Is this a reality in Malaysia or far from it?

Half a century ago, mentally ill patients had few options. They were hidden at home or sent to mental institutions for treatment and often stayed there until they died, unless their family members were willing to take them back.

Having a mentally ill person often left many families with a sense of hopelessness and despair. Medicines were also not as effective as the ones available today.

Fast forward 50 years later, mental health services in Malaysia have improved and expanded beyond mental hospitals and with a good support system, it is possible for mentally ill patients to be treated at an early stage to live normal lives and even work.

Mental health services were decentralised from mental hospitals to the general hospitals with psychiatric wards in the 1970s, and mental healthcare has been included in primary health programmes since 1997, according to the Mental Health Services in Malaysia report published in the Taiwanese Journal of Psychiatry (Taipei).

Services are available at three levels – mental hospitals, general hospitals and primary health centres – as well as specialist services, it said.

Day centres in hospitals and mental health community centres have also been set up to assist patients cope with life and enable them to return to work.

Despite the improvement, mental health services in Malaysia are far from perfect.

There are not enough counselling services in public health facilities while the average cost of seeking counselling in the private sector ranges from RM200 to RM500 per session. If social stigma, which is still prevalent, does not prevent one from seeking help, the high fees may.

Calls have been made for insurance companies to cover mental health services in Malaysia but a proper coverage has not been offered.

Currently, the trail of catastrophic losses and post-traumatic stress following bankruptcy, loss of jobs and homes and loved ones, divorces and domestic violence have been magnified by the Covid-19 pandemic.

Yet the 12th Malaysia Plan (12MP) has made little mention of the direction or plans to arrest the mental stress that the population is experiencing except to say that a national strategic plan which includes measures for prevention, intervention and treatment will be formulated to address mental health issues.

It also says that a national suicide registry will be set up for effective measures to be taken to address the rising suicide rate.

The government needs to seriously increase the number of mental health workers to support the nation’s needs and ensure access of services to all.

The number of psychiatrists in the country, for instance, is way short of the target. There were only 410 registered psychiatrists in Malaysia with a psychiatrist to population ratio of 1.27:100,000, far from the World Health Organization’s recommended ratio of 1:10,000, a 2018 nationwide survey in the Mental Health Services in Malaysia report revealed.

The report by Dr Marhani Midin, Nor Zuraida Zainal, Toh Chin Lee and Nurashikin Ibrahim said only half of the psychiatrists were serving the health ministry while the rest were in the education or defence ministries, or in private universities and in clinical practice.

There is still a huge disparity in the distribution of psychiatrists nationwide. Kuala Lumpur has the best ratio of 5.24 per 100,000 population and Sabah and Kedah have the worst ratio of 0.54 and 0.55 per 100,000 population, respectively.

The report revealed that mental health human resource levels in Malaysia are relatively low. This poses a big challenge in developing mental health services throughout the country.

Currently, there are 346 counsellors under the health ministry’s purview, according to the ministry, and another 200 have been added to provide mental health support to clients at health clinics nationwide during the pandemic.

In 2018, the women, family and community development ministry said it had more than 8,000 registered counsellors (with the Malaysian Board of Counsellors) but that it was not known how many were actually practising.

The government, which has decided to decriminalise attempted suicide, should step up efforts to prevent suicide by making mental health and counselling services accessible to everyone, especially those in rural areas.

The 12MP noted that the incidence of non-communicable diseases (NCDs), which include mental illness, cardiovascular diseases, diabetes mellitus, cancer and injury-related conditions, continues to rise, contributing to an estimated 73% of total deaths in 2018.

“The increasing incidence of NCDs has led to a high number of avoidable premature deaths among Malaysians and higher demand for better healthcare services,” it said.

“Inadequate facilities, mismatch of resources across different levels of healthcare services and unsustainable healthcare financing have affected the delivery of healthcare services.

“This has worsened during the Covid-19 pandemic. Lack of readiness in disease surveillance and public health management remain challenging.”

Overcrowding and long waiting times at public hospitals and clinics continue to affect the quality of service delivery. The lack of specialists impedes the provision of services to rural and remote areas, said the 12MP.

Certainly, more efforts are needed to meet the immediate dire mental health needs of the population during and after the pandemic.

While mental health services have improved through the years, Malaysia is still far from achieving good mental healthcare access for all and there is a great need to step up efforts to achieve that target.