Mental Health And Substance Abuse In Malaysia — Dr Dhanaventhan Raman

By CodeBlue | 17 June 2020

If we continue to treat psychiatric patients in large institutions, we will regress to a point when psychiatry was in its primitive times.

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This Letter is written to highlight two healthcare issues in Malaysia which are, the plaguing drug abuse in Malaysia and the regression of public mental healthcare in Malaysia. It is my opinion that the government needs to be more serious in handling both these issues.

On a more positive note, safe to say our society is more accepting of patients that suffer from various psychiatric disorders. Some insurance companies have even gone so far to even reimburse consultation fees for someone who had purchased the right policy and in the event he or she develops a mental illness or psychiatric illness so to speak.

The government has taken steps to educate society on the dangers of illicit substances and even stepped up efforts to curb the production and distribution of drugs. These are some steps in the right direction.

I wish to ask the government and the Ministry of Health these two questions:

  1. Have we successfully reduced the number of drug offences and have we reduced the number of admissions for substance related disorders?
  2. Have we improved our public mental health services in Malaysia to be on par with advances in the treatment of psychiatric disorders in other countries?

I am afraid answers to both these questions are “No”. Drug abuse is so rampant, and it has gone from bad (in the 1980s) and to worse in recent times, which is probably due to the fact that methamphetamines are the current drug of choice and are more widely available now and easier to consume (methamphetamines can be smoked/ snorted versus most heroin is injected into veins via needles).

The reason why methamphetamines are so popular is because of the intense euphoria and “high” it gives as compared to other substances. Methamphetamines cause the largest surge of dopamine in the brain, making it the ideal and most addictive drug.

As for our public mental health care, the fact remains, the Ministry of Health is still unable to reduce the number of beds in major mental institutions in Malaysia.

The number of beds has been reduced but not significantly enough even after 20 years — patients are being admitted to these institutions daily and to make matters worse, some of these unfortunate patients still end up being long term patients (meaning they will spend the rest of their natural lives within the walls of these institutions).

Public mental health care services in some newer general hospitals are inadequate and don’t even have a psychiatric ward to treat acutely ill patients that require short term admissions.

Treating drug dependants has somehow ended up unceremoniously intertwined with general psychiatry. There needs to be separate facilities for addiction treatment and ideally these should not be under one roof.

It is my humble opinion that if we continue to treat psychiatric patients in large institutions, we will regress to a point when psychiatry was in its primitive times.

The style of segregating mentally ill patients to be treated in mental institutions used to be done 100 years ago when the understanding of mental disorders was limited and there were hardly any medications to treat mental disorders. We have come a long way now; mentally ill patients must not be treated the same way anymore.

What we are doing effectively is this — by encouraging admissions to institutions, we are creating a whole new patient – one that has been successfully institutionalised (chronic inpatients) due to the fact they are not being integrated earlier into society and the patients themselves rather comfortable with their daily routine and prefer to remain incarcerated in the facility rather than free in society.

I agree that efforts to overhaul the psychiatric services requires vision and a ministry that is committed to bring about changes to the way our mental health care services are rendered. Let us not let this aspect of health care be left behind.

Psychiatric patients if rehabilitated correctly have something to offer our society as well. All they need is support. As for the drug problem in Malaysia, enforcement is adequate however people need to be sent a message; drug abusers need to be punished as a deterrent.

Decriminalisation of drug use (removal of criminal penalties for possessing and using a small quantity of drugs for personal use) is NOT a good idea as it will encourage people to try using drugs on a small scale causing a snow-balling effect and there will not be a solution in sight.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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