Mental Health among Youths: Understanding children with mental illness

By Hoe I Yune, Oct 22, 2020

Trigger warning: This story contains mention of depression and suicide.

There were 400 reported suicides in Singapore in 2019, according to the Samaritans of Singapore (SOS). The number of suicides among the 20 to 29 age cohort remains the highest compared with other aged groups, and it remains the leading cause of death for people aged 10 to 29. Males account for more than 66 per cent of suicides.

In part three of our four-part “Mental Health: How are we talking about it?” series, 46-year-old stay-at-home mum Doreen Kho shares her point of view as a bereaved parent and co-founder of the PleaseStay Movement, a suicide prevention initiative led by a group of mothers who lost their children to suicide. 

After losing her eldest son, 11-year-old Evan, Doreen sees that more can be done for youths. As a mum and person living with depression, she shares how she copes with the grief after her son’s passing and how her children 13-year-old Caryn, 9-year-old Javen, and 7-year-old Kaylene keep her going strong. 

The PleaseStay Movement aims to raise awareness on youth suicide and mental wellness among youths. The group has met with agencies like the Ministry of Education (MOE), the Institute of Mental Health (IMH), Samaritans of Singapore (SOS) and many others to discuss ways in which institutions can support youths-at-risk. It is advocating for a national strategy on mental wellbeing and suicide in Singapore.

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Three years ago, I wrote a Facebook post on mental illness in children. It was the day before Evan’s burial and I wanted the world to know that even children as young as him could be struggling with depression.

Evan took his own life after feeling disheartened by his Primary 5 mathematics examination results in 2017. 

That year, he was diagnosed with depression. I first noticed he was gaining weight, cried often, and became extremely sensitive to what people said about him. Friends told me it was normal for a child going through puberty and he was already being counselled in school. But something did not feel right. 

I decided to seek medical avenues and we saw a counsellor outside of school. He was diagnosed with depression and Asperger’s Syndrome, a neurodevelopmental disorder on the Autism spectrum. I was unfamiliar with Asperger’s and researched the condition. I learned that an individual living with it usually faces difficulty with social interactions, possesses focused yet restricted interests, and is resistant to change, although they show strong intellectual and artistic interests.

Evan was very sophisticated in his thoughts and speech, which I had assumed was the result of being amongst adults all his life. Since he was a baby, I would bring him to the office every day. As I learned more about Asperger’s, I better understood his actions and perhaps the reason for his anxiety. We had just moved back from Melbourne after living there for a year, so he was readjusting to Singapore and its school system.

He had been attending counselling sessions almost weekly when his teacher called to say he wrote an essay on suicide. I panicked and made an appointment to visit the counsellor the next day. This time, he was referred to a psychiatrist and prescribed medications. 

I planned to involve Evan’s sisters and brother in family counselling, so that everyone would know how to interact with and support him. As a family, we were all very mindful about our tone and language in conversations. I explained to my other children that they needed to be extra tactful towards Evan as he did not take well to negative comments. He was overly sensitive and would take certain things to heart like thinking he was being reprimanded even when he was not. 

In hindsight, I wish I had taken him out of school and only put him back in the education system once he was more resilient; I wish we had never left Melbourne; I wish he didn’t go on medication, which might work for some but might amplify suicidal thoughts in others. In Evan’s case, he described it as a tool for “false” happiness. There are so many regrets and “what ifs” that I live with, wondering what I could have done differently. 

Evan was incredibly thoughtful and would ask deep, philosophical questions. Speaking with him sometimes felt like chatting with an adult whom I could share everything with.

Evan was incredibly thoughtful and would ask deep, philosophical questions. Speaking with him sometimes felt like chatting with an adult whom I could share everything with.

The Facebook post I penned after Evan’s passing caught media attention and as I did more interviews, I realised that there was so much I wanted to share about childhood depression and suicide. 

I wanted children and teenagers to know that they could reach out for help when they feel anxious or depressed, just as anyone would when suffering from a physical ailment. No one should feel guilty or shameful about depression. 

Depression does not always present physical symptoms, which is part of the reason why people don’t seek help. In the case of depression, there may be little to no physical pain that would drive a person to get professional treatment as it feels like there is no justification to do so. With cancer, you could scan to detect a tumor but depression isn’t as easily detectable or immediately conclusive. It’s a feeling of despair, which may shift and hide from view. 

For children dependent on their parents, seeking help might be even more difficult without their parents’ support. Parents who are less understanding might ask, “Why can’t you get over it?” 

The cost of treatment is another barrier to seeking help as unsubsidised private consultations can cost from $100 to $400 per session. Consultations at public hospitals are more affordable but to get an appointment would require a long wait.

