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Talking about mental health issues is not something everyone is comfortable with. We find out how the Singapore Civil Defence Force has sought to normalise seeking help, even before the COVID-19 pandemic brought mental health concerns to the fore. Transcripts have been edited for clarity and language.

Transcript

Host: Douglas O’Loughlin
Audio: Fei

Douglas: Hello and welcome to the Challenge Podcast where we discuss all things public service in Singapore. I'm your host, Douglas O'Loughlin, an organisation development consultant and a former public officer.

In this episode, we are so happy to have with us Khoo Swee Giang, who is the Lead Psychologist and Head of the Care and Wellness Office at the Singapore Civil Defence Force (SCDF). She provides counselling and crisis support to the personnel in SCDF.

This all sounds very interesting, Swee Giang. Welcome to the show.

Swee Giang: Thank you, Douglas.

Douglas: We heard this is your first podcast?

Swee Giang: Yes! Kind of nerve-wracking, but I guess we’ll do fine.

Douglas: Yes, you're doing fine. So what is your role in SCDF? What does your unit do?

Swee Giang: We are the Emergency Behaviour Sciences and Care unit, EBSC in short. Our unit is staffed with psychologists, uniformed officers and research analysts. We apply psychological principles in our work to support SCDF as an organisation, its operations in protecting properties and saving lives. We also provide mental health support services to all personnel in the force, the regular uniformed or civilian officers and National Service personnel.

Douglas: Well, I can imagine that some of the work your officers do can be quite intense at times. So how do you support the personnel at SCDF? And can you share some of the initiatives you use to help people with their wellness and wellbeing?

Swee Giang: We focus on three different pillars, mainly the organisation, operations and officers. Under organisation, we look into employee engagement surveys to assess personnel engagement and workplace concerns. There is also a psychometric assessment in personnel selection to ensure person-to-job fit.

For operations, we provide critical incident stress interventions in call-outs where personnel are exposed to potentially traumatic operational stress during the course of their work. Our psychologists also form part of the SCDF Operation Lionheart Contingent to render psychological support to our Urban Search and Rescue specialists. These specialists, they are sometimes deployed overseas for disaster relief and humanitarian assistance missions.

Lastly, we have counselling and support services for staff that may be in distress due to either personal or work-related issues. Our team mans a 24/7 helpline for officers to call in any time. Personnel also gain mental health awareness and relevant psychological topics to prepare them for challenges at work.

Douglas: It sounds like a very holistic approach. Some of it is outreach, some of it from the hotline. Out of curiosity, how often do people call? You say 24/7, but do people call in the middle of the night, or is that an anomaly?

Swee Giang: We do have people calling in the middle of the night, sometimes at 3am. But those calls are quite rare.

Douglas: Talking about mental health, it has become quite popular, and we hear of “mental health”, “mental wellbeing”, “wellness”, “mental wellness” – lots of terms get thrown around. So I am just wondering, how do you make distinctions between them?

Swee Giang: I think when we search “mental health” on the Internet, you would see websites from the WHO (World Health Organization) providing a definition of what mental health means. But I realised it's not really a universal definition subscribed by everyone. Every mental health professional has their own idea of what it constitutes. But I guess they all kind of have a common idea of what mental health means, with subtle differences within.

My personal view is that the terms “wellness” and “wellbeing” are more commonly heard these days probably because of the shift towards positive psychology: looking at mental health, not just simply as the absence of mental disorders, but also to give focus to the state of being happy or being satisfied with life in general.

I feel that having good mental wellbeing doesn't mean we are always happy or unaffected by what happens to us. Instead, we are still able to feel a range of emotions such as anger and sadness; we are able to cope with daily life and the stresses around us. I think that is the essence of good mental health.

Douglas: Oh, that's good. And I hope you're right, that wellness is becoming more the term that we use and think about how to be well in a holistic sense. If you look at the spiritual, mental, emotional and physical as part of our holistic wellness, how would mental health fit into the picture?

Swee Giang: I think all these components are interlinked, because there is clear evidence suggesting the positive effects that, for instance, exercise can have on reducing stress and improving mental health. There's also research to say that having a good and meaningful social connection with others contributes to better mental health.

