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RCPsych responds to BBC Panorama programme on antidepressants

19 June 2023

Following the broadcast of Panorama’s ‘The Antidepressant Story’, the Royal College of Psychiatrists has issued the following response: 


“Depression is a serious and potentially life-threatening condition that is treatable, usually involving a combination of self-help, psychological therapies and medications. 


“Treatment options will depend on a patient’s type of depression, how long it has lasted, and whether they have experienced depression in the past.  


“Antidepressants are a clinically recommended treatment, and they are effective at reducing the symptoms of moderate to severe depression, particularly when used in combination with talking therapies. Patients should discuss their treatment options with a qualified practitioner, including their benefits, risks and side effects, to ensure there is informed consent.  


“Medicine continuously evolves, as does our knowledge of treating mental illness, as a result, the College updates its guidance, and ensures it is made accessible to healthcare professionals, stakeholders and partners with lived experience, when new evidence comes to light. Over the last 30 years our understanding of how different types of antidepressants work and the variation in side effects has grown considerably.  

“We know that on average, most patients will benefit from the use of antidepressants, but some do report mixed or negative experiences. This is why their use should be carefully monitored and regularly reviewed. This is particularly important when stopping antidepressants. Antidepressants usually need to be taken for at least six months after your symptoms have gone away. 


“Long-term use of antidepressants should only be considered for people that have recurrent depression and repeated, severe relapses after stopping antidepressants. For those patients, the beneficial effects of continuous use of antidepressants are more likely to balance the potential risks. However, this should be reviewed regularly, and multiple attempts should be made to stop taking these medications after prolonged periods of established wellbeing.


“Most people will be able to stop taking antidepressants without significant difficulty by reducing the dose (known as ‘tapering’) over a few weeks or months. Some people can experience withdrawal symptoms that last longer and may be more severe, particularly when the medication is stopped suddenly.  


“As the body of evidence of withdrawal symptoms has improved, the College has pushed for changes to clinical guidance, to have a greater focus on safely managing withdrawal. This has increasingly been reflected in NICE guidance over the last few years. We also published a patient resource in 2020 to help support people to have discussions with their doctor when they are thinking about stopping antidepressants. We believe this was the first of its kind published by a professional medical organisation. 


“Ultimately, the use of antidepressants, should always be a shared decision between a patient and their doctor based on clinical need and the preferences of the patient. 

“We would advise all those thinking of stopping their antidepressants to talk to their doctor first, as these medications should not be stopped abruptly.” 


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Nobody I’ve been locked up with in a psychiatric hospital felt ‘proud’ of their illness

Eleanor de Jong

It’s great mental health is now openly discussed but the sickest people I’ve known – myself included – have had almost no part in it


Sun 18 Jun 2023 16.00 BST

In the 12 years since I was diagnosed as manic depressive – now commonly referred to as bipolar type one – mental illness has come roaring out of the woods.


Now it’s hard to get through a month without a mental health awareness campaign rearing its well-meaning head.

In 2013 I was advised by psychiatrists to withhold my diagnosis from employers and be judicious with everyone else, as understanding of mental illness was limited in the public sphere and highly stigmatised.

This was, at the time, absolutely the right advice.

‘I couldn’t outrun my trauma’: nobody talks about parenting with complex PTSD

But in the last decade I have noticed a shift in how openly mental health is discussed; how many people are willing to claim psychiatric disorders as their own or armchair-diagnose those around them.


But the sickest people I’ve ever known – myself included – have had almost no part in this opening up, as if we’re suffering from a different condition altogether.


Nobody I’ve ever been locked up with in a psychiatric hospital felt accepting or “proud” of their illnesses. We were never asked to take part in a mental health awareness campaign, though once, as a special treat, we were taken to an isolated, deserted beach and allowed to run free for half an hour.

It was so glorious.


Using psychiatric terms to describe common human experiences is simply not truthful

We certainly never called our illnesses or symptoms “superpowers”. If we had, no doubt our anti-psychotics would have been increased or our courtyard privileges quashed.


The pointy end of mental illness is not photogenic or particularly quotable. It’s desperate and it’s sad, and all people want is to get off the ward and live a normal life. So I find it hard to understand how that level of illness has become entwined with mindfulness, mental-health days and self-care.

What I sometimes see now is normal emotional pain and hardship – grief, heartbreak, stress – becoming medicalised. I also hear the widespread adoption of psychiatric terminology to describe common adverse human experiences.


This is concerning as it trivialises the experiences of those battling severe mental disorders and misrepresents how debilitating these illnesses are.

It’s a climate where sadness can be described as “depression”, stress or nerves as “anxiety” and poor decision-making, overspending or excitement as “mania”.

I like truth, especially in language. And using psychiatric terms to describe common human experiences is simply not truthful.


As a western culture we’ve become more accepting of mood variation, burnout and “a touch of OCD”. This is palatable to us and our sympathies.

But god forbid if you see or hear or smell or feel things that aren’t there.

Research published by Cambridge University Press last year found that discrimination and stigma against those living with schizophrenia actually increased over a 30-year-period, with fewer people wanting to live with or have a co-worker with this diagnosis than in 1990. Other studies from around the globe have found plateaux or increases in stigma against those with severe mental illnesses, especially illnesses with psychotic features.


In Losing Our Minds, the UK psychologist Lucy Foulkes writes that mental health awareness among the general population has gone from “famine to feast” within a decade, and she is concerned that the quality of knowledge people are receiving about true mental illness is poor or simply wrong.


“Everything we might think of as a ‘symptom’ of mental disorder – worry, low mood, binge-eating, delusions – actually exists on a continuum throughout the population,” she writes. “The thoughts, feelings and behaviours that appear temporarily as a natural response to hardship and stress – like when we’re heartbroken – exactly mimic those that, should they persist, are defining features of mental disorders.”

“Bipolar”, my own diagnosis, is a word that has well and truly entered the general fray.

As a writer I am no doubt more sensitive to language misuse than most but I feel deeply uncomfortable when the word “bipolar” is used so offhandly, usually to indicate indecision, whimsy or whiplash moods. (Katy Perry, I’m looking at you.)


Bipolar is an extremely destructive disease and, when people with moody personalities or unruly personal lives claim it as their own, the meaning and pain behind this diagnosis slowly erodes.


Manic depression is not a phase, or an off month or even a susceptibility to mood instability. It’s lifelong, incurable and the best you can hope for is managing your symptoms and keeping the space between episodes as long as possible.


The majority of people with severe bipolar do not lead glamorous, highly creative lives and it’s certainly not a synonym for “interesting”. Indeed, many if not most sufferers are plagued by patchy employment records, high divorce rates, substance misuse and an expected lifespan of eight to 12 years lower than the general population.

So it’s really no small thing to start describing yourself, or someone else, as “so bipolar”.


But in the current culture, which I view as a kind of frantic over-awareness, I sometimes fall into the trap myself.

After multiple hospitalisations and more than a decade of sustained psychiatric intervention, I monitor myself constantly for mania, hypomania, psychosis and depression.

I’d pay every single dollar in my bank account to not have bipolar
Some of this is sensible and falls within the bounds of “psycho-education”, a key part of understanding your illness and learning to check for warning signs of an episode brewing.


But some of it is hypervigilance – medicalising myself.


Earlier in the year my mood was low for months after a home invasion and the sudden death of a family friend. Every day I wondered – am I becoming depressed again?


Depression for me means hallucinating that glinting daggers are projected on to the sides of buildings and billboards, and pressing into my skin. I will continually check my pulse because I become convinced that I have died and no one has noticed, and now goblins are growing in my rotting chest cavity and trying to crawl out of my mouth.


Then, a voice will start whispering macabre instructions. It’s a thing of terror, to be avoided at all costs.

I told my psychiatrist how I was feeling. She probed a little, aware I’d had a rough start to the year. “How are you sleeping?” Fairly OK, considering. “How are you eating?” Heartily! I said.

And I am still enjoying things, I volunteered, chattily. My baby is so funny. I like watching the news with a glass of red. I’ve read all of Claire Keegan and I’ve been taking the dogs out on the salt marsh at sunset.

She didn’t have to say much after that because I’d answered the question for myself; not depressed. Experiencing a hard patch? Sure. Sick? Not this time.

Others have described a formal diagnosis as a relief but I never felt that way. Bipolar did, and continues to, feel like a life sentence. In terms of the adverse life experiences behind and ahead of me – it is.


So it’s heartening to have a diagnosis and also just be sad sometimes, like everyone else. To treat yourself gently, to know it will pass. Because it’s tedious how genuinely serious complex mental health problems are. You can’t laugh off or underplay psychosis and suicidal ideation. And it’s hard to minimise the padded room, the padded gown and the voices that no one else can hear.

In the life of the mind, that’s as bad as it gets.


So count yourself lucky if your sadness is even slightly soothed by a hot bath and a really good book (or run, or swim or Netflix show). Because I promise you, that’s so much simpler and more palatable than the medical alternative.

It can be a huge relief to name sadness or stress for what it is – uncomfortable, yucky, I don’t want it! – rather than wading into the quagmire of whether or not it’s an illness.


It’s fine to ask for help if you’re struggling; great even, to be encouraged.


I’d pay every single dollar in my bank account to not have bipolar. But that doesn’t mean I think it’s a stand-in for dysfunction. Your life going a bit off the rails shouldn’t have you reaching for psychiatric terminology or claiming a diagnosis or wondering what your ex “has” to make him such a dickhead.

When you do this, it undermines the lives of those who are stuck with these illnesses, and have to struggle, pretty much every day, to survive them. Because for us it’s not a phase or a bad patch. You do get better but then you usually get worse again. For us, it’s forever.


Eleanor de Jong is the former New Zealand correspondent for the Guardian. She now lives and works in the Kimberley town of Derby, Western Australia.

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More than 5,000 mental health patients sent over 62 miles for treatment

Figures come two years after ministers pledged to end ‘dangerous’ practice and highlight ongoing chronic shortage of mental health beds in NHS


Denis Campbell Health policy editor

Wed 21 Jun 2023

More than 5,000 mental health patients have been sent at least 62 miles from home for treatment in the two years since ministers pledged to banish the “dangerous” practice.


The disclosure prompted calls for the “scandal” of out of area placements in mental health care to end, with claims that it represents “another broken government promise on the NHS”.

Chronic shortages of mental health beds have for years forced the health service in England to send hundreds of patients a month to be admitted for care, sometimes a long way from their own area.

But in 2016 ministers and NHS bosses committed to end the use of “inappropriate” placements – those caused by a lack of beds and for which there is no clinical justification – by the end of March 2021, after an outcry over the damage they cause.


Mental health campaigners, psychiatrists and patients’ families have argued that being far from home can make already vulnerable patients feel isolated, deprive them of regular visits from relatives, increase the risk of self-harm and reduce their chances of making a recovery.


Analysis of NHS data by the Royal College of Psychiatrists (RCP) has found that 8,925 new “inappropriate” placements occurred between April 2021 and March this year. Of those, 5,335 involved a patient being sent at least 100km (62 miles) from home.

An average of 12 new placements a day started during that time, despite the pledge.

“It’s appalling that the government have not brought an end to the scandal of out of area mental health placements, two years after the deadline they gave themselves for doing exactly that”, said Rosena Allin-Khan, the shadow cabinet minister for mental health, who is also an NHS doctor.


“Two years on, this is another disgraceful broken promise on the NHS, with patients suffering far away from their loved ones and support networks.”

Since April 2021, a total of 695 patients – one in 14 of the total – have been sent to a mental health unit at least 300km (186 miles) away, according to the RCP’s findings.


They included one patient who was taken 605km (378 miles) away from their home in Plymouth, Devon to a residential psychiatric unit in Darlington, Durham in March due to the beds crisis.

Dr Andrew Molodynski, a psychiatrist and the British Medical Association’s (BMA) health policy lead, said: “It is shameful that mental health patients are being routinely let down by this government, who are now two years past their target of ending the practice of sending patients out of area for treatment by March 2021, and still failing miserably.


“This isolating and dehumanising practice is a direct consequence of a fragmented and underfunded mental health care system that has been letting patients down for far too long,” he added.


The RCP and the BMA have written to Maria Caulfield, the mental health minister, recommending a major expansion of community-based services to help reduce the number of people ending up in a mental health crisis and needing inpatient care in the first place.


Dr Adrian James, the RCP’s president, said: “This unacceptable practice … risks patients’ mental health to such a degree that they often remain in hospital for longer.”

The Department of Health and Social Care did not respond directly to the new figures. But a spokesperson insisted that it did still intend to end out of area care. “Everyone should have access to safe mental health care close to home, and we are committed to ending inappropriate out of area placements for adult patients,” they said.


“We’re investing an extra £2.3bn per year in mental health services by March 2024, so that an additional 2 million people can get the support they need and investing an extra £150m to help people experiencing a mental health crisis.” 


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This 48-year-old single mum with schizophrenia is a delivery food rider and a mental health ambassador
After years of struggling with schizophrenia, trauma and grief, Amy Kang found empowerment as a delivery food rider, a job that allows her to take care of her health, be a mental health advocate and spend time with her 15-year-old son. She shares her journey with CNA Women.


This 48-year-old single mum with schizophrenia is a delivery food rider and a mental health ambassador
“I find empowerment in flexible roles like my Deliveroo job, which lets me earn while taking care of my son,” said delivery food rider Amy Kang. 

Izza Haziqah Abdul Rahman
25 Jun 2023 

The first time I heard voices in my head, I was 19. It was 1994 and I was studying business administration at Singapore Polytechnic (SP). I didn’t know it at that time, but it was a sign of schizophrenia.

As part of my co-curricular activity, I went on a camping trip to Pulau Ubin with my friends. At one point, they were teasing me and that made me upset – that was when voices in my head told me to start screaming.


I couldn’t control myself. I knew I was screaming but things seemed to happen in snippets. Everyone thought I was possessed. I was in a daze and everything was so confusing. 

Even after I calmed down, the voices in my head were still there. I was sent home immediately. When I got home, I stayed in my room. My parents were very worried, but we didn’t talk about it.

Months later, when I was on the top floor of the business block at SP, the voices in my head returned. They told me to take the potted plant by the railing and drop it from that height. They told me it was the right thing to do, and I believed them.  


Before I realised what had happened, two police officers were with me. I told them I was a princess. To convince me to go with them, they said they would be taking me to a “castle”. 


The castle turned out to be the Institute of Mental Health (IMH). I was admitted for a few days, and the doctors told me what I had: Schizophrenia.


Even after she was diagnosed with schizophrenia, Kang held on to her adventurous spirit. In this photo, she is in her early 20s and on a backpacking trip in the United States. 

I am now 48 and the voices in my head are still there sometimes. They tell me to do ridiculous and even dangerous things, like jumping off a high floor to fly or to start throwing heavy things around my house. 


It’s a little sad when I think of how I must rely on pills to keep me sane. But it’s necessary to keep me healthy.
Since that first admission to IMH, I go for checkups every three to six months, and get medicine, which I take regularly, to keep my schizophrenia in check. 


There was a time, years ago, when I thought I didn’t need medication. But just within three days of not taking it, I began to laugh and tear uncontrollably. It’s a little sad when I think of how I must rely on pills to keep me sane. But it’s necessary to keep me healthy. 



In my teens and 20s, life was messy. I managed to graduate with my diploma but things at home were hard. My parents had little money and they would fight almost every day. But they, especially my late mum, did all they could for me.


Whenever I had to be admitted to IMH, my mum would close her hawker stall at Mountbatten early and travel all the way to the hospital just to bring me lunch every day. She never judged or questioned me. She would also remind me to take my medicine.

When I was 28, my father committed suicide. At that time, I didn’t realise I was traumatised and grief-stricken – that was the beginning of a bad downward spiral for me.


Because of my schizophrenia, it was hard for me to keep a full-time job so I worked different part-time jobs to support my mum, sister, and two brothers. At different times, I was a ticketing crew member at Universal Studios Singapore, a cashier at a cafe, and a clinic assistant. I was willing to do whatever work I could find.


Two years after my father’s death, In 2005, when I was still grieving for him and looking for a stable job, I got married. I was drawn to my husband as I admired him. He had an entrepreneurial spirit. At one point, we worked as property agents together, and I even helped him in his hawker business selling fish soup. 


However, a few years into the marriage, I realised that our relationship was not working out. We had no stable plan, and we didn’t communicate well with each other.

In 2008, I got pregnant with my son. It was one of the best things to happen to me, yet, I could not be the best mum to him. 


I had many medical checkups, I spent a lot of time at work, at whatever job I had at that time, and his father and I argued a lot.


It’s why I owe so much to my late mother. While I worked, she took care of my son until he was six years old. 

It took time to fix my absence, but we got closer and formed a stronger bond.
My son grew very close to his grandma and they had a very loving relationship. If not for her, my son would not have known a mother’s love. And I would not have been able to learn how to love him as much as I do. 


When he was entering primary school in 2015, even with my struggles, I started to save money so I could take him on short overseas trips and enjoy activities with him. 


Though I couldn’t give him a lot of time, we were together. It took time to fix my absence, but we got closer and formed a stronger bond.



I experienced some of my lowest moments in 2018 and 2019. My husband and I were no longer talking. When we did talk, we would fight. I also struggled with my part-time jobs and during some periods, I was jobless. 

On some days, it was hard to even wake up. I felt out of control. My schizophrenia got worse. I hallucinated more, I had trouble thinking, and my eyes would roll up to the right. I wanted to just lie down and forget the world. 

When I told my doctors about this, they gave me a new set of medication which was very helpful, but I still felt down and sad. 


That year, I came across a Facebook post that changed my life. It was for the Caregivers-to-Caregivers (C2C) programme by Caregivers Alliance Limited (CAL), a non-profit organisation that supports caregivers of persons with mental illnesses. 

The programme saved me. It helped me better understand my mental illness and how I could take care of myself – because I am my own caregiver. 

While visiting IMH helped me medically with my schizophrenia, the C2C programme helped me socially and emotionally. I became more sure of myself and I felt that there was hope for my future – I did not feel so down anymore.


The counsellors helped me realise I experienced grief and trauma in my younger years; it felt like a heavy burden was lifted off my shoulders.
As I went for C2C sessions, I also discovered more about counselling and therapy. I decided to try a session at MindCare, a community mental health service under Ang Mo Kio Family Service Centre. It was eye-opening.

The first time I spoke to the counsellors, I shared my troubles about my schizophrenia, my marriage, and being a mother. The counsellors helped me realise I experienced grief and trauma in my younger years; it felt like a heavy burden was lifted off my shoulders. I remember breaking down in tears.


In 2019, I got a divorce. Some may perceive it as a sad event, but for me, it was a relief. 


I was more outgoing by then and I was invited by CAL to give talks to schools and organisations about my schizophrenia and how I dealt with it during difficult periods in my life. 

I no longer felt so ashamed of my struggles. It inspired others and I feel joy in helping others. To further support people like me, I became a mental health ambassador at the National Council of Social Service. I was able to share my experiences and help normalise conversations surrounding mental health conditions. 

In 2019, I also started working as a food delivery rider. I no longer wanted to jump in between too many jobs so the role has been good for me. 

The best part of being a delivery rider with Deliveroo was the flexibility. I could balance work and family. I could make time to be with my son or attend programmes with CAL. 


When my mum passed away in 2021, I was able to tend to her funeral and mourn her properly. Without having to let go of work, I got to spend quality time with my family, including being there for my son who had lost his grandmother.


Being a food delivery rider also helps me with my schizophrenia. It allows me to focus better and clears my head. Because I can choose when to take orders, when I’m sick, I can just stop and continue another time. 


In Deliveroo, I feel safe. I have my work ‘kakis’ (Malay for close friends), who do deliveries with me. They’re very fun to be with and they understand what I go through with my condition and family. 

Deliveroo also has an in-app live chat for riders to contact the rider support team. It’s good for riders who struggle to finish their order when they get lost or become unwell – I take my medication regularly but this support is something I would need if my schizophrenia symptoms show up. 

Though I don’t earn much, being a food delivery rider allows me to prioritise time with my son and family, and improve my condition. When I accept more orders, I earn more and can provide better support for my son.

Today, I still struggle with my mental health and my past. It’s hard to look back at some memories without crying. There are a few tough days when I feel like giving up. Not every day is smooth.

But I think of my son, and I feel stronger. And even though I cannot spend time with my late mum, I work and volunteer for causes that I think will make her proud. These roles allow me to help others like me, and Mum would be happy about that.


Where to get help:

Samaritans of Singapore Hotline: 1767

Institute of Mental Health’s Helpline: 6389 2222


Singapore Association for Mental Health Helpline: 1800 283 7019


You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.


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The articles we publish on Psychreg are here to educate and inform. They’re not meant to take the place of expert advice. So if you’re looking for professional help, don’t delay or ignore it because of what you’ve read here.

Published on: 07 December 2020

Last updated on: 09 January 2021

My Natural Recovery from Manic Bipolar Symptoms After Spiritual Awakening

The abrupt awakening during the middle of one’s life can very often be displayed in the form of what most would consider signs of insanity or a mental break. Which places strain on the family and friends surrounding this individual, who look on without any reasoning to grasp onto in making sense of the sudden changes in the personality of their loved one. This is a detrimental stage in one’s ascension process and the need for tolerance amongst the support system members (family and significant other) would bring much comfort.

Any individual who has made their passing into the ‘oneness of the eternal present’ moment followed by an immediate return into this 3D reality will be forever changed as an individual with an entire psyche change resulting. The most important thing we can do during this process is to not prevent the evolution of thought processing from moving where it needs to move.

Without real exposure to the information surrounding the ascension of consciousness, you may find yourself in a stressful tug of war battle as you want your loved one to be back to normal, but they are continuing to display strange behaviours and perhaps saying things even stranger.

You may find the individual is expressing and even claiming such things like they believe they are God, or perhaps the second coming of Jesus Christ, which seems to be a popular stage for many who have induced their awakening through methamphetamines or some other substance. Perhaps they are claiming to be experiencing interactions with angels, aliens, or spirit guides – none of the specifics is truly up for debate by anyone outside of the individual experiencing these occurrences.


Now, I am not a doctor nor am I giving any medical advice. This all my own belief and opinion based on my own personal experiences. And experiences are what I have been gifted plenty in the realm of mental health and psychology-consciousness exploration.

Often this midlife awakening will be opened with a stage of what we can relate to as, ‘mania’, or psychosis. This is all resulting from the influx (or downloads) of brand new information on who they are as a living being – their entire view on their own existence has just taken on quite the load of new information. Imagine one day you are living with perspective as it is right now, based on the physical world and all of its ‘laws’ on reality and what is real in this reality. Then, within a moment’s time, that is changed. Flipped upside down, shaken around, and dumped out into pieces on the floor in front of you as you are introduced to brand new elements such as an intelligent life form non-physical making itself known to you. Other than fear initially, you would also come to the stage of awe-inspiring bewilderment – looking to us like the manic behaviours of a bipolar individual.


Who invented the labelling of this diagnosis we call bipolar anyway? I know people suffer from the symptoms, mostly the family members who are trying to deal with an individual experiencing the ups and downs. But is not life filled with ups and downs, and you or I have certain days where we are rushed with good excitement, joy, and positive energies – and on other days we can find ourselves low, not wanting to do anything, perhaps isolating or wanting to be left alone, and even depressive or more anxious than usual?


Salts of the earth for remedy

Life is filled with ups and downs, that seems to be the whole thing here. Although most don’t have to deal with the intensities that the manic-depressive individual is experiencing – as their mood tables can turn on a dime over no real source of external provocation to blame – we need to start seeing these symptoms for what they are. And if one wishes to change the symptoms from their life, then a view of self-control is helpful. This self-control comes through the practice of self-regulating one’s body and mind through simple mindfulness practices and some homoeopathic innovations to medicine.

