• The mental health of students is in the spotlight following an alleged murder at River Valley High School which shook the nation
• The Covid-19 pandemic and reduced interactions in school have exacerbated perennial stress factors
• Some teachers and parents say they’ve noticed children becoming more subdued and withdrawn, and counsellors warn of a prolonged impact on students’ mental health
• Parents and students say that the stigma on mental health issues is slowly diminishing, but more can be done
• Students interviewed said they are quite open to seeking help, although some are unsure how their parents would react when they know about it

SINGAPORE — When Sam (not his real name) graduated from primary school and started classes in secondary school four years ago, he found it tough to make friends.

He was left out of groups, and his overtures to make friends were mocked for being “attention-seeking”. This was hard for him to comprehend as he was a popular student with many friends in his primary school.

The sadness and frustration started to build up within Sam — who declined to be named due to the sensitivity of the topic — and eventually came to a head in Secondary One, where he found himself being taunted again, after being accused by his classmate of defacing the artwork of another.

As they continued to pin the blame on him, Sam started to ask himself what he did to deserve this and why the classmate who accused him was so popular and had so many friends.

“(And) suddenly, I had violent thoughts in my head” recounted Sam. He then grabbed the nearest weapon he could find — a compass (mathematical measuring instrument) which had a sharp pointy end — to attempt to attack his accuser.

A classmate was able to stop him just in time, and Sam found himself sitting in his school counsellor’s office several days later.

This, he said, was the turning point for him. He was able to share his woes freely with the counsellor during their twice-weekly sessions which lasted for the whole of his Sec 1 year.

The counsellor also taught him how to think rationally and manage his reactions appropriately.

Now in Sec 4, Sam said his counselling sessions have left a lasting impression on him and he continues to apply the lessons he had learnt in his daily life.

The issue of mental health among school students in Singapore has been thrown into the spotlight following the tragic incident at River Valley High School recently, where a 13-year-old student was allegedly killed by a 16-year-old classmate.

Police investigations revealed that the older teenager — who has been charged with murder — had previously attempted suicide in 2019 and was a patient at the Institute of Mental Health (IMH).

In a ministerial statement on students’ mental health on Tuesday (July 27), Education Minister Chan Chun Sing said that Singapore must do all it can to help children “find their footing in an intense environment”.

He noted that young people here are learning to cope with the pressures of a competitive, high-performing environment and growing up with social media where comparisons are “incessant and unrelenting”.

“Our approach should not only be to strengthen the overall system of support, but to engender a much more caring, much more nurturing environment in our society,” the minister said.

Mr Chan also announced several new measures to boost mental well-being in schools, including the deployment of more teacher-counsellors, and getting teachers to receive enhanced professional development on mental health literacy.

Weighing in on the River Valley High incident as well, President Halimah Yacob said last week that parents, schools and society at large are “ill-equipped” to deal with young people facing mental health issues.

Looking back at his close shave with violence, Sam said that he did not confide in his parents as he was not close to them. He did not reach out to his teachers either, as they did not seem bothered by “classroom squabbles”.

“I felt so alone. This was the first time I had been in such a situation (of having difficulty making friends), so I didn’t know how to cope.

“Combined with the negative thoughts I had at that time, it was nothing short of a miracle that my situation didn’t worsen,” he said, adding that he has come a long way since then.

Apart from coping with perennial stressors of the educational system and growing up in the social-media age, students in the past 17 months and counting have had to deal with the fallout from the Covid-19 pandemic. And this presents a formidable challenge for some, said counsellors, teachers, parents and students interviewed. 

“We need to be vigilant because the current heightened measures (to curb the virus spread)  can cause a lot of anguish and mental pressure. The pandemic will greatly intensify underlying issues that people, and students, are facing,” said Mr John Shepherd Lim, the chief well-being officer of Singapore Counselling Centre.

While TODAY’s interviews found that parents and students are becoming more aware of mental well-being, counsellors said that one perennial problem remains: The stigma attached to children’s mental health issues, especially among parents.

