Why Do Youths Kill Themselves?

Youth suicide is a growing concern in Singapore, with increasing numbers of young people overwhelmed by pressures they struggle to cope with. Hopelessness plays a critical role, as many youths feel trapped in situations they perceive as unchangeable. To prevent these tragedies, it is crucial for families, schools, and communities to foster open communication, ensuring that young people feel supported and understood in their struggles.

Key takeaways

  • Hopelessness is a key predictor of youth suicide—young people often feel overwhelmed by life stressors and lack coping mechanisms, leading them to believe there is no escape.
  • The accumulation of pressures—such as academic stress, romantic rejection, family issues, and identity struggles—can push vulnerable youths toward suicidal thoughts.
  • Open communication and support from families, schools, and communities are critical to preventing youth suicide, helping young people feel seen, heard, and understood.

Posted on 4 Oct 2024

Written by
Dr Jared Ng, Connections MindHealth

The heartbreaking rise in youth suicides in Singapore is impossible to ignore. In 2023, nearly 30% of suicides involved individuals under the age of 29, with an alarming number – almost one-third – being children and youths between the ages of 10 and 19. Suicide has tragically become the leading cause of death among our youth, surpassing accidents and illnesses. This devastating reality forces us to confront the intense pressures that many of our young people face every day.

Though the media often refrains from reporting youth suicides, perhaps out of concern for contagion effects or protecting vulnerable individuals, those of us working in mental health witness this silent epidemic. These cases are not just confined to adolescents; even children in primary school are not immune. Behind every statistic is a young life lost, and with it, a family and community left grieving, searching for answers.

The youths who take their own lives often appear to be thriving—excelling academically, socially, and physically. Yet beneath this veneer of success can lie a deep, unnoticed despair that ultimately becomes too much to bear.

youth suicides in singapore
The interplay between hope and hopelessness is crucial in understanding youth suicides.
How Hope and Hopelessness Influence Youth Suicide

Hopelessness is a significant factor in suicide risk across all ages, representing a profound state of despair where individuals feel trapped in an unchangeable situation, with suffering that seems endless. This overwhelming sense of hopelessness can lead to the belief that death is the only escape, making it one of the strongest predictors of suicidal behavior. When hope is lost, the risk of suicide dramatically increases.

For young people, hopelessness often stems from life stressors they perceive as insurmountable. Unlike adults, children and youths typically have less experience dealing with complex emotional challenges and may lack the coping mechanisms needed to navigate their despair. Additionally, their natural impulsivity can exacerbate the situation. Young people are more prone to making rash decisions in moments of intense emotion, often without fully considering the consequences. This impulsivity, combined with feelings of hopelessness, can dangerously heighten the risk of suicide, as a young person may act on suicidal thoughts suddenly, leaving little opportunity for intervention.

The interplay between hope and hopelessness is crucial in understanding youth suicides. Hope is a vital psychological resource that begins to develop early in childhood. It starts to form in infancy when a child learns to trust their caregivers and becomes more established around ages 3 to 5, when children develop a sense of purpose and the ability to envision a positive future. However, as children grow older and face more complex social and academic pressures, their sense of hope can be threatened, especially if they encounter repeated failures or rejection. When these pressures become too great, and the child or youth sees no way out, hope can be replaced by hopelessness.

As a parent, it’s essential to understand that even the most successful children can struggle with feelings of inadequacy. Despite outward appearances of success, some youths battle intense internal pressures, setting impossibly high standards for themselves. When they fail to meet these expectations, the resulting feelings of hopelessness, compounded by impulsivity, can lead to a dangerous downward spiral.

Understanding the fragility of hope in our young people is then crucial to grasping the triggers behind youth suicides. But what are these pressures that push them beyond the brink?

academic pressure in Singaporean children
Academic pressure is another recurring theme when young people talk about their stressful situations.
Understanding the Triggers Behind Youth Suicide

Through my practice, I’ve encountered many young individuals overwhelmed by circumstances they don’t know how to navigate—circumstances that drive them to contemplate, or even attempt, suicide. One case that stands out is that of a 12-year-old girl whose parents discovered a suicide note hidden in her pencil case. She had poured out her feelings of profound loneliness, all stemming from the rejection of a crush whom she saw as her ‘true love.’ When she tried to talk to her parents about her heartache, they dismissed her emotions, telling her to focus on her studies instead since she was not doing well. For her, this response deepened her isolation. In her note, she expressed that she felt like a burden to her family and believed they would be happier without her. (For the record, this child is alive, and with the support of her parents, she is now receiving the care she needs and is on the path to healing.)

This case, like many others, reminds us that youth suicide is rarely the result of one factor. It’s often an accumulation of pressures—romantic rejection, academic stress, family dynamics, and more. And while romantic relationships are an important part of adolescence, young people’s sense of self-worth is often tied to many areas—be it friendships, peer acceptance, or family approval.

As a mental health professional, cases like this weigh heavily on me. They reinforce how critical it is to listen to our children, even when their struggles seem small to us. This experience, and countless others, have deeply influenced my approach to treating at-risk youths. I’ve learned that what we might dismiss as “typical teenage angst” or fleeting concerns can be the very thing pushing a young person to the edge. Every cry for help, no matter how subtle, deserves to be heard.

I often ask myself, “What can we do better?” or “What more can be done?” In my years of practice, the answer has always come down to fostering connections—helping young people feel seen and heard before their pain becomes too overwhelming to manage. These stories shape the way I approach my work and emphasise the importance of never underestimating the emotional lives of our youths.

Youth suicides are rarely caused by one isolated factor. It’s usually the accumulation of stressors—romantic rejection, academic pressure, and more—that can push a young person beyond their breaking point.

Family disputes causes emotional distress in children
Family issues, particularly parental disputes or divorce, can also contribute to emotional distress.

Romantic rejection, particularly a first heartbreak, is one of the most common and emotionally intense triggers for young people. Adolescents often experience their first romantic relationships with immense intensity, and when these relationships end, it can feel like the end of the world. Many young people’s sense of identity and self-worth becomes closely tied to their romantic relationships, and a breakup or rejection can lead to overwhelming feelings of worthlessness, despair, and hopelessness. For some, this emotional pain can feel unbearable, especially when combined with other stressors in their lives.

Academic pressure is another recurring theme when young people talk about their stressful situations. Students often feel that their worth is tied to their performance, leading to immense stress. When combined with other stressors like friendship or family issues, the result can be overwhelming despair. We must also consider how these pressures interact with individual vulnerabilities, such as a predisposition to anxiety or depression, to fully understand why some youths are more affected than others.

Identity confusion is also a significant factor. Adolescence is a time of exploration, especially concerning personal identity, gender identity, and sexual orientation. For some, navigating these aspects of themselves can lead to significant distress, particularly if they feel unsupported or misunderstood.

Child abuse—whether physical, emotional, or sexual—can create overwhelming feelings of worthlessness and despair. Studies have shown that children who experience abuse are significantly more likely to develop mental health issues, including depression and anxiety, which are risk factors for suicide. The trauma from abuse can worsen hopelessness, making it difficult for these youths to see a future free from pain.

Family issues, particularly parental disputes or divorce, can also contribute to emotional distress. While not all divorces lead to emotional distress, the instability or conflict surrounding a family breakdown can be deeply unsettling for young people, potentially leading to suicidal thoughts.

It is important to understand that children and youths often face more than one stressor at a time, and these stressors can accumulate, making the situation feel even more overwhelming and inescapable. By recognising the complex interplay of mental health disorders, environmental factors, stressors, and individual vulnerabilities, we can better appreciate the depth of the challenges that many young people face.

Social Media’s Impact on Youth Mental Health

In a world where young people already face immense pressure, social media often amplifies their challenges. It’s not just a space for connection—it’s a constant stream of comparison, where vulnerable youths measure their lives against the carefully curated, often unattainable standards set by their peers.

Many of the young patients I’ve seen talk about how they feel ‘less than’ when scrolling through platforms like Instagram and TikTok. While these platforms can offer a sense of connection, they can also foster deep feelings of inadequacy. For youths already struggling with self-esteem or personal challenges, these comparisons can be devastating. The image of success, beauty, and happiness they see online becomes yet another unattainable goal—further driving feelings of worthlessness.

Cyberbullying is another significant issue that I have encountered in my practice. The anonymity of the internet allows bullies to harass others with little fear of consequences. Victims of cyberbullying often feel isolated and powerless, trapped in a cycle of psychological distress. The pressure to maintain a certain image online, combined with the fear of public humiliation, can push vulnerable youths toward suicidal thoughts as they see no way to escape the relentless negativity.

As a parent, it’s vital to engage in open conversations with your children about their online experiences. Rather than imposing strict bans on screen time, which may feel punitive, encourage your children to share what they see and how it makes them feel. Creating a safe space for these discussions can help them develop a healthy perspective on social media and reduce the impact of negative comparisons.

cyberbullying
In a world where young people already face immense pressure, social media often amplifies their challenges.
Supporting Those Affected: The Role of Postvention

Postvention, the support provided to those affected by a suicide, is a crucial yet often overlooked aspect of suicide prevention. The impact of a suicide extends far beyond immediate family members, affecting friends, classmates, teachers, and even acquaintances. In my own experience, I witnessed this firsthand when my daughter lost a friend after a fall from heights. I was heartened to see that the school had structured interventions in place to support classmates and teachers during this difficult time.

However, it’s important to remember that structured postvention processes often focus on those directly involved in formal settings, such as schools. Other social groups that are equally affected by the suicide may be overlooked. These include peers
from enrichment classes, playground friendships, virtual friend groups, and other less formal social circles. These groups can be just as devastated by the loss, and it is essential to extend postvention efforts to these communities as well.

Effective postvention can take many forms. Schools can start by providing immediate mental health support, such as on-site counselors, and creating spaces where students can talk openly about their grief. Peer support groups can also be invaluable in helping young people process their emotions together. Schools and communities should work to destigmatise conversations about suicide and loss, ensuring that students feel safe expressing their feelings without fear of judgment. Another critical step is offering long-term support—grief doesn’t disappear after a few weeks. Schools and community organisations should follow up with affected youths in the months after a suicide, helping them manage their ongoing emotions.

Just as important as support in schools is the involvement of families in the healing process. Parents and guardians are often a young person’s primary emotional support, and it is essential that they be part of the conversation. Family members should be prepared to discuss the loss in a way that is developmentally appropriate for their child’s age and emotional maturity. Younger children may not fully understand the permanence of death and might express their grief through behavior changes or play, while adolescents might need space to process their more complex emotions, often experiencing a heightened sense of vulnerability. Parents should create a safe, open environment where their child feels supported in sharing their feelings without fear of dismissal.

This is where age-appropriate conversations become so vital. Discussing suicide and loss with children and adolescents requires sensitivity, but it’s necessary to ensure they feel seen and understood. Younger children might need simple explanations, focusing on reassurance and security, while older youths may need a space to explore their feelings more deeply. It’s crucial for parents to acknowledge their child’s emotions, validate their pain, and provide ongoing support as grief evolves.

By providing compassionate and consistent postvention support, we can help those left behind heal from their grief and prevent further emotional distress. It’s vital to remember that postvention is not just about reacting to loss but about reinforcing the connections and resilience that can help prevent future tragedies. Families, schools, and communities must work together to provide a holistic, age-appropriate approach to support, ensuring no young person feels isolated in their grief.

preventing youth suicide together
Parents need to foster open communication, ensuring that their children feel safe to express their fears and anxieties.
Taking Action: Preventing Youth Suicide Together

Preventing youth suicide demands a collective effort. Families play a pivotal role in the well-being of young people. Parents need to foster open communication, ensuring that their children feel safe to express their fears and anxieties. This involves creating a home environment where emotional expression is encouraged and where children know they will be supported and not judged when they share their struggles. It’s equally important for parents to be aware of the signs of distress—such as changes in mood and behavior, withdrawal from social activities, or declining academic performance—and to be proactive in offering emotional support or seeking professional help when needed.

Schools must prioritise mental health by creating supportive environments that recognise the importance of emotional well-being alongside academic success. Schools should work to reduce the stigma of help-seeking and suicide prevention. Teachers and other staff need to be trained to identify signs of distress and intervene appropriately. Additionally, schools can incorporate programs that teach coping mechanisms and stress management skills, helping students build resilience in the face of challenges.

As a broader community, we must challenge the societal norms that contribute to the immense pressure on young people. This includes rethinking our definitions of success and ensuring that mental health resources are accessible and timely. Public awareness campaigns can play a significant role in changing perceptions about mental health and reducing stigma. Policymakers, too, have a crucial role to play in creating supportive frameworks that address the root causes of youth suicide—such as reducing academic pressure, combating child abuse, and regulating the impact of social media.

Addressing youth suicide is a daunting task, but by tackling the root causes, fostering communication, and creating supportive environments, we can help our young people find hope and resilience. Everyone has a role in this effort because, ultimately, it is the collective compassion and determination of the community that will make the difference.

Where to get help:
Mental Well-being
  • Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
  • Samaritans of Singapore: 1-767 (24 hours) / 9151-1767 (CareText via WhatsApp)
  • Singapore Association for Mental Health: 1800-283-7019
  • Silver Ribbon Singapore: 6386-1928
  • Tinkle Friend: 1800-274-4788
  • Community Health Assessment Team 6493-6500/1
Counselling
  • TOUCHline (Counselling): 1800-377-2252
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          • Obsessive Compulsive Disorder—Myths and Misconceptions

          Obsessive Compulsive Disorder—Myths and Misconceptions

          Obsessive-Compulsive Disorder (OCD) is a complex and often debilitating mental health condition that affects millions of people around the world.

          Posted on 25 Jun 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Obsessive-Compulsive Disorder (OCD) is a complex and often debilitating mental health condition that affects millions of people around the world. The 2016 Singapore Mental Health Study (SMHS) highlighted OCD as one of the top three most common mental disorders in the country [1]. The findings revealed that approximately one in every 28 adults in Singapore has been impacted by OCD, sparking discussions that Singapore might be the “OCD capital” of the world.

          Characterised by persistent, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions), OCD can significantly interfere with a person’s daily activities and quality of life. These obsessions and compulsions are not simply excessive worries about real-life problems or personal quirks; they are intense, consuming, and distressingly intrusive.

          Despite its prevalence and severity, numerous myths and misconceptions about OCD persist, which can lead to stigma, misdiagnosis, and inadequate treatment. The 2016 SMHS suggested that the duration of untreated OCD was slightly more than 10 years, underscoring the critical need for awareness and timely intervention. Misconstruing OCD and its impacts trivialises the condition and obscures its true nature [2], preventing those affected from seeking help or receiving the empathy and support they desperately need.

          This article aims to debunk some of the biggest myths about OCD and provide a clearer picture of what the disorder is. By spreading accurate information and fostering a better understanding of OCD, we hope to create a more compassionate environment that encourages those affected to seek treatment and supports them on their road to recovery.

          Content 
          1. Understanding OCD; The relationship between Obsession and Compulsion 
          2. Dispelling Popular Myths: The Realities of OCD
          1. Treatment and Management of OCD
          2. Importance of Seeking Professional Help 
          3. Moving Beyond Misconceptions; Resources for Further Reading or Assistance:

          Understanding OCD; The relationship between Obsession and Compulsion 

          One of the core aspects of Obsessive-Compulsive Disorder (OCD) that is often misunderstood is the distinction and relationship between obsessions and compulsions. These two components are the hallmark features of OCD, but they manifest differently and serve different psychological purposes in the disorder. 

          Obsessions:

          Obsessions are involuntary, persistent thoughts, images, or impulses that intrude into a person’s mind and cause significant anxiety or distress. These are not simply excessive worries about real-life problems but are often irrational or exaggerated fears. People with OCD typically recognise that their obsessions are created in their minds but are unable to control or dismiss them.

          Examples of less visible obsessions include:

          • Fear of accidentally harming oneself or others, even in “absurd” or unlikely scenarios.
          • Intrusive sexual thoughts or images that are distressing.
          • Obsessions with symmetry or exactness, where a slight imperfection can trigger intense discomfort.
          • Fears of shouting obscenities or acting inappropriately in public which lead to social withdrawal.

          Compulsions:

          Compulsions are repetitive behaviours or mental acts that a person feels compelled to perform in response to an obsession or according to rigid rules. The primary purpose of these compulsions is to prevent or reduce the distress caused by the obsessions or to prevent a feared event or situation; however, these behaviours are either not connected logically to the feared event or are excessive.

          Examples of less visible compulsions include:

          • Mental rituals, such as repeating certain words or phrases in one’s mind to ward off harm or bad luck.
          • Counting objects or performing tasks in certain numbers to “neutralise” the anxiety associated with an obsession.
          • Rearranging or organising items until they feel “just right” to alleviate the distress of imperfection.
          • Silently praying or performing rituals that cannot be observed by others, which can often go unnoticed.

          The relationship between obsessions and compulsions in OCD is one of a problematic cycle. Obsessions fuel anxiety, which compels the individual to engage in compulsive behaviours. These compulsions temporarily reduce the anxiety but reinforce the obsession, which makes it even stronger. This creates a vicious cycle that can escalate and become more debilitating over time.

          OCD Cycle
          OCD can be understood as a looping cycle of obsession, anxiety, compulsion and relief. 
          Dispelling Popular Myths: The Realities of OCD
          Myth 1: OCD is just about being overly tidy and organised

          One of the most common misconceptions about Obsessive-Compulsive Disorder (OCD) is that it solely manifests as a preoccupation with cleanliness and a need for order. This stereotype is often perpetuated by media portrayals and casual references that equate being meticulous or neat with having OCD. However, this simplistic view fails to capture the complexity and distress that characterise the disorder.

          OCD Singapore
          Popular culture’s portrayal of OCD undermines the complex and debilitating nature of OCD

           

          Comparison with Normal Tidiness:

          While many people prefer a clean and organised environment, those with OCD experience severe anxiety if things are not “just right.” For example, a person without OCD might feel satisfied after tidying up their desk, but someone with OCD might spend hours arranging and rearranging items to achieve a sense of relief from their distressing thoughts.

          OCD is a clinical condition marked by severe and intrusive obsessions—unwanted thoughts, images, or urges that repeatedly enter the mind and cause significant anxiety [3]. These obsessions are coupled with compulsions, which are behaviours an individual feels compelled to perform in an attempt to reduce stress or prevent some dreaded event or situation, regardless of whether these outcomes are realistic.

