Views from the couch: Understanding the realities of mental health caregiving
No health without mental health Views from the couch: Understanding the realities of mental health caregiving
SINGAPORE - At 29, he still runs to his mother's bedroom when he has a nightmare. His compulsions – repeatedly flicking light switches on and off, obsessively ensuring items are in their exact spots, and even showering for hours – are routines that provide him with temporary relief from his anxiety.
His mother knows that such behaviour is part of his coping mechanism, the rituals that help him manage his obsessive-compulsive disorder (OCD). While she understands and tolerates them, her husband and daughter have struggled, especially in the early years when his symptoms first appeared.
The mother, one of my colleagues, is familiar with the unspoken weight of being a caregiver. It's not uncommon for her to apologise for missing work to be at the Institute of Mental Health (IMH) with her son or to manage a family crisis. I've seen photos of him in the hospital, strapped to a bed, and it's her strength, her unwavering resolve to support him – and that of other caregivers – that keeps me going in my new role.
Over the past five months, leading the combined operations of Caregivers Alliance Limited (CAL) and Resilience Collective, I've witnessed at first hand how mental illness disrupts not only the lives of those living with it but equally, if not more, those of their caregivers as well.
Many people ask how my first 100 days have been, and I answer honestly: I've been on a listening journey, through conversations with my colleagues, events at CAL and discussions with psychiatrists.
For those living with mental illness and their caregivers, normality is robbed, days become chaotic, careers are halted or eventually given up, savings are depleted and familial ties broken.
Bolstering mental health takes a whole-of-community effort. This means not only supporting individual caregivers, but also building a broader ecosystem of care. The goal is to ensure every individual is connected and supported within their communities, encompassing family, schools, workplaces and social groups.
We need to help caregivers help their families
Mental health recovery extends beyond the clinic or hospital. It takes place in the community. Caregivers supporting loved ones with mental health conditions or neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD) should be equipped with the skills to navigate caregiving.
Kelvin, a caregiver to his wife and teenage son, who are both living with ADHD, used to find himself in stressful situations when one of them would trigger the other. Once, while he was driving, his wife screamed at their son, who remained very quiet. They later realised he was so affected that he had swallowed a piece of a plastic bag in the car – as harming himself was his way of coping.
Kelvin now has a better understanding of their condition after going through CAL's 12-week Caregivers-to-Caregivers Training Programme. Not only that, he is now also connected to other parents in similar situations.
Our training programme equips caregivers with knowledge about mental health conditions and teaches practical skills for coping and supporting loved ones. This is complemented by monthly support groups, for both caregivers and care recipients, which provide a safe space for them to share openly and build lasting peer support networks.
Many graduates report increased knowledge, emotional resilience, and the ability to navigate their mental health journeys with confidence.
We need to start caring for young minds
In our close work with IMH's case managers, we find that those struggling with mental health conditions are getting younger – a recent case of depression and vape abuse being a minor at 11 years old.
When youth get burdened with mental health conditions in crucial developmental years, it is even more difficult for them to progress and 'catch up' with their peers.
I met more than 100 first-year students entering the media, arts and design school of a polytechnic and recently discovered from an on-site poll done by CAL that one in four of them was willing to join a support group to help them manage their top five stressors: school, money, family, friends and relationships.
The polytechnic had invited us to meet the students, as part of its month-long mental wellness programme for new students.
The polytechnic students told CAL that most turn to informal support networks such as friends, partners, siblings and parents first when crisis strikes. Bolstering mental health needs to work holistically and is a whole-of-community effort.
Awareness needs to start now, and schools are another key community to start embracing this change. This is why we are going into secondary schools to give talks to raise awareness about mental health for youth.
We continue to partner universities, polytechnics and youth organisations such as the National Youth Council and *Scape, to provide psychoeducation and nurture peer support links early. We conduct mental health talks on topics relevant to students, such as eating disorders and body image. Furthermore, we also aim to 'train the trainer' through peer support training for the school's counsellors and student clubs.
We need to break silos, not just stigma, to collectively help burdened minds find light
Singapore's social service agencies today are still focused on their own areas of specialisation or intervention. Stigma around mental health still exists in Singapore. We need mental health players to band together for greater impact and to normalise mental illness.
One way is to adopt a continuum of care mindset when thinking of our collective clients. How can we journey with youth, families or caregivers through their life stages, pre-empting and preventing mental distress, building resilience for transition periods when they are more vulnerable?
This is why CAL is opening our doors to everyone – those who are well today and those who are in recovery – as we are prepared to connect those in need with other organisations that can help them with the right services.