First of all the consumption of salts is an imperative area of focus for the individuals who are living with symptoms of bipolar. Now, lithium carbonate (a controlled and psychiatrist prescribed medication) is derived from the chemical element of atomic number three, a soft silver-white metal. It is the lightest of the alkali metals – lithium. The compound of lithium carbonate or lithium salt is the combination used as a mood-stabilising drug. Often avoided by psychiatrists today for the effects it can have on the organs after long term usage or digesting them while dehydrated – which most people don’t drink enough in their day – so that is most likely the culprit to the side effects.


That is one option, or if someone prefers to try a more holistic way and are avoiding the prescribed drugs (remember that lithium is just an element of the Earth, undoctored like most of the chemical make up in medicines out there today) then you can always find some salts from overseas, I am told that any Black or Volcanic Salts which may be available are a good option for balancing the volatility of your symptoms.


Your body knows

These salts are sold for cooking and can be found at any shopping centre now, or even Amazon. If a specific salt calls to you while shopping or maybe you know of one right now that is already in your mind as you’re reading – I believe that is your intuitive knowing of what salt is best for you, and you should scrap the suggestions which may or may not work for the majority and take your own advice. Even though it’s usually not in the form of advice – the intuitions most often come as a simple thought, knowing, or visual in the mind’s eye – and rarely do we hear clear directions like: ‘Hey buddy, you should get the Himalayan salt and use 13 dashes a day in your water for best results.’

Unless you are clairvoyant and talking to your guides – then usually as the mind scans over something or you are driving and the auto-pilot mode is on in your analytical side of the brain – the thought, knowing or vision will come through real quick. Sometimes with a deep feeling of knowing or most likely with a simple matter of fact just thought of Himalayan salt and no real clear explanation given.


Be grateful for the messages we do get as individuals on this journey. The body’s intuition knows what it needs and there is no doctor or professional health coach that can give you the knowledge and information that your own body will give you. I learned this over my years working with seniors in corrective exercise as well as providing body work on the side, and as the body work experience grew I began coming aware of the information I was being given from the client’s body.

I began noticing that their body’s energy is doing the work through me. Whatever the energy is that is our energetic conscious connection with the body allowing us to feel and perceive the body as being our own – that is the energy which I am receiving the cues of what to do for their healing. I feel that any true person who is claiming to be a healer knows that in fact, they are not the ones who are administering the healing, rather they are receiving and directing the energies that come through them by way of the individual patient they work with. So there are no masters or chosen ones – if I can do it, you can do it. And if your body can tell me, then your body can tell you – it’s about being quiet enough to hear it.


Start by truly listening in your daily life

to the people who are speaking to you – it’s not as easy as you may think. There will be a whole article on active-listening to come, but letting that go for now we are back to bipolar living.


Breathing and self-regulating

The individual is reaching new heights vibrationally and consciously as one is navigating the ups and downs of surges in energies such as creative flow states, the need for physical movements, exercise, or communicating and interacting with others about the meaning of life (or whatever it may be) often with a raised tone and fast speech.


If you have experienced these surges of energies in your lifetime or have been diagnosed manic-bipolar then you know how difficult it can be to get the words out fast enough to keep the conscious stream of thoughts flowing before they are lost or possibly forgotten. What can be done in these experiences where you catch yourself running your jaw at a mile per second and overly stimulated, excited and anxious in a conversation with someone, or if someone you know is displaying these increased speech patterns and manic conversations?

Breathe – or if it’s your loved one, ask them to breathe.


From the belly up. In fact, the Wim-Hoff breathing exercises are a gift to mankind and should be utilised by all who are living and breathing. But the individual experiencing the manic-bipolar symptoms will find that they can wind themselves down and reclaim their centeredness in a span of 30 seconds or less often. I’ve done this countless times myself, and although there is no money to be made or pill to be sold, you will find this exercise greatly impacting your life – even for the person just dealing with anxieties and stressors of modern-day life! Try it.


The moon balance

The other note to take into consideration on the bipolar individual’s experiences of symptoms and behaviours is that if the moon cycle is watched and the patterns of behaviours are documented or noted, then there may possibly be a connection with the planetary alignments of the moon and their experiences.


Drink water

Remember your body knows and this comes in the first thought you receive (although you may not hear) but this is called your intuition. Our intuitions have been covered and buried under all this data and information stuffed down the conscious pipe during our lifetime since schooling during developmental stages of the brain, and that strengthening of the analytical and logical side of the brain to rely on science, a book, or doctor to tell us everything that is fact or fiction. And now we have the second thought, which in many of us comes louder than the first, and often the only one we hear or cling to.


It’s all about regaining the ability to hear clearly this first thought and not allowing the second thought to send you off in another direction or halt your momentum completely with doubt.


Enjoy the weeks ahead – Covid life isn’t that bad #2020 – and focus on yourself. Time opened for all of us to grow and become better versions of ourselves if we choose it. So make your choice 🙂


James Edward Rawson is a mental health advocate.


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Having a mental health record affect your employment?

Written By Alyssa Reinoso

When we ran our talk on ‘Navigating Mental Healthcare in Singapore’, some of the most frequently asked questions had to do with concerns around the confidentiality of one’s mental health records.


Here are just a few of the questions we received:


How private are mental health records and who can request for access?


Can employers request for our mental health records?


Can the government access our records if we use public mental health services?


Can having a mental health record affect our employment?


How do you think the question of mental illness history in job applications affects a person’s chances of getting employed?


Can I choose not to disclose my mental health history in terms of employment?


There’s a common undercurrent in these questions: plenty of people are afraid to seek help for their mental health because they’re afraid it will affect their employment status or prospects.


These are not unfounded fears, as stigma against mental illness still exists.


In a 2016 survey run by the National Council of Social Service (NCSS), more than five in 10 respondents said they were “not willing to live with, live nearby, or work with a person with a mental health condition”. However, progress is being made. The Tripartite Alliance for Fair Employment Practices (TAFEP) updated its guidelines to employers in 2019, stating that asking job applicants to declare their mental health condition without good reason is discriminatory. Not abiding by TAFEP guidelines can make companies liable to enforcement actions by the Ministry of Manpower on the grounds of discrimination. If you have been unfairly discriminated against due to your mental health or come across a job application form that appears discriminatory, you can report it here.


Who can see my mental health records?

To clear up the big question, employers or potential employers cannot see your mental health records, whether you go through the private or public healthcare system in Singapore. Mental healthcare records are kept confidential from the government and from insurance companies as well, and they cannot request for your information without your signed consent due to data privacy laws. The only ones able to access your healthcare records are healthcare workers.


During our talk, Dr Benjamin Cheah, Consultant Family Physician, National University Polyclinics, confirmed that for all public healthcare services, there is a unified platform that allows healthcare workers to access a certain amount of information, for example, which hospital a patient has been to and the medication they are on, but they won’t be able to see the actual diagnosis. Dr. Daniel Kwek, Senior Consultant, Psychiatry, Ng Teng Fong General Hospital, added, “Even among doctors, if the patient is not under your care, you are not supposed to access a patient’s file.” 


Can I choose not to declare to my employer that I have a mental illness?

According to TAFEP’s guidelines, the only exception where employers can request for your mental health history is if it is a “job-related requirement”. If an employer lists hiring requirements related to mental health, the onus is on the employer to prove that the grounds for doing so are necessary and not discriminatory. For example, the Singapore Armed Forces (SAF) does require enlistees to inform the SAF if they have a mental health condition or a record of mental health issues on the grounds of whether they are mentally able to handle live ammo and weapons. A common misconception is that Government Agencies like the Ministry of Education (MOE) also have mental health as a job-related requirement, but since 2017, the Public Service Division has removed all declaration questions regarding mental health from job application forms. 


Thus, unless there is a legitimate job-related requirement, you do not have to declare your mental health condition to your employer.


If fear of others finding out about your mental health records is stopping you from seeking professional help for your mental health, we hope that this article has given you the confidence to proceed with seeking the support that you need.


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Singapore sees highest number of suicides in over 20 years, with most cases among those in their 20s: SOS
Most age groups saw a rise in suicide rates in 2022, particularly among young people and seniors.

Most age groups saw a rise in suicide rates in 2022, particularly among young people and seniors.

In 2022, Singapore recorded 476 suicide cases, the highest since 2000 when there were 348 cases

The Samaritans of Singapore's figures showed that the highest number of deaths in 2022 was among people aged 20 to 29 and the highest increase was among seniors aged 70 to 79

Suicide remains the leading cause of death for the fourth consecutive year among people aged 10 to 29

The most frequently presented problems for those who seek help with SOS involved family, jobs finances and romantic relationships

SOS said suicide prevention is a complex issue involving various stakeholders and everyone needs to “continue to turn conversations into actions”

Sufiyan Samsuri 
Published July 1, 2023
Updated July 1, 2023

SINGAPORE — In the latest set of data released, Singapore saw its highest number of suicide rates since 2000, and the greatest number of deaths was among young people aged 20 to 29.

The Samaritans of Singapore (SOS) said a press statement on Friday (June 30) that a total of 476 suicides were reported last year, with 91 being people in their 20s.

In 2000, when the non-profit organisation first recorded suicide data, there were 348 suicide cases.

Overall, the latest figures also showed a concerning 25.9 per cent rise from 2021 when there were 378 cases, SOS said.


Last year, suicide rates went up for most age groups, but particularly among the young and seniors. And males outnumbered females among the casualties, as was the case in past years.

People aged 70 to 79 registered the highest increase of 60 per cent in suicide deaths compared to last year, a rise from 30 to 48, SOS said.


For those aged 10 to 29, suicide remains the leading cause of death for the fourth consecutive year, constituting 33.6 per cent of all deaths within this group.

At the same time, suicide deaths for this group rose from 112 in 2021 to 125 in 2022.


On what were the likely causes for the rise in suicides, SOS told TODAY that suicide is complex and influenced by a variety of factors so it cannot comment for sure.


“But according to what we’ve observed from our services (such as the hotline and text chat), the top three most frequently presented problems were family problems, employment and financial difficulties, as well as romantic relationships.”

Dr Jared Ng, a senior consultant and medical director at Connections MindHealth, a standalone psychiatric practice under the Fullerton Health Group, said in the press statement: “Seeing the unprecedented rise in suicide numbers in Singapore is profoundly heartbreaking.

“This increase paints a picture of the unseen mental distress permeating society, especially among our youths and the elderly.

“It is crucial that we remain vigilant to the pressing issues that continue to heavily affect mental health, such as social isolation and loneliness.


“The time is now, to double our efforts in the realm of early detection and to actively encourage a culture of seeking help and watching out for one another.”

SOS said that it observed a 27 per cent increase last year for the use of its services — comprising its 24-hour hotline and text messaging service CareText — as compared to 2021.


Mr Gasper Tan, chief executive officer of SOS, said: “While suicide is a complex issue influenced by various factors, including mental health challenges, social pressures and economic uncertainties, our collective efforts to address these underlying causes must take priority.


“We recognise the urgency of the situation and are committed to continue taking proactive steps to address the rising suicide numbers and provide support to those in need.” 


“Suicide prevention is a complex issue that requires a multi-faceted approach involving various stakeholders, including you and I.


“We must continue educating communities about resources, improve access to mental health support and equip first responders with the knowledge and skills to identify individuals at risk and connect them with appropriate support.”


The organisation has introduced several programmes over the years, it added, including one called Light in the Dark, a support group for people who have attempted suicide, and Be a Samaritan, a first-responder community programme.


It also collaborates with community partners to widen the safety net and raise awareness aimed at reducing stigma and encouraging help-seeking.

Dr Ong Say How from the Institute of Mental Health outlined the importance of forming a safety net to prevent such tragedies.


The senior consultant and chief of the hospital’s department of developmental psychiatry said: “From efforts to improving mental health literacy such as knowing the warning signs of distress and importance of self-care to teaching peer-support skills, we must leave no stone unturned.


“Beyond the knowledge, we should also guide the youth on when and where to seek help.”


Mr Tan of SOS said: “Suicide is preventable. With the mission to be an available lifeline to anyone in crisis, SOS is dedicated to building an ecosystem of care where every individual feels valued, supported and empowered to seek help when needed.”


Samaritans of Singapore: 1-767 (24-hour hotline) or 9151 1767 (24-hour CareText via WhatsApp)
Singapore Association of Mental Health: 1800 283 7019
Emergency helpline of the Institute of Mental Health: 6389 2222 (24-hour hotline)


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For many years, many are in fear
Realities are harsh, nowhere near one envisions

Yet no one wish to talk about this...


What if......IT aren't preventable?


IT has been ongoing for so many centuries 
The ecosystem is detoriating, ever perpetuating
Making it an unsafe "utopia" to be in


Could it be yet another aspiration or ideal akin to the past "zero IT" monologue?"

Or another headless chicken running round the field?

Perhaps such ideals made one feels xxxxxxx (seriously can't think of a word)


"At least there are more related resources out there for "distressed individuals"


But come on, IT has been ongoing and on the rise after so many years so how much more is more???


The mainstream states


IT is somehow the way to relieve oneself from the pain and numbness


But know what?? The realities are these.....


IT will still exist regardless 
IT can never be preventable


IT often send shocks to many because the deceased is perceived as "back to homeostasis" 


Or could it be that sense of peace?


The peace that the person has experienced in leaving this "utopia" full of unrealistic ideals and aspirations?


Since IT is a complex issue, only the deceased will know


Kindly remove the focus on IT is preventable

Strive to accept realities

Apply wisdom and be more discerning 

Allocating resources to better avenues

So to make the ecosystem less distressing 

Making it a more pleasant sanctuary for you and me


Oops! Could it another unrealistic aspiration?


Oh foolish, the bipolaring and MDD me!


Samaritans of Singapore: 1-767 (24-hour hotline) or 9151 1767 (24-hour CareText via WhatsApp)
Singapore Association of Mental Health: 1800 283 7019
Emergency helpline of the Institute of Mental Health: 6389 2222 (24-hour hotline)

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Self-diagnosing mental health conditions with social media and how it can be dangerous

Psychologists in Singapore are seeing more cases of youths diagnosing themselves with mental health conditions based on what they read on social media.


Fong Wai Kei

Published: 9 June 2023, 3:59 PM


“Five signs you have ADHD”, “How to tell if you have Anxiety”, “Symptoms of someone suffering from OCD” – you might have come across these “resources”, but not exactly from licensed professionals.


Instead, creators on social media platforms are seen pushing out these mental health content from the comforts of their homes.


The volume of mental health content on social media platforms is on the rise. Be it pretty Instagram carousels or snappy TikTok videos, mental health information is being packaged into digestible content for youths to consume.


Local media reported that some psychologists in Singapore are seeing more cases of youths diagnosing themselves with mental health conditions based on what they read on social media. Dr Geraldine Tan, a principal registered psychologist from The Therapy Room, was consulted on the rising trend and shared that only 10 per cent of self-diagnosed patients have the conditions they thought they did.


Accountancy undergraduate Teo Min, 21, doesn’t find this statistic surprising. She believes that it starts from finding just one relatable thing about the mental health issue presented.

“[From there,] you start convincing yourself in your head that you relate to the other symptoms presented, just so that you can justify to yourself why you’re feeling this way, and sort of escape from the reality of it,” said the Nanyang Technological University student.

Youths are likely to have come across such mental health content in one form or another. 

This could possibly stem from the characteristics of youth and perhaps the stage of life they are at. “You’re at the age where you’re trying your best to fit in with your peers and your environment, so it’s normal to want to relate to something and latch onto it,” Min added. 


Mental health content on social media has become an accessible and convenient avenue for youths to verbalise their feelings. Instead of grappling with their intangible feelings, such content could potentially provide them with something slightly more concrete to work with.


For Fathinah Al-Husna, 21, she came across these mental health TikToks accidentally on her TikTok For You Page (FYP) but decided to stay because she wanted to get a clearer understanding of what she was experiencing. 


The Sociology undergraduate at National University of Singapore said: “Personally, I find that the content kind of gives me a bit of relief and explanation during my busy moments mid-semester, where I don’t have time to properly visit a medical professional for an explanation on my symptoms.” 

Although she acknowledges that some of the information might be false, Fathinah still found a sense of solidarity in them on days that were harder to get through. “It felt quite paralysing and also lonely as I don’t really share my struggles with my friends,” she added. “So, it felt nice to find content I could relate to.”


This feeling of being less alone is what two local mental health content creators strive to achieve when producing content for the community.

For Calm Collective, the organisation aims to normalise mental health conversations on Instagram, TikTok and Linkedin. Their content is heavily inspired by the team’s personal experiences, learnings and conversations with others.


However, they draw the line when it comes to listing out symptoms of mental health conditions. Alyssa Reinoso, its co-founder and head of content, said: “There is a real danger that people, especially youth, will rely only on social media without seeking a mental health professional to get a proper diagnosis.”


Unlike the team behind Calm Collective, mental health advocate and content creator Ron Yap is more open to including mental health condition symptoms on his Instagram platform @mentalhealthceo. 


With such content being scientific in nature, the 26-year-old sets aside time to look into academic journals and articles by credible authors to ensure reliability. His current pursuit for a Masters in Counselling has also widened his access to more scientific resources.


Condensing technical concepts into a digestible bite-size format is one of the roles Ron believes content creators like him play.


Through his platform, Ron hopes to raise awareness about certain mental health conditions and help his audience make better decisions for themselves in their mental health journey. 


Visually appealing graphics, short skits reenacting and evaluating conversations or direct addresses from creators themselves – mental health content is packaged in a myriad of shapes and forms.


It is this familiarity and fondness youths have developed towards social media that makes it easy for them to find out more about mental health, said Dr Benjamin Hill Detenber, an Associate Professor at the Wee Kim Wee School of Communication and Information.

Apart from misdiagnosis, Dr Detenber posits that exaggerated concern or worry over symptoms could also pose a potential problem.


“Medical doctors and people who study the Internet and social media sometimes refer to this as ‘cyberchondria’,” he said. “In other words, based on information they get from the web or social media, people believe they have various medical or health conditions when they do not.”

Despite these pitfalls, not everyone finds consuming such content to be entirely a detrimental thing. 


While Ron acknowledges the possible harms, he sees how such content can be beneficial in helping one identify certain behaviours.


“What [I find] more helpful is not saying that I 100 per cent have this condition but the idea that I could have this condition,” he explained.


Through his platform, he aims to provide the starting tools that people would need to self-manage their issues or the extra push to spur them to consider going for therapy.


Where listing of symptoms can prove to be more problematic, Calm Collective’s co-founder Alyssa sees greater value in pushing out gentle reminders, self-coping techniques and encouragement to delve further into mental health through further reading.


In particular, life hacks and methods that make life easier have been helpful for one Social Science undergraduate. 

Singapore Management University student Katrina Lumalu, 21, initially sought professional help because of her anxiety. Eventually, her psychiatrist diagnosed her with Attention Deficit Hyperactivity Disorder (ADHD) mixed type.


To her, mental health TikTok videos serve as another avenue for her to receive information. They supplement her understanding of her condition and journey towards getting better. 


For instance, she is now more aware about emotional dysregulation. A possible core trait of someone with ADHD, people with this find it harder to regulate their emotions when provoked. She realises that what was once a trait she blamed herself about is actually something often out of her control.

Now, she exercises more kindness towards herself.


Apart from the educational experience, she also enjoys the use of humour in some of the content she has come across, making things more lighthearted at times.


However, as sincere as content creators’ intentions may be, there will be times when they fall short. 

One of @mentalhealthceo’s posts ‘Things you shouldn’t say to suicidal people’ drew its fair share of negative feedback. Due to a lack of clarity on certain phrases used, what was intended to educate people who weren’t suicidal ended up offending those who were.


“I felt quite bad after that, because the people that I was trying to help with that post were the ones who were hurt by it,” Ron, who runs the account, said.


Even though he is a creator in this online community, he understands the limitations of platforms like his on social media.


He said: “In the end, there’s really only so much that social media can do because again, it cannot replace therapy, it cannot replace professional help.”


Still, some feel that getting a proper diagnosis is often easier said than done.


Katrina, who got diagnosed with ADHD early this year, finds herself on the luckier side of the coin. “A diagnosis is a privilege and not everyone has access to it,” she said.


She explained that an appointment with a private healthcare professional can often be expensive. Consulting a cheaper healthcare professional in the public sector may take months or even a year. In addition, she also believes that those with families who stigmatise mental health may find it difficult to seek treatment without their parents knowing. 


While social media has lowered the barriers to what used to be privileged or difficult-to-access mental health information, it has also “opened the floodgates” for a lot of false or misleading information, shared Dr Detenber.


“With few or no gatekeepers, some novices may find it difficult to discriminate between what is good and what is bad information,” he added.

Hence, he encourages people to turn to official resources instead, being mindful to exercise digital media literacy.

He said: “Personally, I would be very wary of getting any kind of health information from TikTok or YouTube videos.”


“There are plenty of other sources of reliable information on the Internet if one knows where to look, and that’s what I tend to do.

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This radical movement makes space for people with mental health and other challenges to study (and celebrate) themselves
by Satsuki Ayaya & Junko Kitanaka 


Published in association with Mindscapes, Wellcome’s international cultural programme about mental health, an Aeon Strategic Partner

In psychiatry, only experts make diagnoses. They do this by referring to detailed lists of criteria in technical guides, such as the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5; 2013).


With this manual in hand, a psychiatrist can determine whether a person is experiencing trichotillomania (hair-pulling disorder), schizophrenia, antisocial personality disorder, autism spectrum disorder, narcolepsy, childhood-onset fluency disorder (previously called stuttering), selective mutism, rumination disorder, or any of the myriad other disorders in the DSM-5.


Being given one of these diagnoses can sometimes change a person’s life for the better. It can validate their struggles and allow them to finally receive the professional support and medication they need to live a fulfilling life. But being diagnosed can have a dark side, too. It can take over a person’s identity.


A psychiatric diagnosis is not only descriptive, it’s also prescriptive – it contains a narrative about what progress or recovery should look like. And, as this prescriptive narrative begins to dictate a person’s sense of self, a diagnosis can intrude so deeply into their identity that it may be difficult to imagine an alternative way of being.


In Japan, a radical approach called tōjisha-kenkyū has emerged to challenge the prescriptive narratives that dominate mainstream psychiatry. In tōjisha-kenkyū, which roughly translates as ‘the science of the self’ or ‘self-supported research’, people with disabilities and/or mental illness learn to study their own experiences. During the past few decades, this approach has grown from a grassroots movement created by people with schizophrenia and other mental illnesses in a small Hokkaido fishing town, to a revolutionary method for moving beyond psychiatry – a method that is being embraced across the strata of Japan’s rapidly ageing society.

The word ‘tōjisha’ is difficult to translate accurately into English. The term was originally used in law and politics where it referred to the parties – the tōjisha – involved in litigation. Its definition expanded in the 1970s when it became a means of self-identification for people in discriminated groups, including women struggling against a patriarchal society, those with disabilities who had become outsiders, and those who did not conform to gender norms. People in these groups adopted the word because it is loaded with conflict and resistance; it’s a name for those without power who are willing to organise and fight for their place in society, and for a right to determine their own future. ‘Tōjisha’ is how many people who are struggling against discrimination have come to identify themselves in Japan.


