Mental health is described as the shadow pandemic of the Covid-19 crisis, bringing wide-ranging, adverse mental health consequences to every individual. Amidst a surge in cases nationwide, hitting a record 1,755 infections on Friday, demand towards mental health services is likely to soar during and after this pandemic.
The World Health Organisation (WHO) has called for governments to increase investment towards mental health services and programmes. This sentiment was echoed by Bandar Kuching MP Dr Kelvin Yii, who called for investment towards better mental health infrastructure and increasing service accessibility to address the impact of Covid-19.
Given this context, it is shocking that psychiatry and mental health services in the Ministry of Health observed a significant reduction in monetary allocation in Budget 2021, decreasing by 9.1% (RM31 million) from RM344 million in 2020 to RM313 million in 2021. This is the lowest amount allocated since 2017 and the steepest budget cut this area of health care experienced over the last decade.
In particular, the budget for mental health services and infrastructure observed a whopping 61% (RM42 million) reduction from RM69 million in 2020 to RM26 million in 2021. This is the lowest ever monetary allocation towards mental health services and infrastructure.
Barring Budget 2021, available data indicate that the lowest allocation towards services and infrastructure was RM45 million in 2010. This 2010 amount is still 41% (RM18.8 million) higher than what is allocated for Budget 2021. With Malaysia currently experiencing its third wave of Covid-19 and a silent mental health crisis, this reduction is nothing short of appalling.
A WHO survey found that the Covid-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide, when demand for such services is increasing. A significant reduction in budget towards public mental health services would negatively impact accessibility to diagnosis, treatment and support.
Limited access could result in deteriorating mental health conditions in a suffering individual, leading to behaviours such as suicide, self-harm, self-medicating and substance and alcohol abuse. It is also unclear how much of the budget amount, if at all, would be used for mental health prevention activities, which are more important than ever during this pandemic.
Mental health is not the only public health area to have experienced significant budget cuts. According to CodeBlue, the Ministry of Health’s medical budget was reduced by 20% from RM14.2 billion in 2020 to RM11.3 billion in 2021. Almost all health care services are adversely impacted. For example, radiology and oncology experienced a 58% cut, while nephrology experienced a 78% cut.
As patients from all areas of illnesses (such as cancer patients) often require mental health and psychosocial support, this overall, massive reduction on public health spending would have a devastating impact towards the mental health of patients and caretakers across all diseases.
A positive from this year’s mental health budget is a 4% (RM10 million) increase in emoluments in psychiatry and mental health services. This is encouraging as it implies an increase in mental health professionals hired in public health services, given the low psychiatrist-to-population ratio (1.27 per 100,000 population) and counsellor-to-individual ratio (1 to 500) in Malaysia.
While a step in the right direction, the positive impact of this decision threatens to be overshadowed by the negative impact brought by a 61.2% cut towards services and infrastructure. With rising demand for mental health services, mental health professionals may face uphill challenges in maintaining access and quality of care, consequently experiencing greater rates of burnout, chronic stress and mental strain.
This reduction also marks a regression in Malaysia’s mental health budget according to global standards. The WHO’s 2011 Mental Health Atlas indicated that upper-middle income countries were found to spend a median of 2.4% of the national health budget on mental health. Malaysia has consistently hovered below this figure, closer to spending of lower-middle income countries.
For example, 1.1% of the health budget spent on mental health in 2020. However, only 0.98% of 2021’s health budget was allocated to mental health. This figure is between the spending of low (0.5%) and lower-middle (1.9%) income countries.
The drastic reduction in budget would reduce the capacity for services to operate, which would in turn exacerbate the severity of mental health conditions faced by suffering individuals.
Mental health services, prevention and support are needed now more than ever during the Covid-19 crisis. It is damning that the government of Malaysia sees fit to reduce public health and mental health spending to this extent. I urge all citizens and health advocates to speak out against these drastic cuts to health care.
I also urge ministers, civil servants and politicians to reconsider and increase the budget across all public health areas for 2021, especially in mental health. Failure to do may result in devastating consequences to all individuals in Malaysian society, especially among poor and vulnerable communities.
With the loss and uncertainty felt by many during this terrible pandemic, the government of Malaysia has a humanitarian obligation to prevent and to not facilitate even more tragedies in the years to come.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.