At SCDF, we promote this concept called Fitness 4. Because of the nature of a firefighter’s work, our guys need to be more physically fit. But we wanted to sell the idea that fitness doesn't only mean physical fitness. With Fitness 4, we focus on promoting wellness tips in four different domains. Apart from physical, there is also mental, emotional and social fitness.

Douglas: Okay, good. All that you have shared so far has a very holistic picture to it, you know, or a systematic picture…

Swee Giang: Which is what we are trying to do.

Douglas: You have been focusing on wellness in SCDF for some time so it is not a new topic. But COVID-19 seems to have made it rise to the forefront a bit. What do you see that has happened in the last year and a half or so that has been different?

Swee Giang: I guess when COVID-19 hit, the impact was felt on many fronts and resulted in people focusing a lot more on mental health. We hear about people who may be struggling from the repercussions of the pandemic: people who lost their income, people who were coping with the “circuit breaker”.

I had the opportunity to help man the National Care Hotline a few times when it first rolled out in 2020. I witnessed how people struggled differently and how they were affected in many different ways. There has also been a focus on healthcare workers, such as doctors, nurses, and also emergency medical service personnel in SCDF: how they may experience fatigue, burnout, or even anxiety over the possibility of infecting their own family members due to the nature of their work.

So online, I've also seen discussions and articles on how the change in the mode of doing things is affecting people’s mental health. For instance, with work from home being the default, how does it contribute to social disconnect at workplaces? How does it cause stress to people who have to juggle different hats at home?

Douglas: How do you handle these calls? The two groups that you mentioned, like healthcare workers or people who are out of work and lost their income – these are high-stress circumstances that are not necessarily going to go away, right? How do you talk with people like that, and how do you help them get to a different place?

Swee Giang: When I was manning the hotline, there were always supervisors around who acted as our support network. When we get stuck in attending to a person on the call, we can quickly text them and they would be able to share with us some of the help resources that I can direct my caller to.

Douglas: It is very impressive how this all comes together. I think most people, myself included are not always aware of all the support that is available across the system, which is very nice. So let’s zoom into the needs of SCDF folks – what kind of issues do they reach out to you for?

Swee Giang: There are wide-ranging issues covering both the personal and work-related aspects. On the personal front, it could be about relationship problems at home or with their partners. Some of the staff have mental health-related concerns. There would also be very fundamental issues relating to finances, particularly so for the NSF, the National Service personnel, who are enlisted to SCDF. Work-related issues mostly arise from the nature of our officers’ work, which involves saving lives and putting themselves at risk in the call of duty.

Douglas: So they can reach out to you for any number of reasons. Then again, work doesn't have to be work-related, it can just be anything that's been on their mind, and they feel like they want to talk to some kind of professional.

Swee Giang: I think in the past, when I first joined the organisation, we made a clear distinction. But over time we recalibrated our position because we realised that what happens at home sometimes affects what happens at work as well. We cannot be attending to personnel just for work issues and ignoring their personal issues.

Douglas: Once again, this theme of a holistic way of thinking about things shows up. We talked about how mental health has become something we are more open to talk about since COVID-19. Given the SCDF, and indeed the Home Team, is probably more male-oriented in most cases, how do you see that happening in your environment?

Swee Giang: I think earlier I mentioned this Fitness 4 concept that was our way to promote psychological fitness to our staff. Also, our unit was set up in 2013, so I see there is a lot more focus on and recognition of mental wellbeing methods in our organisation.

This has been possible with management support. And with the expansion of our services, personnel started to notice our work and viewed us as a unit that could advocate for their mental wellbeing. There would still be people who are not comfortable talking about mental health issues. But having been in the force for over 10 years, I have seen a positive shift. We have people coming to us with concerns about their peers, or even pitching ideas to us on collaborating with their units on mental health-related outreach programmes.

Another way we normalise seeking help is by promoting social support networks in the force. It sends a very important message to everyone that it is okay to not be okay at times. In 1999, we started an SCDF para-counsellor scheme. It has been around for 20 years and it serves as an important support network for staff that may prefer less formal emotional support. Instead of talking to a psychologist, because sometimes people are still wary about the labels, they may prefer to talk to a peer who is trained in basic counselling skills.

And in 2020, we started a full-time National Service Peer Support Programme to train NSF volunteers with basic skills to help their peers in need. Having different social support networks is what we are trying to do to encourage people to talk about their mental health, and not just to professionals.

