Globally, there is a rising trend of youths experiencing mental health distress or disorders. According to a recent YEAR (Singapore Youth Epidemiology and Resilience) study by the National University of Singapore, one in three youths was found to have internalising symptoms such as depression and anxiety, while one in six had externalising symptoms such as aggression and rule breaking. One in 10 youths was also found to have a current mental health disorder.
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The stigma surrounding mental health persists today. Many believe that mental health struggles are not real, that they are “all in the head” or that the young are simply mentally weak. Children and adolescents facing these challenges should not be shamed. Many can benefit with the right support.
In recent years, KK Women’s and Children’s Hospital (KKH) has observed a positive trend of youths stepping forward to seek mental health support. Many youths have also shown to be open to receiving help for their mental health concerns.
Breaking common barriers to receiving mental health treatment
Myth: This is just a temporary phase and the child will “get over it”
Fact: Most of the time, mental health disorders are multifactorial, and not caused by one specific trigger event. Based on the patients seen at KKH, these can include:
- Family history of mental health disorders
- Living with a chronic medical or neurodevelopmental condition
- Frequent argument with peers or family
- Academic stress
- Financial difficulties
- Anxious or perfectionistic temperament
- Low ability to cope with stress
Myth: Children can manage mental health issues through willpower
Fact: Children are unable to “snap out of it” through willpower when they experience stressors beyond their ability to cope. In severe cases, where mental health distress is not managed well, the child may commit self-harm. Early detection and intervention, such as education, psychotherapy or medication, can help to improve their coping abilities with distress.
Myth: Seeking help for mental health conditions involves taking medications
Fact: The first line of treatment for many mental health conditions includes counselling, psychotherapy and/or behaviour therapy. Should these interventions show limited improvement, or symptoms are deemed more severe, medications may then be included in the treatment plan.
Myth: If a child is diagnosed with a mental illness in a local healthcare institution, all government agencies will know about their condition
Fact: Only healthcare providers caring for the child has access to their medical information. For patient confidentiality, consent from a parent or legal guardian will be obtained in most scenarios when medical information is requested from an external organisation.
Identifying mental health symptoms in the community
Community health professionals can spot symptoms suggesting mental health distress in children and adolescents (Table 1) within the primary care setting. This can help in early identification and referral, which is crucial for timely intervention and treatment.
Table 1. Common conditions and symptoms in children and adolescents
Condition
|
Symptoms
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Anxiety disorder
| - Feeling worried most of the time
- Worried about social situations, crowds, separation from caregivers, their or their caregivers’ health, completing everyday tasks
- Heightened anxiety state, which can manifest into frequent panic attacks
- Physical symptoms such as breathlessness, palpitations, nausea, and abdominal pain
- Psychological symptoms such as feeling a loss of control
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Depressive disorder
| - Feeling sad, worthless, or guilty most of the time
- Seems withdrawn or no longer enjoys/engages in pleasurable activities
- Poor sleep and concentration
- Self-harm expressed through verbalising, writing, or linear marks on their body that suggest self-injury
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Symptoms associated with neurodevelopmental disorders
| Attention deficit hyperactivity disorder (ADHD)
| - Inattentive symptoms such as short attention span around multiple activities, forgetfulness, difficulties with organisation
- Hyperactivity symptoms such as fidgeting frequently or difficulty remaining seated when needed (e.g. in classroom or during mealtimes)
|
Tic disorders
| - Involuntary, repetitive, brief movements or vocalisations.
- Children with tics are at increased risk of anxiety, depression, ADHD and obsessive compulsive disorder
|
Autism spectrum disorders (ASD)
| - Individuals on the autism spectrum are at an increased risk of ADHD, anxiety, depression and other mental health conditions due to difficulties of ASD
- Difficulties include making friends, understanding others’ perspective, engaging in back-and-forth conversation, repetitive speech or body movements, adapting to changes in routines, very high interest on certain objects/topics, managing reactions to sensations involving the bodily sensations.
