Views From The Couch: Tackling the hidden stigma around mental health in Singapore

SINGAPORE – In recent years, Singapore has made important strides in addressing mental health stigma.

National campaigns like the multi-year initiative Beyond the Label by the National Council of Social Service (NCSS); studies such as the Institute of Mental Health’s (IMH) Mind Matters: A Study of Mental Health Literacy (2016 and 2024); and the NCSS Quality of Life Study point to a slow but meaningful shift in public attitudes.

Encouragingly, social stigma around mental health is on the decline. More Singaporeans today are willing to speak openly about anxiety or depression, and seeking help is increasingly seen as a sign of strength rather than weakness.

Yet beneath this progress, two more insidious forms of stigma persist: self-stigma and structural stigma.

Self-stigma is when individuals internalise negative stereotypes about mental illness, and it remains a significant barrier to help-seeking. A previous study by IMH with about 300 patients showed that many people with mental health conditions continued to perceive themselves as less capable or worthy.

Structural stigma, meanwhile, manifests in policies and systems that inadvertently marginalise people with mental health conditions: employment discrimination, barriers to insurance, and a lack of sustained workplace accommodations are some examples.

A powerful example is that of a young woman – let’s call her Valerie – whom I first met when she was just 14. Valerie struggled with intense self-doubt and emotional turbulence, at times convinced she was a “psychopath” due to her perfectionistic tendencies and high expectations from her parents.

Over the years, her journey led to a diagnosis of bipolar disorder. With the right treatment and support, Valerie stabilised and eventually pursued a career in nursing. Despite her open declaration of her mental illness, she faced multiple hurdles – first at the Nursing Board and later at the hospital where she sought employment.

Fortunately, she persevered, secured a nursing job, and returned to our clinic years later, with cakes and gratitude. Her story is one of courage, but it also highlights how structural stigma can stand in the way of recovery, purpose and participation.

To tackle these deeper forms of stigma, Singapore must move beyond awareness and towards empowerment.

One key avenue is the recognition and development of lived experience as a form of expertise. People who have recovered from or are managing mental health conditions offer vital insights into what helps – and what hinders – healing and inclusion. Their stories challenge stereotypes and humanise the narrative.

The NCSS Peer Support Specialist Programme has made commendable progress in this regard. By training and certifying individuals with lived experience to support others, it models how experiential knowledge can inform recovery.

However, more can be done to mainstream this approach across the healthcare system, schools and workplaces.

Importantly, an Asian and specifically Singaporean perspective must shape this development. In our collectivist culture, family plays a central role in both the stigma and the solution. Studies have shown that family reactions can either motivate or inhibit recovery.

The NCSS Quality of Life Study of Adults with Mental Health Conditions in Singapore (2022) revealed that individuals with strong family support report significantly better outcomes in mental health recovery.

The report noted that “support from family was one of the top facilitators identified in their recovery journey”. Conversely, fear of burdening loved ones or bringing shame upon the family remains a key reason for silence.

To shift this, we must create safe environments where families can hear from others who have walked similar journeys. This means investing in community dialogues, multilingual storytelling platforms and training family members as allies in mental health recovery.

Spirituality and cultural values, such as filial piety, compassion and responsibility, can be powerful allies in reframing mental illness as a shared human experience rather than a personal flaw.

We have also created tangible innovations to break barriers of fear. The national mindline 1771, Singapore’s first helpline and text service for mental health, offers a safe and private space for people to take the first steps towards seeking help. This improved access with anonymity can lead to compassionate conversations in person.

Singapore has also begun taking steps to address structural stigma through policy.

released in 2020, offers guidance on supporting mental wellness at workplaces, including non-discriminatory hiring practices and accommodations.

In healthcare, MediShield Life now includes coverage for inpatient psychiatric care, and Integrated Shield Plans have expanded mental health coverage since 2021, addressing previous insurance gaps that affected those with mental health histories.

We should continue to explore policies that enable supported disclosure and ensure non-discrimination in employment, education and housing. Mental health literacy campaigns remain important, but they must go hand-in-hand with giving people good reasons to share their stories – not just the freedom to speak, but the assurance that they will be heard with dignity.

Ultimately, reducing self and structural stigma will require a more nuanced approach: one that blends policy reform, community education, and, above all, the authentic voices of those who have lived through mental health struggles.

Only then can we move from awareness to true acceptance, and ensure that no one walks the path to recovery alone.