Mental health has increasingly become a topic of conversation in Malaysia since the Covid-19 pandemic. Such a conversation often emphasizes on the importance of mental health awareness and education, as well as ways to manage mental health issues. During lockdown periods, some may experience difficulty in adapting to a new routine after a shift to their normal day-to-day activities. The series of lockdowns also impacted many – from students, to workers, to business owners and to many more – that there is an alarming increase in suicide rates of 81% in 2021 compared to the previous year and an overwhelming demand for mental health services.
The General Landscape
Mental health problems know no barriers. Symptoms of mental health problems usually begin in early childhood through adolescence, with some not even identified. In 2019, Malaysia recorded 424,000 children and adolescents experiencing mental health problems.
This shows that the promotion of mental health should be introduced from young to ensure leaders of generations to come are able to effectively manage negative experiences. Thus, Mental health literacy and management is crucial for the development of an accepting and empathetic community that would allow a safe and nurturing space for children to grow.
Malaysia has seen a steady increase in the promotion of mental health awareness over the past two years through efforts ranging from advocacy and literacy programs, to an increase of subsidised and tele-mental health services, and to reviews of mental health-related laws. Awareness on the importance, maintenance and prevention of mental health among the public show a linear growth too.
Challenges and Measures to Mitigate Stigma-Related Pushback
Nonetheless, barriers to mental health awareness in Malaysia remain. The lack of access to practising professionals and services shows a need to increase funding to mental healthcare. For example, many service providers are exhausted with an overflow of demand during the pandemic, particularly those who provide tele-health services.
Just how accessible is mental healthcare to those who have no means to access services? With a 1:100,000 psychiatrist to patient ratio, Malaysia does not meet the World Health Organization’s (WHO) recommended standard of psychiatrist to patient ratio of 1:10,000. The scarcity of practising professionals will largely impact the upkeep of up-to-date data, which ultimately affects the execution of data-driven and informed decisions to further improve mental healthcare in the country.
This lack of manpower may lead to time constraints in developing and executing nationwide efforts. This can, however, be mitigated through a collaborative approach, as mental health is not solely the responsibility of government officials and relevant professionals alone. Educators, policymakers, and members of the various available non-governmental organizations (NGOs) can and should be engaged for the development and execution of nationwide mental health literacy programs to ensure a holistic approach to mental health education.
Apart from that, cultural barriers that arise from the stigma on mental health may lead to a lack of support amongst educational institutions, which includes lobbying of programs and ensuring the buy-ins from staff members as well as recruitment of students. Prolonged stigma will trigger the notion that mental health is a taboo topic, which in turn drives low literacy and awareness, consequently promoting an overall dismissal towards mental health as a whole.
Interviews conducted by the Green Ribbon Group (GRG) with training providers in the United States and Australia discovered a similar issue in the execution of training programs, particularly with regards to the usage of mental health terms in age-specific programs. Age-friendly terms used in training programs must be suitable to specific age groups to secure buy-ins from relevant authorities, such as caregivers, parents and teachers.
For example, terms such as “burnout” may not be suitable for children aged 15 years and below as it may be too complex for their understanding, while “suicide” or “self-harm” may be deemed as “inappropriate” for younger age groups, which may initiate pushback from concerned parents and teaching staff.
Cultivating Healthy Attitudes to Mental Health
A multi-sectoral effort from relevant ministries – such as the Ministry of Health, Ministry of Education, Ministry of Higher Education and the Ministry of Women, Family, and Community Development – can play a large role in promoting mental health awareness.
This can include: 1) the developing tailored mental health subject in schools according to years of study; 2) developing tailored training for first responders such as parents, teachers and caregivers; 3) delivering said subject and training to different demographics; 4) ensuring the upkeep of knowledge on mental health through annual screenings; 5) reviewing and revising current standard operating procedures (SOPs) that involve managing those with mental health problems to ensure humane responses; 6) execution of annual surveys, and; 7) fostering a system to ensure the upkeep and improvement of mental health subject and training.
