According to a 2018 mental health survey conducted by the Institute of Mental Health (IMH)1, approximately 14% of Singaporeans have experienced some form of mental health condition in their lifetime, up from 12% in 2010. Despite this, the majority of these people do not seek any form of help for their mental health conditions and those who do tend to do so after a significant delay after the occurrence of the condition. This phenomenon can largely be attributed to mental health stigma, which remains prevalent in Asian countries like Singapore. Mental health stigma causes mental health disorders to be seen as negative, socially discrediting behaviour, so much so that it becomes an undesirable and rejected stereotype rather than an accepted and normal one. It is also the driving force behind poor support and care for both the mental root cause and the physical symptoms, with wider, more significant impacts on the society. But what exactly is the reason for its prevalence?
Reasons for mental health stigma in Asian cultures
In Singapore’s context, mental health stigma can largely be traced back to traditional beliefs and mindsets that are rooted in Asian cultures. Asian cultures, for instance, tend to place honour, pride and collectivism in high regard, especially within families. Anomalies such as mental illness can therefore be seen as a sign of weakness and a source of shame for the family. A study led by IMH’s research division2 echoes this, with findings indicating that Asian respondents tended to feel more threatened by mental illness as a mark of shame. Similarly, Asians are found to have a lower sense of responsibility towards the mentally ill, as compared to respondents from the other ethnic groups. The concept of ‘face’ comes into play in this regard, as it deals with our moral standing in society3. The need to ‘save face’ and retain honour results in the blatant disregard or trivialisation of mental illness, especially since acknowledging it may lead to a perceived loss of social standing. Likewise, prominent gender roles in Asian cultures also exacerbate mental health stigma, as men are discouraged from exhibiting physical or mental weakness due to traditional notions of masculinity. The influence of these traditional values contributes to the deep-rooted mental health stigma that Asian societies like Singapore face, with generations after generations passing down and reinforcing these mindsets. A research study on Asian immigrant adults, for instance, found that older generations are “more subject to cultural misconceptions and stigma related to mental disorders”4. Unless there is greater awareness on the importance of mental health, as well as a proactive push against its trivialisation, its impacts on our health and society can be more serious than anticipated.
Negative effects of mental health stigma
For those who suffer from mental health conditions, the implications of mental health stigma are undeniably severe. This is especially true as mental health is not a high priority in most Asian countries5. In a 2018 study conducted by the IMH, a staggering 78.4% of individuals with mental health conditions never actually seek any form of professional treatment for their condition. For those that do, the treatment delay remains rather significant. This delay averages 11 years for people with obsessive-compulsive disorder (OCD), 4 years for those with bipolar disorder, 2 years for anxiety and 1 year for depression6.
Poor mental health can also manifest as physical health issues. These problems include chest pain, gastrointestinal problems, musculoskeletal problems or women’s health issues. However, patients without awareness of this link between poor mental and physical health may seek treatment without realising their root cause, leading to unnecessarily prolonged issues and treatment journeys.
Further exacerbating this problem is the lack of mental health support available in Singapore. Singapore has one of the lowest rates of psychiatrists among similar high-income nations, with approximately 2.8 psychiatrists for every 100,000 residents. By comparison, another comparable high-income nation, such as Australia, has 13.5 psychiatrists per 100,000 residents7. On a societal level, this general lack of awareness, urgency and public resources results in lasting negative impacts on the general public perception of mental health, which only serves to make the battle against mental health stigma more difficult. Allowing this stigma to remain so prevalent could lead to the creation of a vicious cycle that trivialises mental illnesses, as we have previously discussed. In Singapore, this phenomenon has been noted by psychologists, who remarked that the public’s general perception of a mentally ill person is one that is violent, unreliable and unstable. Furthermore, it is clear that the stigma is already embedding itself in sections of the younger generations. A 2017 study on mental health stigma in Singapore’s youths8 found that approximately 44.5% of respondents associated mental illnesses with negative, derogatory terms like “stupid”, “dangerous”, “crazy” and “weird”, while 46.2% of them said they would be “very embarrassed” if they were diagnosed with a mental illness. In contrast, only 25.5% of them associated mental illnesses with sympathetic terms like “pitiful”, “sad” and “needs love/care”. With mental health stigma so prevalent in society, it normalises a lack of knowledge and awareness about mental health and further discourages patients to seek help for their condition.
Impacts of mental health stigma in the workplace
In the workplace, mental health stigma can lead to indirect ramifications on our relationships and work performance. A study conducted by the National Council of Social Service9 found that more than 50% of respondents are not willing to live, live nearby or work with persons that have mental health conditions. Additionally, 60% of respondents also believe that mental health conditions are caused by a lack of self-discipline and willpower, so persons with them should not be given any responsibility. This lack of understanding could mean that our employees are suffering in silence without any possible avenues of support - the very same that may make all the difference in getting them started on better mental care and management. Instead, this lack of support could show up in more tangible ways, like higher rates of absenteeism, presenteeism, attrition and even poorer overall return on investment (ROI).