          The manifestations of OCD can be extraordinarily diverse. Beyond the well-known compulsions related to cleanliness, such as hand-washing or sanitising, OCD can involve:

          Symptom Characteristics
          Hoarding Contrary to popular belief, hoarding is not just a problem of disorganisation or messiness. Hoarding OCD can be succinctly described as the difficulty of discarding items regardless of their actual value, driven by a fear of losing something important [4]. Hoarding involves the compulsive collecting or keeping of items to the extent that it impairs functioning. Individuals may fear that something bad will happen if they throw anything away, leading to severe clutter that can affect living condition
          Touch and movement The compulsion to count or perform tasks several times to prevent perceived danger [5]. This symptom involves an intense, irrational fear that not performing a particular ritual or compulsion will result in harm to oneself or others. This can manifest in less obvious ways, such as needing to touch things a specific number of times to prevent a loved one from getting hurt.
          Checking compulsion Repeated checking behaviour such as checking if the door is locked or the stove is off, is driven by a paralysing fear of harm or disaster. Patients of OCD may repeat these actions compulsively even if initials “checks” were done.
          Orderliness and symmetry A compulsion to arrange objects to meet a subjective sense of order, often accompanied by intense discomfort if items are perceived as misaligned or disorganised [6]. Some individuals with OCD are not just discomforted by lack of “order” but may even be plagued with anxiety that something terrible will happen if things are not just right.
          Ruminations and intrusive thoughts These are prolonged and unwanted thoughts about philosophical, metaphysical, or moral issues that do not have clear solutions or outcomes. Such ruminations can be highly distressing and time-consuming, often interfering with the person’s ability to engage in daily activities. Sometimes these can also include disturbing and unwanted thoughts or images about harming others, sexual content, or blasphemous themes that provoke intense distress [7].
          hoarding OCD
          OCD encompasses a wide range of symptoms beyond cleanliness obsessions, including behaviours like hoarding and compulsive checking.

           

          Myth 2: People with OCD just need to relax and stop worrying

          A common but harmful misconception about Obsessive-Compulsive Disorder (OCD) is the notion that individuals can simply choose to ‘relax’ or stop worrying to overcome their symptoms. This belief undermines the serious nature of OCD and suggests that it is within the individual’s control to stop their obsessive thoughts and compulsive behaviours. In reality, OCD is a deeply ingrained disorder with complex biological and psychological roots, and it is not about lacking willpower or personal strength.

          Biology of OCD Explained:

          OCD has a significant biological basis. Research has shown that genetic factors play a crucial role in the development of the disorder, with individuals having a higher risk of developing OCD if a close family member also has the condition [8]. Neuroimaging studies have revealed that people with OCD often have differences in certain areas of the brain, including the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia [9]. These brain regions are involved in decision-making, learning from mistakes, and controlling repetitive behaviours. Abnormalities in these areas can contribute to excessive doubts, compulsive checking, and the intense need to perform rituals that are characteristic of OCD.

          • Serotonin and Brain Function:

          The role of neurotransmitters, particularly serotonin, has also been highlighted in the pathology of OCD [10]. Serotonin is crucial for mood regulation and decision-making processes. Imbalances or disruptions in serotonin levels can exacerbate the symptoms of OCD, which can result in increased anxiety and the compulsion to perform certain rituals [11]. This is why medications that target serotonin levels, such as SSRIs (selective serotonin reuptake inhibitors), are often effective in managing OCD symptoms.

          • Psychological Factors:

          From a psychological perspective, OCD is believed to be influenced by behavioural, cognitive, and environmental factors. For example, behavioural theory suggests that compulsions are developed to reduce the anxiety caused by obsessions temporarily [12]. Cognitively, people with OCD may have maladaptive beliefs about responsibility and harm, overestimating the danger in certain situations and their role in preventing it. This can lead to excessive checking, hoarding, or other compulsive behaviours.

          • Why It’s Not About Willpower:

          Telling someone with OCD to stop worrying or to relax is akin to telling someone with asthma to breathe normally during an asthma attack—neither helpful nor feasible. OCD is not a disorder that can be controlled or willed away by the individual. It requires professional treatment, including therapy and sometimes medication, to manage effectively. 

          Understanding these biological and psychological underpinnings of OCD helps highlight why reducing it to an issue of willpower is not only incorrect but also detrimental. It diminishes the real struggles experienced by those with the disorder and can prevent individuals from seeking the appropriate, evidence-based treatments that they need.

          Myth 3: OCD is not a serious disorder

          Contrary to the dismissive views that label Obsessive-Compulsive Disorder (OCD) as a minor annoyance or a mere personality quirk, OCD is a serious psychiatric condition recognised for its serious impact on daily functioning and overall quality of life. The idea that OCD is not a significant health issue is not only inaccurate but also diminishes the real and sometimes severe challenges faced by those who live with the disorder.

          According to the World Bank and the World Health Organization, OCD is the tenth leading cause of disability globally, and for women aged 15 to 44 years, it ranks fifth. [13]. Studies have shown that individuals with OCD can experience a reduction in quality of life that is comparable to or even greater than those suffering from chronic physical conditions like diabetes [14]. The economic impact is also significant, with many individuals facing challenges in maintaining consistent employment and managing healthcare expenses related to their condition.

          The data and real-life impacts illustrate that OCD is undoubtedly a serious disorder, deserving of the same attention and medical care as any other significant health issue. 

          Impact of OCD on Daily Life:

          OCD can severely disrupt daily activities by making routine tasks extraordinarily difficult and time-consuming. For many individuals, the intense need to perform compulsive rituals—such as repeated hand washing, checking, or arranging items in a specific order—can take up several hours of their day, which severely disrupts their personal, professional, and social lives. The distressing nature of obsessive thoughts can also lead to heightened anxiety, pervasive feelings of disgust, or even a paralysing fear of harming others inadvertently. These experiences can restrict individuals’ ability to function in work settings, participate in social activities, and maintain relationships, which often leads to isolation and loneliness.

          Mental Health Consequences:

          The constant battle with obsessive thoughts and compulsive behaviours can lead to significant emotional distress. Many individuals with OCD experience co-occurring mental health conditions, such as depression and anxiety disorders. The relentless nature of OCD can contribute to feelings of hopelessness and helplessness, which are key risk factors for depressive symptoms and suicidal ideation. Furthermore, the stigma associated with mental health, particularly around a misunderstood condition like OCD, can exacerbate feelings of shame and inadequacy, hindering individuals from seeking help and support.

          Obsessive-Compulsive Disorder (OCD) is not only a complex disorder in its own right, but it is also frequently accompanied by other psychological conditions [15]. This coexistence of multiple disorders, known as comorbidity, can complicate diagnosis and treatment, and affect the overall prognosis of those affected. Understanding the relationship between OCD and its comorbid conditions is crucial for developing comprehensive treatment plans that address all aspects of a patient’s mental health.

          Common Comorbid Conditions with OCD:
          • Anxiety Disorders: OCD is often found alongside other anxiety disorders, such as Generalized Anxiety Disorder (GAD) [16], Panic Disorder [17], and Social Anxiety Disorder [18]. The overlap is understandable, given that both OCD and other anxiety disorders involve chronic worry and fear. However, OCD is distinct in that the anxiety typically stems from intrusive thoughts (obsessions) and is temporarily alleviated by specific actions (compulsions).
          • Depression: Depression is one of the most common comorbid conditions with OCD [19]. The relentless nature of OCD symptoms often leads to feelings of despair and hopelessness, which can evolve into clinical depression. The presence of depression in OCD patients can make symptoms worse and recovery more challenging, as it can sap motivation and increase feelings of worthlessness.
          • Eating Disorders: Eating disorders [20], particularly those involving ritualistic behaviour around food and body image, such as Anorexia Nervosa and Bulimia Nervosa, can also co-occur with OCD. The obsessive thoughts and compulsive behaviours seen in eating disorders can mirror the pattern of symptoms experienced in OCD, reflecting a shared foundation of anxiety and control issues.
          • Tic Disorders: Particularly in pediatric populations, there is a significant overlap between OCD and tic disorders, including Tourette Syndrome [21]. Both conditions involve repetitive behaviours, although the compulsions in OCD are typically linked to obsessional thoughts, whereas tics are often involuntary and not connected to obsessions.
          • Attention Deficit Hyperactivity Disorder (ADHD): Although seemingly counterintuitive due to ADHD’s association with impulsivity (opposite of OCD’s compulsivity), there is a noteworthy rate of comorbidity [22]. The shared features may include high levels of inattention, poor impulse control, and executive functioning problems.
          • Autism Spectrum Disorder (ASD): There is a considerable overlap between OCD and ASD. Individuals with ASD may engage in repetitive behaviours and routines similar to OCD compulsions, but the motivations behind these behaviours differ. Understanding the distinctions and overlaps is crucial for accurate diagnosis and treatment.
          • Autoimmune Conditions: Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition where streptococcal infections lead to the sudden onset or worsening of OCD symptoms in children. This condition highlights the complex interplay between infections and psychiatric symptoms, necessitating a multidisciplinary approach to treatment.
          Depression and OCD Singapore
          Depression is a common comorbidity for individuals with OCD, which often exacerbates the challenges they face.
          Treatment and Management of OCD

          The presence of comorbid conditions in individuals with OCD requires a more comprehensive treatment approach. For instance, a treatment strategy that only addresses OCD may not be effective if the patient is also experiencing major depressive disorder. In such cases, a combination of medications, along with therapy tailored to address both OCD and depression, may be necessary.

          Moreover, the treatment of one condition can sometimes improve the symptoms of the other. For example, the techniques used in CBT for managing anxiety can also be beneficial in controlling OCD symptoms. However, healthcare providers must monitor all conditions closely and adjust treatment plans as necessary to address the full scope of a patient’s mental health needs.

          Effective treatment and management of Obsessive-Compulsive Disorder (OCD) are critical for improving the quality of life for those affected by the disorder. Modern treatment methods, professional help, and support from loved ones form the cornerstone of successful management strategies for OCD. Understanding these elements can empower individuals and their families to seek the right kind of help and support needed.

          • Cognitive-Behavioral Therapy (CBT): CBT is one of the most effective treatment options for OCD, particularly a specialised form known as Exposure and Response Prevention (ERP) [23]. ERP involves exposing the person to the thoughts, images, objects, and situations that make them anxious or trigger their OCD symptoms. The key is to encourage the individual not to engage in the compulsive behaviour typically performed in response to anxiety. Over time, ERP can help reduce the compulsive behaviours associated with the triggers.
          • Medication: Medications, especially those that increase the brain’s serotonin levels, are often prescribed in conjunction with therapy. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly used medications for treating OCD, helping to manage symptoms by balancing neurotransmitters [24]. In some cases, other types of psychiatric medications may be recommended depending on the individual’s symptoms and response to SSRIs. These include:

          Tricyclic Antidepressants (TCAs): Clomipramine is a TCA that has been found to be effective in treating OCD. It works by affecting serotonin levels in the brain, similar to SSRIs, but can also influence other neurotransmitters. However, TCAs can have more pronounced side effects, such as dry mouth, constipation, and dizziness, which need to be carefully managed.

          Antipsychotics: In some cases, antipsychotic medications such as risperidone or aripiprazole may be prescribed as adjunctive therapy, particularly if the patient does not respond adequately to SSRIs alone. These medications can help reduce intrusive thoughts and compulsive behaviours but come with potential side effects like weight gain, sedation, and metabolic changes.

          Benzodiazepines: While not typically first-line treatments for OCD, benzodiazepines like clonazepam can be used short-term to help manage severe anxiety and agitation associated with the disorder. These medications are usually prescribed with caution due to their potential for dependence and tolerance.

          Other Antidepressants: Some other antidepressants, such as Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), may also be effective for treating OCD symptoms in patients who do not respond to SSRIs. These medications work by affecting multiple neurotransmitters, which can be beneficial but also require careful monitoring for side effects.

          Psychiatrists must balance the benefits of these medications against their possible side effects to achieve the best possible outcome for the patient. This involves careful monitoring and adjusting dosages or changing medications as needed to minimize side effects while effectively managing symptoms.

          • Combination Therapy: Often, a combination of CBT and medication provides the best results. This approach addresses both the behavioural and biochemical aspects of the disorder, providing a comprehensive management strategy.
          Importance of Seeking Professional Help

          Managing OCD typically requires more than just willpower or self-help strategies—it needs professional intervention. Mental health professionals can provide a diagnosis, recommend appropriate treatment modalities, and adjust therapies as needed based on how the patient responds over time. Professional guidance is crucial because it ensures that treatment is tailored to the individual’s specific symptoms and severity, which can significantly enhance the effectiveness of the treatment.

          OCD and Counseling Singapore
          Seeking professional help is crucial for OCD patients, as it provides specialised therapies and support essential for managing the disorder effectively.

          Encouraging Support from Family and Friends

          Support from family and friends is extremely valuable in the treatment of OCD. A supportive social network can help reduce the stigma and isolation often associated with this disorder. Family members and friends can also play a proactive role by encouraging adherence to treatment regimens, providing transportation to therapy sessions, or simply being there to listen in a non-judgmental manner.

          • Education: It’s helpful for family and friends to educate themselves about OCD to better understand the challenges and behaviours associated with the disorder. This knowledge can foster patience and empathy, key components of support.
          • Participating in Therapy: Sometimes, therapists may involve family members in sessions to improve understanding and communication around the behaviours and needs associated with OCD.
          • Advocacy: Loved ones can also serve as advocates for individuals with OCD, helping them navigate healthcare systems and advocating for necessary accommodations at school or work.

          In conclusion, the treatment and management of OCD involve a multifaceted approach that includes advanced therapeutic techniques, appropriate medication, and a strong support system. With the right combination of these elements, individuals with OCD can lead fulfilling lives despite the challenges posed by the disorder.

          Moving Beyond Misconceptions

          In this article, we have tackled some of the most persistent myths and misconceptions surrounding Obsessive-Compulsive Disorder (OCD). These myths not only skew public perception but also contribute to the stigma and misunderstandings that can significantly impact those living with OCD. By debunking these myths, we aim to foster a more accurate and compassionate understanding of the disorder, highlighting its complexity and the real challenges faced by those affected.

          Our society stands to benefit greatly from a deeper understanding and empathy towards mental health issues, particularly OCD. Empathy begins with education and awareness, which can break down the barriers of ignorance and fear that often surround mental health disorders. We encourage everyone to advocate for and promote mental health education in their communities, which can transform public attitudes and make a real difference in the lives of those affected.

          • Educate Yourself and Others: Continue learning about OCD beyond this article. Education is a powerful tool for changing perceptions and promoting an environment of support and understanding.
          • Support Mental Health Initiatives: Includes participating in community awareness events, supporting mental health non-profits, or advocating for policies that improve mental health care, your involvement can contribute to a larger change.
          • Show Compassion: If you know someone struggling with OCD, offer your understanding and support. Sometimes, simply being there to listen without judgment can make a significant difference.
          • Seek Professional Help if Needed: If you or someone you know is battling OCD, encourage seeking help from mental health professionals. Early intervention can lead to better outcomes.
          Resources for Further Reading or Assistance:

          By addressing these myths and supporting those affected by OCD, we can create a more inclusive and supportive community. Let’s commit to being part of the solution, promoting understanding, and providing educated support to transform how we deal with OCD in society.

          References 
          1. Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, B. Y., Sambasivam, R., Zhang, Y. J., Shahwan, S., Chang, S., Chua, H. C., Verma, S., James, L., Kwok, K. W., Heng, D., & Chong, S. A. (2019). Tracking the mental health of a nation: Prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiology and Psychiatric Sciences, 29, e29. https://doi.org/10.1017/S2045796019000179
          2. Kaur, R., Garg, R., & Raj, R. (2023). Quality of life among patients with obsessive compulsive disorder: Impact of stigma, severity of illness, insight, and beliefs. Industrial Psychiatry Journal, 32(1), 130–135. https://doi.org/10.4103/ipj.ipj_22_22 
          3. Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019). Obsessive–compulsive disorder. Nature Reviews. Disease Primers, 5(1), 52. https://doi.org/10.1038/s41572-019-0102-3 
          4. Hoarding ocd: Symptoms, diagnosis, treatment, and more. (2023, December 21). Healthline. https://www.healthline.com/health/ocd/your-guide-to-hoarding-ocd-and-its-treatment 
          5. Compulsion to touch things in ocd cases – beyond ocd. (n.d.). Retrieved May 27, 2024, from https://beyondocd.org/expert-perspectives/articles/a-touching-story 
          6. Symmetry ocd: Compulsively orderly. (2024, January 22). https://www.simplypsychology.org/orderliness-and-symmetry-ocd.html 
          7. LPC, S. Q. (2023, August 16). OCD themes that can be hard to talk about. NOCD. https://www.treatmyocd.com/blog/ocd-themes-that-can-be-hard-to-talk-about 
          8. Strom, N. I., Soda, T., Mathews, C. A., & Davis, L. K. (2021). A dimensional perspective on the genetics of obsessive-compulsive disorder. Translational Psychiatry, 11(1), 1–11. https://doi.org/10.1038/s41398-021-01519-z 
          9. Parmar, A., & Sarkar, S. (2016). Neuroimaging studies in obsessive compulsive disorder: A narrative review. Indian Journal of Psychological Medicine, 38(5), 386–394. https://doi.org/10.4103/0253-7176.191395 
          10. Baumgarten, H. G., & Grozdanovic, Z. (1998). Role of serotonin in obsessive-compulsive disorder. The British Journal of Psychiatry. Supplement, 35, 13–20. 
          11. The links between ocd and serotonin deficiency. (n.d.). Retrieved May 27, 2024, from https://www.calmclinic.com/ocd/serotonin-deficiency 
          12. Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181959/ 
          13. World health organisation and ocd | ocd-uk. (n.d.). Retrieved May 27, 2024, from https://www.ocduk.org/ocd/world-health-organisation/ 
          14. Żerdziński, M., Burdzik, M., Żmuda, R., Witkowska-Berek, A., Dȩbski, P., Flajszok-Macierzyńska, N., Piegza, M., John-Ziaja, H., & Gorczyca, P. (2022). Sense of happiness and other aspects of quality of life in patients with obsessive-compulsive disorder. Frontiers in Psychiatry, 13, 1077337. https://doi.org/10.3389/fpsyt.2022.1077337 
          15. Ocd related disorders | baylor medicine. (n.d.). Retrieved May 23, 2024, from https://www.bcm.edu/healthcare/specialties/psychiatry-and-behavioral-sciences/obsessive-compulsive-disorder-program/related-disorders 
          16. Sharma, P., Rosário, M. C., Ferrão, Y. A., Albertella, L., Miguel, E. C., & Fontenelle, L. F. (2021). The impact of generalized anxiety disorder in obsessive-compulsive disorder patients. Psychiatry Research, 300, 113898. https://doi.org/10.1016/j.psychres.2021.113898 
          17. Comorbidity and ocd. (n.d.). Made of Millions Foundation. Retrieved May 23, 2024, from https://www.madeofmillions.com/ocd/comorbidity-and-ocd 
          18. Endrass, T., Riesel, A., Kathmann, N., & Buhlmann, U. (2014). Performance monitoring in obsessive–compulsive disorder and social anxiety disorder. Journal of Abnormal Psychology, 123(4), 705–714. https://doi.org/10.1037/abn0000012 
          19. Tibi, L., van Oppen, P., van Balkom, A. J. L. M., Eikelenboom, M., Rickelt, J., Schruers, K. R. J., & Anholt, G. E. (2017). The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample. European Psychiatry, 44, 76–82. https://doi.org/10.1016/j.eurpsy.2017.03.009 
          20. The relationship between eating disorders and ocd part of the spectrum. (n.d.). International OCD Foundation. Retrieved May 23, 2024, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/ 
          21. The relationship between ocd and tourette’s. (n.d.). NOCD. Retrieved May 23, 2024, from https://www.treatmyocd.com/what-is-ocd/info/related-symptoms-conditions/ocd-and-tourettes 
          22. Adhd and ocd: They can occur together. (2021, March 24). Healthline. https://www.healthline.com/health/mental-health/adhd-and-ocd 
          23. Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181959/ 
          24. Medications for ocd » department of psychiatry » college of medicine » university of florida. (n.d.). Retrieved May 23, 2024, from https://psychiatry.ufl.edu/patient-care-services/ocd-program/medications-for-ocd/ 

          Unravelling the Knots of Anxiety

          Anxiety is not just a medical term; it's a shared human experience, weaving through the lives of countless individuals in myriad, often invisible ways. In this short write-up, Dr Jared Ng sheds light on the realities of anxiety, debunking myths and exploring treatments, all while emphasizing the human experience at the heart of it all.