This multi-sectoral effort is not a new request. Former Deputy Prime Minister Datuk Seri Dr. Wan Azizah Wan Ismail, under the Pakatan Harapan (the Alliance of Hope – PH) government in 2018, had set up a robust approach to review Malaysia’s mental health policies in an effort to mitigate mental health challenges faced by youths. She also called for the decriminalization of attempted suicide during the 12th Malaysia Plan in the Dewan Rakyat in 2021. Outgoing Health Minister Khairy Jamaludin has also launched the National Centre of Excellence for Mental Health (NCEMH), a streamlined platform for mental health services, training and information alongside the National Mental Health Crisis Line in an effort to provide early assistance to those facing mental health problems in October 2022.
What Else Can Malaysia Do?
Proper training on mental health can and should be incorporated as part of the national school syllabus to promote the development of well-rounded individuals. Ideally, children should be taught what mental health is, how it plays a role in one’s overall health and wellbeing, ways to maintain mental wellbeing, and how it affects each area of life.
This is because poor mental health will largely affect a child’s academic, personal and social development. Unattended mental health problems – as simple as stress – may snowball into a much larger issue such as mental illness and suicide. These can be prevented with literacy to mental health.
The request to include mental health as part of the official education syllabus is not foreign to Malaysia alone. In 1986, the WHO has identified children’s and adolescent’s mental health as an essential area for public concern.
WHO has also recommended for schools to function as one of the key support systems for students. This is done through the implementation of mental health awareness, intervention, prevention and rehabilitation as well as the fostering of a healthy psychosocial environment.
These practices have since been executed in various countries. For example, in July 2018, the Department of Education in New York became the first state in its nation to make mental health education mandatory for all its students. Similarly, Singapore’s Ministry of Education has been rolling out mental health lessons in stages in the primary, secondary and pre-university levels since December 2021 and will continue to do so. Efforts like these should be replicated in the Malaysian context too.
GRG aims to do exactly just that. GRG, which was established in January 2021, is a local mental health NGO consisting of a small team of non-mental health professionals and led by HRH Princess Iman Afzan. GRG believes that mental health is not solely the responsibility of government or medical professionals and that the community is an untapped resource to mental healthcare.
Initial data from the programs GRG executed in 2021 in collaboration with the Malaysian Mental Health Association (MMHA) indicate that the public is interested to participate in efforts to improve mental health. A total of 100 individuals undertook the GRG-sponsored Mental Health First Aid training course with over 79% success rate. Furthermore, over 108 individuals undertook the suicide prevention training programme called A Conversation on Suicide. Moreover, a total of 200 counselling and psychotherapy sessions were sponsored across 44 callers, with 16-year-olds being the youngest callers.
Despite these encouraging statistics, a question remains. How soon can we introduce mental health literacy to the community?
To replicate these efforts into the Malaysian context, GRG has placed a focus on piloting mental health literacy programs in secondary schools and universities in 2022. To ensure the needs of students are met, GRG works alongside counsellors and teaching staff in both universities as well as high schools to empower a collaborative and holistic approach.
This model proved to be successful in GRG’s activities in 2021 with the MMHA and the same model has been replicated throughout 2022.
The secondary school programme is executed under GRG’s partnership with Telekom Malaysia (TM) Foundation and Creative Minds under the Foundation’s education arm called TM Future Skills. TM Future Skills: Mental Health Literacy is a two-hour programme for 15–17-year-olds encompassing an introduction to mental health, ways to self-cope and manage, and ways to encourage support amongst peers. The Green Ribbon Effective Agent Training (GREAT) Project is a 1.5-day programme that focuses on an introduction to mental health and empathy training. It aims to create a network of student advocates of mental health.
As of November 2022, GRG has conducted programmes for students across 10 public and private universities and eight public secondary schools, upscaling the mental health awareness of a total number of 495 students. It is hoped that this community approach will create a trickle-down effect, whereby the knowledge learned from these programs is introduced into and practised within the student’s respective communities.
Given these analyses, mental health should be included as part of the national school syllabus. The lack of manpower shows that there is a need for an increase in the mental health resource pool to cater to the needs of the increasing demands of the community. We can only do so with proper education and training. A small step now would leave a lasting impact in the future. However, the challenges discussed must be mitigated to secure a complete buy-in from relevant authorities. Without these interventions, we can foresee mental health problems among students to continue in prevalence in the future.