Absenteeism
Mental health problems are currently the leading cause of absenteeism10. As the frequency of employees’ attendance drops, so does their capability in contributing productively to the company. This means that employers are likely to face greater, tangible losses in terms of their company’s overall performance. For employees, however, this may also mean that the constant absenteeism could reflect negatively on their work performance in the eyes of their colleagues and superiors. Because of this, they might force themselves to show up at work even when their mental health is poor, contributing to an equally worrying trend of presenteeism.
Presenteeism
As you may have already inferred, presenteeism refers to the misconception that work attendance equals productivity. Companies with this point of view tend to believe that their best employees are those who work the longest hours, take the least amount of leave, and even show up when they are unwell. Combined with the fear of ‘losing face’ when it comes to acknowledging existing mental health conditions, employees are led to believe that their jobs and reputations will be on the line should they attempt to seek help or practice self-care. It is the perpetuation of beliefs like these that push employees to avoid taking medical leave for mental care. As such, they show up for work despite needing time off to rest and recuperate and are likely to function at less than full capacity despite being physically present. Our 360° Wellbeing Survey in 2018, for instance, found that almost 70% of global employees go to work when ill or burned out, even though this causes their productivity to drop by approximately 21% while further delaying their chances of recover11.
All this ultimately amounts to massive costs for our companies and our economies. While both absenteeism and presenteeism have been found to cost organisations anywhere from 23 to 44 billion dollars annually12, presenteeism undoubtedly forms the bulk of these costs. More specifically, research tells us that presenteeism has been costing us anywhere from 3 to 10 times more than absenteeism13.
Attrition
The prolonged perpetuation of mental health stigma in the workplace can also lead to high staff attrition rates. For employees who live with existing mental health conditions, having to deal with the stresses of working life while facing mental health stigma at work could be the catalyst that forces them to resign. These staff resignations come at a cost to the employer too. Research has shown that replacing staff who leave their jobs can result in significant costs of up to 33% of an employee’s annual salary14. Moreover, unusually high employee turnover rates could also prove to be detrimental to the company’s overall reputation. Hiring replacements would then be even more difficult and costly. Constant staff turnovers also generate instability in the company, contributing to an overall lack of direction and cohesiveness, which would then affect the company’s growth and competitiveness in the market.
In recent times, the scale of this issue has been growing with a greater number of young employees entering the workforce. Younger workers tend to place a much greater emphasis on their own mental health and are thus more likely to resign when their job contributes to a decline in their mental health. A 2019 study found that half of millennial employees and 75% of Generation Z employees have left jobs for mental health reasons15, signifying how important this issue has become for younger employees. On the bright side, however, this also indicates a crucial generational shift towards becoming more cognizant about mental health and destigmatising therapy.
ROI
Thus far, we have focused on the negative effects that mental health stigma has in the workplace. On the flipside, cost-benefit research has shown that there are net benefits to be gained by companies who invest in mental health support and prioritise destigmatising mental health. A recent WHO-led study estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity16. Beyond showing a clear need for greater expenditure for proper mental health support in the workplace, the results of this study also imply that an improvement in the mental health of employees could lead to a huge improvement in work productivity. If employees have proper mental health support systems available to them, allowing them to better manage their conditions will help to reduce absenteeism, presenteeism and staff attrition rates - all of which would have contributed to the loss in productivity. The same WHO-led study backs this up, with findings estimating that for every $1 put into scaled-up treatment for common mental disorders, there is a return of $4 in improved health and productivity17.
Addressing mental health stigma in the workplace
While some of us have already been pushing against the de-stigmatisation of mental health care, there is still much to be done. In a Working in Asia Pacific report that was conducted just last year in 2019, Singapore fared the worst in workplace mental health issues as compared to other Asian countries like Hong Kong and China18. However, the respondents of the same report also identified some key concerns that may help us to better understand and fight against mental health stigma in Singapore. As such, we have gathered 3 main points from these findings, as well as suggested some possible solutions that can help address each of them:
Concern 1: Many people do not feel equipped enough to support a colleague facing mental health issues at work.
As an employee, supporting a fellow co-worker who is facing mental health issues can be as simple as lending an ear while keeping an open mind. One way to do this is to let your words guide your thoughts. By revolutionising the language that we use to talk about mental health and redirecting it in a more sensitive, empathetic and compassionate direction, we can open ourselves up to opportunities for more meaningful discussions. This is one way that we can gain a greater understanding of mental health and better support others as we move forward.