          Key takeaways

          • Anxiety is a complex emotion that, when persistent and overwhelming, may indicate an anxiety disorder.
          • Not all anxiety is visible, and assuming so can lead to inadequate support for those silently struggling with internal distress.
          • Anxiety disorders represent a spectrum, each with distinct themes and symptoms, ranging from Generalized Anxiety Disorder (GAD) to Post-Traumatic Stress Disorder (PTSD).

          Posted on 3 Apr 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Anxiety is not just a medical term; it’s a shared human experience, weaving through the lives of countless individuals in myriad, often invisible ways. 

          I am seeing a patient, Miss Sally (not her real name), a bright university graduate whose life took an unexpected turn. She was on her way to a job interview when she was unfortunately trapped in a lift for almost an hour. Sally experienced her first panic attack, marked by shortness of breath, chest discomfort, giddiness, headache, and an overwhelming fear of impending doom. She was late for her job interview and she was too discouraged to attend another session, even though the company was sympathetic.

          After her traumatic experience in the life, Sally’s anxiety escalated significantly. She began to fear having more panic attacks, a concern that soon extended to various aspects of her daily life. Initially, she started avoiding taking the lift alone, a direct response to her initial panic attack. However, her anxiety gradually grew to include other enclosed spaces like public transport. This progression of her anxiety led to her avoiding leaving her house altogether, significantly restricting her day-to-day activities and impacting her overall quality of life. Her world became increasingly limited, dominated by the fear of experiencing another panic attack and the physical and emotional distress that accompanies it. Sally’s parents did not understand why their daughter could not find the job or even leave the house after graduation, and this led to conflicts between them.

          Sally’s story is a stark reminder of how anxiety can envelop one’s life, casting a shadow over everyday activities and relationships. As a psychiatrist, I’ve seen how such experiences can lead to a withdrawal from social interactions, a loss of self-confidence, and a sense of isolation, even when surrounded by supportive family and friends. Some of them develop a co-morbid depressive disorder. It’s a poignant example of the hidden struggles many faces, often masked by a veneer of normalcy.

          But Sally’s narrative is just one among many. Anxiety wears numerous faces – from the constant worry of generalised anxiety disorder to the specific, intense fears of phobias, or the daunting challenge of social anxiety. Each individual’s experience with anxiety is as unique as their fingerprint, yet there’s a common thread of needing understanding, support, and effective coping mechanisms.

          In this short write-up, I hope to shed some light on the realities of anxiety, debunk myths, and explore the myriad of treatments available, all while keeping sight of the most important aspect – the human experience at the heart of it all.

          Recognising Anxiety 

          Anxiety, a common yet complex emotion, is something we’ve all experienced at various points in our lives. It’s a natural response to stress, uncertainty, or fear. However, when these feelings become persistent and overwhelming, they may indicate an anxiety disorder.

          Cognitively, anxiety manifests in several ways. It often appears as constant, excessive worrying about everyday activities, where the level of concern is disproportionate to the actual risk or impact. This worrying can be so intense that it interferes with the ability to focus, leading to difficulty in concentrating or a sense of the mind going blank. There’s also a tendency to anticipate the worst, even in relatively benign situations, and to struggle with decision-making due to the fear of making the wrong choice. Intrusive thoughts, which are repetitive and unwelcome, can dominate the mind, contributing to a state of constant fear or apprehension.

          Behaviourally, anxiety influences our actions and choices. It often leads to the avoidance of situations or activities that trigger fear or discomfort. This avoidance can significantly restrict one’s life, limiting opportunities and experiences. Compulsive behaviors may emerge as a coping mechanism, where repetitive actions are performed in an attempt to reduce or control the anxiety. Restlessness is common, manifesting as an inability to relax or sit still, and there can be a tendency to procrastinate or have difficulty completing tasks, rooted in the anxiety itself. People with anxiety often seek reassurance from others, needing constant validation to alleviate their fears.

          Physically, anxiety has a range of manifestations. It can cause palpitations or an unusually rapid heart rate, often accompanied by chest pain. Excessive sweating, unrelated to physical exertion or environmental temperature, is another common symptom. Physical signs of nervousness, such as trembling or shaking, are observable, and gastrointestinal problems like nausea, diarrhoea, or an upset stomach frequently occur. Additionally, muscle tension, leading to headaches and other physical discomforts, is often a physical representation of anxiety.

          It’s important to note that these symptoms can vary widely among individuals. Not everyone with anxiety will experience all these symptoms, and their intensity and frequency can differ. Recognising these symptoms in oneself or others is vital for early identification and intervention. Understanding these signs is the first step in managing anxiety effectively, allowing for strategies and treatments to be tailored to the individual’s specific experiences and needs.

          Myths, Misunderstandings and Misrepresentations About Anxiety 

          The term ‘anxiety‘ is commonly used to describe both everyday feelings of worry and also a clinical psychiatric condition. This dual usage can lead to misunderstandings and oversimplifications of the disorder. For instance, when anxiety is portrayed as just an extreme state of nervousness, it minimises the complex nature of anxiety disorders, which are profound mental health issues impacting one’s life, relationships, and ability to function normally.

          The misconception that anxiety can be overcome solely by willpower is another simplification. It overlooks the intricate interplay of biological, psychological, and environmental factors that contribute to anxiety disorders. Effective management often requires a multifaceted approach, including psychological therapy, medication, and lifestyle adjustments. This myth also perpetuates a stigma, suggesting that those who struggle with anxiety are simply not trying hard enough, or are too “weak” mentally.

          Furthermore, the belief that anxiety is always visible fails to recognise that many individuals with anxiety present a calm exterior despite experiencing intense internal distress. This can lead to underestimation of their struggle and inadequate support from others.

          Given that ‘anxiety’ is used to describe both normal and pathological states, there’s a tendency to either underestimate the severity of the condition or misinterpret normal stress responses as pathological. And because everyone has experienced anxiety at some point, there may be preconceived notions about how one can ‘recover’ from it. However, the experience of anxiety is deeply personal and varies greatly from one individual to another. What may be a minor stressor for one person could be a significant source of anxiety for another. This variation in experiences can lead to misunderstandings about the nature of anxiety disorders and the challenges faced by those who struggle with them. Recognising that each person’s anxiety is unique is crucial in providing appropriate support and avoiding oversimplification of their experiences.

          Types of Anxiety Disorders

          Anxiety disorders are also not a monolithic condition; they represent a spectrum, each type characterised by an underlying theme of excessive fear and worry, yet presenting distinct symptoms.

          Examples:

          1. Generalised Anxiety Disorder (GAD) is characterised by chronic and pervasive worry about a range of topics, often disproportionate to the actual threat.
          2. Panic Disorder involves recurrent, intense panic attacks with physical symptoms like shortness of breath and chest pain.
          3. Social Anxiety Disorder is marked by a deep fear of social interactions due to concerns about judgment or embarrassment.
          4. Specific Phobias involve irrational fears of particular objects or situations, leading to avoidance behaviors.
          5. Obsessive-Compulsive Disorder (OCD) consists of unwanted thoughts and repetitive behaviors aimed at reducing anxiety.
          6. Post-Traumatic Stress Disorder (PTSD) stems from traumatic experiences and includes symptoms like flashbacks and avoidance behaviors.

          Sometimes symptoms don’t fit neatly into these categories, particularly when they are evolving or atypical. The focus in psychiatry is always on the individual person and their unique experiences, emphasising the dynamic and evolving nature of mental health disorders. We treat the person, not the label.

          Is Anxiety Curable?

          While anxiety disorders are complex and long-term conditions, there is a beacon of hope in treatment. People with anxiety disorders often respond positively to a combination of therapies. This includes pharmacological treatments i.e. medication, and non-pharmacological approaches, such as cognitive behavioral therapy and lifestyle changes. An integral part of managing anxiety is the support from one’s network – family, friends, school, colleagues, and employers. Their understanding and encouragement can significantly bolster treatment effectiveness, creating an environment conducive to recovery and well-being.

          Treatment for Anxiety Disorders can be broadly divided into two categories:

          1. Pharmacological Treatments: Medications play a significant role in managing anxiety disorders. These include Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) that help balance brain chemistry. Benzodiazepines are effective for short-term relief of acute anxiety symptoms but are generally not recommended for long-term use due to the risk of dependence. Beta-blockers like Propranolol can also be prescribed to manage physical symptoms of anxiety, such as palpitations and tremors.
          2. Non-Pharmacological Treatments: Cognitive Behavioral Therapy (CBT) is highly effective, particularly for panic disorders and generalised anxiety disorder, focusing on changing thought patterns and behaviors. Techniques like mindfulness, relaxation exercises, and exposure therapy are also integral parts of non-pharmacological treatment. Alternative therapies like hypnotherapy or brain stimulation techniques (like transcranial magnetic stimulation) have shown promise in some cases, and are being researched extensively.
          3. Integrated Care Approach: Often, a combination of pharmacological and non-pharmacological treatments is most effective. Integrated care, which involves coordinating psychological therapy with medication management and lifestyle changes, is considered the best approach for treating anxiety disorders. This holistic approach addresses the multifaceted nature of anxiety, ensuring that treatment is tailored to the individual’s specific needs and circumstances.

          Treatments can lead to significant improvements in symptoms and quality of life. However, it’s important to note that discontinuing treatment can result in a recurrence of symptoms, highlighting the need for ongoing management.

          Conclusion

          In closing, understanding and managing anxiety is a journey both challenging and hopeful. While anxiety disorders are complex and vary from person to person, effective treatments and supportive networks provide a pathway to better managing this condition. Through a combination of therapy, medication, and lifestyle changes, individuals can find relief and improve their quality of life. Remember, anxiety is a part of the human experience, and with the right support and interventions, it can be navigated successfully. There’s always hope and a way forward.

          Epilogue 

          Sally’s journey towards recovery has seen significant progress thanks to a combination of medication and psychological treatment. Psychoeducation for her family played a crucial role in improving their understanding and support, which has been immensely beneficial. I’m delighted to share that Sally is now preparing to start a new job in two weeks, marking a hopeful turn in her journey.

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          • Likes, Shares, and Mental Health Woes — Is Social Media Driving Youth Mental Health Decline?

          Likes, Shares, and Mental Health Woes — Is Social Media Driving Youth Mental Health Decline?

          This article hopes to examine the relationship between social media usage and mental health while exploring the detrimental effects of excessive digital engagement on psychological well-being.

          Posted on 13 Mar 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          In the digital age, the omnipresence of social media in the lives of young individuals has sparked a global debate on its impact on mental health. This discourse, however, is not without precedent; it mirrors historical anxieties surrounding new “technologies” and their potential effects on youthful minds. Reflecting on the 18th and 19th centuries, as books and novels became accessible en masse, similar fears emerged. Critics voiced concerns that these “novel” forms of entertainment might captivate too intensely, risking harm to the pliable minds of the young. In 1907, an editorial titled “Do Boys Read Too Much?” questioned the impact of mass-market fiction on the mental acuity and focus of young readers, foreshadowing today’s worries that perhaps, in an ironic twist, young people now read too little. This historical perspective underscores the cyclical nature of societal concerns regarding the impact of media on youth, setting the stage for the contemporary debate on social media’s role in shaping mental health.

          Singapore’s Deputy Prime Minister Lawrence Wong, on February 7, announced an initiative [1] that brings this debate into the modern era, launching a comprehensive research project aimed at understanding the escalating mental health issues among youth, focusing on social media’s role. This initiative underscores the complex relationship between digital engagement and psychological well-being, marking a renewed interest in exploring how platforms designed to connect and inspire might also be sources of stress, anxiety, and feelings of inadequacy.

          Recent research [2] points to a complex picture. It suggests that while social media has the power to connect and inspire, it also harbours the potential to induce stress, anxiety, and feelings of inadequacy. This article hopes to examine the relationship between social media usage and mental health while exploring the detrimental effects of excessive digital engagement on psychological well-being. 

          social media and distress
          Social media’s pervasive influence is increasingly linked to heightened distress among youth, which exacerbates mental health challenges. 
          The Double-Edged Sword of Social Media

          Social media, in its essence, is a paradox. On one hand, it’s a revolutionary tool that has transformed how we connect, communicate, and consume information. It has democratised content creation, gathered global communities around niche interests, and provided platforms for traditionally marginalised voices. The ability to instantly connect with anyone, anywhere, has made the world smaller and more accessible. For youths, social media can be a vibrant space for self-expression, learning, and exploration. It offers a sense of belonging, a place to find like-minded individuals, and opportunities for activism and social change.

          However, the flip side of this connectivity is its capacity to impact the mental health of young users negatively. For a vivid illustration, consider the story of a patient I encountered during my time in the hospital, whom we’ll call John for confidentiality. John’s tale is a stark reminder of social media’s potent influence over self-esteem and mental well-being. After his social media account was suspended for “buying” followers, John experienced profound emotional distress, so severe that he contemplated suicide. During our clinical interview, he confessed that his self-worth had become inextricably linked to the number of “likes” and followers on his profile. This dependency on digital validation for self-esteem is not an isolated phenomenon but a reflection of the broader challenges posed by social media’s role in our lives.

          This constant quest for validation [3] through likes, comments, and followers can transform social media into a perilous game where self-worth hangs precariously on online approval. John’s story exemplifies how this relentless pursuit of digital acknowledgement can exacerbate feelings of anxiety and depression, creating a cycle of dependence challenging to escape. Furthermore, the impact of social media extends beyond psychological effects, manifesting in real life through disrupted sleep patterns and sedentary behaviour, which can further erode mental and physical well-being.

          social media effects
          Social media is a double-edged sword, allowing for self-expression and connectivity but also cyberbullying and false ideation.

          Reflecting on this, it’s essential to recognise the natural human desire for validation, a sentiment that transcends the digital realm. Just as we observe the counters on our social media profiles—likes, reposts, shares, followers—we find parallels in the academic and professional worlds. For instance, scientists, doctors, and researchers derive a form of validation from seeing their journal publications cited. This desire for acknowledgement and affirmation is a fundamental aspect of human nature. However, the key difference lies in the context and the extent to which this need for validation governs our self-esteem and overall mental health.

          Caught in the “Comparison Trap?” How Social Media Affects Mental Health

          Central to the discourse on social media’s impact on mental health is the pervasive role of comparison and expectation. This phenomenon, deeply embedded in the fabric of online interaction, fuels much of the anxiety and dissatisfaction experienced by young users. With endless feeds of curated content, social media platforms craft an environment where the lives, achievements, and appearances of others are constantly showcased. This setting primes what psychologists refer to as “social comparison theory” [4], the idea that individuals determine their own social and personal worth by comparing themselves to others.

          The “comparison trap” [5] on social media is particularly insidious. It extends beyond comparing oneself to friends and family, reaching into the realms of celebrities, influencers, and strangers with massive followings. These comparisons are rarely fair or realistic, pitting the everyday realities of one’s life against the polished highlight reels of others.

          Photos and stories are meticulously selected and edited to highlight the best moments, accomplishments, and aspects of people’s lives, side-lining the ordinary, mundane, and challenging experiences everyone faces. For young people, whose self-identity and self-esteem are in critical phases of development, this distorted reality can cultivate feelings of inadequacy, low self-worth, and the perception of falling short of peers’ standards online.

          Moreover, social media doesn’t just facilitate comparison; it amplifies unrealistic expectations. Users, particularly youths, are inundated with portrayals of exceptional lifestyles, bodies, and successes, creating a vast divide between expectation and reality. The urge to meet these online personas’ standards can lead young individuals to chase unattainable ideals, fostering frustration, self-criticism, and mental distress.

          fake social media
          Social media often portrays carefully curated images showcasing edited images and unrealistic lifestyles.

          The consequences of this relentless comparison and the clash between expectation and reality are profound. Studies [6] have linked excessive social media use to increased rates of anxiety, depression, and other mental health issues among adolescents and young adults. The mechanism is straightforward: when individuals, especially youths, gauge their worth by the standards of online portrayals, they are predisposed to disappointment and psychological strain. The gap between how they perceive their own lives and the lives of others online can expand, potentially leading to feelings of isolation, envy, and diminished self-esteem.

          In my talks about youth mental health, I often discuss the effects of social media, drawing from personal observations and professional experience. As a member of “Gen X” (yes, that shows my age), my comparators in youth were classmates, neighbours, or friends from the local playground. Today, the range of comparators for young people has expanded globally, courtesy of social media. This boundless arena for comparison magnifies the pressure and challenges they face, emphasising the urgent need for awareness, education, and strategies to navigate the complex web of online social interaction healthily and positively.

          In sharing the story of a patient, John (not his real name), who spiralled into extreme emotional distress after his social media account was suspended for buying followers, the real-world implications of these dynamics become starkly evident. John’s admission that his self-worth was entirely tied to “likes” and followers underscores the dangerous potential of social media to influence mental health negatively. This quest for approval, when rooted in the ephemeral and often superficial metrics of social media, can lead to profound psychological distress.

