By Low Win Li
“You probably need to exercise more, sleep at least 8 hours a day, and avoid social media 45 minutes before going to bed.”[1]
While these methods suggested may be helpful, these methods do not necessarily tackle the root of a mental health condition. There is still a glaring disconnect in the Malaysian public’s understanding of what mental health issues really are.
In May 2019, Malaysia made worldwide headlines when a teenage girl took her own life after 69% of her Instagram followers voted in favour of her death.[2]
When this happened, everyone was scrambling to point fingers at social media, saying that it has become a breeding ground for toxicity: “Social media has been a problem for so many years – why hasn’t anyone done anything about it?”, “We have raised a generation of people-pleasers and social media addicts.”
Sarawak Police Chief Aidil Bolhassan added that the teenager was reportedly struggling with depression[3]. It is not solely social media and the public’s reaction to her poll that we should focus on. Mental health issues left untreated is also a pressing problem that should be given more attention. I came across a Facebook user whose opinion encompasses this issue: “When a person enters the suicidal mind frame, anything can trigger a final tipping point… However, this period is also one of ambivalence. Although any small negative can trigger the final act, any small positive step is too able to discourage the suicidal.”
According to the World Health Organization (WHO), depression is the leading cause of disability worldwide – affecting up to 350 million people. In Japan, absenteeism is higher than presenteeism due to the fear of losing their job if their depression was revealed. Japan also has the highest aggregate costs associated with employees taking time off for depression, with 22% (costing US$14 billion) of people taking 21 or more days. This suggests that employees try to “get over it” – until their depression becomes severe. Although Asian countries do report lower productivity losses due to depression, this may not be an accurate figure as their environments are not as outspoken in speaking up about mental health issues – there may be much more numbers that we don’t know of.[4]
So, what then has been done since this incident?
I. Mental Health Awareness and Accessibility
“More awareness campaigns on mental health, including against stigmatisation of those with mental illness, must be organised to involve employers and employees and other relevant stakeholders. More counsellors and psychologists must be trained to help those suffering from depression and other mental problems.”[5]
Dr Wan Azizah Wan Ismail (Deputy Prime Minister at that time) commented that Malaysia’s Mental Health Policy should be reviewed to encapsulate early preventive measures better. “As mental health is an important aspect in our daily lives, mental health education should be taught as early as possible. Religious education and values must be created early in order to achieve a healthy future”, she said.[6]
Dr Amer Siddiq Amer Nordin, Associate Professor with the Department of Psychological Medicine in University Malaya shared examples of facilities the public can go to in order to seek help. University Malaya Medical Centre (UMMC) has their own psychiatric clinic which accepts walk-ins on Monday to Friday between 8am to 10pm. He also mentioned the Health Ministry’s Klinik Kesihatan and Family Medicine Specialist Clinic, which are able to provide referral letters for treatment at the government hospital’s psychiatric clinic.[7] The Malaysian Psychiatric Association has provided on their website a list of hospitals and private psychiatrists that are registered with their association.
In clarifying the costs involved, RELATE Malaysia has published a list of public hospitals that offers such sessions with a psychologist or psychiatrist. RM 30 will be charged for the first session, while RM 5 will be charged for subsequent sessions at these public hospitals. RELATE has also introduced group therapy for depression, based on the cognitive-behavioural approach for participants to learn how to tackle their low moods.
It is encouraged that the government should join forces and work hand-in-hand with insurers and medical professionals.[8] The Health Ministry has been working with the Education Ministry and the Women, Family and Community Development Ministry to counter mental health issues among teenagers in the country. The Health Ministry is also working with the Community Mental Health Centre (Mentari) to provide relief for those suffering from mental illness.[9]
During the Mental Wellbeing Meeting chaired by Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail, it was decided that calls made to hotlines such as ‘Talian Kasih’ (15999) and Befrienders would not be charged. This would help to increase public accessibility.[10]
II. Insurance companies and mental health
This incident has also sparked the debate on whether insurance companies should step up to provide coverage for mental health conditions. Countries such as the UK[11] and US[12] have provided a comprehensive list of organisations that could assist with insurance, as well as guides explaining how one’s mental health would affect their insurance cover.
