France and Singapore: complementary perspectives on mental health innovation

“Since 2012, men­tal health has been one of the pri­ma­ry con­cerns in Sin­ga­pore,” says Serenel­la Tolomeo about the South­east Asian coun­try, where she is a researcher at the Insti­tute of High-Per­for­mance Com­put­ing. Involved in pub­lic health pol­i­cy, she paints an alarm­ing pic­ture: “One in three young peo­ple in Sin­ga­pore suf­fers from anx­i­ety or depres­sion.” To address this issue, the Sin­ga­pore­an gov­ern­ment has played a key role in improv­ing the men­tal health of its citizens.

To find pos­si­ble solu­tions to this epi­dem­ic of men­tal health prob­lems, Serenel­la Tolomeo pre­sent­ed the recent mea­sures adopt­ed by the country’s insti­tu­tions. In addi­tion to the researcher’s insight­ful com­ments, Quit­terie Mar­que (Man­ag­ing Direc­tor of Koa Health in Asia), Antoine Tes­nière (Man­ag­ing Direc­tor of Paris San­té Cam­pus) and Éti­enne Min­vielle (Direc­tor of the Man­age­ment Research Cen­tre at École Poly­tech­nique [IP Paris]) invite us to take part in a dis­cus­sion on our men­tal health that is as crit­i­cal as it is informative.

There are var­i­ous rea­sons for the psy­cho­log­i­cal dif­fi­cul­ties expe­ri­enced by Sin­ga­pore­ans. For Quit­terie Mar­que, the pro­fes­sion­al and aca­d­e­m­ic pres­sure faced by the coun­try’s inhab­i­tants and the high lev­el of stig­ma sur­round­ing men­tal health issues are major con­tribut­ing fac­tors. Not to men­tion the COVID-19 pan­dem­ic, which fur­ther exac­er­bat­ed the cri­sis: “In 2023, near­ly one in two employ­ees report­ed feel­ing men­tal­ly or phys­i­cal­ly exhaust­ed at the end of their work­ing day,” explains the direc­tor of the Asian and Sin­ga­pore­an com­pa­ny Koa Health. “The pres­sure to per­form well at school is one of the down­sides of an edu­ca­tion sys­tem that is among the high­est-ranked inter­na­tion­al­ly. COVID, mean­while, has led to long restric­tions and dif­fi­cult lockdowns.”

In Octo­ber 2023, in the wake of COVID, the Sin­ga­pore­an gov­ern­ment tack­led the prob­lem head-on. The goal: to imple­ment con­crete actions to address issues such as anx­i­ety and depres­sion through pre­ven­tion and care. These sys­temic and cross-sec­toral mea­sures, aimed at solv­ing the men­tal health cri­sis, are still being imple­ment­ed and adjust­ed in the coun­try. They are based on the “tiered care mod­el” strat­e­gy, which is an adap­ta­tion of the “stepped care mod­el”, a more wide­spread tiered care mod­el used in Cana­da and Aus­tralia, as well as in sev­er­al oth­er countries.

More specif­i­cal­ly, in Sin­ga­pore “peo­ple are divid­ed into four groups. For each lev­el, the gov­ern­ment pro­pos­es dif­fer­ent strate­gies,” says Serenel­la Tolomeo. Tier 1 is for peo­ple in good men­tal health, help­ing them to become more aware of their men­tal state, and Tier 4 is for those who have been under­go­ing treat­ment for years and require more assistance.

The method is based on four key prin­ci­ples. First, it offers a wide range of choic­es and adapts to the patient’s needs and lev­el of dis­tress. The sec­ond key prin­ci­ple of the mod­el is to always pri­ori­tise the light­est pos­si­ble inter­ven­tion based on the person’s needs. Third­ly, the method adapts to what each per­son is will­ing to do for their men­tal health. Final­ly, the last point con­cerns the flex­i­bil­i­ty of the mod­el in dif­fer­ent con­texts, from school to hos­pi­tal to work. “We are not going to solve these prob­lems by improv­ing the health­care sys­tem alone,” adds Quit­terie Marque.

Anoth­er key word in the pro­gramme is “prag­ma­tism”. It relies on dig­i­tal and cut­ting-edge tech­nolo­gies to achieve spe­cif­ic and con­crete men­tal health goals by 2030. Among the actions imple­ment­ed by the gov­ern­ment are resilience cours­es, which pro­vide stu­dents – and teach­ers – with tools to bet­ter man­age adver­si­ty and iden­ti­fy men­tal health vulnerabilities. 

Anoth­er ini­tia­tive worth men­tion­ing is Mind​line​.sg, an anony­mous dig­i­tal plat­form that offers tools and knowl­edge for self-care, access to com­mu­ni­ties for sup­port when fac­ing life’s dif­fi­cul­ties, and refer­ral to pro­fes­sion­als if nec­es­sary. Let’s con­clude this brief overview with anoth­er promis­ing dig­i­tal pro­gramme, Hopes. The pro­gramme tracks indi­vid­u­als’ sleep and phys­i­cal activ­i­ty via a smart­watch and then stores the data col­lect­ed in the cloud. This allows it to be trans­mit­ted to R&D teams or clin­ics to pro­vide bet­ter mon­i­tor­ing of patients, as well as high-risk populations. 

