YOUTHS today are facing increasing mental pressure, especially those who fall under the urban poor demographic.
Not only do they face the usual academic stress other students go through, they also face additional challenges from living in tight financial situations.
SOLS Health managing director and clinical psychologist Ellisha Othman says common mental problems affecting youth are depression, anxiety and suicidal thoughts.
Last May, Yayasan Hasanah reveals that secondary school students living in People’s Housing Projects (PPR) are most prone to mental health issues.
The foundation’s senior vice-president and education head Dr Nur Anuar Abdul Muthalib says this was discovered when they worked with the Education Ministry to identify schools to be part of their programme for secondary school teachers and counsellors.
“Urban poverty is a risk factor for mental health issues and illnesses, ” says Ellisha.
Peer acceptance is important to young people and for these youths, they feel that they do not have that from some of their schoolmates, she adds.
She says this is because the urban lifestyle, which is fraught with commercialism and materialism, causes teenagers to compare themselves to their more well-to-do friends.
“(Then there is) the social issue meaning that in schools, they may have difficulties socialising and interacting because they come from ‘the flats’.
“We see this with the middle-income and higher income communities who might not want to send their children to schools with more PPR students.”
The PPR environment itself is cramped, she says, adding that there are around six to eight people living in a tiny two-bedroom flat.
This is not conducive and most of the youth would prefer to go out, she explains.
“In schools, if you are from the PPR, the authority figures, such as police, parents and teachers, may already label you in certain categories or because you’re from the PPR may think that you’re not smart, may be lazy or a troublemaker.
“This negative contact with forms of authority can also build up and it affects their self-esteem and self identity and as teenagers, identity is very important.”
To help these youths tackle mental health issues, SOLS Health works together with Yayasan Hasanah to provide mental health services to at-risk youth living in the PPR.
Ellisha adds that the child-parent relationship is one of the main factors in mental health wellness.
The relationship is normally lacking among the low-income families as parents sometimes work two jobs or are too tired to spend time with their children once they come home.
Then there is the lack of supervision, she adds.
Their programme with Yayasan Hasanah, called “Close Families Achieve Dreams” (Keluarga Akrab Mencapai Impian), places importance on the family bond.
This is done through instilling open communication, mainly for difficult teenage issues like substance use.
“We also focus on trying to bridge the gap, particularly for families living in the PPR because they have children of different age groups, ” she says.
“How do you adapt your communication style to work with these youth?”
We work with the family and community. A lot of the strength for mental health intervention comes from the community’s support, she says.
A community’s support is even more important since we do not have enough psychiatrists, psychologists and counsellors to go around, she adds.
She also says that these youths live in a constant state of stigma.
Even if they choose to seek help for mental health issues, they fear the stigma that comes from being “seen” at any mental health facility.
It’s not only the youth. Ellisha says that those in these communities are aware of mental health but stigma and the fear of being judged keeps them from seeking treatment or even assessment.
She also says that if a teenager wants to seek treatment from a medical centre, they would need their parents’ consent and that alone will put them off the idea.
“If you want to go to the hospital, you would need to bring your parents along, ” she says, adding that teenagers do not want their parents to know.
Community education worker Simpson Khoo Sing Shern says taboo is a huge barrier keeping these youths from seeking help.
They don’t want to be seen walking in and out of a mental health facility, he adds.
Khoo, who works closely with the PPR communities for the past six years, says awareness programmes are effective but not for the whole PPR community.
“From my experience, it will always be the same group of people coming down to join our activities, ” he adds.
He points out that the ones who really need help, such as those facing anxiety or depression, choose to hide in their homes.
“Even if the programme is free of charge and just downstairs, they don’t want to join.
“Awareness is really lacking and a lot of them are not aware that they have mental health issues, ” he adds.
He says that they believe that they cannot concentrate on tasks or are easily agitated because they’re tired.
Ellisha adds that a lack of understanding of the issues surrounding mental health also causes youths to believe they won’t get the support needed from friends and family.
Youths are aware that they have a problem and are usually prompted by their peers to seek help, she says.
Peers tend to notice when their friend becomes more withdrawn and this boils down to exposure from awareness campaigns, she explains.
Health Ministry Public Health Specialist and Mental, Substance Abuse, Violent & Injury Prevention unit head Dr Norashikin Ibrahim says that although there have been more awareness on mental health issues, we should ensure the right information is being given, especially to those who are facing them.Health Ministry Family Health Development division medical officer Dr Roslaili Khairudin says: “I would say we need to enhance adolescent knowledge of mental health issues and increase awareness of available mental health resources.”
She also says that we need to improve their help-seeking behaviour and access to mental health services.
“This is important to strengthen our efforts to prevent mental health issues and we need to work together to enhance efforts to fix the barriers to provide adolescent-friendly mental health services, ” she adds during a talk at the Symposium On Prevention And Early Intervention For Mental Health Problems in Youth.
Keep them busy
Ellisha also says that there is more to providing mental health services than just dealing with issues.
Coming up with activities that give these youths something productive to do is a better option, she says, adding that it is a preventive measure.
“If we have youth centres in the PPR, if we have those programmes in place, it will really help, ” she says but points out that it must be located within the area like the ground floor of the apartment blocks.
She adds that in developed countries, activities held in youth centres are used as the first step in treating mental health issues.
“There are youth centres in the community with programmes that have been embedded with mental health aspects, ” she adds.
“They focus on the social activity with the mental health component.
“We can also train youths to look out for signs of mental health issues through programmes at the youth centres.
“They can learn a bit about mental health screening and actually share with their friend and provide guidance on how to seek services.
“Most youth mental health services should be within the community where they are in so that it should be embedded together.
It should not just be about going to the hospital because that’s where the stigma is.
Ellisha says that they need to incorporate those facing mental health issues into the community and increase their social functioning.
Having insurance coverage for mental health will help, she adds.
Ellisha says insurance coverage for mental health does exists in Malaysia but it only covers those who are already diagnosed.
“Mental health should be just like physical health.
“If you have a cough or a cold, you see a doctor.
“So, if you feel like you are having some depressive symptoms, you should be able to seek help for that.”
She adds that insurance agencies should provide coverage for screening as well as long-term therapy.
She also says that targeted interventions or programmes are needed to increase the awareness on detection and how to obtain treatment.
“For example, how do you detect the symptoms? How do you distinguish between a child that’s shy to a child that’s withdrawn because of depression or social anxiety?”
Ellisha says that these programmes need to be done at the community-level and not at hospitals where they do not have easy access to.
Those in need of emotional support can reach out to the Befrienders hotline at 03-7956 8145/8144 for assistance.
They can also contact Talian Kanak Kanak (Childline) tel: 15999 (Available 24 hours a day), or go to http://mmha.org.my/resources/directory-of-counselling-services.