At the beginning of the 21st century, this term also began to be used by an invisible minority: those with schizophrenia and other psychiatric disorders. By identifying as tōjisha, members of this minority group sought a way beyond the dominance of medical models, to escape the harm of diagnosis and the rigidity of prescriptive narratives that predefined the path of recovery. But, unlike many other groups of tōjisha who advocated for social change, for those experiencing mental illness, such as schizophrenia, advocating for a place in society is complicated. Their ‘invisibility’ is twofold: they’re not only sidelined from society, but their disorders are also mysterious to themselves and others. Instead of being passive ‘patients’, they could become active ‘researchers’ of their own ailments


What really set the stage for tōjisha-kenkyū were two social movements started by those with disabilities. In the 1950s, a new disability movement was burgeoning in Japan, but it wasn’t until the 1970s that those with physical disabilities, such as cerebral palsy, began to advocate for themselves more actively as tōjisha. For those in this movement, their disability is visible. They know where their discomfort comes from, why they are discriminated against, and in what ways they need society to change. Their movement had a clear sense of purpose: make society accommodate the needs of people with disabilities. Around the same time, during the 1970s, a second movement was started by those with mental health issues, such as addiction (particularly alcohol misuse) and schizophrenia. Their disabilities are not always visible. People in this second movement may not have always known they had a disability and, even after they identify their problems, they may remain uncertain about the nature of their disability. Unlike those with physical and visible disabilities, this second group of tōjisha were not always sure how to advocate for themselves as members of society.


They didn’t know what they wanted and needed from society. This knowing required new kinds of self-knowledge.

As the story goes, tōjisha-kenkyū emerged in the Japanese fishing town of Urakawa in southern Hokkaido in the early 2000s. It began in the 1980s when locals who had been diagnosed with psychiatric disorders created a peer-support group in a run-down church, which was renamed ‘Bethel House’. The establishment of Bethel House (or just Bethel) was also aided by the maverick psychiatrist Toshiaki Kawamura and an innovative social worker named Ikuyoshi Mukaiyachi.


From the start, Bethel embodied the experimental spirit that followed the ‘antipsychiatry’ movement in Japan, which proposed ideas for how psychiatry might be done differently, without relying only on diagnostic manuals and experts. But finding new methods was incredibly difficult and, in the early days of Bethel, both staff and members often struggled with a recurring problem: how is it possible to get beyond traditional psychiatric treatments when someone is still being tormented by their disabling symptoms? Tōjisha-kenkyū was born directly out of a desperate search for answers.


In the early 2000s, one of Bethel’s members with schizophrenia was struggling to understand who he was and why he acted the way he did. This struggle had become urgent after he had set his own home on fire in a fit of anger. In the aftermath, he was overwhelmed and desperate. At his wits’ end about how to help, Mukaiyachi asked him if perhaps he wanted to kenkyū (to ‘study’ or ‘research’) himself so he could understand his problems and find a better way to cope with his illness. Apparently, the term ‘kenkyū’ had an immediate appeal, and others at Bethel began to adopt it, too – especially those with serious mental health problems who were constantly urged to think about (and apologise) for who they were and how they behaved. Instead of being passive ‘patients’ who felt they needed to keep their heads down and be ashamed for acting differently, they could now become active ‘researchers’ of their own ailments. Tōjisha-kenkyū allowed these people to deny labels such as ‘victim’, ‘patient’ or ‘minority’, and to reclaim their agency.


Tōjisha-kenkyū is based on a simple idea. Humans have long shared their troubles so that others can empathise and offer wisdom about how to solve problems. Yet the experience of mental illness is often accompanied by an absence of collective sharing and problem-solving. Mental health issues are treated like shameful secrets that must be hidden, remain unspoken, and dealt with in private. This creates confused and lonely people, who can only be ‘saved’ by the top-down knowledge of expert psychiatrists. Tōjisha-kenkyū simply encourages people to ‘study’ their own problems, and to investigate patterns and solutions in the writing and testimonies of fellow tōjisha.


Self-reflection is at the heart of this practice. Tōjisha-kenkyū incorporates various forms of reflection developed in clinical methods, such as social skills training and cognitive behavioural therapy, but the reflections of a tōjisha don’t begin and end at the individual. Instead, self-reflection is always shared, becoming a form of knowledge that can be communally reflected upon and improved. At Bethel House, members found it liberating that they could define themselves as ‘producers’ of a new form of knowledge, just like the doctors and scientists who diagnosed and studied them in hospital wards. The experiential knowledge of Bethel members now forms the basis of an open and shared public domain of collective knowledge about mental health, one distributed through books, newspaper articles, documentaries and social media.


The audience votes to decide who should win first prize for the most hilarious or moving account


There are two goals to tōjisha-kenkyū.


First, developing and sharing knowledge about yourself; and second, advocating for a place in society. By sharing self-knowledge, those who feel pushed out of society can begin advocating for themselves, together. This is how tōjisha-kenkyū has become helpful for those who might not suffer from a clear case of mental illness but who nonetheless feel marginalised. It has even been adopted by those in the ‘majority’ who seek ways to provide a safer and more comfortable environment for people with different abilities. At a time when ‘citizen science’ was still a new idea, particularly in the rather closed realm of mental health care, tōjisha-kenkyū created a vibrant space for public engagement where those with mental illness did not have to be apprehensive or embarrassed to speak about their differences.


Tōjisha-kenkyū quickly caught on, making Bethel House a site of pilgrimage for those seeking alternatives to traditional psychiatry. Eventually, a café was opened, public lectures and events were held, and even merchandise (including T-shirts depicting members’ hallucinations) was sold to help support the project. Bethel won further fame when their ‘Hallucination and Delusion Grand Prix’ was aired on national television in Japan. At these events, people in Urakawa are invited to listen and laugh alongside Bethel members who share stories of their hallucinations and delusions. Afterwards, the audience votes to decide who should win first prize for the most hilarious or moving account. One previous winner told a story about a failed journey into the mountains to ride a UFO and ‘save the world’ (it failed because other Bethel members convinced him he needed a licence to ride a UFO, which he didn’t have). Another winner told a story about living in a public restroom at a train station for four days to respect the orders of an auditory hallucination.


Tōjisha-kenkyū received further interest, in and outside Japan, when the American anthropologist Karen Nakamura wrote A Disability of the Soul: An Ethnography of Schizophrenia and Mental Illness in Contemporary Japan (2013), a detailed and moving account of life at Bethel House.

Today, tōjisha-kenkyū has expanded far beyond Bethel or Urakawa. Once seen as an unusual and radical technique for those experiencing schizophrenia and other psychiatric disorders, it has now become an approach available to anyone wanting to study themselves and society. In 2015, tōjisha-kenkyū found another home at the Research Center for Advanced Science and Technology (RCAST) at the University of Tokyo. The associate professor Shinichiro Kumagaya, a paediatrician who has cerebral palsy, and the associate professor Satsuki Ayaya, the co-author of this Essay, who has written extensively on her experience of autism, are two researchers at the Center’s Tōjisha-Kenkyū Lab. Together, they are introducing tōjisha-kenkyū to a wider audience of experts by drawing deeply on their own experiences with disability and mental health, as well as working alongside other scientists and tōjisha.


When Kumagaya first began his clinical training at the University of Tokyo Hospital, he soon found that he struggled with the seemingly simple task of drawing blood. Because his hands are partially paralysed, he found it extremely difficult to hold a hypodermic needle. He tried various techniques until he was able to reliably draw blood from his colleagues’ arms. However, when it came to doing the same with babies – as worried parents looked on – his nerves would fail him, and he needed assistance. When he was later assigned to a busy hospital, Kumagaya assumed he would be useless and need constant help, but his supervisor deliberately put him in charge of drawing blood. Rather than obsessing over the ‘correct’ procedure, Kumagaya was encouraged by hospital staff to focus on drawing blood using any technique that worked, so long as it didn’t hurt the patient. Even Kumagaya’s supervisor confessed that he’d made mistakes taking blood, too, which melted any remaining fears. Other staff were quick to adapt themselves to his differences, finding various ways to help. Kumagaya learned that nobody was perfect in a super-busy hospital, and staff were constantly finding ways to help and accommodate each other’s weaknesses. Partial paralysis simply became one of many weaknesses (or eccentricities) among the team. Kumagaya has since drawn on this experience to further develop the methods of tōjisha-kenkyū by helping the Japanese government and those corporations required by Japanese law to hire a certain percentage of people with physical and mental disabilities.

Tōjishas are going beyond individual experiences to collaboratively generate scientific hypotheses


Ayaya’s research at RCAST has explored the history of tōjisha-kenkyū by interviewing the main actors involved in its creation. It has also drawn directly on her experience of autism to develop tōjisha-kenkyū as a research practice. Many of those with mental illness suffer from a profound sense of loneliness because their symptoms and their ‘odd’ behaviour can lead to tension and miscommunication, sometimes resulting in estrangement from others. What some tōjishas find frustrating is that they do not necessarily know what their exact problems are, and they may be accused of lacking self-knowledge. Ayaya often used to feel out of place. Her sense of self and body felt hijacked by other people’s descriptions of her – words that she didn’t always understand.


Practising tōjisha-kenkyū, she began to learn how she experienced the world differently, and began to formulate hypotheses about why, for instance, she was constantly exhausted by sensory overload and extremely poor at sensing her own fatigue, which had led to sudden breakdowns in the past. Everyone’s ‘research’ is different, but in Ayaya’s case, she drew on self-observation as well as published studies in experimental psychology, cognitive science and philosophy to formulate hypotheses about her breakdowns, analysing their underlying mechanism and finding the exact words that explained her experiences. She now presents her hypotheses about autism in tōjisha groups to test how generalisable her findings are. In this way, tōjishas are developing self-understanding and learning to describe themselves in their own words, but also going beyond individual experiences to collaboratively generate scientific hypotheses about their experiences.

At the University of Tokyo, Ayaya and Kumagaya have generated a systematic approach to develop these hypotheses.


This involves three directions of ongoing research: practising tōjisha-kenkyū; validating hypotheses born out of tōjisha-kenkyū; and investigating the effect and efficacy of tōjisha-kenkyū. Part of their work has involved collaborating with communities of people with autism, those experiencing addiction, and children with special needs or learning difficulties. They have also worked with an Olympic athlete and a former astronaut to explore their sense of marginality and the stress of performing in highly competitive and meritocratic communities. To test hypotheses that have emerged from individual experiences, Ayaya and Kumagaya have also collaborated with scientists and other experts to test whether findings might be generalisable to other people with disabilities. As a result, tōjisha-kenkyū is now in the early stages of being implemented by corporations, universities and hospitals as a means of identifying problems and fostering diversity within workplaces.


In 2011, the Japanese government established a Commission on Policy for Persons with Disabilities involving a range of experts who make policy recommendations to ensure Japan is acting in accordance with the the United Nations’ Convention on the Rights of Persons with Disabilities. These experts include social workers, academics, those with disabilities, and even an expert in tōjisha-kenkyū – a role that is currently taken by Kumagaya. Tōjisha-kenkyū is a tool not just for an individual to cope with their problems, but a way of ensuring that society learns to acknowledge and face these problems, too.


What makes this approach so appealing?


Perhaps it can be explained through a principle Kumagaya learned from the Italian psychiatrist, researcher and tōjisha-kenkyū supporter Roberto Mezzina: ‘self-discovery (through self-supported research) is a process of recovery.’ It is a means of recovery because it allows a person to discover meanings and mechanisms in what may otherwise be a chaotic experience.

Though tōjisha-kenkyū began far outside the domain of traditional scientific research, it now seems to have become a form of citizen science, one that takes research out of the laboratory and university, and places it in the hands of those who are neither psychiatrists nor health experts. One thing that distinguishes tōjisha-kenkyū from other forms of citizen science is its unique definition of ‘research’. In the past, citizen science projects on public health involved patients who learned the language and craft of science to actively collaborate with medical experts in search of a cure. An example of this is the collaborative networks that formed during the 1980s and ’90s between people affected by AIDS and the scientists studying it. Citizen science has also developed in mental health care, where user-controlled research has significantly impacted health policies.


While these historical cases have radically reshaped the idea of science and the ownership of its knowledge, the fact that such research may require an engagement with complicated scientific research and expertise could hinder some ‘citizens’ from becoming more involved. Tōjisha-kenkyū, on the other hand, takes an almost guerrilla-like approach: research is a patchwork of individual experiences and whatever is found useful from science. The traditional literature review in scientific articles, where knowledge about a field or debate is compared, is replaced with the act of listening to and comparing the testimonies of tōjisha. This can also become a form of feedback like the peer-review process. What is particularly important about this dynamic is that groups of tōjisha can kenkyū together to examine how problems arise from their specific disabilities, their own eccentricities or quirkiness, or from a specific environment. By finding patterns in causal factors, tōjisha can make more informed plans about what should be done.


They do not have the ultimate answer and speak from multiple positions of being patient, peer and staff member

This approach to research has increasing relevance in corporate Japan, where the number of workers with depression and/or developmental disorders is increasing. The government and corporations are seeking ways to go beyond the traditional machismo that still exists in many Japanese companies, and to cultivate a new work culture where it is OK to show and share one’s vulnerabilities. Kotoko Kita is a tōjisha-researcher hired by the University of Tokyo through Kumagaya and Ayaya’s lab, who was diagnosed with autism spectrum disorder and attention-deficit/hyperactivity disorder. For Kita, tōjisha-kenkyū has become a way to investigate the nature of her disability in the workplace. It’s helped her understand why she has changed jobs more than 30 times – an anomaly in Japan where the idea of lifetime employment still prevails. In her research, she compared companies to see which ones were difficult to work in (those with a culture of machismo and perfectionism) and which were disability-friendly (those with a culture of accepting and sharing each other’s vulnerabilities). Through tōjisha-kenkyū, Kita, Kumagaya and Ayaya have been able to begin designing the workplaces of the future.


Inspired by this work, Kiyoto Kasai, the chair of neuropsychiatry at the University of Tokyo, has implemented a system of peer-support workers at the university hospital with the aim of decreasing the stigma of mental illness. He has helped hire four such workers, who were psychiatric patients themselves. Unlike psychiatric professionals who tend to speak from a position of knowledge and certainty, peer-support workers instead operate as ‘facilitators’ who do not have the ultimate answer and who speak from multiple positions of being patient, peer and staff member. Partly because of their uncertainty, they may be able to listen and empathise more easily with patients while also easing tensions and power imbalances inherent in doctor-patient relationships. Their roles have thus been compared with frontline ‘peace workers’ in medical settings. But they also find it difficult at times to speak from different perspectives when they are surrounded by medical professionals.


While the exact roles and the strengths of peer-support workers are still being debated at the University of Tokyo Hospital, many see this as a step towards creating a democratic and open space within medicine that can change psychiatry from within.


In Japan’s rapidly ageing society, where many people live beyond their 80s, disability is no longer someone else’s business. It impacts everyone. Dementia is a particularly salient example because it looms so large in Japan’s ageing future: by 2025, around 7 million people are expected to be afflicted. One of Japan’s bestselling books of 2022 was a ‘guidebook’ to dementia titled Ninchishō sekai no arukikata (How to Walk the World of Dementia), which was modelled on a Japanese version of the Lonely Planet series called ‘How to Walk the World’. The guide reads like an old-fashioned anthropological textbook, describing the exotic world of those living in the land of dementia.


The book shares the narratives of ‘natives’, describing and explaining why they do the ‘strange’ things that they do, such as forgetting, not being able to count money and/or charge a train card, and sometimes just wandering around aimlessly. Dementia is a great case study of how tōjisha-kenkyū might shape Japan’s future.


At memory clinics for people with dementia where the anthropologist Junko Kitanaka, the co-author of this Essay, has conducted fieldwork, tōjisha are not only invited as ‘experts’ who can evaluate the quality of doctors’ interactions with patients but also as peer-consultants. The faces of tōjisha and patients light up when they discover that they share commonalities. During her research with people who have Lewy body dementia, Kitanaka observed tōjisha and patients sharing similar horrifying experiences, such as hallucinating a curtain-rail covered in snakes or seeing a ghost-like small child in a dark room. These experiences may have been horrifying, but the conversations that follow are full of laughter, fostering a sense of solidarity – similar to the solidarity seen during Bethel’s ‘hallucination contests’.

It’s a vision in which those affected by physical and mental differences have a meaningful place in the future

Through tōjisha-kenkyū, people without dementia can imagine not just how to live with those who are afflicted but also what it is like to be in the mind of someone with a mental disorder. This is also allowing people with ailments to empathise with each other beyond the usual disease categories and across spectrums.


Today, people with dementia, depression, schizophrenia, higher brain dysfunctions and developmental disorders are beginning to share their experiences of control, not being able to manage the excess of their emotions or feeling that their body is in discord with their mind. They might talk about cognitive changes in metaphorical terms, saying that they feel like an old and dysfunctional computer that can open only one window, to run only one application at a time. They may also talk about sensory experiences, such as how the world feels faded, completely devoid of colour, and as if they are moving in slow motion. Many emphasise how lowered levels of working memory make them want to limit any excess information invading their brain and how, in response, they sometimes cannot help but close their eyes, shut their ears, and crouch down in panic.


By working with doctors who are interested in recapturing the symptomatology of mental disorders, these tōjisha are helping reshape psychiatry itself. They are creating a common foundation from which to understand the phenomenology of psychosis and the difficulties of living differently. Importantly, a database built from this new language is now being used by experts in electronics, city planning and community building to help create new and empathetic forms of universal design that accommodate the worlds of tōjisha and those who are neurobiologically different.


It may seem that tōjisha-kenkyū has travelled so far from Bethel House that it has little to do with its origins in Urakawa – and little to do with the methods used by the man who wanted to understand why he set fire to his house. But all forms of tōjisha-kenkyū share fundamental qualities: a communal and open understanding of ailments, and an optimistic view that society can become more inclusive. Tōjisha-kenkyū offers a hopeful vision of coexisting worlds. It’s a vision in which those affected by physical and mental differences have a meaningful place in the future.


Imagine what would happen if experts stopped only defining and diagnosing patients, and instead taught people to study themselves.


Note: This research has been funded by Kakenhi JP21H05174 and JP21H05175.

12 June 2023


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The Big Read: Teenagers hooked on social media — what’s the cost to their mental health?

Experts, parents and youths acknowledge that social media exposure is inevitable in this age, adding that it is important to help the young understand how to use social media in moderation and with boundaries.

In May, the United States’ top health official issued a warning about the “profound risk of harm” that social media could have on children and adolescents’ mental health and well-being

Teenagers and youths interviewed by TODAY speak of how social media addiction has negatively affected their lives and emotions, though most have not stopped using it completely

While studies have drawn correlations between excessive social media use and a negative impact on children and youths’ mental health, more research is needed to conclusively establish its causal direction and full effects, say experts

They also told TODAY that social media addiction is currently not recognised as a mental health disorder, which could impede the consistency of its terminology, choice of diagnostic tools used, and recommendations on treatment

Ultimately, experts, parents and youths acknowledge that social media exposure is inevitable in this age, adding that it is important to help the young understand how to use social media in moderation and within boundaries

Deborah Lau
Published July 21, 2023
Updated July 22, 2023

SINGAPORE — Fourteen-year-old student Nadheeruddin Tajuddin spends about four to five hours a day on social media, sometimes till the wee hours of the morning, which leaves him waking up the next day feeling “not that great”.

At times, he even finds himself getting dizzy or sick after consecutive weeks of late-night scrolling. When this happens, he usually stops using social media for a few days, but eventually returns to it.


While Nadheeruddin — who uses mostly TikTok but also spends time on Instagram and Twitter — feels like social media has affected his ability to concentrate in class, he does not plan to get rid of his social media applications completely as he fears becoming “clueless”.


For Secondary 4 student Rebecca Kui, Instagram’s algorithm and infinite scroll feature means that she is constantly fed videos and content that she enjoys. It keeps her entertained for hours, which makes it difficult for her to close the app.


“It’s kinda scary because you begin to neglect your other priorities, and minutes can turn into hours very quickly,” said the 16-year-old, who likens social media to “drugs but under the disguise of entertainment”.

Rebecca also noted how social media has affected her ability to process her emotions, as she can be fed random and vastly different videos consecutively through her TikTok “For You” page.


From being shown a tearful video about a dog passing away, to someone cracking a joke in the next, Rebecca said it was “scary” that she could go from crying to laughing within seconds, as she did not have enough down time between the videos to fully process what she had watched.


Josiah (not his real name), a 17-year-old polytechnic student, used to spend an average of six to seven hours a day on his devices.


While the bulk of this time was spent on gaming, Josiah would also spend three to four hours on YouTube concurrently, watching game footage as he played. He also uses Discord, a messaging app that is popular among members of the gaming community.


His mother, who wanted to be known only as Ms Lisa, told TODAY that at the peak of Josiah’s addiction, he would be on his phone at every waking moment — even during meal times, or while crossing the road.


Josiah would become angry and aggressive when Ms Lisa and her husband tried to take his devices away, she said.

Once, Josiah — who plays sports and is described by his mother as “strong” — even carried Ms Lisa out of the house by her waist, locking her out of their home after she had switched off the Wi-Fi in a bid to get him to get off his digital devices.

He also began to isolate himself from his family and friends, even declining her offers to take him out for his favourite meal. 


While Josiah had always enjoyed gaming from a young age, he became addicted in secondary school.


This addiction worsened during the Covid-19 pandemic, when classes turned online and he was also not able to play the sports he enjoyed outside, said Ms Lisa, a 45-year-old financial coach.

Josiah (not his real name), a 17-year-old polytechnic student, used to spend an average of six to seven hours a day on his devices.

Eventually, with her encouragement, Josiah sought professional help last year through a boxing and group therapy programme organised by youth-based non-profit organisation Impart, after being addicted for almost three years.


The three teenagers’ experiences echo the findings of studies around the world on the detrimental impact that social media could have on one’s mental health.

Top US health official sounds alarm on child social media use

TODAY's Big Read had previously reported about youths' chase for "likes" on social media and the dangers it poses. 


Last year, Singapore saw its highest number of suicide rates since 2000, with the greatest number of deaths being among young people aged 20 to 29, the Samaritans of Singapore (SOS) said in June.


For those aged 10 to 29, suicide remained the leading cause of death for the fourth consecutive year, constituting more than one third (33.6 per cent) of all deaths within this group. Suicide deaths also rose from 112 in 2021 to 125 in 2022, among this group.


While there are no local studies conclusively linking social media use with suicide, United States research psychologist Jean Twenge argues that there is an indisputable connection between the rise of smartphones and social media and a decline in teen mental health globally. 


In May, the US’ top health official, Surgeon General Vivek Murthy, also issued a stark warning to parents, tech companies and regulators, saying that evidence is growing about how social media use could have a “profound risk of harm” on children and adolescents’ mental health and well-being.


While acknowledging the benefits of social media, Dr Murthy noted that it also contains “extreme, inappropriate, and harmful content” which could “normalise” self-harm and suicide.

It could also perpetuate body dissatisfaction, eating disorders and depression and expose children to online bullying while they are still undergoing a critical stage in brain development, Dr Murthy warned in his report.

Children and adolescents are particularly vulnerable to the effects of social media addiction, experts told TODAY.


Ms Ranjini Veerappan, a certified addiction specialist at Holistic Psychotherapy Centre, said that a child’s brain is still maturing and rapidly developing until they are about 25 years old.


As their decision-making ability, impulse control, and judgement are still being developed, excessive social media use could impact their brain development and potentially lead to long-term cognitive and emotional consequences, she said. 


Given their age, they may also have limited coping skills to manage difficult situations that may arise in the digital world, which could affect their mental health, Ms Veerappan added.

Ms Julianna Pang, an addictions therapist from Visions by Promises, the addictions treatment arm of Promises Healthcare, said research has shown that adolescent brains between the ages of 10 and 19 show an increased sensitivity to social cues and rewards.

“Pre-teens between 10 and 12 are particularly vulnerable to the need for the attention and admiration of others,” she added.