          By drawing on these examples and integrating the broader context of social comparison from my youth to the present, we can better understand the complex landscape of social media and its impact on mental health. It’s a call to action for individuals, families, and professionals to engage in meaningful dialogues and interventions that can steer young people towards healthier, more balanced interactions with social media.

          Cyberbullying and Online Harassment Another Threat to Mental Well-Being

          As a result of the increased use of social media, cyberbullying and online harassment have become widespread problems, which significantly affect the mental health of many young people. While a boon for privacy and freedom of expression, the anonymity afforded by social media platforms also serves as a double-edged sword, which causes some users to engage in behaviour they might not otherwise exhibit in person. 

          Unlike traditional bullying, cyberbullying offers no respite; victims can be reached at any time and place, which makes it an omnipresent source of stress and anxiety. Studies [7] have consistently shown a troubling correlation between cyberbullying and an increased risk of mental health problems, including depression, anxiety, and even suicidal ideation. The relentless nature of online harassment can erode self-esteem, amplify feelings of isolation, and trigger a cascade of psychological distress.

          Moreover, the vastness of the internet and the sheer volume of interactions on major platforms pose significant challenges to monitoring and enforcing guidelines against bullying and harassment. While social media companies have made strides in developing algorithms and reporting tools to combat such behaviour, the reactive nature of these measures often means that the harm has already been done. The delay in response, combined with the difficulty in tracing anonymous accounts, further exacerbates the problem, which leaves victims feeling helpless and unsupported.

          cyberbullying and mental health
          Cyberbullying and online harassment amplify feelings of vulnerability and distress, which pose significant threats to the mental well-being of youth. 
          The Impact of Screen Time on the Mental and Physical Well-Being of Youths 

          Research [8] suggests that excessive screen time is increasingly concerning for its detrimental impact on the physical and mental health of youth. Staring at screens late into the night interferes with melatonin production, the hormone responsible for regulating sleep-wake cycles. This disruption to the body’s natural rhythm makes it harder for individuals to fall asleep and significantly diminishes the quality of rest they receive. The consequences of this lack of restorative sleep extend beyond mere fatigue, affecting cognitive functions and mood and leading to heightened levels of stress and anxiety. Moreover, the allure of screens often detracts from physical activity, fostering a sedentary lifestyle that can amplify health issues like obesity, which, in turn, impacts mental well-being.

          Additionally, the surge in screen time has markedly curtailed opportunities for face-to-face social interactions, which are pivotal in developing and maintaining robust social skills. This decline in direct human contact may culminate in feelings of isolation and loneliness, adversely affecting social health and overall mental well-being. The skills garnered through in-person interactions—such as empathy, interpreting non-verbal cues, and expressing emotions effectively—are vital for personal development and sustaining healthy relationships. As screen time usurps these invaluable interactions, young individuals may find it increasingly challenging to forge and maintain meaningful connections, further affecting their mental health in an era where connectivity, paradoxically, should be at its zenith.

          Furthermore, it is crucial to acknowledge that our time is finite; we only have 24 hours a day. Time spent in front of screens is time not spent sleeping, engaging with friends in person, or participating in physical exercise. In a world where digital engagement is omnipresent, recognising and managing how we allocate our time is more critical than ever. Every hour spent online is an hour less for activities that nurture our physical health, mental well-being, and real-world relationships. Time is a commodity we cannot manufacture or purchase; thus, it’s essential to prioritise how we spend it to ensure a balanced, healthy lifestyle in the digital age.

          screen time mental health
          Excessive screen time disrupts sleep patterns and exacerbates mental health issues among youth

          Balancing the Scale: Strategies to Mitigate Social Media’s Impact on Youth Mental Health

          A multifaceted strategy is essential to effectively mitigate social media’s adverse impacts on youth mental health. This approach encompasses enhancing digital literacy, offering parental guidance, enforcing platform responsibility, and advocating a balanced lifestyle between the online and offline worlds.

          Central to this strategy is the education of youths in digital literacy. They need to learn how to assess and navigate the vast array of online content critically. Understanding the mechanics behind social media algorithms and recognising the curated nature of digital personas enables young individuals better to manage the psychological effects of their digital interactions. This knowledge empowers them to differentiate between realistic and manipulated portrayals of life online, fostering a healthier relationship with social media.

          Parental guidance also plays a critical role in moderating the impact of social media on young minds. Parents should initiate open dialogues with their children about the benefits and challenges of online engagement. Together, they can establish healthy boundaries around screen time. Importantly, if parents choose to use devices and apps to monitor their children’s screen time, this should be done transparently. Monitoring activities should always be conducted with the child’s knowledge and consent to maintain trust and foster open communication within the family. Covert surveillance can erode the foundational trust between parent and child, leading to further issues.

          Recognising that children are at various developmental stages is crucial in tailoring approaches effectively. What might be appropriate for younger children, such as direct supervision and structured screen time, may not suit teenagers navigating the path toward independence. For teenagers, it’s about negotiating boundaries that respect their autonomy while ensuring their safety online. This nuanced approach acknowledges their need for privacy and independence, fostering a sense of responsibility and self-regulation in their digital interactions.

          Social media platforms themselves must shoulder responsibility for creating safer online spaces. Implementing stringent policies against cyberbullying, enhancing privacy settings, and making reporting tools more accessible are essential measures to protect young users from the potential harms of online engagement.

          Encouraging a balanced life is equally important. Young people should be motivated to engage in offline activities and face-to-face interactions. This not only mitigates the risks associated with excessive screen time but also promotes a well-rounded social and emotional development. It’s about finding harmony between digital connections and real-world experiences, ensuring youths develop healthy social skills and maintain physical activity.

          Mental health professionals are integral to addressing the nuanced challenges posed by social media on youth mental health. By integrating discussions of social media use into therapy, creating digital wellness resources, and advocating for mental health-focused policy reforms, they play a key role in fostering a safer digital environment. Importantly, they recognise that excessive engagement with digital platforms may sometimes stem from underlying conditions such as addiction or social anxiety. This insight enables them to provide targeted therapeutic interventions, addressing the symptoms and root causes of unhealthy digital habits.

          Furthermore, these professionals offer crucial support to parents and youths, guiding them through the complexities of digital behaviour and its impacts. By treating underlying mental health issues and educating families about healthy digital practices, mental health experts significantly improve overall digital wellness and promote healthier relationships with technology. Their efforts ensure a comprehensive approach to mental health in the digital age, highlighting the importance of addressing both immediate and underlying issues related to social media use.

          Ultimately, developing resilience in young people to navigate the digital world confidently requires collaborative efforts among educators, parents, platforms, and mental health experts. By promoting digital literacy, engaging in open and honest conversations, respecting the developmental needs of young people, and encouraging a balanced lifestyle, we can create a supportive environment that enables youths to thrive online and offline.

          References 
          1. Anto, A., Asif, R. O., Basu, A., Kanapathipillai, D., Salam, H., Selim, R., Zaman, J., & Eisingerich, A. B. (2023). Exploring the impact of social media on anxiety among university students in the United Kingdom: Qualitative study. JMIR Formative Research, 7, e43037. https://doi.org/10.2196/43037 
          2. Correspondent, G. Y. H. (2024, February 7). Research to look at surge in youth mental health issues; causes could include social media use. The Straits Times. https://www.straitstimes.com/singapore/politics/research-to-look-at-surge-in-youth-mental-health-issues-causes-could-include-social-media-use 
          3. Using social media for reassurance and validation | psychology today. (n.d.). Retrieved February 29, 2024, from https://www.psychologytoday.com/intl/blog/liberate-yourself/202111/using-social-media-reassurance-and-validation 
          4. How social comparison theory influences our views on ourselves. (n.d.). Verywell Mind. Retrieved February 29, 2024, from https://www.verywellmind.com/what-is-the-social-comparison-process-2795872 
          5. The comparison trap | psychology today. (n.d.). Retrieved February 29, 2024, from https://www.psychologytoday.com/us/articles/201711/the-comparison-trap 
          6. Hilty, D. M., Stubbe, D., McKean, A. J., Hoffman, P. E., Zalpuri, I., Myint, M. T., Joshi, S. V., Pakyurek, M., & Li, S.-T. T. (2023). A scoping review of social media in child, adolescents and young adults: Research findings in depression, anxiety and other clinical challenges. BJPsych Open, 9(5), e152. https://doi.org/10.1192/bjo.2023.523 
          7. Li, C., Wang, P., Martin-Moratinos, M., Bella-Fernández, M., & Blasco-Fontecilla, H. (2022). Traditional bullying and cyberbullying in the digital age and its associated mental health problems in children and adolescents: A meta-analysis. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02128-x 
          8. Nakshine, V. S., Thute, P., Khatib, M. N., & Sarkar, B. (n.d.). Increased screen time as a cause of declining physical, psychological health, and sleep patterns: A literary review. Cureus, 14(10), e30051. https://doi.org/10.7759/cureus.30051   

          Caregiver Fatigue: What You Need to Know

          According to a recent survey, in Singapore, caregivers invest approximately seven hours daily in tending to their loved ones, and more than 40% of them are susceptible to depression due to various challenges, including inflation and the impact of COVID-19.

          Posted on 8 Mar 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          In the heart of caregiving lies a paradox of strength and vulnerability, a journey marked by unwavering devotion and unforeseen trials. One of them on this journey is Mrs Tan (not her real name), a 56-year-old woman emblematic of the silent army of caregivers who navigate the turbulent waters of caring for loved ones with debilitating conditions. Tasked with the care of her 85-year-old father, who is battling dementia, Mrs Tan’s story unfolds as a testament to the emotional and physical challenges that punctuate the caregiving experience. From the awkwardness of personal care tasks to the confrontation with aggression when her father, lost in the fog of dementia, reacted violently to her attempts to bathe him, her narrative is a vivid illustration of the daily realities faced by many in similar situations.

          Mrs Tan’s reluctance to seek help, rooted in her role as the eldest child and a deeply ingrained sense of filial piety, underscores a critical issue in the caregiving community: the pervasive sense of isolation and the formidable weight of responsibility that many caregivers carry, often alone. Her story, while unique in its details, reflects a universal theme among caregivers — the struggle to balance the demands of caregiving with one’s own needs and the internal battle between seeking help and maintaining a facade of self-sufficiency.

          Caregivers often find themselves submerged in responsibilities, grappling with feelings of being overwhelmed. The emotional toll can be disheartening, and if left unaddressed, it may take a significant toll on their health, relationships, and state of mind. This accumulating strain can lead to a critical juncture known as burnout [1] — a state marked by emotional, mental, and physical exhaustion that not only affects you but also impacts the person under your care.

          caregiving singapore
          Caregiving is a full-time commitment requiring continual dedication to the well-being of a loved one.

          According to a recent survey, in Singapore, caregivers invest approximately seven hours daily in tending to their loved ones, and more than 40% of them are susceptible to depression due to various challenges, including inflation and the impact of COVID-19 [2]. 

          Recognising the severity of this issue is crucial. Caregiver burnout is not a mere inconvenience; it’s a pervasive condition that alters your attitude, transforming positivity and compassion into negativity and apathy. In the midst of this struggle, it is essential to grasp a fundamental truth: self-care is not a luxury but a necessity. Taking care of your emotional and physical well-being is as vital as ensuring your loved one attends medical appointments or takes prescribed medications. 

          This journey is a marathon, not a sprint, and understanding the signs and consequences of caregiver burnout is the first step toward breaking the cycle of chronic exhaustion, stress, anxiety, and depression. This article aims to explore the multifaceted aspects of caregiving, from understanding the triggers of burnout to implementing strategies to alleviate the burden on caregivers. By bringing to light stories like Mrs Tan’s, we hope to foster a greater appreciation for the challenges caregivers face and the critical role of support systems in sustaining them through their journey.

          Breaking Point: Understanding the Triggers of Caregiver Burnout

          Providing care for a loved one is an expression of deep affection and commitment. Still, it comes with challenges that can gradually erode a caregiver’s well-being, leading to what is commonly known as caregiver burnout. This state of physical, emotional, and mental exhaustion doesn’t happen overnight; it is an accumulation of stressors and demands. Let’s dig deep into the causes that contribute to caregiver burnout:

          Extended Duration of Care: The Wear and Tear on Resilient Caregivers

          Caring for a loved one is more than a short-term commitment; it’s a journey that can extend over years or even decades. While the dedication of caregivers is commendable, the continuous and prolonged nature of caregiving can gradually erode the resilience of even the most steadfast caregivers.

          As time passes, the caregiving demands persist; as a result, caregivers face a series of challenges that can accumulate and take a toll on their physical and emotional well-being. The wear and tear associated with the extended duration of care can often lead to heightened stress levels [3], emotional fatigue, and a sense of being constantly on alert. The strain arising from the responsibility’s ongoing nature emphasises the need for support systems and self-care practices to sustain caregivers on this extended journey.

          caregiver burnout singapore
          Enduring the extended duration of care takes a toll on even the most resilient caregivers. 
          Uncertain Prognosis: Emotional Turbulence in Caregiving

          When facing an uncertain prognosis, caregivers find themselves amid emotional turbulence. When there is little hope for the improvement of the care recipient’s health or when their condition continues to deteriorate despite the caregiver’s relentless efforts, it can take an emotional toll and lead to demotivation.

          The emotional turbulence that accompanies caregiving is profoundly illustrated by the journey of Mr and Mrs Ravi (not their real names), parents to a pair of adult twins with Autism Spectrum Disorder (ASD). Their daily reality is a testament to the emotional strain that uncertainty can bring. The twins, in their late 20s, are non-verbal and prone to aggression, presenting a continuous challenge with no clear prognosis for improvement. Despite Mr. and Mrs. Ravi’s dedicated efforts and unwavering hope, the absence of significant progress in their sons’ condition exemplifies the deep emotional toll such uncertainty can exact on caregivers. Their story underscores the pervasive emotional burden that comes with caring for loved ones when the path forward is clouded with unpredictability.

          Overwhelmed by Responsibilities: Managing the Juggling Act of Caregiving

          Caregivers often find themselves grappling with an extensive list of responsibilities. From administering medications to facilitating daily activities, the demands can become a relentless juggling act. This constant sense of being “in over one’s head” is a key contributor to heightened stress levels among caregivers.

          The Ravis’ situation also highlights the overwhelming nature of caregiving responsibilities. Managing the complex needs of their twins, from ensuring their safety during aggressive episodes to addressing their daily care requirements, embodies the relentless juggling act many caregivers face. This constant state of being “in over one’s head” not only elevates stress levels but also fosters a profound sense of inadequacy and frustration. For Mr. and Mrs. Ravi, the physical tasks of caregiving are interwoven with the emotional challenges of seeing their children struggle, illustrating the multifaceted burden caregivers bear.

          overwhelmed caregiver
          Navigating the juggling act of managing multiple responsibilities often leaves caregivers feeling overwhelmed and overburdened.
          Isolation in Caregiving: The Detrimental Impact of a Lack of Support

          The emotionally exhausting and demanding journey of being a caregiver can become even more challenging for those working without a support system [4]. Caregivers who find themselves without a network of assistance or fail to receive the necessary help are at a heightened risk of burnout. 

          Perhaps most striking in the Ravis’ narrative is the isolation felt in the absence of a robust support system. The challenges of caring for their adult twins with ASD are compounded by the lack of external assistance, leaving them to navigate the complexities of their sons’ care alone. This isolation not only magnifies the stress and exhaustion inherent in their caregiving role but also highlights the critical need for support that transcends mere physical help. The absence of a community to lean on, coupled with the daunting task of coordinating care and managing aggressive behaviors without respite, paints a vivid picture of the detrimental impact that isolation can have on caregivers.

          The stories of Mrs. Tan and Mr. and Mrs. Ravi serve as poignant reminders of the diverse yet universally challenging experiences of caregivers. Through their narratives, we see the essence of caregiving – a role marked by love, resilience, and an often overwhelming sense of responsibility. Recognising the need for support, understanding, and resources for caregivers becomes not just a compassionate imperative but a necessary step in addressing the challenges they face daily.

          Dealing with the Financial Tightrope of Caregiving: The Toll of Financial Strain

          The responsibility of providing care can place a substantial burden on a caregiver’s financial resources [5]. Balancing the costs associated with medical care, medications, and other necessities can give rise to a sense of financial strain, amplifying stress and anxiety within the caregiving experience.

          The financial challenges caregivers face are multi-faceted. From out-of-pocket expenses for medical appointments and prescription medications to the potential loss of income due to reduced work hours or leaving the workforce altogether, the financial toll can be considerable. The financial strain may even permeate other aspects of life, impacting the caregiver’s ability to meet their needs and potentially compromising their financial stability.

          Mdm Rosmah’s (not her real name) narrative poignantly highlights the financial burdens that can beset caregivers, especially when unforeseen circumstances exacerbate an already precarious situation. After her husband was posted overseas for work, Mdm Rosmah made the significant decision to quit her job, dedicating herself to caring for her daughter with severe bipolar disorder. This sacrifice not only impacted her career but also placed her in a vulnerable financial position. The situation took a turn for the worse during one of her daughter’s relapses, which led to thousands of dollars being spent on clothes and cosmetics using Mdm Rosmah’s credit card. This incident not only exemplifies the direct costs associated with caregiving but also the potential for unexpected financial challenges that can deepen the strain on a caregiver’s resources.

          This part of Mdm Rosmah’s journey underscores the multifaceted nature of financial challenges in caregiving, blending the tangible aspects of financial management with the unpredictable elements of caring for someone with a mental health condition. It highlights the critical importance of financial planning, the need for accessible resources, grants, or support programs, and the necessity of contingency plans to manage such crises.

          financial burden caregiving
          Financial strain can be the breaking point for some caregivers.
          The Weight of Caregiver Guilt and Obligation: Balancing Self-Care Amidst Internal Conflict

          The emotional and familial turmoil Mdm Rosmah faces further illuminates the internal conflicts many caregivers experience. When confronted with her daughter’s actions, not only did she face the financial repercussions, but she also encountered a profound moral and emotional dilemma. Her refusal to report her daughter to the police, despite her eldest son’s insistence, reflects the deep-seated sense of obligation and protection caregivers feel towards their care recipients, even in the face of personal harm and financial loss. This decision led to her eldest son moving out, adding to the sense of her family disintegrating, and exacerbating feelings of isolation, guilt, and the weight of her caregiving responsibilities.

