Mental health professionals: Who they are, what they do, whom you should approach

Daniel Wong, NIE NTU current student and Cyrus Chng, alumni from the Master of Arts (Applied Psychology) at the National Institute of Education were interviewed by The Straits Times as mental health professionals in Singapore. 

SINGAPORE – When a teenager battling gaming addiction was referred to counsellor Daniel Wong, it was clear to him that the problem went beyond excessive screen time.

Showing signs of anxiety and depression, the teenager struggled to cope in school. He shut himself off from the outside world, only immersing himself in his games.

Mr Wong, who is with Touch Community Services, says: “It was tricky and I was a little taken aback, because what do we focus on here? His mental well-being, addiction or his personal relationships?”

The counsellor decided to connect with the teen in the gaming world. After a few sessions of playing games together, the teenager began to open up and revealed the real issue – his tumultuous relationship with his father.

The two had frequent arguments. The teen turned to gaming to manage his anger and avoid interactions with his father; the father blamed gaming for his son’s behaviour.

Despite initial hesitation from the teen, Mr Wong decided to involve the family in his counselling sessions.

The focus was on enhancing their communication and reducing misunderstandings, Mr Wong explains. 

The first few family sessions were heated. But gradually over the next nine months, the father learnt that he needed to change how he communicated with his son so he did not come across as nagging or reprimanding, while the teenager was encouraged to find ways to appreciate his father’s advice.

As the teenager’s relationship with his father started to mend, his depressive symptoms lessened, his anxiety attacks stopped and his gaming addiction faded. He came out of his shell and started making friends at school.

Mental health professionals like Mr Wong work behind the scenes, unravelling the complexities of individual struggles.

These practitioners, who include psychiatrists, counsellors, psychologists and therapists, provide support and guidance to individuals facing emotional or psychological challenges. Their work is critical, particularly as mental health becomes a national priority.

Counsellor Daniel Wong recalls helping a teenager to open up by playing games with him during the initial counselling sessions.

The notion of seeing a therapist is often associated with lying on a couch and being psychoanalysed by someone.

But, in reality, mental health practitioners use various approaches, such as medication, talk therapy, cognitive behavioural therapy and mindfulness techniques, to help individuals in need better understand their thoughts and feelings, develop coping strategies and work through their concerns.

Let us dive into their world to understand how they assist those in need.

The psychiatrist

A cornerstone of mental health treatment in Singapore, psychiatrists study, diagnose, prevent and treat mental, behavioural and personality-related disorders. Their approach can include medication, psychotherapy and psychosocial interventions.

Psychiatrists, who are medically trained doctors, can dispense medicine and are regulated under the Medical Registration Act, different from others in the ecosystem.

The counsellor

Mr Wong says: “Unlike other countries where the distinctions between roles are clearer, in Singapore, counsellors are often confused with social workers, psychologists or mentors, which can lead to misconceptions.” 

Counsellors often employ talk therapy to help clients through specific challenges, like work-related stress or personal difficulties.

Besides providing a listening ear, they empathetically guide individuals in exploring their feelings or thought patterns and help them to devise strategies for coping or moving forward.

Mr Wong says he works with clients to achieve their counselling goals. “It could be anything. People can simply say they want to live happier and we can work towards that.”

Mr Daniel Wong says in Singapore, counsellors are often confused with other roles, and this can lead to misconceptions.

He is one of the counsellors overseeing Touch Community Services’ Live On, an intervention programme designed for youth aged 12 to 18 who have been hospitalised for self-harm or suicide attempts, supporting their transition back into the community after their discharge. The programme’s objective is to lower the youth’s overall suicide risk.

Mr Wong also handles calls on TOUCHline, a counselling hotline for the public operated by the social service agency between Monday and Friday.

He says: “We have observed an increase in mental health-related calls nowadays. From anxiety to panic attacks or depression – sometimes, the caller is in obvious distress. They could be crying and breaking down.”

Mr Wong’s priority is to help callers calm down and identify their concerns, and offer a follow-up counselling session if there is a need.

“You may be surprised – sometimes there is no follow-up after the call,” he says. “Often, that call and the listening ear we provide are all that the person needs.”

The counselling psychologist

Counselling psychologists typically have more advanced training than counsellors and are equipped to assess and treat a wider range of psychological issues, besides helping clients address immediate mental health concerns.

Their therapeutic techniques and psychological assessments include cognitive behavioural therapy, psychometric testing and other evidence-based approaches to treat more complex mental health conditions, including trauma and personality disorders.