COVID-19: A NEW PRESSURE POINT

Statistics provided by Mr Chan, in a written parliamentary response separate from his ministerial statement, showed that the incidence of suicide among young people aged 10 to 19 rose last year, compared with 2019, as part of an overall increase in people here taking their own lives during the pandemic. 

Mr Chan said that Covid-19 had aggravated existing stressors for students, such as academic-related difficulties, by disrupting students’ normal routines and creating a heightened sense of uncertainty.

Analysing the chats with primary school children through its Tinkle Friend helpline from April to July last year, Singapore Children’s Society found that children had experienced several challenges as a result of safe distancing measures and school closures.

These included a change in their relationship with parents who had to juggle work demands from home, and being unable to seek support from friends, teachers or school counsellors due to home-based learning (HBL). 

Counsellors, such as Ms Sophia Goh of Sofia Wellness Clinic, said they had seen a spike in the number of students turning to them for help during the pandemic, amid an already increasing trend over the past few years.

Likewise, Singapore Counselling Centre has also seen a spike in student cases since 2018. The period between June last year and June this year saw its biggest rise in cases in the last four years. However, the centre declined to provide actual numbers, citing confidentiality.

The problems faced by students include issues related to depression, anxiety, school stress and bullying. There are also increasing cases of students engaging in behaviours of self-harm such as cutting their wrists or punching walls, said Mr Lim.

Counsellors said that the restricted interactions with others due to Covid-19 safe distancing measures have exacerbated mental health issues faced by children here.

Nevertheless, the Ministry of Education (MOE) said in response to TODAY’s queries that the number of students who have seen or have been referred to their school counsellors for social, emotional or mental health issues has remained “largely stable” over the last few years.

Since the pandemic started early last year, students have gone through several periods of HBL, including during the circuit breaker from April to June last year.

HBL was also implemented in schools in May this year for over a week, when Phase 2 (Heightened Alert) restrictions were introduced amid a spike in community cases.

Currently, when Covid-19 cases surface in various schools, the affected schools would also impose temporary HBL for its students.

When students are on school premises, there are strict safe distancing measures to reduce interactions. These include requiring them to sit in separate individual tables instead of in groups, and encouraging them to remain at the same table during recess to reduce intermingling with other students.

Dr Ong Say How, chief of the department of developmental psychiatry at IMH, agreed that Covid-19 has exacerbated mental health issues faced by students here.

He said that when HBL was first implemented last year, students might have felt increasingly isolated from peers and the supportive environment of school, leading to aggravation of their mood and anxiety symptoms.

“Uncertainty about the future and sense of helplessness about the pandemic situation could further exacerbate their psychological and emotional symptoms,” added Dr Ong, who is also a senior consultant at IMH.

Ms Goh from Sofia Wellness Clinic said that the shift to HBL has made it harder for students to keep up academically, heaping added pressure on them.

With social interactions key to helping students build resilience, reduced opportunities to interact with peers could lead to more students feeling stressed, said Mr Gary Koh, a former school counsellor and family life educator.

The problems faced by students amid an unprecedented pandemic are on top of perennial issues, such as the pressures of the educational system and growing up with social media, said counsellors.

They noted that the benchmark to succeed for youth nowadays had changed from that of previous generations.

Apart from the need to prove themselves academically, young people these days have to be active participants in co-curricular activities (CCAs) and take on leadership positions in schools to stand out among their peers, said Ms Goh.

Mr Lim said that even though teachers may heap praises on students who perform well academically, there could be a “deep void” in them as they feel that their lives are only centred around studying.

Jane (not her real name) is one of those students who find academic stress and keeping up with peers taking a toll on their mental health.

The first-year student at a junior college (JC), said that she had difficulty coping with a new academic environment.

The longer school hours, coupled with additional hours for after-school activities, mean that the 17-year-old would reach home as late as 9pm.

“For someone like me who is struggling with time management, trying to complete homework in a tired physical and mental state after a long day, this often results in my productivity levels dropping and having to pull all-nighters to get work done,” she said.

She declined to be named as she did not want to worry her family members.

Apart from the elevated pressures of the educational system, youths are also growing up with social media. This has increased the pressure of social comparison where young people measure themselves against others, said counsellors.

