After 58 years of independence, what kind of support system do we have for Malaysians with mental health problems such as depression, anxiety, acute emotional distress or those who feel suicidal?
This was among the questions I put forward to consultant psychiatrist Datuk Dr Andrew Mohanraj, who is also Associate Professor of Psychiatry at Perdana University Graduate School of Medicine in Serdang, Selangor.
Dr Mohanraj was quick to point out that while there are some excellent services provided by the Government and private health sector, the reality is that much remains to be done. He raised the following points for our nation to take stock of with regard to mental health services and the gaps that need to be filled.
“Since mental health difficulties do not respect office hour schedules, a 24-hour response service is crucial for people with acute emotional distress,” said Dr Mohanraj. “Not all cases need to be rushed to the Emergency Unit in a hospital and long waiting times at such places may be inappropriate for someone with psychological distress.”
A sympathetic ear is often all that’s needed for those who want to pour out their problems and such catharsis satisfies immediate needs.
NGOs like the Befrienders which provide a 24-hour helpline has helped prevent many suicide attempts by providing emotional support for traumatised individuals. National helpline Talian Nur is another good example.
“More of such services, manned by trained personnel, are needed in society,” said Dr Mohanraj.
A common frustration of patients is that they have to see a different psychiatrist on every visit, and repeat their stories from the start.
Dr Mohanraj pointed out that in Malaysia, there is one psychiatrist for every 115,000 people. The World Health Organisation recommends a ratio of one psychiatrist for every 50,000.
“The number of clinical psychologists in the country remains extremely low. There is an urgent need to employ more of them in the public sector. There are virtually no psychiatric social workers or appropriately skilled occupational therapists in the public and private sectors.”
Dr Mohanraj believes that investing in appropriate human resources can generate enormous returns in terms of reducing disabilities caused by psychiatric conditions. Early detection and intervention will result in the mental well-being of the population.
Role of private hospitals
Not all private hospitals have psychiatric outpatient care. And not a single private hospital in the country has inpatient facilities for psychiatric care.
“This is probably due to the reluctance to overcome barriers in the rather stringent Malaysian Mental Health Act. To make matters worse, insurance policies in our country do not cover treatment for mental illness or psychological conditions.”
Dr Mohanraj pointed out that this is “an unfortunate situation because if the private healthcare system can accommodate the psychiatric needs of certain segments of society, then the public health system need not be overly burdened.”
Psychiatric services focus on “symptom remission”, that is, provide intervention through medication to improve mood or get rid of psychotic symptoms, especially in persons with chronic mental illnesses.
“Persons who suffer from chronic mental illnesses like schizophrenia would have lost the skills to perform even simple tasks. They are often shy and withdrawn. Psychosocial intervention explores the full spectrum of rehabilitation to restore dignity to persons with mental illness,” explained Dr Mohanraj.
He pointed out that organisations such as the Malaysian Mental Health Association helps persons with chronic mental illnesses to integrate into society, so that they can be productive and gainfully employed.
It is estimated that 35%-45% of absenteeism in the workplace in the United States, is due to mental health problems, namely depression, making it one of the most widespread disorders in the workplace.
Today, depression is a major contributor worldwide in terms of total years lost due to disability, and it is expected to be the number one cause by the year 2030, overtaking cardiovascular diseases.
An estimated 400 million people around the world suffer from depression and there are about 3,000 reported suicides every day.
Dr Mohanraj believes corporate houses in Malaysia have not woken up to the fact that depression in the workplace, often disguised as physical complaints, can result in absenteeism and loss of productivity.
“It would be better for big corporations to invest in some form of Employee Assistance Programme and take proactive measures to prevent workplace stress and depression.”
He pointed out that suicides, anxiety and substance abuse are on the increase among students across the country.
Alarmed by this, teachers from at least six schools around the country have been trained to provide mental health intervention for students who need help, under a special programme called Sekolah Minda Sihat.
More schools – especially urban schools – need to be included in this programme.
“The responsibility of promoting mental well-being lies in all of us – from individuals to social groups and businesses. The current corporate social responsibility in mental health issues is rather dismal in Malaysia compared to other countries in the region. It’s time to embark on a courageous transformation programme to provide the full spectrum of mental health services,” added Dr Mohanraj.