Children with depression are severely disadvantaged as they are young and do not have the coping mechanisms to articulate nor manage their condition. I was in my early 30s when I realised I had depression. As an adult, I know first-hand how difficult it can be to battle depression. My maturity helped me in shutting out negative thoughts and being mindful of my triggers. I could redirect my focus towards my responsibilities as a parent, but a child would likely have less control over their behaviour and thought process. 

There are various degrees of depression and some people might display more obvious traits than others. What is most worrying are the smiling depressed. They hide their condition so well that you do not suspect that they may be suffering. They could be the ones who are always cracking jokes to make people laugh.

Evan enjoyed cheering people up and entertained others by performing magic tricks and sharing his comic illustrations.

Evan enjoyed cheering people up and entertained others by performing magic tricks and sharing his comic illustrations.

The memory of having found Evan lifeless is something that I’ll never forget. Although I knew Evan had depression, I didn’t think he would kill himself. I didn’t think that our life together was miserable because we were a close knit family — playing, travelling, and working and studying together. I always assumed that he would stay, at the very least because he loved us so much. His passing really taught me never to take anything for granted. 

In the immediate aftermath, I sunk into a deep depressive state. I stayed in bed all the time and refused to do anything. Guilt kicked in when I blamed myself for not doing enough as a parent. Why wasn’t I more in tune with what went on in his mind? Why couldn’t I take his pain away? Why couldn’t I protect him from the stress and bullying he was facing?

In my broken state, I neglected to acknowledge that my other three children were grieving too. One evening, I saw my 6-year-old Javen staring at the night sky from his room. He told me he was talking to God and Evan. That reminded me I was not the only person mourning; my children were grieving and more than ever, they needed me.

I realised I needed to function and be present for them. I started by sending our domestic helper back. Without her, I couldn’t just sit around drowning in my thoughts, and I was forced to look after my children and the household on my own. In order to make myself go out of the house every day, I made sure I bought enough groceries just for that day. If there were two errands that I could run at the same mall, I’d do one today and the other tomorrow instead of completing everything in one trip. 

I started cooking for my kids daily, breaking up the housework into bite size bits so I could manage each day. Before retiring in 2015, I ran a chain of Korean skincare retail outlets and my children are used to seeing me wear makeup regularly. When I wore makeup, it signalled to my children that “mummy is okay”, so I put in the effort. Life goes on and I am here for them. 

I’m blessed that my kids are all very affectionate and loving. They never fail to shower me with cuddles and “I love you”s. They were a huge part of my healing process. Getting back on my feet with them by my side made me realise that there are more memories to be made with them and that their childhood should not end with the loss of their brother. We needed a new norm — a way to redefine our relationship with Evan. He may no longer be with us in person but he lives on in our memory and hearts, and that keeps us going strong. 

The truth is, it is still a struggle each day. I live with paranoia. I worry about my children’s moods and am extra sensitive towards their feelings, for fear that history might repeat itself. I am careful about scolding them when they do something wrong because I don’t want them to fall into a depressive state, yet I know that disciplining them is necessary to shape them in life.

I don’t think the paranoia about my children’s safety will ever go away. I constantly wonder if Evan’s action has inadvertently exposed them to an undesirable option to solve problems. But I try to focus on what I can do. My kids are still growing and they have such different personalities, so what I’m trying to do is tailor my parenting style according to their needs. 

Knowing other bereaved mums has helped me gain some perspective. Through social media and friends, I’ve met other mums who have lost children to suicide. Knowing them — kind, gentle, and loving women who are model mums in my eyes – I have come to terms with the fact that sometimes things happen and they’re not always within one’s control. Knowing that I am not alone has brought some comfort and has helped me be less harsh towards myself.

People who do not know us might think that depressed children must have been abused or neglected, but they don’t see how much we love our children; how hard we tried to help them. 

When your child is depressed, you worry every day. Depression isn’t widely spoken about and as mums, the available treatments and their potential side effects were all new to us. 

We realised that although there are many organisations such as IMH and MOE playing a part in advocating for mental health issues, and everyone is trying their best, there’s a lack of synchronisation. That inspired us to form the PleaseStay Movement in 2019 to spur a national strategy focused on youth suicide prevention. 

We might not have been able to save our children but we do not want their deaths to be in vain. We want to remove the stigma behind depression and suicide among youths.

Depression is something that is very hard to detect. Unlike other diseases, there is no standard set of signs and symptoms, which makes it all the more important to talk about it. 

Since Evan’s passing, his brother and sisters have been seeing their school counsellor twice a month and it would be a mix of talking and activities such as drawing to help them express themselves. 

My younger two children were really young when Evan passed and didn’t completely comprehend it. Whenever we visited places that we frequented with Evan, they would be reminded of him. 