Tim Oei is the chief executive of Caregivers Alliance Limited, which joined forces with Resilience Collective in January 2025. The new CAL's refreshed brand and mission – 'Mindfull Community' unveiled in CAL's 2024 Annual Report – will be introduced at its mass walk on July 26. Those who are interested to walk in solidarity for mental health and wellness can sign up at https://www.cal.org.sg/a-mindfull-walk
Join ST's WhatsApp Channel and get the latest news and must-reads.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Straits Times
7 hours ago
- Straits Times
Mental health in the age of AI
Apps may be able to assist in cognitive behavioural therapy, detect depression risk in the user's voice, and more, experts here say. SINGAPORE - It is generally a two-month wait to see a psychiatrist at the Institute of Mental Health (IMH) outpatient clinic. So, to help patients through the dry spell between sessions, the hospital is studying if they can use a locally developed AI-powered app that, among other things, provides guided meditation and is able to predict the user's stress level. Since May 2025, IMH has offered the AmDTx app, or a placebo app, to individuals referred by a GP or a polyclinic doctor to the institute, to participate in the trial. 'Coping skills such as deep breathing and sleep hygiene can help one manage stress, or even symptoms of anxiety and depression. They can learn these from the app and start the interventions first. This will hopefully reduce their distress while waiting to see the specialist,' said Dr Christopher Cheok, a senior consultant at IMH and director of national mindline 1771, Singapore's first helpline and text service for mental health. Dr Cheok said the long wait times in public mental healthcare are because of rising demand and limited manpower. IMH is also exploring the use of other apps to monitor and support the care of mental health conditions, including one approved by the United States Food and Drug Administration (FDA). In general, digital tools include AI-enabled chatbots, mobile apps, wearable devices, and web-based programmes. Apps may be able to assist in cognitive behavioural therapy, detect depression risk in the user's voice, and more, experts here say. Top stories Swipe. Select. Stay informed. Singapore Sewage shaft failure linked to sinkhole; PUB calling safety time-out on similar works islandwide Singapore Tanjong Katong Road sinkhole did not happen overnight: Experts Singapore Workers used nylon rope to rescue driver of car that fell into Tanjong Katong Road sinkhole Asia Singapore-only car washes will get business licences revoked, says Johor govt World Food airdropped into Gaza as Israel opens aid routes Sport Arsenal beat Newcastle in five-goal thriller to bring Singapore Festival of Football to a close Singapore Benchmark barrier: Six of her homeschooled kids had to retake the PSLE Asia S'porean trainee doctor in Melbourne arrested for allegedly filming colleagues in toilets since 2021 Some of these tools can be seen at an exhibition on digital mental health, organised by the Yeo Boon Khim Mind Science Centre and D.S. Lee Foundation Mind Art Experiential Lab (MAELab), which opened at the MAELab space in Alexandra Hospital on July 11. While the centre said it does not endorse any of the tools, they demonstrate the potential of digital and AI-powered technology in mental healthcare. Tech can help An app that is available from a healthcare provider, Rejoyn was the first prescription digital therapeutic for the treatment of major depressive disorder to be approved by the FDA, in 2024. The smartphone app, designed to be used alongside medication, delivers a programme of evidence-based brain-training exercises and therapeutic lessons to help adult patients manage their symptoms. Other tools shown at Maelab include an online assessment tool from local firm Neurowyzr, which screens for early cognitive changes, and a Voice AI tool from another Singapore-based firm, Wonder Technologies, that screens for depression risk. The latter will soon undergo testing over a year with participants recruited from institutions affiliated with the National University of Singapore and National University Healthcare System, said the firm's CEO, Ms Wendy Wu. A similar Voice AI tool to detect early signs of depression in older adults is being developed here under SoundKeepers, a three-year local programme announced in October 2024. Its researchers said that developing a native technology for Singapore facilitates compliance with national healthcare data protection standards. It was at the height of the Covid-19 pandemic in June 2020 that the MOH Office for Healthcare Transformation (MOHT) created as a digital mental health resource website, which now boasts an AI-enabled chatbot Wysa. Ms Janice Weng, deputy director of at MOHT, said digital solutions are useful for mental health self-help, and the office would like to pilot a form of self-directed psychotherapy that is being used at IMH in community and primary care settings. iCBT, internet-based Cognitive Behavioural Therapy, could enhance access to affordable mental health care in the community and help reduce unnecessary visits to the hospitals, she said. MOHT is starting to develop AI models analysing Singlish, multilingual texts, and emotional cues and nuances that Western tools may miss, she added. Another digital health platform that it co-developed with IMH uses data from fitness trackers and smartphones to help care teams tailor support and empower individuals with psychosis and mood disorders to manage their own mental health. It may be useful for predicting depression in youth. Digital phenotyping, which uses smartphone data to understand user behaviour, is emerging as a promising way to detect mental health issues. Researchers have found, for example, that shifts in heart rate variability or sleep patterns can signal anxiety or low mood before individuals are even aware of it. Dr Jill Murphy, the executive director of the APEC Digital Hub for Mental Health who was in Singapore recently, said she is particularly excited about how this technology could lead to more personalised care. 