Imagine that you or someone close to you finds themselves in acute emotional distress, feeling anxious, depressed or perhaps suicidal. What supports will be available? Reaching out to care for such people is crucial. While there are some excellent services provided by the government and private health services, including the voluntary sector, the reality is that much is left to be done. Merdeka Day is just around the corner. This year, as we commemorate fifty eight years of Independence, it is important to take stock of where things are with mental health services and highlight the gaps that need to be filled.
Crisis services
For people with acute emotional distress, a twenty four hour response is crucial since mental health difficulties does not respect office hours. Not all cases need to be rushed to the Emergency Unit at the hospital. Long waiting times in Emergency unit may be inappropriate for someone in such a psychological distress.
Many would just want to pour out their problems to someone with a sympathetic ear. Such catharsis satisfies immediate therapeutic needs. A local non-government agency called Befrienders provides a 24 hour helpline and have on record helped prevent many suicidal attempts by simply providing emotional support for traumatized individuals. Talian Nur is another example of such a service rendered by the Ministry of Women, Family and Community Development. More such services, which are manned by suitable personnel are need to diffuse acute psychological crises that can be faced by anyone in society.
Human resources
Trained mental health staff are the cornerstone of a mental health service. A common grievance heard goes something like this: “seeing a different psychiatrist every time and having to tell my story and needs afresh is not very helpful.” In Malaysia, we have one psychiatrist to a population of 115,000 which is admirable although ideally as per World Health Organization recommendations, it should be one psychiatrist to a population of 50,000.
The numbers of clinical psychologists in the country however remain extremely low and there is an urgent need to employ more of them particularly in the public sector. There are almost no psychiatric social workers or appropriately skilled occupational therapists in the public and private sectors.
Investing in appropriate human resources can generate enormous returns in terms of reducing disability as a result of psychiatric conditions. Early detection and suitable intervention will result in the mental wellbeing of a potentially productive population.
Role of private hospitals
Not all private hospitals, even some of the so called multi-specialty hospitals have psychiatric outpatient care. 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. This is an unfortunate situation because if the private health care system can accommodate psychiatric needs of certain segments of society, then the public health system need not be overly burdened.
Focus on psychiatric rehabilitation
Psychiatric services generally have the capacity to only focus on “symptom remission”, meaning providing intervention by way of medication to improve mood or get rid of psychotic features, especially in persons with chronic mental illness. Persons who suffer from chronic mental illness like schizophrenia would have lost the skills to perform even simple tasks. Often they would be shy and withdrawn.
Psychosocial intervention explores the full spectrum of rehabilitation with the objective to restore dignity to persons with mental illness. Organisations such as the Malaysian Mental Health Association works towards integration of persons with chronic mental illness into society, to be productive and if possible to be gainfully employed. More of such agencies need to come to the fore to focus on psychosocial rehabilitation.
Work place stress
In the United States, it has been estimated that 35-45% of absenteeism from work is due to mental health problems namely depression. It is one of the most widespread disorders that exist in workplace. Today, depression is one of the leading causes of the global burden of disease. What this means is that depression is a major contributor worldwide in terms of total years lost due to disability. Depression is expected to be the number one cause by the year 2030 overtaking even cardio vascular diseases. An estimated 400 million people in the world suffer from depression and there are about 3000 reported suicide deaths every day
Corporate houses in Malaysia have not woken up to the fact that depression at the work place, 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 in order to take proactive measures to prevent work-place stress and depression.
School mental health
Suicides, anxiety and substance abuse are seen in an increasing trend in schools across the country .Alarmed by this teachers from six schools across the country have been given training to provide necessary mental health intervention for students needing help. This is a project under the “Sekolah Minda Sihat” programme. More schools need to be included in this programme with special attention to urban schools.
Conclusion
The responsibility of advancing the cause of mental health falls on all of us. Individuals, groups, charities, and businesses should also be looking to see what can be done to improve our mental health and wellbeing. CSR or corporate social responsibility in mental health issues is dismal compared to some other countries in the region. The time is now to embark on a courageous transformation towards the provision of the full spectrum of mental health services.
Dato’ Dr Andrew Mohanraj Chandrasekaran
Deputy President, Malaysian Mental Health Association
Dr. Andrew Mohanraj 