The number of Covid-19 cases was previously on the rise in Malaysia, going up to five digits with the recent spread of the Omicron variant, but has since declined.
The fear of getting Covid-19 and concerns about how it affects everything has caused even many otherwise physically healthy individuals to have mental health issues, ranging from anxiety, stress, and even depression.
These mental health concerns are perhaps a hundred times worse for people suffering from non-communicable diseases (NCDs). Besides their already existing problems of physically and mentally coping with chronic health conditions, these individuals are also at a higher risk of getting severe Covid-19 infections.
Prior to Covid-19, at least one in four cancer patients experienced anxiety and/or depression, and these numbers are predictably worse since the pandemic. For example, in Canada, one in two people living with psoriasis reported poorer mental health since the start fo the Covid-19 pandemic.
Mental health has risen to the forefront with Covid-19, and today, we are witnessing how bad things are. Based on the National Health and Morbidity Survey 2019 (which was carried out before Covid-19), the prevalence of mental health diseases in Malaysia was 472,420 per 100,000 adult population.
This, of course, did not include the significant number of cases that remain unreported for fear of judgement and ostracisation.
We know that things are worse with Covid-19 (including mental health concerns for NCD patients).
Currently, mental health services in Malaysia are delivered by psychiatrists, psychologists, and counsellors. While psychiatrists see patients with severe mental conditions that require prescription of medication, individuals with mild to moderate mental health conditions can be consulted by allied health care workers such as psychologists and counsellors.
From a report titled The NCD And The Healthcare Worker, published by NCD Malaysia in 2021, there is a critical shortage of allied health care workers (HCWs), especially in mental health care.
According to the Malaysian Medics International (MMI), Malaysia is supposed to have one psychiatrist or psychologist per 10,000 people, which equates to about 3,000 mental health practitioners. However, we are nowhere close to this number, with only 479 registered psychiatrists, as of February 2022.
Therefore, people with mental health issues take longer to get the treatment that they need, which can eventually lead to their conditions worsening. For people living with NCDs, where mental health conditions can worsen their other physical illness, the impact can be much worse.
The 100 HCWs interviewed in the focus group discussions report that there is an acute shortage of allied HCWs in Malaysia. One HCW spoke about how there is a need for counsellors to help in supporting behaviour change interventions, which is also an integral part of managing their disease, for people living with NCDs.
“[If we talk about] the lack of human resources, counsellors are one of them. [We] can then discuss behavioural modification issues with the counsellors. It’s difficult to change your eating habits [that have been built] for years.”Participant 6
The small number of psychiatrists and clinical psychologists who are available, in turn, find it difficult to provide quality care to patients.
The limited number of specialists means that patients often wait a long time for appointments. When NCD patients do not receive timely mental health interventions, they risk losing control of their entire disease management.
Living with a chronic condition over years will take its toll, and some patients face burnout as a result of having to manage their conditions. Another HCW interviewed for the NCD Malaysia report, spoke on this and how there is a lack of mental health practitioners to support these patients.
This clearly shows the importance of allied HCWs in this mental health field.
Although mental health services are highly subsidised in the public sector, they are not always accessible to patients. Similar to many other infrastructures in Malaysia, there is an unequal distribution of mental health services across the different states.
Unfortunately, with limited job opportunities and without specialised pathways within the health care system, qualified individuals are unable to enter the system and practice or progress within their respective career pathways. This unfortunately has led to many mental health professionals to leave Malaysia in search of greener pastures in countries such as Australia and the UK that have better employment opportunities and better pay.
From the report, HCWs call for an evaluation of the need for mental health services and an establishment of pathways for mental health practitioners within the health care system in Malaysia.
There is also a need for compulsory continuous professional development (CPD) training programmes for allied HCWs such as psychologists and counsellors.
As awareness of the importance of mental health increases, and more research into psychological interventions are conducted, practitioners need to be up-to-date, to deliver better quality of care.
These CPD programmes should also be standardised for the public, private, and academic sectors so that all mental health practitioners would have access to the same type of development.
Once specialised pathways are established, specialising and upskilling must also be incentivised or at least encouraged with adequate remuneration, especially within the public sector.
Only in this manner can we start looking to close the gap in terms of providing mental health services for people dealing with Covid-19 and people living with NCDs.
The NCD and the Healthcare Worker report is available here.
A summary of the report can be found here.
NCD Malaysia can be found on Facebook and LinkedIn.