Address stigma of mental illness openly

IN 2015, the Health Ministry revealed that 30% of Malaysians have a mental health condition. This figure is alarming and reflects a three-fold increase since 1996.

Yet we have not heard much from the Government to address this issue. The silence from the authorities is disappointing, to say the least. Imagine if the statement had been that three out of 10 people had cancer, or some other physical disease, would not the sense of urgency and call for action be so much greater?

In 2016, the Health Ministry released the Plan of Action for healthcare for 2016 – 2020. The only mention of what is being done/planned to address mental health care was on page 24, which showed that 90% of patients with a mental health condition failed to get a job even after going through the Individual Placement and Support-Supported Employment (IPS-SE) programme at the Pusat Kommunity Kesihatan Mental (Mentari).

The Government has neglected to publicly address the issue time and time again, and to provide effective solutions to the mental healthcare crisis. Very few public figures have openly advocated for mental health issues, which perpetuates the stigma against mental illness and decreases the likelihood of people getting treatment.

Moreover, even if patients seek assessment and treatment, mental healthcare in both the public and private sector is severely lacking. Malaysian Mental Health Advisory Council member Tan Sri Lee Lam Thye recently stated that there is only one psychiatrist per 200,000 people in Malaysia. That is indeed a dire situation for the nine million Malaysians who have a mental health condition.

We have paid and will continue to pay a high price for turning a blind eye to mental healthcare. Mental illness costs the economy millions of dollars in terms of loss of income. It is so high that the Agency for Healthcare Research and Quality estimated a cost of US$57.4bil per annum in mental healthcare in the US, which is equivalent to the total cost of cancer care.

The difference? The bulk of the cost of cancer care comes from the treatment of cancer, whereas the bulk of the cost of mental illness comes from unemployment and unpaid leave, expenses for social support, and other indirect costs caused by the disability.

Mental illnesses are the leading causes of disability adjusted life years (DALYs) worldwide, accounting for 37% of healthy years lost from non-communicable diseases. In Malaysia, depression ranks as the top five cause of DALYs (4.1%; one DALY can be understood as one lost year of “healthy” life).

The reduction in life expectancy for many mental illnesses on average is 13.8 years. This is higher than the reduction in life expectancy linked to moderate to heavy smoking (average of nine years).

Our Government cannot remain silent any longer. We must address the elephant in the room. The stigma of mental illness needs to be addressed in schools, through public education and anti-discrimination campaigns; mental healthcare must be improved with accessible and affordable evidence-based assessments, prevention and clinical treatments; and patients’ rights not to be discriminated against and to make informed choices on their treatment must be legally protected.

DR CHUA SOOK NING

Relate Malaysia