Our young people spend a large part of the day in school with their teachers and classmates. It follows then that the school environment shaping their character, values, attitudes and mental capacities becomes critical as they discover their identity, abilities and potential. While we know that the education system here is one of the best academically in the world, we also know that the rigours of the system bring on demands from within and outside the campus.
Mental health is the foundation for our physical bodies and without support for mental health, we will be disadvantaged in dealing with any challenges. We believe therefore that mental health must be made a priority in our school system alongside academic and physical health, and leaders must have the political will and the courage to include mental health programmes from a very young age, looking closely at prevention and interventions strategies within our schooling system. We share our observations and concerns.
"Over the past three years, the number of children aged 7 to 18 years old admitted into public hospitals for mental health conditions was approximately 569 in 2016, 640 in 2017 and 607 in 2018.... Based on records from the Ministry of Home Affairs, from 2017 to 2019, an average of 1,204 cases of attempted suicide was reported each year."
~ Mr Gan Kim Yong, Minister for Health
Parliamentary Question, 3 Mar 2020
Mental Health Programmes
Having an effective mental health programme in schools is one of the more important preventive strategies employed by countries around the world, some with admirable success. The Ministry of Education's announcement early this year for a Mental Health Programme to be introduced by 2021 drew much praise. This came on the backs of much debate in parliament by several MPs and concerned citizens. We are hopeful that this news will be realised with strong leadership and strict enforcement which will trickle to the ground and into classrooms. MOE's Mental wellness and peer support programmes cannot be delivered to students in isolation . Stronger partnerships with parents and community counselling groups must also be part of the solution. We can learn from many countries with mature and wholistic education systems.
Why Mental Health Should be Taught in Schools?
(adapted from Brainforest resources)
Suicide is the 2nd leading cause of death for ages 15-29 according to WHO. These are critical years even in Singapore (see Suicide Data).
Many mental health conditions start during adolescence when the young person is grappling with many changes in their lives - puberty, academic milestones, sexual maturity and moral choices.
Students learn about physical and nutritional health, but not about mental health specifically. There is little priority paid to psychological and emotional development.
There is an increased pressure in society resulting from information overload, more freedom to choose at an earlier stage in life when young people are less mature and less prepared to make choices.
Most of student’s stress and anxiety come from school and the individuals there. Pressures from schools to perform, parental expectations and self expectations all converge upon the young person.
Learn from Others
Drawing upon the well-oiled Mental Health programmes in schools around the developed nations, there is much we can learn and adapt from. Among those lauded for their mental health support is Finland where their school system includes social and health care teams within the school, including an anti-bullying programme called KiVa.
Finnish schools have had a long history of healthcare in schools dating back to 1900s when doctors were first connected to the school system. Their strong framework is founded on the ideal to build students' mental and social health, in addition to academic success. They recognise that having dedicated health and welfare teams in schools will protect their children and optimise their mental capacity and health. These are legislated in Parliament with strict protocols in place involving parents and children in crisis.
Other countries like England have had studies on integrating education and health under a social care committee. They have also considered incentivising schools to designate a mental health leader within their staff. Canada offers their teens mental health guide free online and encourages institutions of learning to adopt and adapt their document for their own needs.
Resources on stress management, resilience and suicide awareness relevant to school leaders and students.
Leadership & Partnerships
"The principal of the school allowed my daughter to slowly reintegrate into the class and allowed her special leave of absence or late arrivals as she understood how Elisabeth needed time to adjust to her challenges."
- Liping Pauwels
School Principals must lead a with compassion and practice mental health support on the ground. They must be advocates of good mental health which must permeate through the corridors of the campus. They have the bird's eye view on all that happens with the school and beyond. Moreover they have the influence and responsibility to care for both teachers as well as students, and have an added obligation to parents and other stakeholders.
