A Call For Greater Investment In Mental Health — Dr Sean Thum & Dr Arvinder-Singh HS

By CodeBlue | 09 October 2020

We have to ensure Malaysia has adequate capacity to manage both the immediate post-pandemic mental health issues, and also to stay vigilant in preparation for possibly future mental health crises.

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The 10th of October is World Mental Health Day (WMHD), a global celebration of mental health education, awareness, and advocacy against social stigma. It is held annually with different themes each year to reflect the societal response required in the given year, and it is telling that the theme for WMHD 2020 is “Mental Health for All: Greater Investment – Greater Access”.

But what is Mental Health, and how do conditions relating to it affect us?

The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity.

In this context, mental health encompasses a state of mental well-being, in which the individual realises their own abilities, is able to cope with the normal stressors of life, is able to work productively and fruitfully, and is able to make a contribution to their community. In other words – able to lead a meaningful and fulfilling life.

Common mental health conditions include mood disorders such as depression, anxiety disorders, and delusional disorders. The causes of mental health conditions are multi-factorial, which include biological, psychological, and social factors.

Anyone can have a mental health condition regardless of their gender, age, ethnicity, religion, or social class.

In Malaysia, it is alarming to know that there is a three-fold increase of mental health conditions within a 20-year span from 1996 to 2015. The National Health and Morbidity Survey 20191 estimated that 2.3% of the Malaysian population suffer from depression – that’s approximately half a million people! It was also reported that 424,000 Malaysian children were found to have mental health problems including anxiety and depression.

The situation has not been aided by the Covid-19 pandemic. Covid-19 has far-reaching consequences, and mental health complications are alarming. During the Movement Control Order (MCO), Befrienders reported a spike in the number of calls received daily.

Numerous non-governmental organisations, such as the Malaysian Medical Association, Malaysian Medics International, and Malaysian Mental Health Association have also reported similar observations that there was an increase in mental health conditions following the commencement of the MCO.

Little known to many, the impact of mental health conditions potentially affects the nation’s economy. In 2018, mental health conditions experienced at workplaces were estimated to cost the Malaysian economy RM14.46 billion2. That’s almost enough to construct three Merdeka PNB 118 towers!

These figures illustrate that mental health conditions have a major effect on the Malaysian society as a whole, which makes the WMHD 2020 call for greater investment in mental health to be an opportune one.

The investment on mental health should be focused upon two core issues:

  1. Increasing mental health professional/ infrastructure capacity and accessibility.
  2. Eliminating stigma of mental health among Malaysians.

In increasing mental health professional/ infrastructure capacity and accessibility, our focus should be on assisting those in need to access professional help.

We have to ensure Malaysia has adequate capacity to manage both the immediate post-pandemic mental health issues, and also to stay vigilant in preparation for possibly future mental health crises.

There is an urgent need to increase our human resources, and empower our allied partners. The need for human resources here must include the professional workforce (both clinical and academic) and the infrastructure capacity to meet the demands of the future.

At the moment, there are only four mental health hospitals in Malaysia to cater to mental health services. Given the wide scope that mental health covers, the need for research and development is much required – and that is only possible with trained professionals in the field.

In eliminating stigma, we can ensure that there is an environment suitable for patients to feel safe whilst seeking help. There is a need to collaborate with our allied partners, through advocacy programmes, to achieve it. A national level database will assist us in predicting the next wave, and assist in researching opportunities to improve on our services.

Suggestions include3:

i) Human Resource

  • Allocate resources for the training of health care workers involved in the mental health sector. This includes the training of Psychiatrists, Psychiatric Nurses, Clinical Psychologists, Counsellors, and Social Workers. Expedite training.
  • Empower the Social Welfare Department, appointing social welfare officers to all public hospitals.
  • Allocate resources for the training and employment of counsellors at every school (increase number from 1:500 students to 1:250 students).
  • Introduce hazard leave for all mental health workers, whether employed on permanent or contract basis.
  • Allocate resources for the empathic training module (Psychological First Aid-PFA) to train the public as first responders on handling people with acute mental health complaints.
  • Allocate more resources into MENTARI programmes.
  • Allocate more career paths especially where academics and mental health research can be focused on (clinical research etc).

ii) Allied Partners

  • Recognise, acknowledge, and support the efforts of NGOs in aiding government agencies for the management, rehabilitation, and ongoing support of people living with mental health conditions.
  • Elevate the media sector as partners in the journey to eradicate stigma towards mental health by establishing collaborative opportunities.
  • Allocate supportive funding for NGOs to sustain and expand their operations where required.
  • Establish multi-ministerial and multi-sectoral mechanisms on mental health (adopting the model for MOH’s Country Coordinating Mechanism used to govern and monitor implementation of HIV projects under the Global Fund for AIDS, Tuberculosis and Malaria) that encourages interdepartmental consultation and coordination that would act as a precursor to well targeted and effective policies.
  • To increase the scope of insurance coverage for people with with mental health conditions.

iii) Advocacy

  • Strengthen public health campaigns pertaining to raising awareness on mental health, and ways to seek available services.
  • Establish a national curriculum in primary, secondary, and tertiary education to increase awareness on mental health and ways to seek available services + PFA. This will also avoid stigmatisation and help people understand that having mental health issues can affect anyone just like to common cold.
  • Provide, and publicise, a clear guide on ways to seek help.
  • Helping the public understand that the earlier they seek treatment, the better the outcome. Learn to recognise symptoms so that more people are aware and can advocate for intervention at very early stages.

iv) National data and monitoring of mental health disorders

  • Decriminalise suicide attempts.
  • Revive the National Mental Health Registry (NHMR) to ensure comprehensive coverage of mental disorders, regular updates and monitoring, and independence of the registry within the healthcare system.
  • Create a special committee overseeing the NHMR which updates, maintains and monitors the registry, with representatives from multiple ministries, including the Ministry of Health, Ministry of Education, Ministry of Home Affairs and Ministry of Women, Family and Community Development.
  • Make registration of mental disorder cases mandatory by amending the Mental Health Act 2001, with protection to ensure patient rights, anonymity, confidentiality and privacy, similar to the mandatory notification of infectious diseases as provided under the Prevention and Control of Infectious Diseases Act 1988.
  • Generate Public Health involvement by setting up a Public Health division in all four psychiatric institutions.
  • Increase funding for Research and Development in the field of mental health; to incorporate a special focus on research on mental health in the 12th Malaysian Plan.
  • Convert one of our four psychiatric institutions into a Centre of Excellence for Mental Health akin to the Black Dog Institute.

Only by committing greater investment to the agenda of mental health can we improve accessibility to people seeking mental health services in the country.

While the common adage goes “there is no Wealth without Health”, it is important to remember that there is also no Health without Mental Health.

References:

  1. National Health and Morbidity Survey 2019
  2. Chua Sook Ning, The Economic Cost of Mental Disorders in Malaysia, Apr 2020
  3. Malaysian Medics International, Improving Accessibility and Availability of Mental Health Services in Malaysia, June 2020
  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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