When medicine fails to cure loneliness, art becomes a prescription for mental health
Reported by Zhang Heyang, translated by Eira Tan. Click here to read the original article on Zaobao.
As Singapore enters a super-aged society in 2026, mental health challenges across different age groups are becoming increasingly pronounced. Beyond existing medical resources, building a support system grounded in human warmth and social connection has become a crucial issue in public governance and social development.
On December 8-9, the Healing Arts Singapore (HASG) symposium was held at the Yong Siew Toh Conservatory of Music at the National University of Singapore. The symposium focused on how arts activities can contribute to active ageing, youth mental health, and inclusive community building. Participants also highlighted the “social prescribing” mechanism gradually introduced locally in recent years, and launched "THRivE" (Tools for Health Research and Evaluation in Arts and Heritage), an evaluation toolkit tailored for the arts and culture sector, allowing the public to see the prospects and pathways for integrating arts into the public health ecosystem.
Healing Arts Singapore was jointly organised by the Centre for Music and Health at the Yong Siew Toh Conservatory of Music (NUS), the Nanyang Academy of Fine Arts at the University of the Arts Singapore, and the Jameel Arts & Health Lab in collaboration with the World Health Organisation.
ART ENGAGEMENT VS. ART THERAPY
While “art therapy” is no longer an unfamiliar term in the public eye, Ms. Jane Goh, Deputy Director (Creative & Youth Services) of the Singapore Association for Mental Health, explained that what is commonly referred to as “art therapy” actually encompasses two distinct systems:
Arts engagement: Public-facing, experience-oriented arts activities open to the general community.
Arts therapy: A professional clinical intervention, including music therapy and visual arts therapy, conducted with clear therapeutic goals.
Goh takes a cautious stance towards the term “healing”. She explained: “Art does not function like a miracle drug or a painkiller. Rather, it is a medium- to long-term process that requires the interaction of multiple factors. It aims at ‘restoration’ and ‘improvement’, helping individuals to gradually restore function, build psychological resilience, and develop emotional regulation and coping skills.”
Mental health, as she noted, exists along four levels – from generally functioning well and managing everyday stress, to significantly affecting daily life, and ultimately requiring clinical intervention. The association determines the need for clinical intervention through questionnaires and scales, self-reported concerns, and the type of support sought. Some individuals may be referred to specialised support, such as financial counselling, to address specific needs.
ALLOWING CHILDREN TO EXPRESS THEMSELVES THROUGH DRAWING
Generally, art therapy is especially suitable for clients who struggle to express themselves verbally and are unable to undergo traditional talk-based therapy. In this case, the therapist will suggest suitable art media based on the individual’s situation, with the final choice left to the client. Goh emphasises that “allowing the client to choose” is part of the therapy, because choice means regaining a sense of control and agency.
Before becoming a clinical supervisor, Goh worked as an art (painting) therapist. She shared: “Many children have difficulty expressing themselves verbally; their psychological distress often manifests through behaviour, such as sudden silence, emotional outbursts, or anger management issues. These behavioural changes make parents realise that their child may need help, and they then bring them to us for assistance.”
Goh explained that art therapy typically begins with building trust, followed by structured tasks such as drawing a family tree, or mapping a personal timeline. As emotions and relationships emerge in the artwork, therapists will ask questions and plan the subsequent therapy direction and goals accordingly.
The choice of materials is also crucial. Watercolour, for instance, is fluid and difficult to control, and may induce more anxiety in highly anxious individuals. In contrast, coloured pencils, crayons, or oil pastels, which offer greater control, are more suitable as initial tools.
Goh emphasised that art materials are not just tools of expression; they are an integral part of the therapy itself.
TRANSFORMING MUSIC FROM AN EXPRESSION TO A VEHICLE
Fontane Liang, a harpist with the Singapore Chinese Orchestra and a senior music therapist at the Institute of Mental Health with 16 years of clinical experience, explained that music therapy is not necessarily chosen because a patient “likes music”. Rather, in cases of severe trauma, music offers a gentler avenue of expression.
At the HASG symposium, she shared the case of a teenage girl facing compounded trauma: parental divorce, school bullying, and sexual assault. The girl exhibited strong suicidal ideation and self-harm, was plagued by nightmares, and suffered severe impairment of sleep and daily functioning, having been out of school for many years. She also displayed significant selective mutism, barely speaking during psychotherapy and medical settings.
Liang explained: “It is not that she had nothing to say. After the trauma she had gone through, speaking might just feel like being hurt again.”
Over more than 2 years and 30 therapy sessions, the girl remained largely silent, often responding only with nods, head shakes, or simple gestures. The therapy did not force her to speak, but instead relied on shared listening and improvisation. Liang discovered that while the girl was reluctant to directly discuss her feelings, she would proactively point out the “most important line” in a song, leading Liang to realise that the lyrics were speaking on her behalf.
