Mental Health in Malaysia

An overview of the condition of mental health in our country

Mental Health in Malaysia

An overview of the condition of mental health in our country

Overview

Mental health problems are a global burden affecting all aspects of a person’s health, which in return affects economic and social progress worldwide. Mental health has unfortunately been widely neglected in most countries particularly due to the lack of understanding of its causes and implications. The mental healthcare system in Malaysia is still very much in its infancy. Access to treatment is hampered by its often-exorbitant costs and the unfortunate social stigma attached to it. The absence of a system aimed at addressing more rural populations causes an increase in treatment gap across the country.

Globally, every country is a developing country when it comes to mental health. The mental health care system is far from satisfactory in most countries, more so in low- and middle-income countries such as Malaysia. In the last two decades, mental health has become a priority in global health development with the inclusion of mental health in the UN Sustainable Development Goals. However, committing to achieving these goals will be challenging without engagement and support from policymakers to ensure mental health is placed higher on development priorities. Malaysia spends 2.35% of its GDP on health and 0.39% of this is allocated towards mental health, with no specific mental health budget for community mental health programmes. What policymakers fail to understand is that the direct costs of mental illnesses are less than the indirect costs for mental illnesses. This simply means that the negative economic consequences of untreated mental illness are greater than the costs of treatments. Therefore, investing in mental health will in turn be a great investment in the economic development of the country.

Burden of disease

National Health and Morbidity surveys show that the number of adults who are ‘at risk’ of developing some form of mental illness in Malaysia has risen from 10.7% in 1996 to 29.2% in 2015. This alarming increase within the last two decades unfortunately has not been followed up with a development in the country’s mental health policies. It is important to note that the surveys were carried out to detect general mental health problems which suggests that the results are not representative of more severe mental health disorders. Although, those with more severe mental health disorders would fall into this category, the currently available data does not provide an in – depth understanding of the prevalence of different disorders within this population. This raises the concern that there is a lack of data available on the burden of different mental health disorders and limits our understanding on how to move forward when developing the healthcare system for specific mental health disorders.

Shortage of mental health professionals

One of the major challenges to improving the mental healthcare system in Malaysia is the shortage of mental health professionals in government hospitals. The number of psychiatrists has gradually increased between 2013 and 2016, which suggests a promising progress. However, we currently have less than 1/3rd of the recommended number of psychiatrists by the World Health Organisation which is incredibly limited. Clinical psychologists are also capable of diagnosing and treating mental illnesses from a psychotherapeutic point of view. They may not have the authority to prescribe medication but can provide valuable services to those with mental health disorders. Often, people with general mental health disorders might only require psychotherapeutic interventions without pharmacological interventions to address their mental and emotional distress. A report by Penang Institute states that as of January 2017, there are merely 14 clinical psychologists working in public hospitals throughout the country due to the lack of available positions. In 2017 there were only 15 positions available in public healthcare services throughout the country. Although the number of psychiatrists is higher, still far from sufficient, the shortage of clinical psychologists recruited suggests a lack of understanding of the purpose and value of the profession.

Shortage of postgraduate training programmes

The lack of clinical psychologists in the country can also be attributed to the lack of clinical training available. Clinical psychology is a very specialised field which requires the completion of a postgraduate masters and relevant clinical training before practising. To this day, there is only two local universities that offer postgraduate training program for clinical psychology, Universiti Kebangsaan Malaysia, with merely 10 available places per intake. Besides that, there are only three private universities with postgraduate training courses with prices that range from RM 57,000 at HELP University to RM60,000 at Cyberjaya University and over RM300, 000 for the Sunway-UAE University Doctoral programme. Although the courses at HELP and Cyberjaya are a lot cheaper they are still only affordable to Malaysians from a higher socioeconomic background, leaving those from low socioeconomic backgrounds with little options for pursuing a clinical career. 

The government needs to invest in expanding available postgraduate courses in public universities or create scholarships for students to pursue their clinical masters and training overseas. There should be more available spaces within the universities in Malaysia to directly contribute to developing the local manpower. These scholarships would be a great way to develop the mental healthcare system in Malaysia because they are often accompanied by a bond. Through the education they receive overseas, returning students could also contribute to creating new programmes within the countries’ education system whilst adding to the existing workforce. 