We also have a very strong culture of caring for our staff and our National Service personnel. Because we are not just lifesavers, we actively seek ways to be life transformers for them as well.

Douglas: Nice. You are really looking to change the culture of society in some ways, right? To get people to talk to each other, help each other.

Swee Giang: De-stigmatising mental health is an uphill task, but I believe we can start small, one step at a time.

Douglas: Yes, but it feels like it's changing a lot. And you said you have noticed a trend where people are more willing to call the hotline. What are those trends?

Swee Giang: In the past we had more NSFs coming to us, so we sort of became a counselling service for NSFs. But over time, we have regulars coming to us for formal counselling or just a chat to help them crystallise their ideas, get some thoughts on how they can proceed in their path, for instance, in their career or when they are stuck in certain issues in life.

Douglas: Do you see any other misperceptions out there and misconceptions around mental health issues?

Swee Giang: Definitely. I will list three. So the first one is a lot of people tend to have this very black-and-white thinking about mental health, thinking that you are either mentally ill or you're mentally healthy. But I feel mental health is a spectrum. It isn't simply a matter of whether you're sick or not. For example, someone who is diagnosed with anxiety could also feel mentally well on certain days. And even for us, who are not affected by any mental health disorders, there are days where we feel like shutting everyone out and crying our hearts out. There are good days and bad days, whether you have a diagnosis or not.

The second misconception is that people tend to think that mental illness is rare. On the contrary, I am hearing many accounts of people having mental health problems. At one point I was wondering if it was a job hazard. But local research or statistics are starting to show that it's more common than we think.

In a Singapore mental health study, which was conducted in 2016, they found that 1 in 7 people had experienced a mental disorder in their lifetime. What is more worrying about the findings is that a high proportion of people with mental disorders are not seeking help. It goes back to the point about labels that people attach to those seeking help for mental health.

Which brings me to the third point. A lot of people associate seeking help for mental health issues as a sign of weakness. But I see my clients as a very courageous group of people. Because for them to accept that they are going through some difficulty, for them to accept their pain and imperfections, is actually the first active step to help and make things work for themselves.

I feel people who make the call in the first place and open up to a complete stranger are taking a very brave step. For this reason, before I end a phone call, I always thank them for calling.

Douglas: That's wonderful. And actually, it's a good reminder for everyone: if we are struggling a little bit, it's a sign of strength and courage to reach out and talk about it. The other thing you said that I really liked was that it's not a black-and-white issue. There's a term, I don't know if you use it, but I use it a lot, about being crispy around the edges – if you have heard that term before?

Swee Giang: Oh, not really.

Douglas: It is before you reach the point of getting too burned out, overwhelmed or stressed. You incrementally notice it through short-temperedness, some abnormality like binge-eating and you might think, wait a minute, let me catch this now and do something about it to make myself feel better. Maybe get more rest or something. So I really liked the idea that it's not one or the other, that it is a spectrum.

Swee Giang: I think having good awareness of where we are in terms of our mental health at this point, or at regular time points, having that reflection, is really important for us to know. At which point should I stop and take stock of what's happening? Probably I need a bit of rest.

Douglas: Given the work that you all do in your unit, what do you do to take care of yourselves, individually as well as a team?

Swee Giang: Self-care. Self-care is something we always preach to our volunteers. And so every now and then when I see the volunteers, the para-counsellors, I would ask: What are you doing for self-care? Do you rest enough? That's the number one thing. For instance, I am taking the afternoon off today.

Douglas: All right!

Swee Giang: I think setting clear boundaries is also very crucial, especially when it comes to office and personal time. It's definitely important nowadays, when work from home kind of blurs the lines. Sometimes at dinnertime, I'm still on my laptop, and my husband would remind me that we should be spending some time with our children. I think these boundaries also need to be supported by supervisors, your bosses and your colleagues. I'm fortunate to have bosses and colleagues who are very respectful of days when we are on leave or out of the office. Also, minimal discussion about work during weekends. Unless I’m on the crisis roster, because when crisis hits, we just have to work, right?

I find comfort in having colleagues who are similarly passionate about the work we do. All counselling cases are confidential. But sometimes we really need to just share and offload certain things that may have happened during therapy, and our colleagues become the safe place that we can turn to. So having people who are similarly interested in counselling work makes it easier.

