MOH Must ‘Walk The Talk’ On Mental Illness Among Health Workers: Ex-Official

Retired JKNS deputy director Dr Venugopalan Balan tells MOH not to stigmatise health workers with mental health issues, as mental illness is extremely common. “Even among health professionals who have mental issues, they are very hesitant to come forward.”

KUALA LUMPUR, Sept 7 – A former Ministry of Health (MOH) official has called upon the ministry to lead by example in addressing the mental health needs of its staff.

Dr Venugopalan Balan, former deputy director for public health at the Selangor state health department (JKNS), highlighted the need for the MOH to demonstrate compassion towards employees who are struggling with their mental health and provide them with meaningful support.

“In the MOH, we have the Mental Health Unit, but that operates externally. This means they focus on implementing mental health programmes in the community for the public, such as awareness campaigns, early detection, and treatment. This falls under the jurisdiction of the Mental Health Unit, which is part of the NCD programme.

“However, when it comes to addressing the mental health needs of MOH staff themselves, it’s usually managed by the Occupational Health Unit. This can be in the hospital, district health offices, or klinik kesihatan (health clinics).

“Unfortunately, there is still a lot of stigma attached to mental illness. You’ll be surprised that even among health professionals who have mental issues, they are very hesitant to come forward due to concerns about confidentiality, how others would view them, and how it could affect their career advancement,” Dr Venugopalan told CodeBlue when contacted.

Yesterday, CodeBlue reported a government doctor’s claim of mental health discrimination hindering his specialisation as a public health medicine specialist. 

Despite meeting pre-gazettement requirements, the doctor failed gazettement twice, primarily due to perceived shortcomings in leadership skills and other personality and behavioural factors, rather than knowledge and skills, he claimed.

“So, many times, you’ll find our health care staff within the ministry either not seeking treatment for mental illness promptly, trying to treat themselves, or seeking help from the private sector to avoid this stigma,” Dr Venugopalan said.

“Whether these concerns are valid, especially in terms of promotions and career advancement, depends on the administrators directly involved.”

The senior public health consultant pointed out that the MOH has consistently advocated against stigmatising mental illness and has always discouraged penalising individuals with mental health conditions in their public messaging.

“Just like you do not punish a person who has high blood pressure or diabetes by holding onto their career progress, mental illness should be held the same way. Unfortunately, sometimes, the culture in the MOH doesn’t align with their official policy.”

According to the World Health Organization’s (WHO) Guidelines for Mental Health at the Workplace 2022, employees dealing with mental health issues should be supported and accommodated to promote positive mental health, reduce emotional distress, and enhance work effectiveness. 

The guidelines emphasise workplace-focused care, which involves providing flexible working hours, adjusting workload or tasks, coordinating and facilitating regular meetings and follow-up care with psychiatrists or psychologists.

Other recommended organisational interventions include holding supportive meetings with supervisors on a regular basis, scheduling frequent breaks or allowing extra time for task completion, avoiding multitasking, and ensuring accessibility to private rest spaces.

Overcoming Mental Illness Stigma In MOH

Dr Venugopalan said to overcome the mental illness stigma in the MOH, forward-looking leaders who are well-versed in mental illness are needed.

“We need leaders who recognise that mental illness is extremely common in the community. Once an individual is diagnosed, the key lies in establishing a strong support system to facilitate their return to their usual, well self.

“Once the person is stabilised, career movement should be the same as everyone else. 

“You shouldn’t punish a person because of his past history – it’s very retrogressive. All the health awareness that we are giving the community must also be echoed internally and we must actually have in-house training of our own senior staff on this matter,” he said.

Dr Venugopalan suggested that the best approach when an individual undergoes a mental crisis is to grant them a leave of absence.

“They shouldn’t be assessed during that point. They should be granted leave, given the chance to get treatment, to stabilise, and then return. If you are going to evaluate them during a time when they are all stressed out and have other issues, that’s not fair,” said the retired senior public health consultant.

“Personally, I feel it all boils down to maturity. The second thing is this inherent antagonism against people with mental illness. Some of the staff look at them as somehow defective and beyond correction. So, how do we change this mindset? 

“I believe that while we already have awareness programmes and training in place, we need to take it a step further. Beyond the general community, I would suggest that these awareness and sensitisation programmes be actively expanded among our own staff – among our departmental heads and the MOH – telling them that mental illness is common. 

“We should treat them like people who have high blood pressure or diabetes. Once in a while, the diabetes will go haywire but we don’t punish him for that. If a person with mental illness has some relapse, we shouldn’t be punishing them,” Dr Venugopalan said.

Malaysia Needs Public Health Specialists

According to the MOH’s Health Facts 2022, Malaysia had a total of 77,755 doctors in 2021, which included 9,578 house officers. This equates to a doctor-to-population ratio of 1:420, surpassing the World Health Organization’s (WHO) recommendation of one doctor for every 500 people – at least on paper – excluding factors like maldistribution and the concentration of doctors in the private versus public sector.

However, when it comes to specialists, Malaysia is grappling with a shortage

As of June 30, 2020, there were only 3.9 specialists for every 10,000 people, in contrast to the OECD (Organisation for Economic Cooperation and Development) average of 14.3 specialists per 10,000 people in 2018.

Dr Venugopalan said there are a lot of misconceptions about public health.

“To put it simply, public health is all health-related activities that a person faces before they enter a hospital and after they are discharged. 

“In the hospital, it comes under clinical medicine. But before they enter a hospital and after they leave, including rehabilitation, these come under public health. A lot of it comes under prevention, immunisation, disease control. 

“There is also the misperception that anyone can become a public health specialist. That’s an erroneous opinion because there are a lot of technical issues that, if not done well, can derail programmes,” Dr Venugopalan said.

When asked about the demand for public health specialists, Dr Venugopalan said one way to estimate the number of public health specialists needed is to look at the number of public health programmes conducted in a district.

“We have about seven to 10 different public health programmes in a district. So, ideally, each programme should be headed by a public health specialist to give it a firmer foundation. 

“The other thing is how many are graduating. I think at the present moment, there are eight universities that are offering doctorate in public health (DrPH) courses and every year with an intake of about 10 to 15 graduates per university,” he said.

The impact of the Covid-19 pandemic highlighted the need for an increased number of public health specialists, not just for fieldwork, but also at the backend – analysing data, monitoring and devising strategic public health initiatives, as well as conducting research.

“There are a lot of areas where public health specialists can go in and improve the system further. I haven’t even touched on academia, research, and all that. There’s still a lot of avenues for public health specialists,” Dr Venugopalan said.

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