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