Motion on Advancing Mental Heath — Speech by He Ting Ru

Mr Speaker

Today, many would rightly acknowledge the work done in improving access to treatments and interventions for those suffering from poor mental health and the breaking down of stigma. I also note that many officeholders, including the DPM, are slated to speak, and this is attention long overdue. However, today I wish to focus my speech to call for a more holistic and well-rounded approach to mental health which looks beyond lifting people out of situations of poor mental health. I will speak on three broad areas: First, a call for a thriving and flourishing society to be built into policy formulation as an objective. Second, for institutions and agencies to include and accurately promote good nutrition as part of our National Mental Health and Well-being Strategy. And third, for the removal of structural barriers to mental health support and therapy. 

When we look at the larger picture, mental health is a fundamental part of our overall health. Globally, the World Health Organisation has indicated that depression is one of the leading causes of disability, and noted that people with severe mental health conditions die as much as two decades early due to preventable physical conditions.

194 member states, including Singapore, have signed up to the WHO Comprehensive mental health action plan 2013-2030, which commits us to meet global targets for transforming mental health. The plan is wide-ranging, and includes ensuring that member states strengthen information systems, evidence and research for mental health to better understand the needs of the local population, ensuring that data is disaggregated by sex and age, and reflects the diverse needs of subpopulations. It calls for early intervention through evidence-based psychosocial and non-pharmacological interventions based in the community, avoiding institutionalisation and medicalisation. 

While many of these points are echoed in the National Mental Health and Well-being Strategy, as well as in the government’s recently announced push for more community-located delivery of mental health services, I hope that we can also take inspiration from the ethos behind the WHO plan, which I think is summarised best in the WHO’s constitution. And I quote – ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ – unquote.

Many of us know instinctively that this definition makes sense and should be what we aim towards as a society; mental and social well-being does not mean just the absence or suppression of depression, psychosis or any other mental health condition. What we need to consider as part of today’s debate on mental health, is to look BEYOND decreasing rates of mental ill-health, and to discuss how we can elevate well-being. Having a thriving society has to stem from a study of how we can facilitate human flourishing. It is about, in the words of Lyubomirsky, ‘growing the seeds, rather than removing the weeds’.

I do not mean this replaces the important and hard work undertaken by psychologists, psychiatrists, therapists and other workers and volunteers in the mental health sector who spend so much of their life working to tackle challenges brought about by mental illness and neurodiversity. It is without doubt that we are in a much better position today to understand, reliably diagnose and provide the necessary support, medication and treatment for those suffering from various neuropsychiatric conditions. Workers’ Party MPs have previously called on the Government to ensure those in the mental health sector are supported in their work, for instance, by providing sufficient staffing and by facilitating financial support for those seeking the qualifications to become a counsellor.

That said, we should not rely solely on the disease model that has dominated psychology since the Second World War. Instead of asking solely, “how can we make miserable people less miserable”, I would like us to also ask: “what is right with you?” Research in the last two decades has given us a better understanding of how we can measure and apply concepts of engagement, meaning, accomplishments in achieving well-being for individuals, organisations and societies, and that these areas are clear means by which we can improve well-being. In short: how we can go from ill mental health, to promote maximum flourishing.

This is not just about positive thinking or even toxic positivity, but instead it is about figuring out how we can support our citizens in their journey to become the best versions of themselves. The research shows that understanding and ultimately playing to our strengths has the added benefit of helping us face adversity in a way that does not break down our well-being. It is why we end up finding that people can still thrive in conditions of deprivation or conflict.

We need to entrench ideas of harnessing our strengths as individuals and as a society, and use our own unique strengths as a solid foundation to build our future path forward. We can start this by helping our people understand what their own strengths are. The strengths-based approach is already being undertaken in the social work sphere, and I believe that the experience that MSF has here could inform more opportunities for government agencies and institutions to be able to apply this approach to other areas of policy.

As policy makers and political leaders, we should not look to the lowest common denominator, and perpetuate an environment which takes away the factors that our people need to flourish. Aside from strengths, meaning, accomplishment and gratitude, another area which promotes well-being is to identify an up-to-date common set of values as a nation which we embody. 