          Many individuals providing care grapple with feelings of guilt when contemplating taking time for themselves rather than solely dedicating every moment to meeting the needs of their loved ones. The sense of obligation to provide constant care can lead to internalised guilt when considering personal needs or moments of respite. This internal conflict can manifest as a perpetual emotional tug-of-war, contributing to heightened stress and emotional fatigue.

          Acknowledging and addressing feelings of guilt and obligation is a pivotal aspect of supporting caregivers. By fostering a more balanced perspective on caregiving responsibilities, caregivers can deal with the challenges with greater emotional resilience, which can help them ensure a healthier and sustainable caregiving experience for both themselves and their loved ones.

          Understanding these underlying causes of caregiver burnout is essential in developing strategies to prevent or mitigate caregiver burnout. By recognising these stressors, caregivers can take proactive steps to safeguard their well-being while providing the best care for their loved ones.

          The Warning Signs: Recognising Caregiver Burnout Early On

          Caregiver burnout is a state of physical, emotional, and mental exhaustion that can result from the prolonged and overwhelming stress of caregiving. Recognising the signs of caregiver burnout is crucial for taking proactive steps to address and prevent its impact. Here are common signs of caregiver burnout:

          Physical symptoms:
          • Persistent fatigue and lack of energy
          • Frequent headaches or physical ailments
          • Changes in sleeping patterns, either insomnia or excessive sleep
          Emotional signs:
          • Overwhelming feelings of sadness or helplessness
          • Increased irritability or frustration
          • Persistent feelings of anxiety  or worry
          • Loss of interest in activities once enjoyed
          Cognitive impact:
          • Difficulty concentrating or making decisions
          • Forgetfulness or absentmindedness
          • Cognitive fatigue and mental fog
          Behavioural changes:
          • Withdrawal from social activities and isolation
          • Increased use of alcohol or other substances
          • Neglecting personal responsibilities and self-care
          Physical health deterioration:
          • Weakened immune system and increased susceptibility to illness
          • Unexplained weight loss or gain
          • Chronic health issues [6] exacerbated by stress
          Shift in attitude:
          • Increased cynicism or negativity
          • Decreased empathy and patience
          • A sense of hopelessness or helplessness
          Strained relationships:
          • Tension and conflicts with family members, friends, or the person being cared for
          • Social withdrawal and difficulty maintaining relationships
          Neglecting self-care:
          • Ignoring personal needs and well-being
          • Difficulty taking breaks or seeking support
          • Feeling guilty when considering personal time or self-care
          Impact on work or other responsibilities:
          • Decline in job performance or inability to focus at work
          • Difficulty managing other responsibilities outside of caregiving
          Increased health concerns:
          • Elevated blood pressure or other stress-related health issues
          • Compromised immune system leading to frequent illnesses

          Recognising these signs early on is essential for preventing burnout and maintaining the caregiver’s well-being. Seeking support, prioritising self-care, and implementing strategies to alleviate stress are crucial steps to address caregiver burnout effectively.

          Preventing Caregiver Burnout: Essential Strategies for Well-being

          Preventing caregiver burnout is crucial for maintaining the overall well-being of those undertaking the demanding role of caregiving. The responsibilities associated with providing care can be emotionally, physically, and mentally taxing, making it essential for caregivers to adopt proactive strategies to safeguard their own health while ensuring the best possible care for their loved ones.

          self-care
          Taking care of yourself is not a luxury; it’s a necessity.
          1. Prioritise Self-Care

          Taking care of oneself is crucial for preventing caregiver burnout. Schedule regular self-care activities such as exercise, meditation, or hobbies. Ensure you are getting enough sleep and maintaining a healthy diet. By prioritising your own well-being, you’ll be better equipped to handle the challenges of caregiving.

          2. Set realistic expectations

          It’s important to be realistic about what you can accomplish as a caregiver. Understand your limitations and accept that you may not be able to do everything. Set achievable goals and focus on what truly matters. Setting realistic expectations helps reduce feelings of frustration and inadequacy, contributing to long-term well-being.

          3. Seek and Accept Support

          Building a strong support network is essential for preventing burnout. Connect with friends, family, or caregiver support groups to share your experiences. Don’t hesitate to ask for help when needed, whether with caregiving tasks or emotional support. Feeling understood and supported can significantly alleviate the burden of caregiving.

          4. Establish Boundaries:

          Establishing clear boundaries is crucial for maintaining balance in your life. Learn to say no when necessary and communicate your limits to others. This may involve delegating tasks to other family members or hiring professional help. By setting boundaries, you protect your own well-being and ensure that caregiving responsibilities do not become overwhelming.

          5. Take Regular Breaks

          It’s essential to schedule regular breaks to avoid burnout. Allow yourself time away from caregiving responsibilities to relax and recharge. Whether it’s a short walk, a hobby, or a weekend getaway, taking breaks is vital for maintaining mental and emotional health. Breaks provide perspective and help prevent the constant stress that can lead to burnout.

          mental fatigue singapore
          Taking a break can help prevent caregiver burnout and ease caregiver mental fatigue.
          6. Utilise Respite Care Services

          Explore respite care options [7] to give yourself extended breaks from caregiving. Respite care provides temporary relief, allowing you to rest and attend to personal needs. Whether through professional services, friends, or family members, incorporating respite care into your routine is a proactive strategy to prevent burnout.

          7. Seek Professional Assistance

          In addition to relying on personal networks, seeking professional assistance is a crucial strategy for preventing caregiver burnout. Healthcare professionals, such as psychiatrists, can provide valuable guidance on managing stress, addressing emotional challenges, and maintaining overall well-being. Counsellors specialising in caregiver support can offer coping strategies, stress management techniques, and a safe space to express feelings.

          8. Practice Stress-Relief Techniques

          Integrating stress-relief techniques into your daily routine is fundamental for preventing caregiver burnout. Embracing practices like deep breathing, meditation, or yoga can significantly alleviate the physical and emotional strain associated with caregiving. These techniques are not only accessible but can be easily incorporated into even the busiest schedules. Regularly practising stress-relief techniques helps manage immediate feelings of tension and builds resilience over time, enabling caregivers to fulfil their responsibilities with greater ease and endurance.

          stress-relief techniques
          Stress-relief techniques, such as deep breathing or yoga, can help caregivers overcome exhaustion and burnout. 
          9. Utilise Technology

          In the modern era, leveraging technology [8] can be a powerful strategy to mitigate the challenges of caregiving. Explore various technological solutions [9] designed to streamline caregiving tasks and reduce the likelihood of burnout. Utilise medication reminder apps to ensure timely administration and tracking of medications. 

          Online support forums and communities can provide a virtual space for caregivers to connect, share experiences, and gain valuable insights. Additionally, consider incorporating telehealth options for medical consultations. This facilitates convenient access to healthcare professionals and minimises the logistical challenges associated with in-person appointments. 

          Moreover, some medical conditions necessitate specialised care, and technology addresses these distinct needs. For instance, applications such as Alzheimer’s Society’s Talking Point cater to caregivers of individuals with Alzheimer’s or dementia by offering a dedicated online community. These condition-specific apps provide tailored resources, advice, and a supportive environment designed to address the unique challenges caregivers face in these situations.

          Conclusion: Nurturing Caregivers for Sustainable Care

          Selflessness often takes center stage in caregiving, with the well-being of loved ones prioritised above all else. Yet, as the journeys of Mrs. Tan, Mr. and Mrs. Ravi, and Mdm Rosmah poignantly illustrate, the sustainability of care is deeply intertwined with the health and well-being of the caregivers themselves. Each story, unique in its challenges and triumphs, underscores a universal truth: preventing caregiver burnout is not just an act of self-preservation but a crucial component of providing continuous, quality care.

          Mrs. Tan’s struggle with the emotional and physical demands of caring for her father with dementia, Mr. and Mrs. Ravi’s relentless dedication in the face of their twins’ unpredictable behaviors, and Mdm Rosmah’s financial and emotional turmoil while supporting her daughter—all highlight the multifaceted challenges caregivers face daily. Yet, within these narratives, there is a thread of hope and resilience that shines brightly. These caregivers, in recognising their limits and seeking support, embody the very essence of strength.

          By embracing self-care, establishing boundaries, and leveraging technological aids, caregivers can navigate their journey with greater assurance and less strain. Mrs. Tan’s, Mr. and Mrs. Ravi’s, and Mdm Rosmah’s stories serve as powerful reminders that acknowledging the need for help is not a weakness but a step toward a more balanced, healthy caregiving experience. Through open communication and attending to their emotional needs, caregivers can find solace and strength in a community that understands and supports them.

          The path of caregiving, filled with challenges and rewards, calls for a collective effort to ensure it is one marked by support, understanding, and hope. By uniting in this cause, we pave the way for a future where caregiving is not a solitary struggle but a shared journey, illuminated by the compassion and resilience of those who walk it.

          References 

          1. Tan, Gregory Tee Hng, et al. “Factors Associated with Caregiving Self-Efficacy among Primary Informal Caregivers of Persons with Dementia in Singapore.” BMC Geriatrics, vol. 21, no. 1, Jan. 2021, p. 13. BioMed Central, https://doi.org/10.1186/s12877-020-01951-8

          2. YingCorrespondent, Lee Li. “Over 40% of Caregivers at Risk of Depression amid Challenging Environment: Survey.” The Straits Times, 6 Apr. 2023. The Straits Times, https://www.straitstimes.com/singapore/over-40-of-caregivers-at-risk-of-depression-amid-challenging-environment-survey

          3. Schulz, Richard, and Paula R. Sherwood. “Physical and Mental Health Effects of Family Caregiving.” The American Journal of Nursing, vol. 108, no. 9 Suppl, Sept. 2008, pp. 23–27. PubMed Central, https://doi.org/10.1097/01.NAJ.0000336406.45248.4c

          4. Bruening, Rebecca, et al. “Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program.” Journal of Applied Gerontology, vol. 39, no. 4, Apr. 2020, pp. 368–76. DOI.org (Crossref), https://doi.org/10.1177/0733464818825050

          5. Lai, Daniel W. L. “Effect of Financial Costs on Caregiving Burden of Family Caregivers of Older Adults.” SAGE Open, vol. 2, no. 4, Oct. 2012, p. 215824401247046. DOI.org (Crossref), https://doi.org/10.1177/2158244012470467

          6. JD, Ron Ingber. “Caregiver Stress Syndrome.” Caregiver.Com, 2 Feb. 2023, https://caregiver.com/api/content/361e1fc0-fcc1-11e8-8be9-120e7ad5cf50/

          7. Bernstein, Susan, and Shawna Seed. “Respite Care.” WebMD, https://www.webmd.com/cancer/what-is-respite-care.  Accessed 5 Feb. 2024. 

          8. Lindeman, David A., et al. “Technology and Caregiving: Emerging Interventions and Directions for Research.” The Gerontologist, vol. 60, no. Suppl 1, Feb. 2020, pp. S41–49. PubMed Central, https://doi.org/10.1093/geront/gnz178

          9. 6 Indispensable Tech Tools for Family Caregivers | VirginiaNavigator. https://seniornavigator.org/article/75065/6-indispensable-tech-tools-family-caregivers.   Accessed 5 Feb. 2024. 

          Navigating Children’s Grief: How to Help Them Cope

          In the face of childhood grief, Dr Jared Ng emphasizes the intricate and unique nature of children's responses to loss. Drawing on personal experience and professional insights, he underscores the importance of adaptable and observant parenting, acknowledging the diverse ways children navigate their emotions.

          Key takeaways

          • Supporting grieving children requires a delicate balance of empathy, insight, and patience. Parents should cultivate a compassionate space where children feel safe expressing emotions.
          • Open communication about sensitive topics, such as suicide, contributes to demystifying the subject and fostering an environment of trust.
          • Grief extends beyond immediate family and friends, impacting broader communities. Acknowledging and addressing grief in these larger circles is crucial.

          Posted on 25 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Our family recently experienced a situation that brought the topic of loss into our lives. Our daughter, who is 14, was faced with the sudden death of a friend, also 14. Though they met only once a week, the event was significant enough to stir reflections on mortality. At this age, children often first confront death with the passing of elderly relatives, like grandparents. The loss of a peer, a friend, introduces a different dimension to their budding understanding of life and death. This type of loss, unexpected and at a distance, subtly alters their developing concept of mortality, challenging their nascent understanding.

          As a psychiatrist and my wife as a child psychologist, we have guided many children and families through the grieving process. Encountering this with our own daughter, even from a step removed, has provided a unique perspective. This experience has been an insightful journey for our family, not one of deep personal grief for our daughter, but still a moment of learning and reflection. In this article, I aim to share thoughts and perspectives informed by our professional background and our family’s experience with this indirect encounter with loss. I hope to offer my views on the kind of support and guidance children might need when they face similar experiences.

          Navigating the Terrain of Childhood Grief

          In the wake of this recent tragic event, the distinct ways in which children and adolescents process grief have become more apparent within our own household. Each child’s reaction to grief is as unique as their individuality. Some might deeply feel the loss, exhibiting intense sorrow, tears, and a strong attachment to memories. Others may seemingly shrug off the loss with an indifference that can be puzzling, yet this too is a natural part of the spectrum of grief. It’s not uncommon for anger and frustration to surface as young ones try to make sense of death’s finality and apparent unfairness. Additionally, feelings of guilt can unexpectedly arise, haunted by ‘what ifs’ and ‘if onlys’.

          Behavioral shifts often accompany their grieving. A child who was self-sufficient may start to regress, finding solace in old habits or seeking extra reassurance. On the flip side, some might adopt an air of maturity, trying to fill perceived gaps or taking on roles they think are left empty.

          These varied responses highlight that there is no one-size-fits-all approach to aiding a young person in grief. Their path through mourning is deeply personal, influenced by their comprehension of death, their bond with the person who passed, and their emotional and developmental stage.

          Our task as parents is to be observant and adaptable. This means not only hearing their words but also understanding their silences. It involves offering comfort without overwhelming, providing guidance without imposing, and letting the child navigate their grief in their way. Often, the most significant support we can provide is simply being there – a constant, reassuring presence that they are not alone as they journey through the complex emotions of loss and bereavement.

          Supporting Young Hearts in Times of Grief
          father supporting son through grief
          As parents and caregivers, shepherding our children through the turbulent seas of grief is a role that demands a mix of empathy, insight, and patience.

          Our part in their journey of mourning oscillates among being a compassionate listener, a source of comfort, and often, just a silent, supportive presence beside them.

          Fostering a Compassionate Space

          It’s vital to cultivate an environment where a child feels safe to express and explore their emotions. This involves being completely present, both in body and spirit. Active listening goes beyond hearing their words; it’s about noticing their non-verbal cues, understanding the emotions behind their silences, and the messages in their pauses. When our daughter was processing her friend’s death, there were moments when she retreated into quiet reflection (Well, she was never someone very expressive in the first place). Recognising these times as opportunities for silent solidarity, we sat with her, offering a comforting presence, understanding that sometimes words are unnecessary and might even disrupt the healing process.

          Navigating Openness and Privacy

          Encouraging honest communication while respecting a child’s personal space is a delicate act. After our daughter’s friend passed away, we gently invited her to share her thoughts and feelings. We wanted to create a natural and supportive setting for conversation, which meant that we did it away from her two brothers. She would definitely not want to talk about feelings or show any emotions if the brothers were around. Yet, we were equally mindful of her moments of solitude, understanding when she needed to be alone, maybe writing in her journal or listening to music that connected her to her friend. This balance allowed her to independently process her grief, with the assurance of our unwavering support at her beck and call.

          Respecting Teenagers’ Sharing Preferences

          Teenagers, amidst their journey towards self-discovery and independence, may prefer to confide in trusted adults or friends outside the immediate family circle. Honouring and facilitating this preference is key. This would mean arranging conversations with a beloved relative or a close family friend with whom the child feels more comfortable. This would provide the child with alternative avenues for emotional expression. Furthermore, encouraging her participation in peer support groups offered her the chance to connect with others experiencing similar emotions, fostering a sense of solidarity and understanding.

          Modelling Constructive Grieving Behaviors

          As adults, we’re the exemplars of healthy grieving practices. By sharing our own feelings of loss and the coping strategies we employ, we guide children in acknowledging and expressing their grief. This can be through simple actions like discussing our emotions openly, participating in rituals to remember the loved one, or seeking support from friends or professionals. This approach underscores that reaching out for help is a sign of courage and an integral part of emotional resilience.

          For example, we might share our feelings about the loss (“I feel a deep sense of loss too, it’s natural to be sad”) or engage in remembrance activities, like lighting a candle or browsing through photo albums. These actions provide a tangible framework for children to articulate and process their grief.

          In essence, our role in guiding children through grief involves creating a nurturing space where their emotions are acknowledged and respected, balancing openness with privacy, and demonstrating healthy ways to grieve. By doing so, we not only assist them in navigating their current loss but also empower them with the emotional tools to face future challenges.

          Guiding Young Minds Through Discussions on Death and Loss

          Facilitating conversations about death and loss with children requires a thoughtful blend of candor, sensitivity, and a keen awareness of their developmental stage and emotional capacity. In our household, given my professional expertise, we’ve adopted a relatively open stance towards discussing challenging topics, including suicide. I recognise, though, that this level of openness might not be typical in many families, where such discussions are often circumvented or shrouded in ambiguity.

          Tailoring Explanations to Age and Understanding

          When broaching the subject of death, especially in cases of sudden loss like the one involving my daughter’s friend, it’s crucial to provide explanations that are clear and suitable for the child’s age. For younger children, this may involve using simple, straightforward language (“She passed away because her body stopped working and couldn’t be fixed”) and steering clear of complex details. With teenagers, the dialogue may evolve into more profound discussions about life, death, and mental wellness.

          Anticipating and Responding to Emotional Reactions

          Expect and be prepared for various emotional reactions, ranging from sadness and confusion to anger or apathy. Each response is valid and should be met with empathy and reassurance. It’s essential to create an environment where these emotions can be expressed freely and without judgment.

          For instance, if a child shows sadness or becomes tearful during a discussion about death, offer them comfort through physical affection or supportive words (“It’s completely okay to cry, I’m right here with you”). If they express anger or confusion, acknowledge their feelings and propose to explore them together (“I see you’re really upset about this. Would you like to talk more about your feelings?”).

          Approaching the Subject of Suicide

          Discussing suicide with children demands a particularly careful and sensitive approach. In our family, the subject of suicide is openly addressed, a practice stemming from my professional engagements. My children have been exposed to discussions on this topic during my Zoom lectures and online meetings, creating an atmosphere where suicide is recognised as a critical, though difficult, topic.

