This is a Shortlisted entry in the Rice Media x DLS Op-Ed competition. This article represents the views of neither Rice Media nor Dialogic Learning Services and is solely the opinion of the author. Authors’ names and schools have been hidden from readers and Rice Media’s judges so as to prevent bias during voting & judging.
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I tried going to therapy and it failed miserably. Now, to clarify, it was not therapy itself that was the problem, but rather the structural issues with the healthcare system that I discovered while on my quest for mental wellness. Due to some familial issues and academic stressors that I was facing at the start of the year, I decided to seek professional help. Through a friend’s recommendation, I found a “therapist” who was offering her services at a rate of $150 dollars a week.
“You do know Dr Ng* is not a qualified therapist right?”
That was the response I received after informing a trusted adult at school that I had been attending therapy for several weeks. I was confused, understandably. After all, it was listed on her website that she offered counselling services for various mental illnesses and she had a NUS Medical School plaque hanging up on her wall!
“Psychological services are not regulated in Singapore. She’s not a psychologist, she’s a family doctor.”
I couldn’t believe my ears: The same government that banned chewing gum and tells me that I cannot be naked in my own home was not regulating psychological services? There went a few hundred dollars spent on “therapy” out the window. Currently, there is no regulation or policy in Singapore that can prevent a layperson from portraying himself or herself as an allied mental health practitioner. This meant that any Tom, Dick and Harry off the street could set up shop and begin their career as a “counsellor” or “therapist”. Unfortunately for me, I fell right into that trap, readily providing my weekly offering of $150.
I do concede that perhaps I should have done my due diligence when it came to verifying the legitimacy of this therapist. But as someone who was distressed, I was in no state to scrutinise the twenty paragraphs of medical jargon that detailed her medical services. When people make the difficult choice to seek professional help, they are in no state to shop around for therapists, not while they are preoccupied with trying to survive and feeling exhausted from the mental struggles they are subjected to.
Not regulating mental health services is akin to not requiring swim instructors to know how to swim. Mental health therapy could be the tool that empowers people to be the best versions of themselves. However, when unqualified individuals attempt to conduct therapeutic sessions, they circumvent years of proper training and go on to offer therapeutic services under the guise of being qualified, luring in patients who are in genuine need of help and desecrating their trust in the effectiveness of psychological therapy.
At the end of the day, those seeking mental health therapy are real people with real struggles. What happens when these unqualified “therapists” engage in unethical behaviour or potentially aggravate and worsen the conditions of their patients? Who will take accountability then?
The fact that psychological services are not regulated was not the only matter that concerned me. Financial support for those seeking mental health help was insufficient, at best. Under the Chronic Disease Management Programme (CDMP), patients with schizophrenia, major depression, bipolar disorder and anxiety can withdraw up to S$500 from MediSave each year to defray the cost of therapy and counselling treatment. Considering that subsidised counselling or therapy sessions cost an average of S$160 per month and psychiatric medication can cost upwards of S$100 monthly, how long could S$500 really sustain a patient in need of psychiatric help? Are those dependent on government subsidies expected to ration their therapy sessions?
The Singapore Mental Health Study 2016 found that 78.6% of adults in Singapore with mental health conditions did not receive treatment in the past 12 months. The study also found that three out of four respondents not seeking professional help cited high costs of treatment as a deterrent.
Besides the fact that a support framework for those seeking professional mental help is lacking, there also exists a discrepancy in subsidies for physical illnesses as compared to psychiatric treatment. As of today, the daily limit for inpatient MediSave claims is S$450 for physical illnesses as opposed to S$150 for psychiatric treatment.
We have a world-class healthcare system and yet we cannot afford to provide our citizens with adequate psychological support. That’s a bit paiseh, isn’t it?
Singapore’s mental illness scene also boasts an abysmal number of mental health professionals. The recommended ratio of psychologists to population is 10 psychologists per every hundred thousand people. Singapore stands at a current low of 4.4, with only 248 psychiatrists practising in Singapore. Comparatively, the Singapore Mental Health Study 2016 found that the lifetime prevalence of mental illness in the Singapore resident population was 13.9%, which translates to 1 in every 7 persons having a mental disorder at any point in their life.
To make things even worse, in 2018, the average overall median waiting time for new subsidised appointments across the public hospitals was 27 days to see a psychiatrist, and 28 days to see a psychologist. The lengthy wait to even be able to access medical attention is ridiculous: Need medical attention? Come back in a month and we might have some space for you.
But, after all, every man for himself right? Why care about the mental health of others? Here’s the truth we need to see: Singapore cannot afford to be blasé about the current state of the mental health system. Untreated mental illnesses create huge economic and social burdens on society at large. A majority of the financial burden of mental illness is not a result of the cost of treatment but rather the ramification of untreated mental illnesses, take for instance the loss of income due to unemployment, decreased productivity and increased social expenses.
Singaporeans are subjected to tremendous societal pressures. Our education systems are pressure cookers, our job markets competitive and our societal expectations stringent. Of course, it is undeniable that Singapore’s culture of competition and reliance on the hard work of its population has contributed greatly to the economic success achieved thus far. But, we must not neglect the fact that such conditions also perpetuate widespread mental health issues. In order to achieve sustainable growth, it’s imperative that we provide the Singaporean society with adequate mental health services and social infrastructure to combat the psychological impacts that come hand in hand with being a part of this ultra-competitive society.
There is no health without mental health. Rich or poor, mental illnesses do not discriminate and everyone deserves equal access to quality psychological treatment. A depressed and stressed population will only serve to threaten societal cohesion and our nation’s unity. It leaves us vulnerable to threats that endanger our security and sovereignty. So, please, let us not overlook the importance of mental health.
Dear government, do better.
*Names have been changed for privacy.