We believe that the school leadership should make mental health a priority in their schools and recognise that the health and safety of the children under their care is paramount, even above academic rankings. The elite schools are often spotlighted to have high stress levels and in one report it was alleged that four students from such schools had succumbed to self-harm under the weight of various pressure. (Full editorial: More teens in Singapore seeking help from IMH, ST 11 Apr 2019)
Extracting wisdom from an article in Education Week (USA), having a compulsory screening process for mental health for all students at all levels at least once a year is important to remove the stigma of having to see a counsellor at all. This triage system is important to arresting mental health issues before they metastasize into more severe issues.
In addition, principals need also to have oversight on teachers who are their frontline of support for students. "Happy teachers leads to happy students" (NST 28 Jan 2019)
Partnerships with parents, families and the community must play an intrinsic part of the prevention and intervention programmes for mental illness. While we are mindful of the extensive SEL programmes and materials produced by MOE, some children may still fall through the cracks. How can we build better and more effective and sustainable partnerships to support our young in schools and at home? Building Resilience is often quoted as an effective tool to have under our belts. And this must be coupled with other strategies in the system.
A network of support involving Voluntary Welfare Organisations (VWOs) is in place to provide community and clinical support to at-risk children.
The REACH team collaborates with school counsellors/VWOs to provide suitable school-based interventions to help these students.
The support network may be in place but the leadership in schools is vital to ensuring that the delivery is effective and children get the best care possible in schools.
Counselling in schools is an important part of the strategy on supporting young people in their formative years, especially when they face insurmountable challenges and pressures. Studies show that effective school counselling measures will predispose students to better academic achievements. In addition Counselors were found to be effective in delivering bullying interventions in classrooms. Equally important are the roles of teachers as first-responders to mental illness signs in class. How are teachers prepared for these challenges and do classroom management techniques taught in National Institute of Education adequate to arm our teachers?
“Our vision is for every student to be a peer supporter, forming a strong network of support in their class, CCA (co-curricular activity) or peer group, where they can look out for each other and seek guidance from teachers or counsellors where necessary,”
~ Ms Indranee Rajah, 2nd Minister for Education.
If counsellors and teachers are to be the go-to persons for the students, it is important to raise the quality of first-line help. Quality in terms of improving the student:counsellor ratio close to 250:1 as recommended by the American School Counsellor Association for more effective attention to student's needs. We do not know the student:counsellor ratio in Singapore, but we observe about 2 counsellors per schools on average. Where student:teacher ratios are concerned, there is no concensus on the ideal number as reported by the OECD review. It is believed nonetheless that smaller class sizes favour students who are younger and also those who are in some way disadvantaged. The optimum size depends on age and other circumstances like socio demographics. In Singapore we note that student :teacher ratio was reported to be 11.6:1 in Secondary schools in 2018 according to Statistica. These are good by international standards reported in many countries. Favourable ratio ensures more effective delivery of care and optimises counsellor and teacher workloads, which translates to healthier environments for learning and growth.
We are also aware that there is a healthy relationship between schools and the IMH with seamless services for students suffering from acute depression and mental illness. We believe that much is being done to support students who need specialised care in hospitals and this is further discussed under "HEALTHCARE" section.
Peer support systems are effective intervention tools to empower friends to help those at risk of suicidal behaviour. The National Youth Council has also reported that many youths seek out peers for support in mental health. We observe that ground up initiatives like CampusPsy (which focuses on IHLs - Institutes of Higher Learning) have introduced training programmes to educate youths mental health literacy and skills to identify early signs and symptoms of mental health issues among peers. These measures which aim to mitigate downstream depression and anxiety may bode well to prevent suicidal behaviour.
However some suicide-bereaved parents have said that their children had themselves been confidants to their friends, talking them out of self-harm but themselves succumbing to suicide when the weight of their silent struggles on top of their friends' problems become insurmountable. So not every child can be a good peer supporter and attention must be paid to those who may not have a healthy emotional core. Some oversight on the mental health of peer supporters must be heeded.