And then there's always timely guidance and supervision from supervisors when we get stuck in certain cases. And definitely, opportunities to develop and upgrade our knowledge and skills are very important.

Douglas: And it's quite obvious, right? But it is a reminder that you don't need to be in counselling to create little support networks among peers. What do you do if somebody knows that their friend expresses some concern about how they are doing – or maybe they don’t express it but they perhaps get a sense that the person is not at their best? What would you recommend people do? Because this idea of peer support goes beyond just sharing when you had a bad day?

Swee Giang: Yes, I think sometimes when we chance upon friends on the streets or a particular space in the office, we would ask how they are doing. We usually expect them to say, “Oh, everything is fine.” But there will be a time when they will say “not too good”. In situations like these, I guess what we can offer is to give them our undivided attention. When you ask the question, “Are you okay?”, be prepared to set aside some time, for instance, to hear them out. Be really patient to listen to what they want to say.

The next thing is not to judge when they are sharing their experiences. It is usually not helpful when we start to attach labels. For instance, you might say, “Oh, you are feeling down? Are you going through depression?” This does not help.

Instead, offer help by expressing concern and providing help resources. If you are not sure what resources they can go to, you could say things like, “Give me some time while I check to see what is available”, or “we can do this together”.

Finally, I think it is really important for us to check in on them after some time to see how they are coping, something like a follow-up. And it could be through a simple text or phone call.

Douglas: Oh, that's a wonderful tip! Everyone, if we do know somebody who is going through a rough time, check in on them. I think the first part is really, like you said, about just listening, and that can be an act of love for somebody. And to follow up at some point after that exchange to just check in and see how they are doing. Sometimes that can be just as valuable if not more.

Swee Giang: I think sometimes we get so caught up with work, and we forget about following up with the person. But at least, even if it is after a month or two, it shows that this friend thought about me.

Douglas: And I had one of those yesterday and picked up on something that had actually come up a few months ago, and just checked in on it. And the person was so appreciative and surprised. They said, oh my, you remembered! It really does not take a lot to reach out and check in.

So listening, deep listening, being authentic, being present, and this idea of following up. Any last tips for our listeners on how they can check in and take care of themselves?

Swee Giang: I think it's two points. The first is really about looking out for yourself. Earlier, we talked about having this self-awareness of your mental state. When I was doing training on self-care for our para-counsellors, there was this quote I came across by Sidney J. Harris. It goes: “The time to relax is when you don't have time for it.” It is ironic, but it is really very important for us to take note that every time we scramble to look at our calendar, and if we cannot find any days where we can take a break, that is probably when we need to really squeeze in some time off.

It is important for us to make time to take a break or to take leave. And leave does not have to be an elaborate overseas trip, which we cannot have these days. A staycation or just some quiet time is good enough. And self-care is not selfish. It is actually necessary for us to refresh and recharge, and it also allows us to give the best of us in whatever we do.

The second point is to look out for others. Because when you make the workplace a more pleasant environment for yourself and everyone, it kind of spreads. What you can do is probably offer words of kindness or show concern to your colleagues. It helps build social connection. I feel that when we have happy colleagues, it becomes a happy workplace for us.

Douglas: Okay, sounds like we are building momentum. Okay, one last question. So based on that quote from Sidney J. Harris, let's say you have a day and you are feeling a little bit stressed, and you found a pocket of five minutes before your next call, and you have those five minutes to treat yourself, to take care of yourself. What would you do?

Swee Giang: I would make myself a hot cup of tea and just focus on my plant corner in the office.

Douglas: Oh, nice. Okay, good tip. Everyone, think about if you could sneak in five minutes to take care of yourself, what would you do?

Swee Giang: That is a good question.

Douglas: Thank you so much for being here, Swee Giang. Congratulations on your first podcast. And thanks for all that you shared. I don't want to overuse the word “holistic”, but I think almost everything you spoke about had these different levels and different ways of looking at it.

Swee Giang: Thank you, Douglas, for making my first podcast an interesting and pleasant one.

Douglas: Thank you for listening to this podcast. I’m your host Douglas O’Loughlin. Follow us for new episodes, and follow psd.gov.sg/challenge for more public service stories.