Fewer than 400 psychiatrists to treat over four million Malaysians, says expert

Penang Institute research analyst Lim Su Lin speaks at a forum on mental health care in Malaysia in Kuala Lumpur on December 11, 2017. ― Picture by Choo Choy May
Penang Institute research analyst Lim Su Lin speaks at a forum on mental health care in Malaysia in Kuala Lumpur on December 11, 2017. ― Picture by Choo Choy May

KUALA LUMPUR, Dec 12 ― About one in three adult Malaysians, or 4.2 million people, suffer from mental illness, but there are fewer than 400 psychiatrists in the country to treat them, an expert said.

According to a study by Penang Institute, the number of Malaysians who have mental health problems has increased threefold since 1996 from roughly 10.7 per cent of the population to 29.2 per cent in 2015.

Some of the most common mental illnesses plaguing the country are anxiety disorders and depression.

“Based on the National Health and Morbidity Survey 2015, roughly 4.2 million or one in three Malaysian adults are affected by mental health problems.

“Although it seems that a threefold increase since 1996 seems minor, this is not a comparison of raw numbers but represents the population that are psychologically unwell. Kuala Lumpur has among the highest increase at 39.8 per cent since 2015,” said Penang Institute research analyst Lim Su Lin last night.

In a forum titled “Bridging barriers: Improving access to mental healthcare”, the historian whose interest lies in mental health policies added that even more worryingly, the rate of suicide cases has increased by a third from 2011 to 2017.

She said that the highest suicide rates over the years have been in Johor, Perak and Selangor but in 2016, she noticed that Kuala Lumpur and Sabah also had a spike in suicide cases.

Lim pointed out that some of the major issues in treating psychologically unwell patients was the lack of mental health professionals in government hospitals or the public health sector ― leading to low quality care, expensive treatment in private health facilities, little insurance coverage for mental illness, and social stigma prevalent in Malaysian society.

According to Lim, in 2016 the government only had 12 clinical psychologists, 163 psychiatrists, 188 psychological officers, 314 medical officers, 40 social workers, 1,220 staff nurses and 697 assistant medical officers to handle public psychiatric care.

She said Malaysia needs more top-tier mental health care professionals, such as clinical psychologists, whose role is to help people affected by mental health conditions to alter unhelpful thought patterns and behaviours and learn new coping methods, as well as psychiatrists, who are physicians that specialise in mental health care, to prescribe medication.

“In 2014 The World Health Organisation (WHO) conducted a survey and it found that in high income countries, there are an average of 6.6 psychiatrists for every 100,000 population. For low income nation, it is below 0.5 per 100,000 population.

“In that study Malaysia was categorised as upper middle income country like China and Thailand, therefore we theoretically should have 3.5 psychiatrists per 100,000 population. However, in total we have 360 psychiatrists for 31,660,700 Malaysians in 2016, making it 1.1 psychiatrist per 100,000 population.

“Since we only have 14 clinical psychologists, a pathetic number, that means we only have about a quarter (0.28) clinical psychologist for every 100,000 population,” said Lim.

She said the government needs to introduce more courses and grant incentives to students who take up psychiatric courses, which require a medical degree, or clinical psychology which is a Master's degree equivalent.

One of the issues in the government health service is that the system lumps three different types of mental health professionals ― counsellors, counselling psychologists and clinical psychologists ― as Grade S41 Psychological Officer.

“When this happens, they promoted counsellors into a position that is supposed to be for clinical psychologists. Therefore those who are trained as clinical psychologists finds it harder get a job in the government.

“They are forced to go to the private sector and when this happens, the majority of the public will not be able to get quality, accessible mental health care,” said Lim adding that in 2017, only 15 clinical psychologist posts were available in the civil service.

Government clinical charges for mental health care is free for the first consultation and RM5 for every follow-up consultation. The private sector, however, charges anywhere between RM80 to RM250 per consultation, according to Lim.

To make things worse, insurance policies do not cover mental health care, barring critical ones like Alzheimer's and Parkinson's disease.

Lim said the issue facing insurance companies is the lack of evidence to quantify the cost of mental health care.

Social stigma is also another obstacle for those who seek or need treatment.

“Stigma discourages the mentally ill from seeking treatment. Over time, this leads to worsened health and reinforces negative beliefs and prejudices from others. And without treatment, it becomes worse.

“They refuse to come for treatment and see specialists and without treatment, they get worse,” she said.

The Penang Institute analyst added that in Malaysia, stigma comes not only from strangers but even more troubling, from family members, friends and employers ― the basic support system of any human being.

Editor’s note: An earlier version of this story contained errors which have since been corrected. Additional changes were made to more accurately reflect Lim's remarks from the event.

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