          For instance, following one of my lectures, my son approached me with questions about why someone might contemplate suicide. This led to a conversation about mental health, the importance of seeking help, and how overwhelming emotional pain can be. These discussions, albeit challenging, have been pivotal in demystifying the topic and fostering an environment of openness and trust.

          I am aware, however, that this level of frankness is not standard in all homes. In many communities, suicide is still a taboo subject, often enveloped in stigma and misunderstanding. It’s vital for families to break this silence and provide clear, accurate information. This can start with simple steps, such as acknowledging mental health issues and stressing the importance of empathy and understanding for those facing these challenges.

          For example, if a child hears about a suicide from school or media, it presents an opportunity to start a conversation. You might say, “It’s deeply saddening when someone feels such intense pain that they can’t see any other solution. It’s important for us to discuss these feelings and to remember that help is always available.” Such dialogues can lay the groundwork for a more informed and empathetic understanding of mental health and suicide in children.

          Emphasising the Value of Seeking Assistance

          It’s crucial to reinforce that seeking help is a sign of courage, not weakness. Foster an environment where open discussion about emotions and mental health is encouraged, making it clear that expressing feelings and reaching out to trusted adults, friends, or professionals is always a positive and brave step.

          mother helping daughter to cope with grief
          For example, you could say, “If you ever feel very sad or overwhelmed, it’s important to talk about it with someone, like me, a teacher, or a counsellor. Discussing our feelings is a healthy and courageous act.”

          In summary, guiding children through discussions about death and loss involves providing them with appropriate information, supporting them emotionally, and creating a space where difficult topics can be approached openly and with honesty. By doing this, we not only aid them in processing their grief but also lay a foundation for their emotional development and future coping mechanisms.

          Understanding the Ripple Effect of Grief in the Community

          The ramifications of a young person’s passing extend far beyond their immediate family and friends, affecting many in the broader community. This became evident to us following the loss of our daughter’s friend. The wave of grief wasn’t confined to her close classmates; it reached out to youngsters from her primary school, tuition centres, and other social circles. Within her secondary school, it affected the class teachers, CCA teachers, and school leaders. This wider impact is something that’s sometimes missed in the wake of such events.

          As caregivers and community members, recognising and addressing the grief in these larger circles is essential. They, too, deserve acknowledgment and support in their mourning. This could involve reaching out to former teachers, leaders of clubs or groups the deceased was involved in, or parents of other children who knew them. It’s about forging support networks that go beyond the immediate, understanding that grief doesn’t adhere to the limits of existing relationships or environments.

          By offering this extended support, we can help organise memorial events, support groups, or counselling sessions that include these broader groups. Providing resources and advice to adults within these networks also equips them to better support the children they look after. It’s a collective endeavor, a recognition that grief, in its various forms, impacts more individuals than we might initially comprehend.

          Conclusion

          In navigating the complex and varied paths of childhood grief, we, as parents and caregivers, play a multifaceted role. It’s a journey that calls for empathy, understanding, and patience, as we strive to create a safe space for our children to express and process their emotions. Whether it’s providing a listening ear, respecting their need for privacy, or guiding them in understanding and articulating their feelings, our approach must be as individual as each child’s experience of loss.

          By fostering open discussions, encouraging healthy emotional expression, and creating supportive networks, we not only aid our children in navigating their grief but also contribute to building a more empathetic and understanding society. This journey, though challenging, reinforces the importance of togetherness, compassion, and resilience in the face of loss, shaping a supportive community for all who are touched by grief.

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          • New Year, New Horizons: Balancing Resolutions and Mental Wellness

          New Year, New Horizons: Balancing Resolutions and Mental Wellness

          As we embark on the journey of setting New Year's resolutions, the first and perhaps most crucial step is self-awareness and reflection. This introspective process is more than a mere recapitulation of the past year’s events; it is an opportunity to delve deeply into our experiences, understanding our actions, reactions, and the motives behind them.

          Key takeaways

          • Embrace self-awareness through reflective practices to build meaningful and impactful resolutions rooted in personal growth.
          • Foster positive mental health by setting realistic goals, incorporating incremental objectives, and allowing flexibility in timelines.
          • Harness the power of community, involving others in your journey, to create a supportive network that enhances motivation, accountability, and the overall pursuit of objectives.

          Posted on 8 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          As 2024 unfolds, it brings with it the tradition of setting resolutions—a practice steeped in hope and the desire for change. This ritual, while often viewed with optimism, holds a deep and intricate connection with our mental health. The journey of setting and pursuing New Year’s resolutions, as observed in experiences and stories, demonstrates how these personal commitments can significantly shape our mental well-being.

          A Family Conversation on Resolutions

          Over a family lunch on New Year’s Day, a casual conversation about resolutions unfolded into a meaningful dialogue about hopes and aspirations. Each of my children, in their unique way, shared their goals for the year, painting a vivid picture of their individual ambitions and the paths they hoped to tread. (Of course, I had to ask them…it’s not something they would bring up to their parents spontaneously!)

          The eldest, with his O-level examinations happening at the end of the year, spoke earnestly about his desire to achieve academic excellence. My wife and I told him that his goal, while commendable, was not just about grades. It was a journey involving self-discipline, time management, the balancing of stress and studies…essentially, hard work is needed. His resolution opened up discussions about maintaining a healthy mindset amidst academic pressures, and the importance of self-care in the pursuit of academic goals.

          Our daughter, with her own academic ambitions, aimed to improve her performance in school. Her resolution, though similar in nature to her brother’s, was uniquely hers. It brought to light different challenges she faced and her personal approach to overcoming them. Her goal emphasized the need for a tailored strategy that accounted for her learning style, interests, and how she could find joy and satisfaction in her educational journey.

          Our youngest, with the simplicity and enthusiasm characteristic of his age (and birth order), declared his intention to learn badminton (and beat everything else in the school). This resolution, while seemingly less academic, was no less significant. It underscored the importance of physical activity, not just for physical health but for mental and emotional well-being too. His goal reminded us of the joy found in learning new skills, the development of physical coordination, and the value of perseverance and resilience in sports.

          This family conversation highlighted the diversity of resolutions and the different forms they can take. It wasn’t just about setting goals but understanding the underlying motivations, the challenges they may present, and the personal growth they encourage.

          Self-awareness and Reflection: The Cornerstone of Meaningful Resolutions

          As we embark on the journey of setting New Year’s resolutions, the first and perhaps most crucial step is self-awareness and reflection. This introspective process is more than a mere recapitulation of the past year’s events; it is an opportunity to delve deeply into our experiences, understanding our actions, reactions, and the motives behind them. This understanding is the bedrock upon which meaningful and impactful resolutions are built.

          Woman reflecting by the side of the lake overlooking a mountainous range.
          Embrace self-awareness through reflective practices to build meaningful and impactful resolutions rooted in personal growth.

          Reflective practice involves looking back at the past year with a critical, yet compassionate eye. Ask yourself questions like: What were my achievements and why were they successful? What challenges did I face and how did I respond to them? Which habits served me well and which ones hindered my progress? The answers to these questions provide invaluable insights into your personal growth trajectory.

          Through reflection, we can identify what truly matters to us. Sometimes, in the hustle of daily life, our actions and goals may drift away from our core values. Use this time to realign. Do your resolutions resonate with what you genuinely value and aspire to in life? For example, if family is a central value, how do your resolutions strengthen family bonds? If personal growth is your focus, how do your goals foster this growth?

          Analysing both your successes and setbacks from the previous year is helpful. Successes teach us about our strengths and what strategies work for us. Setbacks, on the other hand, are not failures but lessons that help us grow. They pinpoint areas where we can improve and often reveal new paths or approaches we hadn’t considered before.

          The insights gained from self-reflection help in tailoring resolutions that are not only realistic but also deeply personal and relevant to your life. This customization makes the goals more engaging and achievable. If the past year showed you a newfound passion for health, perhaps a resolution might involve learning more about nutrition. If you discovered a tendency to overcommit, a resolution might be about learning to say no and prioritizing your time.

          Finally, reflection allows us to embrace change. As you reflect, you may notice how you’ve evolved over the past year. This realization is empowering and can fuel your motivation for the resolutions ahead. It reminds us that we are constantly in a state of becoming, and our resolutions are a testament to our commitment to continual growth and self-improvement.

          Setting and Navigating Realistic Goals for Positive Mental Health

          Setting realistic goals is vital for fostering positive mental health. It involves balancing ambition with practicality, ensuring that goals are challenging yet achievable based on one’s current abilities and life circumstances. This balance prevents feelings of frustration and inadequacy associated with overly ambitious goals, as well as the lack of stimulation from goals that are too easily attainable.

          Setting goals for the new year 2024
          Foster positive mental health by setting realistic goals, incorporating incremental objectives, and allowing flexibility in timelines.

          In the context of personal or professional development, it’s crucial to set incremental objectives. For instance, in improving physical health, instead of immediately training for a marathon, a more manageable goal for a beginner might be to start with shorter runs and gradually increase the distance. This approach not only makes the goal more achievable but also mitigates the risk of injury and burnout.

          Similarly, in professional development, rather than aiming to land a top management position right away, a more practical goal for someone early in their career would be to seek gradual advancements. This could include taking on more responsibilities, seeking mentorship, or acquiring new skills. These smaller, more realistic goals pave the way for larger achievements while maintaining motivation and a sense of progress.

          When pursuing personal hobbies or skills, such as learning a musical instrument, setting a goal to become proficient within an unrealistically short timeframe can be discouraging. A more effective approach is to aim for smaller milestones, like learning a few chords or songs initially, and then progressing to more complex pieces. This gradual progression encourages a steady and enjoyable learning process.

          The timelines attached to goals are equally important. Unreasonable deadlines can create stress and pressure, negatively impacting mental health. Conversely, well-considered timeframes foster a sense of control and progress. Breaking down larger objectives into smaller milestones is a highly effective strategy. For example, in an academic setting, instead of focusing solely on a final exam result, setting milestones like completing specific chapters or mastering particular concepts can be more beneficial.

          Moreover, flexibility in timeframes is crucial to accommodate life’s unpredictability. Rigidity in timelines can lead to unnecessary stress, particularly when unexpected challenges arise. Allowing room for adjustment ensures that goals remain realistic and achievable, even in changing circumstances.

          The Power of Community: Involving Others in Our Journey

          The role of community in the pursuit of personal goals is profound and often underappreciated. Sharing our goals with others doesn’t just provide a support system – it creates a network of accountability and encouragement that can be pivotal in maintaining our mental health and in achieving our objectives.

          Supportive community huddling
          Harness the power of community, involving others in your journey, to create a supportive network that enhances motivation, accountability, and the overall pursuit of objectives.

          When we open up about our aspirations, we invite others to partake in our journey. This act of sharing can significantly bolster our motivation, especially during times when our resolve might wane. For instance, a person aiming to improve their fitness might find it beneficial to join a local running club or a workout group. The camaraderie and mutual encouragement found in such groups can transform a solitary endeavor into a communal experience, making the pursuit more enjoyable and sustainable.

          In a family setting, discussing resolutions can strengthen bonds and build a sense of collective purpose. When family members are aware of each other’s goals, they can offer specific support, celebrate milestones together, and even collaborate on shared objectives. This involvement creates a nurturing environment where each person’s goals are valued and supported, reinforcing the feeling of being part of a team.

          In the workplace or among friends, sharing goals can also foster a supportive atmosphere. Colleagues and peers can provide valuable insights, advice, and encouragement. They can serve as sounding boards, offer different perspectives, and share experiences that might be helpful. This level of engagement not only enriches the journey towards achieving a goal but also contributes to a sense of belonging and community.

          Moreover, involving others in our goals can lead to new connections and opportunities. Networking with people who share similar interests or objectives can open doors to resources, knowledge, and experiences that we might not have encountered otherwise.

          In addition to providing motivation and support, the community also offers accountability. Knowing that others are aware of our goals and are cheering us on can be a powerful motivator. It adds a layer of responsibility and commitment to our endeavours, pushing us to stay on track and strive towards our objectives.

          Perseverance and Resilience: Learning from Setbacks

          In the journey toward achieving our goals, encountering setbacks is a universal experience (Just think of how many times you had the same resolutions each year because nothing much happened for the last 300-something days). These moments, often perceived as obstacles, are actually pivotal in fostering resilience and self-compassion, two critical components of mental health. Recognizing setbacks not as failures but as valuable learning opportunities can transform our approach to challenges and enhance our ability to persevere.

          This mindset of growth and learning is vital in building perseverance. When faced with setbacks, the key is to engage in reflective thinking. This involves analysing what led to the setback, what can be learned from it, and how strategies can be adjusted moving forward. Such reflection turns challenges into lessons that inform our future actions and decisions. For instance, if someone is struggling to maintain a new exercise routine, a setback can be an opportunity to re-evaluate and perhaps find a more suitable type of exercise, adjust the frequency of workouts, or identify and overcome barriers like time management.

          Positive text on a wall
          Build resilience by embracing setbacks as opportunities for growth and maintaining a positive attitude in the journey of self-improvement.

          Developing resilience, the ability to bounce back from setbacks, is equally important. This involves maintaining a positive attitude and understanding that setbacks are not reflections of personal inadequacy. It’s about embracing the journey, with its ups and downs, and recognizing that each step, regardless of direction, is part of the process of growth. Resilience is nurtured through experiences of overcoming difficulties, and it empowers us to face future challenges with confidence.

          Self-compassion plays a crucial role in this process. It’s about treating ourselves with the same kindness and understanding that we would offer to a friend in similar circumstances. Practicing self-compassion means acknowledging that setbacks are part of being human and not indicative of our worth or potential. This approach helps in mitigating feelings of self-criticism and disappointment that often accompany setbacks.

          Furthermore, sharing our challenges with others can be incredibly beneficial. It not only provides emotional support but also helps in gaining different perspectives. Others can offer advice, share their own experiences of overcoming similar obstacles, or simply provide a listening ear. This shared experience can be a powerful source of comfort and encouragement.

          Incorporating Mental Health Goals: Prioritizing Inner Well-being

          Well, as a psychiatrist, I cannot emphasize enough the importance of integrating mental health objectives into our New Year’s resolutions. While goals often focus on physical health, career advancement, or skill development, prioritising our mental and emotional well-being is equally crucial. This year, let’s make a conscious effort to set resolutions that nurture our mental health, recognizing that a healthy mind is foundational to achieving all other goals.

          Mental health is an integral part of our overall well-being. It influences how we think, feel, and behave in daily life. By setting mental health goals, we acknowledge its significance in our lives and take proactive steps towards maintaining and enhancing our mental state.

          Mental health goals can vary widely, depending on individual needs and situations. Here are some suggestions for mental health resolutions:

          1. Practicing Daily Meditation: Commit to a daily practice of meditation. Even a few minutes a day can significantly reduce stress, improve concentration, and promote a sense of peace and well-being.
          1. Seeking Therapy: If you’ve been contemplating therapy, make this the year to start. Therapy can provide invaluable insights into your thought processes, behaviors, and emotions, helping you navigate challenges more effectively.
          1. Regular Mental Health Check-ins: Schedule regular check-ins with yourself or a mental health professional. These check-ins can help monitor your emotional state and identify any areas needing attention.
          1. Learning and Practicing Self-Care: Dedicate time to learn and practice self-care activities. Whether it’s reading, taking a relaxing bath, or spending time in nature, find activities that replenish and rejuvenate you.
          1. Improving Sleep Habits: Set a goal to improve your sleep habits. Quality sleep is critical for mental health, affecting mood, energy levels, and overall cognitive function. One of my friends just sent me an article about the link between sleep and brain connectivity! Read here.
          1. Building Emotional Resilience: Focus on building emotional resilience by engaging in activities that strengthen your ability to cope with stress, such as mindfulness exercises, journaling, or developing a gratitude practice.
          1. Reducing Screen Time: Aim to reduce screen time, especially before bedtime. Excessive exposure to screens can impact mental health, disrupting sleep patterns and increasing feelings of anxiety and depression.

          Incorporating these mental health goals into our New Year’s resolutions is not just an option; it’s a necessity. By doing so, we not only improve our mental well-being but also enhance our capacity to achieve other goals. Remember, only with a healthy mind can you better navigate life’s challenges and embrace its opportunities.

          Conclusion

          In conclusion, as we embrace “New Year, New Horizons,” the journey of balancing resolutions with mental wellness becomes deeply personal. Family conversations, self-reflective practices, and commitment to realistic goals all play a vital role in shaping this experience. By involving our community and learning from setbacks, we foster a support system that nurtures resilience and growth.

          As a psychiatrist deeply invested in mental health, I advocate for integrating mental well-being into our resolutions. This approach isn’t just a professional recommendation; it’s a personal commitment to nurturing a healthy mind, essential for navigating life’s complexities.

          Let’s step into this new year with a focus on holistic growth, recognizing that our mental health is the cornerstone of fulfilling our ambitions and achieving a balanced, enriched life. Here’s to a year of meaningful progress and heartfelt transformations!

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          • Psychiatrist, Psychologist, or Therapist: Who Should I See?

          Psychiatrist, Psychologist, or Therapist: Who Should I See?

          The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue.

          Posted on 3 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Recent data from the National Population Health Survey in Singapore reveals a concerning trend: the prevalence of poor mental health has risen from 13.4% in 2020 to 17% in 2022 [1]. This increase underscores the critical need for accessible and effective mental health care. As individuals face these growing challenges, a paradox becomes evident – despite the clear need, many find the act of seeking help daunting.

          The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue. People are often hesitant to seek help due to the fear of judgement and the stigma associated with mental health issues. This paradox, where the need for support is evident, yet the pursuit of it is hindered by stigma, highlights a significant barrier in mental health care.

          Navigating the complexities of mental health services adds to the challenge. Choosing between a psychiatrist, psychologist, or counsellor can be overwhelming in Singapore, especially when understanding each professional’s distinct roles and specialisations. The struggle lies not just in recognising these distinctions but also in aligning them with personal mental health needs.

          mental health concerns
          Mental health issues require understanding, compassion, and accessible support.
          So, You Have Decided to Seek Help: A Guide for Approaching Mental Health Services

          Recognising the need for mental health support is a crucial first step. For those hesitant to seek help, understanding how to approach mental health services is vital. Here’s an expanded guide on how to navigate your way through seeking mental health services, incorporating important factors such as rapport, honesty, and practical considerations:

          1. Start with research

          Begin by exploring the different types of mental health professionals. Understand their areas of expertise and what they specialise in. This initial research will provide you with a solid foundation for making an informed decision about whom to approach for your mental health needs.

          2. Consultation as a first step

          An initial consultation is a great starting point. It’s an opportunity to discuss your concerns, understand the therapy process, and get a feel for how the therapist works. Remember, this first meeting is about gathering information and does not lock you into a specific treatment path.

