As the pandemic draws on, mental health should be key priority for Singapore

THE Covid-19 pandemic shows few signs of abating around the world. On the contrary, the emergence of new and more aggressive variants has seen many countries moving in and out of lockdowns, with the unprecedented stress on workers leading to a spike in the number of people seeking mental health support across the globe.

Singapore is no exception. While the government expressed a desire to transition to an approach that treats Covid-19 as endemic, with the Delta variant spreading across Singapore, the country has returned to a partial lockdown until the latter half of August. The city-state has recorded the highest incidence of the virus in 11 months with recent clusters being linked to KTVs and other nightlife establishments. The island saw a reversion to measures and regulations which significantly limit movement and restrict the numbers of people allowed to gather socially.

These changes, as well as analogous measures being reinstituted across parts of Asia, have recast a spotlight on the impact that the pandemic is having on mental health and wellness.

Burnout and chronic stress were already impacting workers across all geographies before the latest Covid-19 wave. The World Health Organization reports that the explosive growth in demand for mental health services in 2021 has been driven by a 400 per cent increase in new depressive and anxiety disorder diagnoses - exacerbated by significant disruptions in care for persons with pre-existing disorders.

In Singapore, suicides climbed across all age groups to reach an eight-year high in 2020 during the Covid-19 pandemic, most markedly among seniors. The 452 suicides reported present the highest numbers seen since 2012.

While these statistics are tragic, there may yet be a silver lining found in the public attention they have sparked. Even in those Asian countries where mental health issues continue to carry a stigma and seeking treatment remains taboo, the rising demand for behavioral healthcare services has raised the public awareness of the need for expanded care as never before.

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This new visibility and the universal nature of the surging demand is prompting governments worldwide to take new, pragmatic, and proactive approaches to improve access to mental health services.

The Singapore government has thus far done an outstanding job in taking welcome steps to tackle the problem, including establishing the National Care Hotline, issuing a Tripartite Advisory on Mental Well-being at Workplaces, and providing additional support for the youth population via the Youth Mental Well-being Network. The government has also created a multi-agency Covid-19 mental wellness task force to coordinate and lead the response. These steps have made a tremendous impact - but much more remains to be done.

UNDERINVESTMENT COSTS

Behavioural health complications cause significant and quantifiable economic human development costs on society. Underinvestment in meeting mental health needs risks astronomical costs to the economy by increasing absenteeism, impeding worker productivity, hindering company profitability, and harming quality of life.

The World Economic Forum projects that mental health conditions will cost nations US$16.3 trillion between 2011 and 2030. Additionally, there is strong evidence suggesting that the fallout from unaddressed mental health issues in the workplace may have an even more significant impact on the private sector.

Depression and comorbid conditions are also associated with workplace safety. For example, the leading cause of lost work hours, measured through absenteeism and presenteeism, was depression. Among workers in the United States, depression was associated with 27 lost workdays per employee, every year.

People experiencing mental ill-health in Australia miss an average of 12 workdays per year and suffer 14 to 18 days of reduced productivity, costing employers billions in lost productivity. By 2030, depression is forecast to be the number one cause of disease burden in the world.

The reciprocal relationship between depression and chronic health conditions has been extensively studied. The prevalence of depression in the general US population is approximately 7 per cent. For those with chronic conditions such as cardiac disease or diabetes, the rate of depression is almost triple (between 12 to 22 per cent).

Approximately 60 per cent of the total cost of depression is spent treating these comorbid conditions. Just as the head is connected to the body, care for depression should be connected to care for chronic medical conditions.

Mood disorders, including anxiety disorders and clinical depression, are also highly linked to physical illnesses. Debilitating medical outcomes - cardiovascular diseases, diabetes, obesity, and gastrointestinal dysfunction - go hand in glove with unmet mental health needs, leading to vicious cycles of poor health outcomes.

Given the increasingly clear picture of the immense costs and far-reaching effects of unsupported mental health needs, the urgent need for a robust and multi-pronged approach to addressing the problem could not be more apparent. When governments strengthen mental health support systems, they ensure care reaches every segment of the population. Better and more comprehensive care leads to healthier, more fulfilled people and more robust economies.

OFT-OVERLOOKED PROBLEM

In the wake of the pandemic, the government has a rare opportunity to carry on its momentum in supporting population health. Building on the steps taken over the past 12 months, there is a tremendous opportunity to make strides in reducing or eliminating the stigma associated with mental illness, clinical depression, and other psychiatric ailments. In addition, Singapore should look to develop a comprehensive support infrastructure that will bolster the economy and public health by investing in initiatives that will endure well beyond Covid-19.

In addition to working with medical professionals, schools, and non-profit organisations, the government should look to the private sector and other governments and consider partnerships with organisations to bring an abundance of experience and proven methodologies for efficiently and effectively providing mental health services. This support can draw on technology and remote resources, offering tremendous savings over traditional clinical infrastructure and treatment models.

For example, our own work with the state of California to help bring medical professionals suffering from the impact of substance addiction and other behavioral health issues back to work has helped 83 per cent of programme participants return to work and saved the state millions of dollars. This kind of return on investment is not atypical. Studies have found that governments see a $4 return on every $1 invested into improving mental health outcomes.

Ultimately, as public health experts, we are concerned that new and more contagious Covid variants will lead to ebbs and flows of Covid responses in the coming years and potentially continue to impact the state of our collective mental health. The pandemic and the shared experience of stress and burnout has highlighted for many of us the all-too-often overlooked problem stemming from limited mental health resources and care.

The public and private sectors should seize on the opportunity to collaborate and seek innovative ways to address the shortfall and draw on the lessons of Covid-19 to provide robust and comprehensive mental health support for the public, including the workforce, even beyond the pandemic.

• The writers are doctors from Maximus. Andrew R Sommers is vice-president, global health, office of the CEO. Alice Bernet is senior clinical director, office of the chief medical officer. Nomana Khan is senior director, Maximus Public Health.