“You want to see how well we are doing with respect to other people, but with social media, the comparison is taken to another level where you can compare yourself with anybody else in the world,” said Ms Goh.

IMPACT OF REDUCED SOCIAL INTERACTIONS

While parents interviewed by TODAY said they have noticed that their children’s social interactions have been affected by Covid-19 curbs, they are divided on whether this would be detrimental to their children in the long run.

Ms Joey Lim, a 37-year-old special needs educator with two sons in primary school, said that while Covid-19 could impact her children’s socialisation skills, she believes they are “healthy enough” and will “have their own way of balancing (the stress)”.

Other parents, however, believe that the reduced peer interaction in schools could have a long-term impact on the mental health of their children.

Mdm Chan, who declined to provide her full name, said that her eight-year-old son, who is in Pri 2, felt lonely in school and did not feel close to his friends or teachers.

The 44-year-old stay-home mother worried that this will reduce his ability to trust and feel secure in an unfamiliar environment as he grows older.

Likewise, Ms Sharanjit Kaur’s 11-year-old eldest daughter, who is in Pri 5, had told her that school now felt “boring” due to the restrictions and the lack of group activities.

Ms Sharanjit, a 39-year-old stay-home mother, said that this could have an impact on her daughter’s social skills in the long run and potentially affect her mental wellness.

Outside of school, the general change in routine for families has also placed a strain on parents’ relationships with their children.

Mr Maran Gopala Krishnan, 49, said that although he has been working from home during the pandemic, his work hours have gotten longer. He thus could not spend as much time with his children at home as he used to.

Mr Maran said he was concerned that this could have a long-term impact on the mental well-being of his children, who are both in primary school. To address this, he makes it a point to set aside time during the weekends for them.

Students whom TODAY spoke to had mixed views on whether Covid-19 has affected their mental health.

Sam, the Sec 4 student, said that he is unaffected by the restrictions from Covid-19 and still interacts with his friends as he normally does.

Jane, the JC student, however, felt that her limited interaction with friends in school due to safe distancing measures has made it harder to build a strong friend support group, which she deemed as “pretty crucial to get through the rigours of JC years”.

Ms Goh said that social restrictions due to the pandemic can affect teenagers’ sense of belonging to a social group which, in turn, lowers their self-esteem.

“There’s also less social support as a buffer when a teen goes through different stressors. These all increase the risk factors for mental health issues,” said the counsellor.

LOOKING OUT FOR STUDENTS IN SCHOOL

In his ministerial statement, Mr Chan acknowledged that Covid-19 had disrupted the social and support networks faced by young people, leading to periods of anxiety and loneliness for many.

To strengthen the mental health support system for students here, he said that the number of teacher-counsellors in school will be increased by more than 1,000 over the next few years — up from over 700 currently, while more school counsellors will also be recruited.

Unlike school counsellors who specialise in providing counselling support, teacher-counsellors are teachers who receive additional training to help students with more challenging social-emotional problems.

CCAs will also resume for secondary schools and pre-universities within the next few weeks while the scope of major national examinations will be reduced to alleviate stress on students.

Speaking to TODAY, several teachers said they have observed different reactions from their students as they adapt to a “new normal”.

While some felt that social interactions among students have been reduced, which could pose a problem in the long term, others said that their students have adjusted well.

The teachers interviewed spoke on condition of anonymity as they were not authorised by MOE to speak to the media.

A primary school teacher noticed that some of her students have become less participative in class discussions after they were made to sit individually, instead of in pairs or groups.

The teacher, who teaches Pri 1 and Pri 5 pupils, said that the students’ confidence could have been affected as they no longer have someone familiar sitting next to them.

Another secondary school teacher said he had noticed students becoming more “subdued and withdrawn”.

“Sometimes they are asked to share their opinions and you need them to repeat because they are wearing masks, but they get annoyed and self-conscious,” he said.

Still, another primary school teacher said that students are “quite resilient” but acknowledged that these are unprecedented times and he could be proven wrong in the long term.