To support this expanded approach to mental health, we should consider findings from existing longitudinal research on wellbeing. Associate Professor Siok Kuan Tambyah and other researchers repeated their Quality of Life Survey in Singapore in 2022, and found a significant decline in Singaporean’s satisfaction with life between 2016 and 2022, and drop in overall well-being between 2011 and 2022. The authors also note that Singaporeans have quote – “become less happy, enjoyed life less and have felt a decreased sense of achievement. [… They also] felt they did not have control over their lives and a sense of purpose” – unquote. 

An interesting observation from this research is also the positive correlation between Singaporeans’ satisfaction with five out of the six recognised democratic rights and their overall satisfaction with life (p 113). The findings further indicated a decline in satisfaction with democratic rights across the years in 2011, 2016 to 2022. The authors, also note that that more in-depth research is required to determine specific concerns and to implement initiatives to better engage the citizenry, and I believe this area is worth looking further at.

Presently, there are also ongoing studies that delve into the allocation of financial resources within Singaporean families towards the family’s well-being. These findings will be instructive, particularly in an environment marked by stressors associated with resource scarcity in the wake of cost of living and climate-related concerns. Such studies may also prove to be pivotal in shaping our national policies spanning economic, housing, health, and social domains – all of which are aimed at fostering a holistic enhancement of overall well-being. We can leverage such findings to set the trajectory of our policies to better support Singaporean families.

The research initiatives I mention above also dovetail nicely with the WHO recommendations to ensure that high quality research and data are available to specific societies and populations, so that we better understand the driving factors that enable Singaporean families to flourish.

We also have to consider high-quality research in areas such as positive physical health. Studies in the US and Europe have found that patients with more optimism suffer from statistically significant lower rates of cardio-vascular disease, and decreased mortality. While the effects are comparatively smaller for other diseases such as infectious illness and cancer, they remain noteworthy. At the moment, I am not aware of similar research being done in Singapore to explore the potential correlation between traits such as optimism and improved physical health. If the findings are replicated here, this would further reinforce the call to delve deeper into understanding how to enable our citizens to flourish beyond just being free from physical and mental health pathologies, but also to flourish in all aspects of their well-being.

Next, no discussion about enhancing and protecting mental health in a holistic manner can be done without mentioning our diet and lifestyle. The emerging field of research about the effect that our every day diet has on our well-being and mood is one that has much to offer. For example, some studies have found that individuals on traditional Mediterranean and Japanese diets – which are high in vegetables, fruits, unprocessed grains, fermented foods, fish and seafood – experience a significant reduction in the risk of depression, ranging between 25% to 35%. Conversely, it has also been found that a diet that is high in refined sugars correlates to impaired brain function. 

It would be a shame if we do not seriously consider the scientific evidence surrounding foods that support good mental health, and implement policies that make it easier to ensure that our diets complement and support our brains. The field of nutritional psychiatry is an emerging one. Nevertheless, I hope that we can use our education and public health systems to include ways in which we can facilitate incorporating eating for a healthy brain into our everyday life. This means eating more varieties of vegetables, fruits, and less processed foods, as well as ensuring that we have adequate intake of healthy fats and fibre — all of which also promote good physical health. 

We can begin by intensifying efforts to amplify and update existing healthy-eating initiatives. The existing Healthy Dining Programme should emphasise clearly that healthy eating goes far beyond just merely counting calories. Aside from eating to reduce chronic illnesses such as diabetes and cardio-vascular disease, it should also consider the importance of consuming a variety of food types to promote maximal healthy brain function. Steps to increase awareness of and to reduce our consumption of refined sugars — which are bad for both our physical and mental health in the long-run — through the introduction of the Nutri-grade sugar level labelling laws are a good start. We should also explore the possibility of heeding the WHO’s calls to implement an effective sugar tax that is equitable and does not punish those on lower incomes.