At the Singapore Civil Defence Force’s (SCDF) Emergency Behavioural Sciences and CARE Unit (EBSC), psychologist Cyrus Chng provides counselling support and intervention to personnel in need.

“Many believe that only those with mental health issues would require psychological support; it’s really beyond that,” he says. For instance, he steps in to offer guidance to national servicemen facing adjustment issues, among other challenges, during their national service at SCDF, as well as to uniformed and civilian officers who encounter challenges during their careers. 

Psychologist Cyrus Chng provides counselling support and intervention to SCDF personnel in need.

Front-line personnel can be deeply affected by distressing experiences on the job, such as failing to resuscitate a victim or managing cases involving vulnerable groups like minors or the elderly. These incidents may leave them grappling with guilt or experiencing flashbacks.

When this happens, EBSC psychologists are called in to conduct psychological debriefings, offer support to those affected and help them process their trauma so they can return to their normal routines.

As stress symptoms can last up to four weeks, Mr Chng follows up with affected personnel about a month after a debriefing. Any officer still struggling with intense emotional reactions is offered individual counselling.

Mr Chng has encountered many clients who delay seeking help until their problems become too severe or overwhelming to handle on their own. This hesitation is often driven by social stigma surrounding mental health, making it difficult for people to acknowledge their struggles or reach out for support.

Mr Chng says it can also be challenging to convince clients’ families of the importance of seeking help. 

Mr Cyrus Chng says it remains a challenge convincing individuals and their families of the importance of seeking help.

He recalls a case in which a national serviceman asked to take a copy of his counselling form home. He wanted to show it to his family, who were sceptical about his mental health struggles.

This was not a typical request, but Mr Chng agreed to provide him with his business card and a picture of the counselling form’s cover page, to reassure the family that their son’s mental well-being was being cared for by a professional in-house psychologist.

This helped the serviceman’s family to eventually come round to supporting his subsequent counselling and recovery journey. Mr Chng says he was not surprised by the serviceman’s need to convince his family, although such situations are uncommon.

He emphasised that healing is a gradual process, and some clients may not see immediate improvements in their symptoms, which can lead to frustration or doubt about treatment. “They should trust and work with mental health professionals to overcome the difficulties they face,” he says, stressing that patience and commitment to the process are crucial for recovery.

The clinical psychologist

Clinical psychologists work with individuals experiencing mental disorders, including depression, anxiety or post-traumatic stress disorder, and provide support during episodes of severe emotional distress.

While they are not medical doctors, they often hold a PhD or doctorate in psychology, which equips them with specialised training in psychological assessment and treatment.

Dr Ho Yiling, a senior principal psychologist at the Psychosocial Trauma Support Service at KK Women’s and Children’s Hospital (KKH), works with patients who have gone through trauma related to pregnancy, childbirth or relationship violence.

She performs psycho-emotional assessments on patients referred by KKH doctors to better understand their struggles and trauma-related symptoms.

If a bereaved patient struggles with sleep difficulties, she may use relaxation techniques, cognitive behavioural therapy or other trauma-focused interventions to help them manage the issues and gradually return to their daily routines.

Dr Ho also frequently collaborates with patients’ spouses, family members or other mental health professionals to provide comprehensive care. This may involve coordinating support networks or helping to improve communication within families.

KK Women’s and Children’s Hospital’s clinical psychologist Ho Yiling meets patients who experienced trauma related to pregnancy, childbirth or relationship violence.

Describing recovery as a journey, Dr Ho notes that patients typically need between 12 and 16 hour-long sessions to overcome their traumatic stress symptoms.

“It can be quite daunting for patients to embark on this journey because they are learning new skills and discussing difficult topics,” she explains. “Their engagement and motivation may fluctuate based on life circumstances and the impact of their stress symptoms. Thus, it’s crucial to build a good rapport and ensure they feel physically and psychologically safe.”

While she was training for her psychology doctorate in Australia, Dr Ho worked for a service providing outreach mental health support to people in the regional towns of Queensland.

“I noticed that many adult clients suffering from long-term mental health difficulties were socially isolated, with severe mood disturbances, involved in substance abuse and had very rough childhoods.”

While working with an outreach service in Australia, Dr Ho Yiling realised that people have a fundamental need to be seen, valued and loved.

“I witnessed first-hand the profound impact of safe and trusting relationships, as well as the potentially devastating consequences when those relationships are lacking in these adults,” she says, adding that she came to appreciate that people have a fundamental need to be seen, valued and loved.

