Are You OK?

Mental Health in Singapore:

The Family
Lim Choon Guan

Psychiatrist, Senior Consultant

IMH
Recap: True or False
 About mental health

 Mental health is about mental illnesses only

 Classification systems help to us to study mental illnesses better

 Only doctors classify disorders

 There is only one classification system used internationally

Do you agree?

 The concept of family unit remains

strong in Singapore today
Objectives

 The importance of family

 Family life cycle

 Healthy Families

 Dysfunctional Families

 Singapore Families
 What Is a Family?

The family is the natural and fundamental group unit of society

and is entitled to protection by society and the State

United Nations, 1948

A group consisting of two parents and their children living together

as a unit

Oxford dictionary
Types of Families

 Nuclear Family
 Extended Family

 Reconstituted Family

 Single Parent Family

 Adopted Family

 Intermarriage Family

 Maid in the Family

Singapore Family Values
Family in Singapore
Singaporeans’ Values

Our Singapore Conversation Survey: Dec 2012- Jan 2013

 Family Life Cycle

Single
Aging family members adult
Married Couple

Home leaving young Child bearing family

adults
Family with preschool
children

Middle aged
parents

Family with teenagers Family with school children

Marriage
 Happily married couples are more
likely to enjoy better mental and
physical health
 Husbands tend to put on weight!

 Why?
 Marriage improves healthy lifestyles
 Healthy people get married and stay
married
Why Marriage?

 Reproduction
 Companionship
 Sex
 Escape
 Forced marriages
 Having a family
What Makes Marriage
Successful?
 L isten
 O verlook

 V oice

 E ffort
Family Life Cycle Stages

 Family with young children

 Adjust marital system to make space
for children
 Join in child-rearing, financial and
household tasks
 Realign with extended family to
incorporate parenting and
grandparenting roles
Parent’s Roles
 To provide emotional attachment and
bonding with their child.
 To provide a secure setting for their child to
grow
 To acts as models of behaviour and
attitudes.
 To meet a child’s needs for new
experiences.
 To maintain discipline
 To learn about communication and
relationships at home
Family Life Cycle Stages

 Family with adolescents

 Adjust relationships so adolescent can
move in and out of the system
 Refocus on midlife marital and career
issues
 Start joint caring for older generation
Family Life Cycle Stages

 Children leaving home

 ‘Empty nest’
 Renegotiate marital system as a dyad
 Develop adult-to-adult relations with
grown children
 Accept in-laws and grandchildren into
system
 Cope with disability and death of
parents
Family Life Cycle Stages

 Late Life
 Adjust couple functioning in face of
physiological, financial and work-role
decline
 Deal with loss of spouse, siblings and
friends
 Accept assistance from children/
outside agencies
The Well Functioning
Family
 Roles
 Relationships

 Rules
Family Problems

 Divorce
National Divorce Figures

Top reasons:
1.Unreasonable
behaviour
2.Lived apart >
3 yrs
Duration of marriage for
divorces
Predictors of
Dysfunctional Families
 Parental ill health
 Spousal violence
 Addictive behaviours
 Parents married early
 Big age gap in parents
 Whirlwind marriages
 Different religions and other incompatible
goals
 Lack of growth in marriage
 Affairs
Areas of Marital Conflict

 Work
 Stress

 In-laws

 Money

 Sex

 Housework

 Baby
Resolving Conflicts

 Solve with soft approach

 Motivated to repair relationship

 Regulate emotions

 Compromise

 Tolerance
Unhealthy Involvement of
Child in Parental Conflict
 Ask child to take sides
 Spy on other parent

 Using child as communication

channel
 Criticize other parent

 Treats child as friend and support

Divorce: How to talk to the
child
 Do not keep it a secret or wait till last minute
 Do this with spouse
 Keep things simple and straight-forward.
 Tell child divorce is not their fault.
 Admit this will be sad for everyone.
 Reassure child that you both still love them and
will always be their parents.
 Do not discuss each other’s faults or problems
with child
Divorce: Legal Aspects
 From 1 Dec 2016, parents with at least one child
<14, who do not have an agreement on the
divorce and all the ancillary matters, have to
attend the Mandatory Parenting Programme
(MPP) by MSF before filing divorce application
 Counseling at Divorce Support Specialist
Agencies:
 Financial challenges
 Living arrangements
 Child custody and access
 Importance of co-parenting and parenting plan
Divorce: Legal Aspects

 Custody
 Legal decision-making authority child’s life
 Religion, education, health, activities
 Usually joint custody
 Care and control
 Which parent child lives with
 Access
 Periods during which parent without care
and control is granted time to spend with the
child
 Is Divorce Harmful to
Children?
 Hetherington (1993)
 Majority of children do not have serious
problems
 Some exhibit emotional problems
• Behavioural changes (regression, bedwetting,
defiance, clinginess)
• Teens (academic problems, suicidal behaviour)
 Is Divorce Harmful to
Children?
 Amato and Keith (1991), Amato (2001)
 Studies showed children worse off
• Academically
• More behaviour problems
• Negative self concepts
• Problem with peers
• Trouble getting along with parents
Is Divorce Harmful to
Children?
 Wallerstein et al (2001)
 25 year follow-up
 Some children grew up having
difficulties in relationships
• Fearful of marriage
• Fearful of becoming parents
• More marital breakdown
Why are some children
more affected?
 Resilience of child
 Other stresses, including
socioeconomic disadvantage
 Parenting quality
 Single parent/new family composition
 May become more permissible or harsher
 Degree of parental distress
 Degree of marital conflict
 How Children Can Be
Affected
Divorce

Loss
Distrust
Guilt

Shame Inferiority
Effects on Child

 Sense of loss
 Abnormal family

 Fear of abandonment

 Mixed feelings

 Anger/ frustration/ rejection/ insecurity

 Feels responsible, guilty, self blame

Grief Reaction (to loss)
- Kubler Ross
 5 stages: DABDA
 Denial
 Anger
 Bargaining
 Depression
 Acceptance
 Unresolved grief can lead to mental
health problem eg. Depression
 Sudden losses, close/ambivalent relationship
Parents Facing Adjustment
During/After Divorce

 Life stress e.g. moving, changing

school
 Parental depression

 Reduced parenting capacity

 Economic loss

 Custody issues
The 3 Wishes of Children
from Divorced Families
 Parents back together again
 Life back to “normal”

 Parents are married

Family Problems

 Divorce
 Child abuse
 What Is Child Abuse?
 Child abuse is defined as any act of omission
or commission by a parent or guardian which
would

 endanger or impair the child’s physical or

emotional well being,

 and is judged by community values and

professionals as abusive (MSF, 2012)
Types of child abuse

 Physical
 Sexual

 Emotional

 Neglect
Child Abuse

Source: Ministry of Social and Family Development

Factors associated with
Child Abuse
Child Factors
 Child with disabilities, prematurity, behavioral problems

Parental/Family Factors
 Domestic violence
 Substance abuse
 Parental immaturity
 Parental expectations inconsistent with child
development
 Social isolation
 Family stress from illness, poor finances, divorce
 Adult caretakers who themselves were abused as
children
Family Problems

 Divorce
 Child abuse

 Others
 Chronic illness
 Death
 Moving/ Relocation
Food for Thought

 How has family of today changed over

the years? What are the reasons for
these?
 How will this affect future generations
and society as a whole?
 Is there anything which should be
done then, and if so, what and how?
Additional Resource

 Focus on the Family

 https://www.family.org.sg/
 Online resource, not meant to be read
as part of the course