Mental illness stigma: Is this a public health crisis?

With almost a third of the world’s population on some form of lockdown due to the COVID-19 pandemic, lengthy periods of isolation and social distancing have led to increased feelings of anxiety, depression and stress.

For some people, the anxiety stems from the fear of infection, or seeing their loved ones become ill. For others, it’s the effects of the economic downturn and the fear of unemployment. For many, it’s the uncertainty of how long this unusual, isolated lifestyle will continue. It is inevitable that the global pandemic, compounded by a financial crisis, will have an impact on the mental health of individuals globally.

Social stigma has always been a huge obstacle for the mental health community. When individuals diagnosed with mental illnesses are viewed in a negative light, or worse, when mental disorders are seen as fictitious, individuals who think they need professional help are less likely to seek treatment. Although the number of mental health support groups and advocacy organisations have grown over the years, the stigma still persists.

Black Dot Research carried out a survey to understand the attitudes of Singaporeans towards mental health disorders and the corresponding treatment. The survey compiled answers from 98 respondents, compromising of a mix of ages, genders, ethnicities, and education backgrounds to best represent the Singapore population.

ADDICTED, ANXIOUS AND LONELY

The prevalence of mental health disorders globally remains poorly understood, and this might very well be the case in Singapore too.

A nationwide study done by the Institute of Mental Health (IMH) reported 1 in 7 people in Singapore has experienced a mood, anxiety or alcohol use disorder in their lifetime. What makes such metrics even more challenging is that the spectrum of mental health disorders can be broad. A campaign that was previously ran by Touch Community Services & Nanyang Polytechnic to fight social stigma related to depression and mental health issues, featured a woman who had been dealing with depression two years prior to being diagnosed for Major Depressive Disorder (MDD). Diagnosis statistics alone would therefore not necessarily bring us close to the true figure as mental health has been suggested to be underreported in Singapore.

91% of our respondents said that stress was a leading contributor to poor mental health. There is also further evidence suggesting that having access to information can enable us to swing out of sync after huge events i.e. COVID-19, and much of this is heightened by a constant cycle of social media and news.

Abuse (87%) and family problems (79%) were also identified as common stressors too. We are told to stay home for our own safety and everyone else’s — and while this crucial measure is helping to flatten the curve, it has advertently led to the rise in cases of domestic violence. AWARE, a gender equality advocacy group, has reported receiving a record-breaking number of calls since the outbreak of COVID-19—a bulk of which pertains to violence from family members. Home may not therefore be a safe option, especially for victims and survivors of domestic violence.

IS IGNORANCE BLISS?

The survey found that 73% of people said they would be very or somewhat comfortable interacting with someone with a mental health disorder, and 71% would be very or somewhat comfortable sitting next to someone with a mental health disorder. Those numbers dropped, though, for more intimate encounters: the proportion of people comfortable letting someone with a mental health disorder into their homes was 54%, and only 40% said they would be comfortable dating someone with a mental disorder.

Notably, 36% of our respondents do not consider the most common mental health disorders to be disorders, which is defined as a disruption to regular bodily structure and function. 31% said they did not consider anxiety disorders including phobic, obsessive compulsive (OCD), post-traumatic disorder (PTSD), or generalized anxiety disorders as mental illness, and 21% said the same about autism.

OSTRACIZING MENTAL HEALTH

For individuals with depression and other related mental or substance use disorders, the present moment where the pandemic is in full swing is one where they can experience escalated distress. This is a double crisis, both of physical and mental health, and those living the psychiatric challenges need not only acknowledgement of their condition but also treatment of them.

While 67% of our respondents agreed that mental health practitioners will be very helpful in times of distress, psychological treatments were initially not considered to be ‘essential services’ under circuit breaker measures, much to the disappointment of mental health professionals. However, the situation has recently taken a turn, as the Ministry of Health (MOH) has re-categorized psychology and social work services as ‘essential’.

POOR RECOGNITION OF MENTAL ILLNESS

The survey also delved into attitudes that individuals have towards those who are living with a mental illness. Some words or phrases that have been used to describe someone who experiences mental health problems were wide-ranging terms — some of which includes hallucinations (78%), suicide (76%) withdrawal from society (71%), and violent behaviour (63%). These words have been originated in different contexts and have since been commonly associated to poor mental health.

77% of our respondents also agreed that there is no visible or active support for the mentally ill in the society. When it comes to government policies, mental-health advocates have long fought for health-care and employment laws that treat patients of mental illnesses similarly to how patients of other illnesses are treated. Furthermore, stigma has made the public less willing to pay for mental healthcare.  The financial coverage under the present healthcare system stresses on individual responsibility — it is based on a system of compulsory medical saving accounts and market forces.

On the bright side, 53% support legislature of a parity law that establishes a mandatory inclusion of mental health coverage — which can hopefully create a new system that puts people with mental illness at an advantage without resulting in disparity of medical coverage.

NEW WAYS TO (MEANINGFULLY) CONNECT

48% agreed that institution-level support can be improved by including more recovery-oriented services that can be made available for people in crisis on any day, at any time. This is timely, given that many currently using technology to manage their mental health. This will likely become more commonplace and even necessary as the need to practice “social distancing,” maintaining a physical distance from others to avoid the spread, increases.

Leveraging on technology, from hotlines to apps to telemedicine — is not new in the mental health field. One of them, National Care Hotline, which connects people to specialists and information, recently published data that showed at least 6,600 calls were made seeking support amid COVID-19 just two weeks into its launch.

STIGMA AMONG MINORITIES, MIGRANTS & MEN

Apart from enabling easy access to the local community to get help during this difficult time, we cannot forget the migrant workers in Singapore who are  also experiencing the psychological toll of being quarantined in their dormitories while enduring the looming threat of contracting the virus. HealthServe, a non-profit organization serving the migrant worker community in Singapore, reported that two weeks into launching their virtual counselling practice, they had over 150 migrant workers call in. These individuals reported feeling distress ranging from severe mental health conditions, recent deaths of their family members back home, and being transferred to and from various locations without fully understanding the reasons why.

51% of respondents agreed that specialised assessments and treatment options that can serve consumers with diverse backgrounds should be made available, and in this case, migrant workers—inclusive of domestic helpers— should be viewed more than just digits on a spreadsheet.

As the government looks to leverage on technology to scale mental health services, they must therefore also consider the overall user experience, bridging multiple organisations to meet the needs of often vulnerable users.

CREATING SUSTAINABLE COMMUNITIES

Much good has come of the increased willingness to have open discussions about mental disorders. There is greater acceptance than in the past that mental illness is real and common, and that when it arises, its causes are complex and cannot be explained away as weakness or lack of character. All of this is vital in reducing stigma, which in turn encourages people to step forward and seek help without shame.

If you or someone you know is seeking help for mental health-related issues, here are some helplines

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