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Post-traumatic stress disorder (PTSD)
PTSD is typically caused by a distressing or scary situation, including serious accidents (e.g. car accident, near drowning), difficult personal experiences (e.g. sudden loss of a loved one, bullying), disasters (e.g. fire), and more
| - Behavioural changes (e.g. difficulty sleeping, avoiding reminders of the event)
- Change in thoughts (e.g. poor concentration, nightmares) or feelings (e.g. frequently scared/sad)
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Delivering timely mental health support to children and adolescents
Launched in 2023, the Paediatric and Adolescent Wellness Service (PAWS) in KKH has a dedicated pool of physicians providing care for children and adolescents who present with mild-moderate mental health conditions and symptoms. These include but are not limited to ADHD, mild to moderate depressive or anxiety disorders and tics with co-existing mental health symptoms.
PAWS aims to decrease waiting time to treatment, improve accessibility and achieve better clinical outcomes for children and adolescents who require mental health support.
Adopting a novel collaborative model care, PAWS physicians are paediatricians trained in child and adolescent mental health. A first of its kind in Singapore, the team works closely with and receives supervision from child psychiatrists at the KKH Child and Adolescent Mental Wellness Service, to provide comprehensive care within the hospital.
After meeting with PAWS physicians, a mental health assessment and a treatment plan is formulated. This typically includes psychoeducation, where children and adolescents and their parents learn more about what is causing their symptoms. Treatment may also include counselling or therapy from providers including school counsellors, social service agencies, hospital counsellors and psychologists. Sometimes, psychotropic medication is prescribed. PAWS physicians would then follow up with the child to monitor their progress and recovery.
Healthy mental state for a healthier future
Since its inauguration, PAWS has seen more than 360 patients, with the most common symptoms being inattention and hyperactivity, followed by anxiety and depressive symptoms. Patients have shown to benefit from the holistic plan that PAWS offers, with most cases improving within an average of six months.
A key to a healthier future lies in a healthy mental state. While children and adolescents may be susceptible to mental health disorders as they are still developing their means to cope with their symptoms, with early identification of symptoms and timely provision of treatment, they can be empowered to heal, improve and thrive.
Refer a patient
While there is no one-size-fits-all answer, in general, if symptoms impact the child or adolescent’s daily function or lasts for a few months, it is recommended to consult a community health professional.
Community health professionals can refer a child or adolescent for assessment by the General Paediatrics Service at KKH via KKH Central Appointments at
+65 6294 4050 or
[email protected]. Eligible patients will be internally referred to PAWS.
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Dr Samuel Lim Zhi Rui, Consultant, General Paediatrics Service, KKH
Dr Samuel Lim is a paediatrician with a special interest in children and adolescent mental wellness. He graduated from the National University of Singapore (NUS) Yong Loo Lin School of Medicine and subsequently attained a Master of Medicine (Paediatrics) and is a Member of Royal College of Paediatrics and Child Health, United Kingdom (MRCPCH (UK)).
Dr Lim is accredited as a specialist in paediatric medicine and has completed a Graduate Diploma in Mental Health with NUS.
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Dr Ryan Wu Song Lian, Consultant, General Paediatrics Service, KKH
Dr Ryan Wu graduated from NUS with a Bachelor of Sciences (Honours) degree and worked at the Ministry of Health (Communicable Diseases Department) from 2008 to 2009. He subsequently enrolled in the Duke-NUS University School of Medicine and graduated in 2013 with a Doctor of Medicine postgraduate degree.
Dr Wu underwent paediatrics residency training with SingHealth in 2014 and obtained a Master of Medicine (Paediatric Medicine) in 2017. He was accredited as a specialist in paediatric medicine in 2021 and also a member with the Royal College of Paediatric and Child Health, United Kingdom (MRCPCH (UK)).
With an interest in adolescent mental health issues, Dr Wu completed a Graduate Diploma in Mental Health with NUS in 2023. He believes that the body and the mind are closely linked, and that holistic care for each patient involves ensuring good body and mental health.
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Dr Kwan Rui, Associate Consultant, Department of Child Development, KKH
Dr Kwan Rui is a paediatrician who supports children with neurodevelopmental disorders with co-occurring mental health difficulties. He completed his paediatric medicine training in SingHealth. He was attached to Lucile Packard Children's Hospital Stanford Developmental Behavioral Pediatrics in California as part of his training.
His previous psychiatry experiences include working in general and child psychiatry at the Institute of Mental Health as well as military psychiatry in the Singapore Armed Forces Psychological Care Centre.
Dr Kwan is inspired by the perseverance and commitment of these children and their parents who have worked through their difficulties. He strives to provide care with the same ethos.
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