At the same time, she also grew to realise that while human beings are vulnerable to trauma, they are equally resilient – even if the journey to recovery may take a long time.

“I have worked with patients who had gone through very adverse circumstances but managed to take something away from and live through it,” she says. “Even if it takes a long time, when I see them functioning better, it’s always motivating.”

The correctional psychologist

Some may think Ms Georgina Tay has a dangerous job.

As a correctional rehabilitation senior psychologist in the Psychological and Correctional Rehabilitation Division of the Singapore Prison Service, she works with clients who are mostly high-risk offenders. Some were involved in violent and sexual crimes.

“To be honest, I rarely feel unsafe,” Ms Tay emphasises. “We are closely monitored on the CCTVs and there is an alarm in the room. We can press it to alert our colleagues or the prison officers.

“But really, the inmates trust us a lot. They are respectful and know we come in to help and empathise with them.”

Ms Tay’s main role there is to address inmates’ negative thinking patterns that led to their offences, encouraging them to reflect on their actions and internalise positive changes.

Correctional rehabilitation senior psychologist Georgina Tay says she seldom feels unsafe even though her clients are mostly high-risk offenders.

Instead of typical private, one-on-one sessions that psychologists have with clients, Ms Tay likes to experiment with different approaches, depending on the circumstances and objective.

She once used a narrative therapy approach, turning the offenders’ stories into a song. She and her colleagues crafted lyrics using the offenders’ words, composed a melody and performed the song for the group.

The lyrics reflected the inmates’ past experiences and struggles. Part of the song goes: “Young and alone. There was no one whom I could turn to. Bullied in school. I was teased and being beaten. I felt sad, I felt angry. Violence was all around me. I saw it all, I lived it all. Then I learnt. If I don’t stand up for myself, nobody will.”

The impact was clear. Some inmates went silent, others appeared contemplative. It was a moment of potential change.

“For me, this was profoundly powerful. These inmates had never heard their stories reflected back to them in such a way,” Ms Tay says.

Many inmates said it gave them hope and helped them understand their destructive behaviours, inspiring them to build new identities. Although this event happened nearly a decade ago, it still resonates with her.

Ms Georgina Tay says effective rehabilitation goes beyond individuals, especially since many inmates tend to come from marginalised backgrounds.

Offering psychological support is inherently complex and never one-size-fits-all, she says. Ms Tay explains that correctional rehabilitation psychologists do not enter a prison with the assumption they can rehabilitate everyone. Instead, they rely on “RNR”, assessing the risks, needs and responsivity of each inmate.

Some inmates may already be reflecting on their actions upon sentencing, while others may not be ready for such introspection. Many inmates come from marginalised backgrounds with a whole spectrum of needs, from financial assistance to family issues. There are also those who require more intensive psychological interventions.

Ms Tay also helps evaluate inmates’ suitability for various rehabilitation programmes, taking their overall behaviour, recent progress in rehabilitation and reintegration plans into consideration.

These include community-based programmes that aid inmates in rejoining society with support from their families and communities, and other in-care psychology-based programmes.

Ms Tay emphasises that effective rehabilitation involves not just focusing on the individuals but also helping them access support within the community. “Some of them are very used to a particular lifestyle – resorting to violence or getting into trouble, or being in prison, where everything is structured and controlled – so any form of change or mindset shift is definitely challenging for them.”

The art therapist

Apart from psychologists, therapists are another group of mental health professionals who use various methods to help individuals develop coping strategies, build resilience, enhance overall well-being and prevent the escalation of psychological concerns.

Art therapists use art as a way for individuals to express themselves and communicate, helping to improve their mental health.

Ms Yoko Choi from the Institute of Mental Health employs art therapy interventions to support patients with mood disorders, such as major depressive and bipolar disorders, and assist them in their healing journey.

People may believe using art therapeutically requires good drawing skills. However, Ms Choi says that art therapy is totally different. “It supports people whose experiences are difficult to put into words,” she says.

Specifically, art therapy combines hands-on art-making with personal reflection to help individuals understand, process and express their feelings and experiences.

Institute of Mental Health art therapist Yoko Choi says art therapy creates a safe space for overwhelmed individuals to express their emotions and understand their challenges.

Individuals can use shapes or colours to symbolise their emotions or relationships. They can also leverage breaking, pounding or throwing art materials like clay to illustrate what they have been through. Either way, art therapists guide them to raise self-awareness and cultivate self-compassion.

“These actions stimulate inner dialogues, allowing individuals to go deeper into very complex experiences,” Ms Choi explains.