As the treatment progressed, Liang began to explore music from a “medium” into a “vehicle” for expression. She invited the girl to co-create a song, which the girl displayed clear interest in. Liang deliberately refrained from leading the composition, instead using an AI music composition program as a neutral third-party platform. The AI-assisted song became a turning point in the treatment. The song carried the girl’s gradually emerging thoughts and emotions during the treatment process, including what kind of person she is becoming and what she hopes to do. She was no longer hiding in silence or fear.
SOCIAL FACTORS AFFECTING PERSONAL HEALTH
While clinical art therapy may seem distant to the general public, everyday participation in arts activities can positively regulate mental well-being. Goh explained that the Creative Hub, under the Singapore Association for Mental Health, uses visual arts, writing, music, and physical activities to help individuals process and regulate emotions. One of their flagship programs, “EatMoveCreate”, includes group baking workshops where participants collaborate and converse, fostering trust and social connection. Other initiatives such as “Walk with Music” and “Doodle for Mindfulness” combine low-intensity physical activity with simple creative processes to help participants manage their emotions. These workshops are typically free or subsidised, and catered to all age groups.
Associate Professor Lee Kheng Hock, Deputy Chief Executive Officer of SingHealth Community Hospitals, noted that in a super-aged society, 1 in 4 Singaporeans will be aged 65 and above. Meanwhile, the prevalence of chronic diseases, such as hypertension and diabetes, continue to rise. While traditional medical models are highly effective in treating acute illnesses, society must shift from reactive “sick care” to prevention-oriented “preventive care” to ensure the sustainability of the healthcare system and reduce the long-term burden on hospitals.
Against this backdrop, non-pharmaceutical social interventions become a key mechanism. Lee emphasised that research shows 80% of a person’s health is determined by non-medical factors – the social determinants of health – including living environment, social connections, and lifestyle. Only about 20% is determined by clinical care.
“At SingHealth Community Hospital, we often see patients whose recovery is hindered not because of physical or medical problems, but because of their family situation and social circumstances.”
Loneliness and social isolation are particularly prevalent among the elderly, and their adverse health effects have been proven to be comparable to smoking. Lee emphasises that “medications cannot cure loneliness, and surgery cannot restore the meaning of life when lost”. When this psychological distress is combined with financial strain or poor housing conditions, it results in repeated hospital admissions. Social prescribing thus addresses these gaps through non-clinical community resources, filling the gaps in traditional healthcare.”
Lee shared a case where an elderly woman was transferred to the community hospital after a hip surgery. While her apparent need was physical rehabilitation, the deeper issues were social isolation and the fear of becoming a burden to her son, with whom she lived. As a result, she gradually closed herself off. A care coordinator also discovered that her lack of digital literacy affected her connection with her family. Through “e-social prescription”, the team taught her to send WhatsApp voice messages, allowing her to rebuild communication and autonomy without burdening others. She was later referred to community companionship services and an active ageing center, where she continued to practice her digital literacy skills and also rediscover her interest in cooking, thus reintegrating her into the community.
UNDERSTANDING WHAT MATTERS MOST TO PATIENTS
Regarding how the social prescription is “dispensed”, Lee explained that it is an interdisciplinary process, but at the implementation level, it is led by a dedicated care coordinator. Doctors and nurses may observe patients’ psychological and social needs during rounds, and the coordinators will also proactively screen in wards to identify high-risk cases. The coordinator’s role is more like a “contact person”, and through interaction with the patients, they seek to understand “what is most important to the patient” rather than simply “what illness the patient has”.
Based on these assessments, the coordinator will then assess the key social factors affecting the patient’s health and work with the patient to develop a personalised care plan, matching them with community resources that align with the patient's interest and circumstances such as active ageing centers, interest groups, or digital literacy courses. The social prescription will only be formally implemented when the patient understands and is willing to participate. This ensures that the patient takes ownership of their own health. Lee added that the social prescriptions are extremely diverse, and can include karaoke, museum visits, heritage walking tours, chess, tai chi, and gardening.
ACTIVELY INTEGRATING THE ARTS INTO DAILY LIFE
At the HASG symposium, Assistant Professor Kat Agres, Director of the Centre for Music and Health at the Yong Siew Toh Conservatory, chaired the launch of The THRivE Toolkit – an evaluation toolkit specifically designed for the arts and heritage field. The toolkit integrates standardised scales, research methodologies, and Singapore case studies to help practitioners measure the impact of arts and cultural activities on health and well-being in a more scientific and comparable manner.
Agres noted: “Many arts practitioners have not been trained professionally in using scales or handling data. But without these [evaluation] standards, it is difficult for the public and policymakers to understand the impacts of art and what it is changing.”
She emphasised that integrating art systematically into healthcare is a long-term process that requires both time and practical application. “But people should not wait until illness strikes to seek clinical treatment or social prescriptions. Culture, art, and community activities should be proactively integrated into daily life, just like exercise and a healthy diet”.
Agres uses the concept of a “seatbelt moment” to explain this: people did not develop the habit of wearing seatbelts overnight. Rather, behaviour changed gradually only after evidence had steadily accumulated and the public’s understanding of risk had fundamentally shifted. She points out that from the implementation of social prescription to the launch of a national-level “Healing Arts” initiative, the role of art and culture in health is gradually approaching such a critical point.