Sunny Side Up: Can online therapy help with Malaysia’s mental health crisis?

The increase in need for mental health services during the past few months adds to the current lack of resources in Malaysia. Photo:

From the start of 2020, the world has been adjusting to new ways of living as we work to overcome the crisis of the Covid-19 pandemic. As scientists and medical professionals strive to understand the virus, industries have found themselves having to adapt and survive in this new environment, which has given rise to the curious paradox of crises paving the way for opportunities.

In the mental health field, counselling and psychotherapy in Malaysia has seen an increase in telepsychology, or online therapy. Psychological services closed their doors earlier this year, but millions of Malaysians were still in need of mental health support. During the movement control order (MCO) period, a study by Malaysian think tank The Centre released in April said half of its 1,084 respondents reported issues with their mental health. The study reported that 22% of respondents experienced severe or extremely severe anxiety, with women and people under the age of 35 saying they experienced high levels of negative emotions during the MCO period.

Factors such as living in low-cost housing and crowded households and living in isolation are said to have an impact on mental well-being with people showing, for example, extreme signs of depression, anxiety and stress.

The increase in need for mental health services during the past few months adds to the current lack of resources in Malaysia.

In June 2020, Health Ministry director-general Datuk Dr Noor Hisham Abdullah revealed that thousands of people had called the ministry’s hotline. He acknowledged that the 148 counselling officers employed at the ministry is over 100 times fewer than the number needed to cope with demand. Dr Noor Hisham revealed that the ratio of counselling officers to population is currently one to 52,000 people, and added that, ideally, it should be one to 500 people.

With the cautious adoption of telepsychology in Malaysia – by phone, video, email or text message – there are understandable concerns about the situation’s legalities and ethics, not least of all regarding clients’ well-being, privacy and confidentiality.

The most common form of online therapy is conducted via video sessions and has been practised in the West for more than 20 years, with robust practices and ethical guidelines in place. The American Psychological Association (APA) has cited studies that show online therapy as “equivalent to face-to-face care in various settings and an acceptable alternative” to in-person therapy. The APA also points to studies that show people in need of further support are more likely to seek out in-person therapy after receiving initial online interventions.

Clients receiving online support might feel more comfortable opening up to their therapist from their home setting, and for those who feel reluctant to go to an office (where they might be seen by others), online therapy can be an alternative that works well, provided they have the private space for each session.

That said, there are several concerns about client safety and well-being. For example, online therapy might not be suitable for those with severe conditions or those who are at risk of self-harm. In emergency situations, certain actions can be taken by a therapist when the therapy is in-person. For example, if an at-risk client suddenly leaves the room, they can be followed to ensure they don’t harm themselves; whereas, if they leave the online session, the therapist has little immediate control of the situation. However, there are potential workarounds to such difficult situations (including deciding from the start whether online therapy is suitable for the client).

Of course, the provision of high-quality, ethical support is crucial, and therapy of any sort should always have the client’s well-being, dignity and safety at the heart of any consideration.

Generally speaking, the evidence suggests that people can be well-supported and make progress via online therapy just as when seeing a therapist in person. It’s also a cost-effective treatment, with pricing typically being between 50% and 75% of conventional therapy.

Here in Malaysia, mental health NGO Relate Malaysia has been providing online therapy since 2018 and continues to serve many people in need of support. It also has a growing waiting list of clients. Its founder, Dr Chua Sook Ning, ensures services are delivered to a high standard in line with strict protocols and robust ethical guidelines, and includes regular supervision of practitioners and their cases.

Perhaps the most alarming insight from the director-general’s comments is surely that so many Malaysians are in need of mental health support and yet, there’s not nearly enough practitioners or resources to ensure everyone who needs them gets access to mental health services.

While there is a lot to consider when it comes to adopting online therapy, its efficacy and convenience of use has been demonstrated when offered to suitable clients with appropriate measures in place.

Like any change, there will exist some reluctance to adopt online therapy as a suitable alternative to conventional treatment. On the other hand, with so many people in need, it might be time to fully embrace the opportunity that online therapy offers in helping to put a dent in the growing need for mental health support.

Sunny Side Up columnist Sandy Clarke has long held an interest in emotions, mental health, mindfulness and meditation. He believes the more we understand ourselves and each other, the better societies we can create. If you have any questions or comments, email The views expressed here are entirely the writer's own.

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Sandy Clarke , mental health , counselling , online


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