Recently, the Mental Health Promotion Advisory Council of Malaysia has urged the government to provide more registered psychiatrists, in hope to cater to the needs in public and private healthcare in the country.

One of its prominent members, Tan Sri Lee Lam Thye said Malaysia is currently lacking in numbers of psychiatrists with only 360 of them registered in both sectors.

“Psychiatrists are trained medical doctors. They can prescribe medications while psychologists focus extensively on psychotherapy and treating emotional and mental suffering in patients with behavioural intervention,” he explained.

To depict what the shortage translates to, Befrienders KL, a non-profit mental health organisation, reported through a survey, that suicide is the second leading cause of death for youths between the age of 15 and 29 in Malaysia.

Statistics of those who contacted Befrienders Kuala Lumpur with suicidal thoughts in 2015 – 2016. Photo credit: Befrienders/NST
Statistics of those who contacted Befrienders Kuala Lumpur with suicidal thoughts in 2015 – 2016. Photo credit: Befrienders/NST

Suicide is usually due to stressful life events, substance abuse, physical or mental illness, stigma and discrimination in getting treatment for mental illness, and lack of social support, says Dr Abdul Kadir Abu Bakar, a committee member of the Malaysian Psychiatric Association (MPA).

Sharing their views on this issue, our two guest experts have narrowed it down to the lack of focus on as well as the understanding of mental health.

Media lacks all-round focus on mental health issues

“I think we recognise and understand more about medical and physical illnesses than mental health problems because we do not talk enough about mental health problems,” remarks Dr Philip George, an Honorary Consultant and Substance Abuse Psychiatrist at Hospital Tuanku Jaafar, and presently a Professor at the Clinical School of the International Medical University.

“Most medical publications or mainstream medias are happy to highlight more on medical and physical illnesses, and sadly, not so much about mental health,” he adds.

Another consultant psychiatrist, Dr Sivakumar Thurairajasingam, echoes in agreement with Dr George’s opinion, stating that there is also the possibility of the public not securing sufficient understanding of what mental health issues are.

“I feel that they confuse mental health issues with psychiatry,” asserts Dr Siva (as he refers himself as) who is also Associate Head (Education) at the Clinical School Johor Bahru, Monash University.

“Psychiatry is just a small component of the entire umbrella; which is mental health. Under mental health, there are other issues such as behavioural problems; for instance, school bullying, car rages, drug addictions, etc. These issues, as portrayed by media, have been the “face” of mental health. So, there is a lack of recognition and understanding of mental health,” he adds.

Lee also urges that awareness of mental health issues must also be raised in school, while simultaneously making mental healthcare more accessible.

Dr George agrees, saying that mental health “should be a topic or subject just like how they teach about dental health or medical health – mental health issues should also be talked about,” he asserts.

Shortage of psychiatrists may contribute to increased violence rates

Dr Philip George says that an increase in mental health professionals and psychiatrists would naturally mean a reduction of the number of new patients addicted to drug or alcohol use – or even relapses. Photo credit: IMU
Dr Philip George says that an increase in mental health professionals and psychiatrists would naturally mean a reduction of the number of new patients addicted to drug or alcohol use – or even relapses. Photo credit: IMU

Despite an overall reduction in the crime index, police statistics revealed that violent crimes rose by 2.4% when 22,326 cases were reported last year, compared to 21,810 cases reported in 2015. According to Lee, the violent behaviour among youths could be associated with mental health problems.

The shortage of psychiatrists may have contributed in some way, as psychiatrists and mental health professionals have an important role in prevention, says Dr Siva – considering a lot of substance use problems can sometimes be due to self-medication of anxiety or depression disorders.

“If there were more accessible or more numbers of mental health professionals, then people with anxiety or depression disorders can get more appropriate treatment rather than relying on drug or alcohol use,” explains Dr George.

“There is a relationship and of course, those with substance use problems actually do fare better with medical models in treating their addiction – and that usually needs the background of psychiatry and addiction medicine,” he elaborates.

