A Psychiatrist's Take on Mental Health in Singapore

Across schools, homes and workplaces, mental health shapes how we learn, relate, and perform. Yet many of the struggles adults face at work have roots that trace back to much earlier in life. 

In this episode of Health Unfiltered, host Veronica speaks with Dr Hong Lin Feng, Consultant Psychiatrist at Connections MindHealth, about how mental health evolves across life stages — from childhood and adolescence to parenthood and the pressures of working life. 

Drawing from her clinical experience, Dr Hong explains why mental disorders are typically defined by their impact on day-to-day functioning, rather than a strict numerical threshold. She explores the rise in anxiety among youths, maternal mental health and its influence on children, and why completed suicide rates remain higher in men. 

The conversation also examines how stigma, gender norms, caregiving pressures, and workplace culture affect the way distress is expressed and why psychological safety is essential for healthier organisations. 

Watch the episode: Health Unfiltered - Episode 10

Transcript

SPEAKER_01 0:00

Health doesn't always shout. Sometimes it whispers. And if we don't tune in, we might miss it. Welcome to Health Unfiltered, a series by Fullerton Health. Here, real people share the moment they choose to pause, check in, and take charge of their health. These are stories of courage, of early detection, of life change, not by symptoms, but by a single decision. Because behind every diagnosis is a voice, a family, a future. And then a reminder that the best time to act is before it's too late. I'm your host, Veronica, and I invite you to listen, reflect, and be inspired. This is Health Unfiltered. Let's begin. Mental health at work doesn't exist in a vacuum. The way we cope, relate, and perform as adults is often shaped long before we step into our first job. On this episode of Health Unfiltered, we will discuss how mental health evolves across life stages and why that matters for today's workplaces and future workplaces. Thank you for joining us today, Dr. Hong. Mental health is such a big word today, right? In workplace, in schools, in our social life. Can you help us define what is mental health conditions? What are the mental health conditions and how has it evolved over time?

SPEAKER_00 1:32

I think if we were to talk about mental health, how we define it, that's a very big sort of area to define. Like how do we define physical health as well, right? I guess the perhaps one way to look at it is what's the impact on mental health in terms of our daily life. And of course, I think this sort of varies across life stages. So perhaps you know, when we are looking at people who are studying, I think one key thing would be to look at the educational attainment, uh, social relationship. So I guess good mental health would enable this kids, teenagers, um, young adults to be doing well in this aspect. And as we move into the older age group and I guess the working adults, uh, occupational functioning is very important. So again, good mental health would mean that someone who's able to contribute to their work meaningfully. And of course, a big part of it for someone in perhaps their 20s, 30s, it's also about perhaps I mean, I guess if we talk about traditional kind of things, marriage, ability to form a family, um, good mental health, being in a good mental state will allow someone to sort of achieve that. But of course, I think in modern society we also don't define um having a family as something that is critical. I think there's also other things that people look out for, you know, in terms of personal fulfillment. Um, yeah, so I guess essentially being in a good sort of mental state um allows one to achieve what they want in those sort of domains. Um I think another part that you were saying, mental disorder. So I think in terms of mental disorder, um the concept uh if we could if again we were to compare to physical health disorder, sometimes it can be a bit hard to define. I guess with physical health disorder, um, for example, if we were to talk about blood pressure problem, um diabetes, um, there's usually a blood test, you know, and there's a cutoff, and um if you're above that cutoff, then you know you are deemed to have a certain condition. Um, however, with mental health uh in this aspect, um there's no sort of numerical definition. Uh often we talk about, I guess, what are the symptoms that are present, and the most important part again is what is the impact on the functioning. Um, generally, if people have symptoms and there's a clear impact in terms of the functioning, then we would sort of term it as a disorder in that sense. Yeah.

SPEAKER_01 4:30

So we go into something deeper. Um, the WHO data reveals that there's about a billion people globally that has mental conditions, mental health conditions. And in Singapore, there are about 300 to 400 um mental health, suicide related, um, mental health-linked suicide um every year in Singapore. Um, as a psychiatrist, what the does all this number mean to you?