Ms Jeanette Houmayune, a professional counsellor and family therapist at Talk Your Heart Out, noted that children and youths’ constant comparison of their body image, lifestyle, and social life with those of their friends on social media platforms could impact their self-esteem.

Excessive social media browsing, also known as “doom-scrolling” through Instagram reels and YouTube shorts, may also lead to addiction issues, as adolescents’ developing brains are particularly vulnerable to impulsive, dopamine-driven feedback loops, said Ms Houmayune.


Beyond these, experts warn that the long-term effects of a social media addiction on children and youths’ mental health and development are far-reaching and should not be ignored, even after the addiction has been overcome.


Dr Adrian Loh, a senior consultant psychiatrist from Promises Healthcare, a psychiatric clinic and mental health centre, said: “Addictive behaviours at a young age are definitely a concern.

“Aside from the direct effects, we also find that people who struggle with one addictive behaviour may be vulnerable to other kinds of addictions in the course of growing up.” 


This could include a transference of the addiction from one substance or habit to another, such as alcohol, substances, pornography or gambling, he added.


Agreeing, Ms Claire Leong, a counsellor at Sofia Wellness Clinic, said: “This is because addiction is usually a form of maladaptive coping. Until they find healthy coping skills, they are likely to fall into different types of addiction as they experience more stressors in life.”

Experts also warn of the long-term negative impact of such social media addiction.


Dr Ong Say How, a senior consultant and chief of the department of developmental psychiatry at the Institute of Mental Health (IMH), said that existing research findings suggest that a developing child or youth with excessive smartphone use and similar behavioural addiction would not have the opportunity to develop the “essential cognitive capability and emotional skills necessary” to function healthily as an adult later in life.

However, more research is needed to understand this relationship better, he added.


Alluding to the long-term effects of addiction, Mr Narasimman Tivasiha Mani, executive director of non-government organisation Impart where Josiah sought help, said that social media addiction can contribute to anxiety, depression, loneliness, and other mental health problems.


“If left unaddressed, these issues could become more prevalent and severe among the current generation of youths as they grow older,” he said.


“An entire generation struggling with mental health and well-being could place a significant burden on healthcare systems and society as a whole, affecting productivity and overall quality of life.”



Most of the nine teenagers, aged 13 to 18, whom TODAY spoke to acknowledged that being on social media has affected their mental health in varying ways — from skewing their perceptions of beauty, to reducing their attention span, self-esteem, and ability to process emotions.


Only one teenager, 16-year-old Natalie Tan, said that she does not have any social media presence to begin with — though it was not a personal choice, but one mandated by her parents.

“We’re all at the age where (with) our hormones and everything, we’re very prone to comparing ourselves to other people — in the sense that I already compare myself to others in real life, there’s no need for me to compare myself to other people whom I don’t even know online,” said Natalie.

She added that she had seen how her peers compared themselves to images of “women with perfect bodies” on social media.


While not being on social media has been healthy for her in a way, it does make her feel like she is missing out on some things at times.


Natalie said that a lot of conversation topics discussed by her friends tend to start from things they have seen online.

“Because of that, I don’t know what they are talking about, so sometimes I feel a bit left out. I can only sit there and nod, but I have no idea what’s going on.”


For Nadheeruddin, because he uses social media to “check on what’s happening”, he worries that he might become “clueless” if he stops using it completely.

Most of the nine teenagers, aged 13 to 18, whom TODAY spoke to acknowledged that being on social media has affected their mental health in varying ways — from skewing their perceptions of beauty, to reducing their attention span, self-esteem, and ability to process emotions.

While the youths told TODAY that they are aware of how social media has impacted their mental health, none of the other teenagers, apart from Natalie, have completely stopped using social media, opting instead to take breaks or create their own boundaries where necessary.


Josiah told TODAY that his internet addiction has “definitely decreased” his attention span.


“You just know that at the flick of a button, you can just find something that you may find entertainment in, for a couple of seconds.”


He added that doing his homework, or looking at a piece of paper which he could not scroll, had become “so boring and mindless”.


While Josiah said that going for therapy has helped him to manage his internet addiction — he now tries to limit his screen time, including not using his devices in the morning — he has not stopped using them completely.

He finds that social media could still be a good platform for keeping in touch with friends whom he does not see often, or who do not live in the same country. 


Today, Josiah, who has completed his therapy sessions, also volunteers with Impart to help children build positive coping skills and mental resilience, through sports. 


For 14-year-old Aqil Ahdan, a Secondary 2 student, spending six to seven hours on social media daily is not out of the norm. He uses TikTok the most, followed by Instagram and YouTube.


While Aqil admitted that six to seven hours is “quite a lot”, he is not concerned and does not actively limit his time on social media, as he feels it does not affect his school work or physical health.


Instead of looking at the amount of time he spends on the apps, Aqil said that he is more cautious about what he posts.


He recalled an instance when he had uploaded video clips of himself on his TikTok account, only to have people he knew comment on the posts to body-shame how he looked.

“It made me feel insecure about myself, like I wasn’t a good person to be with.”


Aqil added that he got over these negative thoughts by taking a break from social media to exercise and focus on activities outside of the platforms.

Still, he eventually returned to social media since it still has its benefits, such as allowing him to learn stuff and gain new knowledge through the content viewed.



Despite the growing body of evidence, experts told TODAY that social media addiction is currently not recognised as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders, which provides mental health professionals in countries like Singapore and the United States with a standard classification of mental disorders.


“Hence, we can only highlight the impact of excessive social media use but we won’t be able to talk about diagnosis since it’s not a recognised disorder,” said Dr Ong of IMH. 


The World Health Organization, which produces the International Classification of Diseases (ICD), has also not initiated any formal working committee to look into social media use disorder, said Ms Pang of Visions by Promises.


Ms Pang added that for a condition to be included in the ICD, it requires the gathering of sufficient research data, with consistent outcomes from around the world, about the condition’s diagnostic criteria, severity assessment, and its treatment recommendations.


Not having a formal inclusion of the condition in the ICD may affect the consistency of its terminology, choice of diagnostic tools used, and recommendations on treatments, she said.


Furthermore, while existing studies have drawn correlations between excessive social media use and its resultant negative impact on children and youths’ mental health, experts said that more research is needed for a conclusive look at its effects, and to establish that social media is indeed having a detrimental impact on adolescents’ mental health.

Despite the growing body of evidence, experts told TODAY that social media addiction is currently not recognised as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders, which provides mental health professionals in countries like Singapore and the United States with a standard classification of mental disorders.

Dr Jeremy Sng, a lecturer at Nanyang Technological University’s (NTU) School of Social Sciences, said: “Many studies have claimed to find links between social media use and mental health issues, but the causal direction of these studies is actually unclear.”

It is important to also consider the study’s methodology, as correlation does not always mean causation, he said.


“The effects of social media are very difficult to disentangle, because it’s not that we are only using social media.

“We are also doing a lot of other things — we are going to school, we're dealing with family, relationships, and all that. So it’s difficult to pinpoint that something has happened solely because of social media.”


Dr Loh from Promises Healthcare added: “For social media, it has been around for barely past a decade, so we are still trying to understand downstream implications.”


When does social media consumption morph into social media addiction? 

To this, Ms Jane Goh, deputy director of creative and youth services at the Singapore Association for Mental Health, said: “As a simple rule of thumb, if you find yourself constantly refreshing your social media applications and chasing validation and likes online, or posting to garner attention, then it could be time to reevaluate your social media habits.”

Experts also say that the long hours spent on Instagram, TikTok and the like may not necessarily be a sign of such an addiction. Instead, a good gauge of whether one’s social media use has become problematic is when it starts to displace other activities.


“Healthy social media use may look different for each person,” said Ms Leong from Sofia Wellness Clinic.

“Before I would call any behaviour an ‘addiction’, I look at three different factors — tolerance, dependency, and dysfunction,” she said.


Dr Ong of IMH added that for symptoms to be pathological, it must affect the person’s daily functioning, which could include avoiding school, giving up social gatherings, or experiencing mood swings.


“When all these things break down, that is when it’s a sign that it’s more than just a hobby. It’s a sign of an addiction.


“If a young person spends many hours on social media but still makes time to meet friends and have perfect relationships, including doing well in school, eating well and sleeping well, then in the eyes of the person and the clinician, it might not be considered a problem,” he said.


Mr Mark Rozario, a clinical psychologist at Mind What Matters, added that while the disruption of one’s daily routine or schedule can be a clear sign of risk, another signal is if one is also spending more time on social media than initially planned.


“Youths may not identify it themselves, so it could also be their peers, siblings, (or) close ones who point it out,” he added.


Regardless, addiction is a progressive illness with increasing severity of symptoms, said Ms Pang of Visions by Promises.


“Instead of focusing on whether or not there is an addiction before seeking help, early intervention is encouraged. In this regard, it would be helpful to look for signs of mood changes, changes in self-care habits, or difficulty in self-regulation when there is an interruption to use,” she added.

Since there is no escaping from a rapidly digitalising world, parents, professionals, policymakers and social media companies alike will have to navigate the myriad challenges, alongside children and youths’ exposure to, and use of, the various platforms, experts told TODAY.

To protect Singaporeans from harmful online content, Parliament passed a law in November which empowers the authorities to issue directions to online communication services to ensure local users are protected from content such as sexual violence and terrorism.

Providers who fail to comply with these directions could be subjected to fines of up to S$1 million.


To minimise the damage that social media could do to young people, Dr Murthy, the US Surgeon General, said in his report that parents and caregivers can create a family media plan which sets technology boundaries at home, create tech-free zones and report problematic content and activity.


Ms Jane Goh, deputy director of creative and youth services at the Singapore Association for Mental Health (SAMH), said that educating the young on social media use would be the way to go.


“While preventing the use of social media would seem like a simple solution, it would also create a feeling of isolation from their peers, creating a feeling of Fear Of Missing Out (Fomo),” said Ms Goh, echoing the sentiments of youths like Nadheeruddin and Natalie.

Agreeing, Ms Nicole Pang, who is head of mental health care at Impart, said that managing social media use is not solely about limiting the amount of time spent, but in empowering youths to establish their boundaries and make active decisions on the kind of content they would like to engage in or not interact with.


Rebecca’s father, Mr Kui Tuck Meng, 62, said: “We are at the age where we need to allow our children to use all these social media for their social interactions, which have their good side, as long as they are able to control its usage and are discerning to access and avoid bad social media postings.”

In turn, Rebecca said that teens like herself are still forming their world view and will require some form of guidance.


“Hence, although I think we’re capable of managing our social media usage, parents should still check in and remind their children to strike a balance between social media and their offline lives.”


Mr Brucely Christopher Edison, who has two sons aged 18 and 20, noted that with mobile phones becoming a necessity, it is hard to control what children use them for.


“For me, I think it’s almost virtually impossible to control them, because the moment you give them a phone, it’s an open channel and they are able to set up (social media) accounts,” said the 49-year-old business-owner.

He added that if parents were aware of what their children did on social media, they would be able to pick up on instances when their children were influenced and “bring them back”.

Since there is no escaping from a rapidly digitalising world, parents, professionals, policymakers and social media companies alike will have to navigate the myriad challenges, alongside children and youths’ exposure to, and use of, the various platforms, experts told TODAY.
Ultimately, the ability to navigate social media in a healthy way requires not only tech savviness and knowledge of risks online, but also self-understanding and emotional and behavioural regulation, said Dr Andrew Yee, an assistant professor of media and communication at the Singapore University of Technology and Design. 

“We can help young people develop that by having conversations about how and what they feel, including when they encounter things they see on social media.”


Ms Leong of Sofia Wellness Clinic added that it is also important to understand that those who are addicted to social media today are not doomed to a life of addiction and dysfunction.


“It is possible to get better. It has to begin with the awareness that the current behaviour is unhealthy, and there has to be an intention to do something about it,” she added.

This is what Mr Khairul Azri, a 28-year-old graduate student, has done.

He used to be active on his Instagram account in junior college and during his early years in university.


“Year 2 of university was a very bad year for me,” said Mr Azri, adding that he wasn’t doing as well as he wanted to academically.


He found himself frequently doom-scrolling on Instagram, looking at his connections’ updates about their grades and exchange or summer programmes, which made him feel worse about himself.


“It really creeps up on you, how it affects you mentally. Next thing you know, you’re just looking through post after post, and making yourself feel worse and worse.”


He stopped using Instagram, Facebook and Twitter entirely from his second year of university.


Echoing his sentiments is 27-year-old software engineer Caleb Lee, who has deactivated his Instagram account for about a year now, the longest he has stayed off the app.


He told TODAY that spending too much time on Instagram could skew his perception of a “normal day”.


“Right now, there’s way more content on social media … (and) let’s say you spend three hours on average everyday scrolling your phone,” he said.


“Instagram needs to find the best content among this growing mass of content to tailor to your three hours. Naturally the content will become more and more attention grabbing, so you’ll start to see the worst of the scandals and you’ll see the best of other people’s lives.”


Still, he acknowledges that social media is not all bad.


“At this point, we wouldn’t really know what are the good parts about it and what are the bad parts about it, until you actually learn it the hard way — by maybe staying in it for too long, or in my case, removing myself from the situation,” he said.


“Now that I’m away for one year, I can see there are actually many good things about it if I know how to control it instead of letting it control me.”


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意识到同性吸引力或不同的个人性别认同常常会导致情感冲突。这可能包括担心自己不是异性恋、困惑、焦虑和否认感情。这种内部冲突常常导致尝试表现得像异性恋(即“通过”)。有时,个人会试图“克服”自己的性取向或性别认同,特别是当他们害怕受到信仰谴责时。LGBTQ 人群在这个阶段通常会“出柜”,即保守自己的身份。对于跨性别者来说,在开始向他人透露之前也是如此。然而,许多人在网上或通过阅读或朋友寻找信息。这个阶段可能很深.


第二阶段 –向他人披露




第三阶段-- 与其他男同性恋、女同性恋、双性恋和跨性别者的社交


当跨性别者开始寻找 LGBTQ 群体并与他们建立联系时,孤立和疏远的感觉就会减少。尽管女同性恋、男同性恋或双性恋熟人可能不是跨性别者,但他们经常有共同的感受和挣扎。积极的自我意识可以通过拥有共同经历的其他人的认可、教育、支持和接受来加强。在此阶段,积极的 LGBTQ 榜样尤为重要。




这个阶段的标志是自我感觉良好,寻求积极的关系,并体验平静和满足感。此时,LGBTQ 人士开始意识到同性吸引力和同性关系是人类爱的正常且健康的表达。跨性别者发现,按照自己认同的性别生活感觉诚实而真实。








LGBTQ 身份出柜的情况不止一次。这是一个发现、接受并与他人分享自己的性取向或性别认同的终生过程。在我们的社会中,我们通常假设每个人都是异性恋,并且按照出生性别生活。LGBTQ 人群必须不断决定在什么情况下以及向谁透露自己的性取向或性别认同。出柜是自我接受和促进情感、身体和精神健康的重要一步。对于 LGBTQ 人群来说,出柜有助于结束秘密和孤立的痛苦。



Strong Family Alliance 是一个非营利组织,致力于支持 LGBTQ+ 社区儿童的父母。强大的家庭联盟为父母提供准确的信息、见解、保护孩子安全和健康的方法,并鼓励他们用爱引导并随着时间的推移解决问题。

Strong Family Alliance 是一家注册 501(c)3 组织。您的捐款在法律允许的最大范围内可以免税。

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Seeking self-help, mental health coaches? Here's what to look out for


Nurjannah Suhaimi/TODAY

Demand for self-help programmes conducted by life coaches has been increasing globally over the years
However, some engage in unethical practices that may be harmful to their clients.

Mental health practitioners and participants of such programmes share with TODAY common red flags to watch out for.

They also give practical tips on how to find the right kind of coaches or mental wellness support to fit one's needs

Taufiq Zalizan

Published August 4, 2023
Updated August 4, 2023

SINGAPORE — As awareness of mental health and emotional wellness gains traction globally, so has the demand for self-help programmes conducted by life coaches.


A study conducted by the International Coaching Federation (ICF) in December 2022 estimated that the number of such coaches globally has reached 109,200, a 54 per cent jump from the 2019 global estimate.

Coaches, mental health practitioners as well as individuals who have gone through such coaching sessions told TODAY said that these programmes can help participants improve themselves such as through nudging mindset changes or clarifying thought processes.


However, they cautioned that as with other industries, there are players in the self-help space who engage in bad practices that can be financially — or even emotionally — detrimental to clients.


It is also important for people to know when they should be seeking therapeutic help from clinically trained professionals and when it is okay to rely on self-help.

“A coaching or self-help programme might harm us if we are feeling emotionally or psychologically fragile,” said Ms Diana Petrov, a counsellor from psychological consultancy firm Mind What Matters.


TODAY spoke with coaches, mental health practitioners and individuals who have gone through self-help programmes who shared some of the red flags to watch out for and how to find the right type of support to meet one’s needs


Scare tactics

Some motivational or self-help coaches employ tactics that bring about unnecessary negative feelings.

Principal psychologist and director at The Therapy Room Geraldine Tan recalled cases when she had to work with teenagers who came back from motivational camps with “depressive” symptoms. 


As it turned out, the camp organisers had sought to “break” the students first before cheering them on as a means of motivating them.


TODAY understands that one of the ways this was done was by making the teens imagine that a great tragedy had befallen their family members and letting the students dwell on those thoughts, before the organisers gave them words of advice.

One former client of coaching programmes also described how some coaches left him feeling “empty” with the advice that they dished out.

For example, when he was seeking ways to improve himself so he can make bigger strides in his career, a coach insisted that he ruminate over the definition of joy instead, saying “otherwise, (regardless) everything you do… you will feel empty”.



Others warned about how some organisations that run self-help programmes may ensnare their participants to prolong their commitment there through emotional manipulation.


Mr Sherman Ho, co-founder of Happiness Initiative, a social enterprise focusing on well-being research, recalled a case of an individual who was sold packages after packages of self-help sessions — each costlier than before — after enrolling in a programme.

“The way they pitched it was, ‘If you really care about your growth and well-being, what is money to you?’,” he added, describing such tactics as manipulative.


Coaching practitioner Maisie Cheong believes that coaching “is not meant to be a dependent relationship”, where the coach encourages the client’s over-dependence on the coach. 


“The aim, at least for my coaching, is that I would love to have you empowered after one session,” she said.


However, she shared that some individuals might choose to intentionally embark on additional sessions as they see fit, when they feel that they would benefit from additional reminders or follow-up support.


Pushing for more sales

Besides urging their existing clients to sign up for more packages, some organisations also pressure them to bring onboard other individuals to also enrol in their programmes.


Participants and some mental health advocates go as far as to compare such tactics to multi-level marketing, which commonly employs hard selling tactics and encourages participants to look into recruiting others in their own circle that ultimately benefits the organisation.


Dr Tan of The Therapy Room said whether an organisation focuses more on how their clients are getting better or how many new sessions are being sold, is telling of its priorities.


Those who spoke to TODAY gave the following suggestions to guide a person in finding the right kind of support for their wellness need:


Understand one’s own needs

Coaching practitioner Kuik Shiao-Yin said that to avoid unethical practices in the industry, customer education is key.

“Customer education is necessary too: Being aware that self help must not be seen as a replacement for professional help; recognising what abuse and manipulation looks like and paying attention to what feels ‘not ok’ to you,” said Ms Kuik, who is a former Nominated Member of Parliament.

Mr Ho said that broadly speaking, counselling helps one to “untangle” issues from the past while coaching “tends to be more future oriented”.

The mental health experts said it is important to know where and when to tap the right kind of help to avoid potential harm.


Check credentials and testimonials

Ms Petrov from Mind What Matters stressed the importance of doing research “with an objective mind”.

This would involve looking at the coach’s certification and paying attention to whether they have any published materials, books or free resources that can help one understand their service and the value they bring.

Reading testimonials from past clients may also be helpful, though it would still involve some level of “discernment”, said Ms Carol Lim, a coaching practitioner, given how it was not impossible for an organisation or a coach to post made-up testimonials online.


She suggested asking for referrals from those one knows or trusts, as these would be more reliable compared to strangers' online reviews.


Give it a whirl

Where possible, speak to the prospective coach first.

“Some coaches actually offer the opportunity for a free discovery call,” said Ms Cheong, adding that she herself does this to allow a person to have a sense of whether he or she can feel comfortable opening up to her.

“Because it is a working relationship, and there needs to be trust.”

Ms Lim said that this complementary chat is sometimes referred to as “chemistry call”.


“The reason why coaches offer this is because the success or failure of a coaching is also very much dependent on the coaching chemistry between the two people,” she added.


Trust your feelings

Above all, it is important to trust one’s own feelings when going through coaching sessions.

“For any programme we might choose, we should ensure that we feel safe and empowered during the course and that we have the option to safely terminate it if it is a mismatch, if it does not meet our goals or if we feel invalidated and unsafe,” said Ms Petrov.


Agreeing, Ms Cheong added that people should not feel compelled into signing up for something they are uncomfortable with.


“A coach, or just any person, who actually cares about you will not try to convince you that you’re less able in any way just so they will be needed,” she said.


“An ethical coach will always just hold out a hand as an invitation and say 'You can take it if you need a thought partner’.”


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Self-help coaching: Clients, industry players speak of how dodgy coaches can do more harm than goodNurjannah Suhaimi/TODAY

Self-help coaching programmes are gaining traction as more people find ways to improve mental health and overall wellness

However, practitioners and past participants of such programmes cautioned that dodgy coaches and organisations can do more harm than good to their clients, given the unregulated space

The damage may arise from manipulative sales tactics or dubious coaching techniques, bringing about potential financial and emotional harm
Still, experts acknowledge the potential benefits of such programmes and suggest public education and greater emphasis on ethical practices as ways to mitigate potential harm

Taufiq Zalizan


Published August 3, 2023
Updated August 4, 2023

SINGAPORE — Looking to improve himself professionally in order to do better at work, a consultancy professional who only wants to be identified as Edwin sought out the help of a career coach. 


However, after 10 sessions costing about S$9,000, he realised that the person was not giving advice to improve the areas he had identified but was instead “digging a bigger hole” in his life with the questions asked.


For example, instead of guiding him on ways to improve his skillsets so that he could clinch more sales as he had hoped for, the coach asked him to reconsider if his current sales were already enough and to ponder over other things in life that the coach said were more meaningful.


“I ended up asking my friend ‘Do you think I have a problem? The coach says I’m not joyful’, despite the fact that my life was going well otherwise,” said Edwin, who was then in his mid-30s.

The friend pointed out how Edwin only became less happy after going for the coaching sessions, and both of them came to the conclusion that “something must be wrong with the coach” instead.

Now in his early 40s, Edwin has written off self-help coaches after trying three different ones.


He said that while it may work well for others, it was not effective for him personally.


Ms Mary Teo, 30, has attended three life coaching programmes comprising 10 sessions each with a coaching organisation here, spending around S$9,000 in total.


She said she joined the programme at the recommendation of a friend and because she was “not in a good place” mentally at that time, and added that she benefited from attending the self-help programme.


“I found my mind could think and focus better. And I felt physically lighter and less prone to certain ailments like muscle tensions,” she said.


However, she stopped attending further programmes there due to the “cult-like” culture she observed in the organisation, among other issues.

These include holding intensive boot camps where participants would get locked in a venue for a few hours on end to complete exercises, and compelling their clients to commit to the organisation and raise funds for it.

Self-help coaches have been growing in popularity here amid growing awareness of the importance of mental health and emotional wellness. 


Some self-help coaches and mental health experts told TODAY said these services tend to be popular among young adults at certain crossroads in their lives or who want to improve their mental wellness after working for some years.


Given the unregulated and diverse nature of the industry, with each coach professing a certain specialty, inevitably individuals could come across some dodgy coaches who may do more harm than good to their clients, the experts cautioned.


