SINGAPORE - When Ms Jamie Tan was nine, she struggled to come to terms with her parents' divorce, which eventually led her to self-harm in primary school. Despite turning to two co-curricular activities in secondary school to distract herself, she would occasionally skip school or have meltdowns.
She got professional help at 15, and was diagnosed with major depression and anxiety. Now 20, Ms Tan, a student, hopes to be a psychologist to help youth struggling with mental health.
The subject of mental well-being among the young has taken on a new urgency in public discourse following Monday's incident at River Valley High School (RVHS) where a 16-year-old allegedly killed his schoolmate, 13.
It was reported that the older boy had been assessed at the Institute of Mental Health in 2019 after he attempted suicide.
Experts told The Sunday Times that the challenges faced by youth today are different from those decades ago, especially with social media, more pressure at school and a change in wants and needs wielding a bigger influence.
But the stigma of getting help remains, they added, urging members of the public to change their mindset and encourage more young people to seek support.
Associate Professor Daniel Fung, chief executive of the Institute of Mental Health (IMH), said previous generations worked to meet basic needs. But youth today have higher-level needs like self-esteem, resulting in worries about their purpose in life which, if not addressed, can lead to mental health issues.
Mr Asher Low, founder of youth mental health charity Limitless, said growing up with the Internet and social media can make children feel inadequate.
"The comparison, stress and feeling of not being good enough come with social media. The hyper connectivity also results in youth here being more affected by overseas issues, such as the Black Lives Matter movement, global warming and other issues," he said.
Dr Adrian Wang, a psychiatrist who runs his own practice at Gleneagles Medical Centre, said the game changer in the last few years has been social media.
"A teenager's online identity is very much part of their personal identity. Teenagers want to feel accepted and well-regarded by friends on social media," he added.
"In fact, most teenagers are more comfortable communicating via social media than via face-to-face conversations. This creates problems such as the possibility of being bullied or marginalised online."
While some may admit the need for professional help, getting it may be challenging, said experts.
Reasons include cost, fear of the stigma that could come with seeking help, not wanting parents or others to know and not being aware about where to find support.
Ms Bettina Yeap, programme head at Care Corner's mental health department, said more young people are seeking help anonymously for a sense of safety.
"This is unlike if they were to approach a counsellor in school and worry about face-to-face interaction or being judged by other people," she added.
Dr Clare Ong, a psychologist, said that there is a perception that only naughty students see the counsellor.
Mr Low said some children and youth also do not want their parents to know, as they are "paiseh" (Hokkien for embarrassed) or their parents contribute to their stress and mental health struggles.
Parents might disallow the child from getting treatment or respond to their child without empathy, making things worse, he added.
A key issue to tackle is how to encourage more youth to seek help, said experts. Care Corner's Ms Yeap said it has a questionnaire on Telegram for youth to gauge symptoms of mental health issues, and they can contact the organisation after getting their results.
She said: "They could start off with a completely anonymous Instagram DM (direct message), then a WhatsApp number and then hopefully a Zoom call. Eventually, we hope to move meetings face-to-face."
Ms Porsche Poh, executive director at mental health advocacy organisation Silver Ribbon, said there are free or subsidised services from charities and social service agencies.
Under the Chronic Disease Management Programme, those with schizophrenia, major depression, bipolar disorder and anxiety can withdraw up to $500 from MediSave per year. Since Jan 1, patients with complex chronic conditions can use up to $700 annually.
Consultations at public hospitals and IMH can tap public subsidies. A subsidised first-time session with an IMH consultant for a child or adolescent can cost $46 or less, according to its website.
The cost of private sector consultations can go into the hundreds. The Raffles Medical Group website says one consultation session with a counsellor or psychologist starts from $150.
Ms Poh added that it is a good time for schools to review existing mental health support, and called for more teachers to be equipped with the skills to identify and detect symptoms in students and refer them to a school counsellor.
On Friday, Education Minister Chan Chun Sing said he would deliver a ministerial statement in Parliament this week on what is being done to support schools and look out for students in need.
IMH's Prof Fung acknowledged that young people who show signs of depression and anxiety remain a significant concern.
He said: "Many people would rather tell their friends instead of adults, or seek answers online. So, we want to provide a good curated site with relevant information."
Such efforts include mindline.sg, a website which consolidates access to local stress management and coping resources.
More education for parents and the older generation to understand the complexities of mental health issues is also needed so they can better assist the youth, said Limitless' Mr Low. "We want to encourage the youth to come forward but we must also make it easy for them," he added.
Counsellors provide support in schools
Each primary and secondary school as well as junior college has one to two school counsellors who provide social and emotional support to students, said the Ministry of Education (MOE).
Responding to queries from The Sunday Times, Mrs Tan Chen Kee, divisional director of the student development curriculum division, said for those needing further help, the counsellors work with community mental health professionals.
School counsellors are professional counsellors with a diploma, bachelor's or master's degree in counselling, according to MOE's website. Those who apply should preferably have at least a year of full-time work experience in teaching, counselling or volunteering with children and youth.
School counsellors are different from teacher-counsellors who are trained in areas such as suicide intervention, grief and loss counselling, and psychological first aid.
Mrs Tan said: "All teachers are trained to identify signs of distress in their students. They are also provided with tools, such as a student well-being check-in survey, to regularly monitor students' well-being, and provide them with guidance and support."
She said MOE's Character and Citizenship Education curriculum was recently revised and emphasises mental health education to encourage students to seek help, be aware of or identify friends who may be struggling, and reduce stigmatisation.
She added: "We are on track to have a peer support structure and culture in all primary and secondary schools by end-2021."
National Care Hotline: 1800-202-6868 (8am - 12am)
Fei Yue's Online Counselling Service: eC2.sg website (Mon to Fri, 10am to 12pm, 2pm to 5pm)
Institute of Mental Health's Mental Health Helpline: 6389-2222 (24 hours)
Samaritans of Singapore: 1800-221-4444 (24 hours) /1-767 (24 hours)
Singapore Association for Mental Health: 1800-283-7019 (Mon to Fri, 9am to 6pm)
Silver Ribbon Singapore: 6386-1928/6509-0271 (Mon to Fri, 9am to 6pm)
Tinkle Friend: 1800-274-4788 (Mon to Fri, 2.30pm to 5pm)/ Tinkle Friend website (Mon to Thu, 2.30pm to 7pm and Fri, 2.30pm to 5pm)
TOUCHline (Counselling): 1800-377-2252 (Mon to Fri, 9am to 6pm)
Care Corner Counselling Centre (Mandarin): 1800-353-5800 (Daily, 10am to 10pm)