Trigger warning: Mentions of suicide. This story was brought to you in collaboration with the Lien Foundation.
All images by Xue Qi Ow Yeong for RICE Media unless stated otherwise.
“Please, please help me.”
An elderly patient sits outside the psychologist’s clinic room at Tan Tock Seng Hospital, pale and shivering. She’s distressed, waiting to see a psychologist even though she doesn’t have an appointment scheduled that day. At a loss for what to do, she’s reeling from the effects of nearly overdosing on Faverin, a medicine used to treat depression.
Dr Huang Wanping, a Senior Principal Psychologist at Tan Tock Seng Hospital, was her attending psychologist. The patient had been seeing her regularly, struggling under the weight of stressful, ongoing family woes.
She had been triggered by an altercation at home the day before. Feeling trapped and helpless, she had taken more medication than she should have.
She remembers guiding the patient into her clinic room, helping her settle down before trying to understand what happened. Despite the circumstances, Dr Huang was relieved that the patient still remembered their conversations enough to come to the hospital to seek help.
It’s far from an isolated case; many elderly patients carry similar silent burdens. Moments like these reveal just how deeply those struggles can run beneath quiet exteriors. And in a rapidly ageing society like Singapore, where one in four citizens will be over 65 by 2030, it’s a haunting reminder of how mental health issues among seniors often go undiagnosed, misunderstood, or ignored altogether.
After almost 20 years in psychiatry, Dr Huang’s colleague, Dr Tang Hui Kheng, has experienced her fair share of elderly patients with high suicide risk. The 53-year-old does outpatient work as a Senior Consultant at Tan Tock Seng Hospital, while doubling as a visiting consultant for IMH patients with intellectual disabilities.
“Some high-suicide-risk elderly patients are still highly rational,” she explains.
“They say, ‘There’s nothing left for me, I’ve lived my whole life, and if I continue on, it means I deteriorate. I may suffer more, and I don’t have any loved ones, so where does that leave us?’”
Dr Tang shrugs her shoulders. “Keeping them against their wishes indefinitely in the hospital is not quality of life.”
As mental health practitioners, it’s always a tough call, she says. They have to build therapeutic rapport with their patients while still making sure they’re not risking the patient’s safety.
This was only a glimpse into what Dr Tang, Dr Huang, and other mental health professionals face in their work with Singapore’s ageing population. As the country’s silver tsunami swells, how do they keep going when the emotional toll threatens to pull them under?
Tough Calls
For many elderly Singaporeans, spirituality and cultural norms shape their understanding of life and death. Meeting them where they are (whether through religious principles, family obligations, or personal legacies) makes mental health support feel more relevant and accessible.
But there’s a fine line that mental health practitioners tread when they try to provide quality of life to a patient who refuses to live their last few days within the sterile walls of the hospital.
Dr Tang recalls a case she co-managed with a palliative care team years ago.
“[The patient’s] last wish was to ‘just go home, set her things in order, and die’. In the end, we felt like we had to respect the patient’s dignity, weigh the pros and cons, arrange for a social group to check in on her, and enlist the homecare team to support her. She still chose to take her own life.”
Till today, she questions: Should they have stopped her from being discharged and denied the person’s dignity? Should they have forcefully kept the patient in the hospital, where she might have succumbed to illness or infections? Should they have sent her to IMH and inadvertently caused her further distress?
Dr Huang, too, remembers an instance where she was treating a suicidal patient who was in her 40s.
“During our session, the patient openly confessed that she intended to go home to kill her son with a chopper before turning it on herself. It’s important that patients trust us to share their innermost, frank thoughts. It’s part of the job to be non-judgmental, and I’m mentally prepared to hear such statements.”
Even after years of clinical experience, moments like these still hit hard—a brutal reminder that beneath every diagnosis is a human soul grappling with unimaginable darkness. And it falls on the clinicians to absorb it without flinching.
Yet Dr Huang says the work remains meaningful and fulfilling as she gets to help the elderly focus on what truly matters to them, guide them to make choices that are aligned with their priorities, as well as strengthen their coping skills, in turn improving their quality of life.
“It’s important to acknowledge and validate their thoughts and feelings—be it feelings of frustration, loneliness, feeling overwhelmed or even a sense of losing control,” Dr Huang explains.
