what we have. This is another coping tip to share — the intentional practice of gratitude to tame that perfectionist, or that sense of entitlement in us.

So that was what I did, I focused on what I still had which I’m very convinced today was what saved me that night. Like a good lawyer, I plucked up enough courage to argue with my mind that I’ve not lost yet until I have tried everything. So I overcame my shame and ego, sought help from family and friends, and saw a psychiatrist who deemed that my condition was not clinical. Please don’t get me wrong, I clearly didn’t become ok overnight — the pain didn’t just go away, it was real and excruciating even as I slowly but surely climbed my way out of this deep dark abyss. Again, I suspect this is similar to the way you good lawyers work on difficult cases — it was a long process of discovery, determination and discipline for me.

I’m grateful every day for having come out on the bright side of that deep dark slide and am now thriving in spirit and purpose because of it. Yet I connect with the pain and possibility of every story I listen to. We are all responsible for each other’s mental wellbeing so please take time to look after each other’s, and our own mental health. It’s ok not to be ok. It’s ok to ask for help because what we can’t say, we can’t manage.

I got out of that deep dark hole because of the support system I had and still have. Everyone deserves that but not everyone has that, including with family and friends. So I’m heartened that many of the advocacy efforts by the mental health sector have borne fruits. We now finally have a National Care Hotline is a 24/7 one to call if you need support relating to COVID-19 — its 1800 202 6868. You can find really helpful tips and resources at one trusted curated site called My Mental Health in the Stay Prepared SG portal. https://stayprepared.sg/mymentalhealth/ We are still fighting for more to be done in the affordability, accessibility and quality of our mental healthcare system that should mirror that of our world class healthcare system. But I want to acknowledge the baby steps in the right direction that we are seeing in recent times!

My cousin summed up his lived experience with depression to me once, “it’s like treading water in the open seas all the time with no shore in sight — and then I finally get so tired that I have to let go and let myself drown because that’s the only way left to go. I am fighting — every moment, every day.”

So here are three invitations for you to reframe before I wrap up because I could go on for hours on this topic.

First invitation: Instead of seeing persons with mental health issues as weak and vulnerable, we should see them as WARRIORS because they are battling with their own mind. Let’s see them not by the illness they have but by the strength and courage that they show us through this war they fight every day. And support them by listening to them, including and celebrating them.

Second invitation: When we feel stressed or depressed, instead of allowing shame and fear of judgement to take over, let’s ask ourselves 2 questions: “What new things am I learning here about me?” and “Who and where can I ask for support?”. Because vulnerability is the only true gauge of strength, and asking for support is the only way for others who care about you to do something to show that care. This reframing is another coping tip.

And the third invitation, and perhaps the most important one: How can you care more for yourself? Self-care is not selfish. It’s about giving the world the best of you, not what’s left of you. We have heard this many times — we can’t pour from an empty cup, so be kind to yourself.

Thank you for listening. As a leadership coach, I would dishonour my professional code if I do not check you out. So, could you please go to mentimeter and share how you feel now as we check out?

Will leave you with this slide. Find time for you and for those who matter. May you be safe and well. ❤

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Anthea Ong is a Nominated Member of Parliament. (A Nominated Member of Parliament (NMP) is a Member of the Parliament of Singapore who is appointed by the President. They are not affiliated to any political party and do not represent any constituency. There are currently nine NMPs in Parliament.)

The multi-sector perspective that comes from her ground immersion of 12 years in different capacities helps her translate single-sector issues and ideas across boundaries without alienating any particular community/group. As an entrepreneur and with many years in business leadership, it is innate in her to discuss social issues with the intent of finding solutions, or at least of exploring possibilities. She champions mental health, diversity and inclusion — and climate change in Parliament.

She is also an impact entrepreneur/investor and a passionate mental health advocate, especially in workplace wellbeing. She started WorkWell Leaders Workgroup in May 2018 to bring together top leaders (CXOs, Heads of HR/CSR/D&I) of top employers in Singapore (both public and private) to share, discuss and co-create inclusive practices to promote workplace wellbeing. Anthea is also the founder of Hush TeaBar, Singapore’s 1st silent teabar and a social movement that aims to bring silence, self care and social inclusion into every workplace, every community — with a cup of tea. The Hush Experience is completely led by lovingly-trained Deaf facilitators, supported by a team of Persons with Mental Health Issues (PMHIs).

Follow Anthea Ong on her public page at www.facebook.com/antheaonglaytheng

A full-time human, and part-time everything else.