'Although more research is needed in this area, it has the potential to shift the focus from broad categories of mental illness like depression to a more patient-centred approach,' she said. Tailoring interventions and treatment plans to match a person's unique needs, values, culture and experiences could also increase engagement with digital tools, she added. Dr Murphy was a plenary speaker at the July 16-17 Singapore Mental Health Conference, addressing how to use digital technologies to promote equitable access to mental health promotion and care in the Apec region. Treading with caution A big problem with digital mental health tools, however, is the sheer number of options out there, the majority of which have not been proven to be effective. Adjunct Associate Professor Cornelia Chee, head and senior consultant at National University Hospital's psychological medicine department, said plenty of work remains to establish the effectiveness, safety, and ethical use of digital and AI-enabled tools in real-world clinical settings. She cautioned that these tools should complement, and not replace, the therapeutic relationship that remains central to mental healthcare. The Organisation for the Review of Care and Health Apps (Orcha), founded by clinicians from the United Kingdom's National Health Service, reviewed approximately 35,000 uses of digital health technology, and found just 20 per cent to be secure, cyber-safe, and clinically effective. Dr Cheok said a search shows that there are more than 10,000 mental health apps on Apple and Google Play Store. 'In general, I think because apps are not regulated, no one can vouch for the quality of the information contained in the app or the intervention that's within the app, and one thing the public may not be so aware of is how their data is being used,' he said. 'Therefore, whichever apps we choose to evaluate, they must have shown to be useful in other countries and have been subjected to research studies for efficacy and validation.' Dr Cheok said IMH picked the AmDTx app as it was shown to work overseas, and is now studying its effectiveness in the local population. The other test site for the trial, expected to end by the first quarter of 2026, is the Singapore General Hospital. For now, Dr Murphy advises checking app privacy policies, published scientific studies, and endorsements from reputable organisations when evaluating digital mental health tools. She said organisations like Orcha have established standards for reviewing apps. Orcha has also created a Mind App Library, where users can browse apps that meet the standards that it has identified, she said. Associate Professor John Wong, director of the Yeo Boon Khim Mind Science Centre, said that with more apps coming to market, individuals must learn to make informed choices. 'What you really want is not to tell people what to buy, what to use, but what is in the technology, what is it that you need? And then they can be informed users,' he said. IMH chief executive officer Daniel Fung said validated digital tools for the population will likely be accessible through in the future. MOHT's Ms Weng said programmes such as , iCBT, and peer-led platforms could in the future make mental healthcare widely and easily accessible. 'Singapore can pioneer a hybrid model – where AI handles scale and prevention, and limited manpower focuses on where the needs are best met with empathy and complex care,' she said. Tracking tiny shifts in our bodies that hint at mental strain An exhibition on digital mental health tools highlights some biomarker changes that precede mental health issues. It was launched by the Yeo Boon Khim Mind Science Centre at its MAELab space in Alexandra Hospital. 1. Depression and anxiety Biomarkers: Reduced heart rate variability (HRV), poor sleep quality, decreased activity levels. Insight: These changes often show days or weeks before someone reports feeling low or anxious. Wearables can detect the trend early, nudging users to seek help or adjust their lifestyles. 2. Burnout or chronic stress Biomarkers: Elevated resting heart rate, decreased HRV, poor sleep quality. Insight: These signs appear subtly – even before people feel stressed. Smartwatches can send alerts for persistent physiological stress. 