SPEAKER_00 4:57

Um I guess every death by suicide is something that we do treat um it seriously, right? And I think the general trend is also that um death by suicides are increasing. Some of them perhaps they do present with um, they do have a history of mental health disorder. Some perhaps they never came to seek help. Um, but uh I think knowing these figures are really very important. And of course, um I think beyond that is also trying to have an understanding of why it's happening, because then that will help us to shape how we can prevent this death by suicide as well. Yeah. And if there's a patient that comes to you to say, Dr.

SPEAKER_01 5:42

Hong, I cry silently at night, and I try not to make noises so that people can't hear me. Um does that take pain to the next level for the patient?

SPEAKER_00 5:56

I think in a sense, yes, because I guess it sort of portrays the picture that they are suffering in silence. And I guess that was something that had been um that perhaps has been happening in the field of mental health for a long while, where you know, uh mental distress shouldn't be something that is expressed openly. Um but hopefully, you know, in the current day and age, with the changing sort of mental health landscape, people would be more open in sharing their distress. And I think this should be applicable to both males and females as well, because sometimes there's there are also certain uh differences in an expectation of how perhaps a male and female should express their distress. Um, but I think we should build a climate where you know different types of expression of needs are identified and attended to.

SPEAKER_01 6:47

Yeah. And um you specialize in women, adolescents, as well as young people, right, in terms of uh mental wellness. Um has it changed in terms of the proportion of um gender getting into depression and coming up to you to seek help more often than before?

SPEAKER_00 7:09

Um okay, so I guess if we were, unfortunately, I guess I mean you like you mentioned, you know, I I work with mainly women um for the past few years, so I don't see a lot of the adult male um patients. But if you were to talk about the younger sort of population, teenagers, um actually there are, I do see a fair few of you know teenager boys coming in with emotional struggles as well. So um perhaps that's a reflection of um what I guess is being sort of taught at school in terms of emotional literacy. I think that is one component that the Ministry of Education has become quite focused on. And I guess as a whole, Singapore is becoming um is stepping up their game in that aspect. So um I guess I do see a you know sort of a fair number of you know young males coming in talking about their struggles as well.

SPEAKER_01 8:06

And what sort of uh struggles are um most common amongst the younger people in Singapore?

SPEAKER_00 8:14

Primary school kids um they tend to present with neurodevelopmental issues. So, for example, um conditions like attention deficit, hyperactivity disorder, that's coming up a fair bit as well. Um, autism spectrum disorder, uh, they do present as well. And I think part of why they are presenting a bit more, I think it's also the um sort of public education on this sort of condition, so allowing sort of early access to screening and treatment as well. If we were to move into the sort of secondary age group, um that's where we see a little bit more of the anxiety and mood difficulties coming up. Um, those often would be driven by academic pressure, peer relational sort of issues. And for some, I guess unfortunately, who come from a disadvantaged uh family background, I guess um the baggage and trauma from um their early childhood experiences also tend to come up. Sure.

SPEAKER_01 9:18

And um, is there any difference between the younger adults and maybe the adults that are working already in the workforce in terms of the kind of anxiety they face, the depression that they go have to go through?

SPEAKER_00 9:33

So I guess in terms of um, I guess if we were to talk about their source of stress, that of course with um uh schoolgoing kids, academic definitely you know is a huge source of pressure. Alongside that, um, given that current stage of life, the importance of uh peer identity, yeah. So that's a quite common source of stressor. So bullying at school, um, they do come up. I guess when you move a bit into the working adult um kind of population, then that work stressor would be, of course, more prominent. Um as they are looking into forming their own family or for you know individuals who have formed their family and have children, um, then stresses in terms of marital caregiving responsibilities, uh, they tend to come up. And I guess this caregiving responsibilities uh does not uh solely limit to the caregiving of children. For some who have elderly parents, then there's also that um, you know, being responsible for their elderly parents as well. So um the nature of um, I guess the source of stress they evolve over time. In terms of how they express it, perhaps you know, for um the younger population, um, they are still at the stage in terms of learning to uh express their feelings, learning to uh of ways to cope with their feelings, so they may not be sort of fully skilled in that um that part. Uh so they sometimes it can be difficult for them to express, so we may they may not be able to exactly say that, oh, they're feeling depressed or they're feeling anxious, and it may come up in other forms, for example, even like physical symptoms. So often you see kids with uh multiple physical symptoms, you've gone to the doctor, nothing comes out of it. Then I think it would be good to consider whether there's a mental health origin in it. Um so I mean, adults, we of course, I think, I guess in this part in terms of being able to express their feelings, we do hope that you know adults have that ability. But what we also see uh is uh is that if for the young people who never really had that chance and opportunity to learn about their feelings, to regulate their feelings, sometimes they may also then have difficulties in their later adulthood to talk about all these struggles as well. Uh so sometimes it's not too dissimilar in terms of you know how they express their needs. How they cope with the stress.