Regulation, public education and an emphasis on “ethical” coaching are key to mitigate the risks of such harms, they added.


The International Coaching Federation (ICF) — a global organisation that does certifications in coaching — defines the practice as “partnering with clients in a thought-provoking and creative process that inspires them to maximise their personal and professional potential”.


Practitioners and clients who spoke to TODAY say coaches act as a soundboard and prompt the clients with questions to help them in their thinking process and sometimes reframe certain issues to help them reach their objectives.


These goals differ based on the coach’s niche and the programme offered.

For example, business and executive coach Carol Lim coaches business and organisational leaders on how to lead and manage their teams as well as how to make executive decisions and strategise.


“In coaching teams, I look into things like psychological safety, culture, how to promote greater diversity of thought in decision making and how to avoid groupthink and be more inclusive, among others,” she said.


Meanwhile, Ms Maisie Cheong advertises herself as a "human connection and communication" coach. 

Her clients include those facing difficulties in connecting with their loved ones as well as others seeking clarity when making important decisions or those facing obstacles in setting goals or changing certain mindsets.


She would surface assumptions that the clients may have and help them see the issue more clearly. 


Unlike clinical psychologists and therapists, coaches do not undergo training to handle psychological issues, but they learn methods and frameworks of coaching.


Ms Cheong, for example, has recently completed a three-month coaching certification programme which involved theoretical and practical training.


“In every session, there is also a live practicum where you have to coach on the spot and be observed and be critiqued after that,” she said, adding that she will be attaining other certifications related to her specialisation in the coming months.


There are many international and local organisations that provide training for coaches, the most notable being the ICF which was set up in 1995.


What is the difference between a coaching programme and other forms of mental health support then?


Ms Diana Petrov, a counsellor from psychological consultancy firm Mind What Matters, said: "If we are generally coping well and wish to develop new skills, grow certain areas of our lives or make decisions, we can turn to a coach or a self-help programme. 


"However, if we face serious challenges in coping with the demands of life, work, relationships , we should seek therapeutic help from a trained mental health professional," she added. 

In response to TODAY's queries, president of the Consumers Association of Singapore Melvin Yong said that it has received four consumer complaints against life coaches or self-help programme service providers from Jan 1 last year to Aug 3 this year. 

“In general, consumers reported that they encountered unpleasant experiences when they were attending self-help programmes or coaching sessions,” he said.


“These unpleasant experiences include instances when participants felt that the coaches were judgmental and impatient towards them when they were sharing personal issues, when coaches were unable to answer questions posed by participants, and when participants were asked to introduce new participants to join the programme.”


Former Nominated Member of Parliament Kuik Shiao-yin, who herself is a coaching practitioner, recently wrote a post on professional networking site LinkedIn to draw attention to the potential harm that can come about from bad actors in the coaching field.


“Not all self-help programmes are helpful. Some feel helpful at first but evolve into something potentially harmful,” she wrote in the post last week.


“Some even tip over into being psychologically, emotionally and financially abusive.”


Speaking to TODAY on Thursday (Aug 3), she said that her posts were sparked by her own bad personal experiences as a trainee before she got herself certified in coaching and facilitation.

“In one of the sessions, I felt angered and humiliated by a trainer’s process. No check-in of care was extended either in-session or post-session,” she shared, adding that the sessions pushed boundaries unnecessarily and made her uncertain and uncomfortable. 


“You were left to pick up the pieces of your own self-worth because the session’s underlying message was ‘if you have an issue, it’s about you and your issues — and nothing to do with us’.”


Here are some negative practices that coaches, mental health experts and former clients of coaching programmes shared with TODAY:


Negative methods, untrained in handling psychological issues

Dr Geraldine Tan, principal psychologist and director at The Therapy Room, told TODAY of her experience dealing with some teenagers who went through bootcamps in school organised by motivational organisations.


“These camps motivate you by breaking you first. They leave you very vulnerable first. And then it's the rah rah rah rah sort of momentum,” she said.


Instead of becoming motivated, some of these teenagers who were referred to her for help instead showed depressive symptoms and had suddenly become withdrawn from their families and found it difficult speaking with their parents, among other signs that she saw.


Edwin, the consultant who had tried programmes with three different coaches, recalled how a coach threw him “open ended” advice like how one must figure out what brings joy in life.

“They might say things like ‘Otherwise, everything you do, no matter how successful it is, you will feel empty’,” he said.


“These kinds of statements are not very helpful for clients, I think.”


Cult-like groups

Executive and business coach Carol Lim recalled a case she knew about, where an individual who enrolled in a self-help programme in an effort to improve her career, became an “evangelist” for the programme, actively promoting it to others.


While the individual enrolled in the organisation with career-related improvements in mind, the organisation also offers programmes targeted at youths, couples and families.


“Naturally they (the organisers) will go ‘Not only do you need it, the whole family needs to do it too. Bring in your spouse, your kids’,” she said.


Mr Sherman Ho, co-founder of mental health-focused social enterprise Happiness Initiative, said that some of such groups have a “cult-like” tendency in getting existing members to recruit new ones and do work for the organisation.


“What happens in that situation is that when they coerce these people to spend so much time (with the organisation), what they're also doing is that they are really cutting off a lot of external social support structures,” he said.


“They spend less time with family, they don’t have enough time to spend with their friends and so on.” 


Clients or cash generators?

Sometimes the kind of work or activities the organisations urge their clients to do also seem to be for its own financial benefit.


Ms Teo, the past self-help programme participant, said that a friend of hers had taken part in an advanced programme at the motivational organisation she was in. As part of the programme, the friend was tasked to do fundraising for the group, on top of paying a costly fee to enroll.


“The company rationalised it by effectively saying: ‘You must return to the society that groomed you, because it was the coaching organisation who groomed you, so you must pay them back’,” said Ms Teo.


There are also some cases where participants were compelled by the service providers to take up increasingly costly follow up programmes.


Dr Tan of The Therapy Room noted that while it is natural for organisations to look for income to fund its services, how their key performance indicators (KPI) is framed could be indicative of their priorities.


“Whether your KPI is the number of people getting better, or is your KPI ‘Have we improved in our profits from month to month? Have we sold (packages) to more people this month?’” she said.



As with all industries, having some bad players in the coaching industry is inevitable, said past programme participants, coaches and other mental health practitioners.


“I think for the coaching industry, it gets a bit more of that highlight because it is an industry that has many variables and is centred around subjective, intangible experiences that are more open to interpretation,” said Ms Cheong, the coach.


Mr Ho likened it to the scourge of scams, which have been gaining a lot of attention in Singapore in recent years but cannot be completely eradicated.

“If someone approaches you and says ‘I can help you to solve your life problems’, that's actually quite an appealing thing to want to invest money in,” he said.


Public education, though an uphill task, is key to help people spot potential negative practices in the mental health and wellness space, he added.


Accreditation and regulation could go some way to mitigate risks as well, said some practitioners, as there is no formal licensing system here for coaches.


Ms Kuik however noted that it might be tough to implement.


“It’s difficult to police and enforce. There’s a whole other issue there where even (psychological) therapists in Singapore are not all officially registered. So you do have ‘therapists’ and ‘counsellors’ who are untrained as well,” she said.


Ms Kuik pointed to a non-government organisation in the United States called Seek Safely, which was started by someone whose sister died in a training session gone wrong.


The Seek Safely website lists different red flags to watch out for in dodgy training programmes, and Ms Kuik said a similar resource in the local context would be helpful, too.


On the coaches’ part, Ms Cheong stressed the importance of ethical coaching. 


This would entail things like avoiding avoiding hard marketing or abusive messaging, as coaching is "not something that you tell people they need".


"People have to choose it intentionally for themselves because they are empowered to take action,” she added.


It would also include the responsibility to coach in one’s area of specialisation and redirect the client to another professional if the client’s needs lie beyond that area of specialisation.


The mental health practioners said that despite the negative experiences one may face in the mental health and wellness space, the fact that these individuals are going out there to seek help or improve their mental wellness must be encouraged.


“What we need is a better education in darker dynamics and support each others’ courage to keep seeking help from safer, more skillful people,” said Ms Kuik.


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Parents settle with IMH, psychiatrist for S$330,000 over son's suicide; ex-lawyers press for 'unpaid' fees

Parents settle with IMH, psychiatrist for S$330,000 over son's suicide; ex-lawyers press for 'unpaid' fees
After initially seeking S$3.3 million in a medical negligence suit over their son's suicide, the parents settled for a sum of S$330,000, but one of the lawyers has urged the sum to be paid to court as he thinks they will "run off" with the cash.


Parents settle with IMH, psychiatrist for S$330,000 over son's suicide; ex-lawyers press for 'unpaid' fees

Lydia Lam
25 Aug 2023 02:50PM (Updated: 28 Aug 2023 12:16PM)

SINGAPORE: The parents who sued a private psychiatrist and the Institute of Mental Health for S$3.3 million (US$2.4 million) over alleged negligence linked to their son's suicide have settled for a sum of S$330,000.


However, the father's former lawyer filed court summonses asking for the money to be paid into court, as he felt the plaintiffs might "run off" with the settlement money while his fees of more than S$372,000 remain unpaid. 

A second lawyer, who acted for the deceased man's mother in the suit, is claiming fees of about S$141,000.

In a judgment released on Friday (Aug 25), Justice Choo Han Teck dismissed the summonses by the first lawyer. He said that all those involved may move on "sadder but wiser" if the lawyers can settle with their ex-clients on costs and "leave them with a sum sufficient as a balm for their grief".


Mr Steven Joseph Arokiasamy, a 68-year-old retiree who previously worked with the Ministry of Defence, and Madam Tan Kin Tee, a 67-year-old part-time teacher, had sued Dr Nelson Lee Boon Chuan and IMH for S$3.3 million.


They blamed the defendants for the suicide of their son, Mr Salvin Foster Steven, who died aged 31 in 2017.

Mr Arokiasamy was initially represented by Mr Vijay Rai, while Mdm Tan was represented by Mr Anil Balchandani.

However, the pair terminated the services of both lawyers in July, before the trial was set to begin in September.

About a week after this, the parents settled with the defendants and agreed to discontinue the suit.


On his judgment, Justice Choo said this would ordinarily mean "an uneventful end", but Mr Rai filed a summons for his law firm to record the settlement, with the sum of S$330,000 to be paid into court.


Mr Rai later filed another summons for his law firm to be joined as a plaintiff or claimant.


He wanted to be made a plaintiff so that he can pursue his own demands over the settlement. He said that his fees rendered so far came to about S$372,000, with a separate sum of about S$13,000 in disbursements likely to be incurred.

These amounts do not include a sum of about S$56,000 already paid to him, nor another S$40,000 in costs to be paid to the defendants for a discontinued action against a second psychiatrist.


Mr Balchandani, the former lawyer of the deceased's mother, said he would be seeking costs of about S$141,000. This does not include a sum of about S$10,600 that was already paid. Mr Balchandani expressed support for the two summonses brought by Mr Rai.


According to Justice Choo, Mr Rai filed the summonses because "he is anxious to have the S$330,000 paid into court because he thinks that the plaintiffs, especially the father, may 'run off' with the settlement money".


Justice Choo dismissed the two summonses, with Mr Rai's law firm to pay costs to the plaintiffs and defendants.


In explaining his decision, Justice Choo said the pleadings did not indicate what cause of action the parents relied on.

He said it appeared that they claimed that their son was prescribed the wrong medication, was not properly attended to and was wrongly diagnosed as suffering from depression and not schizophrenia.


However, the judge said these claims should have been made on their son's behalf, by the father suing as the administrator of his son's estate.

"It does not explain why the father (personally) and the mother were suing as plaintiffs," said Justice Choo. "In their respective affidavits, they claim that their son's death drove them to depression and they could not therefore work."


The parents said this led to them being dismissed from their jobs.


Justice Choo said that the parents' case appeared to be "a difficult one", with an early settlement sparing them much anger and grief, not just "on account of the loss of their son, but now fuelled and furthered by festering animosity with their own lawyers and a looming sense of dread over the fees".

He said the settlement that was reached, "without admission of liability, was "in itself right and fair", but said he was not satisfied that the fees incurred are justifiable.


He cited a previous document from November 2020 that estimated the fee for Mr Rai's law firm, inclusive of trial, to be about S$150,000.


This estimation was expected to be lower if the matter was settled before trial, which turned out to be the case.


"Despite having settled the suit before trial, Mr Rai is now claiming a sum of at least S$372,022.34, with an unknown amount yet to be claimed in further bills," said Justice Choo.


He said Mr Balchandani's fees of S$141,061.55, while a smaller sum, are "not insubstantial as well".


"In this connection, Mr Balchandani's support of both summonses is misplaced," said Justice Choo. "The overall sum which the father and mother have already paid and the sums the lawyers are now claiming against them amount to around S$600,000, almost twice the settlement sum received by them before trial."


He said the clients are entitled to have the lawyers' fees taxed, to determine what the actual amount payable is.


"Until that is done, I need not comment further - save to say that it is for Mr Balchandani and Mr Rai to justify why the plaintiffs should incur the costs of hiring two sets of counsel to act for them in the matter of the death of their son," said Justice Choo.


He said there were overlaps in the work done by both lawyers, which should be considered in rendering the final bill.

"It is not too late for parties to salvage something from this situation," concluded Justice Choo. 


"If Mr Balchandani and Mr Rai can come to a settlement on costs with their clients and leave them with a sum sufficient as a balm for their grief, then everyone concerned may move on, as they say, sadder but wiser."


Source: CNA/ll(rj)


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Content consist of issues on suicide, kindly read at one’s discretion.




Perhaps humans need a label

A label to make sense of

The whats

The whys

The whichs 

The whos

The when and.... 

The hows


Can't humans see MHC mental health challenges as....


An organic as a phase of uphill tasks that need to be experienced in totality?


An mental health hygiene ie. Emotional, Social and Psychological entrenchments that need to be address periodically?


An immensely "superstitious" beliefs that its by divine arrangements.... a life lesson that one need to learn and escape from the viscious cycle trapped within?




Labels, categorisations, classifications... the never ending processes, protocol and procedures. 


MHC are all listed in the DSM and ICD the professionals said


A buffet line for the professionals to pick and choose what is/are the best fit(s)


A list of checkboxes ticked, followed by the dispensement of a cocktail of medications 


As cold as a vending machine with no warmth or personalised services


It seems that they have forgotten their clients are an individual, a person with unique strengths and coupled with adversed traumatic experiences


Persons who are traumatised by their past, living anxiously in their here and now and fearful for the future. 


Some just choose to end it all so as to "reset" their life journey button.... entering into their next phase of life.... in hope to experience something different




One can never be in the shoes of the other no matter how hard one attempts to do it 


So kindly wake up humans (me included) ...... show a little kindness and more magnanimosity while believing the karmic cycle to avoid any hostilities 


Make this world a better and more enduring sanctuary to live in for you and for me


Perhaps perhaps just perhaps 


An ivory tower district full of ideals and aspirations that are tougher to achieve, realistically. 




SOS (Samaritans of Singapore)

1-767 (24hrs)


Care Email



Care Text: https://www.sos.org.sg

accessible via Chatbox function

Daily (24hrs)


For International helplines, kindly refer to Befrienders Worldwide. If you or someone you know is in immediate danger, contact 24-hour emergency medical services

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Commentary: Not all mental health apps are helpful. Here's what you need to know


There are thousands of mental health apps available on the app market, offering services including meditation, mood tracking and counselling, among others.

You would think such “health” and “wellbeing” apps — which often present as solutions for conditions such as anxiety and sleeplessness — would have been rigorously tested and verified. But this isn’t necessarily the case.


In fact, many may be taking your money and data in return for a service that does nothing for your mental health — at least, not in a way that’s backed by scientific evidence.


Although some mental health apps connect users with a registered therapist, most provide a fully automated service that bypasses the human element. This means they’re not subject to the same standards of care and confidentiality as a registered mental health professional. Some aren’t even designed by mental health professionals.

These apps also increasingly claim to be incorporating artificial intelligence (AI) into their design to make personalised recommendations (such as for meditation or mindfulness) to users. However, they give little detail about this process. It’s possible the recommendations are based on a user’s previous activities, similar to Netflix’s recommendation algorithm.

Some apps such as Wysa, Youper and Woebot use AI-driven chatbots to deliver support, or even established therapeutic interventions such as cognitive behavioural therapy. But these apps usually don’t reveal what kinds of algorithms they use.

It’s likely most of these AI chatbots use rules-based systems that respond to users in accordance with predetermined rules (rather than learning on the go as adaptive models do). These rules would ideally prevent the unexpected (and often harmful and inappropriate) outputs AI chatbots have become known for — but there’s no guarantee.


The use of AI in this context comes with risks of biased, discriminatory or completely inapplicable information being provided to users. And these risks haven’t been adequately investigated.


Mental health apps might be able to provide certain benefits to users if they are well designed and properly vetted and deployed. But even then they can’t be considered a substitute for professional therapy targeted towards conditions such as anxiety or depression.

The clinical value of automated mental health and mindfulness apps is still being assessed. Evidence of their efficacy is generally lacking.

Some apps make ambitious claims regarding their effectiveness and refer to studies that supposedly support their benefits. In many cases these claims are based on less-than-robust findings. For instance, they may be based on:


  • user testimonials
  • short-term studies with narrow or homogeneous cohorts
  • studies involving researchers or funding from the very group promoting the app or evidence of the benefits of a practice delivered face to face (rather than via an app).

Moreover, any claims about reducing symptoms of poor mental health aren’t carried through in contract terms. The fine print will typically state the app does not claim to provide any physical, therapeutic or medical benefit (along with a host of other disclaimers). In other words, it isn’t obliged to successfully provide the service it promotes.


For some users, mental health apps may even cause harm, and lead to increases in the very symptoms people so often use them to address. The may happen, in part, as a result of creating more awareness of problems, without providing the tools needed to address them.

In the case of most mental health apps, research on their effectiveness won’t have considered individual differences such as socioeconomic status, age and other factors that can influence engagement. Most apps also will not indicate whether they’re an inclusive space for marginalised people, such as those from culturally and linguistically diverse, LGBTQ+ or neurodiverse communities.


Mental health apps are subject to standard consumer protection and privacy laws. While data protection and cybersecurity practices vary between apps, an investigation by research foundation Mozilla concluded that most rank poorly.

For example, the mindfulness app Headspace collects data about users from a range of sources, and uses those data to advertise to users. Chatbot-based apps also commonly repurpose conversations to predict users’ moods, and use anonymised user data to train the language models underpinning the bots.

Many apps share so-called anonymised data with third parties, such as employers, that sponsor their use. Re-identification of these data can be relatively easy in some cases.


Australia’s Therapeutic Goods Administration (TGA) doesn’t require most mental health and wellbeing apps to go through the same testing and monitoring as other medical products. In most cases, they are lightly regulated as health and lifestyle products or tools for managing mental health that are excluded from TGA regulations (provided they meet certain criteria).


Although consumers can access third-party rankings for various mental health apps, these often focus on just a few elements, such as usability or privacy. Different guides may also be inconsistent with each other.

Nonetheless, there are some steps you can take to figure out whether a particular mental health or mindfulness app might be useful for you.


  • consult your doctor, as they may have a better understanding of the efficacy of particular apps and/or how they might benefit you as an individual
  • check whether a mental health professional or trusted institution was involved in developing the app
  • check if the app has been rated by a third party, and compare different ratings
  • make use of free trials, but be careful of them shifting to paid subscriptions, and be wary about trials that require payment information upfront
  • stop using the app if you experience any adverse effects.

Overall, and most importantly, remember that an app is never a substitute for real help from a human professional.


The Conversation

Jeannie Marie Paterson is a Professor at the Melbourne Law School. Nicholas T Van Dam is the inaugural Director of the Contemplative Studies Centre and Associate Professor at the Melbourne School of Psychological Sciences at the University of Melbourne. Piers Gooding is a Senior Research Fellow at the University of Melbourne Law School.


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“Creating Hope Through Action”

Suicide is a major public health problem with far-reaching social, emotional and economic consequences. It is estimated that there are currently more than 700 000 suicides per year worldwide, and we know that each suicide profoundly affects many more people.

“Creating Hope Through Action” is the triennial theme for the World Suicide Prevention Day from 2021-2023. This theme serves as a powerful call to action and reminder that there is an alternative to suicide and that through our actions we can encourage hope and strengthen prevention.

By creating hope through action, we can signal to people experiencing suicidal thoughts that there is hope and that we care and want to support them. It also suggests that our actions, no matter how big or small, may provide hope to those who are struggling.

Lastly, it serves as a reminder that suicide prevention is a public health priority and urgent action is required to make sure suicide mortality rates are reduced. WHO will continue to work with its partners to support countries to take concrete measures in this direction.

World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organization (WHO). The 10 September each year aims to focus attention on the issue, reduces stigma and raises awareness among organizations, governments, and the public, giving a singular message that suicides are preventable.


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** Content contain issues on suicide, kindly read at your own discretion and seek professional support if need be. 


Imagine if this commentary would to be post and publish on the mainstream print and social media, how will the response be like?  Or will it even make it to that medium in the first place?




" The month of September is dedicated to World Suicide Prevention month and 10th is the day to commemorate this. 


Acoording to current statistics "There would be at least ONE person who will choose to end their life prematurely and abruptly (on their own) daily in Singapore." Some of us who have multiple encounters with people who has completed suicide or experienced the journey of suicide attempt(s) will know this: 


"Suicide completion is unpreventable "


If suicide is preventable or zero suicide is highly achieveable are your mantra then may I suggest that you belong to the one of the many mainstream thinkers who is being unrealistic, living in their own bubble (some call it ivory towers). 


When a person completed suicide it is absolutely not an act of impulse. On the contrary, it is often carefully planned and well thought through. That determination and courage he possessed are undescrible, beyond any words in text and spoken. I am definitely not trying to glorify suicide in any sense but citing a mere reality that often the mainstreamers are so opaque to see. If we are told not to be an extremists when giving our opinions then let's face it, the current time, money and manpower resources being invested in suicide awareness will definitely reap a poor ROI. Am I being an extremist standing on the other end? No, I am just trying my best to harmonise in giving both my subjective and objective views on this. 


One can write an entire dissertation on this topic. Perhaps it is seriously time to better review what are the ways to better improve one's holistic well-being rather than focusing on this suicide prevention fad. 


I said my piece... and I rest in peace. 

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Do signed up for the Free & Online Mental Health & Well-Being Global Summit happening September 12-18. Please check it out here and join in for this extraordinary event on creating better mental health & well-being. Day 1 has started and one can view videos presented by the plenary speakers for free once its launched, for the first 48hrs. Content can also be purchased at an affordable rate as well. 


Day 1: Redefining Mental Health: Building Ecosystems of Well-Being Cassandra Vieten, PhD

Hear about the many innovative treatments and practices that are revolutionizing how we approach mental health and well-being
Discover what it means to create an ecosystem of well-being and why it is important to spend time and attention on practices that support mental, emotional and psychological resilience. Why mental health is a whole body affair and how we can shift our focus from what we need to get rid of — symptoms, addictions, neuroses — to what we can add


Here’s the thing: Mental Health and Well-Being are not what you think. Or, not only what you think...

Mental health is not just in our heads. It is in our whole bodies — our hormones, our glucose levels, our gut, our energy and our spirit.