Dr Lee Boon Chye (Deputy Health Minister at that time) acknowledged that mental illness is a major problem in Malaysia. “With coverage, it will help to increase awareness on mental illness, also to provide those who are stricken with mental illness with some coverage in time of need,” he said, noting that seeking treatment is not cheap. He also encouraged insurance companies to provide coverage for mental illness.[13] Dr Lee made reference to the insurance scheme has been implemented in Singapore. There were 5 categories of mental health issues covered: major depression, bipolar disorder, schizophrenia, Tourette’s, and obsessive-compulsive disorder.
As of July 2019, the Malaysian chapter of AIA has included mental health as part of its insurance coverage in Malaysia. The policy covers six mental health conditions: major depressive disorders, post-partum depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder and Tourette syndrome.[14] Etiqa Life Insurance Bhd had also launched the country’s first critical illness (CI) rider to include mental illness coverage with its SecureLink investment-linked insurance plan, called IL CI Plus (investment-linked critical illness plus). The rider covers 68 critical illnesses, including four types of mental illness — bipolar affective disorder, major depressive disorder, schizophrenia and schizoaffective disorder.[15]
Although having this debate has sparked conversations of ways we can tackle mental health better, it should not be the responsibility of insurers alone.
The stigma and ignorance of mental health problems also hurts our economy. The lack of action to deal with these issues leads to poor productivity of their workers, and other additional costs.[16] For a more in-depth look into this topic, RELATE Malaysia published a study ‘Workplace mental health – The business costs’, that estimates the total productivity and business costs of mental health problems in Malaysia according to absenteeism, presenteeism, and staff turnover attributable to mental health issues.
The Ministry of Health (MOH) has since allocated RM344.82 million under Budget 2020 for psychiatric and mental health work, marking a 3 per cent increase from 2019.[17]
At the end of the day, let us keep in mind that:
- Mental Health is a collective responsibility. All of us should take up the responsibility to foster wellness and to look out for each other. Speaking at the “Are You Okay?” talk at International Islamic University of Malaysia (IIUM), Syed Saddiq (Minister of Youth and Sports at that time) spoke about the importance of having a good support system when one is going through struggles with their mental health.[18]
- The stigma surrounding mental health still exists. We should all learn to be more empathetic and understanding of what mental health is, and those who are struggling with their mental health.
- “Mental health well-being should be viewed as ‘the whole is greater than the sum of its parts. Physical and mental health should not be seen as mutually exclusive.”[19]
[1] Ethan Rakin, ‘Mental health issues in Malaysia are set to worsen in the coming years – here’s what you can do to prevent it’ (Business Insider Malaysia, 7 August 2018) <https://www.businessinsider.my/mental-health-issues-in-malaysia-are-set-to-worsen-in-the-coming-years-heres-what-you-can-do-to-prevent-it/>
[2] Jamie Fullerton, ‘Teenage girl kills herself ‘after Instagram poll’ in Malaysia’ (The Guardian, 15 May 2019) <https://www.theguardian.com/world/2019/may/15/teenage-girl-kills-herself-after-instagram-poll-in-malaysia>