Dr George also notes that an increase in mental health professionals and psychiatrists would naturally mean a reduction of the number of new patients addicted to drug or alcohol use – or even relapses.

More emphasis and priority should be placed on mental health

Lee urges the government to “find ways to encourage more experts in this field as we need 3,000 psychiatrists in order to achieve the ratio set by World Health Organisation (WHO).” The current ratio of psychiatrists to the total population in the country is 1:200,000, a stark difference compared to 1:10,000 recommended by WHO. “We have to make a comparison here… There is actually at least a three-fold increase of psychiatrists in Singapore, compared to Malaysia,” highlights Dr Siva.

“One might ask why. It is not only a three-fold in psychiatrists, it is also an increase in those working in the mental health field – social workers, psychologists, etc. Singapore has a mental workforce,” he remarks.

Dr Siva suggests that it boils down to the fact that there is more emphasis and priority given to the field of mental health within the public and in medical schools in Singapore.

More needs to be done to realise the importance of psychiatry

“Psychiatry is just a small component of the entire umbrella; which is mental health,” says Dr Siva, who is a visiting Consultant Psychiatrist to Columbia Asia Hospital Nusajaya, Johor. Photo Credit: Dr Sivakumar Thurairajasingam
“Psychiatry is just a small component of the entire umbrella; which is mental health,” says Dr Siva, who is a visiting Consultant Psychiatrist to Columbia Asia Hospital Nusajaya, Johor. Photo Credit: Dr Sivakumar Thurairajasingam

Currently, a general minimum period of seven to eight weeks is provided in medical schools, as what is recommended by the WHO. Students therefore understand psychiatry as a discipline and can consider it as a career choice.

For example, at Monash University, where Dr Siva is an Associate Professor in Psychiatry, there is a huge component of psychiatry in the MBBS programme, which earlier versions did not have. But, is this sufficient?

“The problem is, when young doctors, especially those who have just graduated, don’t get the exposure again, their interest wanes,” says Dr George.

“So, it may be important for house officers, medical interns or housemen to refresh their understanding, knowledge and management skills – and maybe even encourage them to consider psychiatry as a career path,” he suggests.

Portrayal vs. reality: Combating stigmatisation of psychiatry

Dr George also mentions that psychiatry may often be perceived as “less” appealing as compared to other disciplines, such as cardiology, obstetrics and gynaecology and other “life-saving disciplines”. However, he does not believe in that and reminds that “psychiatry builds a person and has a huge impact; not just on the person but on the family and the community as well.”

In reality, psychiatrists rank near the lower end of the income scale, in comparison to other specialties. Nonetheless, urging budding doctors to have the correct mindset, Dr George opines that “if you view the medical profession (as a whole) as a way to help those in distress, then doesn’t matter what discipline you choose.”

Recalling from his personal experiences, Dr George shares that he was provided the opportunity to be exposed to the field of psychiatry during his time in Hospital Bahagia Ulu Kinta – or more famously known as Hospital Tanjung Rambutan.

“Having that exposure made me understand that psychiatry is an important discipline of medicine – that it is just as beneficial to patients, as cardiology or surgery, or any other discipline.

“To me, the fact that I was treating the whole person, and not merely just an organ – his (the patient’s) whole life, his family, the environment – everything was important to my management of that person,” he asserts. MIMS

Read more:
Suicide rates on the rise among teenagers and in urban areas in Malaysia
Malaysia’s stigma of people with mental health problems: A pressing concern
One in three Malaysians have mental health problems as government action plan to be unveiled

Sources:
https://www.nst.com.my/news/nation/2017/07/253500/malaysia-needs-3000-registered-psychiatrists-meet-who-recommendation-lee
http://www.themalaymailonline.com/malaysia/article/lee-lam-thye-urges-government-to-recognise-importance-of-mental-health#im8Uv8cDjSRxWgVP.97
http://www.thestar.com.my/news/nation/2017/07/02/lam-thye-focus-on-mental-health-of-malaysian-youth/