Art therapists tailor art materials to their clients’ needs and ages. For an elderly person who has lost a child, she might use materials that they are familiar with, like paper, for an activity like making flowers. “As we do so, we can talk about flowers as a metaphor of life,” she says. “This can be empowering for the seniors, letting them know that while they grieve, they can create something meaningful.”

For younger clients, Ms Choi may create a doll and play and tell stories with them to explore ideas of death and fear.

Ms Yoko Choi demonstrates how patients may reveal their mental state and emotions through the use of clay and figurines in an art therapy session.

Despite its open and creative nature, art therapy is not a random process. Art therapists are skilled in structuring sessions effectively by setting up the space and using relevant materials. These sessions, typically lasting an hour, can be directed, with a specific topic, or non-directed, allowing spontaneous expression.

Regardless of the approach, the goals are consistent. Ms Choi helps her clients process their emotions, unpack past trauma and understand its impact on their current lives.

“Guided by their creative process, they gain a sense of safety, building connections to the self, and work towards change and transformation,” she says.

The play therapist

“Play is natural and non-threatening,” says Dr Vinita Sajan Tahilramani, a senior play therapist.

Her clients are children who may be old enough to speak but struggle to articulate their feelings. Through play therapy, these children can express their emotions and experiences in a safe and supportive environment.

Dr Tahilramani, who is with the Department of Paediatrics at the National University Hospital’s Khoo Teck Puat – National University Children’s Medical Institute, works with children aged three to 10. Many are referred by paediatricians.

For instance, a child may repeatedly complain about abdominal pain and refuse to go to school, and when doctors find nothing physically wrong, they refer the child to play therapy to explore possible anxiety or coping struggles.

Early difficult experiences, like a parent involved in a serious accident, or significant life transitions, such as frequent family moves, can have a profound impact on a child’s sense of stability and security. 

Play therapy provides a space for children to process these experiences that may have contributed to emotional distress.

Dr Vinita Sajan Tahilramani, a senior play therapist, holding Eyeball, a dinosaur puppet in her play therapy room. 

Dr Tahilramani’s therapy room is filled with toys like building blocks, doll houses, puppets and characters from popular animated series like Inside Out and Paw Patrol, as well as sand trays.

The first play therapy session involves only the parents, to understand the child’s developmental history and temperament. Dr Tahilramani’s approach is trauma-informed, meaning she takes into account all the early difficulties and challenges a child might have faced and how they play a part impacting their emotions and behaviours. 

“Our focus is to help children feel safe. We don’t rush into therapy or push an agenda. The child chooses what to play with, and once they experience the non-directedness and safety, they’ll want to come back,” she explains.

Dr Vinita Sajan Tahilramani demonstrating how her young clients would assemble the train track. She aims to always ensure they feel safe in the therapy room.

As the sessions progress, toys become the child’s language. Dr Tahilramani follows the child’s lead and interprets the symbolic meaning they attach to toys, which can reveal deep feelings. For example, a child might use a doll house to express feelings about their parents’ separation.

“It looks simple, but there are some really difficult feelings coming out,” she says. Over time, the child might attribute new meanings to toys and express their inner world. “We are trained to play with that flow and work with them in that manner,” she adds.

Dr Vinita Sajan Tahilramani lets her young clients take the lead and interprets the symbolic meaning they attach to various toys, which can reveal deep feelings.

Play therapy is confidential. While Dr Tahilramani shares general insights with parents, she never discloses specific details of the sessions. “It’s natural for parents to ask if their children had ‘fun’, but like counselling, play therapy involves a lot of hard work. Nobody asks if someone had ‘fun’ after a counselling session,” she points out.

“Many children that come to play therapy have had multiple adverse life experiences. It helps if we look at this child in a more compassionate way.”

Finding the right support

These mental health professionals tell The Straits Times that if more people understand the distinct but complementary roles various mental health professionals play, they will be clearer on who they can approach for help with specific issues.

This will be key to providing people with effective support and care.

Mental health issues can range from emotional and cognitive disorders to conditions that have underlying biological or neurological factors. These play out in various ways, affecting an individual’s thoughts, feelings, behaviours and overall functioning in daily life.

For the practitioners helping such individuals, misconceptions, stigma and scepticism are some challenges that can hinder their ability to provide effective care and interventions.

“I often tell my patients, when we break a bone, we don’t try to recover on our own – we see a doctor,” Dr Ho, the clinical psychologist, says. “Similarly, if we have a mental health crisis, we should reach out for help too. It just involves a different organ in our body – not the bone, but the brain.”

