Malaysia’s stigma of people with mental health problems: A pressing concern

20160819150000, Brenda Lau
psychiatry, public health, men's health, women's health, children's health, mental healh
Those with mental health problems need our support to obtain the help that they need
Uncle Tim (not his real name) was a quiet and reserved man in front of family. He often hid his amusement by trying hard not to laugh, portraying a cool demeanor. When he was teased about it, he would show a rare sheepish smile. It was almost the highlight of every family visit. Strangely, in front of friends on the other hand, he laughed with all his heart and joked around.

Unbeknownst to everyone, he felt the need to show the cool side to his family as he believed that it was very masculine and proved a strong character. In front of his friends, he felt comfortable to let these walls down.

Uncle Tim was a very fit person, often waking up at 6am to go cycling before he went to the local 'kopitiam' with his friends to chat about random topics. At noon, he would head to the office.

This went on for approximately 20 years, until an unfortunate financial situation hit him.

Uncle Tim was not materialistic, but he worked hard all day and night to provide for his two daughters and wife, trying to lead a comfortable life. He refused any part of his inheritance previously and let his brothers have it. He was kind-hearted and sensitive. However, the unfortunate financial event hit him like a ton of bricks. It meant all his hard work went down the drain.

How could he start again? He was nearing 60 and even if he had the will to earn all the money back, his body and mind refused to cooperate.

He withdrew more and more into a shell he created for himself out of shame. He avoided crowds and extended family visits, afraid of being judged. He was beginning to get depressed. He could not sleep and even if he did, he did not feel rested in the morning. He heard voices and he saw things. He refused to eat and drink. He just wanted to be alone.

Uncle Tim passed away in April.

He committed suicide.

The public is quick to judge others as “crazy people!"


It all began five years ago, when Uncle Tim began to feel stressed over how to earn his money back and when he hit a roadblock, he felt like there was no other way, he started suffering from chronic depression.

He visited a doctor who diagnosed him with depression and prescribed him sleeping pills and anti-depressants. However, his thoughts were stronger than that. He had multiple attempts of suicide and his family kept close watch over him. Just when it seemed like it was getting better, he ended it all.

Unfortunately Uncle Tim lives in Malaysia where mental health is rarely brought up as a sign of help, even though 29.2% of adults in the country suffer from various mental health problems.

Society equates people with mental health problems as those with mental illnesses, thinking they are crazy and cannot be helped, which only makes it more difficult for them to come forward for treatment.

For example, Uncle Tim was having mental health problems, which could have been addressed if he found someone to talk about it, before it turned into a mental illness.

Dr Uma Visvalingam, a consultant psychiatrist at Putrajaya Hospital, said there was prejudice against those with mental health problems because most people had misconceptions about their condition.

"They do not really understand the difference between mental illness and mental health problems. The two conditions have different medical approaches.

"People are quick to judge and say they (mental health patients) are crazy, when they actually require monitoring by psychiatrists," she said.

Dr Uma explained that those suffering from mental health problems were not yet at a critical level, and consultation sessions could help alleviate their problems.

She said those suffering from mental illness, on the other hand, had to go through a consultation process and take continuous medication, and took a longer time to be treated.

Mental health problems affect children as well


Mental health problems are on the rise but many feel at a loss as they feel like there is no one to turn to. Like Uncle Tim, many feel ashamed of their condition and that they would be judged.

This points towards a larger societal issue and begs the question, are Malaysians too judgmental?

The condition can affect children and young adults as well, in fact it might be worse as children do not yet possess strong wills. Parents often compare academic results of their children with those of their peers, unknowingly leading them towards a state of mental stress and an emotional state of disappointment for not being recognised.

In 2011, it was found that among secondary school children, 17.1% had symptoms suggestive of severe anxiety disorders, 5.2% had severe depression symptoms and 4.8% experienced severe stress.

According to the National Health and Morbidity Survey 2015, the prevalence of emotional problems among children 5 to 15 years of age was 15.7%. Meanwhile, peer problems were 32.5%, conduct problems were 16.7% and pro-social skill was 11.2%, respectively.

These numbers although low, pose a significant threat if the children are not given help early on as the psychiatric morbidity was recorded at 20.3% for children and adolescents (5 to 15 years olds), compared to 11.2% for adults (16 years and above).

"Such cases are on the rise because many do not know how to deal with mental health problems and they do not take it seriously," Dr. Uma said.

Dr Uma pointed out that mental health problems could be detected at an early stage through signs such as chronic depression, losing interest in daily work, as well as disruption to eating and sleeping schedules.

"Ideally, the individual concerned should see a psychiatrist to be treated and prevent the problem from lingering," she said, adding that moral support from family and friends also played an important role in curbing the problem.

Addressing the factors of prejudiced stigma in Malaysia


However, despite the ideal situation of the individual concerned, coming forward to admit their condition, there are many factors contributing to this stigma in Malaysia preventing them from doing so.

These include the inaccurate media portrayal of mental health issues, language and cultural influences, a lack of public knowledge, doctors' attitudes towards the field of psychiatry, and the psychiatrists themselves, according to Dr. Lim Sheri from the Penang Medical College.

She suggests that the stigma can be tackled in four areas: society, media, medical education and the field of psychiatry.

Firstly, inaccurate media portrayal is a serious problem as the media is crucial in influencing public perception. Public education is also more effective if focused to targeted key groups, according to Dr. Lim.

Secondly, Malaysia is a melting pot of cultures and with that comes the different types of languages that may become a barrier in these situations. Therefore Dr. Lim suggests that psychiatric terminology should be adapted to local languages and cultural beliefs to avoid misconceptions.

Thirdly, doctors and other healthcare professionals play an important role as well as positive attitudes towards mental health problems or mental illnesses can help patients manage better, therefore these attitudes should be implemented through early psychiatric postings during medical school, she suggests.

Finally, psychiatrists play the most important role as they are equipped with the proper knowledge and should correct misconceptions, avoid misdiagnosis and ineffective treatments. Cultural competency also leads to better management of patients by awareness towards socio-cultural and religious influences.

It is hoped that through these four steps, the Malaysian public and healthcare professionals should help someone similar to Uncle Tim to prevent taking his own life. MIMS

Helplines:
Malaysian Mental Health Association : (+603) – 7782 5499
Befrienders Malaysia: (+603) - 79568144 / (+603) - 79568145
List of psychiatrists in Malaysia

Sources:
http://newswire.bernama.com/News.aspx?news_id=20160816BN0217SUB2
http://www.aseanjournalofpsychiatry.org/index.php/aseanjournalofpsychiatry/article/viewFile/326/210
http://wmhp.cmhaontario.ca/workplace-mental-health-core-concepts-issues/what-is-mental-health-and-mental-illness
http://www.iku.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol2.pdf


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