RESEARCH conducted during the Covid-19 pandemic has revealed that mental health issues among Malaysians increased by two-fold compared with baseline data from the National Health and Morbidity Survey 2019. The outcome of this is a soaring figure of 2,800 suicide cases throughout the pandemic thus far. We are concerned by the likelihood that members of low-income groups especially will develop mental health issues as they have experienced double the financial hardship.
Increasing mental health issues is a reflection of gaps in accessing mental healthcare. Poor help-seeking behaviour stems from high mental health stigma, and low mental health literacy hinders people from getting the needed treatment.
By realising stigma is a threat to successful prevention and treatment of mental health issues, high-income countries like Britain have adopted online, low-intensity psychosocial therapy as one of the mainstays in dealing with mild common mental health issues (research published in 2009 and 2021 by Britain’s National Institute for Health and Care Excellence). Their research has shown that online therapy reduces stigma and promotes the uptake of treatment (British Journal of Psychiatry at bit.ly/mental_stigma).
An online, culturally sensitive health promotion tool called ReSHApe (Recognise, Self-help and Help-seeking), developed by a group of researchers from Universiti Malaya, showed a positive uptake from people in the low-income group and reduced mental health issues through a positive psychology approach (bit.ly/tool_mental). This health promotion tool was developed and used during the pandemic.
Digital mental health services have the advantage of being able to reach out to underserved groups with low budgets; they are also less stigmatised and use minimal professional assistants. The drawback is high dropout rates but this is offset by the massive outreach. Hence, we offer a few policy recommendations for mental health digitalisation:
1) Anti-stigmatisation mental health promotion intervention for vulnerable communities should be a policy priority and made explicit in the national mental health policy and strategic plan.
2) Leverage on non-professional workers to implement less structured mental health intervention that promotes positive psychology in a community setting. Such an approach is culturally appropriate, less stigmatised, less labour- intensive and can strengthen a limited mental healthcare workforce.
3) Improve network coverage to give better Internet access in areas like rural enclaves in Sabah and Sarawak, and help people in low-cost housing neighbourhoods go online with more subsidised charges. Reducing network inequity among the poor can help to enable access to quality online mental healthcare.
4) Invest in online research related to social behaviour in a real-world setting to understand poor help-seeking behaviour. Research done by social scientists shows that human belief systems could defy evidence-based intervention and persuade adherents to go for less scientific options. Such behaviour may explain vaccination hesitancy in the community despite adequate health education.
Digitalising mental healthcare can help destigmatise public health measures to resolve unmet needs and allow the vulnerable to access quality healthcare through sound technology. Optimising digitalisation can help to close the gaps in mental healthcare in Malaysia.
DR WONG MIN FUI @ ESTHER WONG
Department of Social and Preventive Medicine,
Universiti Malaya
ASSOC PROF DR MAS AYU SAID
Public Health Medicine Specialist, Department of Social and Preventive Medicine,
Universiti Malaya
ASSOC PROF DR HAZREEN ABDUL MAJID
Nutrition and Dietetics, Head of the Centre for Population Health, Department of Social and Preventive Medicine,
Universiti Malaya
PROF DR ROZMI ISMAIL
Deputy Dean of Postgraduate, Psychology and Human Wellbeing Research Centre,
Universiti Kebangsaan Malaysia
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