Mental Health Resource Guide: FAQ
By Hoe I Yune, Nov 05, 2020
Amidst the COVID-19 pandemic, more Singaporeans have been seeking help for mental health issues. In 2020, Samaritans of Singapore (SOS) received 26,460 calls for help from January to August, up from 21,429 in the same period the year before. Seeking treatment for mental health may be daunting but remember it is a normal process in your pursuit to wellness; mental health is no less important than physical health.
While working on our four-part “Mental Health: How are we talking about it” series, we recognised that there is an overwhelming amount of information out there, as well as avenues for help and support. But there is some way to go before normalising mental health talk and treatments, which is why we want to continue the conversation.
We decided to speak with mental health professionals — certified peer support specialist and Institute of Mental Health (IMH) outreach group volunteer Michelle Lai, executive director (clinical) Madam Yang Chek Salikin from Club Heal, Alliance Counselling counselling psychologist Cristina Gonzalez, Family S.O.S child therapist Katy Harris, Singapore Counselling Centre (SCC) and Association of Women for Action and Research (AWARE), and come up with a resource guide to help readers navigate talk about mental health and possibly clarify uncertainties and misconceptions.
Mental health is complex, nuanced, and unique to every individual, but we hope you’ll find these answers helpful.
Why should I see a counsellor?
You don’t need to be officially diagnosed with a mental health struggle to see a counsellor. Anyone can schedule an appointment and regular sessions could be useful to improve one’s quality of life. Think of it as a way to reflect and recalibrate once a month or once every two months.
A key factor of consideration could be if you want to learn how to cope with a certain difficulty. For instance, maybe you recently lost a loved one or feel as if you’re on the brink of being burnt out at work. Counselling sessions can be helpful to introduce coping strategies on how to manage negative thoughts that pop into mind.
“Although I think everyone can benefit from counselling sessions, I would especially advise someone to visit a counsellor when negative thoughts grow overwhelming and affect your everyday life and ability to function for a period of two weeks or more,” says Michelle Lai who is a certified peer support specialist and Institute of Mental Health (IMH) outreach group volunteer. “It could be an inability to function in any area of life — physically, socially, spiritually, emotionally or professionally."
Signs and symptoms to look out for include — but are not limited to — sleep disturbances, appetite changes, concentration problems, breathlessness, excessive fear and worry, and irritability. There’s no hard and fast rule to this but try to understand how symptoms are interfering with your personal, social, and professional or academic life, advises counselling psychologist Cristina Gonzalez from Alliance Counselling. For example, if you couldn’t make it for a meeting because of anxiety, this could be related to life satisfaction. Ask yourself: How satisfied do you feel with your life? Can you perhaps cope but sense of satisfaction is low? Try to identify changes in your behaviour and why they’ve occurred.
What is the first step I can take?
There are a few ways in which you can approach treatment. For one, you could speak with a general practitioner (GP) at your nearest clinic, who can then refer you to a counsellor, psychiatrist or psychologist. You could also contact a counsellor directly to find out more about the available services or book an appointment. (We’ve compiled a list of free and affordable counselling centres at the end of this post.)
You can read up more about their services and cost on their websites. If cost is a concern to you, do raise it up with the counsellor to discuss if the centre could help with further subsidies. Some might offer a discount or waiver on a case-by-case basis.
We understand that it can be daunting to speak to someone in person or over the phone, and you could also consider reaching out to the Community Health Assessment Team (CHAT) through their online text-based webCHAT service (Tuesdays-Saturdays, 1pm to 8pm). CHAT does not directly provide counselling but can answer questions that youths between ages 16 and 30 may have about mental health and recommend counselling services for your consideration. You may be asked questions to receive a more personalised service, but there’s no need to reveal your identity. When we tried, it took us 3 hours to be connected to a mental health professional the first time and a handful of minutes the second time.
Beyond the Label’s helpbot Belle also comes in handy for directing individuals to mental health resources and helplines. As of October 2020, clients who expressed any intention to harm oneself on the Belle Bot platform will be directed to SOS Care Text to be attended to by SOS trained volunteers.
The National CARE hotline operates from 8am to midnight daily: 1800-202-6868.
Where can I seek immediate help for myself or someone else?
For an immediate response, call 995, IMH Mental Health Helpline (+65-6389 2222) or SOS (1800-221-4444), which are 24/7 services. Stay on the line until someone comes to you.
Or, head over to the Accident and Emergency (A&E) department of your nearest hospital. Do not feel like you have to do this alone and if a friend or family member is with you, ask them to go with you. Remember: you are not wasting anyone’s time. “You can visit the A&E department of hospitals, such as IMH, to seek help, and you will be directed to resources and to talk to a doctor and social worker on the day itself. Then depending on the case, a follow up will be arranged,” explains Michelle. “I understand that some people might hesitate visiting a hospital, worrying that they’ll be admitted against their will but such cases are incredibly rare. So please do not worry about seeking help.”
Who should I call: a psychologist, psychiatrist or counsellor?
Depending on the individual seeking treatment and circumstances, treatment could come in the form of “talk therapy”, which is the basis for psychotherapy and counseling, and/or it could involve medication.