SPEAKER_01 12:16

Correct. Um you spoke about a few things, right? One, we talk about the children. If you put the same child, same child in a different environment that's a bit more relaxed when it comes to uh growing up faces, right? Will this child be much better in terms of the mental state?

SPEAKER_00 12:34

I guess it's possible. It's possible, right? I mean, when we look at mental health, uh and if we were to talk about mental health conditions, what are the treatment uh interventions, one key thing is always to address the source of stress. So if you know academic pressure is something that is really driving all these difficulties, then by alleviating that a change of environment, in a sense, it it does, it will help, you know, with some of the struggles.

SPEAKER_01 13:03

Yeah, the reason why I ask this is because a lot of parents or young parents with young kids, right? Um, sometimes we forget we could be the source of stress to our children. Um already there are so much pressure in school, academically, I need to perform. And if parents are not educated in terms of how to better de stress their children, um it might add on, right? And therefore, certain parents may see certain behavior, or teachers may certain see certain behavior as performance related and not realizing that it's because we have inevitably caused some stress to the child. Yeah, so I think that's also something that I think driving awareness of that amongst you know Singaporeans will be very helpful for the children, not to add on, but to alleviate for to help them alleviate. Then we talk about the younger um or the teens, right? The younger adults. Um they face different kinds of social um pressure from our generation or my generation for that matter. Um do you see a trend in these young people that they become a little bit less resilient because they know that I have a certain condition or they have a stigma, that um if I were to express to people that I have a mental condition, I have challenges in expressing my emotions or managing my my um emotions, then I will be outcast by my colleagues or my friends. Yeah. Do you see that coming out amongst young people?

SPEAKER_00 14:39

I think one I guess important uh thing to sort of address, you know, your question is how we define resilience. Right? Um perhaps uh if we were to talk about 10, 20 years ago, resilience might be defined by the fact that you just endure everything, you don't complain about anything, everything that is given to you, you just do it, right? Um, but I guess um I'm not too sure if that is really applicable in this kind of day and age. Um in terms of really if we were to think about resilience now, perhaps it's more about um understanding your limits, what is it that you're capable to do, what is beyond your limits, and when things are sort of beyond you, um that it's okay to ask for help, and knowing that um after asking for help that you can rebound, I think that's probably a more holistic view in terms of um defining resilience. So, in that sense, I don't think necessarily that you know younger people in the current generation are less resilient. Uh, in fact, they they may be better in terms of understanding um how they feel and being able to sort of draw boundaries. But I guess the tricky thing may then be um how do we ensure that there are adequate support to it and how you know people around them um respond to their emotional needs. Yeah.

SPEAKER_01 16:16

And that is really quite true because um the younger people today are probably a bit more vocal. They know how to express themselves and they can learn how to cope with their emotions much better than maybe 10-20 years ago when people are growing up, right? Um maybe I'd kind of um move away from this topic to detection. Is there such a thing as early detection of mental condition or late-stage detection of mental health conditions?