3. Menstrual-related mood disorders Biomarkers: Changes in sleep patterns, increased body temperature and resting heart rate. Insight: Devices can track how your body responds across cycles and alert you to abnormal patterns, such as more severe mood changes. Know your biomarkers Heart rate variability HRV – the variation in time between each heartbeat – can indicate overall stress burden and recovery status. Reduced HRV has been observed in anxiety disorders, depression, and more. HRV is highly individual, as it is influenced by factors such as genetics, age and sex, so comparing it across individuals is often unhelpful. Longitudinal tracking of one's own HRV baseline offers more meaningful insights. While a higher HRV is generally considered better, there is no universal cut-off for what constitutes 'low HRV'. A sustained drop of 20 per cent to 30 per cent below an individual's norm over weeks or months may be more indicative of concern than a one-off low reading. Respiratory rate The number of breaths you take every minute reflects how your body is functioning, especially during rest or sleep. Changes in your respiratory rate – especially when you are asleep – can be early signs of not just issues such as infections, but also of stress or anxiety. It can also be due to overtraining or hormonal fluctuations. Body temperature Wearables can measure peripheral skin or wrist temperature (not core temperature). A rise in temperature from your baseline level can signal the early stages of infection or illness while a subtle rise can indicate ovulation due to hormonal changes. Look for repeated or sustained increases from your usual pattern. Also, a small elevation of 0.2 deg C to 0.5 deg C, for example, may not point to illness but, when combined with other symptoms, it might suggest your body is under stress. Sleep metrics Sleep, including its various stages, can be tracked by analysing metrics such as HRV, body temperature and more. They help to detect sleep patterns linked not just to physical issues – such as reduced deep sleep after overtraining – but also mental health issues, such as insomnia in depression or fragmented sleep in anxiety. A lack of sleep is associated with irritability, anxiety, and a higher risk of depression. Deep sleep regulates stress hormones while REM (rapid eye movement) sleep supports emotional processing. Activity metrics These include steps taken, calories burned, distance travelled and activity intensity. Physical activity triggers endorphins, dopamine, serotonin and norepinephrine, which are key regulators of mood, motivation, and stress resilience. Regular activity is linked to reduced stress, improved mood, better sleep, and lower rates of depression and anxiety. Tracking one's activity metrics can reinforce these positive behaviours.
Independent Singapore
2 days ago
- Independent Singapore
Experts link rise in suicides among Singaporeans in their 30s to job insecurity, family pressures, and mental health stress
SINGAPORE: Job insecurity, family pressures, and mental health struggles are among the reasons behind the rise in suicides among those in their 30s in Singapore, according to experts. New figures released on July 19 showed 75 individuals in their 30s died by suicide in 2024, up from 66 in the previous year. It was also the highest number recorded among all age groups, based on provisional data cited by Channel News Asia (CNA) . Principal clinical psychologist Dr Sharon Lu of the Institute of Mental Health (IMH) told CNA that those in their 30s—the sandwich generation—juggle building their careers, raising children, and caring for ageing parents, while also managing financial pressure. At the same time, they worry about job security, housing loans, and daily family expenses. 'The pressure to meet societal expectations and perceived life achievements can further compound these stresses and create social isolation,' she added. Dr Lu noted that suicide is rarely caused by one issue alone and is the result of biological, psychological, social, and cultural risk factors, along with a lack of resilience factors. See also Woman who threw her son from 9th storey flat jailed 5 years While many assume that depression is the cause of all suicides, Dr Lu said that 'someone who is not depressed can still be suicidal.' Psychiatrist and deputy medical director Dr David Teo of Connections MindHealth said many in their 30s start to question whether they've reached the goals they set in their 20s, and when those go unfulfilled, it can lead to 'a sense of failure or hopelessness.' He also pointed to the role of social media, which often fuels comparison and leaves people feeling left behind. SOS' senior manager and lead counsellor Chan May Peng also noted that those in their 30s are 'at crossroads'—questioning career choices, managing relationship commitments, and adjusting to caregiving roles, with some having little or no support. Dr Teo said having a strong social support system is important, while Dr Lu added that prioritising self-care, practicing self-compassion, and maintaining a clear work-life balance can help too. See also NTUC Study reveals Singaporeans fear becoming Sandwich Generation 'Sometimes, people may feel like they don't have enough time for self-care, but it is not something to be done only when it's convenient,' said Dr Lu. Regular exercise, getting enough sleep, meditation, and improving financial habits can all help. Ms Chan also suggested simple ways to reset mentally, like taking short walks in the park while listening to music, journaling, and shifting focus away from overwhelming thoughts, which can create space for emotional recovery and reduce mental load. Experts advised checking in, listening, and encouraging those showing signs of distress or talking about death. Mental health professionals pointed out that signs of stress may not always be obvious. Changes in sleep and appetite, physical fatigue, irritability, or anxiety could be warning signs. Ms Chua from SOS said asking someone directly if they've been thinking about suicide creates a safe space for someone to open up. Dr Teo added that you can also encourage them to seek professional help immediately and check in with them regularly to remind them they're not alone. Dr Lu said giving away personal items, pulling away from others, or changes in what they like or share on social media could be signs someone is at risk. Many who are suicidal already feel guilty or like a burden. What they need most, said Ms Chan, is someone who will listen without judgment, validate their pain, and encourage them to seek help. If you or someone you know is struggling, support is available through the National Mental Health Helpline (1771), the Samaritans of Singapore Hotline (1767), and the Singapore Association for Mental Health Helpline (1800 283 7019). /TISG Read also: Chinese company's 'unhappy leave' draws mixed reactions from netizens; one says it's just a way of 'protecting their loss margin'