Psychiatrists in Singapore are regulated by the Ministry of Health and are medical doctors who can prescribe individuals with medication and perform ECT (electroconvulsive therapy). Psychiatrists usually work together with psychologists to provide holistic treatment. A psychologist would primarily aid a client by counselling and psychotherapy.
Although certain theories and frameworks in the counselling and psychotherapy treatment might overlap, there are subtle differences. Counselling usually focuses on specific issues in the present, such as everyday issues, stress, grief and loss or relationship problems, whereas psychotherapy would usually focus on uncovering how past events might cause problems in the present. This could be used to address anxiety, mood or eating disorders. Counselling is usually a short-term treatment of about six months (although it can be extended), whereas psychotherapy might run over the course of a longer period.
Both psychologists and counselors would use psychotherapy and counselling, which would equip you with coping mechanisms that do not involve medication. How they differ is psychologists tend to have additional training and education, so that might make them a better fit to treat certain mental health disorders.
Whether you’d like to seek help or want a listening ear, a straightforward first step would be to visit your neighbourhood healthcare provider, or log on to CHAT’s online text-based webCHAT service to seek advice from a mental health professional. The conversation can remain anonymous, and the professional on the line would ask a few questions to understand your situation. Then they’ll be able to advise what kind of professional you should seek consultation or treatment from. It’s also a good chance to ask other questions that you have in mind.
What can I expect from my first counselling session, and how long will treatment last for?
The precise details might differ across centres, but the first session should begin by establishing what you and the counsellor would like to work on together, what the issue is, when it began and if you’ve received treatment in the past.
At Club Heal, a charity that supports the societal reintegration of individuals with mental health issues, executive director (clinical) Madam Yang Chek Salikin explains that after six sessions, both counsellor and client will review to see if the situation they set out to work on has been resolved or if they should continue with more sessions. The first two sessions would usually take place quite close to each other, then sessions might take place a few weeks or a month apart. In between, the client would work on the exercises that the counsellor gives them.
At AWARE, the first session would usually involve rapport building between the counsellor and the client. The counsellor would listen to the client explain the issue, why they are there, what they want to work on, and how the counsellor can support them. Frequency and duration for the entire course of treatment will depend on the needs of the client, the clinical approach of the counsellor and the availability of both client and counsellor. The Women’s Care Centre normally recommends that sessions happen every two weeks in the initial stages, then duration can be up to the client to schedule with her counsellor after the first session.
Multiple session therapies aside, Singapore Counselling Centre, which provides counselling and psychological services, also runs single sessions. A single-session would suit individuals whom the counsellor deems to be largely functional, with lower risk and need levels, and during it, the counsellor would focus on teaching the client to identify maladaptive thought processes and learning tools to reframe thoughts and modify behaviours.
What should I look out for when choosing a counsellor?
Finding the right treatment and practitioner might take time but it’s important that you’re comfortable with who you decide to see. There is no shame in seeing multiple counsellors before finding one that works for you.
Michelle suggests to look out for a counsellor’s professionalism — do they impose their personal values on you during a session? Do they share the same view of your illness? Do they want you to participate in a therapy method that you are not comfortable with? It’s important that you find your opinions and sense of self to be respected.
To get an idea about their approach and experience, try asking questions such as: Have you seen clients with similar concerns to my own? When was the last time you treated someone with a similar problem? Counsellors and psychologists are not regulated by the government in Singapore and it is okay to request for credentials.
If it matters to you that your therapist is aligned with you when it comes to religion, race, sexuality, and age, then those are factors that you might want to take into consideration as well.
Can I choose to change my medication?
As a medical professional, a psychiatrist would be able to diagnose one’s condition and if necessary, prescribe the right medication for it. It’s advised that individuals and caregivers work with a psychiatrist to understand what symptoms the medication can treat and possible side-effects.
A psychiatrist might be the expert in recommending solutions to patients but the patient and the patient’s caregivers may have a better understanding of the symptoms and events that lead to the illness. So patients and caregivers can play a more active role to enable the best possible treatment. For more on what you can ask yourself and the psychiatrist to help determine a medication that suits you, read this.
What is the difference between treatments by a public hospital and private practitioner?
A public healthcare provider would usually cost less per counselling session than a private practitioner, but it would likely also mean a longer wait and bigger gap in between sessions.
**Rates can be viewed here: IMH, TTSH, SGH and KKH
To qualify for subsidised mental healthcare, visit a polyclinic, get a referral letter from the doctor and book an appointment at a public clinic. Find out more here.
What are available subsidies for treatments?
MediSave can be used for psychiatric treatment and medication at public hospitals as well as approved private hospitals and medical institutions. For inpatient treatment, you can use up to $150 per day for daily hospital charges, capped at $5,000 per year.
You can also use up to $500 per MediSave account for outpatient treatment like counselling. Under the Chronic Disease Management Programme for chronic conditions such as schizophrenia, major depression, anxiety and bipolar disorder, each claim is subject to the patient paying 15 per cent of the bill in co-payment.