[3] Emma Snaith, ‘Teenage girl ‘jumped to her death’ after posting Instagram poll on whether to kill herself’ (The Independent, 15 May 2019) <https://www.independent.co.uk/news/world/asia/instagram-suicide-girl-poll-malaysia-borneo-police-a8914646.html>
[4] Asian Scientist Newsroom, ‘The Cost of Workplace Depression in East Asia’ (Asian Scientist Magazine, 12 October 2016) <https://www.asianscientist.com/2016/10/health/workplace-depression-east-asia/?fbclid=IwAR3xNgXgWz4iHrk4bfPwBfp6ascrRLe-MR3zDlj3kvzptGoliBF5LGATwm8>
[5] Beatrice Nita Jay, ‘Government called on to decriminalize suicide, help the mentally ill’ (New Straits Times, 4 January 2019) <https://www.nst.com.my/news/nation/2019/01/446788/government-called-decriminalise-suicide-help-mentally-ill>
[6] Bernama, ‘Do not neglect people with mental health problems’ (11 October 2018) <http://bernama.com/en/news.php?id=1652502>
[7] Health Care Today, ‘SJ Assemblywoman Michelle Ng Initiates Integrated Mental Health Eco-System’ (23 May 2019) <http://healthcaretoday.com.my/sjcarewarriors.html>
[8] Dashveenjit Kaur, ‘Allianz wary on mental ills coverage’ (The Malaysian Reserve, 31st May 2019) <https://themalaysianreserve.com/2019/05/31/allianz-wary-on-mental-ills-coverage/?fbclid=IwAR1jxIOVJO2CPDpQ6VcdTzfCRwzwgqDaqD2Gi6EeH8tNqxgdLAPcftBdVA0>
[9] Sylvia Looi, ‘Mental illness should be covered by insurance, says deputy minister’ (MalayMail, 23 May 2019) <https://www.malaymail.com/news/malaysia/2019/05/23/mental-illness-should-be-covered-by-insurance-says-deputy-minister/1755693>
[10] Malay Mail, ‘AGC to look into decriminalising attempted suicide, says Dr Wan Azizah’ (Malay Mail, 14 June 2019) <https://www.malaymail.com/news/malaysia/2019/06/13/agc-to-look-into-decriminalising-attempted-suicide-says-dr-wan-azizah/1761913>
[11] Mind, ‘Insurance cover and mental health’ (April 2018) <https://www.mind.org.uk/media/23627384/insurane-cover-and-mental-health-2018.pdf?fbclid=IwAR0iiF8MQlrho34cWUrPMz_AsrDYctvpdAKXbeKrda4uohZ7brlkFTenF_Y>
[12] Hillside Atlanta, ‘Treatment Services’, <https://hside.org/mental-health-insurance-provider-coverage/?fbclid=IwAR2VYG8d4U6jBlP26kv-ptXNBVrGyRLyR8EkHZb7xQr7L03SAfobCSsC_fQ>
[13] Sylvia Looi, op.cit.
[14] Syed Jaymal Zahiid, ‘Malaysia AIA now offers insurance for serious mental illness’ (Malay Mail, 5 July 2019) <https://www.malaymail.com/news/life/2019/07/05/malaysia-aia-now-offers-insurance-for-serious-mental-illness/1768584>
[15] Vanessa Gomes, ‘Insurance: Providing mental illness coverage’ (The Edge Markets, 18 November 2019) <https://www.theedgemarkets.com/article/insurance-providing-mental-illness-coverage>
[16] Tarrence Tan, ‘Mental health hurts economy badly’ (The Star, 18 February 2020) <https://www.thestar.com.my/news/nation/2020/02/18/mental-health-hurts-economy-badly>
[17] CodeBlue, ‘MOH Gets Tiny Mental Health 2020 Budget Raise’ (CodeBlue, 25 October 2019) <https://codeblue.galencentre.org/2019/10/25/moh-gets-tiny-mental-health-2020-budget-raise/>
[18] Danial Dzulkifly, ‘Friends, family should be there for those facing mental distress, says minister’ (Malay Mail, 17 May 2019) <https://www.malaymail.com/news/malaysia/2019/05/17/friends-family-should-be-there-for-those-facing-mental-distress-says-minist/1754080>
[19] Allison Lai, ‘Accept mental health as illness’ (The Star Online, 21 June 2019) <https://www.thestar.com.my/news/nation/2019/06/21/accept-mental-health-as-illness/>