We still sometimes talk about Evan as if he is still around and it’s in our conversations that he lives on. When we dine at a restaurant and see something he liked, we would say, “Evan would love this”. 

I reassure them that it is okay to miss him and thank them for remembering him, then ask about things that they did together. Among my children, the impact on my eldest daughter Caryn was probably the greatest. She and Evan were a year apart in terms of age, so not only did she lose her brother, she lost her best friend. When he passed, she was filled with guilt as he had confided in her about his suicidal thoughts, but she didn’t tell us out of loyalty. I understand that she must’ve felt so frightened and helpless, and I wanted to reassure her that it wasn’t her fault that the tragedy happened.

Caryn has matured very quickly because of it. The other day, I asked Caryn how she would support a friend who is depressed. She said, “You cannot promise them that things are going to be okay but you can hold their hand and let them know that they are never alone, and there is someone who wants to listen.” These are conversations that we have regularly because I want my children to be able to accept and offer kindness, as well as support others. 

Many kids think they need to be loyal to their friends by keeping their secret, but if a friend indicates the wish to end their life, kids need to know that they should tell a trusted adult.

However the responsibility cannot solely rest on the shoulders of other children. Some children may not have the mental resilience or know-how to take on the weight of their friend’s stress. And if they feel unable to help, this could also create a sense of guilt within them.

On top of parents being vigilant, we think schools can help identify students who are facing difficulties. Some children might not feel like they have an outlet, even if they have struggles and insecurities. For the past year, the PleaseStay Movement has been in ongoing talks with social advocate and former Nominated Member of Parliament Anthea Ong, MOE, and IMH about providing more effective support for young people in schools. We have raised ideas like implementing mental health first aid training for teachers to tackle the root of mental health issues and introduce timely interventions. It’s a huge undertaking but we want to do what we can to speak up and share solutions based on personal experience and what we see that exists in other countries.

Many circumstances can lead to an individual’s low self-esteem and depression but only when children have a safe space to talk about these situations can problems be identified and resolved. 

As a mum myself, I know not all children will come forward if it’s mental illness specific but ideally, regular school counselling sessions should be made compulsory for everyone. That way, students won’t feel alienated or judged for seeing the school counsellor. I hope that one day, children will be able to have regular chats with a school counsellor just as they have dental clinic checkups. 

Realistically speaking, it’ll take years before the initiative kicks off because schools currently face a shortage of counsellors. More training would need to be conducted and whether or not mental health services in schools see an improvement will depend on the priority it receives from relevant bodies. Teachers could also be trained on how to spot symptoms so as to assist counsellors.

We’ve received numerous messages and comments from the public since the PleaseStay Movement has been featured in the media. When people reach out, we do what we can to offer help and support wherever possible. As an advocacy group, we hope that slowly and surely, we will raise more awareness on mental health and avoid the tragedies of suicide.

Depression does not discriminate. It doesn’t matter if you come from a rich or poor family, intact or broken; it doesn’t matter what gender or age you are. 

For growing kids, they’re experiencing emotional, mental, and physical changes, and face tremendous pressure to be successful and popular. From social comparison to cyberbullying, the stress of growing up is immense. For boys*, there is still the widely prevalent perception that it is unbecoming for a boy to cry and that sadness is a sign of weakness. They feel embarrassed to show their vulnerability. 

Parents and guardians need to acknowledge that childhood depression is real. Possibly acknowledge their pain enough to say, “Okay, take a day off school”.

Even if I were to be confronted by a similar situation again, I can’t say for sure that I’ll know exactly what to do. All I can say is that as parents and adults, we need to be observant, acknowledge a child’s pain, and help them seek professional support as quickly as possible where necessary. 

The pain of losing Evan may never go away, but today, his siblings and I are able to talk about him with smiles instead of tears.

The pain of losing Evan may never go away, but today, his siblings and I are able to talk about him with smiles instead of tears.

Evan was affectionate and loving, and that is something that I will remember him by. I might not have been able to save him but I want to do right by my other children and help other children and their parents. 

Photos provided by Doreen. 

For more on the PleaseStay Movement, please visit their Facebook page. If you or your loved one is in need of support or a listening ear, you may contact Samaritans of Singapore (www.sos.org.sg), Silver Ribbon Singapore (www.silverribbonsingapore.com) or Singapore Association of Mental Health (https://www.samhealth.org.sg/). For caregivers, you may find resources and support at Caregivers Alliance (https://www.cal.org.sg/). 

This is the third part of our four-part series “Mental Health: How are we talking about it?”. Click here for the first and second stories. Part four will be uploaded next week. 


Writer’s Note:

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. 

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