SPEAKER_00 16:46

Uh yes, definitely. I think um prevention is always a key in terms of both physical and mental health. Um, and I do see some of it coming into play um in sort of Singapore. I mean, given my experience uh with my past work, um, where I work a lot with perinatal patients. So, screening of uh depression in pregnant and women uh who have just delivered, there are active programs that are happening. So that is, I guess, one uh important thing when we talk about pre-prevention of mental health and maternal health is particularly important because of its uh effect on the growing child as well. Um, we we do know that you know if a mom suffers from mental health issues which are not being well managed, the child subsequently may um struggle with their own mental health issue, right? So I think this is one uh clear example of how screening, especially at the sort of maternal stage, helps to prevent um subsequent mental health issues in offsprings as well. Yeah, so there are two things that you mentioned.

SPEAKER_01 18:00

One is um detection uh for maternal health, right? Is it really possible to detect that I can potentially have a condition that is not um present now? For example, today I'm pretty well, I my mental health is quite strong. But because of a certain stage of my life, it could be giving birth, postnatal, then it triggered something in me that kind of put me into a mental condition. It's possible.

SPEAKER_00 18:33

Um if I understand you correctly, I do think it's possible. You know, that there is um, you know, a lot of ladies that I've seen, actually they've been uh functioning very well uh up to the point that um they get pregnant or they deliver. Sometimes with um at various life stages, you know, there are various demands, and sometimes um things can tip over, but that doesn't mean it's permanent, it may be a temporary thing, right? Um so with that, I think that if we time it um correctly, we can pick up individuals who may be at higher risk of um mental health conditions, and um I guess we can I think to sort of uh accurately say if you do develop, I think that that does require longitudinal sort of monitoring.

SPEAKER_01 19:25

And about also the learning about the history of this person, what they have gone through in their early days of their life is also quite important. Yes, of course. So it could be the reason why I have um mental condition right now is because it it could be triggered and reminded me something of what happened when I was very young. That's what I was going through, right?

SPEAKER_00 19:44

Yes, yes, yes.

SPEAKER_01 19:44

So the second thing that I wanted to kind of ask you about is this um how a mother's condition, mental condition can affect the offspring. Does it mean that if I'm a mother I'm going to a to be mother or I'm planning to give birth to a child, should I consider not having a child because I have a mental condition for the sake of the well-being of the child?

SPEAKER_00 20:10

I think that's a very sort of extreme kind of thought, right? For sure. Uh but I would say it's not something that you know um women uh that I've met, it's not something that they have not brought up as well, right? So, I mean, definitely there's higher risk for the offspring, but that there's but that does not guarantee definitely, right? Uh there are, of course, other things that you know one can do to sort of mitigate that risk. I think what is important, uh, of course, knowing, you know, having that higher risk and all this, I think that's important. But I think what is even more important is actually the environmental kind of factors. So sometimes we talk about gene versus environment, how much of it plays a part. And I think increasingly there is recognition that environmental factors are actually quite important. So I think things that uh would be helpful in terms or protective against mental health difficulties, for example, I guess, uh what are the early caregiving experiences like? Uh what is the quality of parenting that the child receives? Um, the ability, um, what are the sort of um, how is the environment like physical environment in terms of where the child is growing? Is there access to sort of I guess um uh basic needs as I think basic needs of course we need to consider, but also is there access to you know um uh help when you know the child is trying to express needs. So that emotional availability that's also very important. So, in that regard, um I guess for the mother who has pre existing mental health issues, it's important. What is even more important, I think, is for their mental health uh condition to be under um to uh to be you know stable, well controlled. That's important so that they can be emotionally available for the child when it's needed.

SPEAKER_01 22:06

Recently I heard a story, um, Dr. Hong, that a mother found out that she has bipolar condition after giving birth. And the behavior of the mother may has may have caused the child in the child's growing years to become depressed. Right? So under such situation, as a psychiatrist, what kind of help can you render the mother and the child to help them get out of this kind of situation? Or the tension, the struggle that they are going through.

