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A “Social Determinants” Approach to the Mental Health Crisis at Yale-NUS

All PostsOpinionA “Social Determinants” Approach to the Mental Health Crisis at Yale-NUS

Story by | Madhumitha Ayyappan (she/her)
Illustration by | Eunice Loh (she/her)

In Singapore, the differential access to health services, also known as health inequity, is often framed as a challenge that is felt exclusively by communities at the periphery, such as migrant workers, domestic workers and people living with HIV/AIDs. While their lack of access to good health is a very real and pressing issue, this everyday battle is not only fought by a select few communities in society. Here at Yale-NUS College, health inequity is no less familiar to the many students who constantly worry about the lack of accessibility to psychological services at the on-campus counselling centre or the nearby University Health Centre. While I by no means intend to trivialize marginalized groups by comparing their struggles to that of university students, the sad reality is that the mental health landscape at Yale-NUS is definitely not a bed of roses.

According to the Yale-NUS Counselling Centre, we have one of the highest ratios of university psychologists to students in the world. However, our need for mental healthcare is not sufficiently met. One common grievance among students is with regards to the extremely long wait times at the college’s in-house Counselling Centre. The center’s statistics show that during non-peak periods (beginning of semester), the wait time is approximately 2 weeks. During peak periods like the middle and end of the semester, the waiting list can extend up to a whopping 4 weeks. These estimated waiting times are prolonged even further if the student has to follow up with the same counsellor from their previous visit.

To overcome this bottleneck, the center has been offering external referrals to students that entitle them to eight free face-to-face counselling sessions per year with select service providers. Still, this move has only slightly ameliorated the situation, owing to the poor visibility of this scheme among the student body and the limited number of students who can be supported through the budget set aside for it. According to the staff at the centre, there have been instances when the budget had depleted within the early part of the full academic year, rendering students unable to access free external services in the later part of the year. 

When such measures fail, one avenue that students can turn to is the belt of NUS health insurance schemes that they are covered by. However, these schemes provide widely different coverage for Singaporean and international students, despite both groups belonging to the same academic institution. For example, when it concerns outpatient treatment by a psychiatrist or psychologist, the NUS Insurance fact sheets state that Singaporeans and Permanent Residents can have their visits to psychiatrists at all government restructured hospitals (with referral from NUS counsellor or physician) reimbursed at subsidized rates while international students are bound by a claim limit of $2,000 per year which only applies to treatment at the A&E Departments of either the Institute of Mental Health or the National University Hospital.

Additionally, like most other insurance plans, these schemes are also decorated with a generous amount of complicated clauses, one of which requires students to obtain a referral from a NUS counsellor in order for external treatment to be subsidized. Seeing that waiting times can extend up to four weeks at the Counselling Centre during peak periods, this means that a student would have to wait for at least one month to access an outpatient mental health treatment that is covered by their student insurance.

These challenges in accessing mental health services are further complicated by issues of transparency, as students are not rendered access to the full list of standard and non-standard drugs that can be covered by their insurance schemes. Especially for students in need of medications to treat their psychiatric conditions, this uncertainty of cost hampers their ability to budget their healthcare expenditure, adding only further bouts of anxiety to an already overwhelmed state of being. 

While I recognize and deeply appreciate the tremendous amount of effort by the college to offer these services to students in the first place, there still exists an urgent need to recognize that access to mental health services remains a fundamental issue for our college community.

This then raises several key questions: Why aren’t our mental health needs being sufficiently met? Are we simply a loud and outspoken bunch of students that keeps asking for more? Or are there deeply entrenched structural issues in this institution that need to reform before our collective mental health can change for the better?

One approach that can help us answer these seemingly difficult questions is to consider the role of social determinants of health, or more specifically, mental health in this context.

According to the World Health Organization, “social determinants of health” are the non-medical factors that influence health outcomes of people and have an important influence on health equities that are unfair and avoidable. This angle emphasizes looking at the value of the lived experiences of our target population (students) and learning how factors such as their social networks, gender and sexuality, socioeconomic status, expectations of academic outcomes, learning, and the wider set of forces and systems influence their health.

In taking such an approach, rather than shifting the blame disproportionately onto the Counselling Centre or the health system, we are encouraged to look inward into the various moving parts of our college experience and ask ourselves: What among these might have contributed to our current mental health climate? This could take the form of the notorious hustle culture that we normalize on campus, the sleeplessness of community members which is so often heralded as a badge of honor, and the clubs and societies that we happily overcommit ourselves to, just to name a few. Are we doing too much? And is this having an adverse effect on our health in the name of academic and college rigor?

 Professors also have significant roles to play in creating the academic culture of our campus. Currently, toxic academic expectations are set in the form of academic workloads that far exceed student capacities. This is apparent when one sifts through the college’s Academic Resources Hub on Facebook, where it is not rare to find students expressing their sentiments regarding professors who assign over 100 pages of reading multiple times in a week, sometimes even before the semester has begun.

Perhaps, if there was one thing that we could learn from the “social determinants of mental health” approach, it would be to pay attention to the structurally damaging elements within our academic institution as a way of improving our collective mental health. Doing so would allow us to come to terms with the reality that students, faculty and staff help construct and define Yale-NUS’s mental health landscape as we know it. At the same time, it also brings to light the fact that all three stakeholders have a shared responsibility to critique our current comparative and competitive culture, and to instead cultivate one of collaboration and care.

To this end, thinking about ways in which we can respectfully engage with professors to set more reasonable academic expectations can be a viable first step. Some ideas that come to mind are reviewing faculty policy on academic expectations and workload for course offerings, as well as to inform professors on best practices when it comes to responding to students with certain learning accommodations. At the same time, it is also important to introspect how we, as students, can start making small changes to our daily lives for the betterment of our mental health. This could take the form of rethinking our priorities, reviewing our academic expectations of nothing less than an A, as well as recalibrating our commitment to caring for our mental health through the various on-campus initiatives, just to name a few. At the end of the day, these small individual-level changes can accumulate to have a tremendously beneficial ripple effect on our communities.

While the offerings of the counselling centre and student health insurance coverage still require deeper consideration, there is an even greater urgency to tackle structural issues that form the root of the mental health crisis at Yale-NUS College. Ultimately, our community’s mental health is not merely a matter of cure but prevention, and the steps that we take to address this crisis ought to be motivated by a nuanced understanding of the stressors that always linger in the backdrop for students.

(The writer is grateful to Residential Life Officer, Rachel Tan for inspiring this op-ed.)

The views expressed here are the author’s own. The Octant welcomes all voices in the community. Email submissions to: yncoctant@gmail.com

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