Looking after your mental health

The importance of mental health

Mental health and physical health are not separate, they are very closely intertwined. People with poor mental health tend to be at higher risk of coronary heart disease, high blood pressure, and so on. The state of your mental health deeply impacts how you think, feel, and act in everyday life. 

Just like how we must care for our physical bodies, we also need to look after our mind, especially our mental health. When we say mental health, we are talking about your emotional, psychological, and social well-being. 

In this section, we explain:

• What mental health is

• The symptoms of the most common mental health conditions in Singapore, how you can practice self-care, and where you can find help in Singapore.

Why this matters to people living with HIV

People living with HIV (PLHIV) tend to experience higher rates of mental health conditions than the general population. This could arise from the stress of their diagnosis, having to adapt to their diagnosis, and facing HIV stigma and discrimination. 

People who are the most vulnerable to contracting HIV are from other marginalised groups such as people who have sex (taboo in conservative societies), men who have sex with men (MSM), those who engage in sex work, and those who inject drugs. 

Because of their existing marginalisation from society, these communities are already at higher risk of having or developing a mental health condition. 

1 & 2: Anxiety and depression

Anxiety and depression can be experienced separately, although they may occur together.

It is normal to have feelings of sadness after a bad day or week and feelings of anxiousness before an important event, like a test or a work deadline. 

However, if these feelings are persistent and occur for prolonged periods, you could have an underlying mental health condition. 

This article explains the distinctions between anxiety and depression, and feelings of anxiousness or sadness as opposed to mental health conditions. 

There are also many types of anxiety and depression, therefore, it is important to meet with a mental healthcare professional to have a formal diagnosis. 

Anxiety and depression have a few symptoms in common, such as:

Apathy

Apathy refers to the loss of interest or not finding pleasure in activities or hobbies that you previously enjoyed. Some people experiencing depression also voiced having persistent feelings of emptiness.

Helplessness and hopelessness

Those with anxiety and/or depression often feel pessimistic and hopeless regarding their mental health and physical condition. Some also feel guilty and see themselves as worthless or helpless.

Changes in habits

If you are experiencing changes in your appetite and sleeping patterns, such as sleeping too much, having insomnia, overeating, or feeling a loss in appetite could be signs of depression. Other changes in habits like consuming more alcohol and engaging in risky behaviour could also indicate depression. 

Persistent fatigue

If you feel tired or sluggish most of the time, this could be due to depression or anxiety. If not, it could also be due to another physical medical condition, like an underactive thyroid. Nevertheless, you should speak with a doctor and mental healthcare professional to find the cause. 

Difficulty focusing or making decisions

The symptoms of depression and anxiety include difficulty concentrating, paying attention to others, making decisions, or recalling details. This is because many people with depression or anxiety fear making the wrong decision. 

Mood swings

Frequent mood swings, being easily irritated, very impatient, or overly self-critical can be indicative of depression or anxiety. 

Unending worry

Unending worry can manifest in anticipating every possible problem and being distracted from the present. Difficulty with controlling unending worry can leave a person feeling quite stressed and tired. 

Wanting to be alone

It is okay to enjoy time by yourself, like reading and meditating. However, this is different from needing to stay home and socially withdraw from others because it takes too much energy to interact with them. 

3. Schizophrenia 

Schizophrenia is not about having a split personality, that is a common misconception. It is a condition that affects a person’s sense of reality. 

Schizophrenia is now known as a spectrum disorder and has various sub-types. The symptoms can vary greatly from person-to-person, a diagnosis is usually made if a person experiences one of the following symptoms for at least 30 days:

• Delusions

• Hallucinations

• Disorganised speech 

• Disorganised behaviour

• Negative symptoms 

More detailed information on the symptoms of schizophrenia can be found here.

Untreated psychosis can cause a great deal of suffering to the person with schizophrenia and the people close to them. 

Treatment usually consists of medication, psychotherapy, rehabilitation and counselling. Early intervention and treatment can reduce the risk of suicide and aggression. 

The Institute of Mental Health (IMH) also has an Early Psychosis Intervention Programme (EPIP), it specialises in the early detection and management for individuals with early psychosis (16 to 40 years old) and those at high risk of developing psychosis (16 to 30 years old).

4. Bipolar disorder

Bipolar disorder is a mood disorder. It is marked by extreme changes in mood from high to low and vice versa. Extreme highs are referred to as mania and extreme lows are depression. 

Episodes of mania and depression can often last for several weeks or months. In between these episodes, the person may appear to function as usual. These mood swings can affect sleep, energy, activity, judgment, behaviour, and the ability to think clearly.

It is important to remember that the symptoms of bipolar disorder can vary greatly from person-to-person, a formal diagnosis may also take time.

When depressed, the person with bipolar disorder:

• Feels persistently sad

• Feels hopeless

• Feels lethargic

• Experiences disturbances in sleep and appetite

• Feels excessively guilty

• Feels negative

• Feels suicidal

When manic, the person behaves quite differently. They: 

• Become overly elated and energetic

• Become more irritable

• Require less sleep

• Have racing thoughts

• Talk very quickly

• Make many grand plans

• May believe that he has supernatural powers, or a special mission

• May impulsively engage in potentially dangerous behaviour

There are various types of bipolar disorder: bipolar I, bipolar II, cyclothymic disorder, and other types. Treatment is available for the various types of bipolar disorder, it usually takes the form of medications and psychotherapy.  

Treatment is highly recommended as untreated bipolar disorder can lead to problems like drug and alcohol use, suicide or suicide attempts, legal or financial problems, damaged relationships, and poor work or school performance.

5. Substance use disorder 

Substance use disorder is a diagnosable, complex medical condition and not a ‘moral failure’. The disorder affects a person's brain and behaviour, leading to an inability to control the use of a substance. Those who are addicted may continue using the drug despite the harm it causes.

In addition to drugs and medication, substances can also include alcohol, marijuana, and nicotine. 

The symptoms of substance use disorder can be grouped into 4 categories: 

1. Impaired control

It is a strong urge to use the substance as well as desire or failed attempts to cut down or control their substance use.

2. Social problems

Substance use causes an inability to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use.

3. Risky use

Substance is used in risky settings and the person continues using it despite known problems.

4. Drug effects

Person has the need for larger amounts to get the same effect or experience withdrawal symptoms (different for each substance).

A more detailed description of the signs and symptoms of drug use can be found here. 

Talking to a doctor

Not everyone who uses substances becomes addicted. You are advised to see a doctor if you:

• Cannot stop using a drug

• Continue using the drug despite the harm it causes

• Have engaged in unsafe behavior, such as sharing needles or having sex without a condom

• Think you may be having withdrawal symptoms after stopping drug use

It can be daunting to talk to a doctor about suspected addiction, especially in Singapore. Thus, calling helplines or hotlines can be a good way to learn about treatment options. The sooner you seek help, the greater your chances are for long-term recovery. 

Every person’s treatment plan is unique, and there are multiple treatment options available. We provide the contact information of organisations specialising in addiction recovery in this section.