Even more than tan­gi­ble actions, the per­cep­tion of men­tal health issues is chang­ing in Sin­ga­pore. In this regard, Quit­terie Mar­que has high­light­ed three guide­lines to fol­low to improve the way men­tal health issues are treat­ed in the coun­try. These include rebal­anc­ing the resources allo­cat­ed to men­tal ill­ness pre­ven­tion in rela­tion to those allo­cat­ed to clin­i­cal care. The sec­ond guide­line con­cerns the inte­gra­tion of men­tal health issues into the tra­di­tion­al health­care sys­tem, so that they are no longer treat­ed as “sep­a­rate” prob­lems. Final­ly, the last cru­cial point is to take advan­tage of the mas­sive oppor­tu­ni­ties offered by dig­i­tal tech­nol­o­gy to pre­vent and treat psy­cho­log­i­cal vulnerabilities.

This inter­na­tion­al dis­cus­sion sought above all to “build bridges between Sin­ga­pore and France”, in the words of Serenel­la Tolomeo. The aim was to learn from each other’s expe­ri­ences to improve the effec­tive­ness of men­tal health ini­tia­tives. Can the two coun­tries, sep­a­rat­ed by a thir­teen-hour flight and poli­cies and cul­tures that dif­fer in many ways, learn from each other?

For Antoine Tes­nière, the sit­u­a­tions in France and Sin­ga­pore share cer­tain com­mon fea­tures, which is already a start­ing point. Indeed, the psy­cho­log­i­cal well-being of the French is also in con­sid­er­able cri­sis. In France, one in four peo­ple will expe­ri­ence men­tal health prob­lems in their life­time, and around 13 mil­lion peo­ple suf­fer from anx­i­ety and depres­sion or psy­chot­ic dis­or­ders. Anoth­er com­mon­al­i­ty is that in France, too, COVID-19 has only exac­er­bat­ed the sit­u­a­tion. “It is esti­mat­ed that anx­i­ety and depres­sion dis­or­ders have dou­bled between the time of the COVID out­break and today. At the time, they affect­ed around 10% of the pop­u­la­tion, where­as today that fig­ure has risen to almost 19%.”

In France, around 13 mil­lion peo­ple suf­fer from anx­i­ety and depres­sion or psy­chot­ic disorders.

Faced with this epi­dem­ic of men­tal health issues, France’s approach to tack­ling these prob­lems is sim­i­lar to that adopt­ed by Sin­ga­pore in terms of recog­nis­ing the impor­tance of pre­ven­tion: “If we look beyond men­tal health, 80% of our health­care system’s expen­di­ture is on treat­ment, and 2–3% on pre­ven­tion. How­ev­er, accord­ing to fig­ures from stud­ies car­ried out at Euro­pean lev­el, every euro invest­ed in pre­ven­tion could yield up to €14 in return,” explains Antoine Tesnière.

The French strat­e­gy also involves invest­ing in cut­ting-edge dig­i­tal tools that can detect, diag­nose, mon­i­tor and treat dis­or­ders. To imple­ment fur­ther mea­sures to resolve these issues, “data-dri­ven strate­gies and algo­rithms – includ­ing tele­con­sul­ta­tions, tele­mon­i­tor­ing, dig­i­tal ther­a­pies and con­ver­sa­tion­al tools – are rel­e­vant areas of research,” adds the direc­tor of Paris San­té Campus.

How­ev­er, a cul­tur­al divide per­sists between the two approach­es to man­ag­ing men­tal health issues. Antoine Tes­nière points to the dif­fer­ence in the pro­cess­ing of cit­i­zens’ per­son­al data in France and Sin­ga­pore. While the use of this data could bring indi­vid­ual and social ben­e­fits, the ques­tion of “trust” in its man­age­ment aris­es: “In Europe, dur­ing Covid, the issue of data sen­si­tiv­i­ty is more impor­tant than in oth­er coun­tries, par­tic­u­lar­ly in South­east Asia, where the debate has not been as com­plex.” Quit­terie Mar­que points out that in Sin­ga­pore, the prob­lem is not so much one of con­trol­ling peo­ple, but rather the fact that the coun­try’s gen­er­al approach antic­i­pates, plans and imple­ments mit­i­ga­tion mea­sures: “There is an equiv­a­lent to the GDPR in Sin­ga­pore. Mind​line​.sg, for exam­ple, places great empha­sis on anonymi­ty, which some­times lim­its the pos­si­bil­i­ty of analysing data.” Final­ly, Serenel­la Tolomeo empha­sis­es that it is a ques­tion of main­tain­ing eth­i­cal stan­dards in data man­age­ment, while recog­nis­ing the need for a col­lab­o­ra­tive approach to solv­ing the crisis.

Lucille Caliman