How Malaysians struggling with mental health issues are getting caught up in endless red tape
On her good days, Vishalatchi Arunagiri went for flower arrangement classes, wrote, and gave speeches and media interviews as a mental health advocate. On her bad days, the 26-year-old could do none of that. Severe anxiety and a diagnosis of schizo-affective disorder crippled Vishalatchi, leaving her unable to feed, clean or take care of herself. Delusions filled her head. So did the voices – which attacked her mum and siblings while pushing her to kill herself.
As Vishalatchi teetered on the tightrope between productivity and paralysis, she was supported by her 61-year-old single mother, Mala Davi N Thanjappan.
“Visha is very attached to me. I cannot leave her and go to work for too many hours; she often has anxiety attacks when alone,” said the Montessori education consultant. Mala’s freelance career allows her to provide this care, but the downside is irregular projects and pay.
Approximately one in three Malaysian adults suffers from a mental health condition or is at risk of developing a diagnosable mental illness, according to the country’s last National Health and Morbidity Survey (NHMS), in 2015.
Mental health figures into the vast majority of suicides, with 90% of cases associated with mental health disorders, according to the World Health Organisation (WHO). WHO reports an average of 2,000 suicides a year in Malaysia, or more than five a day.
A WHO study in 2016 found that two disorders alone – anxiety and depression – knock $1 trillion off the global economy each year. Many of those living with these afflictions struggle with productivity at work or can’t hold down a job. This squeezes their earnings, which means less ability to pay for mental health treatment. Thus a vicious cycle is born.
Cheaper treatment can flip the script. It certainly did for Vishalatchi, who gets free care at a public hospital as a holder of an OKU card under the government’s Social Welfare Department – OKU stands for “orang kurang upaya”, which means “disabled person” in Malay. This saves Mala an average $247 that she used to cough up every month for her daughter’s treatment at private facilities since mental health treatment is not covered by most medical insurance in Malaysia.
Even paying patients at public mental healthcare facilities save substantially, according to
“VISHA IS VERY ATTACHED TO ME. I CANNOT LEAVE HER AND GO TO WORK FOR TOO MANY HOURS; SHE OFTEN HAS ANXIETY ATTACKS WHEN ALONE”
published by the Malaysian think tank Penang Institute earlier this year.
Take the treatment charges for depression, for example. The report calculated that the total price for psychiatric consultation, psychotherapy and medication is at most $55 a year in public healthcare sectors. In private hospitals, the amount balloons to $2,016.
In its pre-election manifesto, the newly elected government of Malaysia promised to channel more resources to mental healthcare through government hospitals.
More money would be nice. Since 2012, the Malaysian Ministry of Health (MOH) has spent less than 1.5% of its annual operating budget on mental healthcare.
But money may not be able to fully patch the gaps – not when much of it is caused by a broken system, as laid bare by the dearth of clinical psychologists in public service.
To be fair, the mental healthcare workforce is shorthanded all around. It’s just not a popular career choice in Malaysia. Yet the shortage of clinical psychologists in government-run facilities seems self-inflicted. The MOH has capped its positions for clinical psychologists at 15, even though there are 45 hospitals under the ministry offering psychiatric services throughout the country, according to the Bridging Barriers report.
In other words, more clinical psychologists could not enter the public service even if they wanted to. Here’s why that matters.
Clinical psychologists are instrumental in psychiatric departments. They perform different functions from psychiatrists, but both complement each other in stabilising a patient’s condition. Psychiatrists diagnose mental disorders and offer biomedical treatment, often with medication, but popping pills alone cannot cure underlying issues that lead to a disorder.
Clinical psychologists cannot prescribe medicine, but they are trained to do psychological assessments, crucial for accurate diagnosis of some disorders. They also administer clinical interventions to assist in emotional and mental recovery, as well as long-term behavioural change.
In many cases, clinical psychologists help treatments stick – but there were only 14 clinical psychologists employed in Malaysian government healthcare facilities as of January 2017, compared with 114 psychiatrists. This is actually a step up from 2016, when 12 clinical psychologists were working in these facilities. In contrast, there were 188 counsellors, who deal with less severe emotional distress compared with clinical psychologists within a non-psychiatric setting.
The prevailing sentiment among clinical psychologists is that the government has mixed up its role with that of counsellors.
The recruitment system could be part of the problem. Under the civil service, clinical psychologists are
SA staffer for Malaysia's SOLS Health, an NGO offering community psychological healthcare, leads indigenous children at a summer camp
SClockwise from top left: Dr. Alvin Ng, Ellisha Othman, Lim Su Lin and Dr. Ang Kim Teng