As the affordability of healthier food options remains a barrier to achieving healthy dietary practices, we must increase accessibility to healthier and more nutritious foods to as wide a segment of the population as possible. In a fast-paced society with escalating concerns about the ever-rising cost of living, the prospect of incorporating whole foods, often more expensive than readily available highly processed options, adds another layer of concern. With a global surge in food prices, it is the lower-income groups with the least resources that would face greater barriers to healthier food options.

The costs — both financial and also time costs — associated with eating healthily have to be mitigated further, to ensure that the ability to eat for a healthy brain is not one which is exclusive to those with greater economic means. 

One way to achieve affordability and accessibility of healthier food choices is to ensure that our government policies really lean into supporting the promotion of healthy diets. For example, in our drive to reach 30 by 30 for food sufficiency, we need to ensure that the bulk of this would meet nutritional criteria. The WHO has indicated that countries can stimulate the supply of nutritious food by creating large-scale predictable demand and making production and procurement of such foods more economically viable, and I believe that changes to our policies can be made to accommodate these aims.

Other areas which are promising and should be given more attention include supporting research which is specific to our geography and population, especially as it appears that we do have unique biological responses to certain foods. I spoke during last year’s COS about the work being done by local enterprise AMILI to better understand the gut microbiome in local populations. Given the gut-brain axis links the emotional and cognitive centres of the brain with peripheral intestinal functions, we should continue to pursue research in this area to better understand our own population’s needs and which foods would best support mental health and well-being, and to harness newer technologies such as artificial intelligence to bring down the costs associated with tailoring healthy food choices to specific sub-groups in the population. 

Employers too, in their drive to support employee well-being, should consider ways in which to encourage healthy and mindful eating. Small initiatives such as offering fruit and nut instead of sugary snacks and biscuits in the office pantry, providing more accessible storage and food preparation areas, providing access to water in more places, and having regular healthy eating weeks or events to help employees understand how to incorporate eating for a healthy mind and body into their daily lives.

Lastly, to further enhance mental health support and break down the social stigma, we can do much more to continue removing barriers to mental health support and therapy. 

In respect of the upcoming guidelines for insurers to adopt fair and responsible practices towards persons with disabilities and those with mental health conditions, our regulators should ensure that guidelines prohibit insurers from declining applications on the basis of their disabilities or mental health conditions. Any differential treatment of persons with disabilities and mental health conditions should also be justified by accurate and relevant actuarial or statistical data, and there should be a mechanism by which insurers justify this. Insurers should also be required to make transparent their grounds for differential treatment or rejection of applications from persons with disabilities or mental health conditions. This will go a long way in ensuring no one is left behind.

The current lack of regulation of mental health workers is another area which warrants more attention. While it is undoubtedly the case that there are many dedicated and committed workers in the mental health space that are doing amazing work in raising the well-being of our society, we have to move beyond providing guidance on professional and ethical conduct for psychologists, councillors and therapists. Setting up a regulating body with input from bodies such as the Singapore Association for Counselling and Singapore Psychological Society will ensure a universal standard of care and quality of care in the provision of such services to support mental health, and to ensure that there is at least a baseline level of training, expertise and ethical practice that underline the provision of such services. We should also look to establish safeguards, such as requiring those who work with children to be subject to mandatory background checks, for the protection of vulnerable minors.

Finally, I would like to reiterate a policy call from my Cost of Living speech last November. I hope that the government would consider allowing the use of Medisave to access mental health services in other practice settings aside from purely psychiatric settings, particularly in the private sector. It would not be a big step to use our 3Ms framework to better improve access to mental health treatments and interventions, as Medisave is already being approved for use for mental health services at places like IMH and polyclinics. 

To close, although we have experienced headwinds in recent years, and are rightly focusing on how to support increasing incidences of poor mental health, it would be remiss of us not to look to a more holistic view of how to increase well-being. We have to build on research about how positive interventions at the personal, community and policy level can have a protective factor through challenging times, and also to look at how our nutrition can better support us in our quest for good mental health. All of us have a role to play in working to improve our own well-being, and given that happiness spreads more easily than depression, the hope is that increased well-being can continue to ripple and spread to the wider community, so as to increase flourishing for all.