SPEAKER_00 22:40

I guess what you've described showcased, like, you know, how again, like uh maternal uh health is closely linked to the offspring's mental health. Um I suspect what I'm hearing in this situation is that the mother bipolar was probably not very well controlled. And I um so in in this situation, I think emphasis on um a regular treatment plan, be it medication or psychological intervention and being sort of compliant with it, I think that's quite important. Um I guess with the child it's important to understand what is the nature of the difficulties, um, what age the child is, because if you can imagine a primary school age versus a secondary school age kid, they would have very different needs. Um if it's not so bad, nowadays school, I think they are um they have the most school they do have at least one school counselor, right? So um they usually are a good source of support. If let's say um the emotional difficulties are not too um complicated. Uh I think the other good thing about school counselor, if um, once they get in touch with the kid is that um they are also trained. Um, if let's say something the kids struggle a bit more than what they can handle. Um nowadays, school counselor are built with the knowledge uh to know where where they can refer to. So uh typically um it will be, I guess, psychiatrist uh psychiatrists who specialize in child and adolescent mental health.

SPEAKER_01 24:22

Yeah. Um we shift gear a little bit to um men. Um there's also studies to show that men are becoming a little bit uh in terms of the stats, in terms of um suicide cases, right? Um are men and women built differently in managing mental health conditions?

SPEAKER_00 24:42

It's built differently in terms of, you know, biologically, and also I think it's partly shaped by societal expectations. I think for a long time we do know that um the completed suicide rates in males do tend to be a bit higher, um, whereas female they may try a bit more, but they may not uh complete suicide in that sense. Um I think what what we understand of this sort of picture is because males, uh once they set their mind in terms of doing something, they generally would go through with it. Yeah, so that's why the rate of completed suicide are higher. Um females, I guess, uh they may be sort of more open in expressing, you know, uh how they feel. But um, with that being said, they do tend to carry their emotional difficulties over longer periods of time. So, like traditionally, uh males are told to uh suppress their feelings, like uh boys, they don't cry, right? So they tend to keep it uh within themselves for an extended period of time. And often when they um and even their symptoms, uh it may not be the traditional, they won't say like, oh, they're depressed or they're anxious, or it may uh symptoms may um they may come across as irritable, uh not performing at work, or you know, having risk-taking behaviors such as uh alcohol or you know, drink driving, and that may be a reflection of uh or an expression of their mental health difficulties.

SPEAKER_01 26:21

And I've also come across um friends or colleagues, um, past colleagues that um men, right? And they they they shared with me what what they are going through. Um and the amount of stress at work actually caused them not to be able to perform. Um but it didn't happen in the past. It is only at the later stage of their life that they realize that the amount of stress at work um is something that presses on them so hard that they can't breathe, they can't think, they can't perform their work anymore. And um, like you say just now, because men are tall from young, you can't cry, you can't express yourself, you need to be a tough guy. And the moment they collapse, um, they don't know that there's help, right? And as a father, as a as a male figure at home, they don't want to share with their family what they are going through. And therefore, suicide becomes something that kind of becomes a a um the only way out for them. And I've seen um male suicide, I think two in the last three years from maybe friends at the network, right? And we realize these people don't they don't express themselves that well because in social gathering you can't tell this person is unhappy or that person is suffering, like Robbie Williams, right? We can't tell that he was a decider. Um how do we at work or even in our social environment um be a bit more, I don't know, be a bit more knowledgeable or a bit more sensitive to such symptoms or I don't know, sickness that our friends, our family members are sending to us. Whether it's male or female, it doesn't matter. How do we become more aware of such sickness, uh sickness, so that we can be a bit more proactive in finding out how to help them?

SPEAKER_00 28:26

I guess to start off with, um I think that it needs to begin um like discussing about mental health in general needs to become something that is quite natural, right? Um, that is not a taboo, right? So um I think that sort of environment needs to be created. Um I think being sort of um vulnerable and open about how you're feeling definitely invites, uh I think it invites conversation and makes the other party uh more willing to talk about their own struggles as well. Sometimes uh rather uh then labeling certain things, um, like um if someone you know becomes a bit more withdrawn, rather than um thinking what is wrong with that person, maybe being a little bit more curious in terms of, hey, what's happening with him, um, that will also invite, I think, more conversation uh in that aspect. So I think that's very important in the workplace as well, where um uh psychological safety is very important because only with psychological safety then you can talk about mental health issues. Sometimes with working adults and typically those in more like high, stressful, demanding corporate kind of environments, it can be quite hard to talk about their mental health difficulties because they may be worried that uh there may be repercussions. Hey, uh, would I be deemed incapable? Um, would I be penalized? Would I be robbed of that promotion because um because they might think I'm weak, right? So I think mental health needs to be um deemed as important and something that people can freely talk about, and important leaders in organizations can talk about as well. Um, because if they do talk about it, then of course you know employees will be um more comfortable in that regard, right?