MediSave may be used for your spouse, children, parents and grandparents (grandparents must be Singapore citizens or permanent residents). On top of that, through MediShield Life, you could claim up to $100 per day for hospitalisation.
Among private insurance policies, AIA Beyond Critical Care offers coverage for individuals who are diagnosed with major depressive disorder, schizophrenia, bipolar disorder, obsessive compulsive disorder and tourette syndrome (up to age 21). A caveat is that the individual cannot have already been diagnosed with mental illness and this is a means of protection for a future diagnosis.
Nevertheless, rest assured that there are always free helplines to call for immediate help and organisations that provide an additional subsidy based on your needs. IMH rates can be viewed here, and in the event that you face financial difficulties, you will be referred to their in-house medical social workers.
If I’m living with mental illness, must I inform my employer?
Employers asking job applicants to declare their mental health conditions without good reason is discriminatory, according to Tripartite Alliance for Fair and Progressive Employment Practices (Tafep), who updated its guidelines in December 2019.
In other words, you have no obligation to disclose or discuss your mental health issues with employers unless it is likely to affect your performance or ability to meet the requirements of a job safely. For instance, a person with a history of mental health issues might want to declare their history if their job entails shift work and night shifts don’t suit their condition; a person who feels drowsy after taking medication in the morning might be encouraged to declare so if required to operate machinery, so that safe and suitable work arrangements can be made.
Having said that, it is an individual’s right to draw boundaries in terms of how much is disclosed. You don’t need to go into details about your medical condition as long as you inform the company about how your work will be affected and how the company can help or make suitable arrangements accordingly.
(Silver Ribbon released a handbook on mental health matters for employers and employees, which can be read here.)
How can I support a friend?
Everyone’s mental health journey is different, and mental illness doesn’t have a “look”. But if you suspect that a friend or loved one is struggling, you could broach the subject by asking how they’re feeling. Maybe you’ve noticed that they haven’t been sleeping well or that they’ve been displaying behaviour or mood changes. You would know your friend best but sometimes to be an active listener helps a person to open up about deeper things that are troubling them. Show support by asking open-ended and neutral questions like “are you okay?” instead of “you don’t look okay”. Try to let them make their own decisions, although you might want to offer to see a GP or counsellor with them.
Show that you’re listening by reflecting back on what you have heard and show unconditional presence, says Cristina. Use words like “you look sad, this must be hard for you” to let the other person know that you are listening and are empathetic, instead of giving advice. Cristina suggests to ask someone if they want your advice before giving it, because sometimes it is very invalidating to give advice when you do not know what the other person is going through. “Sometimes we don’t know what to say, and it’s okay to say that you don’t know how to respond and feel shocked, but that you want them to know that they are not alone,” she adds.
“You might not be experiencing what they're experiencing or be able to explain away their fear and pain, but sometimes all one is seeking is a hand to hold and a listening ear,” says Michelle. Another way to support them is by making their daily functioning tasks less daunting. “Offer to cook for them, buy groceries or just text them “good morning, you can do it”, Michelle adds. “You can also match their (decreased) activity levels by inviting them to your house to have a simple sleepover if they find it hard to get out of bed and are always tired.”
If they do not want to talk about their mental health struggles, you can engage in their interests or other happenings in their lives. You can also help them to take a break from thinking about their problems by telling them about your life, like what you had for lunch and what you did at work today.
How much would a parent be privy to if a child attends counselling?
Minors under the age of 21 would need their parents’ consent in order to seek counselling, but what is said between the therapist and the child would usually be confidential.
“Most therapists understand that parents might require some information about what is going on — or some guidelines about goals or progress, but they often present this information in a way that does not disclose private thoughts and feelings of the child. So the discussion is in more general terms,” says child therapist Katy Harris from Family S.O.S. “For example, I might share how parents can support a child outside of the session, but I wouldn’t repeat what the child said to incite the topic.”
The overall aim would be to create a therapeutic relationship in which the child can be vulnerable, respected and supported. With children over 10, Katy would also have a conversation with the child on what can and cannot be shared with the parent. In the event that signs of potential or actual self-harm arise in session, she would first investigate its level of threat before planning with the child how to disclose this in order for everyone to be aware and more able to support the child.
How can I find support for myself as a caregiver?
Hotlines, help and support:
Mental health is a complex subject — one which affects individuals to varying degrees and in different ways. We’ve only just scratched the surface with our “Mental Health: How are we talking about it?” series, and this resource guide is by no means exhaustive. If there are any tips that you wish to add, please comment below, or write in to firstname.lastname@example.org and email@example.com.
We hope to continue the conversation, so if there’s something that you wish we would cover, please don’t hesitate to reach out as well.
Click here for the first, second, third and fourth stories of our series. On the Dayre app, we’ve also released a new mental health-themed sticker pack, which you can find by searching “mental health” in the sticker store. Mental health matters. You matter. When words fail you, use our stickers to express your feelings.
My name is I Yune, and you can find me at @i_yune on the Dayre app. On my personal account, I’ve written about normalising conversations about mental health, reading more widely on social issues and the little things that keep me sane while staying at home in this pandemic.
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