Ministry of Health and ministry of education do not need to be the sole provider of these scholarships. Partnering with relevant private companies within Malaysia to create shared scholarships may be a more practical source of funding.

Stigma

One of the biggest and unfortunately invisible barriers that affects the development of mental health in Malaysia is the lack of education on it, which leads to stigma against it. Stigma is the negative assumptions or beliefs held against people with mental illnesses which reduces them to a stereotyped group. These negative assumptions can lead to discrimination and prejudice against this group. In some countries this discrimination can go as far as being physically chained and shunned by society. In Malaysia, the discrimination is subtle yet prominent. Being an Asian country with Asian values, there is an existing notion of viewing mental illness as a weakness or character flaw. This simple, yet powerful subconscious narrative can discourage people from seeking treatment and therapy in the fear of being discriminated or losing the respect of the people around them. 

The government needs to invest in increasing awareness on the importance of seeking treatment and do so through implementation of more accessible treatment options without compromising on quality. Another way to change the conversation surrounding mental health is through education in schools and workplace. This education should not just consist of knowledge on etiology of different disorders but should also include practical knowledge and skills to support people with mental health disorders and how to be sensitive to their symptoms. Mental health should not just be an additional subject in schools, but it should also be the lens through which we restructure the education system.

Mental Health Act 2001

The first ever Malaysian mental health policy was introduced in 1998 and The Mental Health Act was passed in 2001, yet it did not come into effect until 2010. The act addresses provision of care in psychiatric hospitals, psychiatry nursing homes and community mental health care centres. The act outlines patients’ rights in these three services and promotes decentralised community mental health services within Malaysia.

The full Mental Health Act 2001 can be accessed here

Mental health problems are a global burden affecting all aspects of a person’s health, which in return affects economic and social progress worldwide. Mental health has unfortunately been widely neglected in most countries particularly due to the lack of understanding of its causes and implications. The mental healthcare system in Malaysia is still very much in its infancy. Access to treatment is hampered by its often-exorbitant costs and the unfortunate social stigma attached to it. The absence of a system aimed at addressing more rural populations causes an increase in treatment gap across the country.

Globally, every country is a developing country when it comes to mental health. The mental health care system is far from satisfactory in most countries, more so in low- and middle-income countries such as Malaysia. In the last two decades, mental health has become a priority in global health development with the inclusion of mental health in the UN Sustainable Development Goals. However, committing to achieving these goals will be challenging without engagement and support from policymakers to ensure mental health is placed higher on development priorities. Malaysia spends 2.35% of its GDP on health and 0.39% of this is allocated towards mental health, with no specific mental health budget for community mental health programmes. What policymakers fail to understand is that the direct costs of mental illnesses are less than the indirect costs for mental illnesses. This simply means that the negative economic consequences of untreated mental illness are greater than the costs of treatments. Therefore, investing in mental health will in turn be a great investment in the economic development of the country.

National Health and Morbidity surveys show that the number of adults who are ‘at risk’ of developing some form of mental illness in Malaysia has risen from 10.7% in 1996 to 29.2% in 2015. This alarming increase within the last two decades unfortunately has not been followed up with a development in the country’s mental health policies. It is important to note that the surveys were carried out to detect general mental health problems which suggests that the results are not representative of more severe mental health disorders. Although, those with more severe mental health disorders would fall into this category, the currently available data does not provide an in – depth understanding of the prevalence of different disorders within this population. This raises the concern that there is a lack of data available on the burden of different mental health disorders and limits our understanding on how to move forward when developing the healthcare system for specific mental health disorders.

One of the major challenges to improving the mental healthcare system in Malaysia is the shortage of mental health professionals in government hospitals. The number of psychiatrists has gradually increased between 2013 and 2016, which suggests a promising progress. However, we currently have less than 1/3rd of the recommended number of psychiatrists by the World Health Organisation which is incredibly limited. Clinical psychologists are also capable of diagnosing and treating mental illnesses from a psychotherapeutic point of view. They may not have the authority to prescribe medication but can provide valuable services to those with mental health disorders. Often, people with general mental health disorders might only require psychotherapeutic interventions without pharmacological interventions to address their mental and emotional distress. A report by Penang Institute states that as of January 2017, there are merely 14 clinical psychologists working in public hospitals throughout the country due to the lack of available positions. In 2017 there were only 15 positions available in public healthcare services throughout the country. Although the number of psychiatrists is higher, still far from sufficient, the shortage of clinical psychologists recruited suggests a lack of understanding of the purpose and value of the profession.

