Man at His Best

The Mental State Of Malaysia

Despite some of us being aware of what mental illness does to a person and to those around them, many people out there remain oblivious to the causes, treatment and effects of mental illness.

BY Sim Wie Boon | Oct 22, 2016 | Fitness & Health

Illustrations by Rebecca Chew

The stigma associated with mental illness remains strong from a cultural standing shaped by decades of superstitious belief which lead it to be as a punishment from a higher being, supernatural causes or just a defect in ones personality. 

According to the deputy president of the Malaysian Mental Health Association (MMHA) Datuk Dr Andrew Mohanraj, there is still a lot to be done in the sense that people are not very aware of issues relating to mental health.

“We’re talking about how we understand the illness and how we accept it, as well if knowing what are the appropriate interventions for that particular psychological issue or illness and where can we seek help. “

He points towards the Asian mentality that shapes how we view mental illness.

“In Asia, we tend to take a different view of mental illness. We are very much restricted by our own concepts of mental illness which leads us to attribute a lot of superstitious belief to it. Many believe that chronic mental illnesses such as schizophrenia are deeply connected to some form of black magic and some other supernatural causes. This is clearly seen by the fact that the first contact by any form of intervention in Malaysia is more often than not, the traditional healers such as a pawang, bomoh, dukun or better known as witch doctors.”

The same sentiments are echoed by Befrienders publicity director Ardy Ayadali who says that superstitious belief tends to hamper the effort by the government and NGOs when it comes to promoting mental health awareness.

“It’s bad enough that the majority population of Malaysia are very religious which straightaway stigmatises mental illness and treats suicide as a one-way ticket to hell,” says Ardy.

Culture and religion aside, modern depictions of mental illness has further skewed the public’s awareness and perception towards its sufferers.

Dr Andrew notes that the media’s constant use of pejorative phrases and actions which stereotypes chronic mental illness in association with violence has created a very negative light for those suffering from schizophrenia or bipolar disorders.

“Such association of mental health sufferers of being violent are absurd as the reality paints an opposite picture. In fact, people with mental illnesses suffer more violence than actually committing them. Whenever a person with chronic mental illness commits violence, or someone with bipolar disorder becomes difficult to manage, that’s because they are not taking their medications. Plain and simple,” he reinforces.

For Ardy however, the past few years has seen a new form of negativity that has further perpetuated the misunderstanding of mental illnesses and the people suffering from it.

“When people suffer from some form of mental illness and express it on social media, they get judged, ridiculed or criticised. Recently there was this girl called Arlina, who got cyber-bullied until she had to deactivate her Twitter account. Instead of empathising or sending support or help, people still ridiculed her and criticised her,” Ardy says.

Despite an obvious plea for help or hint towards something deeper, many chose to look past it and adopt an aggressive approach.

“I think the main problem is social media itself, because you’re hiding behind the keyboard. If you look at their profile pictures, they’re hiding behind cat pictures or something,” he says.

True enough; the privilege of being anonymous has led many people to bring out the worst of them and Ardy points out that these hurtful things might be what we as a society actually feel.

“When you look at the remarks that people write, they are just simply very nasty and you know to the point where you wonder, don’t they feel? Don’t they have family members or friends who are going through the same thing?”

Despite the situation, Dr Andrew believes that on some fronts, the efforts to change the national mindset regarding mental illness has gained some ground.

“I’m happy to say that our country is one of the few countries in this part of the world that have worked very actively towards setting up secondary care in general hospitals, meaning a general hospital will have a psychiatric ward,” says the MMHA deputy president.

“The government has indeed made great strides in mental healthcare. We have moved away from institutional care in consistence with the paradigm shift of moving away from institutional care as advocated by WHO,” he said.

The direction of care that the government has been championing is now towards a rehabilitation direction whereby major mental health hospitals such as the Ulu Kinta Mental Hospital in Tanjung Rambutan no longer accept situations which see family members coming in just to dump their afflicted member there to rot.

“The hospitals have a programme to stabilise people suffering from mental health and send them back to society. If anything, they will track down the family members of the stabilised patient. Those who cannot be traced will remain in the hospital’s care unfortunately.” 

While the effort of moving towards rehabilitative care for mental health patients is to be applauded, Ardy feels slightly disheartened when it comes to the awareness campaigns and efforts to increase the knowledge of such ailments amongst the public.

“Most of the time, it only crops up during something like World Suicide Prevention Day or Mental Health
Day. It should be talked about all year ‘round, not only when there’s a high-profile issue like a high-profile suicide and then only people talk about it. It should be continuous and the government needs to play a very important role in advocating and implementing key initiatives to actually tackle the issue especially at school level.”

The efforts poured into raising awareness amongst school kids can be a little sticky.

“When a NGO like us, want to go into the schools to organise a talk or workshop on how to handle stress or how to help friends who are suicidal, we have to go through multiple levels of bureaucracy and red tape, in the end, it bounces around and we don’t get anywhere.”

This leaves the efforts of raising awareness at a school level to those within the government. 

“Right now, we do a lot of outreach on a community level. We get a lot of requests from private schools, colleges and universities to give talks with regards to a whole lot of issues and we can actually see that it’s very beneficial to the students there.”

For Dr Andrew, this could have a lot to do with the lack of human resources within the mental healthcare sector itself.

“There is a lack of psychiatrists, social workers, psychologist and therapists. The number is quite laughable. A few years back, there were only eight clinical psychologists for the whole country,” he says. 

“We already don’t have enough paediatricians, what more for psychologists, psychiatrists and therapists? We don’t have enough. Let’s say if every single district hospital—I’m not talking about kampung hospitals or clinics—but district hospitals (You have country, state, and districts: Each state is divided into 20 or 25 districts), just main district hospitals just to have either a paediatrician or a psychiatrist or a psychologist is enough already,” says the Feilina Feisol, the National Autism Society of Malaysia chairman.

The truth of the matter is that many people just don’t want to apply to become a clinical psychologist. Or more so when they get trained they rather go into the private sector which can be quite lucrative and glamorous.

“There’s also a lot of stigma within the profession as well. People often laugh at those within mental healthcare and say “there must be something wrong with them after working so long with them”. I remember a time in the ministry when I was there where people used to be transferred, those who had disciplinary problems, ie coming in late and had problem with other colleagues, they’ll transfer them to the psychiatry department. So psychiatry became a dumping ground and disciplinary punishment. Of course it has changed now and is slowly getting better.”

Despite the lack of mental healthcare professionals, volunteers like Ardy believes that once society as a
whole begin to talk about mental illness more openly; the de-stigmatisation of mental health will truly take a turn.

“Unless we as a society start talking about it, people will still be very judgmental and they’ll just feel like people with mental health issues are people who crave attention or who are just faking it, things like that. They don’t take it seriously.” 

And people do actually want to talk about their problems, as proven by the Befrienders receiving up to 20,000 calls last year which breaks down to around 50-60 calls per day. 

“I feel that young adults are going through a lot nowadays with so many things going on in the world. They are faced with very high pressures at work and even in school. So they need a place to vent their frustration. For us (Befrienders), someone can call up and tell you 1,001 different problems that they are going through and we help them deal with the range of emotions they are going through.”

Surprisingly, many callers don’t even realise that they are feeling a certain way.

“When we come up with the right feeling to describe whatever they are going through, in that sense, they get the validation.”

And maybe at the end of the day, the best way to raise the awareness and mental health literacy among us all is to continue the conversation on problems faced by us and people suffering from mental illness continues in an open and accepting manner. Because at the end of the day, we all just want to be heard.

First published in Esquire Malaysia, October 2016.