Mental health is not just limited to our insides. It relies on our outsides as well – our relationships, our surroundings, our communities, environments and society. In short, mental health is everywhere. That’s why it doesn’t make sense to focus only above the neck to cultivate mental and emotional balance and resilience. Mental health and well-being rely on a whole bunch of stuff, like your: Biology – including “hard-wiring” and genetics, but also your hormones, blood sugar, microbiome (gut health), neurotransmitters, vitality, brain function, structure and more…all of which are affected by and can be influenced by:


  • exercise and movement
  • what, how and when you eat
  • sleep quality, cycles of activity and renewal
  • time in light/sunshine vs. dark
  • exposure to heat and cold
  • and much more
  • strong relationships, friendships, social support and community
  • connection to nature, animals, and the Earth’s elements and seasons
  • connection to religion or spirituality for some, and for others important human values such as truth, justice and beauty
  • experiencing and expressing virtues such as honesty, gratitude and love
  • having a sense of meaning and purpose
  • engaging in art, music, creativity and play
  • being able to contribute or be of service to others, society and the world
  • taking time in contemplation, reflection, mindfulness, meditation and quiet time


Given what we know now, focusing solely on the head (like, only addressing brain chemistry, or only addressing thinking patterns) to treat mental health issues or cultivate mental well-being — in ourselves, in our loved ones, in society — just doesn’t make sense.


Our mental health and well-being rely on an interlocking set of practices and conditions (an ecosystem) that we can gradually build over time to create the optimal conditions for our well-being in body, mind and spirit. The great news? We know what these practices and conditions are, and we can build a personal system that supports our thriving.


Credit: Mental Health & Well-Being Global Summit September 12 - 18, 2023

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What Is Mental Wellness?


Five Key Things to Know About Mental Wellness
1. Mental wellness is more than just the absence of mental illness.
The complex relationship between mental illness and mental wellness is best understood by envisioning them sitting on two separate continuums (see figure below). The horizontal axis measures mental illness from high to low, while the vertical axis measures mental wellness from languishing to flourishing. About 85% of the world’s population does not have a diagnosed mental illness, but these people are not all “mentally well” or thriving because of pervasive stress, worry, loneliness and other challenges. On the other hand, those who have a diagnosed mental disorder can still have moderate or positive mental wellness (e.g., having good relationships, feeling happy, or functioning well at a job). Practices that increase our mental wellness are increasingly recognized as protective factors for our mental health, as well as helping reduce the severity and symptoms of mental illness (alongside conventional treatment regimens).


2. Mental wellness is an active process of moving from languishing to resilience to flourishing.
On one level, mental wellness is about prevention; coping with life’s adversity; and being resilient when we face stress, worry, loneliness, anger and sadness. On another level, mental wellness moves us toward a deeper, richer and more meaningful human experience, which is often described as flourishing. What it means to flourish is subjective and personal, and it is shaped by individual values, culture, religion and beliefs. For one person, it can mean functioning at the top of their game and achieving their life goals, while for another, it might mean self-transcendence.


3. Mental wellness helps to shift the perspective away from stigma to shared humanity.
Even though the mental health field has done a lot of work to mitigate the stigma surrounding mental illness, a sense of shame, denial and secrecy continues to afflict people in communities and cultures around the world. Mental wellness can help shift our focus toward a more positive and empowering approach (how we can feel, think, connect and function better), rather than just avoiding or coping with illness. It emphasizes our capacity to build resilience; to reduce suffering; to find inner peace and joy; and to seek meaning, purpose and connection—a universal longing shared by all people.


4. Mental wellness grows out of a grassroots, consumer-driven movement.
People desperately need non-clinical, non-pathologizing strategies to cope with everyday mental and emotional challenges like stress, burnout, loneliness and sadness. Evidence shows that improving our mental wellness can even reduce our risk of developing mental illness, but not enough attention is paid globally to mental illness prevention and mental wellness promotion. Consumers, practitioners and businesses have led the charge in seeking self-directed, alternative solutions outside of the established fields of medicine, psychiatry and psychology. They are bringing centuries-old natural and holistic mental wellness modalities into the mainstream, pushing science into areas where it has not gone before to consider the efficacy of ancient practices and emerging solutions.


5. Mental wellness is multi-dimensional, holistic and personal.
Mental wellness recognizes the integrated and holistic nature of our health and wellbeing. The state of our mind affects our body and vice versa. Sometimes, when our circumstances change, we need to adopt new practices or strategies to handle stress, improve resilience, and deal with adversity. In this study, we segment the key strategies for mental wellness into four main pathways: activity and creativity, growth and nourishment, rest and rejuvenation, and connection and meaning. Each of these has mind-body and internal-external dimensions (see figure below). Together, they represent a menu of options for pursuing mental wellness; there is no set path, and people can choose the strategies and activities that are the most important or effective for them.


The Mental Wellness Economy
GWI defines the mental wellness economy as consumer spending on activities, products and services whose primary aim is to help us along the mental wellness pathways of growth and nourishment and rest and rejuvenation. It encompasses four subsectors:

  • Self-improvement
  • Brain-boosting nutraceutical and botanicals
  • Meditation and mindfulness
  • Senses, spaces and sleep

GWI estimates that the global mental wellness industry was worth $120.8 billion in 2019 (see figure below). This estimate represents consumer expenditures on the four subsectors that we have defined as part of the mental wellness industry; it focuses on proactive, wellness-focused, consumer- and private sector-driven activities (that is, things outside of the psychiatry, psychology and clinical/medical spheres). These figures are broad, global estimates that we aggregated based on a wide range of secondary data sources. [Note that the data presented here were extracted from GWI’s 2020 report, Defining the Mental Wellness Economy. Updated mental wellness data can be found at: Wellness Economy Data Series.]



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Credit: The Global Wellness Institute TM (GWI) is a nonprofit organization with a mission to empower wellness worldwide by educating public and private sectors about preventative health and wellness.


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Over 140 with mental health conditions trained to provide peer support to help others recover


UPDATED NOV 20, 2022, 6:43 PM SGT


SINGAPORE – More than 140 people with mental health conditions have undergone training to become peer support specialists to help others who are struggling.

The Peer Support Specialist Programme, launched in 2016 by the National Council of Social Service (NCSS), has conducted nine runs so far. It equips people with mental health conditions with the skills needed to leverage their experiences while supporting others on their recovery journey.


Of those trained, close to half are employed as peer support specialists or in roles related to peer support and mental health in social service agencies and healthcare institutions, director for services at NCSS Sim Hui Ting said.


Mr Tan Kok Liang, 47, was diagnosed with schizophrenia in 2009 after he started hearing voices and experiencing hallucinations. While most people found comfort at home, he would hear the tortured screams of a woman along his corridor.


When the screaming got louder, he called the police and ran up to his neighbour’s homes to ask them to stop torturing the woman.


The police advised his mother to seek professional help. Mr Tan was referred to Anglican Care Centre Simei for rehabilitation in 2010 after psychiatric evaluation.

Mr Tan, who was previously a property agent, said he felt hopeless as he never imagined he would be suffering from mental illness, and spent his days sleeping, waking only for meals.


“Things started changing a year later. I noticed people around me moving on with life. Some started going out to work and study. I started thinking that maybe I could do so as well.“That motivated me to carry on, and made me more determined to be more active in Simei.”


A decade later, Mr Tan is now a programme assistant and peer support specialist at the same centre where he once underwent rehabilitation. He was part of the pioneer batch in NCSS’ Peer Support Specialist Programme in 2016.


He said his experience with mental health issues helps him advise his peers on how to manage symptoms and prevent relapse.


“Being like a friend to them, I act as a pillar of support (to help them) to receive appropriate help in their journey. Sharing my recovery story gave me an opportunity to use my lived experience to support and help other fellow members.”


He added: “I am living evidence that recovery is possible, and that gives hope to the members.”


Ms Sim said that through sharing similar experiences in managing the challenges of mental illness, peer support specialists provide a relatable model of what success could look like in everyday life.


“They could inspire other people with mental health conditions to believe that they can recover, reintegrate into the workplaces and community, and lead meaningful lives.”

Many peer support specialists have received positive feedback on their contributions in the mental health landscape, she added.


NCSS is reviewing the peer support services and training to evaluate how to improve the programme and potentially broaden the roles of peer support specialists beyond mental health services.


A survey conducted in March with 607 Singaporeans found that two in five people have experienced mental health struggles. Almost 80 per cent of respondents also said that they know someone who has struggled with mental health.


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Benefits of peer support


There is a rise in recovery-oriented care models in the West, where people with lived experience of mental illness become formal service providers due to their abilities to better empathise with and provide fresh perspectives for patients. However, there is still much resistance in mental healthcare systems in Asia, which primarily adopts a biomedical approach. This form of caregiving stems from the perception that ‘health’ is an absence of diseases, thereby playing a role in fostering negative attitudes to the concept of recovery in the field of mental health. The lack of recovery-oriented care models in Asia also contributes to its cultures’ more substantial social stigma surrounding mental health concerns. 


Who are peer support specialists and what do they do?

This article seeks to introduce peer support as a growing profession in mental health settings that are increasingly adopting recovery-oriented approaches to well-being. Termed as “peer support specialists” in Singapore, these are people with lived experiences of struggles with mental health who are trained to support current mental health patients. They form an essential part of recovery in mental health settings due to their personal experiences and ability to provide peer support in ways that professional training is unable to replicate.


What is the difference between Peer Support Specialists and Experts by Experience?

Countries such as Singapore and the United States use the term ‘Peer Support Specialists (PSS)’ while in the United Kingdom, ‘Expert by Experience (EbyE)’ is used.


What are the benefits of peer support as a complement to seeking professional help?

Unlike trained mental health professionals, PSS engage with patients differently by providing emotional support and encouragement. According to a Nesta article, PSS have the ability to empower patients to open up about their personal experiences, hence sharing more meaningful connections and facilitating recovery. Furthermore, involving PSS in mental healthcare creates an active partnership approach through mutual respect and interest via the provision of different perspectives. Last but not least, the inclusion of peer support specialists helps fast forward the process of moving clinically-driven treatments in mental health institutions to an emphasis on holistic recovery. The last point is particularly crucial as peer support helps people create hopeful life narratives during difficult situations, instead of viewing themselves as weak, deficient or ‘mentally ill’ which tends to happen in biomedical settings. 


How are they involved in Singapore’s mental health scene?

While Singapore still has a long way to go with regards to mental health awareness, recent situations such as increased mental health cases arising from the Covid pandemic and the River Valley High School tragedy has forced society at large to improve mental health support in the country. Having PSS in mental health recovery is an example. Institute of Mental Health provides peer support services, and training is available for those who are keen on becoming one through programmes such as the Peer Support Specialist Programme by the National Council of Social Service.


Increasingly, with mental health being brought to the public’s attention, having a better understanding of the mental health scene and offering support is more pertinent than ever. This is where PSS play a crucial role. While peer support is not a replacement for professional help, it can work together with treatment. 



Kuek JHL, Chua HC, Poremski D Barriers and facilitators of peer support work in a large psychiatric hospital: a thematic analysis General Psychiatry 2021;34:e100521. doi: 10.1136/gpsych-2021-100521






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Study: No reliable evidence of mental health first aid’s effectiveness

by Ashleigh Webber

1 Sep 2023

Many employers offer mental health first aid training. But is there enough evidence behind it?

There is no reliable evidence to suggest that mental health first aid is effective, and studies examining the practice are at a ‘high risk of bias’.


This is according to Cochrane, the charity that examines medical research to help medical professionals formulate an evidence-base for the health interventions they enact.

Researchers reviewed 21 trials of mental health first aid (MHFA) training, involving 22,604 participants, and found that many studies did not measure relevant outcomes, lacked good-quality evidence, were not sufficiently large enough to show potential differences in outcomes, and had a “high risk of bias”.


MFHA is a brief training programme that was developed in Australia, but has been rolled out by hundreds of employers worldwide and is widely used in the UK. Many employers have nominated ‘mental health first aiders’ among their workforce.


Mixed response to MP’s mandatory mental health first aid training proposal

The programme covers the symptoms of various mental health conditions, including when someone might be experiencing a crisis, and trainees are often taught how to provide immediate help to people experiencing mental health difficulties and how to signpost to professional services.


However, many employee health and wellbeing professionals have been critical of the programme and have raised concerns about it being used as a tick-box exercise. The pressure it puts on employees who have volunteered as mental health first aiders has also been raised as a concern.


Cochrane’s Mental Health First Aid as a tool for improving mental health and well‐being report found that the 15 studies that compared MHFA training with no other intervention showed that MHFA “may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain”.


No study measured mental health service usage at six to 12 months, and the researchers could not find published data on any adverse effects or harms resulting from MHFA.

Only one study with usable data compared MHFA training with an alternative mental health literacy intervention, but it did not measure outcomes in individuals in the community, nor did it examine outcomes at six to 12 months after the training programme was completed.


The authors concluded there was a “lack of good quality evidence” as to the efficacy of MHFA training.

Lead author of the review Rachel Richardson, a researcher at Cochrane, told OHW+ that they found only a small number of papers that attempted to answer the question of whether MHFA training actually improves the mental health of employees.


She said: “The evidence that we did find was of very low certainty – there were flaws in the way that the research had been designed and carried out which made the findings less reliable.

“Broadly speaking, we did find some evidence that MHFA training may improve mental health literacy and reduce stigma among trainees, although there were frequently too few people included in the studies to be able to reach definitive conclusions.”

Richardson suggested that employers should consider what they are aiming to achieve and then decide on an intervention based on the evidence available.


“If the aim is to improve the mental health and wellbeing of staff, for example, then there is no good evidence that MHFA will achieve this,” she said.


“Unfortunately, looking at other interventions, it’s clear research has not delivered the evidence that we would like to use as the basis for any generally applicable shift in policy or workplace practices to improve employees’ mental health. In the absence of any such broad interventions, employers might like to ask staff whether there are specific issues in the workplace that negatively affect their mental health and address these directly,” Richardson added.


Earlier this year Conservative MP Dean Russell proposed legislation that would make offering MHFA training a legal requirement in UK workplaces, however there has been no indication this would be taken forward.

Ashleigh is editor of OHW+ and HR and wellbeing editor at Personnel Today. Ashleigh's areas of interest include employee health and wellbeing, equality and inclusion and skills development. She has hosted many webinars for Personnel Today, on topics including employee retention, financial wellbeing and menopause support. Prior to joining Personnel Today in 2018, she covered the road transport sector for Commercial Motor and Motor Transport magazines, touching on some of the employment and wellbeing issues experienced by those in road haulage.


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The Newer Narratives to Mental Health and Wellness (v.2023)


Human created DSM and ICD 70 years ago

The bible for Psychiatric World 

Claiming there are no cure to mental illnesses 

only to be treated with professional interventions


The 5Ps of case formulation

Presenting, Predisposing, Precipitating, Perpetuating, and Protective factors

Co-relates to the Biological, Psychological, Social, Spiritual, Sensual 

Not forgetting the Body, Mind and Spirit Head, Heart and Hand


The newer narrative now is to look beyond the conventional 

Opening oneself to the renaissance of mental health and wellness

In fact the cure to metal illnesses has been there all along


In ancient days, our forefathers used

I-Ching and Western Astrological to seek for life events answers

Nature, Arts, Exercise, Creativities, Melodies, Sauna and the even Jacuzzi

To harmonize and reconcile with their intrinsic, 

inconsistencies so as to gain more inner peace, near equilibrium 


In present days, perhaps a quicker remedy is needed 

Patience and applied wisdom often are out of the equation 

Hence came the Psychotropics medications, ECT treatments 

and the latest, Transcranial Magnetic Stimulation (TMS)


( According to Google

TMS  is "supposed to replace ECT

used to treat depression that has not responded to other therapies

but is often not as effective as ECT for very severe illness.

It involves the use of rapidly alternating magnetic fields to stimulate specific areas of the brain") 


The once non mainstream has become the mainstream in a full cycle

Mental illness is no longer seen as binary

it is on a continuum, a spectrum

Now the latest, in the quadrant (with X and Y axis)


How amazing our Universe is,

giving mankind the wisdom so as to salvage their dignity 

their once foolishness that almost detriment a community of kindred spirits


Is making a U-turn necessary?  

Why can't Modern Psychiatric and Ancient remedies be married? 

How about exploring and expanding its repertoire 

For another Newer Narrative to Mental Health and Wellness v.2024?





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'Your story matters': MMA fighter Angela Lee opens up on new initiative, suicide attempt and sister Victoria’s death

In her first interview in Singapore since Victoria’s death, ONE Championship titleholder Angela Lee talks about her non-profit organisation Fightstory, which aims to help people with their mental health.


'Your story matters': MMA fighter Angela Lee opens up on new initiative, suicide attempt and sister Victoria’s death


Michael Yong
26 Sep 2023 07:53PM
(Updated: 26 Sep 2023 07:56PM)


Warning: This story discusses suicide and contains descriptions of a suicide attempt.


“The feeling of missing her doesn’t go away. That’s the hardest part – I don’t think that will ever fully go away.”


For mixed martial arts (MMA) champion Angela Lee, the pain of losing her younger sister Victoria remains raw. Aged 18, Victoria took her own life on Dec 26, 2022.

Mental health is a subject close to Lee's heart. Last week, the 27-year-old revealed that her car crash in Hawaii in 2017 was a suicide attempt and not an accident.

Speaking to CNA during her first trip back to Singapore since Victoria’s death, she opened up about her younger sister, her own dark moments six years ago and how they spurred her to set up non-profit organisation Fightstory to help people with their mental health.


Angela, Victoria and their brother Christian Lee all fought at ONE Championship events, representing Singapore and the United States.

Angela is ONE’s reigning atomweight champion and Christian holds the lightweight and welterweight titles, but neither has fought since Victoria’s death.


Lee's voice broke slightly as she spoke about her younger sister. Paying tribute to her, she said her younger sister was “wise beyond her years, even though she was 18”.

“Victoria was the kind of person who never really wanted to worry anyone. She was very considerate and she’s always looking out for others’ feelings,” she added.

“I think that’s one of the main reasons why she didn’t fully come out and share what she was going through, because she didn’t want any of us to be concerned or worried. I think a lot of people feel like that sometimes.”


She described Victoria as an "old soul" who loved vintage music records and baking cheesecakes.


“She was a very talented individual, she just excelled at everything she did … and when we (Angela and her family) come home, she's there at the airport, with this big cheesecake for us.


One of Lee's favourite memories of Victoria was surprising her for her birthday in 2018 while they were in Singapore. A day before Lee's fight - a successful defence of her title against Japan's Mei Yamaguchi - she arranged balloons and a cake in Victoria’s hotel room.


“She was so surprised and she was speechless,” recalled Lee with a smile.


“She was like, ‘Did you do this?’ ... and she was so happy. I was so glad, she deserves all these special moments.”


Victoria was close to Lee, her husband Bruno Pucci and their two-year-old daughter Ava. When Ava was born, her parents decided that they wanted Victoria to be her godmother.


“We’ll do our best to keep living life and keep her memory alive. It’s hard because my daughter Ava, she’s just so young,” she added.

“But I do my best to show her photos and videos and just keep talking about Victoria, what she was like, so that she can hold on to some kind of a memory of her.”


The youngest person to become an MMA world champion at 19 years old, Lee was struggling to make weight for a title defence in 2017. She crashed her car in November that year and was rescued by passing motorists.


Six years on, Lee said she was in a “very dark place” then, and felt very alone.


“I felt like I was dealing with a lot of pressure. At the same time, I felt like I couldn’t speak up about it or say anything to anyone,” she told CNA.

“That resulted in me purposely crashing my car ... leaving it in fate’s hands to see what happens next to me, and I just didn’t really care at that point.”

Looking back, she said she did not think to reach out to anyone before the incident.


She added: “I will be honest. I was never fully transparent, or I never fully spoke about everything that I was feeling. I thought that it was normal what I was feeling, and I just thought that I needed to keep on going, just power through.


“I understood that there were ups and downs to this life.”


Her job is in stark contrast with opening up about weaknesses or struggles, said Lee. As a fighter, you are taught not to show any vulnerability – “we put up this shield or this mask”, she added.


That mindset got her to where she is today, she admitted, but it “lacks a balance”. It should not be "win at all cost", and your life and mental health should be of top priority.

“A lot of times, when you’ve trained for so many years to do whatever it takes to win, you’re often sacrificing yourself and putting yourself in danger and at risk.

“It’s hard to talk about because it very much could be a good thing and beneficial, but then also, it could be a bad thing and detrimental. So finding that balance is really key.”


Lee recalled how Pucci had rushed back to Hawaii from Singapore after her crash.

She told him the truth. He was shocked and confused, but at the same time relieved, because he already felt “something was a little bit off”, she said.

“I told him ‘I am so thankful that you asked me’ … as difficult as it was to answer, that’s what I was needing,” she said.

She was visibly emotional as she spoke about her husband and how he has supported her.


“Through it all, (he was) very patient, not forcing me to speak more than I was ready to. But when I was ready to speak, he was there to listen.

“It’s very rare to find that kind of trait in people. Through the years, our relationship has just gotten stronger and stronger … with each obstacle or adversity it’s just grown, and now with our daughter, (it’s grown) so much more.

“I think what’s most important is that we’re aligned on this communication and always having this honesty between each other.”


Lee encouraged people to reach out to their loved ones who may be struggling.


“I think sometimes we need to ask the people we love those hard questions, because we care, because we want them to know … we give them that opportunity to speak up. And if he (Bruno) didn’t ask me, I don’t know if I would ever be able to share,” she added.

Since her revelations last week, she has received countless messages from family and strangers as well, with many sharing their own struggles with mental health.

Why talk about it now?

“If I’m going to be that voice that says, ‘Hey your story matters, and it’s important and it can help someone else’, then I need to take that first step,” she explained.


Lee's car crash and Victoria’s death spurred her to set up non-profit organisation Fightstory. Although the aim is to champion a movement for mental health and wellness through combat sports, it is not only for fighters.

“Whether you’re a fighter in the cage, or you’re a teacher or a doctor or a stay-at-home mum, we’re all fighters in our own way,” said Lee.

Although still in its infancy, Lee said Fightstory will put out a podcast and videos on mental health, as well as a programme to help people with their nutrition and physical health.

“If you are eating the right things, if your recovery is good, if you are sleeping well enough, if you are taking care, going outside and getting what you need, I think that is going to boost your mental health greatly.”

She hopes people will find a community through Fightstory, where they can share their own mental health struggles and stories. It gives others hope when more people share about their experiences, Lee said.

“I’m not here to tell everyone to open all those old wounds and share your story because there’s a time and place for everything. Everyone has their own journey of self-healing.

“But if you are at that place where you’re ready to open up and share what you’ve gone through, it can be extremely healing as well. And to look back, and to see how far you’ve come since then, it’s a very proud feeling to have.”


Where to get help:

Samaritans of Singapore Hotline: 1767

Institute of Mental Health’s Helpline: 6389 2222

Singapore Association for Mental Health Helpline: 1800 283 7019


You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.


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Credit: Author: Peter A Levine, PhD Developer of Somatic Experiencing


(This article originally appeared in the The SAGE Encyclopedia of Theory in Counseling and Psychotherapy; Ed. Ed Neukrug Thousand Oaks: SAGE, 2015. Print.)

Definition of the topic: Bottom-up Processing

Trauma affects brain, mind and body. However, the body often is neglected in the psychotherapy of trauma. SE teaches that trauma is not caused by the event
itself, but rather develops by the failure of the body, mind, spirit and nervous system to process extreme adverse events. Many approaches to treating trauma
aim to correct faulty cognitions and/or access and express emotional content. In contrast, the approach presented here, engages the “Living Body,” through
contacting primal sensations that support core autonomic self-regulation and coherence. Work at this level allows the Body to speak its mind. In doing this, the processing moves upwards from these core sensations, upwards, towards feeling/emotions and cognitions. This way both mind and body are given an equal place in an integrative and holistic treatment of trauma.

