Mental health: Suffer the children
  In Singapore, as in much of Asia, stress starts early

Far Eastern Economic Review
August 9, 2001

Trish Saywell/SINGAPORE

BEHIND SINGAPORE'S NEAT streets and orderly society lies a serious health problem. A highly competitive primary-school system and anxieties among children about less-than-perfect grades is driving more of the country's youth into the armchairs of psychiatrists. Ministry of Health statistics reveal the number of new cases of young people under 18 visiting psychiatrists at government-run outpatient clinics doubled from 1126 cases in 1990 to 2,491 cases in 2000. Half were of primary-school age.

Just how bleak is the life of a Singaporean primary school student? In a survey of 1742 children aged 10 to 12 commissioned by Singapore Press Holdings last year, students said they were more afraid of exams than of their parents dying. One in three said they sometimes thought life isn't worth living. "That's scary," says Brian Yeo, a psychiatrist in private practice at Mount Elizabeth Hospital. "What kind of life are we putting our kids through if they're so frightened of examinations?"

Singapore is not unique in driving its students hard. Academic achievement and getting into a good high school and university are challenges faced by children across Asia. In Japan, for instance, students who can't cope are staying home for months on end.

In Singapore, a growing number of students and their parents are consulting psychiatrists for help. Typically the children are not clinically depressed and don't require anti-depressants. "The majority are cases of reactive depression that respond more to individual counselling and family therapy," says Yeo.


But will the pressures these kids face make them more prone to bouts of depression as adults? "The long-term consequences will depend on children's resiliency," explains Yeo, "which in turn depends on the support they get from their parents . . . We need to instil basic self-confidence in the child so that any failures or disappointments will be seen as opportunities to try again rather than as a lack of ability."

In many cases it is parental pressure that is pushing up stress levels. "I got a call from a girl in primary school who scored 98 percent in an exam and she was scared she would be caned," says Joelle Chung, a volunteer counsellor at Tinkle Friend, Singapore's only national telephone helpline for primary-school children. "I congratulated her on getting 98 and tried to cheer her up, but I could tell she was stressed . . . When kids call us rather than talk to their parents, it shows there's a problem."

Alfred Tan, executive director of the Children's Society, which set up Tinkle Friend, cites a case last year of a nine-year-old boy who was caned for scoring 44 out of 50 in a spelling test. "Many of the issues are the results of poor parenting skills," says Tan.

That's because parents have high expectations, explains Ng Koon Hock, a psychiatrist in private practice in Singapore. "They want their children to do better than they did," Ng says. "When they try to coach the child, he becomes inattentive. He doesn't finish his work, he'd rather watch TV. Some parents bring them in to find out what's wrong."

Much of the problem lies in an education system that streams kids according to their ability from the age of 10. The Ministry of Education argues that putting students of different abilities in the same class is counterproductive. Before it introduced the system in 1980, just 58 percent of a primary one class completed secondary school. By last year the figure had reached 93 percent. "It is not clear that allowing many pupils to drop out or experience related failures in a system without streaming, as was the case before 1979, is a superior approach," said Ong Wee Hong, a spokeswoman for the Ministry of Education, in a written response to questions from the REVIEW.

But some psychiatrists argue that streaming puts excessive pressure on kids who might not make the grade. "I'm not saying streaming is all bad," says Yeo. "We have high rates of kids who get into college. But if you don't peak at certain times, you may not be able to get into a more academic stream . . . For kids who are below average, they feel they're not performing well and they get depressed."