SPEAKER_01 30:28

Um the environment needs to be a bit more inclusive of people with different kinds of conditions, not just mental health conditions. But I think this whole drive awareness on how to better include people with mental conditions, mental health condition into our work environment and how to embrace them, how to take care of them, how to even look out for sickness, to make sure that we are there for them. Um it will be very helpful for people who are really struggling. Um, this next question I have is do you think, Dr. Hong, is possible that we we are all born depressed? Somebody asked me this question before. Is it possible that we are all born depressed and it trigger it's triggered at different times of our life that we are not aware of?

SPEAKER_00 31:18

That's a very interesting question. I guess it's the like uh a similar question that comes to mind is if we are born good or evil. Um, I would like to think that we are born with a blank palette. And um perhaps, you know, because our of our early childhood experiences, maybe some of our palette are brighter in colours. Um, some of our palette, unfortunately, maybe you know more dark. Um, so I think it's more of you know how we grow up and how it mold our palette, yeah, and our tendency then to perhaps look at things in a more positive versus a more negative manner.

SPEAKER_01 32:03

Dr. Hong, what would you like to see in terms of mindset shift um in mental health in Singapore?

SPEAKER_00 32:13

I think it's undeniable that mental health has come into a lot of people's attention. At this point, we are still seeing, I guess, um, individuals with mental health disorders um coming into treatment as that being the focus. But I think the shift should happen in terms of rather than focusing on treating disorders, we should actually think about what to do to promote mental well-being. And um if we were to look at the population, uh if we were talking about um the younger population, school-going kids, that would start within like um school or even at the home setting, where parents should become very comfortable uh in emotional literacy. So, what that means, you know, talking about feelings, not only about the kids' feelings. I think it's important to talk about their own feelings as well. And if things get out of hand, it's okay to seek help as well. So I think that's quite important to happen at the home front, right? Uh so at school, I feel that everybody should uh be equipped with the vocabulary of talking about feelings. So this would include you know, school kids, counselors, uh teachers, and I think importantly for I guess um adults, um, they they should be also equipped with skills to pick up uh or to detect kids who may be struggling, and importantly, kids who may be presenting with sort of atypical symptoms because those are the ones that typically get left out or get help a bit later. If we were to move on to the adult working population, um I think a change in terms of organizational culture is important. So when we talk about, we we earlier we talked about how for working adults a large source of stress would be work-related stress. So I think it's important to uh for organization to consider what contributes to this stress. Um working hours, um, expectations of work, um, leadership, uh, communication and trust. I I think those are aspects of work culture that should be looked at to promote good mental well-being and hence preventing um or at least reducing incidences of mental health disorder. How about in the family? As kids, we learn how to manage stress and um and you know regulate our feeling from our parents. For parents, I think it's very important for them to talk about feelings openly, not only about the kids' feelings, but their own feelings as well. And um, own feelings doesn't uh only include positive feelings. I think it's important to talk about their own emotional struggles. Uh with that, it's then important to explore how they overcome their struggles. And if there are times where things get too much, um, for parents to actually tell the kids that, you know, I'm seeking help and it's okay, so that it normalizes for the kid when they struggle, they need help, and that's okay to get help.

SPEAKER_01 35:24

And sometimes it's you it can surprise you how your children can help you to normalize your or regulate your emotions. True. That's something that I've learned with my children. Yeah, so thank you very much, um Dr. Hong for joining us today and for sharing.

SPEAKER_00 35:38

Thank you.

SPEAKER_01 35:39

Thank you for joining us. We hope this conversation encourages both individuals and organizations to think differently about mental health. Not just as a workplace issue, but as something shaped over. Until next time, this has been Health Unfiltered.