Experts say it takes a village to normalise conversation on mental health issues and improve youths' access to mental health support.
According to the World Health Organisation (WHO), one in seven or 14% of young people aged 10-19 years’ experience mental health conditions, which are largely untreated.
Globally, mental disorders account for a significant portion of disease burden in youths, but unfortunately these disorders are not detected until much later in life. Studies have found that the incidence of mental disorders peak during adolescence. Up to one in five people experience clinically relevant mental health problems before the age of 25, with 50% of them being symptomatic by the age of 14.
“Stress during adolescence can be exacerbated by exposure to adversity, peer pressure, exploration of identity, digital and social media influence, gender norms, and global events such as climate change, economic downturns and pandemics. Youths from ethnic minorities, low socioeconomic households, violent and/or abusive homes are at an increased risk of mental health issues,” says Dr Priyanka Rajendram, Assistant Director of Integrated Health Promotion, Ministry of Health (MOH) Office for Healthcare Transformation.
A period of intense growth and upheaval
Adolescence is a period of intense physical, biological, social and emotional change. The hormones produced by adolescent brains, including the adrenal stress hormones, and sex and growth hormones, influence brain development.
Research also shows the human brain is reshaped at the onset of puberty, and its circuitry does not fully mature until the early 20s. Among the last connections to be established are those that are critical for emotional regulation, judgement, and problem-solving which impact almost everything adolescents do, such as how they respond to addictive substances, social pressure, and tendency to engage in risk-taking behaviour.
“Every child’s emotional development is different, and is shaped by his or her unique combination of genes, brain development, environment, experiences with family and friends, and community and culture. All these changes are happening in a time of contradictions; adolescents are seeking a sense of identity and demonstrating a need for independence, while needing validation from their peers. While they feel emotions intensely, their rational-thinking capabilities are not yet fully developed, which makes them particularly sensitive to the judgement of people in their close circle of influence: parents, teachers, peers and siblings,” explains Dr Priyanka.
Is social media the cause?
Unlike previous generations, Generation Z have been born into a digital world where digital technology and social media is an inextricable part of daily life. Their sense of identity and purpose is often closely intertwined with what they consume online.
Studies show almost 92% of teens from the ages of 13 to 17 are online regularly, and 75% of them have internet access on their digital mobile phones. Most teens are said to spend at least nine hours a day on digital media, with about 24% saying they love to remain online all day long.
Several studies show that teenagers and young adults who spend the most time on Instagram, Facebook and other digital platforms were shown to have a substantially higher rate of reported depression (from 13 to 66%), compared to those who spent the least amount of time. However, this does not mean social media actually causes depression, although the two are correlated.
"Digital media is a truly complex environment; a double-edged sword. It can serve as an amazing, positive medium for young people to connect with each other and the world, and develop skills. For example, online communities can provide marginalised groups such as the LGBTQ+ people a space where they feel socially accepted and validated, which is supportive of mental health,” says Professor Susan Sawyer, Director of Centre of Adolescent Health at the Royal Children’s Hospital and Professor of Adolescent Health at the University of Melbourne.
“On the other hand, there are also issues that develop as a result of overuse of social or digital media such as loss of sleep, lack of physical activity and its impact on obesity, social comparison and feelings of inadequacy, poor academic performance, cyber-bullying and social exclusion, access to pornography, and so on.”
Dr Priyanka adds, “Social media is not like rat poison which affects everyone equally. It is more akin to alcohol; mildly addictive, and for some young people, can lead to dependency and mood disorders.”
Barriers to reaching out for help
Despite increasing conversations surrounding mental health and mental illness since the pandemic, the stigma surrounding mental illness is very deep-rooted, and remains a formidable barrier for youths seeking help for their mental health, particularly in Asia.
There are three main types of stigma when it comes to mental illness. They are self-stigma, which is the negative attitude and internalised shame people with mental illness have about their own condition, and public stigma, which is largely based on societal norms, beliefs and mindsets, such as the notion of ‘loss of face’, a strong feature of Asian cultures. There is also systemic or institutionalised stigma, such as the lack of access to professional help, which acts as an additional barrier for marginalised or at-risk youth.
A 2017 study on mental health stigma among Singapore’s youth revealed approximately 44.5% of respondents associated mental illness with negative and derogatory terms such as 'stupid', 'dangerous', 'crazy' and 'weird'; while a further 46.2% of them said they would feel 'very embarrassed' if they were diagnosed with a mental illness.
“There are also many structural issues, including cost of mental health services, as well as long wait times before one can access help, which prevent many young people from seeking help through these channels,” shares Dr Sharon Sung, Assistant Professor and Senior Clinical Psychologist with the Signature Programme and Health Services and Systems Research, Duke-NUS Medical School.
Parents, families play a crucial role
Parents and elder members of the family play a significant role in influencing how youths frame or perceive mental illness and mental health.
Data from the Singapore Human Resilience Scale developed by the National University of Singapore (NUS) revealed adolescents became less resilient with age, especially those between 14 and 16 years old.
“It was found not only were adolescents particularly vulnerable during this period, but certain factors appear to have the greatest impact in shaping their mental resilience and well-being. Positive self-image and building relationships were found to be two of the most protective factors against an individual’s attempts at self-harm or suicidal ideation, differentiating those who are more resilient versus less resilient,” shares Dr Priyanka.
“The home environment and relationship between a child and his or her primary caregivers also significantly impact the way he or she responds to challenges in life. The embarrassment, shame, and prejudice associated with mental illness by adults in the family and close social circles can prevent youths who are suffering from mental illness from reaching out for help,” she adds.
Normalising conversations around mental health
The good news is that for most adolescents and youth, mental health distress is episodic and not permanent. Experts agree that with the right person-centric support, most youth can successfully navigate the challenges that come from experiencing a mental health disorder.
“A support system addressing the various concerns of the patient according to the degree of severity of the issues and their impact on everyday life is necessary, so we can deliver more personalised support and intervention to every child and youth. In most cases medical intervention is not required. Youths with anxiety and mood disorders tend to benefit tremendously from peer support as the first layer of intervention and are more likely to seek out support from someone in their immediate circle than a healthcare professional,” elaborates Dr Sung.
“It is important to provide a range of treatment approaches or interventions to address the spectrum of mental health illnesses, including peer support and counselling at schools, community, tertiary institutions and workplaces with young, entry-level employees and beyond,” she adds.
Dr Priyanka asserts, “Instead of focusing on destigmatising mental health, which implies an act of undoing something that already exists, which is always more difficult, let us shift our focus to normalising conversations surrounding mental health and well-being, which implies an act of creation that is more positive and hopeful."
“Concerted effort in this direction by all the stakeholders towards a culture of open conversation around mental well-being and acceptance of mental health conditions can go a long way. Starting from the immediate family, community, schools, and workplaces, we can influence knowledge, attitudes, and practices that aim to shift cultural and social norms surrounding mental health and well-being.”
The first step in building a more resilient society is opening ourselves up to accept that the process will be an uncomfortable one; but one which we must endure, as there can be no growth without discomfort.
Article is written by Bridges M&C Account Director Hyma Haridas.
The speakers featured in this article were featured in the Temasek Shophouse Conversations entitled ‘Youth Mental Health: Opportunities and Challenges in a Digital World’ which was organised by Temasek Foundation to encourage conversations on mental health among the youth and explore ways to improve support and access for communities at risk through innovative solutions.