Some teachers, as well as parents and counsellors, however, were doubtful whether educators themselves have the ability to monitor students for mental health-related issues.

Said the teacher who teaches Pri 1 and Pri 5 students: “It’s a known fact that most of us teachers are not well-versed in mental-health related issues. We have never attended courses and lessons about mental health, and we are not in that line (of job). So in terms of noticing, observing… signs in relation to mental health, we’re not able to.”

A SHARED RESPONSIBILITY 

While several measures related to students’ mental well-being are already in place, such as peer support systems in schools to encourage students to look out for one another, some parents said much more needs to be done to support their children’s mental health.

Ms Doreen Kho, a stay-home mother whose three children attend counselling sessions, said that some teachers still have a dismissive attitude towards mental health.

Recounting an incident when her eldest daughter — who is now 14 — was first enrolled in Sec 1, Ms Kho, 47, said that the teacher had immediately assumed that her daughter did not require counselling even before consulting her.

Ms Kho, whose younger children are in Pri 4 and Pri 2, said that while teachers may be able to pick up external symptoms of mental wellness such as sleeping in class or failing to do their homework, mental illness is “something more that meets the eye”.

Her oldest son, Evan, committed suicide in 2017 after suffering from depression at the age of 11. Her younger children are undergoing counselling for post-traumatic stress disorder and to help them cope better emotionally.

Other parents and counsellors felt that there is too much burden placed on teachers who also have to juggle school and administrative work.

Mr Maran, who is the director of marketing and communications at a food-and-beverage company, said that looking out for mental health issues in children should be a “shared responsibility” between parents and teachers.

While parents should monitor their children at home, teachers should alert parents to changes in their students’ behaviour.

With reduced interactions between students likely to continue for quite some time, Mr Lim of Singapore Counselling Centre suggested that up to eight counsellors should be deployed to schools, up from the current maximum of two. On top of resuming CCAs, Mr Koh, the former school counsellor, said that teachers can incorporate “more fun” activities in class.

MORE AWARENESS, BUT STIGMA PERSISTS

While Mr Chan has called for a “whole of society effort” to avoid another school tragedy, some counsellors noted that many people still attach a stigma to mental health issues, and consequently to students attending counselling sessions.

This is despite increasing public awareness of mental health problems and a greater willingness by parents and students to seek help when needed.

Ms Goh, the counsellor, said that one of the first questions which parents ask, before sending their children for counselling, is whether there will be a record which could affect their school and career opportunities.

To reduce the stigma among students, Mr Lim said that they must be convinced that seeing a counsellor is not a form of punishment but an opportunity for them to receive care and speak openly about their troubles.

Students interviewed said they are quite open to seeking help, although some are unsure how their parents would react when they know about it.

For Sam, he said he did not feel any stigma in visiting his school counsellor. He noted that it was also common for his schoolmates to visit the counsellor, while his parents also did not express any surprise when he informed them about his counselling sessions.

Similarly, Nura (not her real name), a first-year junior college student, said that as her school promotes counselling, she was not too hesitant to visit a counsellor to seek help for academic stress in early July.

Rather, it was worries that her concerns were not severe enough to warrant counselling that had initially held the 17-year-old back.

Jane, the other JC student who spoke to TODAY, said that while her father has been “chill” about her plans to see a school counsellor, she is “a bit more scared” to inform her mother who is the stricter parent.

“I don’t think my mum would have reacted the same as my dad…I don’t think it will be well-received if I told her directly,” said Jane.

While some parents said they would allow their children to get counselling if required, they would not publicise it to protect the young ones from being judged by others.

Mr Maran, for example, said that if his children need to go for counselling, he would not let others know about it, apart from their teachers and family.

Several parents, counsellors and students suggested implementing mandatory and regular counselling sessions for all children in school — akin to visits to the school dentist — to normalise such sessions and reduce the stigma.

For Sam, that first visit with his counsellor four years ago has turned his life around.

“I feel like I have come a long way since then,” he said.

“Because I was able to overcome that struggle, I feel fortunate to have escaped. I’m now doing much better than before, and I have many friends from all classes, and good grades to back it up.”