KUALA LUMPUR, Oct 6 – The rising demand for mental health services across the country, with cases of anxiety and depression surging during the pandemic, has made it difficult for people to get the help they need.
Mental health care providers are calling for more trained therapists and counsellors in public hospitals to cope with the overwhelming demand as more people struggle with mental health issues, especially children who are left to feel lonely and hopeless about their future.
Dr Gayathri K. Kumarasuriar, a psychiatrist at Melaka Hospital, said there is a particular need for more occupational therapists – especially those who specialise in child and adolescent care – to meet demands as the existing number of staff is “simply not enough”.
“While there is a growing awareness of the professional role of occupational therapists in the management of mental health, the numbers are simply not enough to handle the demand in government hospitals.
“Many have to multitask with adult patients as well. Appointments to see them can stretch for several weeks to months sometimes. There is an urgent need, and the government must look into this,” Dr Gayathri told CodeBlue in a joint response with Dr Nurulwafa Hussain, head of the psychiatry and mental health department at Melaka Hospital.
“We need to train more occupational therapists specialised in child and adolescent care, create more job spots for them and educate the public on their role in helping to manage children and adolescents with mental health issues,” Dr Gayathri said.
According to the Malaysian Medics International (MMI) in its policy brief titled “Improving Accessibility and Availability of Mental Health Services in Malaysia”, Malaysia is supposed to have one psychiatrist or psychologist per 10,000 people, equating to about 3,000 mental health practitioners. As of February 2022, there are only 479 registered psychiatrists.
Deputy Health Minister Dr Noor Azmi Ghazali was previously reported as saying that one in 20 children in Malaysia aged five to nine are estimated to have mental disorders, including developmental disorders. The National Health Morbidity Survey 2019 (NHMS) further found that one in eight adolescents, aged 10 to 19, have mental disorders.
In addition to counsellors working full-time in schools, Dr Gayathri said play therapists, which Malaysia is extremely short on, can play a bigger role to address mental health in children.
“Play therapy is an important mode of therapy that uses play to uncover and deal with psychological distress. Play therapists are trained to work with children of all ages, ranging from nursery right up to adolescents.
“They play an important role working with children and their families teaching them how to handle difficult situations, for example, conflicts and also work through bereavement, depression and other traumatic experiences.
“With their intervention, play therapists help children gain insight of their experiences, build resilience, handle stress, develop coping techniques and decrease problem behaviour as well as internalised conflicts.
“They also work closely with the parents or carers, sometimes including them in the therapy as well. Recognizing their role in helping to manage children and adolescents with mental health problems and creating jobs for them in the government will be a tremendous help to the current treating teams as well,” Dr Gayathri said.
Parents Can Be Trained To Deal With Children’s Mental Health
Dr Nurulwafa, who is also a child psychiatrist, said preventive measures, such as parenting courses, can help many struggling parents to raise happy and resilient children.
In Malaysia, culture and stigma are often perceived as key barriers that prevent parenting and mental health from going hand in hand, Dr Nurulwafa said. Asian households typically shy away from conversations about emotions that may affect a child’s mental wellbeing.
“In our culture, we don’t talk about emotions every day. Some emotions are even seen as unacceptable. We would scold children when they fight with each other, and we leave them with advice when they are not happy with their teachers or friends rather than talk about how they feel going through all these challenges – whether they feel like harming themselves, and talk about how to help them dealing with the problems together,” Dr Nurulwafa said.
Dr Nurulwafa cited the Starting Well Partnership in the United Kingdom, a programme under the UK’s National Health Service (NHS), as an example that grants parents and carers access to family learning courses to improve their health and wellbeing, in addition to knowledge that covers the birth of the child to topics like autism and being a male caregiver.
Dr Gayathri said treating a child or adolescent with mental illness is not a one profession job and requires the support and management of a “trained multi-disciplinary team”.
“While child and adolescent psychiatrists focus on the mental health problems of this specific population, occupational therapists, clinical psychologists and counsellors have to cover all age groups.
“These teams exist in many government hospitals which provide mental health services for children and adolescents, but these teams are stretched to the maximum.
“There is a need for more clinical psychologists and trained counsellors who specialise in child and adolescent mental health. It would be very helpful to create positions for them at the primary care clinics as well as community mental health centres for easier access to services. This will also decrease the waiting time for appointments at the government hospitals,” said Dr Gayathri, who also cited efforts by the NHS.
In the UK, mental health professionals such as psychiatrists, psychologists, community psychiatric nurses, social workers, and occupational therapists work in a mental health team. These teams, unlike the Malaysian teams that primarily serve in hospitals, can be accessed at the primary care level.
Individuals can get help from the whole team or from one or two members of the team, and patients would usually get referred to mental health teams through health professionals, although referrals could also be made by social services, the police and family members.
Dr Gayathri said such teams would be extremely beneficial to communities, many of whom are not able to access public mental health services and are unable to afford private mental health care, which is not covered by most insurance companies.
In addition to the mental health teams, Dr Gayathri also suggested that the government collaborate with registered NGOs to better meet the mental health needs of children.
“The Office of the High Commissioner for Human Rights (OHCHR) in article 24 of the Convention on the Rights of the Child has clearly stated that children have the right to enjoy the highest attainable standard of health and access to health care services.
“Are we providing enough health care for our children and adolescents? While the physical health care and vaccination schedules provided to them are excellent, mental health care services are lagging far behind. There is an urgent need to look into this area of health care.
“Let’s look at the gaps in our services and build bridges across them. We have the resources but we are fragmented. Why not work together? Collaborate with registered NGOs and qualified private mental health care service providers to build a strong support system for this special population,” Dr Gayathri said.
Dr Nurulwafa lauded some actions taken by the government, via the Ministry of Education (MOE), to conduct mental health screenings in children using the WHOOLEY, PHQ-9, and GAD-7 toolkits and referring students with significant scores to clinics for treatment and counselling.
However, despite programmes such as Klinik Mesra Remaja, which applies to individuals ages 10 to 19, Dr Nurulwafa noted that many school children fall outside the net of services cast by the government as they suffer from school refusal or neglect by their parents.
“Even though the service is available and accessible, it could not cater for children with school refusal and those who are neglected by parents that need outreach services,” Dr Nurulwafa said.
School refusal refers to an intense fear of going to school. It can be caused by many factors, among which are separation anxiety and specific fears about performance elements such as writing papers, presentations, sports activities, and learning difficulties.