In Conversation with Doctors


Stop the Stigma

by Assoc Prof Dr. Ng Chong Guan – Consultant Psychiatrist

1.Mental health is often a taboo topic and is expected to increase by 2020. Can you elaborate on the types of mental health and the causes?

Mental illness has the capacity to affect an individual’s mood, thoughts, behaviours and even their work and family life. While there are a variety of mental illnesses, some of the more prevalent ones are depression, anxiety disorders and schizophrenia.

Briefly described, depression is characterised by persistent feelings of worthlessness, hopelessness, emptiness, sadness and guilt. Anxiety disorders, on the other hand, is characterised by excessive worry and fear. Schizophrenia is what people typically picture when they think of the term “madness”. Individuals with schizophrenia may behave erratically as they may experience hallucinations (seeing or hearing things that are not there) and delusions (believing something that is not real).

Stress is usually a contributing factor to most mental illness. However, it alone is not sufficient to cause or trigger mental illness, though it can prolong it. More often, mental illness is a result of a combination of stress, biological factors, environmental factors, or a combination of these.

2.How can one tell if someone has poor mental health?

Some of the more common signs of poor mental health include a lack of concentration, irritability, lethargy, withdrawal from social activities, and restlessness. This list, however, is not exhaustive as people respond very differently to a variety of situations. Thus, it can sometimes be difficult to tell if someone has poor mental health.

Within the capacity of mental disorders itself, different disorders present with different symptoms and the same disorder may even present differently in different individuals. Additionally, some individuals may not show symptoms that are easily observable but still experience distress. This may happen for a variety of reasons, such as perceiving their distress as a burden to others or feeling as though they lack a safe space to share.

3.How can family members and friends support members undergoing mental issues?

There are some general strategies that family members and friends can use to provide support. Perhaps the most important, and one of the first steps in this journey, is to listen with empathy. Some key things to keep in mind is to listen actively to what’s being shared with the aim to understand, not to dismiss, correct or provide solutions.

Acknowledgement of their feelings towards their symptoms does not mean that you have to agree that it is an appropriate response, but that you understand that this is what they feel and that they are not going through it alone. Let them lead the discussion at their own pace and let them share as much or as little as they are comfortable sharing.

While social support does play a crucial role in mental health, it is important to know your limit and to provide balanced support. If you are concerned, encourage the individual to seek proper help from qualified professionals. Where medication is involved, it is then important to encourage them to take it regularly to ensure it works the way it should. It may feel natural to take full responsibility when a loved one has a serious mental illness. However, this is not healthy for either party. Research suggests that individuals show more improvements when allowed appropriate responsibilities for themselves.

For instance, rather than volunteering to schedule all their appointments and planning out their daily activities, it may be more helpful to simply provide them with assistance and gentle reminders instead. Allowing them some control over areas in their life, such as making decisions is an important step in their recovery.

4.Do you think Malaysians are aware of the topic on mental health?

Mental health awareness in Malaysia has increased tremendously in the past few years, due in part to efforts by Non-Governmental Organisations (NGOs), the government and the advent of the internet. However, it is not yet where it needs to be. A study from earlier this year examining perceptions of a small sample of Malaysian youths towards mental health and help-seeking behaviour found that while they had limited knowledge on serious mental health issues and expressed concerns about stigma, they were curious to learn about it and advocated help-seeking behaviours. This contrasts a previous study in 2007 which found that Malaysians of various age groups had a generally low level of mental health knowledge and viewed it rather negatively.

Given the many physical as well as mass media campaigns focusing on mental health, the general public is more exposed to prevalent disorders and their symptoms, but only in terms of theoretical knowledge. There still seems to be a lack of understanding of its causes, recognising when professional help is needed and knowing how to properly support those who need help. A common script seems to be, “I feel empty and unhappy, but I don’t think it’s that severe.” Even with increased knowledge, the stigma of mental illness still prevails. It may help to think of seeing a mental health professional like seeing a medical doctor or going for a medical check-up. People are becoming more pro-active in recognising early signs of cancer and seeking professional help to prevent it; mental health deserves the same. We know the conditions are treatable and it is important that the early signs of mental illness are given the same attention and appropriate treatment as we would to physical illness.

5.How can the government help contribute and spread awareness on mental health, as well conduct campaigns and awareness in schools?

Conducting awareness campaigns about mental health in schools is a good effort as it would introduce students to topics regarding mental health and provide the opportunity for further discussion. Theoretically, this could aid in the destigmatization of mental illness. Ideally though, it needs to happen on a larger scale and for people of all ages, not merely students. The issue here is that we lack adequate resources allocated for mental health. As said by Tan Sri Lee Lam Thye, patron of the Malaysian Psychiatric Association (MPA), compared to an international average of 2.8%, Malaysia’s government only devotes about 1.3% of its health budget on mental health.

Given the increasing prevalence of mental disorders such as depression in both adult and younger populations (as per the National Health and Morbidity Survey 2015), the Ministry of Health (MOH) could allocate more funds and focus to the development of curative and preventive programmes as well as the integration of mental health into primary care. The government could also actively partner with various NGOs such as Malaysian Mental Health Association (MMHA) to increase wider advocacy of mental health issues. Greater dissemination of information to wider audiences may be achieved in this way as different NGOs target different audiences via diverse media while addressing specific areas of mental health.

Beyond these, mental health is still a rather new topic, globally as well as within Malaysia. While there are efforts to implement current mental health policy and legislation (e.g. the Psychiatric and Mental Health Operational Services Policy 2011, applicable to psychiatrists), licensing and clear code of conduct do not yet exist for other non-medical practitioners; though this is thankfully in the works.