          3. Choose based on rapport and therapeutic alliance

          Selecting a mental health professional can sometimes feel more daunting than choosing a life partner. The therapeutic alliance [2], or your rapport with your therapist, is crucial. You will share deep, personal aspects of your life, so feeling comfortable and connected with your therapist is paramount. Don’t hesitate to meet with different therapists to find the one with whom you feel most comfortable.

          4. Be open and honest

          Approach your sessions with openness and honesty. Being candid about your feelings, thoughts, and experiences is essential. Similarly, be open about practical considerations like the cost of sessions. Discussing fees upfront can help set clear expectations and ensure that the therapeutic process fits within your budget, an important aspect of maintaining a stress-free therapeutic relationship.

          5. Seek support

          Sharing your decision to seek therapy with a trusted friend or family can provide additional emotional support. You could ask someone to accompany you to your first session if it makes you more comfortable. Knowing you have the support of your loved ones can make a significant difference in your mental health journey.

          supporting friend
          Support from a friend or family member can provide extra emotional and mental support.
          6. Be prepared for a process

          Therapy [3] is a process that involves navigating through complex emotions and thoughts. It requires patience and commitment. Remember that progress in therapy often comes in small steps and requires time.

          7. Celebrate your progress

          Recognise and celebrate your progress, no matter how small it may seem. Acknowledging your efforts and the steps you’ve taken can be incredibly empowering and motivating as you continue your journey.

          8. You are not alone

          Finally, remind yourself that you are not alone. Many others have embarked on this journey before you; support is always available. Your decision to seek help is a brave and significant step towards a healthier life.

          For the rest of the article, we will first further explore and differentiate between the roles of psychologists [4], psychiatrists [5], counsellors [6], and therapists [7]. We will then shed some light on who you should choose concerning your situation. We hope this guide will empower you with the necessary insights and considerations for starting your mental health journey. With the right approach and support, seeking help can lead to profound personal growth and improved well-being.

          What We Do: A Closer Look at Mental Health Professionals’ Roles

          Having understood the initial steps in seeking help, it’s important to delve into the specific roles of mental health professionals. 

          1. Psychiatrists: Medical experts in mental health

          Psychiatrists are medical doctors in Singapore who specialises in diagnosing and treating mental illnesses, uniquely positioned to evaluate both the physical and psychological aspects of their patient’s health. Their role is multifaceted, encompassing a range of responsibilities:

          • Diagnostic assessments: psychiatrists are proficient in conducting comprehensive diagnostic evaluations. They use various assessment tools and techniques, including psychiatric interviews and psychological tests. As medical doctors, psychiatrists are particularly attentive to ensuring that psychiatric symptoms are not the manifestation of a medical illness. They often incorporate neuroimaging or lab tests into their assessments to rule out physical health conditions that could present with psychiatric symptoms.
          • Medical and psychological expertise: their training as medical doctors is fundamental to their practice. Psychiatrists consider the interplay of biological, psychological, and social factors in mental health, allowing them to offer a holistic approach to treatment.
          • Prescribing medication: being medical doctors, they are authorised to prescribe medication. They manage medication plans for a range of mental health conditions, from mood disorders to severe mental illnesses.
          • Psychotherapy provision: many psychiatrists are also trained in providing psychotherapy, enabling them to integrate therapeutic techniques into their treatment plans.
          • Treatment planning and management: psychiatrists develop and manage comprehensive treatment plans that often combine medication, psychotherapy, lifestyle changes, and other interventions.
          MRI brain mental health
          Psychiatrists are medical professionals who may use brain imaging to rule out neurological conditions that may cause psychiatric conditions.
          2. Psychologists: Specialists in behaviour and mental processes

          Psychologists are professionals specialising in understanding the intricacies of the human mind and behaviour. Their expertise is not limited to therapy but extends to a broad spectrum of activities that contribute significantly to mental health care and research. Here are key aspects of their role:

          • Deep dive into human behaviour: psychologists extensively study how individuals think, feel, behave, and interact. They are particularly focused on the patterns and motivations underlying human behaviour, making them adept at understanding complex emotional and cognitive processes.
          • Conducting psychological assessments: a crucial aspect of their work involves conducting detailed psychological assessments. This includes:
          • Personality tests: to evaluate personality traits and identify patterns that may impact mental health and behaviour.
          • Cognitive assessments and IQ testing: to measure cognitive abilities such as memory, problem-solving, and intellectual functioning. These assessments are essential in identifying learning disabilities, giftedness, and cognitive impairments.
          • ADHD assessments: using various tools and interviews to assess attention, impulsivity, and hyperactivity, which are key in diagnosing Attention-Deficit/Hyperactivity Disorder [8].
          • Autism evaluations: through observational assessments and structured interviews, psychologists play a vital role in diagnosing Autism Spectrum Disorder and understanding the individual’s social, communication, and behavioural challenges.
          • Diagnostic interviews: to identify specific mental health conditions and understand the individual’s mental health history and current symptoms.
          • Providing psychotherapy: psychologists are well-known for their role in providing psychotherapy. They employ various evidence-based therapeutic approaches like cognitive-behavioural therapy (CBT) [9], psychodynamic therapy [10], humanistic therapy [11], and more. Their therapy sessions are designed to help individuals understand and work through their problems, enhance self-awareness, and develop healthier coping mechanisms.
          • Specialised areas of focus: many psychologists specialise in areas such as clinical psychology, counselling psychology, child and adolescent psychology, health psychology, neuropsychology, and forensic psychology, providing targeted care and interventions.
          child psychologist
          Psychologists specialise in different areas, such as child and adolescent psychology.
          3. Counsellors: Advisors for specific life issues

          Counsellors are key figures in the mental health landscape, offering tailored support and guidance for various life challenges and transitions. Their role is multifaceted and client-centred, focusing on empowering individuals with the tools and insights needed for personal growth and problem resolution. Here are some key aspects of their role:

          • Personalised support: counsellors work closely with individuals to provide personalised support tailored to their unique circumstances. This involves understanding each person’s background, challenges, and goals to offer relevant and effective guidance.
          • Development of coping strategies: counsellors are adept at helping individuals develop coping strategies for managing stress, anxiety, and other emotional challenges. They provide tools and techniques for better emotional regulation and resilience.
          • Relationship and family counselling: in the realm of relationship and family counselling, they address issues such as communication problems, marital conflicts, and family dynamics, facilitating healthier relationships and improved interpersonal skills.
          • Life transitions and adjustments: counsellors often assist individuals navigating significant life transitions such as divorce, retirement, relocation, or losing a loved one, providing support and strategies to adjust to these changes.
          Collaborative Approach in Mental Health Care: A Unified Effort

          As we have seen, psychiatrists, psychologists and counsellors have different expertise. They bring together their diverse expertise to offer comprehensive care. This collaborative approach combines medical, psychological, and social perspectives to ensure holistic treatment for patients. Psychiatrists often lead in medical evaluations and medication management, while psychologists delve deep into in-depth therapy. Counsellors add a crucial dimension by supporting everyday life challenges and specific life issues.

          The success of this approach hinges on continuous communication among all professionals, ensuring that treatment plans are cohesive and adapt to the patient’s evolving needs. Additionally, family involvement is a key aspect, especially with children or adolescents, where family dynamics significantly impact treatment. Counsellors often engage with family members to enhance communication and understanding, while psychiatrists and psychologists guide the management of the patient’s condition in the familial setting. This unified effort ensures a well-rounded and effective approach to mental health care.

          psychiatrist
          Choosing between a psychiatrist and a psychologist depends on a number of factors.
          Case Example: Collaborating for Comprehensive Patient Care

          Jane, a 30-year-old woman, sought help from a psychiatrist due to her struggles with anxiety and mood swings. After a detailed diagnostic assessment, the psychiatrist diagnosed her with bipolar disorder and started a medication regimen to manage her symptoms. To complement the medical treatment, the psychiatrist referred Jane to a psychologist for psychotherapy.

          In her sessions with the psychologist, Jane engaged in cognitive-behavioural therapy, which helped her understand and manage her thought patterns and emotions. During therapy, it became evident that Jane was also facing significant challenges in her marriage, which were contributing to her stress.

          To address this aspect of Jane’s life, the psychologist coordinated with a counsellor specialising in marriage counselling. The counsellor worked with Jane and her husband, providing them with strategies to improve communication, understand each other’s perspectives, and strengthen their relationship. This counselling was crucial in helping them navigate the complexities of Jane’s mental health condition within the context of their marriage.

          Throughout her treatment journey, there was ongoing communication between the psychiatrist, psychologist, and counsellor. This was done with Jane’s consent, of course. This collaborative approach ensured that all aspects of Jane’s mental, emotional, and relational health were being addressed cohesively. The team adjusted their strategies based on Jane’s progress and the evolving dynamics of her personal life.

          The integrated efforts of the psychiatrist, psychologist, and marriage counsellor gave Jane a holistic treatment experience. This multi-pronged approach not only helped her manage her bipolar disorder but also supported her in building a healthier, more understanding relationship with her husband, significantly improving her overall quality of life.

          So…do I see a psychiatrist or psychologist first?

          When faced with whether to see a psychiatrist or psychologist, it’s important to consider the nature of your concerns and your preferred approach to treatment. This decision often hinges on the specifics of your mental health needs, the severity of your condition, and your openness to various forms of therapy.

          If you suspect that the issues are linked to an illness, such as in cases of severe depression, bipolar disorder, or schizophrenia, or if you’re experiencing symptoms that significantly impact your daily functioning, seeing a psychiatrist could be the right choice. Psychiatrists, as medical doctors, are adept at managing complex mental health conditions, particularly those requiring medication. Their medical training offers a comprehensive approach that may include medication, psychotherapy, and lifestyle changes.

          On the other hand, if you’re primarily seeking to understand your thoughts, emotions, and behaviours or grappling with life challenges, stress, anxiety, relationship issues, or mild to moderate mood disorders, a psychologist might be more suitable. Psychologists specialise in psychotherapy, offering a range of therapeutic approaches to help you explore and manage your mental health concerns. Their focus is on providing profound insights and coping strategies through talk therapy.

          Treatment preferences also play a crucial role in this decision. If you are open to the possibility of medication as part of your treatment, a psychiatrist with the authority to prescribe would be the suitable professional to consult. However, for those who prefer a treatment approach focused exclusively on psychotherapy without medication, a psychologist is often the better choice.

          psychiatrist
          A psychiatrist conducts proper diagnosis and prescribes medications to address mental health concerns.

          The journey of mental health care is sometimes a collaborative one. Psychiatrists and psychologists frequently work together, and it’s not uncommon to start with one and be referred to the other as your treatment progresses. This collaborative care approach ensures that all aspects of your mental health are being addressed.

          If you’re still uncertain about which professional to see, a consultation with a psychiatrist or psychologist can be a wise first step. They can assess your situation and, if needed, refer you to another professional for additional support.

          Ultimately, whether you see a psychiatrist or psychologist, the most important step is reaching out for help. Both are committed to helping you navigate your mental health journey and can guide you towards the path that best suits your individual needs.

          Do I need counselling or psychotherapy?

          Understanding whether you need counselling or psychotherapy [12] is an important step in seeking mental health care. While the terms are often used interchangeably, subtle differences in focus and approach might make one more suitable for you than the other.

          Counselling typically addresses specific, current issues or life challenges. It is often more short-term and goal-oriented, focusing on providing guidance, problem-solving strategies, and support. Counsellors work with individuals to develop coping mechanisms for managing stress, navigating life transitions like career changes or relationship difficulties, and handling day-to-day emotional challenges. If you need assistance with a particular life event, decision-making, or managing emotional responses to recent changes or stressors, counselling could be the right choice.

          Psychotherapy, on the other hand, tends to delve deeper. It is often more long-term and explores underlying patterns of thoughts, feelings, and behaviours. Psychotherapy aims to uncover the root causes of your challenges, providing a deeper understanding of yourself and your experiences. It can be particularly beneficial for individuals dealing with long-standing psychological issues, complex emotional difficulties, or mental health disorders. If you’re looking to explore your past, understand persistent negative patterns, or address more complex emotional or mental health issues, psychotherapy might be more appropriate.

          Both counselling and psychotherapy provide supportive environments where you can talk openly about your feelings and experiences. The key difference lies in the depth and scope of the work. Counselling often deals with the ‘here and now,’ helping you to navigate current life situations, while psychotherapy may involve a more extensive exploration into your psychological makeup and past experiences.

          In many cases, the decision doesn’t have to be one or the other. Some individuals might start with counselling to address immediate concerns and later transition into deeper psychotherapeutic work as they uncover more about themselves. Mental health professionals can guide you in choosing the most suitable approach based on your individual needs.

          Remember, the most important step is recognising when you need support and taking action to seek it. Whether through counselling or psychotherapy, reaching out for professional help is a commendable and significant step towards your mental health and well-being.

          Conclusion 

          In conclusion, understanding the diverse landscape of mental health care is crucial, particularly in the context of Singapore, where we’re witnessing a significant rise in mental health concerns. Whether it’s a psychiatrist, psychologist, or counsellor, each professional plays a unique role in providing care and support. It’s important to choose the right professional based on your individual needs while also considering factors like therapeutic rapport and practical considerations such as cost.

          Seeking help for mental health issues is a sign of strength and self-awareness, not a weakness. It’s a proactive step towards understanding yourself better and improving your overall quality of life. Remember, the mental health journey is not one you must walk alone. Help is available, and reaching out is the first step towards healing and growth.

          If you or someone you know is struggling with mental health issues, we encourage you to seek support. Consult a mental health professional for guidance, talk to friends and family for emotional support, and explore the various resources available in Singapore. Let’s break the silence and stigma surrounding mental health together. Your mental health matters, and taking the first step towards seeking help is a courageous move that can lead to transformative change.

          Remember, you are not alone, and support is available. Your mental health journey is important, and taking the first step today can lead you towards a healthier tomorrow.

          References
          1. Ganesan, N. (2023, September 27). Prevalence of poor mental health increasing in Singapore; young adults have highest proportion at 25.3%. Retrieved from CNA: Channel News Asia: https://www.channelnewsasia.com/singapore/poor-mental-health-young-adults-seek-help-moh-survey-3802531 
          2. Therapeutic Alliance – an Overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/psychology/therapeutic-alliance#:~:text=Therapeutic%20alliance%20(TA)%2C%20a,therapy%2Drelated%20tasks%20and%20goals.  Accessed 2 Jan. 2024.
          3. Therapy | Psychology Today. https://www.psychologytoday.com/us/basics/therapy.   Accessed 2 Jan. 2024.
          4. Contributors, WebMD Editorial. “What Is a Psychologist?” WebMD, https://www.webmd.com/a-to-z-guides/what-is-psychologist.  Accessed 2 Jan. 2024.
          5. “What Is A Psychiatrist? What They Do and When to See One.” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/22702-psychiatrist.  Accessed 2 Jan. 2024.
          6. Services, Department of Health &. Human. Counsellors. http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/counsellors.   Accessed 2 Jan. 2024. 
          7. “What Therapists Do and When to See One.” Verywell Mind, https://www.verywellmind.com/what-is-a-therapist-2672019.  Accessed 2 Jan. 2024.
          8. CDC. “Attention-Deficit / Hyperactivity Disorder (ADHD).” Centers for Disease Control and Prevention, 16 Oct. 2023, https://go.usa.gov/xRAsU
          9. “What Is Cognitive Behavioral Therapy?” Https://Www.Apa.Org, https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.   Accessed 2 Jan. 2024.
          10. Treatment, Center for Substance Abuse. “Chapter 7—Brief Psychodynamic Therapy.” Brief Interventions and Brief Therapies for Substance Abuse, Substance Abuse and Mental Health Services Administration (US), 1999. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK64952/
          11. Contributors, WebMD Editorial. “What Is Humanistic Psychology and Humanistic Therapy?” WebMD, https://www.webmd.com/mental-health/humanistic-psychology-and-humanistic-therapy.  Accessed 2 Jan. 2024.
          12. Psychotherapies – National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/psychotherapies.  Accessed 2 Jan. 2024.
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          • Understanding Psychiatric Medications: Navigating Treatment Options

          Understanding Psychiatric Medications: Navigating Treatment Options

          In the realm of psychiatric medications, embracing a holistic approach that prioritizes individualized treatment plans, fosters understanding of side effects, encourages collaborative efforts, and addresses financial considerations is essential for achieving effective and compassionate mental health care.

          Key takeaways

          • Medication is a vital component of mental health treatment but works best as part of a holistic approach that includes psychotherapy, lifestyle changes, and support systems.
          • Due to the variability in individual responses to medication, personalized treatment plans are crucial for effective care.
          • Knowledge about potential side effects, including how to manage them and the importance of professional guidance, is essential for both patients and healthcare providers.
          • Open communication and collaboration between patients, caregivers, and psychiatrists are fundamental in optimizing treatment outcomes.
          • Addressing financial constraints and exploring cost-effective treatment options ensure that patients receive necessary care without exacerbating financial stress.

          Posted on 3 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          In the realm of mental health, medication plays a pivotal role in managing and treating a variety of psychiatric conditions. As a psychiatrist, I have witnessed the transformative impact these medications can have. Yet, I also recognise the complexities and concerns that accompany them. Often, apprehensions held by patients and their caregivers can lead to reluctance or refusal of this treatment modality, which can significantly affect recovery and stability. This write-up aims to demystify psychiatric medications, shedding light on their types, mechanisms, and the subtleties of their clinical use.

          It’s crucial to acknowledge that medication is just one component of a comprehensive approach to mental health care. Effective treatment typically involves a combination of approaches, including psychotherapy, lifestyle adjustments to cope with real-life stressors, support from family and friends, and consideration of spiritual aspects, among others. Each of these elements plays a vital role in the holistic management of mental health conditions. However, the focus of this article will be on the medication aspect, aiming to provide clarity and understanding about this specific and often crucial element of psychiatric treatment.