As an employer, you can also support your employees in learning more about mental health by making professional support and resources more easily accessible. The more we normalise mental care, the easier it will be to overturn the negative stereotypes of mental illnesses.
Concern 2: Many respondents did not feel comfortable discussing mental health conditions with their colleagues.
Having open and honest discussions about mental health despite its existing stigma can prove to be difficult for some, especially with their job on the line. It will take time for us to develop trusting and friendly relationships for these conversations to take place, but this is a necessary step that can help improve the workplace culture nonetheless. To accelerate this process, committing ourselves to mental health-related programmes and resources can put us more at ease when it comes to talking about topics that are new to us. It can also introduce us to fresh perspectives that we may not have been aware of previously, all of which are essential when it comes to fighting against mental health stigma.
Concern 3: Many respondents felt that they simply lacked time and resources to invest in mental health care.
Employers have a key role when it comes to empowering employees to invest in mental health care. Implementing policies that send a message that the company treats physical and mental health equally is one way of doing so. When employers provide more opportunities for self-management and self-care through solutions like flexible working hours or telecommuting, employees are made aware of the freedom that they are afforded in order to best care for themselves. The recent pandemic has proven that productivity remains high with remote working arrangements - and can even increase productivity in some cases. A study found that working from home for as little as one day per week can already boost output by up to 13%19. With employees having more time and resources to practice mental care at home, one might even say that this boon to work performance is almost expected.
Over to you
As companies in Asia begin to turn their attention towards mental health in the workplace, many are grappling with similar issues and figuring out where responsibility for mental health should lie. With the enormous stigma and taboo surrounding the topic, many are also realising the importance of incorporating sustainable mental health solutions into their employee wellbeing strategies. After all, it has been estimated that “50% of the general population in middle- and high-income countries will suffer from at least one mental disorder at some point in their lives”20, making this a serious issue that is only growing more urgent by the day. Reforms within our work cultures can therefore go a long way in fighting against mental health stigma and reinforcing Whole Person Health . Our belief is that our physical and mental health are inherently connected, which means that we will need to invest in both our body and mind in order to care for ourselves holistically. In this sense, building support networks within family, friend and colleague groups can be a great help in reducing the general taboo around mental health. And if we can start off by getting these basic units of society to push against deep-rooted mental health stigmas, then it follows that society as a whole will be able to do it as well.
Committed towards making real progress in this area, Cigna Healthcare invites senior executives and people managers from all organisations to take the 5% Pledge – to commit 5% of your work hours to listen, craft and implement tangible change to improve mental health and well-being in your company. Visit The 5% Pledge for more information.
Resources:
1. Institute of Mental Health. (2018). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime.
2. Pang, S., Liu, J., Mahesh, M., Chua, B., Shahwan, S., & Lee, S. et al. (2017). Stigma among Singaporean youth: a cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population.
3. Nair, D. (2019). Saving face in diplomacy: A political sociology of face-to-face interactions in the Association of Southeast Asian Nations.
4. Jang, Y., Chiriboga, D., & Okazaki, S. (2009). Attitudes toward mental health services: Age-group differences in Korean American adults.
5. Meshvara D. (2002). Mental health and mental health care in Asia.
6. Institute of Mental Health. (2018). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime.
7. Our Better World. (2019). Mental health in Asia: The numbers.
8. Ng, K. (2018). ‘Crazy, weird, scary’: Survey unveils negative labels youths associate with mental illness. TODAYonline.
9. National Council of Social Service. (2018). Understanding the Quality of Life of Adults with Mental Health Issues.
10. Starling Minds. (2020). The Economic Impact of Mental Illness: Absenteeism & Presenteeism.
11. Mills, P. (2019). Building a Whole Person Health Approach to Chronic Stress at Work. Cigna.
12. Starling Minds. (2020). The Economic Impact of Mental Illness: Absenteeism & Presenteeism.
13. Starling Minds. (2020). The Economic Impact of Mental Illness: Absenteeism & Presenteeism.
14. Springhealth. (2020). The Hidden Costs of Mental Illness.
15. Hoffower, H. (2019). 50% of millennials have left a job for mental-health reasons, a new study found — and it speaks to some of the biggest problems plaguing the entire generation. Business Insider.
16. World Health Organisation (2019). Mental Health in the Workplace.
17. World Health Organisation (2019). Mental Health in the Workplace.
18. Park, R. (2019). Stigma and mental health in the workplace.
19. Lufkin, B. (2020). The remote work experiment that upped productivity 13%. BBC.
20. Trautmann, S., Rehm, J., & Wittchen, H. (2016). The economic costs of mental disorders.