“When they feel there’s no way out or have suicidal thoughts, they worry they aren’t able to control, I encourage them to refrain from being impulsive and instead come to the hospital to seek help. There’s a whole team here to support them, whom they can confide in and will listen.”
In urging patients to seek help, clinicians like Dr Huang and Dr Tang often set aside their own unravelling, shouldering invisible burdens behind steady voices and stoic smiles.
Riding the Emotional Waves
“Everyone can say they’re okay,” Dr Tang adds. “But what’s important is, how do we really emphasise that they’re really okay?”
The death of an elderly patient carries a particular kind of sorrow—not just because of the loss itself, but because it forces clinicians to confront the painful question of whether more could have been done to ease a lifetime of unseen suffering.
Each time an elderly patient takes their own life, it shakes the very foundations of caregiving, challenging the very belief that compassionate professional intervention will do some good.
Whenever such incidents happen, Dr Tang makes sure that everyone affected—the doctors and nursing staff—is supported through peer support sessions. But there are still tell-tale signs that maybe things aren’t getting better.
In the silence that follows such tragedies, she has seen the guilt fester quietly in some clinicians’ eyes. It manifests itself as hyper-vigilance in subsequent patients who express suicidal ideations, excessive medical leaves and obvious signs of exhaustion.
All Dr Tang can do is listen empathetically as they talk about their feelings of guilt and express their perceived self-blame for whatever happened to the patient, and guide them through their coping process.
The harsh light of hindsight is often unbearable. Even the most seasoned clinicians find themselves trapped in an endless loop of “what ifs” and “if only”. They question every word they’ve said, every subtle clue they might have overlooked.
“Not everyone is ready to share, but those who do wonder if they’ve missed something during their last interaction with the patient, replaying the encounters in their mind, especially if their last encounter was challenging,” Dr Tang explains.
The sharper the memory of a difficult interaction—a patient who seemed withdrawn, agitated, or simply resigned—the deeper the wound cuts. It feels as if somehow their perceived failure to read the invisible signs was a betrayal of the trust patients placed in them.
Then, there are those who worry about legal issues. Have they really done their best? Did they consider all the options available for the patient? The tragedy lingers, feeding the clinicians’ fear that perhaps, despite all their training and all their empathy, they were not enough.
Dr Tang manages a small smile. “We try to reassure them and convince them they shouldn’t blame themselves. In this profession, incidents like these are inevitable.”
While it sounds like Dr Tang has her hands full, thankfully, there are hospital protocols in place to support their clinicians whenever incidents, be it patient suicide or daily stressors, happen.
With every department within Tan Tock Seng Hospital, there’s a ‘peer support chain’ and welfare officers. Immediately after an incident occurs, the person in charge of each department recognises and acknowledges the staff that’s affected—from the ones who have more direct interaction with the patient, to the doctors, the nursing staff, therapists, pharmacists, and even the health attendant.
As part of this chain, Dr Tang will hold debrief sessions in groups or, in some cases, one-on-one for the doctors and staff who’ve built a close relationship with the patient over their visits.
Even with the inter-departmental support provided by the hospitals, clinicians are also encouraged to find their own sources of self-care.
Professional organisations such as the Singapore Psychological Society (SPS), along with Employee Assistance Programs (EAP), also offer therapy and mental health counselling specifically designed for mental health practitioners.
Now in her early 40s, Dr Huang has been in the field for nearly two decades. Though she’s thankful that she hasn’t lost a patient to suicide, her back-to-back sessions with patients sometimes leave her emotionally and mentally drained by the end of the day.
“I’d snap at people and be insufferable around my family. It’s a tell-tale sign that I brought my work back home with me,” she admits.
“Sometimes, things patients say affect me too. But I need to keep reminding myself that I’m only human and I need to take care of myself.”
On days when she’s not feeling great or not in a good head space, she knows it will affect her form as a psychologist. Thus, she’s learned to prioritise self-care.
If long runs outdoors aren’t enough to clear her mind and lessen the weight on her shoulders, Dr Huang’s other alternative is to lose herself in a good book to escape the heaviness of the day.
She also expresses that she is grateful that she does not work remotely. “The segregation of workspace and home helps to draw the line between work and personal life. I can choose not to bring my work or emotions home with me, and I can leave it at the office,” she laughs.