Historical Context
In the early 1970’s, Somatic Experiencing (SE) was developed by Dr. Peter A. Levine, a biophysicist and stress researcher who received his doctorate in Medical Biophysics from UC Berkeley in 1977 and then in Psychology from International University in 1979. Levine’s clinical work began in the late 1960’s with a private practice focusing on mind/body awareness and stress reduction. He refined his techniques to specifically engage our innate capacity to rebound from exposure to life threat and in response to overwhelming events. As an ardent student of naturalistic animal behavior (ethology) he recognized that animals in the wild exhibited an apparent immunity to becoming traumatized.

Combining this understanding with his studies of comparative neurophysiology, Levine realized that, as part of the animal kingdom, we utilize the same parts of the brain to mediate survival instincts and behaviors. He reasoned that the human animal, should therefore also exhibit the same capacity to rebound from threatening encounters. Through mind/body awareness, Somatic Experiencing evolved to help people tap into the same innate resilience. Levine’s work has been applied to many kinds of trauma including motor vehicle and other accidents, molestation, rape, invasive medical procedures, war trauma, natural disasters, torture, as well as to developmental and perinatal stress. In recognition for his landmark work in developing Somatic Experiencing, Levine received the 2010 Lifetime Achievement Award from the US Association of Body Oriented Psychotherapy as well a similar award from the Reiss-Davis Child Study Center for his contribution to infant and child psychiatry (2011). Somatic Experiencing® is taught worldwide and provides effective skills appropriate to a variety of healing professions including: mental health, medicine, physical and occupational therapies, bodywork, addiction treatment, education, as well as community leadership. For information see: www.SomaticExperiencing.com

Theoretical Underpinnings
SOMATIC EXPERIENCING® (SE) is a body awareness oriented, “bottom-up,” approach for the treatment for stress and trauma. It is a naturalistic, psychobiological method for resolving trauma symptoms and relieving chronic stress byre-establishing Core Autonomic Nervous System Regulation. This approach helps to build resilience and enhances the individual’s capacity to have new empowered bodily (interoceptive) experiences, those that contradict the previous traumatic ones of fear, overwhelm and helplessness. In addition, the SE approach releases traumatic shock, a key to transforming PTSD and the wounds of emotional and early developmental attachment trauma. SE offers a framework to assess where a person is “stuck” in the fight, flight, freeze, or collapse responses, and provides clinical tools to resolve these fixated psychophysiological triggers. When acutely threatened, we mobilize vast energies to protect and defend ourselves. We duck, dodge, twist, stiffen and retract. Our muscles contract to fight or flee. However, if our actions are ineffective, we freeze or collapse. This “last ditch” innate defense of shutdown, when observed in animals, is called tonic immobility and is meant to be a temporary state of paralysis. A wild animal exhibiting this acute physiological shock reaction will either be eaten, or if spared,
resume life as before its brush with death. Humans, in contrast to other animals, frequently remain stuck in a kind of limbo, not fully reengaging in life after experiencing threat as over- whelming terror or horror. In addition, they exhibit a propensity for freezing in situations where a non-traumatized individual might only sense danger or even feel some excitement. Rather than being a last- ditch reaction to inescapable threat, paralysis becomes a “default” response to a wide variety of situations in which one’s feelings are highly aroused. For example, the arousal of sex may turn unexpectedly from excitement to frigidity, revulsion or avoidance. Although humans are also designed to rebound from high-intensity survival states, we also have the problematic neocortical ability to override the natural regulation. Through rationalizations, judgments, shame, enculturation, and fear of our body sensations, we are able to disrupt our innate capacity to self-regulate, essentially “recycling” disabling terror and helplessness. If the nervous system does not reset after an overwhelming experience, sleep, cardiovascular, digestion, respiration and immune system function become disturbed. Unresolved physiological distress can also lead to an array of cognitive, emotional and behavioral symptoms.

Major Concepts
SE facilitates the completion of self-protective motor responses and the release of thwarted survival energy bound in the body, thus addressing the root cause of trauma symptoms. This is approached by gently guiding clients to develop increasing tolerance for difficult bodily sensations and suppressed emotions. It is critical to resolve the biological shock reactions and then, secondarily, process related emotions, perceptions and cognitions. This entails bringing the client out of immobility and into the active empowered defensive responses which were previously lacking at the time of the traumatic experience. Another key concept in Somatic Experiencing is to not retraumatize the client by exposing the individual’s experience too rapidly or too intensely. To do this, the therapist must accurately track the client’s inner experience. SIBAM is a map which allows t therapist to join with client’s as a means of following and mapping the clients inner experience. It details the experiential channels of Sensation(Internal-Interoceptive), Image, Behavior (both voluntary and involuntary), Affect(feelings and emotions) and Meaning (including old/traumatic beliefs and new understandings). Being able to track the client’s channel allows you to use the appropriate language. For example, to respond to the thought: “I am a badperson” an appropriate response might be “oh, so you have the thought that you are a bad person,” i.e. normalizing that this is a (potentially neutral) observation and then reflection: “where in your body to notice that?” Somatic Experiencing® catalyzes corrective bodily experiences that contradict those of fear and helplessness while resetting the nervous system, restoring inner balance, enhancing resilience to stress, and increasing people’s vitality, equanimity and capacity to actively engage in life. SE does not require the traumatized person to re-tell or re-live the traumatic event. Instead, it offers the opportunity to engage, complete and resolve -- in a slow and gradual way --the body’s fight, flight, freeze and collapse instinctual responses. Individuals locked in anxiety or rage, relax into a growing sense of peace and safety. Those stuck in depression, gradually experience their feelings of hopelessness and numbness transformed into empowerment and mastery.

When working with traumatic reactions, such as states of intense fear, Somatic Experiencing® provides therapists with nine essential building blocks. In therapy sessions, these steps are intertwined and dependent upon one another and may be accessed repeatedly and in any order. However, if this psychobiological process is to be built on firm ground, Steps 1, 2 and 3 must occur first and must follow sequentially. Thus, the therapist needs to:

1. Establish an environment of relative safety.-- The therapist must help to create an atmosphere that conveys refuge, hope and possibility. For traumatized individuals, this can be a delicate task.


2. Support initial exploration and acceptance of sensation.-- Traumatized individuals have lost both their way in the world and the vital guidance of their inner promptings. Cut off from the primal sensations, instincts and feelings arising from the interior of their bodies, they are unable to orient to the “here and now.” Therapists must be able to help clients navigate the labyrinth of trauma by helping them find their way home to their bodily sensations and capacity to selfsoothe.


3. Establish “pendulation” and containment: the innate power of rhythm. While trauma is about being frozen or stuck, pendulation is about the innate organismic rhythm of contraction and expansion. It is, in other words, about getting unstuck by knowing (sensing from the inside), perhaps for the first time, that no matter how horrible one is feeling, those feelings can and will change.


4. Titration is about carefully touching into the smallest “drop” of survival-based arousal, which increases stability, resilience and organization and prevents retraumatization.


5. Replacing Passive with Active Responses.---This provide a corrective experience by supplanting the passive responses of collapse and helplessness with active, empowered, defensive responses.


6. Uncoupling fear from immobility.-- Separate or “uncouple” the conditioned association of fear and helplessness from the (normally time-limited but now maladaptive) biological immobility response….the “physio-logical” ability to go into, and then come out of, the innate (hard-wired) immobility response is the key both to avoiding the prolonged debilitating effects of trauma and to healing even entrenched symptoms.

7. Resolve hyperarousal states by gently guiding the “discharge” and redistribution of the vast survival energy mobilized for life- preserving action while freeing that energy to support higher- level brain functioning. As one’s passive responses are replaced by active ones in the exit from immobility, a particular physiological process occurs: one experiences waves of gentle involuntary shaking and trembling, followed by spontaneous changes in breathing—from tight and shallow to deep and relaxed.


8. Engage self-regulation to restore “dynamic equilibrium” and relaxed alertness.--- A direct consequence of discharge of the survival energy mobilized for fight-or flight is the restoration of equilibrium and balance.


9. Orient to the here and now, contact the environment and reestablish the capacity for social engagement. --- Trauma could appropriately be called a disorder in one’s capacity to be grounded in present, here-and-now, time and to engage, appropriately, with other human beings.

Therapeutic Process
Just as she did every morning at work, Sharon was reading over her emails. It was a crisp, clear New York autumn day. Startled by a thunderous, deafening crash, she turned to witness the walls in her office moving twenty feet in her direction. Though Sharon was mobilized, immediately, springing to her feet and readying to flee for her life, she was slowly and methodically led down 80 floors via stairwells filled with the suffocating, acrid smell of burning jet fuel and debris. After finally reaching the mezzanine in the north tower of the World Trade Center one hour and twenty minutes later, the south tower suddenly collapsed. The shock waves lifted Sharon into the air, throwing her, violently, on top of a crushed bloody body. An off-duty police detective discovered her, dazed and disoriented, a top the dead man. He helped her find her way out of the wreckage and away from the site, through absolutely thick, pitch blackness. In the weeks following her miraculous survival, a dense yellow fog enveloped her in a deadening numbness. Sharon felt indifferent by day; merely going through the motions of living with little passion, direction or pleasure. Just a week before she had loved classical music; now “it no longer interested her…she couldn’t stand listening to it”. Numb most of the time, sleep became her enemy; at night she was awakened by her own screaming and sobbing. For the first time in her life, this once highly motivated executive could not imagine a future for herself; terror had become the organizing principle of her life. Almost before I had introduced myself, she began talking about the horrors of the event, blandly, as though it had happened to someone else. I noticed a slight, expansive gesture made by Sharon’s arms and hands.. Sharon’s body was telling another story, a story that was hidden from her mind. I ask her to put her verbal narrative aside for the moment and to place her attention, instead, on the nascent message her hands are communicating to both of us. Perplexed at first, Sharon describes the gesture as though she is “holding something”. Unexpectedly, a fleeting image of the Hudson River appears in her mind’s eye, the daily view from the living room in her apartment across the river from Manhattan. Jumping back to the narrative story, Sharon becomes agitated as she tells me how she is haunted, re-visited, by the smoldering smoke plumes which she now sees every day from this same window. They evoke the horribly acrid smells from that day; she feels a burning in her nostrils. Rather than letting her go on “reliving” the traumatic intrusion, I firmly contain and coax her to continue focusing on the sensations of her arm movements. A spontaneous image emerges, one of boats moving on the river. They convey to her a comforting sense of timelessness, movement and flow. “You can destroy the buildings but you can’t drain the Hudson”, she pronounces softly. Then, rather than going on with the horrifying details of the event, she surprises herself by describing (and feeling)how beautiful it had been when she had set out for work on that “perfect autumn morning.” As Sharon holds the images of the Hudson River, along with the associated body sensations, she becomes aware of a sense of relief. She now innocently recalls how she had been excited to come to work that day. Continued attention to stimulate an almost playful curiosity. As she looks quizzically at her hands, first one then the other; we both breathe a sigh of relief. Sharon can now begin to stand back and” simply” observe these difficult, uncomfortable, physical sensations and images without becoming overwhelmed
by them.

When the first plane hit the building, only ten stories above her office, the explosion sent a shock wave of terror through her body. Sharon needed to inhibit the primal urge to run and walk in an orderly line down the stairs along with dozens of other terrified individuals; this was the case, even though her body was “adrenaline-charged” to run at full throttle. In following her “body story,” islands of safety“ are beginning to form in Sharon’s stormy trauma sea. As she attends to this “felt sense,” she becomes aware of an overall feeling of agitation in her legs and arms and tight “lumps” in her gut and throat. In suspending the compulsion for understanding, she experiences a sudden “burst of energy coming from deep inside my belly.” Does it have a color I ask? “Yes it’s red, bright red, like a fire.” Though, visibly startled by its intensity, she does not recoil from its potency. Her experience shifts into (what she recognized as) a strong urge to run, concentrated in her legs and arms. She feels this as are lease of energy. When she eventually reached the mezzanine, the south tower collapsed and she was thrown violently into the air. Finally, there was the stark horror of finding herself lying semiconscious on a dead body. With the new resources she has gained, Sharon is now able to process the emotional reality of this horror. Sharon no longer felt trapped in the anguish of the event; it began to recede to the past where it belonged. It was now possible to travel on the subway to hear her favorite music at Lincoln Center. A new and different meaning for her life arose out of a new and different experience at the instinctual bodily level.

See: Posttraumatic Stress Disorder Therapies; Mindfulness-Based Stress Reduction.

Further Readings:

In an Unspoken Voice; How the Body Releases Trauma and Restores Goodness (2010), North Atlantic Press, Berkeley Ca
Waking the Tiger, Healing Trauma (1996), North Atlantic Press, Berkeley Ca Scaer, Robert (2001,    2010) The Body Bears the Burden: Trauma, Dissociation,
and Disease.

Scaer, Robert (2005) The Trauma Spectrum: Hidden Wounds and Human Resiliency; W. W. Norton & Company; Van der Kolk, Bessel (2014) The Body Keeps the Score: Brain, Mind, Body in the Healing of Trauma, Viking Adult.

Porges, Stephen (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation, Norton

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Mad in America


Mental Disorder Labels in Children Impact Identity Development

Sophie Isobel examines the moral implications and potential long-term effects on self-identity in children diagnosed with psychiatric disorders, urging deeper reflection on how society approaches child mental health.


By Justin Karter -October 4, 2023

At a time when an increasing number of children are being diagnosed with psychiatric disorders, many researchers are advocating for a deeper examination into the broader moral implications of these diagnoses on young minds.


Sophie Isobel, from the University of Sydney, has recently suggested that while these diagnoses can provide a sense of understanding or temporary relief, they might also impart lasting impressions on a child’s self-perception, potentially affecting their self-worth and sense of identity.


Published in the journal Children & Society, Isobel’s article warns of the sustained and significant impacts on children’s lives, especially concerning what they believe to be true, and how they understand themselves.


“Most adults have some choice in how much they incorporate their psychiatric diagnosis into their understanding of themselves, but diagnostic effects may be particularly problematic during childhood when the self is still developing,” Isobel writes.

“Children develop their sense of self experientially and relationally across the developmental years. Self-concept (how people view themselves) and social identity (how they represent themselves in the world) are intrinsically interconnected. Psychiatric diagnosis can pose a threat to both of these processes, minimizing children’s potential to separate socially constructed descriptions of their experiences from their core construction of self and their interactions with the world.”

A surge in the number of children diagnosed with psychiatric disorders has ignited a debate about the broader moral implications of such classifications.


While medical professionals have historically accepted these psychiatric diagnoses, the nuances of identifying mental illnesses in children often differ from the clear-cut physical diagnoses found in other medical specialties.


Isobel critically assesses these diagnoses, focusing on their potential long-term effects on children’s self-perceptions and their personal truths. Additionally, she emphasizes the need to consider the moral outcomes of assigning children diagnostic categories steeped in uncertainty.


Isobel’s paper uses Critical Theory to explore how societal and political structures shape our perceptions of reality, particularly in relation to child mental health. The theory encourages us to question established norms, practices, and power dynamics, revealing hidden imbalances and abuses of power. It provides a platform for challenging accepted norms without altogether rejecting or accepting diagnoses.


Childhood, Vulnerability, and the Escalating Concern of Mental Health
Central to Isobel’s argument is the concept of ‘epistemic injustice,’ wherein children, merely by their age, are perceived to have a diminished ability to comprehend or articulate their experiences. Consequently, they face societal prejudices that limit their ability to convey or process their own distress.

Society’s emphasis on protecting children is frequently intertwined with concerns about potential risks. While adults juggle anxieties about an unpredictable future, children, largely powerless, rely on adults to make safety decisions for them.


While children largely depend on adults, they also possess internationally recognized rights, which include entitlements to freedom, safety, and care. However, these rights sometimes conflict with the dominant protective discourse, especially concerning children’s mental health.


This emphasis on children’s mental health isn’t misplaced. Recent statistics are eye-opening: Epidemiological studies estimate that a staggering 10% to 20% of all children worldwide have diagnosable mental health disorders. Alarmingly, despite stable adult diagnosis rates over the past five decades, child diagnosis rates have surged, accompanied by a notable uptick in prescriptions for psychoactive medications, including antidepressants and stimulants.


Diagnosis in Psychiatry: A Nuanced, Contested Terrain

The process of diagnosing mental disorders involves a combination of cultural norms, societal expectations, and professional expertise. In psychiatry, this process primarily relies on checklists of symptoms to identify disorders. However, a significant issue arises due to the subjective nature of these checklists. Although designed to reduce biases and ensure consistency, the disorders identified through these checklists lack scientific verification.


There are no biological markers or tests available to confirm their presence.

One of the most debated topics in child psychiatry is Attention Deficit Hyperactivity Disorder (ADHD). It is one of the most commonly diagnosed childhood mental health disorders in the Western world, but recent data suggests a possible overdiagnosis and over-treatment of ADHD.treatment of ADHD. Notably, children born closer to school entry cut-off dates, thus being younger in their academic year, have a higher likelihood of an ADHD diagnosis.


This relationship between developmental maturity and societal expectations clearly illustrates how societal constructs might inadvertently influence disorder diagnosis. Both the educational and healthcare sectors often tie institutional funding to these diagnoses, adding layers of complexity.

When a diagnosis is made, treatments are often recommended, including medication. The use of drugs for children with psychiatric conditions is a topic of debate. While many children report benefits such as improved emotional stability and academic performance, they also express concerns about physical side effects, feeling forced to take medication, losing their independence, and changes in their perception of what is normal.


Family, Power, and Perception in Child Mental Health Diagnoses

Diagnosing mental disorders in children is a complex process that involves various factors such as family beliefs, societal expectations, and healthcare dynamics. Isobel stresses the significance of taking the child’s perspective into account. Even though the United Nations advocates children’s right to express themselves, their views are often filtered through adult perspectives. Their understanding of terms like “mental illness” and their identity after receiving a diagnosis highlights the complex nature of mental health.


Isobel cites previous research, highlighting how children often wrestle with their self-identity following a mental illness diagnosis. For instance, some children perceive the diagnosis positively, feeling it helps others to “be nicer to them.” Conversely, many internalize feelings of being “inferior, inadequate, damaged, incomplete, and undeserving of happiness.”


The Moral Dilemmas of Childhood Psychiatric Diagnoses

Child psychiatric diagnoses often tread a precarious line between societal norms and individual behaviors. Beyond just their clinical implications, these diagnostic labels inherently carry moral undertones, delineating what society deems “right” or “wrong.”


Many of the diagnostic criteria in prominent medical publications like the DSM-5 not only reflect behavioral patterns but also subtly comment on the morality of these behaviors. Terms like “Oppositional Defiant Disorder” and “Disinhibited Social Engagement Disorder” link individual pathologies with broader societal contexts, reinforcing the complex interplay of social norms and individual health.


Historically, several behaviors deemed ‘deviant’ or ‘immoral’ have been relegated to the purview of psychiatry until society evolves a broader acceptance or understanding of them. The study raises the example of suicide, which has long been treated as a purely medical issue despite clear societal influences like family conflict, bullying, and social marginalization.

While some of these labels serve as tools for understanding and intervention, their implications on the individual’s perception of self, especially in malleable stages like childhood, can’t be ignored.


In closing, Isobel urges a critical reflection on the ways society addresses child distress. She calls for a renewed commitment to ensuring that children, despite their vulnerable stage of development, are educated about the constructed nature of psychiatric diagnoses. This, of course, requires greater “conceptual competence” from providers and educators.



Isobel, S. (2023). Considering the moral implications of psychiatric diagnosis for children. Children & Society, 00, 1–10. https://doi.org/10.1111/chso.12694 (Link)

MIA Research News Editor: Justin M. Karter is the lead research news editor for Mad in America. He completed his doctorate in Counseling Psychology at the University of Massachusetts Boston. He also holds graduate degrees in both Journalism and Community Psychology from Point Park University. He brings a particular interest in examining and decoding cultural narratives of mental health and reimagining the institutions built on these assumptions.

© 2023 Mad in America Foundation


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Tenth Ten 


World Mental Health Day 2023

Claim its turf to be one of the most pressing

Universal human rights

Advocating with all their might 


Yet it's entire content sprouted from ICD and DSM


An awkward gap created within, finding all sorts of the meanings on what constitutes Mental....









Will DSM and ICD ever be eradicated? 


It may not be so soon....or will never be, because.... 


Some find meaning in all these diagnoses (A learned helplessness behaviour?)


Others detested it


Whilst the majority distant from not discussing openly about it


How to bridge the gap?


Especially the conversation within the many generations we have?


Are the older ones listening to their intuitive self or too busy in life to place it as top priority


Are the younger ones willing to put  their lifetime at that pedestal, to be pasted with labels after labels....


but in fact dictated by merely just by these two manuals?


Experiencing the least perfect ecosystem that sees cost of medical treatments soar like an eagle? 


One has to wonder

Wonder if it is of worth.....

A disorder illness challenge whatever that is claimed to be incurable, only treatable 


One has to decide,

before that two manuals do it on behalf of oneself or even to a group





Edited by amuse.ed
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Commentary: Do you really have a mental disorder? Or are you just going through a tough time?

As mental health literacy continues to grow, so too has the trend of self-diagnosis. But not every sad event in everyday life is a mental health disorder, says psychiatrist Dr Jared Ng.


Commentary: Do you really have a mental disorder? Or are you just going through a tough time?

Jared Ng
11 Oct 2023 06:13AM

SINGAPORE: The topic of mental health has gained significant visibility in recent years, encouraging more open dialogue and demanding greater attention from healthcare systems worldwide. This increased awareness is undoubtedly a positive step towards destigmatising mental health, but it also brings forth an important question:


Are we over-medicalising mental health symptoms?


Mental health disorders have a long history of being viewed through various lenses, from moral defects to supernatural explanations like demonic possession and witchcraft. It was not until the late 18th century that the first asylums were established, marking a shift toward a more medical approach to mental health.

Unfortunately, these asylums were more about isolating the mentally ill from society rather than treating their conditions. Even when there were “treatments” (such as bloodletting and rotational therapy), they were often barbaric, inhumane and ineffective.

A significant shift occurred with the advent of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the 1950s. It aimed to classify mental health disorders based on clinical symptoms and other specific criteria, providing a standardised framework for diagnosis and collaboration among mental health professionals. The latest edition, DSM-5-TR, was published in 2022.


While the DSM has been instrumental in guiding clinicians worldwide, it has also been blamed for contributing to the over-medicalisation of mental health. The expanding diagnostic criteria have also faced significant criticism for potentially leading to over-diagnosis and for contributing to the medicalisation of normal human experiences and distress, like sadness.


Using “depression” as an example, the definition of major depressive disorder (MDD) in the DSM-5-TR includes experiencing a depressed mood most of the day, nearly every day, for at least two weeks.


By setting a relatively short time frame of two weeks, the concern is that normal, albeit intense, periods of sadness may be pathologised. The controversy was further fuelled by the removal of the "bereavement exclusion" in a previous edition of the DSM.

Critics argue that this change could lead to overdiagnosis of depression in people experiencing normal grief shortly after a significant loss. This could lead to the over-medicalisation of normal emotional experiences, and in turn, the unnecessary treatment, stigma and neglect of the social, cultural and psychological contexts in which these emotions occur.



Mental health in Singapore, especially among youths, has worsened. A study by the National University of Singapore in April showed that one in 10 teenagers in Singapore suffers from at least one mental health disorder. The research also showed that youths are increasingly turning to digital media as a source of self-therapy.


Separately, data from the National Population Health Survey 2022 showed that 25.3 per cent of Singapore residents aged 18 to 29 suffered from poor mental health last year. This is an increase from 21.5 per cent in 2020. Overall, 17 per cent of Singapore residents faced mental health issues last year, up from 13.4 per cent in 2020.

