Mental illness in Malaysia: the imperative to destigmatise

Mental health advocates and professionals agree that one of the biggest obstacles to address mental illness and mental health problems in Malaysia is removing the stigma and dispelling public misconceptions. The situation seems to be worsening. The 2015 National Health and Morbidity Survey (NHMS) showed that the prevalence of mental health problems in Malaysian adults has increased to 29.2%, a three-fold increase from 1996. While there have been many initiatives and programmes on mental health carried out in Malaysia, and even an attempt at drafting a national strategic action plan on mental health in 2019, de-stigmatising mental illness remains a challenge.

Past research has indicated that stigma is caused by a variety of factors that include lack of awareness and lack of viable information. Notable mental health experts such as Associate Professor Dr Sivakumar Thurairajasingam from Monash University, have lauded the significant improvements in mental health awareness in Malaysia. However, the stigma remains pervasive, making it likely that Malaysians will continue to keep their mental illnesses hidden.

At the macro-level, mental illness negatively impacts the economy. According to RELATE Malaysia, the estimated business cost of mental health disorders among employees in 2018 stood at RM14.5 billion. This is roughly equivalent to 1% of the country’s gross domestic product (GDP) for that year. As Malaysia seeks to transition to a developed economy, mental health illness is a sizeable economic lost that Malaysia can avoid. With pervasive stigma, Malaysia may incur larger economic costs.

Mental illness is often associated with suicide. In Malaysia, attempted suicide remains a controversial issue due to Section 309 of the Malaysian Penal Code, under which someone who attempts suicide can be punished by up to one year in jail, or a fine, or both. The World Suicide Report released by World Health Organisation (WHO) showed that Malaysia is included in the minority group of 24 countries which still legislate against attempted suicide. Punishing at-risk individuals for attempting suicide further perpetuates the stigma of mental illness, making it more difficult to solve the problem.

Community-driven initiatives can be avenues for solving problems that affect the individual, even for de-stigmatising mental illness. The SJ Care Warriors initiative, kick-started by assemblywoman YB Michelle Ng, is a notable example. SJ Care Warriors is a mental health programme initiative which focuses on building the community’s resilience, through training for early intervention and suicide prevention. It is important to increase the number of community-driven action groups in both rural and urban areas making mental illness assistance more accessible and the outreach more prominent. But solutions must be in tune with the needs of the local population. Local municipalities and state governments can provide initial seed funding for community-driven programmes. Mental health professionals could lend their expertise, either on a permanent or rotational basis.

Data collection on mental illness remain non-centralised, making monitoring and evaluation challenging. Malaysia needs a national research institute dedicated to mental health and illnesses, acting as a centralised data hub to provide accurate and viable information. Such information could be disseminated to the public via simple infographics and easily understandable data, thus improving the Malaysian population’s ability to debunk myths and inaccurate assumptions about mental illnesses. Data and research findings from this institute could also be used by the government ministries to formulate policy solutions. A prime exemplar of this kind of agency would be the National Institute of Mental Health in the USA, which is the lead federal agency for research on mental disorders. A federal-level mental health research institute not only ensures consistent and sizeable funding, it also shows that combating mental illnesses is one of Malaysia’s top priorities in its development agenda.

Malaysia’s labour force has recently seen a spike in mental illness. According to Malaysia’s Healthiest Workplace survey by AIA Vitality 2018, mental illness has increasingly affected Malaysian employees over the years. This can lead to staff absenteeism and high turnover rate which in turn negatively impact the productivity of a company. This highlights the importance of having an Employee Assistance Programme (EAP) that focuses on handling mental health and preventing the onset of mental illness in the workplace. Malaysian companies should, at least, provide some form of service to safeguard employees’ mental wellbeing as well as an avenue to which they can freely ask for meaningful support. Only a handful of Malaysian companies, such as the Malaysian Aviation Group (MAG), have incorporated provisions for mental health for their employees.

Technology yields enormous benefits toward de-stigmatising mental illness. A paper published in the Taiwanese Journal of Psychiatry found, that as of July 2018, Malaysia had only 410 registered psychiatrists. This amounts to a national average of 1.27 psychiatrists per 100,000 people, far below the recommended ratio of one psychiatrist per 10,000 population. Since Malaysia is sorely lacking in trained mental health professionals, technology may fill in the gap. With widespread access to smartphones, chatbots could be an alternative to in-person mental healthcare as well as normalizing mental health well-being. The famous mental health chatbot, Woebot, uses cognitive behavioural therapy along with recommending exercises to combat negative thinking and ways to manage mood disorders such as depression and anxiety. Perhaps in the near future, there could be a Malaysian-version of Woebot.

Most importantly, public schools represent ideal sites for addressing stigma around mental illness. The latest figures from the National Health and Morbidity Survey 2019 showed that about 424,000 children in Malaysia were experiencing mental health problems, which accounts for about 8% of those aged five to 15. Every school should inculcate mental health literacy programmes to improve the negative perception toward mental illnesses and to act as effective platforms for the dissemination of useful information. Students who have the right information can exercise more control over their mental health and assist other students. One such programme could be mental health first-aid to teach students to correctly identify and respond to mental illnesses. Unfortunately, in Malaysia, mental health literacy programmes are often organised only at universities and private education institutions.

Therefore, the Ministry of Health needs to make the strategic leap from awareness of mental illnesses to de-stigmatising it altogether. The most important outcome is to bring about positive change to Malaysian lives, and this starts with dispelling the public misconceptions about mental illness.