Breaking the Silence on Ageing
Despite the heavy emotional toll her job brings, Dr Huang continues to stand by her role and firmly says that more can be done to help the elderly who are contemplating suicide.
A lack of family kinship, the loss of purpose in retirement, and the deeply ingrained Asian value of not wanting to burden others have been identified as key drivers behind the rising rates of elderly suicide.
While schools educate their teachers to screen for mental health in youth and children, with more being done to train and raise awareness, there’s still a gap in mental health among the elderly.
“For youths, schools serve as one safety net and their home, another. But for the elderly, they may not have enough safety nets to address their issues,” Dr Huang explains.
“We’re not picking up on the warning signs early enough. And by the time we do, it’s festered to a point the elderly don’t see a way out and the condition’s so entrenched, it’s harder to treat.”
Sure, today’s families are becoming more sensitive and attuned to their elderly parents’ cognitive and behavioural changes, bringing them to the hospital for check-ups to clarify the possibility of a neurodegenerative disease process like dementia.
But when they find out that their parents might have other underlying mood issues such as depression, the family may be at a loss on what to do, whilst some find it hard to accept and become avoidant, Dr Huang says.
It’s a tragic paradox. While families are open to solving physical health concerns, mental health remains taboo and often deprioritised when basic needs take precedence. The stigma surrounding mental illness can make family members feel uncomfortable or uncertain, leaving elderly individuals isolated in their struggles.
Perhaps our strong standing in Asian culture has taught us to view depression as a personal weakness, a failure of will, or something to be ashamed of—especially among the older generation who grew up during times when mental illness wasn’t readily acknowledged.
It’s a vicious cycle because our elderly may be in denial and be reluctant to seek help for fear of stigma.
That leaves adult children in limbo—do they confront their parents with the truth, when they’ve been raised to view mental health as disgraceful, and risk being labelled “disrespectful” for “diagnosing” their own parents?
Acknowledging that perhaps their parents are suffering from a mental health condition also opens doors to treatment, including hospitalisation and medication as appropriate, or even the consideration of placing their parents in a care facility. It’s a choice that carries both emotional and social consequences in traditional Asian families.
As a result, avoidance becomes a coping mechanism: if we don’t name it, we don’t have to deal with what comes after.
But in doing so, we unknowingly leave the elderly trapped in a kind of tunnel vision, unable to see the full suite of alternatives. Their world narrows until dying feels like the only way out and the only escape from problems they’ve long buried.
The Mental Health of Mental Health Workers
As the government moves toward prioritising mental health and well-being, there’s hope that a broader suite of solutions will help make it a society-wide effort.
But that shouldn’t be limited to hiring more psychiatrists or psychologists, though they’re increasingly recognised as essential to providing effective care.
With social services set to be strained in the coming years with an increasingly ageing population, Singapore can’t afford to forget about the welfare of mental healthcare workers who treat them.
It’s true that a listening ear may be the best way to help someone, but even the quiet anchors need someone to support them, too.
As Dr Tang continues to support her colleagues and staff through difficult incidents, she too prioritises her own self-care. To be her strongest for others, she knows she must first be her strongest for herself. Even the ones who heal need healing.
“Working in this line, your bucket can become empty very quickly. If so, it’s hard to give emotionally and be with the patient as well,” she offers.
They’ll need all the help they can get, especially as practitioners like Dr Huang do what they can to meet rising demand for elderly mental health care while working within limited resources.
Still, there’s hope. Though fragile, it keeps them moving forward. It lies in the quiet resilience of clinicians who show up day after day. It lives in every difficult conversation, every small breakthrough, and every moment of shared humanity between doctor and patient.
The road might be steep ahead—a path made bumpy by an ageing population, overworked practitioners, and systemic cracks. Yet, for every life saved, for every moment of dignity preserved, it’ll be worth it.
After all, healing is not a one-way offering. It must also circle back to mend the weary hands that give it.
Helplines in Singapore
Samaritans of Singapore (SOS) Crisis Helpline
Call: 1-767
Institute of Mental Health Helpline
Call: 6389 2222
National Care Hotline
Call: 1800 202 6868
Singapore Association of Mental Health (Toll-Free Counselling Hotline)
Call: 1800 283 7019
ec2 online counselling
Visit: www.ec2.sg
CHAT
Visit: www.chat.mentalhealth.sg