The lack of clinical psychologists in the country can also be attributed to the lack of clinical training available. Clinical psychology is a very specialised field which requires the completion of a postgraduate masters and relevant clinical training before practising. To this day, there is only two local universities that offer postgraduate training program for clinical psychology, Universiti Kebangsaan Malaysia, with merely 10 available places per intake. Besides that, there are only three private universities with postgraduate training courses with prices that range from RM 57,000 at HELP University to RM60,000 at Cyberjaya University and over RM300, 000 for the Sunway-UAE University Doctoral programme. Although the courses at HELP and Cyberjaya are a lot cheaper they are still only affordable to Malaysians from a higher socioeconomic background, leaving those from low socioeconomic backgrounds with little options for pursuing a clinical career. 

The government needs to invest in expanding available postgraduate courses in public universities or create scholarships for students to pursue their clinical masters and training overseas. There should be more available spaces within the universities in Malaysia to directly contribute to developing the local manpower. These scholarships would be a great way to develop the mental healthcare system in Malaysia because they are often accompanied by a bond. Through the education they receive overseas, returning students could also contribute to creating new programmes within the countries’ education system whilst adding to the existing workforce. 

Ministry of Health and ministry of education do not need to be the sole provider of these scholarships. Partnering with relevant private companies within Malaysia to create shared scholarships may be a more practical source of funding.

One of the biggest and unfortunately invisible barriers that affects the development of mental health in Malaysia is the lack of education on it, which leads to stigma against it. Stigma is the negative assumptions or beliefs held against people with mental illnesses which reduces them to a stereotyped group. These negative assumptions can lead to discrimination and prejudice against this group. In some countries this discrimination can go as far as being physically chained and shunned by society. In Malaysia, the discrimination is subtle yet prominent. Being an Asian country with Asian values, there is an existing notion of viewing mental illness as a weakness or character flaw. This simple, yet powerful subconscious narrative can discourage people from seeking treatment and therapy in the fear of being discriminated or losing the respect of the people around them. 

The government needs to invest in increasing awareness on the importance of seeking treatment and do so through implementation of more accessible treatment options without compromising on quality. Another way to change the conversation surrounding mental health is through education in schools and workplace. This education should not just consist of knowledge on etiology of different disorders but should also include practical knowledge and skills to support people with mental health disorders and how to be sensitive to their symptoms. Mental health should not just be an additional subject in schools, but it should also be the lens through which we restructure the education system.

The first ever Malaysian mental health policy was introduced in 1998 and The Mental Health Act was passed in 2001, yet it did not come into effect until 2010. The act addresses provision of care in psychiatric hospitals, psychiatry nursing homes and community mental health care centres. The act outlines patients’ rights in these three services and promotes decentralised community mental health services within Malaysia.

The full Mental Health Act 2001 can be accessed here

Prepared by Vaisnavi Rao

References

  • ASEAN . (2016). ASEAN Mental Health Systems Report.
  • Chong, S., Mohamad, M., & Er, A. (2013). The mental health development in Malaysia: History, current issue and future development. Journal of Asian Social Science , 9 (6).
  • Davies, R. (2018). Shekhar Saxena: making mental health a development priority. The Lancet, 392(10157), p.1509.
  • Lim, S. (2018). Bridging Barriers: A Report on Improving Access to Mental Healthcare in Malaysia. Penang Institute. Retrieved here.
  • Martin, B. (2017, June 30). Depression, the silent killer. Retrieved from The Star Online.
  • Ministry of Health, Malaysia. (2015). National Health and Morbidity Survey.
  • Kleinman, A., Estrin, G., Usmani, S., Chisholm, D., Marquez, P., Evans, T. and Saxena, S. (2016). Time for mental health to come out of the shadows. The Lancet, 387(10035), pp.2274-2275.