As mental health literacy continues to grow, so too has the trend of self-diagnosis. The vast wealth of information available on the internet empowers individuals to educate themselves about mental health conditions, including their symptoms and available treatments.


This can provide a sense of relief and validation, as individuals gain a framework for understanding their distressing experiences which might otherwise feel overwhelming. It offers a path towards treatment and can initiate critical conversations about mental health. This is not a bad thing.

We just have to bear in mind its potential for pitfalls. Misinterpretation of symptoms, the over-pathologising of normal emotional responses and confirmation bias can lead to inaccurate self-diagnoses, which in turn can result in unnecessary anxiety, delayed professional help, or inappropriate self-treatment. 


Simultaneously, individuals may begin to perceive their emotional, psychological and behavioural responses only through a medical lens. While this can offer a form of validation and a structured approach to treatment, it can also potentially serve as a form of avoidance. By attributing all responses solely to an illness, individuals might inadvertently evade acknowledging and addressing challenging life circumstances or personal behaviour patterns.


It can become tempting, and seemingly easier, to blame a disorder for one's actions or feelings, rather than confront the underlying issues that may be at play.


The relationship between the rise of digital mental health platforms and the medicalisation of emotional, psychological and behavioural responses, is a "chicken or egg" scenario. Both phenomena have evolved in parallel, raising the question: Which one is driving the other?


As conditions like depression, anxiety and ADHD have come to be seen more as medical disorders rather than personal flaws or moral weaknesses, the landscape of treatment has expanded significantly.

This expansion, in turn, has provided fertile ground for the rise of digital health platforms. Tech innovators have seized the opportunity, developing myriad apps and websites that offer self-screening for mental health conditions.


But has the rise of digital mental health platforms inadvertently encouraged a culture where everyday emotional fluctuations are seen through the lens of pathology? With these tools at our fingertips, the line between normal psychological variation and mental health disorder can blur.


The medicalisation of mental health may have set the stage for these platforms to emerge, but their prevalence may also be driving further medicalisation. Like the chicken and the egg, it's hard to determine which came first, or indeed, which is the main driver of the other. What is clear is that these two phenomena have become intertwined in our modern understanding and approach to mental health.


In the complex discussion on the over-medicalisation of mental health issues, it's imperative to underline that the challenge lies in striking a nuanced balance.


On one hand, we must be cautious about over-pathologising normal emotional experiences, which could lead to unnecessary medical treatments and stigmas. On the other hand, it's vital to not under-recognise or trivialise mental health issues that require professional intervention.


Everyone has a role to play in fostering a balanced, compassionate approach to mental health. Individuals, family members, friends and society at large contribute to the mental health landscape by recognising signs of distress, offering emotional support and encouraging professional consultation when needed. These collective efforts can significantly improve the quality of life for those navigating mental health challenges, steering them toward appropriate avenues for diagnosis and treatment.


Importantly, professional help does not automatically imply pharmacological treatment. The bio-psycho-social-spiritual model advocates for a more holistic approach to mental health care, one that encompasses not just biological but also psychological, social and spiritual dimensions of well-being.

This rounded model offers an array of interventions that can be tailored to the individual's needs, from psychotherapy and lifestyle changes to social support and spiritual guidance. Medication becomes just one of the options, to be used when appropriate and in conjunction with other forms of intervention.


In Singapore, the newly launched National Mental Health and Well-being Strategy seems to adopt a balanced approach, providing a four-tiered model that tailors mental health services to the individual's severity of needs. From community-led mental health promotion and peer support at the lowest tier, to specialised clinical interventions at the highest, the model offers a diverse range of care options. This design potentially minimises the risk of over-medicalisation by providing alternative paths for treatment and support, thus aligning well with the multi-dimensional approach of the bio-psycho-social-spiritual model.


Striking the right balance in mental health care is indeed a delicate task, fraught with potential pitfalls at either extreme. However, it's a crucial endeavour for constructing a healthcare system and society that recognises, supports and nurtures the mental well-being of all its members, whatever their needs may be.


Given the multi-faceted nature of mental health, it's important that we continue to adapt and refine our approaches, guided by ongoing research, societal changes and the lived experiences of those we aim to help.


Dr Jared Ng is Senior Consultant and Medical Director at Connections MindHealth. He was previously chief of the department of emergency and crisis care at the Institute of Mental Health.

Source: CNA/aj

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United Kingdom 


UN and WHO call for 'significant shift away from biomedical model of mental health'

But what does it mean for us all? I have summarised the new guidance for you.


11 OCT 2023

I am writing to you today about an important development in trauma-informed approaches to mental health, pathologisation, and trauma.

This development could change the lives of millions of people around the world - by moving us all away from the dominant biomedical model of mental health, and towards social models, rights-based models, and trauma-informed approaches to understanding distress and trauma.


On the 9th October 2023, The World Health Organisation and United Nations collaboratively published their new practical guidelines to move away from the biomedical model of mental health, and instead, focus on the social determinants, oppression, poverty, abuse, violence, and other contextual factors that caused trauma and distress in humans.


At my company, VictimFocus, working towards our anti-pathology trauma-informed (APTI) models in policing, local authorities, health, education, charities, and private services has been paramount for several years. All our commissioners and colleagues work with us on the basis that they are working towards implementing anti-pathology, trauma-informed environments, policies, principles, training, education and support, not only for those in need, but for their workforces.


There has been much interest around implementing trauma-informed working, and moving away from biomedical models of mental health for several years. We have worked on projects for the NHS, who are trialling trauma-informed, anti-pathology versions of CAMHS in some places in the UK, for example. We are also working with a number of police forces to move to trauma-informed policing, improving victim care, writing new training packages, and working with force leadership to explore how they can truly implement trauma-informed approaches to their work in VAWG and wider.


This guidance is global, powerful, and long overdue. It is one of the first, and clearest, examples of guidance from the WHO and the UN which describes the biomedical model of mental health as ineffective, oppressive, harmful, outdated and narrow in focus. The document clearly argues for a human rights based approach to human suffering, a trauma-informed approach to mental health, and a move to anti-pathology, and anti-oppressive practice. Everyone at VictimFocus are proud to have been working to these standards and principles for several years, and we thank all our commissioners and leaders who have being doing the same.


What does the guidance say?


The guidance is pretty long, at over 200 pages. We recommend that you read it if you can, and consider the implications for your own lives, services and workforces. We will be here for you whilst you do this, and can help to build action plans and frameworks when you are ready.


I have summarised some of the most important parts of the report for you.

Here are some key takeaway points from the report:


1.       WHO and UN are calling for significant shift away from the biomedical model of mental health which encourages psychiatric diagnoses, medications, forced restraints, institutionalisation, imprisonment and other oppressive medical practices – towards a trauma-informed, social, human rights, person-centred approach to mental health


2.       WHO and UN highlight the current ways the biomedical model of mental health harms, oppresses, controls, isolates, stigmatises and discriminates against those who have been told they have psychiatric disorders, and who have not been validated in their traumas, distress, poverty, environments, oppression, or experiences


3. WHO and UN recognise that women and girls, people who are gay, lesbian, bisexual and transgender are more likely to be labelled as mentally ill, and more likely to face forced sterilisations, coerced abortions, coerced contraception, and conversion therapies.


4.       WHO and UN recognise that there are widespread human rights violations and harm being caused by current biomedical model approaches to mental health, which includes our psychiatric hospitals, services, treatments, and approaches


5.       WHO and UN recognise that people who have been diagnosed with psychiatric disorders have been positioned as dangerous, unreliable and unstable, meaning that they are stigmatised and discriminated against in multiple systems of power (including health, criminal justice, family justice, education, employment, finances and their rights)


What changes are the WHO and UN expecting to see?


1.       The end of discrimination based on psychiatric diagnosis, including discrimination used to prevent access to health insurance, accommodation, and support


2.       The recognition and respect for legal capacity and personhood of people using any kind of mental health services


3.       The essential use of informed consent in all psychiatric services, treatments and approaches which includes accurate and truthful explanations of treatment evidence bases, side effects, withdrawal impacts, possible complications and non-medical alternatives


4.       The elimination of coercive or manipulative practices in psychiatry and mental health, including the end of all forced psychiatric treatments, or treatments that are coerced or manipulative (e.g. You can only access support if you take this medication/You can only have access to your children if you accept this diagnosis and take this medication)


5.       The prohibition of involuntary sectioning and hospitalisation and forced treatment


6.       The elimination of forced seclusion and restraints


7.       The development of trauma-informed, rights-based community support for everyone in need of support in their trauma or distress


8.       The development of peer-led and peer-run support services for people in distress and trauma


9.       The implementation of programmes to help the deinstitutionalisation of people who have been institutionalised for long periods


10.   Accountability in all psychiatric services and provisions, which includes the establishment of independent monitoring bodies


11.   Establishing a system for implementing redress, reparations and remedies where people have been harmed by psychiatry and the biomedical model of mental health


Why is this new guidance so important?


According to the document, the following reasons have been presented by the UN and WHO as to why this guidance to move away from the biomedical model is so important:


1.       Stigma, discrimination and several other human rights violations occur regularly in mental health and psychiatric provisions to this day.


2.       There is an overreliance on biomedical approaches to treatment options, which favour medications, and more dangerous procedures such as ECT


3.       Many people with psychiatric diagnoses, particularly those who are minoritized and marginalised, are not treated equally in law


4.       Access to justice for people with psychiatric diagnoses on file has commonly been restricted, affecting their right to a fair trial, denying them the possibility to contest detention, forced treatment and abuses in mental health services.


5.       Psychiatric diagnoses have been used to restrict a person’s right to file a police complaint or stand trial, to be taken seriously, to be protected from abuse, to be believed, to be seen as a credible victim or witness, to give evidence, to have access or custody of their children etc.


6.       People with psychiatric diagnoses on file will often be treated as if they do not have mental capacity and cannot make their own decisions about their lives or their care – including whether or not they wish to receive any care for perceived ‘mental health issues’


7.       International human rights laws require non-discrimination and respect for human rights in all settings, including psychiatry


8.       All humans should have the right to reject medical treatment in psychiatry and mental health, and should not be able to be forced or coerced into accepting medications or other treatments


9.       There is little focus on the social determinants of ‘mental health’, as the biomedical model has been so influential. Instead there needs to be focus on the true roots of human suffering and distress including oppression, harm, violence, abuse, poverty, cultural norms, discrimination, isolation, disadvantage, exploitation, bullying, chronic illness, lack of access to services and breaches of human rights


10.   There has been little acknowledgement of the racism, colonialism, homophobia, ageism, sexism, misogyny, ableism, classism or the many other factors that psychiatry has leant upon and supported over decades.


Further, there is much evidence that those from poverty, those with refugee status, those who seek asylum, and those from indigenous communities and cultures are more likely to be positioned as mentally ill, dangerous, and non-credible


11.   Psychiatry and the biomedical model of mental health is dominated by Western reductionist medical beliefs that people are mentally disordered and dangerous, which came from colonial rule, and the rise of the lunatic asylums via the church and the government


As you can probably see from this short summary of points, the new guidance from the UN and WHO has the potential to change millions of lives, and will contribute to the paradigm shift many professionals and members of the public have been waiting for. The guidance was developed in consultation and collaboration with a global group of mental health, psychology, psychiatry, and human rights experts, academics, practitioners, leaders, activists, law makers, organisations, people who have been harmed by psychiatry and people with lived experiences of oppression, harm, violence, abuse, and discrimination.


It is an important first step for humans around the world, and one of the first clear condemnations of the human rights violations in our mental health systems in the UK and beyond.


*** This is an edited version of content. For full article, kindly click HERE for details.

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A Chinese translation of the aboved posted content. For individuals who wish to forward to their loved ones who are more comfortable in their native anguage. 


翻译: 谷歌

2023 年 10 月 11 日


这篇文章是关于心理健康、病理学和创伤知识方法的重要发展。这发展可能会改变世界各地数百万人的生活—— 让我们所有人远离主流的心理健康生物医学模式,转向社会模式、基于权利的模式和基于创伤的方法来理解痛苦和创伤。


2023 年 10 月9 日世界卫生组织和联合国合作发布了新的实用指南,以摆脱心理健康的生物医学模式,转而关注社会决定因素、压迫、贫困、虐待、暴力和其他造成人类创伤和痛苦的背景因素。





该指南相当长,超过 200 页。如果可以的话,我们建议您阅读它,并考虑它对您自己的生活、服务和劳动力的影响。当您这样做时,我们将在这里为您提供帮助,并在您准备好时帮助制定行动计划和框架。我为您总结了报告中一些最重要的部分。



1. 世卫组织和联合国呼吁重大转变,放弃鼓励精神病诊断、药物治疗、强制约束、收容、监禁和其他压迫性医疗做法的心理健康生物医学模式,转向基于创伤、社会、人权、以人为本的心理康健方法。


2. 世卫组织和联合国强调目前心理健康生物医学模式对那些被告知患有精神疾病以及未经证实遭受创伤、痛苦和贫困的人造成伤害、压迫、控制、孤立、侮辱和歧视的方式环境、压迫或经历 。


3. 世卫组织和联合国认识到妇女和女童、男女同性恋、双性恋和跨性别者更有可能被贴上精神病标签更有可能面临强迫绝育、强迫堕胎、强迫避孕和转化疗法。


4. 世卫组织和联合国认识到,当前的心理健康生物医学模式方法(包括我们的精神病院、服务、治疗和方法)造成了广泛的侵犯人权和伤害。


5. 世卫组织和联合国认识到被诊断患有精神疾病的人被定位为危险、不可靠和不稳定的。这意味着他们在多个权力系统(包括卫生、刑事司法、家庭司法、教育、就业、财务及其权利)也高度可能地受到歧视。






2. 承认和尊重使用任何类型精神卫生服务的人的法律行为能力和人格。


3. 在所有精神科服务、治疗和方法中必须使用知情同意,其中包括对治疗证据基础、副作用、戒断影响、可能的并发症和非医疗替代方案的准确和真实的解释。


4. 消除精神病学和心理健康方面的胁迫或操纵行为包括结束所有强迫精神科治疗或胁迫或操纵性治疗(例如,只有服用这种药物,您才能获得支持/您只能获得支持。如果您接受此诊断并服用此药物,才可以接见您的小孩)


5. 禁止非自愿分段住院和强制治疗。


6. 消除强制隔离和束缚。


7. 为每个在创伤或痛苦中需要支持的人提供基于创伤的、基于权利的社区支持。


8. 为处于困境和创伤中的人们开发同伴主导和同伴运行的支持服务。


9. 实施帮助长期被收容者脱离收容的方案。


10. 所有精神科服务和规定的问责制其中包括建立独立的监督机构。


11. 建立对受到精神病学和心理健康生物医学模式伤害的人们实施补救、赔偿和补救的制度。








2. 治疗方案过度依赖生物医学方法。这有利于药物治疗和更危险的手术,例如电休克疗法(简称ECT)。

3. 许多患有精神病的人,特别是那些少数和边缘化的人,在法律上没有受到平等对待。


4. 备案有精神病诊断的人诉诸司法的机会通常受到限制,影响了他们获得公平审判的权利,剥夺了他们对精神卫生服务中的拘留、强迫治疗和虐待行为提出异议的可能性。


5. 精神病学诊断被用来限制一个人向警方提出申诉或接受审判的权利、受到认真对待的权利、受到保护免遭虐待的权利、被相信的权利、被视为可信的受害者或证人的权利、提供证据的权利、有权探视或监护其子女等。


6. 记录有精神病诊断的人通常会被视为没有心智能力,无法对自己的生活或护理做出自己的决定——包括他们是否希望因感知到的“心理健康问题”而接受护理。


7. 国际人权法要求在所有情况下不歧视和尊重人权,包括精神病学。


8. 所有人都应有权拒绝精神病学和心理健康方面的治疗,并且不应被迫或胁迫接受药物或其他治疗。


9. 由于生物医学模式的影响力如此之大,人们很少关注“心理健康”的社会决定因素。相反,需要关注人类痛苦和困扰的真正根源,包括压迫、伤害、暴力、虐待、贫困、文化规范、歧视、孤立、不利、剥削、欺凌、慢性病、缺乏服务和违反人权。


10. 几十年来,人们很少承认种族主义、殖民主义、恐同症、年龄歧视、性别歧视、厌女症、体能歧视、阶级歧视或精神病学所依赖和支持的许多其他因素。此外,有大量证据表明,来自贫困的人、具有难民身份的人、寻求庇护的人以及来自土著社区和文化的人更有可能被定位为患有精神疾病、危险和不可信的人。


11.  精神病学和心理健康的生物医学模式以西方还原论医学信念为主导,认为人是精神错乱和危险的,这种信念来自殖民统治, 以及通过教会和政府兴起的疯人院。









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By Guest • 7 November 2022


Generation Z: The Role of Nudity in Improving Mental Health

The findings of a recent national Ipsos poll on attitudes to Naturism show a growing enthusiasm for nude recreation amongst 16–24-year-olds, with 55% having participated in such activities as skinny dipping, nude sunbathing or visiting a Naturist beach/resort.


Almost half (47%) of all 16–24-year-olds said they had been naked in the company of others in the past year (excluding partners, family, and healthcare settings), and 23% describe themselves as Naturist or nudist.  When similar statistics are examined in older age groups, they are much lower. For example, 4% of 45–75-year-olds describe themselves as Naturist or nudist and only 6% of 45–75-year-olds have been naked in the company of others in the past year.


Why are younger adults embracing Naturism and nude recreation more than their older counterparts and why does it matter?


To interpret these trends, it is important to understand who these young adults are and what their experience of the world has been so far. Young adults of 16-24 years old are often described as Generation Z. They are the first generation to have had access to the internet and portable devices from a young age, meaning that their entire experience of the world has been heavily influenced by social media.


Their actions have always been subject to the scrutiny of their friends and elders and their perception of the human body has always been through stylised imagery, social media filters and influencers.  They are also the generation who have suffered restrictions such as COVID-lockdowns at an age that we would normally be discovering our independence.  Kane, 20, says:


“Being chronically online, you start to lose touch with reality.  When all you see are people posting their workout videos you get a warped view on life, and start thinking "if they can do xyz or look like xyz so should I".”


The pressures to achieve a 'perfect body' leads to problems with self-image, having an impact on mental health that can be seen across healthcare.  One in five young women aged 16-24 self-harm, a number that has tripled over a 15-year period (The Lancet Psychiatry).  Suicide is the leading cause of death in men aged 20-34, accounting for over a quarter of fatalities (Office of National Statistics).  The most direct consequence of living online is the deterioration of body confidence and poor body image, with 5.6% of women aged 17-19 suffering Body Dysmorphic Disorder (NHS).


Kane’s own story is a typical example of this:


“Mental health and body image are always going to be inextricably linked and will influence each other.  I have faced problems with my body image due a variety of reasons, most namely dysphoria and my body not feeling like my own.  When my mental health started to decline, I developed an eating disorder and began self-harming in an attempt to feel ownership over my body.  This of course did not help my body image/ self-esteem, and that in turn did not help my mental health, leading to a downwards cycle where both declined.”


Poor mental health is having a devastating effect on young people. Unfortunately, healthcare focuses on ‘treatment’ when things reach a crisis point, rather than early intervention, and for mental health issues, that is too late.


So, where does Naturism come in?


Whilst simple nudity does not provide an instant fix to all of these challenges, there is evidence to show that it does help.  Published studies conducted with Professor Keon West have found that spending even short period of times naked with others improves body appreciation and reduces social anxiety, while ongoing participation in Naturism leads to long-term positive body image and higher self-esteem.  In a world where even urgent healthcare is becoming increasingly difficult to access, it is no surprise that Generation Z are finding their own solutions and turning to social nudity as a way to nurture and protect their mental health.

It is these findings and challenges with regard to Generation Z that have led us to launch the EveryBody initiative.


EveryBody will create events tailored to Millennials and Generation Z and provide opportunities for young and not-so-young adults to try nude recreation in a safe, non-sexual environment with a firm emphasis on freedom, equality and body positivity.


The need and the demand for such opportunities are clear and we will do our best to provide them.




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WHO-OHCHR launch new guidance to improve laws addressing human rights abuses in mental health care

9 October 2023 News release Geneva


Ahead of World Mental Health Day, the World Health Organization (WHO) and the Office of the High Commissioner on Human Rights (OHCHR) are jointly launching new guidance, entitled “Mental health, human rights and legislation: guidance and practice”, to support countries to reform legislation in order to end human rights abuses and increase access to quality mental health care.


Human rights abuses and coercive practices in mental health care, supported by existing legislation and policies, are still far too common. Involuntary hospitalization and treatment, unsanitary living conditions and physical, psychological, and emotional abuse characterize many mental health services across the world.


While many countries have sought to reform their laws, policies and services since the adoption of the United Nations Convention on the Rights of Persons with Disabilities in 2006, too few have adopted or amended the relevant laws and policies on the scale needed to end abuses and promote human rights in mental health care.

“Mental health is an integral and essential component of the right to health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.


“This new guidance will support countries to make the changes needed to provide quality mental health care that assists a person’s recovery and respects their dignity, empowering people with mental health conditions and psychosocial disabilities to lead full and healthy lives in their communities.”

“Our ambition must be to transform mental health services, not just in their reach, but in their underlying values, so that they are truly responsive to the needs and dignity of the individual. This publication offers guidance on how a rights-based approach can support the transformation needed in mental health systems” said Volker Türk, UN High Commissioner for Human Rights.


Promoting more effective community-based mental health care

The majority of reported government expenditure on mental health is allocated to psychiatric hospitals (43% in high-income countries). However, evidence shows that community-based care services are more accessible, cost-efficient and effective in contrast to institutional models of mental health care. 


The guidance sets out what needs to be done to accelerate deinstitutionalization and embed a rights-based community approach to mental health care. This includes adopting legislation to gradually replace psychiatric institutions with inclusive community support systems and mainstream services, such as income support, housing assistance and peer support networks.


Ending coercive practices

Ending coercive practices in mental health – such as involuntary detention, forced treatment, seclusion and restraints – is essential in order to respect the right to make decisions about one’s own health care and treatment choices.


Moreover, a growing body of evidence sets out how coercive practices negatively impact physical and mental health, often compounding a person’s existing condition while alienating them from their support systems.


The guidance proposes legislative provisions to end coercion in mental health services and enshrine free and informed consent as the basis of all mental health-related interventions. It also provides guidance on how more complex and challenging cases can be handled in legislation and policies without recourse to coercive practices.

Using the guidance to adopt a right-based approach to mental health

Recognizing that mental health is not the sole responsibility of the health care sector alone, the new guidance is aimed at all legislators and policy-makers involved in drafting, amending and implementing legislation impacting mental health, such as laws addressing poverty, inequality and discrimination.


The new guidance also provides a checklist to be used by countries to assess and evaluate whether mental health-related legislation is compliant with international human rights obligations. In addition, the guidance also sets out the importance of consulting persons with lived experience and their representative organizations as a critical part of this process, as well as the importance of public education and awareness on rights-based issues.


While the guidance proposes a set of principles and provisions that can be mirrored in national legislation, countries may also adapt and tailor these to their specific circumstances (national context, languages, cultural sensitivities, legal systems, etc.), without compromising human rights standards.


On 10 October, WHO will join global communities in marking World Mental Health Day 2023, the theme of which is “Mental health is a universal human right”.



2023年10月9日 新闻稿 日内瓦







联合国人权事务高级专员Volker Turk指出,“我们决心彻底改变精神卫生服务。我们不仅要努力扩大其范围,而且要改变其基本理念,以切实满足个人需求和维护个人尊严。该出版物指导如何在尊重人权的基础上支持精神卫生系统开展所需的转型工作。”




















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Edited by amuse.ed
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