The recently released National Health and Morbidity Survey (NHMS) 2023 has highlighted several key mental health issues that are of serious concern.
One million people, or 4.6% of Malaysia’s population, aged 16 years and older have symptoms of depression.
This is double the figure obtained in the previous NHMS in 2019.
What is more alarming is that half of this population, or 500,000 Malaysians, reported having thoughts of harming themselves or being better off dead.
Teenage problems
Mental health problems have become widespread in recent years with notable increases not only in depression, but also anxiety and stress, among various demographic groups.
In Sarawak, for example, 35.8% of the population aged 16 and over reported mental health problems, with the highest incidence among the Bumiputera community.
This shows that mental health issues are not necessarily limited to the challenges of urban life in the Klang Valley.
The mental health of adolescents is particularly alarming.
The survey revealed that 18.5% of adolescent girls reported experiencing suicidal thoughts, compared to 7.6% of adolescent boys.
Additionally, 13.4% of adolescent girls had attempted suicide, more than double the rate of 5.7% among boys.
A significant 25% of adolescents reported feelings of depression, with the rate being twice as high among girls as among boys.
High rates of verbal and physical abuse were reported in the home, affecting the mental health of adolescents.
About 41% of adolescents experienced verbal abuse, with higher rates among females than males.
Additionally, 7.5% reported physical abuse, again with a higher prevalence among women.
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Bullying remains a major problem: 8.6% of adolescents report having been bullied, especially during the early stages of secondary education.
Cyberbullying is also common: one in five adolescents suffers harassment through digital platforms, which affects men more than women.
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These findings underline the urgent need for comprehensive mental health support and interventions, particularly for youth and vulnerable communities in Malaysia.
Actions to take
Addressing these issues involves promoting a safe psychological environment and implementing specific mental health programs and policies.
Based on the findings of the 2023 NHMS and other related studies, several specific interventions can be recommended to address the alarming mental health problems in Malaysia:
> Improve mental health services.
We need to improve access to mental health services, especially in rural and underserved areas.
This includes expanding the number of mental health professionals available and integrating mental health services into primary health care settings.
While this is recognized as a short-term challenge, it can be mitigated immediately through short courses in mental health for primary care physicians to help improve their skills and knowledge.
Online telehealth and mental health services can be developed and promoted to reach those who cannot access traditional in-person services due to geographic or social barriers.
This has been done successfully in many countries, including Australia, which reported high satisfaction with telehealth services.
Investment in user-friendly platforms, telehealth infrastructure and organizational guidelines is needed for the successful integration of video conferencing into public mental health systems in Malaysia.
> Start mental health programs in schools.
Comprehensive mental health education can be implemented in schools to raise awareness and reduce stigma.
This may include teaching students about mental health, emotional regulation, and coping strategies.
Schools must have adequate counseling services and trained mental health professionals to help students facing mental health challenges.
Several schools in Malaysia have adopted the acclaimed mental health first aid course, but it needs to be further promoted to reach more schools.
> Carry out awareness and community support campaigns.
National campaigns can be launched to raise awareness of mental health issues and reduce stigma.
These campaigns should focus on educating the public about the signs and symptoms of mental health disorders and the importance of seeking help.
This should be the mandate of the newly created National Center of Excellence in Mental Health, in collaboration with other stakeholders such as non-governmental organizations (NGOs) and research bodies.
> Start community programs.
Community programs can be implemented that provide support and resources to people facing mental health issues.
This may include peer support groups and community workshops.
This is already being done through the Mentari Community Mental Health Centres, established by the government.
There are more than 30 such centers across the country, not including those run by NGOs such as the Malaysian Mental Health Association, but this initiative should be further expanded to have nationwide coverage.
> Implement specific interventions for vulnerable groups.
Create specific mental health programs for adolescents, addressing issues such as bullying, cyberbullying and abuse.
These programs should provide safe spaces for young people to discuss their experiences and receive support.
There should be novel interventions to combat cyberbullying, which has become a widespread phenomenon.
Furthermore, there is a need to introduce gender-specific interventions that address the increased frequency of mental health problems among adolescent girls.
These interventions should focus on empowerment and building resilience.
> Have early intervention and prevention.
Regular mental health screening should be implemented in schools and primary care settings to early identify people at risk for mental health problems and therefore provide timely interventions.
This can be achieved by training teachers, school staff and primary health care providers to recognize early signs of mental health problems and provide initial support and referrals in collaboration with local primary health care centres.
Once again, there is a need to immediately build the capacity of school staff and primary health care providers, rather than focusing on increasing the number of formally trained mental health professionals.
> Address abuse and violence
It is necessary to provide comprehensive support services to children and adolescents who suffer verbal and physical abuse.
This includes advice, legal support and safe havens.
Preventive measures should include programs aimed at preventing abuse and violence in homes and schools.
This may include parent workshops and school policies that promote a safe and supportive environment.
> Take political action
Strengthen national mental health policies and ensure they are adequately funded and implemented.
This includes policies that promote mental health, prevent mental illness, and provide care and rehabilitation services, going beyond the usual focus solely on curative care.
> Enable protective legislation
Laws and regulations that protect children and adolescents from abuse and harassment, both online and offline, need to be enforced.
This may mean stricter penalties for perpetrators and better protection mechanisms for victims.
In line with international conventions and practices, the government may need to consider creating a Mental Health Commission to help facilitate this.
Working together
Implementation of these interventions requires a multi-faceted approach involving collaboration between government agencies, healthcare providers, schools and organizations representing service users and carers.
By addressing these issues holistically, Malaysia can significantly improve the mental health and well-being of its population.
In addition to mental health conditions, the 2023 NHMS also highlights troubling statistics on chronic physical illnesses such as hypertension (high blood pressure), obesity, and high cholesterol levels.
These conditions can also cause psychological stress, affecting quality of life, which in turn can contribute to depression.
On the other hand, depression itself can lead to behaviors that worsen our physical condition, such as poor diet, inactivity, and abandonment of medical treatment.
Therefore, it is essential to address the mental health of people with diabetes, obesity and high cholesterol.
Integrated care that combines physical and mental health treatments may reduce the risk of depression in this group.
In conclusion, the alarming rise in mental health conditions in Malaysia demands our immediate and unwavering attention.
The data paints a sobering picture, but it also illuminates a ray of hope and a call to action.
The responsibility is not only of the government, but also of each and every one of us.
Employers, educators, and community leaders play critical roles in creating environments that promote mental well-being.
Together, we can transform the mental health landscape in Malaysia, ensuring that every mind is valued, every voice is heard and every soul finds solace.
The time to act is now.
Let us face this challenge with the urgency and dedication that it so deserves.
Professor Datuk Dr Andrew Mohanraj is a consultant psychiatrist, president of the Malaysian Mental Health Association and director of the Mental Health and Wellbeing Impact Laboratory at Taylor University. For more information, please email [email protected]. The information provided is for educational and communication purposes only and should not be construed as personal medical advice. The star makes no guarantees about the accuracy, completeness, functionality, usefulness or other guarantees regarding the content appearing in this column. The star disclaims all liability for any loss, property damage or personal injury suffered directly or indirectly from reliance on such information.