          A Primer on Psychiatric Medications

          Psychiatric medications are diverse, each tailored to address specific aspects of mental health conditions. The primary groups of these medications include:

          1. Antidepressants: Typically used for depression, these drugs modulate neurotransmitters such as serotonin to alleviate depressive symptoms.
          • SSRIs (Selective Serotonin Reuptake Inhibitors) Example: Fluoxetine (Prozac), Escitalopram (Lexapro) and Sertraline (Zoloft)
          • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) Examples: Venlafaxine (Effexor) and Duloxetine (Cymbalta)
          • Other Antidepressants: Remeron (Mirtazapine) and Valdoxan (Agomelatine)
          1. Antipsychotics: Crucial in treating psychotic disorders like schizophrenia, they influence dopamine pathways.
          • Example: Risperidone (Risperdal) and Olanzapine (Zyprexa) are often used for schizophrenia and bipolar disorder.
          1. Sedatives and Anxiolytics: Employed for anxiety and sleep disorders; this category includes benzodiazepines and Z-hypnotics, known for their calming and sleep-inducing effects.
          • Benzodiazepine Examples: Lorazepam (Ativan) and Diazepam (Valium)
          • Z-hypnotic Examples: Zolpidem (Stilnox) and Zopiclone (Imovane)
          1. Mood Stabilizers: Vital in the management of bipolar disorder, helping to regulate mood fluctuations.
          • Example: Lithium Carbonate and Sodium Valproate
          1. Others, such as stimulants: Specifically designed for conditions like ADHD (Attention-Deficit/Hyperactivity Disorder), these medications help improve focus, attention, and self-control.
          • Example: Methylphenidate (Ritalin, Concerta) and Lisdexamfetamine (Vyvanse) are commonly used to treat ADHD.

          Occasionally, medications not traditionally categorized under these classes are also employed to alleviate symptoms associated with mental health conditions. An example is Propranolol, an “older” blood pressure medication. In psychiatric care, Propranolol is often utilized off-label for its ability to reduce physical symptoms of anxiety, such as palpitations and tremors

          How does psychiatric medication work?
          How does psychiatric medication work?
          Mechanism and Efficacy

          Psychiatric medications exert their effects by influencing various chemical pathways in the brain, akin to how other medications act on different parts of the body. These drugs target specific physiological processes to alleviate symptoms or modify disease progression.

          • Neurotransmitter Regulation: Many psychiatric disorders are linked with imbalances in neurotransmitters. Antidepressants, for example, increase serotonin levels, often low in depression, while antipsychotics target dopamine pathways, which can be overactive in conditions like schizophrenia.
          • Receptor Activity Modulation: Medications like benzodiazepines enhance the effect of GABA, reducing anxiety and aiding sleep by calming the nervous system.
          • Promoting Neuroplasticity: Some psychiatric medications may enhance the brain’s ability to form new neural connections, improving cognitive functions and mood regulation.
          • Variability in Individual Responses: The effectiveness of these medications varies greatly among individuals due to genetic, lifestyle, and health factors, necessitating a personalized approach.
          • Trial and Adjustment: Finding the right medication often involves trial and error to balance therapeutic benefits against potential side effects.
          Understanding and Managing Side Effects of Psychiatric Medications

          All medications, including those used in psychiatry, come with the potential for side effects. Managing these side effects is vital and typically requires carefully balancing the medication’s therapeutic effects with the need to reduce any unwanted reactions.

          There are potential side effects for psychiatric medication
          It is important to understand and manage potential side effects in psychiatric medication for overall health.

          As mentioned in the previous section, psychiatric medications are formulated to specifically act on certain pathways in the brain to treat mental health disorders. However, the very mechanisms that make these drugs effective can also lead to side effects, some of which may be unintended or undesirable.

          1. Neurotransmitter Effects: For instance, increasing serotonin levels can alleviate depressive symptoms but may also result in nausea, headaches, or sexual dysfunction. Similarly, antipsychotics, which modulate dopamine pathways, can cause drowsiness or more severe movement disorders.
          1. Receptor Activity: Enhancing GABA activity with benzodiazepines might relieve anxiety but can also lead to drowsiness, confusion, or dependency issues.

          Common Side Effects by Medication Class

          • Antidepressants (SSRIs, SNRIs): Typically include nausea, headaches, and sexual dysfunction, with risks like serotonin syndrome especially in the context of an overdose.
          • Antipsychotics: Range from weight gain to more severe conditions like Neuroleptic Malignant Syndrome and tardive dyskinesia.
          • Sedatives and Anxiolytics: Can cause drowsiness and dependency issues, with severe withdrawal symptoms upon abrupt discontinuation.
          • Mood Stabilizers: Often lead to weight gain and tremors, with risks like lithium toxicity.
          • Medications for ADHD: May result in loss of appetite and insomnia, with a potential for abuse in stimulant medications.
          Managing Side Effects: Balancing Benefits and Risks with Professional Guidance

          The management of side effects in psychiatric medication therapy involves a nuanced balancing act. This process is deeply personalized, as the occurrence and severity of side effects can vary widely among individuals due to factors such as age, overall health, genetic makeup, lifestyle, and the concurrent use of other medications. Adjustments in dosages, switching medications, or adding treatments are often necessary to counteract negative effects and to maintain the therapeutic efficacy of the drugs.

          Given the variability in how individuals experience side effects, professional guidance and regular monitoring become essential components of effective medication management:

          • Balancing Therapeutic Benefits and Side Effects: Striking the right balance is crucial for successful treatment. This sometimes involves the process of cross-titration, where one medication is gradually decreased while another is increased, to find the most effective and tolerable treatment combination.
          • Understanding Medication Interactions: It’s also vital to understand the potential interactions between various medications, including over-the-counter (OTC) drugs, traditional medicine and supplements. These interactions can significantly impact the safety and efficacy of treatment.
          • Informed Decision-Making: Making informed decisions about medication therapy requires a comprehensive understanding of potential side effects within the broader context of the patient’s overall health and treatment goals.

          Patients are strongly encouraged to maintain open and honest communication with their psychiatrists about their experiences with prescribed medications. This includes discussing any side effects experienced, as well as the perceived effectiveness of the treatment. By sharing this information, patients play an active role in their treatment process.

          • Reducing Polypharmacy: Open dialogue can help in minimizing the practice of polypharmacy – the use of multiple medications by a patient – especially if some drugs are found to be ineffective or cause adverse effects.
          • Adjusting Dosages: Feedback from patients is crucial in determining the optimal dosage of medications, aiming to achieve the maximum therapeutic effect with the minimum necessary dose.
          • Minimizing Side Effects: Understanding each patient’s unique reaction to a medication allows for adjustments that can reduce side effects, improving overall treatment adherence and quality of life.
          • Teamwork in Treatment: The psychiatrist and patient, along with other healthcare professionals if needed, work as a team. This collaborative approach ensures that treatment decisions are made considering the patient’s comprehensive health profile and personal preferences.
          Navigating Financial Constraints in Psychiatric Care

          Financial considerations are a crucial and often challenging aspect of psychiatric treatment. The cost of medications can significantly impact treatment choices, especially for patients with limited insurance coverage or financial resources. Open discussions about the cost of medications can lead to the exploration of cost-effective alternatives that do not compromise the quality of care.

          Cost of medication can impact treatment choices.
          Cost of medication can impact treatment choices.
          • Understanding Medication Pricing: The cost of medications can vary widely, influenced by factors such as brand versus generic formulations, the cost of research and development for new drugs, marketing, and patent issues. Newer, branded medications are often more expensive than older generics, but this does not necessarily correlate with increased efficacy or safety.
          • Generic vs. Branded Medications: Generic medications, which are typically less expensive, can be equally effective as their branded counterparts. They contain the same active ingredients and undergo rigorous testing to ensure their safety and efficacy.
          • Therapeutic Equivalence: When cost is a concern, psychiatrists can explore therapeutically equivalent medications that provide similar clinical benefits but at a lower cost.
          • Insurance Coverage and Assistance Programs: Understanding a patient’s insurance coverage and exploring available assistance programs can help in mitigating the financial burden of medications.
          • Balancing Cost and Clinical Needs: The goal is to balance financial considerations with clinical needs, ensuring that patients receive effective treatment without undue financial strain.
          • Transparent Communication: Encouraging open and transparent communication about financial constraints allows psychiatrists to tailor treatment plans that are both clinically effective and financially feasible.
          • Ongoing Cost Management: Managing the cost of psychiatric medications is an ongoing process. Regularly reviewing and adjusting medication regimens can help in finding the most cost-effective treatment solutions over time.
          Empowering Patients through Understanding and Collaboration

          In conclusion, understanding psychiatric medications is an integral part of managing mental health conditions. This article has aimed to provide clarity on the various types of psychiatric medications, their mechanisms, and the intricacies involved in their use. By demystifying these medications, we seek to empower patients and caregivers, enabling them to engage more actively and confidently in the treatment process.

          As we navigate the complexities of psychiatric medications, let us remember that the journey towards mental wellness is a collaborative one, with each patient’s unique needs at its core. Psychiatrists, healthcare providers, patients, families and their support networks all play pivotal roles in this journey.

          Together, through understanding, communication, and empathy, we can work towards effective, compassionate, and comprehensive mental health care.
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          • How can I convince a loved one to seek psychiatric help?

          How can I convince a loved one to seek psychiatric help?

          Poor mental health is a growing concern in Singapore. The National Population Health Survey (NPHS) 2022 revealed that poor mental health increased from 13.4 per cent in 2020 to 17 per cent in 2022

          Posted on 18 Dec 2023

          Written by
          Dr Jared Ng, Connections MindHealth

          Poor mental health is a growing concern in Singapore. The National Population Health Survey (NPHS) 2022 [1] revealed that poor mental health increased from 13.4 per cent in 2020 to 17 per cent in 2022 (with young adults contributing to the highest proportion of poor mental health at 25.3 per cent). Whilst this increase may not be dramatic per se, it is an indicator that the state of mental health in the country is significantly declining. The survey also revealed that young adults are most vulnerable to declining mental health. 

          In our lives, it is common to have an inkling about a loved one’s deteriorating well-being. Whether you’re a parent, sibling, friend, partner, or colleague, you may have felt the urge to intervene in the lives of someone you care about in hopes that they would seek professional psychiatric help. However, this display of love can be tricky. 

          The stigma around the topic of mental health is, unfortunately, still evident in our communities. A 2017 [2] study in Singapore revealed that almost half (approximately 44.5%) of respondents, made up of adolescents, associated mental illnesses with negative, derogatory terms like “stupid”, “dangerous”, “crazy”, and “weird”, while 46.2% of them said they would be “very embarrassed” if they were diagnosed with a mental illness.

          Concerned Asian woman
          Whilst young adults are most troubled with mental health in Singapore, our teenagers also seemingly have high levels of negative connotation to the issue. 

          Given the negative connotation around the subject, how can you masterfully suggest seeking help for the ones you love? In this article, we have provided a comprehensive guide on techniques to convince a loved one to seek psychiatric help. 

          1. Don’t push the trigger button 

          Culturally, Asians seem brasher in casual conversations, though it is not necessarily intended with malice. For instance, a mother may observe her son’s binge eating tendencies and voice it as “You are going to become fat if you keep this up!”. Whilst this sentence, when dissected, is harsh, there is often genuine concern about her son’s well-being and the impact that binge eating will have on his health.

          However, the method employed by the mother will not halt her son’s binge eating tendencies. If anything, it may cause further upset and fuel the root cause masked by this specific behaviour. So, how can you approach your loved ones tactfully? 

          The first step is to understand their list of triggers. For example, for individuals dealing with anorexia, pointing out their weight loss, whether positively or negatively, could further encourage starvation behaviour. The trigger, in this case, is weight loss. If you’re dealing with a loved one who’s depressed, blatantly pointing out their behaviour change could result in self-consciousness.

          consoling son
          Be tactful and loving when approaching a loved one with concerns about their mental health.

          Instead, frame your concern with more caution. For example, when initially approaching a loved one, your concern may be worded as:

          •  “I am worried about your health and the future consequences. Do you have any intention of remedying them?” 
          • “ I am deeply concerned and hope I am not overstepping, but it appears you are demotivated to nourish yourself. Would you like to talk about it?’”
          • “I intuitively feel that you may be burdened by something. Is there an issue that is lying heavy on your heart? I hope you know I am always ready to listen.”

          As shown in the examples above for various cases, when initiating a conversation about issues presented by your loved ones, you first take away the spotlight from them by highlighting how YOU are genuinely concerned for them with I-statements [3]. Once the concern you have presented is received positively, you can open the doors to seeking psychiatric help. 

          2. Tone it down 

          As important as it is to carefully curate your words when approaching a vulnerable individual, the tone of your voice is crucial. Have you ever gotten into an argument because the opposing party claims your tone was disrespectful, condescending or even patronising? Most people lack awareness of how their tone of voice [4] could add more fuel to the fire. As the famous saying goes, it is not what you say but how you say it. 

          When speaking to a loved one in a troubled state of mind, it is important to present your intention as “concerned” versus “accusatory”. Your tone of voice will definitively play a significant role in how the message is relayed and received. When attempting to suggest to a loved one to seek psychiatric help, you should: 

          • Speak in a lower tone: psychologically troubled people may be defensive and argumentative; however, that does not justify you raising your voice at any point. Stay firm with your intention and remind yourself they do not necessarily come from a malicious place. 
          • Speak slowly: make sure to add pauses and provide conversation space. If you are talking over your loved one or rushing through your “speech”, it may be difficult for them to capture your intention. Remember, you are also creating space for them to open up about the issues they may be battling. 

          “How do I know if my tone is right?’. For starters, try recording yourself and listen to how you sound. Often, this might suffice for you to correct your tone before approaching the one you love. You may also attempt a role-play with a trusted friend or family. Ask them to react negatively and observe if your tone changes when challenged. 

          This is not to say that you should put up with disrespect or that an emotional reaction is unwarranted when boundaries are crossed. We are fully aware that the average person is not a trained professional, so if the conversation becomes heated at any point, diffuse the situation immediately and hold the conversation for another day. 

          Partner consoling his wife
          Speaking calmly and gently is essential in opening up conversations about seeking psychiatric help. 
          3. Set and setting 

          As mentioned before, it is possible for a well-intended conversation to turn sour quickly. Therefore, taking some time to choose the right location to have this conversation is just as important. We advise opening a sensitive discussion, such as seeking psychiatric help in a private setting, perhaps in a familiar and safe place, like homes or favourite cafes. Padding the location with some of their favourite foods or drinks adds an element of comfort and encourages your loved one to open up. 

          Essentially, you should try not to have sensitive conversations in a sterile environment, including their workplace or people they may react sensitively to. For instance, attempting to approach your sibling at home where your parents are possibly eavesdropping or would be quick to insert themselves in the conversation could cause further damage. Your intention may even be questioned as an attempt to humiliate or embarrass. 

          If you attempt to help a coworker or subordinate, doing so over a dinner, which offers some privacy, may be better than a “meeting” in a conference room. Alternatively, a video call could be advantageous as they would be at home, allowing them to ruminate about the conversation within the safe walls of their home. 

          Girl supporting loved one
          Holding sensitive topics in a private and safe setting would help your loved ones to open up. 
          4. Be prepared for the rebuttals 

          In a society like Singapore, suggesting psychiatric help may cause a backlash. So be prepared for all the possible reasons your loved ones might oppose the idea, such as: 

          • Are you suggesting I am crazy?: Just because I can’t visibly see the state of your mind doesn’t mean you should be deprived of help. I am in no way stating you are crazy, but I think it’s time you sought help in the name of self-kindness. 
          • People will think I’m weird: weirdness is a subjective idea. I think you are an amazing person, and watching you deteriorate over poor mental health saddens me. It is my intention to preserve the beautiful person that you are, even if that means seeking psychiatric help. 
          • I can’t afford an embarrassing diagnosis: a diagnosis is not a label nor a life sentence. It will help you accurately identify the issue at hand. You will then have all the tools to manage your life effectively and learn to navigate complex situations with a professional. I genuinely believe you deserve assistance to reach your peak potential in life. Please don’t allow a diagnosis to hinder you. 

          As presented above, these rebuttals are not argumentative but come from a place of empathy. You are also wording your rebuttal in ways that present elements of support and care. 

          5. Physical assistance

          Assuming you are successful at the conversation phase of this process, it is now time to be physically involved. This includes guiding them to the appropriate healthcare provider, setting them an appointment (with their consent), following them to their first session, or even driving them to the clinic. When the person you love is vulnerable and potentially mentally distraught, these seemingly “simple” tasks could easily overwhelm them. Gifting them your time and effort will bring comfort and a sense of security to your loved ones. 

          We recognise that intervening in the lives of a loved one and taking up some load could easily overwhelm an individual. Do not risk your mental health in the process of helping others, as this would not be beneficial to any party. Carefully gauge your comfort level and the extent you are willing to commit. Refrain from overpromising and under-delivering, too, as this could further disappoint the ones you love. 

          Wrapping up 

          If you’ve reached the end of this article but feel uncomfortable executing any of these steps, you can instead identify the next best person to help the ones you love. This should be someone you believe also has your loved one’s best interest and can execute this process more efficiently. 

          If you believe the person you love is at risk of harming themselves or the people around them, you must consider contacting emergency lines in Singapore: 995 for an ambulance or 999 for a police emergency. You can also call the SOS Hotline (1767) or the IMH Helpline (63892222) If you believe the issues are urgent but do not warrant contacting the police/SCDF ambulances. If you have general inquiries, contact us to guide you per your specific situation. 

          We applaud you for caring for the people you love and doing the due research. We hope that stigmas surrounding mental health are eliminated in the years to come. Until then, as long as one is surrounded by people who care for them like yourself, hope remains. 

          References
          1. Ministry of Health Singapore (2022) National Population Health Survey 2022 , NATIONAL POPULATION HEALTH SURVEY 2022. Available at: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nphs-2022-survey-report-(final).pdf (Accessed: 08 December 2023).
          2. Pang, S. et al. (2017) Stigma among Singaporean youth: A cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population, BMJ open. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652546/ (Accessed: 08 December 2023).
          3. Rogers, S.L., Howieson, J. and Neame, C. (2018) I understand you feel that way, but I feel this way: The benefits of I-language and communicating perspective during conflict, PeerJ. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961625/ (Accessed: 08 December 2023).
          4. Raeburn, D.C. (2022) Improving and watching your tone of Voice, Raeburn Psychology . Available at: https://carolinaraeburn.com/improving-and-watching-your-tone-of-voice/#:~:text=Your%20tone%20of%20voice%20is,language%20through%20conversation%20with%20others. (Accessed: 08 December 2023).
          5. Ho, R.C. et al. (2015) An overview of mental health legislation in Singapore, BJPsych international. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618915/#:~:text=The%20Mental%20Health%20(Care%20and%20Treatment)%20Act%202008,-The%20Singapore%20Mental&text=Under%20the%20new%20Act%20(see,for%20up%20to%2072%20hours. (Accessed: 08 December 2023).
          6. Institute of Mental Health Homepage (no date) Institute of Mental Health. Available at: https://www.imh.com.sg/Pages/default.aspx (Accessed: 11 December 2023).