Independent Singapore
4 days ago
- Independent Singapore
'At my wits' end': A sister's plea sheds light on undiagnosed ADHD in Singaporean kids
Singapore: In a heartfelt Reddit post on r/askSingapore, a concerned sister described her younger brother's growing struggle with schoolwork as he approaches Primary 6 — a make-or-break year for many students in Singapore's education system. 'All of my family is tired,' she wrote. 'He seems to have no motivation to do things better for himself… I'm open to any suggestions.' A silent struggle One of the top-rated comments asked a simple but powerful question: 'Have your parents got him assessed for ADHD?' For many Singaporeans, this would be a difficult suggestion to swallow. And for this family, it was no exception. The original poster explained that her parents were 'VERY VERY resistant' to exploring possible behavioral conditions unless a doctor or teacher explicitly recommended it. 'Because of their mindset,' she added. This experience isn't uncommon. In Singapore, stigma around mental health and neurodevelopmental conditions remains deeply entrenched. While awareness has grown in recent years, the belief that academic underperformance is purely a result of laziness, defiance, or parenting failure still lingers — especially among older generations. But ADHD — attention deficit/hyperactivity disorder — is neither a character flaw nor a result of poor discipline. It's a recognised, diagnosable neurological condition that affects millions of children globally and often continues into adulthood. And critically, it can be managed — and sometimes even turned into a major asset. See also Ajoomma is Singapore's pick for the Oscars 2023! What ADHD really looks like According to the Mayo Clinic, ADHD presents in two key clusters of symptoms: inattention , and/or hyperactivity/impulsivity . Inattentive traits may include frequently making careless mistakes, difficulty staying focused, avoidance of tasks that require sustained mental effort, forgetfulness and losing things. Meanwhile, hyperactive and impulsive children may fidget or squirm constantly, interrupt others, talk excessively, struggle with waiting turns or sitting still. However, not all children with ADHD fit a hyperactive stereotype . Some are dreamier, quieter — struggling internally with attention regulation, but dismissed as merely lazy or disinterested. And while every child zones out or fidgets occasionally, what differentiates ADHD is the persistence and intensity of these symptoms, especially when they disrupt life at home, school, or socially. A lens Many parents worry that a diagnosis might 'label' their child. But experts argue it can instead be a lens through which to understand them — one that opens doors, not closes them. Many experts say it's about knowing how they learn, how they think, and how we can meet them where they are. This user shared how their son — the same age — had benefited tremendously after early diagnosis and support from a proactive school. Why early intervention matters Left unaddressed, ADHD can spiral into low self-esteem, school refusal, strained family relationships, and even depression. But early diagnosis and intervention can make a world of difference. Treatment often includes psychoeducation (understanding ADHD and its impact), behavioral therapy, parent training, and in some cases, medication , such as stimulants, which help regulate focus and impulse control. While ADHD can't be 'cured,' children thrive with the right support — the same brain that jumps from idea to idea may also be the one that sees connections others miss. In fact, many experts now describe ADHD as a 'superpower in the right environment.' But it begins with awareness — and a willingness to listen not just to teachers or doctors, but also to the child. Getting help in Singapore For families in Singapore, there are both public and private pathways to ADHD assessment. Polyclinic referral : Parents can request a referral to a public hospital (such as KK Women's and Children's Hospital, National University Hospital or the Institute of Mental Health) by describing their child's symptoms to a general physician. This is usually subsidised. HealthHub direct booking : Through the HealthHub app, parents can also request appointments. Private clinics : These typically offer shorter waiting times but come at a higher cost. Neuropsychological assessments can range from $450 to over $4000, depending on the depth and provider. Reframing the narrative The sister's post ends on a tired but hopeful note: 'I'm open to any suggestions.' And in that openness lies the beginning of something better — not just for her brother, but for countless children in Singapore who are battling battles few can see. They are not broken. They are wired differently — and in the right light, that wiring can shine.