Sometimes, patients’ families may be dismissive or in denial due to generational differences in understanding mental health or the stigma associated with it, among other reasons.

Dr Ho Yiling often tells her patients that “if we have a mental health crisis, we should reach out for help” instead of going it alone.

Mr Wong, the counsellor, says: “Take depression, for example. Some parents I work with do not believe in a diagnosis, or they may say things like ‘this didn’t exist in my time’.”

These reactions can lead to conflict and impede effective support, and getting everyone on the same page to help those in need may be as difficult as the issues themselves.

Another myth that mental health professionals fight to correct is the idea of quick fixes.

Many people, they tell ST, expect immediate results from therapy or counselling, but real change takes time.

Mr Chng, the counselling psychologist, says patience and trust in the process are crucial. “You won’t see overnight miracles, but working with a mental health professional can help you navigate your challenges.”

Another widespread misconception is that psychological trauma is rare and confined only to catastrophic events like wars or natural disasters.

In reality, it lurks in the shadows of everyday experiences.

Mr Cyrus Chng says working with a mental health professional can help one navigate one’s challenges, but real change takes time.

“Trauma is more common than people think, and the experience of trauma can be highly subjective,” Dr Ho explains. “Harassment, bullying or emotional abuse can be just as damaging as physical threats.”

The practitioners tell ST that real progress in mental healthcare requires a collective shift in perspective here – one that acknowledges the intricate nature of mental health struggles and the necessity for sustained, compassionate support.

More recognition for the professionals

Mental health professionals play a crucial role as psychological well-being becomes an increasingly important focus in society, and the Government is looking to grow their numbers as well as take steps to ensure standards in the quality of care provided.

Nearly half, or 49 per cent, of adults surveyed said they felt depressed to the point of hopelessness for extended periods, according to an Ipsos World Mental Health Day survey published in October 2023. The survey of 1,001 people aged 21 to 74 also found that 27 per cent have seriously contemplated suicide or self-harm.

And in a recently released nationwide survey on youth mental health by the Institute of Mental Health, one in four youth reported having severe or extremely severe symptoms of anxiety.

Singapore aims to increase the number of public-sector psychologists by 40 per cent by 2030. Additionally, 28,000 front-line personnel and volunteers serving at community and social service touchpoints will be trained to help identify those struggling with mental health issues.

While psychiatrists, who are medically trained doctors, are regulated under the Medical Registration Act, counsellors and psychologists are currently self-regulated and do not require licences to practise.

But MPs and professional associations, including the Singapore Psychological Society (SPS) and Singapore Association for Counselling (SAC), have called for a regulatory framework that would raise the standards and safeguards of the profession, which involves working with vulnerable individuals.

SPS president Adrian Toh said there are currently 692 psychologists registered with the society. They are governed by its code of professional ethics.

Registration is not mandatory, but requirements include a postgraduate degree in applied psychology with coursework in psychological assessment, intervention and ethics, as well as 1,000 practicum hours, including 400 hours of supervised practical training.

Practitioners registered or licensed in other recognised countries can also be SPS-registered.

SAC-registered counsellors must hold a postgraduate degree in counselling from an institution recognised by the association, and need to clock 600 hours of face-to-face counselling and 60 hours of clinical supervision.

The association has more than 1,900 members, of whom over 620 are registered counsellors and 731 are working towards full registration.

The Association of Psychotherapists and Counsellors Singapore recognises practitioners’ qualifications and experience on a five-level framework, which are published in the members directory alongside each practitioner’s professional specialities.

This starts with certified professionals holding a relevant degree or postgraduate degree, and having at least 150 hours of supervised practicum. The highest level, Certified Master Practitioner or Supervisor, requires a relevant master’s degree, 500 hours of supervised practicum, and supervisor certification from approved institutions.

A regulatory framework that recognises mental health professionals’ qualifications and expertise could help demystify the field, and provide clarity on who one should approach for specific issues, practitioners say.

Ms Tay, the correctional rehabilitation senior psychologist, supports the call for better regulation and recognition of mental health professionals, but says it is equally important to have standardised training and development in place, and to ensure that rates are affordable and access to care is increased.

“In a way, this also ensures mental health practitioners receive proper training and are equipped with the necessary skills for the job,” she says, adding that the main ethical consideration is to “do no harm to the clients”.

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Source: The Straits Times © SPH Media Limited. Permission required for reproduction.